.

Today the respiratory therapist and I gave lectures to the nurses in the pediatric ward while the neonatologist was doing grand rounds for another hospital in Harare.

Walking through the pediatric ward on our way to give our lectures was delightful. Although the children were sick enough to be brought to the hospital, most were smiling and playing, even as they were keeping close to mom or another caregiver. Age of the children in the ward varied widely, and we later found out that they treat babies as young as one day and up to 12 years of age. Children with stunted growth, even if they are over 12 years old, will often be admitted as well.

My lecture consisted of how the nurses could give hands on support to breastfeeding mothers through assessment and treatment of common issues; insufficient milk supply, nipple pain, low milk supply, breastfeeding management, plugged ducts, mastitis, and candidal overgrowth. The lecture was very well received. I have mentioned before that there is a great deal of public and community support for breastfeeding. However, knowledge of basic techniques to assist a mother through breastfeeding difficulties and concerns seems to be lacking, keeping in mind I have only been here a few days and have seen so little.

Things I would like to find out for the future include what sort of training nurses and doctors receive in assisting breastfeeding hands on, how much breastfeeding management information is available to the public, and how common that knowledge is among women who are breastfeeding or planning to breastfeed. I would like more information on the prenatal education mothers are receiving regarding breastfeeding and how those who are supporting breastfeeding get around inappropriate feeding methods when they are used by mothers in Zimbabwe.

Tuesday and Wednesday (today), we spent most of our time with the midwifery students at the Harare Central School of Midwifery. To become a midwife, you must first become a nurse, so the students we were teaching and talking with were quite advanced in their studies. I learned a great deal about breastfeeding in Zimbabwe, and where challenges still remain.

Support for breastfeeding is found at all levels. The policy for breastfeeding follows the World Health Organizations’s (WHO) which recommends exclusively breastfeed for 6 months, then continue to breastfeed with the addition of appropriate complementary foods for up to two years and beyond. There is a stigma attached to bottle feeding in public, and if a mother is on a bus and her baby starts to fuss or cry, she will be encouraged to breastfeed the baby by all of the other passengers. Mothers can breastfeed their babies anywhere without difficulty.

However, the rate of exclusive breastfeeding is only 1 in 3 babies under 6 months (Zimbabwe 2010-11 Demographic and Health Survey, Key Findings). Babies are being started on porridge or other foods very early, as is traditional.

The midwifery students I met with were very knowledgable about breastfeeding policy and how to educate mothers. However, there were many situations where they did not have practical knowledge of how to support a mother in breastfeeding her baby. Our discussions included many wide ranging topics; hand expression, flat and inverted nipples, positioning and latch, public breastfeeding, working and breastfeeding, breastfeeding through a pregnancy and tandem nursing, low milk supply, oral care using breastmilk for low birthweight infants, and HIV and breastfeeding.

After our time with the midwifery students, we were taken on a tour of the maternity ward. As I mentioned in my earlier post, many of the women who deliver at this hospital are at risk or are high risk pregnancies. If the baby is born and is healthy, the baby stays with the mother. There are no cots or basinettes for the babies, they are kept in arms or next to the mother in bed. If the babies are having complications or need to be observed, they are taken to one of three nurseries.

There are three nurseries with a 100 bed capacity between all three. The smallest of the nurseries is for the premature and very low birthweight (VLBW) infants. They are kept in one of the 10 isolettes in the nursery. Mothers are free to visit at any time, and while we were there we were privileged to see a mother hand express, then remove her baby from the isolette to breastfeed on the partially empty breast. After she was done breastfeeding, she fed the expressed milk to the baby through a syringe. Kangaroo Care is practiced, and there was a booklet on Kangaroo Care attached to one of the isolettes. Once the babies are well enough to go home, they continue Kangaroo Care at home, and come back to the hospital once a week for follow up.

The second nursery has more cots, but is still fairly small. This is where the babies who had complications in delivery and need special care, but do not need isolette care, go after birth. The mothers still have access to their babies, but the babies are kept under the direct supervision of nurses.

In the third, and most crowded, nursery are the babies who simply need to be observed. Many of the mothers were sitting in the room on hard chairs at the end of the cots, dozing with their heads on the cots. These babies will be discharged according to following criteria. They need to be breastfeeding well and gain at least 50mg per day for three days.

After our tour, we were zipped to the University of Harare School of Medicine, where our neonatologist gave a lecture on supporting NICU babies.

