Archive | IBCLCs traveling the globe

World Breastfeeding Week: Breastfeeding in Papua New Guinea

In celebration of World Breastfeeding Week, Lactation Matters will post every day this week, highlighting the stories of breastfeeding in different cultures and countries.

Written by Jeralie Fairbanks, RN, IBCLC

In June 2012, I had the opportunity to visit Kudjip Nazarene Hospital in the Western Highlands Province of Papua New Guinea. As a lactation consultant in the United States, I was amazed at how women in Papua New Guinea breastfed and the many cultural differences surrounding infant feeding. There are many spiritual practices that interfere with the initiation of breastfeeding, however, breastfeeding is the only option for most women as formula and milk of any kind are not readily available. If women deliver in a hospital and their newborn is premature, then their newborn can receive formula. There are no breast pumps available in this part of Papua New Guinea so women hand express to feed their premature infants.

Papua New Guineans are tribal oriented, which means that the tribe raises the children. When a woman comes into the hospital for childbirth, she brings family tribe members or village wontoks (clan members) with her. After the baby is born, the family members help to care for the newborn while the mother sleeps and recovers. This entails holding the newborns, swaddling in cloth, or bringing the baby to the mom to breastfeed. Because the infant mortality rate is 43.29 deaths/1,000 live births, many do not initiate bonding with the infant out of fear that the baby might die.

The country of Papua New Guinea is approximately the size of California with a population of 7 million. Access to health care is limited and many women deliver in their village. It is one of the most culturally diverse countries with varying practices related to childbirth and breastfeeding.

While in Papua New Guinea I had the opportunity to visit a health clinic in a village. This clinic had a birthing center that had just opened. There were posters about infant growth and the importance that a baby is weighed monthly. There were, also, pictures demonstrating the importance of maternal nutrition while breastfeeding. I was pleased to see the progress since my last visit in 2008. Although a third-world country, it is progressive.

I taught at the School of Nursing in Kudjip and stressed the importance of skin-to- skin at birth and initiating breastfeeding within the first hour. The students in the School of Nursing were very receptive and interested in this and were talking with patients about what they had learned the next day in the hospital setting. It was encouraging to know that all that is needed is education to provide an improvement in outcomes.

Women in Papua New Guinea have no difficulty breastfeeding in public as that is simply what the breasts are for. Babies are carried in bilums on either the mom’s or family wontok’s back. And babies are breastfed on demand. It was exciting to be able to provide an IBCLC’s viewpoint and positively impact initiation of skin-to-skin and breastfeeding at Kudjip Nazarene Hospital.

Jeralie Fairbanks RNC, IBCLC is a Labor and Delivery Nurse at Rogue Regional Medical Center in Medford, OR where she enjoys assisting families with their first breastfeed and those first few days.  She is married and has two sons ages 12 & 9. She has a passion for missions and has had the opportunity to travel to the Nazarene Seo Company Hospital in Kudjip, Papua New Guinea twice.

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IBCLCs Volunteering at HIAM-Health in Timor Leste (East Timor )

Article by Sue Williamson IBCLC, Anne Scollon IBCLC, and  Maree Twomy,Dietician

Sue, Maree & Anne relaxing with their much needed ILCA Fans

This is the first-hand recollection of volunteering overseas in East Timor as shared by three Australians, two IBCLCs and a Dietician, after their month long experience at HIAM-Health. This facility provides a place for mothers and babies to come for a week after being in Dili Hospital, to learn about health and nutrition.  Timor Leste (East Timor) has a population of  1 million, with unfortunately an infant mortality rate  as high as 111 per 1000 births in some districts. Over 50% of children under 5 years are malnourished and hungry (MoH 2008) HIAM Health is an abbreviation of the East Timorese words Hamutuk Ita Ajuda Malu “Together we help each other”.

 “Almost home”…an email shared from Sue, Anne, and Maree.   Bon Dia Colleagues, Friends, and Family,

Our time at HIAM health Dili has been an amazing cultural, emotional, and educational experience for Anne, Maree and myself. The Timorese have endured incredible hardships and yet are simple, happy people, interested in learning, especially those in our class room.

Leaders breastfeeding their children

We have had 20 days of teaching breastfeeding and nutrition, also laughter, singing, and exercises.  Our endorphins are high. We sleep well. The 3 of us have bonded well and our skills complimented each others’ personalities. We could have never picked a better team.    We have taught women and men from 3 different communities; Aileu , Ermera district, and Atauro Island. They are valued leaders in their communities – non medical. They have shared with us their culture and stories and we will never forget.

