Saturday, April 18, 2015

Typhoon Haiyan/Yolanda part-2: Rescuing Breastfeeding

Breastfeeding Expert Support Team with mobile Breastfeeding Tent-Philippines  from the "Final Report on Breastfeeding Action-Lifeskills 8Jan2014"

"Even in the best, most hygienic conditions, artificially-fed babies are five times more likely to suffer diarrhoeal diseases.  In an emergency situation, even where bottle feeding is not normally associated with increased mortality in a non-emergency setting, infant feeding methods can become an issue of life or death.  Unsanitary, crowded conditions, a lack of safe water and a lack of facilities to sterilize feeding bottles and prepare formula safely and correctly means that artificially fed infants are more than 20 times more likely to die from diarrhoea and other infectious diseases than infants who are exclusively breastfed."  
"Infant feeding in emergencies:  experiences from Lebanon," by Ali Maclaine
Humanitarian Exchange Magazine Issue 37 March 2007

My previous post on Typhoon Haiyan/Yolanda was in my mind unfinished.  Why? Because there seemed to me to be much more that needed to be shared. How do you impart through words the work of these dedicated women to protect and promote breastfeeding in the aftermath of such devastation?  The Philippine Breastfeeding Expert Support Team (BEST) understood the barriers to promoting and protecting breastfeeding and created solutions through the use of their mobile breastfeeding tents.  One of the barriers is that in the aftermath of an emergency, there is a deluge of infant formula donations.  There is a lack of understanding that even under the best circumstances, infant formula has risks.  During an emergency those risks escalate.

One of the most challenging aspects in the aftermath of a disaster is how to manage formula-fed infants knowing that these babies are at higher risk for morbidity and mortality.  The Philippine BEST group used a variety of strategies to help moms relactate.   Peer counselors helped educate and inspire mothers to breastfeed.  Hand expression was taught, confidence was given that the milk was there.  Wet nursing was used to help fed babies while they were transitioning to the mother's breasts.  Donor human milk was used to help those babies who lost their mothers.

The following is 17 pictures and inspiring stories of breastfeeding mothers in the Philippines.  The first slide is of Velvet Escario-Roxas, who has trained many breastfeeding peer counselors, is Executive Deputy Director at Arugaan (means "to fully nurture with a lifetime commitment," in Filipino) Toddler Center in Quezon, and was very involved in the mobile Breastfeeding Tent after the typhoon.  Also in these pictures is Bing Guevara who was also very involved in mobile breastfeeding tent after Typhoon Yolanda.

The founder of Arugaan in Quezon is Ma Ines Fernandez.  She is an inspiration to many.  She recently was made an Ashoka Fellow and I think the following video is helpful in understanding why she is such an inspiration.  Ashoka Fellows are "leading social entrepreneurs who are recognized for their innovative solutions to social problems...demonstrating unrivaled commitment to bold new ideas and prove that compassion, creativity and collaboration are tremendous forces for change."

I am inspired by this group of dedicated supporters and protectors of breastfeeding in the Philippines.  Hopefully, you will be, too!!  We need more programs like this around the world.  In heartfelt gratitude for the many people around the world who protect and promote breastfeeding.
Valerie W. McClain

Saturday, April 4, 2015

Typhoon Haiyan/Yolando: Protecting and Promoting Breastfeeding in the face of Disaster

"Breastfeeding serves to protect a child's right to food security and medicine.  Temporary lack of food and water in emergency conditions in a disaster-stricken area cannot be presumed to justify the prescription of formula for babies.  In such situations, the health risks to which the babies are already  exposed can only be exacerbated when panic sets in and authorities unjustifiably offer formula as an emergency response."
--"Vulnerability:  From Protection to Empowerment," by Leonardo D. de Castro and Ma. Ines Av. Fernandez, Asian Bioethics Review vol.6 no.4 (2014)

Recently I had the privilege of being introduced through the email to some dynamic women who by their commitment and actions are making a difference in their communities.  Each of them using their different skills but recognizing the value of working together have created a blueprint for promoting and protecting breastfeeding during emergency situations.  They live in the Philippines, a country consisting of 7107 islands in the area geographically known as the "Ring of Fire."  The country is prone to earthquakes and typhoons.  Ma. Ines Fernandez is the founder of Arugaan, a non-governmental organization (NGO) that was instrumental in making Quezon City the first mother-baby friendly city in the Philippines. She created an innovative creche program that promotes and protects breastfeeding for working women.  In 1986 Ines co-authored and lobbied for the Philippine Milk Code (WHO Code--The Philippines is one of 37 countries in the world that fully implements the WHO Code).

Ines wrote a proposal that helped Arugaan receive funding from the World Health Organization to support breastfeeding in emergencies through the use of mobile breastfeeding tents. Mobile tents create a safe space for mothers and children with an opportunity to rest and recuperate from the trauma and struggles of survival after a disaster.   The tents also create an opportunity to educate moms about the importance of breastfeeding, the risks of infant formula, relactation, and the importance of nutritious, indigenous foods.  This education is combined with individual counseling or group counseling on breastfeeding, demonstrating positioning at the breast, breast massage to stimulate a milk supply, hand expression, wet-nursing/cross nursing. Healthy indigenous foods were provided for the moms as well as a creche for children.   In her email she mentioned that the Philippines encounter 21 typhoons yearly and that they "weather the storm with smiles."  This positive attitude shines forth in the pictures and papers that were shared with me regarding their work with supporting breastfeeding in the aftermath of Typhoon Haiyan/Yolanda, a category 5 typhoon that killed 6300 people and displaced 4 million people. 
From Jenny Ong's blog

