Liberian Fistula Program continues with your Caring Crowd funds

By: Dr. Ambereen Sleemi, Executive Director

I returned from Liberia this past December, completing our 1st phase of our fistula project that was funded through your donations on Caring Crowd. This is a continuation of our ongoing fistula project since 2015. Delivering bags full of much needed suture and antibiotics (not available at Phebe Hospital), evaluating over 40 women for surgery, completing 18 operations and treating at least 5 more with non-surgical therapy. We are set to return in January 2020 to complete the second part of this campaign. Local paper New Dawn Liberia covered our trip, and we meet with Dr Jefferson Sibley, Chief Medical Officer at Phebe Hospital and Dr Bannet Ndyanabangi, the new UNFPA Liberia country representative, securing our commitment to return in early 2020 and every 4 month for the remainder of the year and beyond, hoping to complete at least 50 fistula surgery operations. Surgical training is a large part of our commitment and I had 2 new younger surgeons eager to learn about vaginal surgical approaches and basics of obstetric fistula surgery.

And we got thrilling news! Meet Matina and her newborn. Matina had 2 previous fistula repairs in Liberia with our team in the last few years. She’s been dry and became pregnant. She came to the maternity waiting home and last week had a safe cesarean section and delivered her healthy baby boy. This is part of what your generous donations make possible. Thank you, thank you! Please consider an additional donation so we can bring the best care to the most vulnerable populations around the globe.

Updates from Vieques

Our 5th medical trip to Vieques (and 6th to Puerto Rico) since Hurricane Maria wrapped up a few days ago and was a resounding success. We were joined by a team from the University of Connecticut’s Department of Family Medicine and partnered with local community based organizations and organizers.

Photo Credit: Ambereen Sleemi

Health and Wellness for Vieques Youth

An important focus of this visit was to enhance health education and wellness for the adolescents on Vieques. Working at the local public middle and high school, 2nd year Family Medicine resident physicians gave presentations to over 60 students about hygiene, nutrition, substance-abuse, bullying and more. They did a great job! 

Photo Credit: Ambereen Sleemi

Prevention of chronic diseases is vital, especially here in #Vieques.  Rates of preventable illness are much higher than mainland Puerto Rico and the US.  People who live in Vieques are eight times more likely to die of cardiovascular disease and seven times more likely to die of diabetes than others in Puerto Rico. Vieques has a 30 percent higher rate of cancer than the rest of Puerto Rico, and nearly four times the rate of hypertension. In addition, the effects of Hurricane Maria had a profound affect on the mental health of inhabitants; thus there is a crucial need to confront this with a concerted effort.  Feedback from students and teachers was remarkably positive and we hope to build on this initiative to give students more knowledge about their health and well-being. A trip to the Vieques Boys and Girls Club made sure younger students also participated in focused health workshops. We also made our first visit to the Vieques Senior Center, bringing supplies, conducting well checks and speaking with seniors and administration about their specific needs. 

Home Visit Program 

Our teams continued our Home Visit Program, this time focusing on households in Esperanza.  Well-visits and home checks include assessment of home safety, roof/plumbing checks and food security.   

Photo Credit: Marc Baptiste

We were able to follow up with Claribel, who recently lost her husband after a long ailment. On our last visit, she was awaiting roof repairs and solar panels- happy to report she has both now thanks to local support. 

Photo Credit: Ambereen Sleemi

Photo Credit: Ambereen Sleemi

Photo Credit: Ambereen Sleemi

In addition, we identify the needs of caregivers who look after their homebound loved ones. Caregivers like the Solis family, which is dedicated to tending to their bedridden mother for years. They’re doing an amazing job, as were all the families caring for their loved ones here. Some need supplies, others need roof/floor repairs. Working with community organizations, we’re able to help connect needs to resources.  

Photo Credit: Marc Baptiste

NEEDS ASSESSMENT 

Continuing our partnership with local organizations/activists in Vieques, including Vieques Love, BiblioCeiba and Kathy Gannett, is vital to bring care to residents on this island. During our trip, we met with folks from Sociants--a digital platform designed to identify social determinants of health—to discuss a much-needed and overdue needs assessment on VIeques.  Participating in this initiative will allow for collection of important data that will inform our work to bring better medical care to Vieques. 

