Most precious cargo – breastmilk

 

 

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Cup-feeding a baby with donated human breastmilk at a relocation site in Cagayan De Oro.

 

I’m sorry for the lack of updates. I would use the holiday season as an excuse but the truth is I’m still stuck at December 17th. My next few posts will be about Typhoon Sendang (Washi) – stories I have to tell because of the kindness and generosity shared during critical times. Incredible things have happened. I will however insert some regular programming in between.

One of the many things UNICEF and it’s partners did in response to the Sendong/Washi flood was to collect human breastmilk donations. In emergencies, breastfeeding is a lifesaving response, especially when clean water and sanitation services are in short supply. UNICEF and partners give mothers all the support they need to continue breastfeeding during and after emergencies.

I sent out information about the breastmilk drive through Twitter. Thank you for the great response. However at one point had to deal with the harshest and ugliest comments (nevermind the negativity).

Dr. Mianne Silvestre of UP-Philippine General Hospital and  a supporter of the NGOs Kalusugan ng Mag-Ina and Team Unang Yakap sent this update, “Various private individuals are mobilizing their networks for what we hope will not be just distribution of donor milk but a series of “breastfeeding missions” like we organized for Ondoy years back. We hope that peer counsellors get involved for breastfeeding counseling, relactation, cooking lessons on complementary feeding, with the last resort being cup feeding of donor milk and wet nursing. Dr. Jessa and I are capable of helping with supplying donor milk through our linkages with the UP-PGH Milk Bank and private groups but really need your help with all the rest, on the ground.”

The call for donations of human breastmilk is still ongoing. There are two drop off points:

Quezon City/San Juan/Cubao area:
17 Green Grove Villa, Lantana Rd., Barangay Mariana, New Manila, QC (office of Kalusugan ng Mag-Ina, Inc).

Manila area:
UP-PGH Human Milk Bank, 4th Floor, Left Central Block (LCB) c/o Tina or Grace (during office hours) or the NICU Fellow (after office hours)

 At the end of this post is a document signed by the Department of Health, UNICEF, World Health Organization, Plan International, Save the Children, Department of Education, DILG and many other organizations supporting and explaining the importance of breastfeeding in times of emergencies. I know, based on the reaction in Twitter, that there are still a lot of misconceptions from well-meaning donors who give infant formula and breastmilk substitutes as part of their relief packages. Though your intentions are good, you may actually be causing harm by exposing infants to danger and possible death. Please read after the jump by clicking “More.”

Last December 23rd, the first delivery of human breastmilk arrived in Cagayan de Oro. Here are photos from the field showing how this most precious cargo was sent to Mindanao.

 

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The breastmilk is safely stored in a donated freezer.

 

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The breastmilk arrives at NAIA Terminal 2, at 5.00am, thanks to the Pepsi delivery guys.

 

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Being checked in by Philippine Airlines, hope it makes it safely.

 

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UNICEF Nutrition officer, Paul Zambrano, relieved that the milk has arrived.

 

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Loaded on to local pick up by Pepsi, CDO.

 

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Cooler arrives at Northern Mindanao Medical Centre where staff of the paediatric and neonatal department are waiting.

 

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The breastmilk is still frozen, so will keep for many months, if necessary.

 

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The team are relieved the first transfer went smoothly. All photos above, UNICEF/2011

 

Click “More” to read additional information on how human breastmilk saves babies’ lives.

 

Report of the Nutrition Cluster on Infant Feeding in Emergencies, Philippines October 2009, Typhoon Ondoy –

The Nutrition Cluster joint statement on appropriate infant and young child feeding in the current emergency, and caution about unnecessary use of milk products.

Major  health problems in the Philippines, which are most likely to be exacerbated by this crisis, relate to malnutrition and communicable  diseases  (malaria, dengue, measles), especially in children. Given the structural damage caused by the cyclone  and  flooding to water supplies, there is an additional risk of water borne diseases affecting large numbers of  the  urban,  rural and displaced populations. Infants and young children may have been orphaned or separated from their mothers.

During  emergency situations, whether manmade or natural disasters, disease and death rates among under-five children  are  generally  higher  than  for  any other age group. The younger the infant, the higher the risk. Mortality may be particularly high due to the combined impact of a greatly increased prevalence of communicable diseases and diarrhoea and  soaring  rates  of under-nutrition. The fundamental means of preventing malnutrition and mortality among infants and young  children  is  to  ensure  their  appropriate feeding and care. The aim should be to create and sustain an environment  that encourages frequent breastfeeding for children at least up to 2 years of age. Where infants are not breastfed, comprehensive interventions are needed to reduce the high risks of artificial feeding in this environment.

