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Thursday, January 24, 2013

Pearls from the Compostela Valley Breastfeeding Mission Experience - Part 1

I was quite blessed to be part of the breastfeeding drive for babies of Compostela Valley.  Through this drive, I was finally able to meet Dr. Lei Camiling Alfonso of Caleb's Closet Ecostore.  We had been email and FB-mates but never got to meet each other in person.  She was very involved in the drive and we finally met in my hometown when she flew in to transport breastmilk to ComVal.  I asked Lei to share her story and experiences during the trip to ComVal and she generously agreed.  Aside from her online store, Lei also shares her thoughts and blogs at Lei's Anatomy.  Read on and learn!

This is the first of three parts.
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Face it, our country is disaster prone. And relief work is something that has really sparked my interest because of the sheer need and urgency. This has taken a whole new meaning with my new understanding of breastfeeding and its implications for infants in disaster areas. Most health workers have little knowledge of breastfeeding and lactation management during crisis. I have read the theories and the expert recommendations, but I haven’t seen them work on the ground. During the holidays, I was privileged to be with my Team UnangYakap mentors, Dr. Maria Asuncion Silvestre and Dr. Donna Isabel Capili supported by WHO Philippines (thru the United Nations Central Emergency Fund) to conduct a breastfeeding mission for Pablo victims in one of the evacuation sites. I am thrilled to report to you some realizations:



1. As in past disaster experiences (Post-Ondoy and Post-Sendong), MOST MOTHERS in evacuation centers are breastfeeding. 

Good news is, when we got to the Grand Stand evacuation center in New Bataan, ALL of the mothers we saw were breastfeeding, reportedly exclusively. While we may have anticipated starving little babies, it was uplifting to find that they had the most secure food supply among all the victims! 


Problems start when these breastfeeding moms begin to doubt their ability to produce enough milk and are offered breast milk replacements. True enough, when we surveyed their breastfeeding concerns, some reported (perceived) low milk supply. Stress delays the ejection of milk from the breasts, but doesn’t affect production in significant ways. The solution to this is support and reassurance, not milk substitution. If even well-meaning donors in the evacuation center introduces milk formula at this point, the mother is most likely to “convert” to mixed-feeding or bottle-feeding, as studies have shown.

What we saw in New Bataan was beautiful, despite the surrounding circumstances. Serendipitously, we arrived in Compostela Valley during the launch of a Woman-Friendly Space. Organized by a women’s organization, BalaisaKababaihan , the Municipal Mayor’s Office and the Provincial Health Office of Compostela Valley, it aims to integrate services directed towards mothers who are either pregnant or with small children. The goal is for a space where mother survivors can lounge around, receive food rations/provisions without having to line-up with the rest of the evacuees, nurture their nurslings in relative comfort, and offer support to each other. What a simple and genius intervention!

If we can protect the mother, provide her with proper nutrition, if we can make things a little easier for her, we ultimately benefit both her and the nursing infant. This is one important component of the Infant Feeding During Emergencies Strategy. Hopefully, more relief workers would embrace this strategy.
During the launch of the pilot Women Friendly Space in Compostella Valley.  Team Unang Yakap, Dr. Maria Asuncion Silvestre in a photo-op with Gov. Arturo Uy of Compostela Valley, Mayor Lorenzo Balbin, Jr. of New Bataan, Ms. Ugochi Daniels who is the country director of UNFPA, Philippines with breastfeeding mothers of New Bataan.  Photo by Dr. Lei Camiling-Alfonso.
Women Friendly Space.
Photo by Dr. Lei Camiling-Alfonso
2. There is actually no need to call for powdered milk donations for infants. 

Well-meaning people have done this in the past. The needs of babies are usually overlooked during times of crisis simply because they can’t talk. However, good intentions should also be guided by expert recommendations. Policies restrict the distribution of formula milk during crisis for a reason. Formula milk can be extremely dangerous for babies in difficult circumstances.
Try to imagine how you would cope without water, food, nor electricity. Now imagine how doubly tough this is for mothers with young children (and how about 4 of them in tandem?). If the mother is bottle-feeding, the first problem is clean water pantimpla. The next problem would be water for cleaning the bottle, panghugas.

Velvet Escario-Roxas of Arugaan, a community-based breastfeeding support group, shared that during the Ondoy experience, one mother-survivor reported a dramatic increase in her breast milk supply in just two days (contrary to the expectation that milk production will stop during times of stress). To think that prior to the tragedy, this mother was already giving her baby mostly formula milk. Why this increase in milk supply? Because in the low-resource setting of an evacuation center, she had no choice but to breastfeed! And this worked to the advantage of the natural processes that control milk production in a woman’s breasts. The more demand, the more supply. It’s as simple as that.

Breastfeeding is a robust human process, and it makes sense because it is essential to the survival of our own kind. For those who breastfeed, there is a difference between perceived insufficiency (false, MOST common complaint) and real low milk supply. Truth is, even among malnourished women the quality and composition of milk is relatively unaffected. Women can produce ENOUGH milk except in rare medical conditions. It is very interesting (and empowering) to note that even grandmothers have been reported to produce milk again for their own grandchildren.

A mother in any evacuation center should be helped to do the same primarily for own baby’s benefit, and consequently for her own convenience. Only breast milk can afford immunoprotection through the specific antibodies and proteins found only in human milk. Each breastfeed is like a dose of painless vaccine against the lurking germs that are surely present in unsanitary evacuation centers.
Dr. Donna Capili and the breastfeeding mothers caught in a light moment.
Our role during the breastfeeding mission: to promote, protect and
support breastfeeding among this special group of survivors. 
Older children do not have to drink milk to assuage their hunger pangs. Mothers should be taught how to cook locally available indigenous foods, e.g. kamote, saba, cassava etc. The Infant Feeding During Emergency strategies safeguard mothers and babies who have already started to mix-feed of bottle feed by offering viable alternatives like wet nursing and donor milk while the mother is being assisted in building up her own milk supply in a feasible process called relactation.

Babies whose mothers are undergoing relactation, young infants orphaned in the disaster, malnourished infants and other young infants with various medical conditions are priority recipients of donor milk.

You can read Part 2 here.

About the Author:

Dr. Lei Camiling-Alfonso graduated from UP Diliman, B.S. Molecular Biology (cum laude) before pursuing medicine at the UP-Philippine General Hospital. Fresh out of medical school, she served a far-flung island group in Palawan as a DOH Doctor to the Barrio until a sensitive pregnancy forced her to return to Manila. Her personal encounters with our public health system as well as her own difficulties as a breastfeeding mother prompted her involvement with Unang Yakap (Essential Intrapartum and Newborn Care), a WHO initiative for evidence-based labor/delivery and newborn care practices, for almost a year now. She is currently trying to pursue a career in the local field of Breastfeeding Medicine and would probably go into Obstetrics as a back-up plan. She runs an e-commerce site that promotes mindful parenting. Her son Caleb is still breastfeeding past 2 years of age.


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