By Pat Young, APN, IBCLC
I’ve just returned from a trip to Uganda in East Africa. While there, I visited several hospitals – rural and city, public and private.
First, let me say that the poverty is mind boggling. I have a new theory that every health worker in a developed country needs to go on a medical mission to a third world country!
Second, the level of care in a good, private hospital was similar to what someone would have received here in the United States in the 1960s. Americans would now consider such care substandard, but the people are trying so hard to improve, even without the resources of a developed country. In the capital city of Kampala, the public hospital is very aware of the Baby Friendly Hospital Initiative (BFHI) and using skin-to-skin care for mothers and babies.
Most deliveries (city and rural) are unmedicated. C-sections in the rural hospital are “knocked out” and mothers miss the first few hours of their babies’ lives. In the rural hospitals, mothers must be accompanied by her family to feed her as there are no cafeterias. She comes to the hospital in labor with her mat on her head so that she will have a clean place to lay on the floor after her delivery.
Of the hospitals surveyed by BFHI, most are meeting 80% of the Ten Step goals. Most health care providers had never heard of La Leche League International (there are currently no groups meeting in Uganda) or mother-to-mother peer support. I can see that breastfeeding support needs to go two ways in Uganda – from the bottom up and the top down – to improve care.
Almost every mother breastfeeds. How long she does so is becoming the crux of the problem. Formula advertising is rare, except in the grocery stores where it is featured by location and on displays. In the villages, there is simply no safe way to use formula, although some try it. I saw several of these babies in the ward of the hospital that dealt with malnutrition. I also saw one infant who tried mightily to breastfeed but transferred very little milk as his was tongue-tied.
One thing that really impressed me was the use of skin-to-skin care with preemies. Mothers are taught skin-to-skin care (a la Nils Bergman) and as soon as the infant shows adequate sucking skills, they are sent home. The babies are seen weekly until they reach 2.5kg and then monthly until they are 2 years of age.
I had the opportunity to spend time with a wonderful woman in the capital city who is working on the hours necessary to qualify for the IBLCE exam. I don’t believe that there are any other Ugandans aspiring currently towards IBCLC certification. She needs any help we can give her.
How can we help breastfeeding support in these countries?
- Go on a medical mission and have the opportunity to experience it yourself.
- Sponsor aspiring IBCLCs (like WALC, the Wisconsin chapter of USLCA, has done) and help these health care providers get the materials and education that they need to reach their IBCLC goal. Health care providers in third world countries often have access to computers. ILCA offers a number of educational opportunities like CERPS on Demand and webinars. There are also impressive conferences like GOLD Lactation and iLactation which are completely online. Consider sponsoring someone to “attend” one of these opportunities. For example, you could sponsor someone from Uganda to attend the GOLD Conference for $49. Be creative and think of other ways to share of your knowledge and expertise.
- I am looking for any pediatric stethoscopes you might have lying around. There is a need in the pediatrics ward in one of the rural hospitals I visited and likely in others as well. I have a Peace Corp volunteer who is willing to distribute the donations. If you are able to help, please email me at firstname.lastname@example.org.
Have you participated in breastfeeding support in a country other than your own?
We’d love to hear about it at Lactation Matters. Please leave us a comment.
Pat Young has 5 grown children, 15 almost grown grandchildren and 5 great grandsons. She got involved with La Leche League in 1966 with the birth of her 4th baby and became a leader a year later. She took the first IBLCE exam in 1985 and worked as a hospital lactation consultant from 1986 to 1991. She received her MSN and became a Pediatric Nurse Practitioner in 1994. She continues to lead La Leche League meetings and work part-time as an APN as well as helping mothers as an IBCLC.