Sharing Midwifery wisdom in Pakistan

Hello, this is Claudette Banda, midwife and psychiatric nurse-practioner, writing a guest blog post about the recent team expedition to the Koohi Goth Hospital in Karachi, Pakistan. This was my first year joining in, but IMR has been visiting this site since 2023 to support their efforts to improve women’s access to high quality, evidence-based care in Pakistan. This year’s team consisted of Dr. Ambereen Sleemi, Dr Ralph Chesson, Mayano Ochi, CNM and I.

Koohi Goth is a lovely hospital in urban Karachi. Whereas the streets of an urban area are crowded and dusty, Koohi Goth’s campus is grounded in nature with shady trees and small zoo! The campus includes a hospital, pharmacy, dormitories, and a nursing school. I was most impressed by Koohi Goth’s commitment to not just quality care, but equally to elevating the prospects of the surrounding community. Housekeeping staff receives free basic education as a part of their work day. Young women from the neighborhood are invited on campus for 6 months at a time for basic classes in reading, writing, sewing and marketable skills. The campus restaurant provides food to all present. Care at Koohi Goth hospital is free for patients, including supplies, space, food and staff services.

The surgeons spent their days teaching a 3-day seminar to resident physicians and attending physicians on the management of complex fistula cases as well as taking complex cases to OR so that the learners might have the opportunity to observe varying operating techniques. Mayano and I spent our days at the nursing school.   

Pakistan currently has a national health agenda to encourage more midwifery-led obstetric units. Eight midwives from around Pakistan, but mostly from the Punjab region, came to Karachi to take a 10-day seminar coined ‘Training of Trainers’ (ToT). Participants were lecturing and clinical faculty at various nursing schools. We delivered 4 days of didactic and skills content as a component of the ToT program. Our topics included CMQCC standards in sepsis care and ALSO standards in the management of shoulder dystocia. We were able to set aside long sessions for postpartum mental health management as well as hands on training in optimizing fetal position - which of course might serve to reduce the work load for the fistula surgeons! All fistula surgeons look forward to going out of business.

I had so many remarkable moments along the way, it’s hard to narrow it down to just one thought to end this blog post. So, I end with gestalt. A midwife’s work is broad, profound and recognizable across space and time: to walk with, defend and serve women, the world over. Sometimes, that might look like training trainers. I felt as much the midwife this week as I did the first time I received a newborn or the hundreth time I placed an IUD or the thousandth time I wrote down “24 YO G2P1 here for routine care.”

- Claudette Banda, 2026

Fistula surgery training for international fistula surgeons

KARACHI OCT 2025

IMR participated in a 2 week fistula surgery training in Karachi, Pakistan as part of a great initiative to train international fistula surgeons in October 2025. We were thrilled to be invited as partners in this training project with our partners at Koohi Goth Hospital, and look forward to returning and continuing this initiative.

We were invited as as part of a regional fistula training program in Karachi. Hosting surgeons from Nepal, Bangladesh, Afghanistan and Pakistan for 2 weeks of didactics, clinical, surgical and bedside training is all part of working to end fistula worldwide. We're happy to have been part of this wonderful effort in partnership with UNFPA Pakistan and Koohi Goth hospital.

Obstetric fistula care in Liberia

Last month, we returned to Liberia at Phoebe Hospital, where we've been working to offer surgical services to women suffering with obstetric fistula and other types of maternal birth trauma for the last decade. In that time, we have performed several hundred surgeries and cared for many more.

For 2 weeks, we worked on a Ministry of Health sponsored campaign. This effort was championed by Drs. Minnie and Lise, as well as all the hospital staff so instrumental to the success of these efforts. It was wonderful to be with the fistula care team here and reconnect with old friends. Obstetric fistula is a devastating birth injury that is preventable, affecting over 1/2 million women worldwide. 

Many cases of fistula can be cured with specialized surgery. We are thrilled to be able to bring the #bestcareeverywhere to cure those suffering with fistula. #endfistula

Hurricane Melissa recovery in Jamaica

In October 2025, Hurricane Melissa, a category 5 hurricane, landed on the western shore of Jamaica and caused vast destruction of flora, fauna, homes, and infrastructure. Hurricane Melissa knocked out power, water, and health infrastructures in many parts of the island such as Westmoreland and St. Elizabeth parishes. These areas were severely damaged with all health centers and hospitals destroyed. This month, our team of doctors- Josh, Amy, and Ambereen, worked in partnership with Breaking Healthcare Barriers (BHB) and the Ministry of Health in such hurricane-damaged areas. Each day, a clinic and pharmacy  was set up in remote areas that suffered the most from he storms, including the towns of Williamsfield, Parottee and Grange. We worked with local healthcare workers and BHB volunteers to see over 150 patients, fill prescriptions, treat ailments and provide counseling.