Thanks to our entire team who provided incredible preventive health education,  medical expertise and support for our work to bring the best care possible to Vieques. We thank Marc Baptiste, a remarkable photographer for lending his talent to document our work and the people for whom we care. To John and Amy Boggs and Laila O’Neal—we’re thankful you joined our team. To Drs. Guajardo, Rivera and Blumenfeld, thanks for bringing your U. Conn family to join ours. Go Huskies!

By: A. Sleemi, MD, MPH, Executive Director

Returning to Destra

10/24/19

UPDATE

The political pressures in Haiti have increased to the extent that IMR has found it too unstable to conduct our follow up trip during the pre-arranged dates. We have maintained close contact with our partners in-country to monitor conditions in realtime, so we expect to be returning soon. Throughout the process, our ties have remained strong in Leogane and continue to work in offering assistance however we can.

As soon as we know when we able to return, we will announce dates. In the meantime, IMR is working with local personnel towards assisting however we can in supporting the community of Destra.

-Josh Schiller

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IMR will be returning to the Destra region of Leogane at the end of September.  This marks the first follow-up visit after we initially engaged the area in January, 2019, and we are poised to further the relationships we have forged over this time.  IMR has collaborated with GOALS Haiti since the outset and they’ve facilitated community outreach as well as provided storage for our medications.

We will be continuing our mission to provide training to local practitioners with two days of classroom training, followed by two days of bedside correlation during clinic.  During our last trip, we met Jessumene Jean Paul, a former nursing student and resident of Destra, who showed extraordinary dedication to the people of Destra.  After attending our seminar, she was actively engaged throughout our clinic using the skills that she had learned earlier in the week along with initial training she received during nursing school before she had to discontinue due to financial constraints. Her devotion to the craft of healthcare provision as well as to her childhood home made her an excellent addition to the IMR family as a collaborator.  Since then, IMR has funded her re-entry into nursing school to continue honing her clinical skills. She has also been assisting IMR by conducting home visits to follow-up with patients in the community that had been identified as higher risk during our first clinic.  

In the meantime, IMR has formed another multi-disciplinary care team from Brooklyn, comprised of several branches of medicine, including Emergency Medicine, Internal Medicine, and Psychiatry.   Like last visit, we will have a mix of nurses and physicians with expertise in both adult and pediatric care, along with practitioners who have professional experience in EMS/pre-hospital care and global health.  This trip will make the return to Haiti for some on the trip, while being the first for most; that being said, everyone is excited.  

In addition, IMR will be forging new alliances with local healthcare providers while in-country.  In addition to our relationship with St Boniface in Fond-des-Blancs, we will be inviting the staff of the Raisin Foundation Health Center in Leogane to teach with us and join in our clinic.  This may lay the ground work for an expanding collaboration in the near future.

Our trip will be September 23-28.  We are all looking forward to it. 

By: Josh Schiller, MD, Medical Director

Mountains for Mamas: An Update

SHE DID IT!!!

“While traversing this relentless present, if you can support the human ahead or behind you in the climb of life, that’s when you realize what it’s all about: loving hard as we climb with purpose, intention and grace. And as a mother, I can’t think of an intention more fitting than to support new mothers in their next step, on one of their most difficult climbs.”

-IMR Board Member and Climber of Peaks, Gillian Green

A few months ago, our board member Gillian set out to climb mountain peaks in Mexico and raise funds for IMR. We can’t be more thrilled to have someone like Gillian on our board, supporting mothers and other vulnerable populations around the world. These peaks are no match for some as determined and dedicated as her. We are thankful for all those who supported her tremendous effort, raising over $1200, which goes to our programs to give women suffering with obstetric fistula, a devastating birth condition, another chance at getting their lives back. Over 90% of women with fistula have lost their newborns to obstructed labor, and in some cases, lost family, friends and social ties over the chronic urine and or fecal incontinence caused by the injuries. It is estimated that only 1 in 50 women who need surgery for fistula actually get an operation. We are working to change this by working with local surgeons, medical societies, Ministries of Health, and other advocacy groups to provide safe and skilled operations in Liberia, Haiti and Malawi. Each project also has local surgeons who are committed to ending fistula in their communities, who need the surgical training to provide the best care. 

Thanks to Gillian and those who supported her, we are able to provide surgical care to cure these injuries and train more local surgeons in affected communities. For more information about what drew Gillian to mountain climbing, please see our interview with her here. 