It has been a wonderful, if exhausting, two days, and I look forward to sharing what tomorrow will bring.

Today was our first day in the hospital.  We were able to view part of the labor and maternity wards and the nursery.  One of the first things one sees upon entering is a breastfeeding support banner hanging down from the ceiling in the middle of the entranceway.  Breastfeeding support signs are everywhere.  HIV and breastfeeding protocols are posted on large posters.  I was delighted to see this massive and visual support for breastfeeding.

The statistics at this hospital are overwhelming.  At the hospital where we are working, they deliver 10,000 babies a year.  Most of them are complicated deliveries sent to the hospital from smaller district or rural clinics.  Ten c-sections are performed a day, and last night alone there were 40 births.  There is an enormous shortage of staff.

The medical students we met with today were delighted to hear our neonatologist talk about pulmonary hypertension and how to manage it.  We also discussed breastfeeding and the realities of what they see.

According to the students, everyone starts out breastfeeding.  Many, if not all, mothers and babies who are having difficulty breastfeed initially begin hand expression and cup or syringe feed the milk to the baby.  It is common to feed porridges and other foods from a very early age, sometimes as early as one week.  Hence, mixed, inappropriate feeding is common.  By 6 months, very few babies are exclusively breastfed.

Mothers who are HIV+ have the choice of whether to breastfeed or formula feed, with an emphasis on breastfeeding and a warning against mixed feeding.  However, with the amount of early solid feeding, and the small number exclusive breastfeeding, mixed feeding is almost inevitable.

Many mothers do continue to breastfeed past one year, even if they are mixed feeding through most of that time.  The students stated that while some mothers breastfed to 2 years, it is most common to wean around 18 months.

It is clear that breastfeeding support is high.  The question is, are mothers getting education on feeding prenatally?  Are mothers given breastfeeding support once they are out of the hospital?  Are there mother to mother support groups, or professional help mothers could access if breastfeeding is challenging?  These are critical for raising the exclusive breastfeeding rates.  Every answer I receive forms more questions in my mind.

In the time it takes you to read this sentence, a baby will have died.  We can only imagine the grief and the pain the parents feel, the loss of that child’s potential to smile, to laugh, to create.  The impact of the death of a child is something many of us can comprehend.  When we move from considering the plight of an individual child to a larger context, such as the number of children that died today worldwide, we lose the emotional impact of the information.  When death becomes a statistic, the value of each individual is lost.

In discussing the mortality and breastfeeding rates for a given country, we are confronted with numbers that have no relatable human side.  The statistics may give us the number of how many children died between birth and 28 days, or what percentage of babies are still breastfeeding exclusively at 6 months, but they do not tell us the stories of the people in those populations.  Without the stories, we do not have the technical or emotional context we need to be able to relate to the circumstances of other people in the world.  Though we can use statistics to show us a larger picture of the issues facing a population, we should never forget the individuals behind the numbers.

(more…)

Like an object dropped in water, I am creating ripples that flow outward and bring positive change.

Today, the ripples are small, and will affect only a few.  I updated the whole format of my website to better serve my needs.  I started this blog to have a forum for my ideas about infant feeding in emergencies, breastfeeding support, and global breastfeeding advocacy, as well as share my activities.

In September 2010, I traveled to Haiti as a volunteer lactation consultant to educate and assist mothers and babies with breastfeeding.  I came home having learned at least as much as I taught. While my short visit was one drop in the huge bucket of aid that was sent to Haiti in the months following the earthquake, I am hopeful the ripples from my visit continue to expand outward.

In April 2012, I will be traveling to Zimbabwe on a volunteer neonatal mission, as the team’s lactation consultant.  I will be assisting mothers and babies with breastfeeding in the Central Harare Children’s Hospital, which serves some of the country’s poorest residents.  In addition, I will be educating hospital staff and medical students in how they can best support breastfeeding mothers and babies.

This new site is designed to allow me to add new information more regularly. For example, I expect to post updates about my upcoming trip, both beforehand and while in Zimbabwe.  It also allows me to involve readers interactively, with comments on blog posts, and a “Donate” button at the top of the main page, allowing people who wish to help me afford the airfare to Zimbabwe an opportunity to do so.  I still have a Downloads section, where I will place PDFs and other files I want to share.

I have begun to do some research on breastfeeding rates and mortality rates in Zimbabwe, and I will be sharing those, as well as my motivation for volunteering in my next post.