IMR Update from the Team

What a year we’ve just come through! There’s an end in sight and we at IMR cannot wait to get back to the work that’s been put on hold. We want to thank everyone who has supported us through it all.  

2020: Shifting Gears and Meeting Changing Needs

2020 started out for IMR, as for most people, fairly routine. Our project in Liberia had a renewed sense of accomplishment and support from Phebe Hospital’s Administration, a new commitment of support from UNFPA Liberia and a continued growing trust from our patients and vital staff members. We had just finished a successful fistula campaign in Dec 2019 and were back 4 weeks later to continue to work and follow up with our patients. 

The next month, February, we returned to provide medical relief to southern Puerto Rico where earthquakes had wreaked havoc. Our team delivered supplies and then returned to Vieques where we followed up with patients, attended community and partner meetings focused on getting a much-needed hospital to this island.

In early March, we held our Board meeting in Miami and all returned home to a changed and disrupted world.  The world was beginning to feel the burden of COVID.  

Towards the end of March, we quickly mobilized our medical supply contacts and shifted to supplying critical PPE to 20+ NYC healthcare partners. This ranged from Emergency Rooms, Labor and Delivery wards, homeless/indigent care clinics, inpatient Covid wards, nursing homes and more. 

In response, we launched a successful fundraising campaign and raised over $150,000 in a few weeks, with the focus on PPE distribution across NYC.  Almost 12 months later, we are still delivering PPE, including medical-grade masks, face shields, gowns, gloves, shoe/hair covers and cleaning/disinfectant supplies. We expanded our shipments to Vieques healthcare workers and contact tracers, checking in frequently on their needs. Along the way, we’ve developed strong relationships and are proud of the partnerships we’ve made. 

Honoring Eddy Rose’s Legacy

IMR has also responded to the world’s calls for equity and active antiracism. We expanded our Eddy Rose Scholarship to support a Black Birthworker--SUNY Downstate Midwifery student Tyla L. was chosen from a pool of highly dedicated practitioners. This was a direct response to the  recognition of how inequity manifests in maternal mortality here in NYC. We are looking to raise funds to expand this award to black doula students as well as indiginous/Native American birth workers. 

Globally, IMR’s ongoing support of local scholars has been fruitful. Our Nicaraguan scholar, Carlos Rose, is set to graduate from medical school in Managua this year and Jesumene, our Haitian nursing student scholar has had her studies interrupted by COVID. She’ll return, with our continued support as soon as she is able. 

New and Continuing Partnerships

We have an exciting new partnership with a Haitian community advocacy group in Brooklyn, called Life of Hope. LOH is a Central Brooklyn organization serving marginalized communities to advance healthcare information, advocacy and mentorship. We’re now part of their Sante Se Lavi health initiative, which includes health outreach monthly at the local Flatbush Caton Market, mentoring under-represented minority high school students in healthcare careers, and creating a Health-Hub that will be a source of health screening, advocacy and information. 

IMR has maintained regular communication and strategic meetings with our partners in Haiti, Liberia, Malawi and Vieques with community health advocates. All sites have suspended most non-critical services, but we plan to resume fistula and UROGYN operations and primary care clinics once vaccines become more available and our partners feel it’s safe for us to return. 

Until then, we’ll continue to provide support the best way we can, by advocating for global equitable access to the COVID vaccine. We are planning for our first medical trips to begin this summer.

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I hope this gives an overview of our work last year and how we hope to proceed this year. We are very eager to continue to bring the best care everywhere.

-Ambereen, Josh and Mayano

A quick update on our PPE project

As Covid-19 cases rise to over 9 million and we pass the tragic mark of over 228,000 people who’ve died in the US, we have continued to provide weekly personal protective equipment (PPE) deliveries to our NYC healthcare partners for the last 7 months. All current data shows that COVID cases and hospitalizations are increasing here in NYC. This is supported by what we’ve heard from the doctors and nurses we check in with weekly. We are fully committed to supporting our partners through this next wave of cases. From our ER partners in Queens, “We are definitely seeing more cases coming into our hospital.”

The requests have ranged from respiratory mask and isolation gowns, along with face shields. We expect the needs to change over the next few months. Each partner site has unique PPE needs and we hope to be able to keep our emergency supply cabinet stocked to meet this need. 

Thanks to everyone who has supported our work. We couldn’t have done it without you! We’d like to continue to be able to support our healthcare workers. Please consider a donation.

In other news, we’re so proud of one of our partners, Nurse Amy Sullivan from Wykoff ER who was named one of Time magazine’s 100 most info people for 2020. Congratulations Amy and a big cheer to all healthcare workers around the globe doing the most amazing work of caring for all who’ve been suffering through this pandemic. 