The Malawi Fistula Program: Expanding Access to Fistula Surgery and Care

This past May, we returned to Malawi to be a part of a fistula surgery campaign in Lilongwe. It was held at the Bwaila Fistula Center, the major, and only, fistula center in the country. Two local surgeons were part of the surgical training and 30 surgeries were completed. Since the procedures, all patients have had short-term dryness, which is a tremendous outcome.

It was wonderful to see how this center has become a successful model for providing comprehensive care to women with fistula and related conditions, such as anal sphincter trauma. Safety protocols in the operating room and the wards were posted, daily didactic bedside rounds were conducted, and coordinated care from arrival to surgery were in place. From the rehabilitation program, vocational training, and discharge protocols— there were many lessons we can bring to the fistula program at Mulanje District Hospital, IMR’s partner site that we hope to help develop into a facility as successful as Bwaila.

Bwaila operating rooms

IMR volunteer, Liz Santaniello, FNP, cares for patients post-surgery

In addition to providing excellent surgical care, the Bwaila Center has a remarkable reusable pad project that’s part of the rehabilitation center. The pads created through this sewing initiative allow women to manage incontinence from traumatic birth/fistulas and during menses. It is also a means to make and sell a product. There are plans in place to bring this project to several centers, including Mulanje. We’d like to be able to support this and help make it a reality. 

Reusable sanitary pads

For this campaign, our hosts were fistula surgeons: Dr. Rachel Pope and Mr. Chisomo Chalamanda. Our fistula surgeons in training were Gerald and Austine, both with a commitment to fistula repair for some time. We were honored to work with them as well as the wonderful nursing staff on the wards and in the operating room. We also worked with the Malawi UNFPA and Bwaila staff (supported by the Freedom from Fistula Foundation) to plan for one to two return trips to Malawi this year set at Mulanje District Hospital.

The Mulanje District Hospital continues to make preparations to be able to provide fistula care services throughout the year. We are committed to ensuring Mulanje and the southern region of Malawi has trained surgeons and supplies to do this. This includes returning in October to continue surgical training for local surgeons and to work with local partners to create protocols that are similar to the ones in the Bwaila Center, the future referral hospital in Lilongwe. 

 The success of these projects will mean so many more Malawian women can have this life-altering surgery for free. With more trained local fistula surgeons, this will amplify the care we can help give. That is something we all can celebrate.

Ambereen Sleemi

Executive Director

Our team

Giving birth should not cost your life: Labor and loss in Haiti

“We have a problem, her blood pressure is really high, she has a severe headache and swelling. Oh, and she’s in her third trimester.” These are words that would make any clinician caring for a pregnant woman very concerned. 

Imagine spending months anticipating the birth of your child, whether it be your first or your fifth. Because of your geography or lack of funds, you have no access to a clinic or to medications, blood tests, ultrasounds, or medical support to guide you through this universal process. For most pregnancies around the world, thankfully the outcomes are joyful. But in a number of cases, the situation can turn catastrophic. 

High blood pressure in pregnancy (pre-eclampsia), hemorrhage, and infections are the most lethal causes of maternal mortality around the world, including Haiti. In Haiti, almost 60% of women give birth without a skilled attendant. This translates to a patient population that is high risk and the highest maternal death rate in the Western Hemisphere (World Bank, 2017). If there’s a complication during childbirth, the results can be dire for mom and newborn. 

Road to Destra

Magdala being transferred to St Boniface Hospital, a few hours south of Destra

When we partnered with GOALS Haiti in Destra, our mission was to train primary healthcare workers and provide medical care to the people who call this northern coastal village home. There is affordable healthcare that is geographically close by, however in an area where poverty and inequality are the norm, getting basic healthcare is almost unattainable. During the January pilot launch of our clinic, we saw nearly 200 people, ranging in age from eight months old to 99 years old. One of them was Magdala J., a mom of three who was pregnant with her fourth child and obviously towards the end of her pregnancy. Magdala gave birth to her other three children with no skilled care at home, as almost all the women did in Destra. However, this pregnancy would be different from the others. She came to the clinic because she was experiencing headaches, swelling and generally not feeling very well. The baby had been moving fine and she was able to do her daily work and care for her children. She just felt a little off. Thankfully, she came in that day and had her blood pressure checked. It was abnormally high. This can reflect a condition called preeclampsia (or toxemia), one of the top killers of pregnant women in the world. The treatment is delivery— a life-saving measure for mom and baby alike.  When asked more specifically at the clinic, it turns out Magdala was exhibiting the most common symptoms of preeclampsia: headache, swelling, visual changes, and upper abdominal pain. Since we have an ongoing relationship with St. Boniface Hospital, an institution that provides very low cost/free care, we made arrangements to have Magdala transferred that day. Our colleague at St. Boniface, Dr. Germinal, is a capable and skilled OB/GYN so we knew she would be in good hands. 