The local hospital in Black River was destroyed and plans are being made to rebuild. Until then, we hope to return as needed and continue to support these communities.

#bestcareeverywhere

IMR begins partnership in the Barbados

IMR fostered an agreement last week with the University of West Indies (UWI) Campus in Cave Hill, Barbados to provide training in Ultrasound and Simulation for the Department of Accident and Emergency Medicine (A&E).  Hosted by Drs. Lynn-Marie Lovell and Reginald King, IMR brought a team of Emergency Medicine physicians from the US to discuss the institution of parallel training programs starting in the Spring, 2026 on an on-going basis. 

UWI—Cave Hill’s Queen Elizabeth Hospital provides the only tertiary care on the island, serving a catchment population of approximately 300,000 patients.  IMR will support UWI’s A&E residents and faculty training, as well as senior medical student clinical education.  We are excited to expand UWI’s teaching capacity, and look forward to working with our partners in Barbados into the future!

2024 Year in Review

Continued support for our partners in Ukraine

IMR has been supporting healthcare workers in Ukraine over the past two years by providing training and supplies to care for those affected by the war. In 2024, we trained medical students and resident physicians in the recognition and management of emergency conditions in primary care settings. In total, our seminars were attended by close to 100 future healthcare providers! In addition, we provided critical equipment and supplies for medical students at the National University of Uzhhorod, battlefield medics, and civilian healthcare providers. We are also thrilled to continue working with our Ukrainian IMR Ambassador Mariya. 

IMR is looking forward to returning to Uzhhorod and Lviv in May 2025 to continue providing medical education and training to our partners.

Commitment to caring for women with fistula

In 2024, IMR has been busy at work to do our part in eliminating obstetric fistula. This year has taken us back to Liberia, Madagascar, and Pakistan, and we began a new partnership with the Department of OBGYN at Edwards Francis Small Hospital, UNFPA, and the Ministry of Health in The Gambia.

In Madagascar, we were amazed by the quality of care provided by the nursing staff to the patients undergoing fistula surgery. Pre- and post-operative care is crucial to ensure the recovery is smooth so the surgical repair stays intact. IMR worked with the staff to create a nursing protocol for peri-operative care that we hope will be a valuable guide for our other partnering facilities.

In Pakistan, we were warmly greeted back to Koohi Goth Women’s Hospital to train local gynecologists in fistula repair and to treat women who had come from all over the country seeking a cure for their devastating condition. We were also delighted to instruct the wonderfully curious and engaged midwifery students at Koohi Goth, where 280 young women complete their 2 year diploma program for free, with room and board included! They are essential to their communities in preventing maternal mortality and obstetric fistulas, and it was a joy to contribute to their learning.

As part of IMR’s campaign to end fistula, our co-founder and Managing Director Mayano is running the Los Angeles Marathon in March 2025! No matter how challenging the training and the race may be, it will be nothing compared to the daily struggles of women with fistula. Support her efforts by donating below!

IMR returns to Vieques

2024 saw IMR’s return to Vieques, a community that’s near and dear to our IMR family since Hurricane Maria in 2017. We conducted home visits to vulnerable populations in Esperanza, the southern part of the island, carrying on a practice that we started a few years ago. We were also able to donate medical supplies to individuals and to community organizers. We look forward to a return this spring to continue our partnership with local community organizations.

Celebrating our Eddy Rosé Scholars

We were so proud to see our Haitian nurse scholar, Bettina, graduate from nursing school! Bettina hopes to return to her home region of Destra to serve those who have both geographic and financial difficulty accessing healthcare.

We were also honored to award $10,000 to our Black Birthworker Scholar Isatou, a Nurse Midwifery student at SUNY Downstate. Her passion for midwifery was undeniable and you can get to know her more here.

Henry was a Physician Assistant at Phebe Hospital where we worked in Liberia. When he told us he was accepted into medical school in Rwanda but could not attend due to financial difficulties, we knew we could not let such wonderful talent go to waste. He is our third scholar for this year, and we are so proud of him for pursuing his dream of becoming a doctor.

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At IMR, we are a small but mighty group who’s committed to the betterment of the lives of those most in need. We are nothing without your continued support, and because of your contributions, we were able to achieve so much last year. We look forward to making more positive change in 2025!

