Interview with Betina, Haitian Nursing Scholar

IMR has roots in the Destra region of Haiti. Residents of Destra, like many other regions of Haiti, has challenges accessing primary healthcare due to physical and economic constraints. IMR has sought to bridge these gaps by establishing a clinical presence there, as well as sponsoring a local aspiring practitioner to pursue formal training in healthcare.

This year, IMR provided a scholarship through our partner GOALS Haiti for Betina Perpulus to attend nursing school. She hopes to return to Destra to care for her community after graduation. We checked in with Betina to see how things are going.

How is the nursing program running?

Betina: The nursing program is going very well. I always go to school on time, the teachers make it easy to understand the program, and I always complete my homework on time. I'm always studying my lesson every day to make sure that I'm moving forward with my nursing program.

What did you learn which is interesting in the nursing program?

B: What I've learned in the nursing program I find interesting is taking blood pressure, giving IVs to patients, how to do the injection with a syringe, how to take temperature, and control the level of blood sugar in the patient. All of these are very interesting to me. 

What are some challenges or difficulties you faced in the nursing program?

B: One of the difficulties I had in the nursing program is where I live and there's a river that is called La Rouyaume. It was flooded due to heavy rain, and everyone in my community could not cross the river and go into town. I missed a lot of days of school because of the flood and was very behind in my class assignments. I had to stay up late at night to study harder so I would not be left behind in my class. Luckily for me, all that hard studying paid off, and I was able to pass on to the next level of the program. 

What do you enjoy in the nursing program?

B: What I enjoy the most in the nursing program is injecting IVs for patients and taking blood pressure, I like it when I’m taking the level of the blood sugar of the patients.

When you graduate from the nursing program what will that mean to you, and what positive impact will it have on your community?

B: Graduating from the nursing program will have a significant impact on me because my dream was to graduate from high school and continue to go to school so that I could have a degree in nursing. Also, the impact it will have on my community because there isn't any hospital in Bossan where I live. Therefore, I will be helping people in my community when there's someone who is sick. Often late at night, we have people who get sick and don’t have transport to go to the hospital in the town. Soon I will be able to give these people the first aid treatment they need to get well. All thanks to GOALS and their supporters which I will forever be thankful. 

Mountains for Mamas

A note from our board member, Gillian Green, who is climbing Ama Dablam in Nepal to raise awareness and fund for our obstetric fistula repair program

I write to you from Ama Dablam base camp in the Himalayas. Base camp is a temporary home at the foot of a mountain where hopeful mountaineers acclimatize, take rest and refuge, and the point from which they make at attempt at reaching the summit of their dreams.  

Climbing to the summit of Ama Dablam, once a crazy, unattainable idea, is shifting from a dream to my imminent reality. I am humbled by my surroundings and your support. 

For this climb I am raising awareness and funds for International Medical Response, an organization for which I have been honored to serve on the board for the last several years. IMR's mission is to supplement, support and enhance healthcare systems in communities across the world that have been incapacitated by natural disaster, extreme poverty, and/or regional conflict. I encourage you to read more about our mission and programs on our site https://www.internationalmedicalresponse.org/aboutus. 

One such program is our campaign to end obstetric fistula, spearheaded by IMR's Executive Director Dr Ambereen Sleemi. Obstetric fistula is preventable and most often occurs during labor in regions with inadequate access to comprehensive maternal healthcare. Having been a young mother, I cannot fathom having my first few days and months with Penelope being in preventable physical suffering and social isolation as is often the case for these mothers. And so this program is dearest to my heart. Thus was born our campaign in 2019: Mountains for Mama's.

Ama means mother and Dablam means jewel box in Nepalese. Mothers are the jewels of this good earth and deserve the best possible healthcare to ensure they can take refuge in their bodies. The work we do is their proverbial base camp - we provide them with surgical care so they are free from suffering when they climb to meet the demands and gifts of mothering.  

If you believe in the work we do at IMR, may I ask that you spread the word and if you're in a position to do so, give any amount as all is appreciated (a link can be found below).  We are a small organization with extremely low overhead and powered mostly by volunteers so your gift goes directly to the execution of our global programs. 

For each of you, I am humbly filled with gratitude greater than these mountains that surround me. Thank you for being my proverbial base camp. 