Born too soon

We got word a few days later that she had an emergency cesarean delivery and the baby was transferred to the neonatal intensive care unit, which is rare in that region. Luckily,  she was in a hospital that could perform an emergency delivery safely and had a nursery that could take care of a premature baby that had been stressed in utero by the effects of preeclampsia. It was estimated that Magdala was around 32-33 weeks pregnant when she delivered, an age when many babies born in Haiti do not survive. We returned to Haiti recently and followed up on the baby who is now healthy, at home and both are doing fine. We're thankful that we held the clinic in January and that Magdala had confidence in our ability to care for her— she and the baby both survived a condition that is life-threatening. 

Through our partnership with GOALS Haiti, we were able to educate the community about health issues such as Magdala’s, and we’ll continue to involve local citizens who will be part of our efforts to bring better healthcare and awareness to Destra. We look forward to our return this September.

Ambereen Sleemi, MD, MPH

All photos used with permission.

Mountains For Mamas

Our board member Gillian is an avid adventure seeker and climber of peaks. On May 23rd, International Day to End Obstetric Fistula, she will be travelling to Mexico to climb Iztaccihuatl and Pico de Orizaba, standing at 5,215 meters and 5,630 meters, respectively. Pico de Orizaba is the third highest peak in North America. The climb will be called Mountains for Mamas as a dedication to raise funds for IMR’s work to treat women suffering from obstetric fistula.

Gillian has been a great supporter of IMR and we wanted to learn more about what intrigues her about scaling peaks and how she prepared for this huge feat! Thank you Gillian for climbing these 2 Mexican peaks as a fundraiser for IMR. We are humbled and awed by this endeavor.

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1) What about these two Mexican peaks drew you and what are you doing to prep for these climbs?

Any day on a mountain is better than a day at sea level! It’s become a small obsession of mine, so I have slowly begun to build my climbing resume. I choose these two peaks because they allow me to go relatively high in a relatively short amount of time. And the views are other-worldly gorgeous! But as you aptly ask, climbing is just as much about the process as it is about summiting. And so we start at the beginning…

The mountain commands all your faculties so I try to find balance among differing regimens. I lift weights for strength– every day is leg day! For cardio, I run in rain, snow or shine with my trusty, fluffy steed of a puppy named Benji. And when I can, I do an epic 3 hour session on the stair-master with 40-50 lbs in my pack. For physical and mental balance, I do yoga. There is something magical and deeply applicable about learning to breathe through difficult poses.

2) What are your future goals as a climber?

In truth, I’d love to do this full time. But in the meantime I hope to find my way to the Himalayas later this year or early next year. I would love to tackle a 7000 meter peak, whether in the Himalayas, the Karakorum or the Trans-Alay Range. The idea is to systematically test how your body will react at increased altitude as well as acquire the skills you need to operate in these inhospitable environments. Mistakes are amplified in the theater of high altitude mountaineering and only through experience can you learn how to operate in these hostile conditions. And with this experience I’d love to eventually climb something a little higher like Shishapangma, Cho Oyo or even Everest. But with a slightly more unusual intention. Since the advent of commercial high altitude mountaineering, anyone with a dream and a checkbook could find their way onto Everest. This doesn’t interest me. My dream is to be a part of a rope fixing team and humbly shadow the incredible Sherpa mountaineers who are the oxygen of the Himalayan climbing ecosystem. This is a lofty dream, but you have to take that first step sometime and somewhere.

Though through it all, my ultimate goal is to raise loads of funds in support of IMR when I climb!

3) How does climbing reflect your outlook on life?

One can make the obvious inferences regarding climbing - as a single mother in New York City, the proverbial application is certainly fitting. Often you feel like you’re battling uphill against the wind and elements of an industry (and society) that was not constructed in your favor, all while your thighs and toes are burning in new and unfathomable ways. Nevertheless, I have spent most of my professional years helping pave the way for and supporting women in a male dominated industry through my leadership roles in women’s networks at various investment banks. High altitude mountaineering, similar to finance, is very male dominated but, as with all things in the natural world, mountains are the great equalizer an show no favoritism. I hope my burgeoning story will inspire any young girl with a dream to do something that others, whether directly or indirectly, tell you that you can’t.

