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Haitian Women's Collaborative Project Update

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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

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.

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IMR partners with GOALS Haiti

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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.

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Announcing our new Executive Director!

 

Please welcome IMR's new Executive Director, Dr. Ambereen Sleemi.

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Ambereen is a co-founder and  Surgical Director of International Medical Response. She has been a crucial figure at IMR since inception and has led our projects in Puerto Rico, Malawi, Liberia and Haiti. Her passion for quality care has fueled her to treat women with fistulas and other pelvic floor disorders all over the world. 

As a female pelvic medicine reconstructive surgeon (Urogynecologist) and trained obstetric fistula surgeon, Ambereen serves as an obstetric fistula surgeon for the Eritrean Women’s Project in Mendefera, Eritrea since 2007, and as a surgical team co-leader for Medicine In Action’s spring trip to Kingston, Jamaica as well as on the medical board. She spent 6 years on the executive committee of the International Society for Obstetric Fistula Surgeons (ISOFS) and is still an active member. In January, 2013, she developed the Haitian Women’s Heath Collaborative in partnership with the Department of Ob/Gyn at the National Hospital in Port-au-Prince, Haiti. This project has expanded to a partnership with St. Boniface Hospital in the southern part of the country, continuing our pledge to increase safe surgical capacity in Haiti. 

She holds an MD/MPH from George Washington University School of Medicine, and is currently pursuing her M.S. in Epidemiology at Columbia University’s Mailman School of Public Health. She trained in Ob/Gyn at Louisiana State University in New Orleans, LA, in Female Pelvic Medicine and Reconstructive Surgery at Maimonides Medical Center and in obstetric fistula surgery in Northern Nigeria. 

We are thrilled to have Ambereen lead us through this new chapter!

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Healing in Malawi: An Update on our Surgical Obstetric Fistula Program

 Photo: L. Santaniello

Photo: L. Santaniello

In December 2016, we launched a partnership with the UNFPA Malawi, the Malawi Ministry of Health, and local district hospitals to help treat women in the southern region who are suffering with obstetric fistula and to train surgeons in fistula surgery. It is estimated that over 2 million women suffer with this condition and for every 1 woman treated, 50 remain untreated. IMR is committed to treat the women affected, often the poorest and most marginalized, for free. Importantly, our commitment goes beyond surgery and extends to training surgeons and nurses in this field. This includes pre- and post- operative care and patient safety.

Last April, Liz Santaniello, MSN, FNP-BC and I worked at the Mulanje District hospital. We evaluated 30 women with fistula and treated over 25 with very successful outcomes. IMR held a day-long training workshop for surgeons and nurses in Mulanje.

WHAT IS AN OBSTETRIC FISTULA? Obstetric fistula is a debilitating child birth injury that results from prolonged obstructed labor (it can often be several days) and the inability to obtain a timely and safe operative delivery, in almost all cases, a cesarean section. These injuries have severe complications, leading to a hole between the bladder and vagina, or the rectum and vagina, resulting in constant urine or stool leakage, and in some cases, 15-20%, incontinence of both. Since the injury is vast, leading to tissue death and scarring, we often see damage to pelvic organs, infertility, leg paralysis (footdrop), skin ulcers and more. This injury also leads to social isolation and depression.

Over 90% women lose their babies during birth. This was true in Mulanje also. Some are fortunate, as were Emily and Christine, in Mulanje, both were healed after we repaired severe birth trauma in the form of a fistula and ruptured anal sphincter. They both were able to continue to breastfeed their babies. They’ll return home to family once  healed and  counseled on ways to prevent this from recurring in next pregnancies: good prenatal care and delivery in a hospital, preferably by cesarean section.

 Photo: A. Sleemi

Photo: A. Sleemi

WHAT DO WE DO IMR has surgeons who have advanced specialty training in how to repair these devastating and often extensive pelvic injuries. Our surgeons have spent years training in the best centers in the world with the most experienced fistula surgeons. Our fistula surgeons return frequently to work with the world’s experts to continue advance their surgical skills to help women. We are also educators, with decades of teaching students, residents and fellows worldwide. Patient care and teaching are our passion.

WAYS TO HELP We’ll be returning to Malawi later this year to continue training local surgeons and transforming women’s lives with surgical repairs of fistulas. None of our work in Malawi, Liberia, Haiti or Puerto Rico could happen without your support. Please make a tax-deductible donation here.

-Ambereen Sleemi, MD, MPH, FACOG
Executive Director, Surgical Director

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IMR in Vieques

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Last week, we traveled to Vieques, Puerto Rico to help care for the population on the island that is still suffering from the aftermath of Hurricane Maria. We partnered with other organizations on the ground as well as Jordan Aid International to care for over 200 people on the island of Vieques. Vieques was particularly hard hit by Maria and has had a long-standing history of health disparities for the last few decades. The need for medical care on Vieques was glaringly obvious. Chronic conditions such as diabetes, high blood pressure, asthma and mental health issue such as depression and anxiety remain. 

 Puerto Rican physician Manuel Betancourt triages patients

Puerto Rican physician Manuel Betancourt triages patients

Since Maria, the public hospital had not opened to its full functioning capacity and currently there’s an urgent care center but all emergencies and obstetric care has to be obtained on the main island of Puerto Rico. This means that someone in need has to take a boat or plane to get to the main island for urgent medical care. IMR worked with a dedicated team of internal medicine, pediatrics, family medicine, gynecology, and many nurses and non-medical volunteers who made this three day clinic a tremendous success.

Thanks in part to the generosity of our donors we were able to provide medications, medical care, therapy, and disease management for the people of Vieques. We would like to especially thank MAP International for their medical supply donation. There’s a lot to learn about the history of Vieques, some of it can be found here.

 IMR volunteer, Angela Baumeister, RPAC, listens intently to her young patient

IMR volunteer, Angela Baumeister, RPAC, listens intently to her young patient

As the need continues, IMR will continue to return to the island work with our partners to provide the best medical care we can. It’s unclear when the current medical crisis will be over, however we are committed to being able to help as long as we can. Our supporters donations and support can help us have a long-term presence in Vieques and Puerto Rico for as long as needed. Please consider making a tax-deductible donation below to help us continue our work. We are grateful for your support.

Thank you,

Ambereen Sleemi, MD, MPH

 IMR team in Vieques

IMR team in Vieques

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