Mulford/WABA Fellow Update: Reflections Upon Penang, Malaysia

We are proud to once again welcome Dr. Genevieve Becker to Lactation Matters. Dr. Becker just completed her time in Penang, Malaysia as the Chris Mulford World Alliance for Breastfeeding Action (WABA) ILCA Fellow, where she is working with WABA at their headquarters on outreach and advocacy projects. She offers up reflections on her experience here.

By Dr. Genevieve Becker, IBCLC, FILCA

I am truly grateful for the opportunity to spend six weeks with World Alliance for Breastfeeding Action (WABA) as the Chris Mulford WABA-ILCA Fellow. It was a wonderful experience. I wrote in a previous blog post about the first part of the Fellowship and participating in the WABA/UNICEF Stockholm Symposium: Contemporary solutions to an age-old challenge: Breastfeeding and work, held 26-28 September 2015. This article is about my time in Penang, Malaysia at the WABA office.

My activity was quite varied. WABA is about advocacy and I spent some time exploring what the term advocacy means in relation to ILCA members – is it a verb as in “to advocate for . . . ,” or a noun, like in “the advocacy committee,” or something totally different? Advocacy seemed to be about using your voice so those with power – those who can influence things that matter – hear your voice and they act. Eventually, I developed an outline of how the ILCA web site could provide a platform to raise awareness, inform and develop the skills of advocacy among ILCA members, and highlight opportunities to use those skills and to add their voice to advocate for skilled lactation care available to all mothers.

The Baby Friendly Hospital Initiative (BFHI) has long been a topic I am particularly interested in. I presented a workshop to local hospital breastfeeding leaders and administrators, as well as medical students, through the Penang Medical College. I also presented a session during the Breastfeeding Advocacy and Practice two-week course attended by participants from countries in Asia, Middle East and Africa.

BFHI Workshop at Penang Medical College

These presentations, though titled as addressing challenges to implementing BFHI practices, provided an opportunity to discuss the language used about BFHI practices. Many of us are familiar with the change in communication standards that use “breast is best” to “breastfeeding is normal” and from the “benefits of breastfeeding” to the “risks of not breastfeeding.” I was able to give participants a handout with links to read more about this concept in case it was new to them. I put forward the concept that practices of BFHI are not interventions; they are the biological norm, and thus we should not expend our energy arguing the “evidence” for these practices. All mammals keep their newborns close by and feed their babies their milk, and support is provided by the “herd.” To facilitate human mothers and babies to do these normal practices is not an “intervention” – it is supporting the norm. It is up to the health workers who want to separate baby and mother and use non-human milk to prove that these interventions are safe and beneficial.

Look at the way practices of BFHI are phrased in your work. Are they supporting the biological norm or are the practices an “intervention” to be implemented? The BFHI is 25 years in existence in 2016. Perhaps it is time to ensure its standards are the normal course of care and not special “above normal” care.

Assisting with the Breastfeeding Advocacy and Practice course, with lead trainers Dr. Felicity Savage and Sandra Lang, provided me with experience of facilitating clinical practice sessions with the participants on three hospital visits as well as a visit to a community health service. In these visits, the course participants observed breastfeeding using a structured observation tool, took histories to recognize the elements that contributed to a breastfeeding difficulty, assisted mothers to develop skills, saw how labour and birth practices could influence breastfeeding, discussed with mothers in the community how they might address challenges to breastfeeding as well as learning from mothers’ experiences. I also facilitated communication skills practice in the classroom. Hearing about breastfeeding related practices across the many diverse countries was fascinating and highlighted how many similarities there are for babies, mothers, and health workers, whether they are from Singapore, Brunei, Fiji, Malaysia or Ireland.

IBCLCs at the BAP Course

The fellowship is funded by ILCA and WABA and I was the 7th WABA-ILCA Fellow since 2007. I undertook a survey of the past fellows to explore and report what could be learnt from their fellowship experiences towards ensuring the fellowship activity was worthwhile to WABA, ILCA, and the fellow herself.

I also contributed to Health Care Practices issues when needed while based at the WABA Secretariat. This included sharing documents, contributing to general discussions, participating in an informal visit from a distant maternity service to the office and a formal visit from Dr. Shin Young-Soo, WHO Regional Director of the Western Pacific accompanied by Malaysian Ministry of Health officials.

I worked full days though there was still some time for leisure activities. Penang Island is a densely populated busy industrial and business area as well as a tourist destination. It has been an important sea port for hundreds of years contributing to the blending of cultures and peoples that live there – Chinese, Indian, Malay, and more recently English, Australian, Dutch, Japanese and many other backgrounds. Penang was Britain’s first settlement in Southeast Asia (1786) and the English influence is still very strong with English widely spoken, which makes it easy for those who speak the language to get around. There is an excellent public transport system and after a few hours of walking around, it was a pleasant rest to ride an air conditioned bus observing the activities on the streets as we passed.

I found every person I met to be friendly and helpful and a general relaxed atmosphere. Georgetown, the city of the island, is a UNESCO world heritage site to walk around and experience the traditional cultures side by side with modern high rise buildings as well as resort beaches. As well as a good public health system, large private hospitals on Penang serve residents (with private insurance) as well as medical tourism from other south-east Asian countries. My experience of getting a tooth filling replaced would have me returning if only to obtain immediate inexpensive high quality dental care. Penang Island connects to mainland Malaysia by a ferry and two modern bridges across the 4km (2.5 mile) channel allowing it to be a distinct area though in easy reach of the rest of Malaysia.

The weather is tropical, 28-32 C day and night with moderate humidity, though for half my stay there was unfortunately a heavy “haze” or smog from plantation burning in nearby Sumatra, which obscured the sun and limited outdoor activity. Towards the end of my stay, the smog lifted and I was able to enjoy walking on the beach, exploring the botanic gardens and relishing the sunshine before returning home to my usual grey wet winter. Very enjoyable was the wide variety of inexpensive food that was easily available. Some evenings, I prepared my own meals with food from open air markets or international chain supermarkets and some evenings I sampled the variety within a few minutes’ walk of my apartment. The people in the WABA office were very informative and tolerant of my endless questions about food ingredients, cooking methods, and taking me to different eating places each lunchtime to fulfill my wanting to sample every food from every culture! But there was so much variety, I only was able to sample a small range.

I particularly enjoyed working in an atmosphere of interesting people who were enthusiastic about the work that they did. Every day brought interesting activities, new information and lively discussions. Overall, my Fellowship was great!

Genevieve Becker is a registered dietitian and an IBCLC who has worked in maternal, infant and young child feeding for over 30 years. Her main interest is the education and performance of health workers. She has earned a Masters of Science (Community Health), a Masters in Education and a PhD, all which examined aspects of assessment of health worker performance in assisting mothers to learn skills related to breastfeeding. She is the lead author for the Cochrane systematic review on methods of milk expression. She was a volunteer counsellor with a mother-to-mother support group for 20 years.

Her business, BEST Services, provides consultancy services related to breastfeeding education, support and training nationally and internationally. Some current contracts include the coordination of the Baby Friendly Health Initiative in Ireland and assisting countries to revitalise their BFHI activities. Genevieve was the lead for the updating and revision of the UNICEF/WHO BFHI global materials in 2006-2009.

Genevieve served for 6 years on the ILCA Board and is currently the only FILCA in Europe. Genevieve lives in Galway city, on the west coast of Ireland with her husband. Their daughter currently works in New York City and their son and two granddaughters live in Ireland.