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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

Road to Destra

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

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.

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.   

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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"

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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.