Mountains have a way of amplifying the conundrum of the human condition. There’s an internal shift that happens when you’re at the mercy of this beautiful, wild planet. You realize that safety is an illusion, and as much as you want to believe that you are in control, the unforgiving elements, the terrain’s unpredictability and your shallow breath remind you that are not. You are stripped of your past and future; nothing matters but the present. And your present is only your next step, the next one… and the one after that. There is a quiet grace to this simplicity juxtaposed against the backdrop of the harshest places on this planet. While traversing this relentless present, if you can support the human ahead or behind you in the climb of life, that’s when you realize what it’s all about: loving hard as we climb with purpose, intention and grace. And as a mother, I can’t think of an intention more fitting than to support new mothers in their next step, on one of their most difficult climbs.

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If you would like to contribute to her campaign, please click here.

IMR and GOALS Haiti launches partnership

In mid January 2019, a medical team from International Medical Response (IMR) travelled to the Destra community for a training seminar for local healthcare practitioners, followed by a clinic.  The IMR team was comprised of physicians, nurses and EMS techs, with this venture representing the inauguration of what will likely be an on-going collaboration between GOALS and IMR.  This initial trip was highly successful--ten trainees were tapped from the local community to engage in a day-long training seminar, and then assisted with patient care in the following days in the clinic.  Nearly two hundred patients were seen, ranging from eight days old to 97 years, many of whom had rarely seen a physician prior.  IMR also identified a one of the trainees to serve as the local healthcare agent in Destra for follow up care, with remote support from IMR until the planned return in July 2019.   

In addition to the large number of patients who were cared for at the clinic, we had two big saves that otherwise may have resulted in lives being lost.  As IMR and GOALS continue to work in partnership, we hope to establish an ongoing presence in Destra.  IMR's primary goals are to build a network of healthcare agents on the ground to address the concerns of the community, and to create a triage system by which we can direct patients to the appropriate care they require. 

This would not be possible without the support IMR has received from GOALS; they have been instrumental in providing the guidance required to addressing community needs directly.  We look forward to building on this trip, and creating a reliable service to the people of Destra. 

Jonathan Kaplan MD, Volunteer Physician

Joshua Schiller MD, IMR Medical Director

Dr. Sleemi to join panel at Ensemble Studio Theatre's "Behind the Sheet"

We are excited to share that IMR’s Executive Director Dr. Sleemi will be joining a panel of experts for a conversation on February 2nd after the 2pm performance of BEHIND THE SHEET. The play, written by Charly Evon Simpson and produced by Ensemble Studio Theatre in NYC, “confronts the history of a great medical breakthrough by telling the forgotten story of a community of enslaved black women who involuntarily enabled the discovery. In 1840s Alabama, Philomena assists a doctor—her owner—as he performs experimental surgeries on her fellow slave women, trying to find a treatment for the painful post-childbirth complications known as fistulas. Reframing the origin story of modern gynecology, the play dramatizes how these women supported each other, and questions who, and what, history remembers.”

We hope you can join us! Click here for more info.

Fistula program in Liberia continues

In November, we returned from our sixth trip to Liberia where our surgery program is going remarkably well. We continue to work with the Liberian Ministry of Health and Dr. John Mulbah, our partner in Monrovia, to provide equipment, training, and care for women suffering with birth injuries and obstetric fistula (OF). OF is a devastating condition that affects almost 2 million women worldwide and it’s estimated that almost 100,000 new cases develop annually. OF is a condition of poverty and neglect and it affects the most marginalized populations: poor women who are pregnant.

Our work in Liberia started in 2015 after the Ebola outbreak and has been remarkably fruitful with over 150 cases done. We’re committed to training Liberian medical residents and surgeons in pelvic reconstructive surgery and fistula repair as these procedures are highly technical and require skilled surgeons. It’s estimated that each case costs $900 to $1000 per patient. These estimates include the operation, transportation, post operative care, food and all medications and equipment. It is our hope that in 2019, with your generous donations, we will continue our work helping in the recovery of at least another 60 women and continue training new young generation of surgeons who will go on to become vital to the medical care of this country.