The Nutrition Cluster reiterates that infants should start breastfeeding within one hour of birth  and  continue  breastfeeding exclusively (with no food or liquid other than breast milk, not even water) until six  months  of  age.  After  this  period,  infants  should begin to receive a variety of foods, while breastfeeding continues  up to two years of age or beyond. Under normal circumstances, infants who are not breastfed are five times more  likely  to  die from pneumonia and 14 times more likely to die from diarrhoea, than infants who are exclusively breastfed  for  the  first  six  months. The valuable protection from infection and its consequences that breast milk confers  is all the more important in environments without safe water supply and sanitation. Therefore, creation of a protective  environment  and  provision  of skilled support to mothers of newborn infants and breastfeeding women are essential and are priority interventions.

The Nutrition Cluster note that donations of infant formula and other powdered milk products are  often  made,  whilst  experience  with  past  emergencies  has shown that without proper assessment of needs, an excessive  quantity  of  milk  products  for feeding infants and young children are often provided, endangering their lives.  There  should  be no donations of breast milk substitutes (BMS), such as infant formula, other milk products, bottle-fed  complementary  foods  represented  for use in children up to 2 years of age, complementary foods, juices, teas  represented  for  use  in  infants under six months; and bottles and teats. Any unsolicited donations especially Breast Milk Substitute (BMS)  should be reported to DOH-HEMS Hotline at Tel. No. (02) 711-1001 or 711-1002 or DOH-FDA Hotline at Tel. No. (02) 8078285 and directed to DOH-HEMS.

Any  provision  of  BMS  for feeding infants and young children should be based on careful needs assessment to inform purchase  of  supplies  and  the  package  of  nutritional  and  medical  care needed. Therefore, all donor agencies, non-governmental  organisations (NGOs), media, individuals wishing to help and other partners, should avoid calls for and sending donations of BMS, bottles and teats and refuse any unsolicited donations of these products. BMS should be used  only  under  strict control and monitoring and in hygienic conditions, and in accordance with the International  Code  of  Marketing  of Breast-milk Substitutes, Milk Code in the Philippines, and Policy on the Acceptance of Processed Local and Foreign Donations and subsequent relevant World Health Assembly resolutions, as well as humanitarian agencies’ policies and guidelines. There should be no general distribution of BMS and/or powdered milk.

There  is  a common misconception that in emergencies, many mothers can no longer breastfeed adequately due to stress or  inadequate nutrition. A desire to help may result in the inappropriate donations of infant formula and other milk products.  Stress  can  temporarily  interfere  with  the  flow  of breast milk; however, it is not likely to inhibit breast-milk  production,  provided  mothers  and infants remain together and are adequately supported to initiate and continue  breastfeeding.  Mothers  who  lack  food  or who are malnourished can still breastfeed adequately. Adequate fluids and extra food for the mother will help to protect their health and well-being.

If  supplies  of  infant  formula  and/or powdered milks are widely available, mothers who might otherwise breastfeed might  needlessly  start  giving  artificial feeds. This exposes many infants and young children to increased risk of infectious  disease, malnutrition and death, especially from diarrhoea when clean water is scarce. The use of feeding bottles  only  adds  further  to  the risk of infection as they are difficult to clean properly. Bottled water is not sterile.

In  exceptionally  difficult  circumstances,  therefore,  the  focus  needs  to  be  on creating conditions that will facilitate  breastfeeding,  such  as establishing safe ‘corners’ for mothers and infants, one-to-one counselling, and mother-to-mother support. Traumatised and depressed women may have difficulty responding to their infants and require particular mental and emotional support. Every effort should be made to identify ways to breastfeed infants and young children who are separated from their mothers, for example by a wet-nurse.

The decision to use infant formula in separated and orphaned infants should be informed by results from an assessment by  qualified health and nutrition workers trained in infant feeding issues. Criteria for targeting and use should be established.  Given  the  damage  to water sources and sanitation facilities, only ready-to-use infant formula is the most appropriate as it does not need to be mixed with water. Caregivers should be encouraged to feed the ready-to-use infant  formula  with  cup and spoon. Bottles and teats should not be provided. UNICEF will support training of staff and education of mothers on how to use the ready-to-use formula safely. This will be accompanied by monitoring of the distribution and use of formula.

Treatment  of  severely malnourished children, whether facility or community based, should be done in accordance with international  standards  and  best practice and closely monitored. Standard commercial infant formulas are not meant for this purpose.

Children  from  the  age  of  six  months  require  nutrient-rich  complementary  foods in addition to breastfeeding. Complementary  feeding  should be addressed with priority for locally available, culturally acceptable, nutritionally adequate  family  foods.  Provision  of  fortified  foods  or micronutrient supplements such as vitamin A or zinc in supervised  programmes  for  young children  represent  a much more appropriate form of assistance than sending milk products. In rations for general food distribution programmes, pulses, meat, or fish are preferable to powdered milk.

We urge governments and partners to include capacity building for breastfeeding and infant and young child feeding as part  of  emergency  preparedness  and  planning,  and  to commit financial and human resources for proper and timely implementation of breastfeeding and infant and young child feeding in the emergency.

Designated Cluster: Nutrition Cluster composed of DOH, UNICEF, WHO, Plan International, Save the Children, ACF-E, MSF, WFP, PNRC, FNRI-DOST, HKI, DILG, DepEd,

 

 

 

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