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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.

Ambereen Sleemi, MD, MPH

All photos used with permission.



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IMR and GOALS Haiti launches partnership

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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

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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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Summer Update: Building more partnerships in Haiti

Christie Louis, WHNP, talks to healthcare workers and medical students about hypertensive emergencies in obstetrics

Christie Louis, WHNP, talks to healthcare workers and medical students about hypertensive emergencies in obstetrics

In June, IMR was invited again to present at "World Health: Special Focus on Haiti", a medical conference in Limonade, Haiti in collaboration with NOAH-NY, Healthfirst, and Howard University Hospital. We gave lectures on Pelvic Floor Disorders and held a workshop on Ob/Gyn emergencies including postpartum hemorrhage, hypertensive disorders of pregnancy and ectopic pregnancy to a room full of Haitian medical and nursing students. We were joined by Christie Louis, WHNP, first-time volunteer with IMR. 

After the conference, Dr. Sleemi traveled to southern Haiti to begin a partnership with St. Boniface Hospital in Fond-des- Blancs. St Boniface is located in a remote mountain region about a 3 hours drive from Port- au-Prince. It’s remote area lends to a very large patient cachement area, treating over 100,000 patients per year with over 200 surgeries per month. The Department of Ob/Gyn invited IMR to come and work with the 2 staff physicians, Chairman Dr. Guerrier and Dr. Germinal. Enhancing the vaginal surgical approach in pelvic reconstructive techniques for prolapse and incontinence will be the focus.

Dr. Meyer working with Dr. Guerrier, Chief of Ob/Gyn, to repair an obstetric fistula at St Boniface

Dr. Meyer working with Dr. Guerrier, Chief of Ob/Gyn, to repair an obstetric fistula at St Boniface

Clinically, Dr. Sleemi and IMR volunteer Dr. Bill Meyer saw many patients with complete prolapse that had been untreated for years, leading to extreme discomfort and bleeding. We treated pelvic organ prolapse, genital fistula and a few congenital vaginal abnormalities.

We look forward to continuing our growing relationship with St. Boniface Hospital and improving care for women with devastating childbirth injuries and other debilitating gynecologic conditions.

My experience at the conference in Haiti was beyond my expectation... Interacting with individuals that are passionate about teaching and helping those who are not as fortunate as us is a rewarding feeling. Living in a country where medical technology is so far in advance you easily forget about the basics. This trip has changed my perspective in life and how I will practice as a Clinician. I’m more determine then ever to master my craft and learning alternative ways to practice preventive care and treatment.
— Christie Louis, WHNP
Staff and faculty of "World Health: Special Focus on Haiti"

Staff and faculty of "World Health: Special Focus on Haiti"

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Haiti Update: Pelvic Reconstruction Surgical Trip

IMR continued our work for the Haitian Women’s Collaborative project in May by working side by side with the Department of Obstetrics and Gynecology at the National hospital in Port au Prince. The Dept. is led by Dr. Viala and supporting attending physicians including Dr. Batsch Jean-Jemeau are partners in our educational pursuits. With support from the operating room team, anesthesia and nursing, we were able to focus on teaching pre-operative evaluation of surgery patients, review laboratory testing and develop further guidelines on patient safety. Ensuring all complex cased of pelvic reconstruction were performed with senior resident, hands on training, mentorship and didactics remain the cornerstone of our work.

Cases of vaginal prolapse and maternal birth trauma were cared for and preventive strategies were discussed. Pre- and post-operative surgical care was discussed with trainees and students.  We were happy to have Dr. William Meyer, a urogynecologist from the University of Arizona, Tucson, join us and share his surgical expertise with the residents.

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Emergency Medicine training for Haitian nurses begins!

Earlier this year, we began hearing stories from Port-Au-Prince's Haitian National Hospital (HUEH) that there was a dire need for practitioners who specialized in Emergency Medicine. HUEH is Haiti's national government run hospital, yet currently there are no EM-trained practitioners on staff.  To address this crucial need, we conducted the first of our training sessions for the ER nursing staff of HUEH, which consisted of approximately 25 participants.

Lectures were given in a small group format based with discussion facilitated by IMR's Dr. Schiller, translated by IMR volunteers. We also brought Dr. Cameron Kyle-Sidell from University Hospital, a hospital built by Partners in Health in Mirabalais, to provide lectures in an effort to coordinate between the two hospitals more closely. The seminar was very well received by participants and we hope for this project to continue over the next year, with expansion to include interns and residents.


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Updates from the Haitian Women's Collaborative Project

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By: Ambereen Sleemi

We traveled to Port-Au-Prince in February to continue our work in the National Hospital.

The team consisted of myself and gynecologic surgeon Dr. Lise Rehwaldt. I was thrilled to have Lise join me and contribute her vast experience working in resource-poor areas, gynecologic surgery and resident education.  Cervix cancer screening was performed, and didactic training was given.  This was the 1st time we had the capability of performing screening and hope to continue to build on this initiative. One of our patients had advanced cervix cancer and her referral to a facility for further treatment was secured. 

IMR’s focus on surgical training continued with major operations performed in the hospital’s ORs, focusing on using what is readily available and creating feasible alternatives to other needs.  Residents actively participated in all cases, which consisted of major pelvic reconstructive surgery for pelvic organ prolapse and genito-urinary fistulas (obstetric and iatrogenic).

The feedback from attendings and residents was again overwhelmingly positive as we seek to build on the relationships formed with the Ob/Gyn department and the hospital.   We traveled to the newly built hospital in Mirebalais and met with the head of Ob/Gyn to discuss possible collaboration in the future.

Our work was supported in part by generous donations of medical supplies from Direct Relief International and surgical supplies from MAP International’s GEMS program  in partnership with Ethicon/J and J.

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