Also the HIAM health workers were in our sessions most of the time.  They have heard the information 3 times over, so hopefully they can continue to teach the mothers in the centre. There are nurses amongst them plus those who are studying nutrition, a great benefit to the centre. They have been very impressive.  Jill (director at HIAM Health) has chosen well and they have great respect for her and Rosaria.  We had about 15 to 20 people at each session.   The Mothers and babies/ toddlers in residence, about 10 to 15 at a time, plus some siblings, usually stay for 21 days depending on the conditions. We have children with Tuberculous, heart disease with a weak suck etc.  All with malnutrition, they are put on a “plump-up” corn meal program. It takes about 2 months to make a difference in their body structure. There are 10 breastfeeding mothers in the center at the moment and we will be teaching and encouraging them over the next couple of days and spending time with the little one with a weak suck.

Around maternal health, the mothers eat very little in pregnancy so they can have small babies for easier labour.  Many still give birth at home and some still don’t give colostrum.  Instead they give sugar water. The mother and baby stay beside the fire in a smoky room for a number of days, postpartum. They usually breastfeed for beyond 2 years of age, and all sleep with their babies. Mothers believe when they are pregnant with their next child, that they should wean the first so he / she won’t be infected by the milk. With inverted nipples and delayed milk supply they stop breastfeeding. If their milk is not flowing well by day 2 they give up.

The two directors, Jill Hillary (Aussie) and Rosaria Martins da Cruz (Timorese) are amazing.  Jill works as the advisor and Rosaria as the up-front person.  Both had a vision for this place, meaning ‘together we can help each other’. You can read all about them on the HIAM Health web site.

There is a miracle tree here, called the MORINGA tree, and it is very high in protein, vitamins, and minerals.  Maree has been encouraging everyone to eat it 3 times a day for health and wellbeing. What a blessing as it grows all over Timor.   It’s like breast milk… free and readily available.

We visited Dr Dan Murphy’s clinic at Bairo Pite. So many medical problems and then a ward full of stunted young children,  oh so much to take in!  During our 2 hour round with him, we checked 5 new babies born overnight and witnessed a mother with Tuberculosis, who has been ill for many years, take her last breath! He sees 300 patients a day in his clinic!

Our rest and recreation at Atauro Island over night seemed like a ‘full week’ of rest. We stayed in an Eco hut and enjoyed meeting people who were bringing various skills to help Timor get back on their feet. It warmed our hearts to hear their stories. The clear sea water refreshed us to no end. We enjoyed being at the celebration for Tour de Timor, the extremely tough annual bike ride.  We even shook hands with the President, Prime Minister and his Aussie wife, Kirsty. Oh my, what a day! We also were invited to the US Embassy to have cocktails with Judith Fergin the Ambassador.  Always so much excitement going on here in Dili, we will never be the same. I think that will be enough for now, see you when we get home.”

Blessing Sue, Anne and Maree

Read about the History of Timor Leste (East Timor)

Sue:  aussiesjw@gmail.com

Anne:   scollona@optusnet.com.au

For more information about Sue, Anne, and Maree’s trip to East Timor, please see their article in the February E-Globe.

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IBCLCs Traveling the Globe: Conference in Uppsala, Sweden: Part 2

On September 14-16, 2011, 215 participants from 26 countries around the world took part in a 3 day Neo-BFHI program in Uppsala, Sweden. Ten Australians, from New South Wales, South Australia and Victoria were amongst the multidisciplinary group.

The purpose of the conference and workshop was to present and discuss evidence for adaption of the WHO/UNICEF 10 steps to Successful Breastfeeding for neonatal intensive and intermediate care and to discuss a draft document prepared by a working group from the Nordic countries and Quebec.

IBCLCs at the Uppsala Workshop

Day One of the conference was opened by Professor Paula Meier from the United States. She spoke of breastfeeding support for infants in neonatal units. Human milk banking was the norm in many units and Professor Meier stated ‘that by giving the at-risk premature infant artificial milk, it was putting them at further risk of complications’. The predominantly female lineup of speakers spoke on varying aspects of care with Renee Flacking, a health care worker and mother of a premature infant, discussing the U.K. and Swedish experience.