Announcing our 2020-2021 Black Birth Worker Scholarship recipient

“I believe that midwifery meets at the crossroads of many fights – whether it be racial justice, gender equality, LGBTQ rights, abortion access or medical malpractice and mistreatment – and is birthed from the struggles of my ancestors.”

-Tyla Leach

We are ecstatic to introduce Tyla Leach, the recipient of IMR’s scholarship for Black Birth Workers through Eddy Rose Excelente Fund! She will be awarded $10,000 which was partly funded by our generous partner, Actions@EBMF.

Tyla is currently a student at SUNY Downstate Health Sciences University’s Midwifery Education Program. We were inspired by her commitment to serving Black, Indigenous, and LGBTQ birthing people and impressed by her ability to lead and bring communities together.

Currently in the US, Black women are 3x likelier than white women to die of complications related to pregnancy. IMR strongly believes that representation matters especially when it comes to decreasing these racial health disparities. We believe that receiving care from Black birth workers is one important way Black birthing people can feel safe and empowered during pregnancy and childbirth. Our Eddy Rose Excelente Fund Black Birth Worker Scholarship Program aims to increase diversity within the profession by supporting Black students who desire to enter it.

There were many more highly qualified applicants than the number of scholarships available. If you share our commitment to supporting Black birthing people and Black birth workers, please donate here. Your contribution will allow us to award more scholarships to amazing students like Tyla!

The Eddy Rose Excelente Fund- The Black Birth Worker Scholarship

Over the years, IMR has provided support for practitioners in resource-poor regions pursuing a formal education in healthcare through the Eddy Rose Excelente Fund. The fund was created in honor of Nicaraguan Ob/Gyn Dr. Eddy Rose, a great doctor and friend that our Executive Director Ambereen had known since 2001. In his spirit of caring and kindness, we established the Eddy Rose Excelente Fund (Fondo Excelente) that provides scholarship to help pay the grantee’s tuition in their program of choice. We currently support two scholars through this fund and we’re excited to add a third. Currently, these are our scholars:

• Destra, Leogane, Haiti: We met Jesumene Jean Paul, a former nursing student and resident of Destra who had to discontinue her education due to financial constraints. Her devotion to caring for others 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.  Jesumene also assists IMR by conducting follow up visits and providing meds to the patient population established during IMR clinics.

• Managua, Nicaragua: Carlos Rose is Eddy’s nephew who is currently a fourth-year medical student in the five-year medical program at Managua American University (UAM). Carlos has been supported by the scholarship since his second year and has worked with IMR’s Executive Director Ambereen in the operative room when she works in Granada, Nicaragua. He plans to become a surgeon and practice in Nicaragua. Carlos, who is kind, gentle and dedicated, was inspired to go into medicine by Eddy.

In addition to our two current scholars, IMR will be offering a scholarship to support Black birth workers. Maternal healthcare in the United States has seen a crisis over the last two decades with pregnancy-related mortality rate steadily inclining. While maternal death rates around the world have dropped by more than a third from 2000 to 2015, the rates in the United States has more than doubled since 1987. According to data from CDC, significant racial disparity in pregnancy- related mortality contributes to the increased rate. Between 2011-2016, Black women were 3 times more likely to die from pregnancy-related causes than White women. The maternal mortality rate for Black women during that same period was 42.4 per 100,000-- worse than 85 other countries around the globe.

A solution to this epidemic must be multi-pronged. However, we believe that one of the ways to decrease the disparity is by supporting more Black individuals who are committed to caring for birthing people. Representation matters and can be vital to promoting safe, equitable and respectful maternal care. We plan to support future midwives and doulas as the focus of this scholarship because we believe that these two groups of birth workers have the potential to majorly impact the outcomes of pregnant people. Studies show that when cared for by a midwife, women are less likely to deliver by Cesarean Section, a surgical procedure that can increase a person’s risk of hemorrhage, infection, blood clots and other surgical complications. It has also been shown that for people whose labors are attended by doulas (a person who provides emotional and physical support during labor, birth, and postpartum period), they were more likely to have spontaneous vaginal birth and less likely to require pain medication including epidurals.

While we know that midwives and doulas can have a positive impact on birthing people, it is also evident that the community of birth workers is currently overwhelmingly white. For example, according to the 2019 Demographic Report by the American Midwifery Certification Board, 86.9% of Certified Midwives (CM) and Certified Nurse-Midwives (CNM) in the United States identified as White or Caucasian and 6.31% as Black or African American. Black birthing people deserve to have access to care-providers from their communities. Our hope is that by offering this scholarship, it will decrease some of the financial barriers put upon Black students who desire to enter the profession. We will inaugurate this scholarship with an award to a midwifery student at SUNY Downstate in Brooklyn, NY.

For more information or an application, please email info@internationalmedicalresponse.org.

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.