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.

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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.

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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.   

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"

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.

Updates from Puerto Rico

In October, we returned to Vieques, Puerto Rico for our 4th visit this year to assist with post-hurricane medical care and recovery.  People on Vieques have had extremely limited access to healthcare since Hurricane Maria struck more than a year ago. The IMR team arrived on October 19th, and conducted a two day clinic in Esperanza, where we saw approximately thirty patients.  The team was made up of Drs. Sleemi and Schiller, two Emergency Medicine resident physicians from Maimonides Medical Center in Brooklyn, Drs. Suman Gupta and Cecily Sotomayor, and our colleague Ana Aurrecochea, a surgical nurse from California.

In addition to clinical care, IMR worked in conjunction with local community leaders  to provide home visits for Vieques’ more vulnerable patient population, in which we were able to assess needs and provide appropriate medications and follow up.  

The trip was short and sweet, but  there is still much to do. While Vieques has achieved a measure of stability in its access to healthcare, it’s still experiencing interference in basic infrastructure.  Electrical power is interrupted on a regular basis, putting patients reliant on ventilators at high risk for decompensation, as well as compromising refrigerated food and medications (such as insulin) for the more susceptible patient population.  Please continue your support of IMR so that we can support those who need it most.

Looking forward to a productive 2019!

Haitian Women's Collaborative Project Update

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

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.

IMR partners with GOALS Haiti

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.

Announcing our new Executive Director!

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

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!

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

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

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

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

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

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