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.

---

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.

---

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.

Updates from Puerto Rico

In October, we returned to Vieques, Puerto Rico for our 4th visit this year to assist with post-hurricane medical care and recovery.  People on Vieques have had extremely limited access to healthcare since Hurricane Maria struck more than a year ago. The IMR team arrived on October 19th, and conducted a two day clinic in Esperanza, where we saw approximately thirty patients.  The team was made up of Drs. Sleemi and Schiller, two Emergency Medicine resident physicians from Maimonides Medical Center in Brooklyn, Drs. Suman Gupta and Cecily Sotomayor, and our colleague Ana Aurrecochea, a surgical nurse from California.

In addition to clinical care, IMR worked in conjunction with local community leaders  to provide home visits for Vieques’ more vulnerable patient population, in which we were able to assess needs and provide appropriate medications and follow up.  

The trip was short and sweet, but  there is still much to do. While Vieques has achieved a measure of stability in its access to healthcare, it’s still experiencing interference in basic infrastructure.  Electrical power is interrupted on a regular basis, putting patients reliant on ventilators at high risk for decompensation, as well as compromising refrigerated food and medications (such as insulin) for the more susceptible patient population.  Please continue your support of IMR so that we can support those who need it most.

Looking forward to a productive 2019!

Haitian Women's Collaborative Project Update

This past September, IMR returned to Haiti for our third trip this year continuing our pelvic surgery training initiative: the Haitian Women's Collaborative Project. This trip was full of many highlights including operating on 15 patients alongside our Haitian colleagues and students, introducing our new volunteer Amaris Lunde to our care team in Haiti, being interviewed by Radio Television Caraibes, and an invitation for our Executive Director Dr. Ambereen Sleemi to join the Haitian Society of Obstetrics and Gynecology (SHOG) as an honorary member.

The week started at St. Boniface Hospital in southern Haiti, operating and caring for women with pelvic organ prolapse (a condition where one or more of the pelvic organs like the uterus or bladder drop to or through the vagina), vesicovaginal fistulas (a hole that forms in the vaginal wall), and more. Since 2014, we've worked with Haitian OB/GYN resident physicians at St. Boniface, National, and Croix des Bouquet Hospitals as part of their training program to increase their surgical skills. Our focus continues to be on improving a surgeon’s skills using a minimally invasive approach that leads to fewer complications and quicker recovery for our patients and implementing initiatives to increase patient safety in the Operating Room. IMR volunteer Amaris Lunde, a Nurse Practitioner from Portland, OR, assisted and trained Haitian nurses caring for patients in the post-operative period. Senior OB/GYN resident physicians from Port au Prince joined us for the week for training. We then traveled to Port au Prince, joining our longtime local partner Dr. Batsch. Together, we operated on women with obstetric fistula (a hole that forms between the vaginal wall and rectum or bladder due to prolonged, obstructed labor), again focusing on surgical techniques, patient safety, perioperative care and more.

Dr. Batsch and Dr. Sleemi with Radio Television Caraibes

In between their busy schedule operating on patients, Dr. Batsch and Dr. Sleemi were interviewed by Radio Television Caraibes, one of the oldest and most popular Haitian broadcasters, about maternal health, birth complications and obstetric fistula. Many women with fistulas and other pelvic floor disorders suffer silently so the chance to inform the public about these devastating conditions was an opportunity not to be missed. We continued our campaign to raise awareness by meeting with UNFPA Haiti (United Nations Populations Fund) to discuss how to assess prevalence of fistula and pelvic floor disorders in Haiti.

Finally, we would like to congratulate Dr. Sleemi, our Executive Director, who received an official invitation to be an honorary member of the Haitian Society of Obstetrics and Gynecology (SHOG), the professional organization for all OB/GYNs in Haiti. This honor is a reflection of her passion and continued dedication to caring for women of Haiti.

IMR partners with GOALS Haiti

IMR is thrilled to announce that this December, we will be working with GOALS Haiti to provide a seminar to the aspiring healthcare providers in the Leogane region of Haiti.

GOALS is a grass roots effort to engage the region’s youth in athletics as a means of developing leadership, team building and health consciousness. Working in partnership with GOALS will give us the opportunity to reach areas that are currently underserved by local healthcare systems. Building capacity with practitioner training will promote sustainability to provide primary care in the near future.

In addition, we will be opening a primary care clinic to serve the wider community for five days. This will serve multiple purposes, the first being that higher risk patient populations will have greater access to medical evaluations. Secondly, the clinic will serve as excellent bedside training for those attending the seminar. Thirdly, the clinic will act as a foundational link towards building a sustained effort in promoting healthcare in the future to Leogane.

We look forward to this new partnership that will deepen our commitment to improving the health of Haitians.