Mostly, thank you for your support of IMR throughout the years. 

Gillian

2021 Year in Review

Nothing has been the same since the COVID pandemic started in March 2020 but we have found ways to continue supporting our partners both domestically and internationally. We are thrilled to share with you some of the bright spots we have achieved this year.

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PPE PROJECT

We have continued to supply PPE through the summer to our partner sites in NYC. Large PPE donations were also made to our partners in Liberia, as well as hospitals in the Dominican Republic, St. Vincent and the Grenadines after the volcanic eruption. 

VIEQUES, PUERTO RICO

In the fall, we were finally able to return to Vieques, Puerto Rico with guidance from the island's epidemiologist. While IMR continued to support the island’s test and trace team with PPE, it was wonderful to be back in the community. We continued home visits and worked with community leaders on building a resilient hospital on the island. 

LIBERIAN FISTULA PROJECT

In December, we were so excited to finally return to Liberia where we evaluated over 30 women and performed over 20 operations to fix obstetric fistula. Many are women who have waited years for this surgery. We were thrilled not only to provide life changing surgery but our patients were also able to receive COVID vaccinations prior to their procedures. 

HAITI

The ongoing pandemic, political turmoil, and safety concerns in Haiti made it impossible for IMR to return to Haiti this year. However, we continued to support our Haitian colleagues and partners by donating medical and surgical supplies so they are able to continue caring for women with birth trauma and fistula especially after the tragic earthquake this summer. 

We also received an update from our local partner GOALS about a pregnant woman that IMR cared for during our previous visit. At the time, IMR had helped coordinate an emergency transfer to St. Boniface Hospital due to severe preeclampsia, a life threatening complication in pregnancy. The baby, who was born by emergency c-section, is now a toddler who is thriving. We were so happy and relieved to hear that both mom and child are doing well and cases like this remind us of why we do what we do.  

LOCAL COMMUNITY SUPPORT

This year, we established a relationship with our new local community partner Life Of Hope, supporting their community baby showers in central Brooklyn that promote safe motherhood and birth in the Haitian/Caribbean diaspora and the community-at-large. Please consider donating to our wishlist which gets needed supplies to the large number of pregnant Haitian migrants that are newly arriving in Brooklyn.

We also donated at-home electric blood pressure cuffs to pregnant patients at a community health clinic in Los Angeles. Hypertensive disorders in pregnancy can be deadly and making at-home monitoring accessible to people in low-income households could help save lives.

EDDY ROSE SCHOLARS

Carlos Horacio Rose finished med school this year with our support! He’s in Nicaragua and is now applying for surgery residency as he finishes his internship in Managua.

We also continued our annual tradition of awarding $10,000 to a Black midwifery student at SUNY Downstate. Arielle Sooknanan is our much deserved awardee this year, and she is working hard in her final year to complete her studies to become a midwife.

“I can hardly believe the year is already ending. Classes this semester were challenging especially with finals occurring on the heels of this omicron variant wave and in the midst of some family health issues. However, my amazing classmates and I pulled through with some study groups and I’m so excited to embark on this last upcoming semester. I’m looking forward to the end and finally being able to work as a midwife.”

-Arielle Sooknanan, Student Midwife and Eddy Rose Scholar

In addition to Carlos and Arielle, IMR began sponsoring a Haitian nursing student, Bettina Pepilus. Bettina came to us through our local partner, GOALS, and hopes to provide care in Destra where she would play an integral role in extending care to the area.

"Receiving this scholarship is very important for my life because I like nursing and I know my family cannot afford to pay for nursing school, and thanks to GOALS and IMR I have their support so I can now go to school. It was a great joy for me and my family when I knew I was awarded this scholarship. My family and I want to say a big thank you and God bless you to the people that sponsored this scholarship.

The impact I can have will help young girls, boys, and elders with how to protect themselves and show people how to be careful with their health in life. I would like to inspire others to be a nurse.”

 – Bettina Pepilus, Eddie Rose Scholar

We look forward to supporting Bettina and strengthening our ties with Destra while the region endures continuing political instability.

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Finally, THANK YOU to all of our supporters who have made this work possible. The last two years have been challenging to say the least, and we truly could not have done this without you. We look forward to sharing more new good news in 2022.

-Ambereen, Josh and Mayano

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