Working to eradicate fistula in Pakistan

Earlier this month, we had the great privilege of visiting IMR partners in Karachi, Pakistan. Our team included our Executive Director and UroGynecologist Dr. Sleemi, her long time mentor Dr. Ralph Chesson, Nurse Midwife and IMR Managing Director Mayano Ochi, and Jacqueline Kirk, who was there to document the stories of the hard work that our partners in Pakistan have put in. IMR has been working in Pakistan since 2022 in our effort to end fistula.

On the outskirts of Karachi is Koohi Goth Women’s Hospital where we spent the majority of our time. Koohi Goth is an incredible facility dedicated to the eradication of fistula where they perform free surgical repairs for women suffering from fistula. Women come from all over the country in pursuit of a treatment that will end their daily suffering due to the urinary and fecal incontinence that fistulas cause. Throughout the week, Dr. Sleemi and Dr. Chesson performed surgery on the patients at the Fistula Center alongside our Pakistani colleagues. Many of the Pakistani surgeons expressed gratitude to have received high quality mentoring and instruction from these two experts.

One of the strong beliefs that Koohi Goth holds is that skilled midwives are the key to fistula prevention. Koohi Goth hosts a 2-year diploma program for midwife students that come from some of the most rural and impoverished areas of the country. They receive their education, along with room, board, and text books all for free. They are even given a small monthly stipend. All of this is in an effort to increase the midwifery workforce who will then return to their villages where they will help save women’s lives and prevent fistulas by identifying abnormal labor and determining when a C-section is necessary. We were honored to have had the chance to instruct these eager students who clearly had so much passion for their studies, both in the classroom and in the clinical setting, .

It was humbling to witness and learn about the challenges that the midwives, doctors, and the patients face in Pakistan. IMR is committed to helping alleviate some of the burden and look forward to returning again next year.

Haitian Nurse Scholar Bettina graduates from Nursing School!

IMR is thrilled to announce the graduation of Bettina Perpulus from nursing school in Leogane, Haiti this summer. She has been an excellent student who hopes to return to her home region of Destra to serve those who have both geographic and financial difficulty accessing healthcare.  IMR has been proud to partner with GOALS—an advocacy group building community through soccer programs—to sponsor Bettina throughout her nursing education, and look forward to supporting others who have similar ambitions in the region. 

“Today I'm living proof with the right support system anything is possible, thank you GOALS and I.M.R. for believing in me and as a result I will help others believe in themselves too."

-Bettina Perpulus

Clinical partnership launched in Gambia

This past October, we returned to Gambia to launch our clinical partnership with the Department of Ob/Gyn at Edwards Francis Small hospital, UNFPA,  and the Ministry of Health in Banjul, Gambia. Our focus was teaching about pelvic floor disorders, obstetric fistulas and more.  Dr. Ambereen was joined by Dr Svjetlana  Lozo, a trained urogynecologist. Lectures were given daily to post graduate trainees and healthcare students, and surgeries were done in the operating room. These included surgeries for obstetric fistula and other urogynecology-related disorders, with a focus on the vaginal approach. Overall, the week was a very successful start to our partnership.

We must thank our hosts, including the department chair, Dr. Keita, and the entire team for making it such a success. Teamwork is the only way safe surgery happens, from the cleaners, sterilizers, nurses anesthetists and all who interact with our patients- from the time they enter hospital doors to their discharge home. We thank our patients for trusting us with their care and we look forward to our return in the upcoming year.

Vieques in October

We’ve just returned from a trip to Vieques last month,  a community that’s near and dear to our IMR family. IMR has had the pleasure and privilege to support and volunteer here since Hurricane Maria in 2017. This recent trip was a small team of Ambereen and Liz Santaniello, NP, a cherished IMR volunteer and family. We conducted home visits to vulnerable populations in Esperanza, the southern part of the island, carrying on a practice that we started a few years ago. We donated medical supplies to individuals and to community organizers. These included glucometers, testing strips, lancets and other diabetic supplies, wound care items as well as other items that have been identified as necessities for the residents. Solar lights and powerful flashlights were also handed out on our home visits. Thank you to everyone who  supported our trip. We were given an update on the healthcare facility/hospital that’s currently under construction, as all are eagerly waiting it’s opening so that the residents of Vieques can get the healthcare that they’re entitled to and deserve. We’re planning a return this spring to continue our project.

Thanks so much for your ongoing support and please contact us if you’d like more information.