Randa Saadeh gave the WHO perspective on adaption of the ten steps, while Yvette Sheehy, from Sydney, discussed their Hospital in the Home: ‘The Discharge on Tubes – DOTS program’-infants discharged home on tube feeds with health care support.
The closing speaker for Day One, Birgitte L Ekeberg, spoke of ‘Moving towards family centered care , the first Family Centered Neonatal Intensive Care Unit in Norway’.

On days two and three, participants chose workshop groups to attend, and discussed the draft BFHI Initiative in Neonatal Units document and the Ten Steps, and came together in the afternoon of the final day to present the outcomes of their discussions. The final document, which is a Global document, will need to be representative of all participants and there was considerable debate on how this could be implemented worldwide. As bottle feeding and pumping is the norm in some parts of the Western world the impact of including this in developing countries was an issue.

Uppsala University hosted the meeting and welcomed participants with a welcome reception opened by Vice-Chancellor Anders Hallberg followed by the conference dinner which was held at the Norrlands Student Club. Participants were serenaded by the student choir during the dinner.

Kersten Hedberg Nyqvist

Kersten Hedberg Nyqvist, one of the conference organizers, was overwhelmed by the number of participants who wished to visit the Uppsala Family centered neonatal unit and after discussions with the unit managers decided the numbers were too many. With the interests of those within the unit in mind and the interest shown by conference participants she opted on a presentation that was to challenge the practice of many. Parents live in the neonatal units with the babies and infants from 32 weeks. They are given the opportunity to have Kangaroo Mother Care, 24 hours a day, while parents are taught to recognize the cues of the baby and breastfeed them when they are ready. Babies are discharged at 34 weeks partially breastfeeding, partially tube-feeding. Kersten stated ‘that there is no such thing as non-nutritive sucking’. She also said that the program has taken time to implement and one of the biggest problems is staff attitudes to change.

While walking to the bus to leave Uppsala for home, the chilly wind was blowing as winter was closing in. Thousands of bikes were chained up in this university town and I thought how lucky these babies are to be cared for in a society so socially aware.

Susanna Scurry
RN,RM, BFHI Educator & Assessor, LCANZ Board of Director, IBCLC

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IBCLCs Traveling the Globe: Uppsala, Sweden: Part 1

Baby-Friendly Neonatal Care Conference and Workshop Uppsala, Sweden, Sept 14-16, 2011

L to R is Yvette Sheehy, Anne Merewood, Annette Wright, Susanna Scurry

IBCLCs, hospital clinicians, researchers, and lactation professionals from around the world met at the Baby Friendly Neonatal Care Conference and Workshop in Uppsala, Sweden, for a groundbreaking meeting on a proposed expansion of the Ten Steps to Successful Breastfeeding to the Neonatal Intensive Care Unit. The conference was the brainchild of the Nordic expert group, in response to the document “Baby-Friendly Hospital Initiative. Revised, Updated and Expanded for Integrated Care”, UNICEF/WHO 2009.

On a packed first day in the beautiful and historic Uppsala University, 220 attendees from 27 nations listened to internationally representative presentations on the importance of breastfeeding in intensive care, and about innovatory programs and guidelines that are making NICUs more Baby-Friendly. Many speakers and participants were leaders of the Baby-Friendly initiative in their home countries.

On days 2 and 3, attendees met in workshops to discuss each of the Ten Steps, and their potential adaptation to the NICU. Participants also made suggestions for monitoring progress and standards. In the final session, group leaders summarized suggestions for all attendees.

Uppsala was an appropriate location for this conference, with its hospital NICU standing out as one of the world’s most family centered units. The working group will take conference suggestions and use them to create a final document to present to the World Health Organization for approval in the future.

Abstracts from oral, poster, and workshop presentations will be published online by the Journal of Human Lactation (JHL) in early 2012. JHL aims to publish the recommendations in full when they are finalized.

The conference was not all hard work. The Conference Dinner at Norrlands Student Nation included student singing and other musical entertainment, and the meeting opened with Swedish-style sing-alongs to “We are Family, Baby-Friendly Centered Family” and – but, of course – Abba’s Mama Mia…..

Anne Merewood PhD MPH IBCLC
Director, The Breastfeeding Center, Boston Medical Center
Associate Professor of Pediatrics, Boston University School of Medicine
Division of General Pediatrics
Boston, MA 02118

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