Such an endeavor takes the work of many people.  One person, one group, one organization cannot do this kind of work alone.  With the spirit of cooperation and collaboration, Arugaan BEST (Breastfeeding Emergency Support Team) lead by Ma. Ines Fernandez worked with the Breastfeeding Pinays-an online breastfeeding support group of 40,000 members administered by Velvet Escario-Roxas and her trained peer counselors and co-founder of the Facebook group Breastfeeding Pinays, Bing Guevara; LATCH (Lactation, Attachment, Training, Counseling, Help)-a breastfeeding support group with Jenny Ong who is a trained breastfeeding counselor and Dr. Lei Camiling-Alfonso,Dr. Donna Capili, Dr. Mianne Silvestre from Kalusugan ng Mag Ina (KMI) who are also promoting a program called First Embrace.   Jenny Ong with her organization LATCH helped get the money needed for transportation fares for community mothers so they could volunteer at the tents.  Donor breastmilk (no donor breastmilk from outside the Philippines was allowed) was collected and airlifted to evacuation centers and a hospital in areas impacted by the storm to help infants in need.  Infant formula donations were discouraged because the mixing of infant formula with contaminated water can cause gastrointestinal illnesses and can be fatal.

There were many people involved in this collaborative approach and there were many agencies like UNICEF and the WHO, the Philippine government agencies (DOH and others) and international non-profit organizations like Save the Children coordinating the approach to help the survivors of the typhoon.
 Mobile breastfeeding tents were used at evacuation centers in Manila.  Later they were able to use their mobile Breastfeeding Tents to make visits (and return visits to see how moms and babies were doing) to the villages in Leyte/Samar hard hit by the typhoon.  I was impressed by the documentation that was done by this Arugaan endeavor and that they did follow-up visits. The breastfeeding tents encouraged more breastfeeding among mothers and at the same time educated communities on the importance of breastfeeding. 

One of the things I know from the hurricanes I have witnessed in Florida is that the impact of a hurricane/typhoon is felt in a community for years.  Homes have to be rebuilt or repaired, jobs may be lost, food security may disappear for many families.  Many close-knit families have lost their loved ones and often have to move to new locations causing additional stress.   The stress of this instability and personal loss may be long-lasting for families impacted by such storms.   

Breastfeeding is a well-known safety net for mothers and babies against the damaging effect of poverty and/or natural disasters.  Infant formula is a known risk in such situations because the safety of water supplies are often questionable, access to fuel/electricity may not exist meaning that sterilization of bottles/nipples will be difficult putting infants at high risk for infections and death.

"Uncontrolled distribution of infant formula exacerbates the risk of diarrhoea among infants and young children in emergencies."
--"Donated breast milk substitutes and incidence of diarrhoea among infants and young children after the May 2006 earthquake in Yogyakarta and central Java," by DB Hipgrave et al., Public Health Nutr. 2012 Feb 15(2): 307-315

"According to reports from the Philippines cases of gastroenteritis increased last year during Typhoon Yolanda because donated infant formula was mixed with contaminated water."

One of the things that happens during and after natural and man-made disasters is that good-hearted people believe that donating infant formula is the answer for babies during such emergencies.  What happens is that these donations often sabotage the breastfeeding mother, put more infants at risk for diarrhea and death, and are difficult to control and monitor. Not only that but once you have infants dependent on infant formula (an expensive product even in developed countries), then when all the free infant formula is no longer available, how will an infant survive? I remember years ago trying to talk to some missionaries regarding this issue.  They were collecting infant formula in our area to go to the survivors of an earthquake in Nicaragua who were living in tents in a landfill.  I could not convince these very kind-hearted people that it was a dangerous thing to do.  They assured me that they had water-filtering devices they were bringing as well as infant formula.  They did not understand that what they were creating is dependency upon a product that would not be available for free after the donations stopped.  Which meant that infants would be at increased risk for malnutrition and death, when families could no longer get free infant formula.  And by the time free formula ended, mothers would not have the information or help to relactate.

Hurricane Katrina was an eye-opening event for many of us here in the US.  The conditions were unbelievable for a country that is considered rich and modern.  I remember one night seeing the news in which it was stated that mothers with brand new babies in the New Orleans Superdome had run out of infant formula and water in which to keep their infants fed and hydrated.  I saw mothers giving people their babies to other people who were lucky enough to get a bus out of the brutal conditions of the Superdome.  They did this so that their infants could have food and water.  Watching those news clips and saying to myself, if only those mothers had some LLL leaders, IBCLCS or WIC breastfeeding peer counselors standing next to them to say that they could breastfeed their babies and here's how to do it.  Breastmilk will provide your infant with nutrition as well as keeping them hydrated.  Formula feeding mothers who have newborns still have milk in their breasts.  Relactation in the newborn period is much easier than relactating with an older baby (and that, too, can be done with knowledge and help).

Reading and seeing the pictures of what is being done by the breastfeeding organizations in the Philippines blows me away.  Why?  Because they are showing us a blueprint in how to protect and promote breastfeeding in emergencies.  I dearly wish that here in the USA we can follow their example. This can be done by any country (other countries are doing it) and it is a vital and dynamic way to help mothers and babies during emergencies.  The presence of such programs increases the knowledge in communities of the importance of breastfeeding.  I salute and applaud the efforts of this amazing group of women in the Philippines who are promoting and protecting breastfeeding.  May they stay safe as another typhoon heads their way--Typhoon Maysak.
Valerie W. McClain