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Helping Breastfeeding Mothers in Haiti: One Women’s Experience

Following is a Guest Post from my friend HopeAllison Dwiggins. HopeAllyson is an IBCLC who recently traveled to Haiti with Circle of Health International. For a week she provided lactation support in a maternity clinic in Fond Parisien and the surrounding community. She taught classes to nurses and expectant mothers, as well as assisting mothers who had just given birth in breastfeeding their babies. Upon returning home, she presented a poster at Children’s Hospital of Philadelphia’s Global Pediatric Health Symposium, The Impact of Disasters on the Health of Children. The poster presentation was entitled, “Lactation Support in Haiti.” HopeAllyson will be presenting a similar presentation at the International Lactation Consultant Association’s conference this summer.

For more on breastfeeding and the aftermath of the Haitian earthquake, see my earlier blog post: Hell, Haiti, Good Intentions and Breastmilk Donations.

Breastfeeding is essential for all human beings, but nowhere is the need to breastfeed more acute than in a situation where there is little or no access to clean water, safe shelter, or reliable food supplies. Most, if not all, in the lactation community, are concerned with the issue of lactation support and how it is addressed by the non-governmental organizations (NGOs) and humanitarian relief organizations offering relief services immediately after a crisis.

When I went to Haiti, in September 2010, to provide lactation support in a maternity clinic and the surrounding community, I expected to come home with the story of how I had helped mothers breastfeed, of the classes I had given and the support I provided. And I did come home with many stories…but none of them were my own.

Over the months since I returned home, many people asked how my trip went, as if I had been on vacation and could sum up my experiences in one or two words. I tried.

“It was intense.”

“It was challenging.”

“It was amazing.”

I did not want to use the cliché, “It was life changing,” though it was. I was encouraged to present my work at symposiums and conferences. I was asked to give talks on what I had done in Haiti. But there was an underlying assumption that this was it – I had done my part, and I was finished.

But really, this is just the beginning.

Writing this post is the next step, my next step, in what I hope will be a much larger program which will do even more than I can do myself. It has been difficult for me to write this post because there is simply so much to say, but so few words that can actually express the reality of what I experienced.

How can I describe in words what I need emotions to truly convey? I could write many paragraphs about the feeling of my heart in my throat, from both excitement and fear, as I said goodbye to my husband and children. I could describe in detail the soaring of confidence as the plane landed in Haiti – the feeling that, perhaps, I could help in some small way. I could write an entire post about my gratitude at being welcomed with so many warm, sincere smiles. I could try to express my dismay on hearing of injustices that continue every day, but then I’d also have to write about the hope I felt because of the resilience I saw every minute, which I know will someday make a difference.

But then I’d still be left with an incomplete story because as much as I hope I helped the people of Haiti, they helped me, too. So how do I impart the lessons I learned, when I had come to teach? I came to educate expectant mothers on the importance of breastfeeding, but instead I was taught the importance of listening for the questions they didn’t ask. I came to answer questions from medical staff on how to support lactation, but instead I was shown glimpses of the cultural knowledge of which I lacked any understanding.

I came to make a difference; I left humbled by the way others made a difference in me.

So let me try to share some of that difference, to return to you the stories I heard, saw and experienced in my brief time amid the island and its people.

My first hour in Haiti was spent talking to Hermann. Hermann is almost 70 years old, fluent in English and teaching himself Spanish. He works as a taxi driver in Port au Prince. After my plane landed, I made my way through customs and immigration and found myself waiting outside for my colleague, whose plane was not due to land for another hour. Hermann had not found himself a fare among those on my plane, so we sat and he told me about his country, his fears and his hopes.

Hermann told me he was grateful for all of the people coming to Haiti, but that they would not help his country. His country needed to fixed, yes, but it could only be fixed from within. He told me of the bodies, still buried in the rubble of the earthquake, and the families that could not move on because there was no closure for their loss. He didn’t seem to believe there would be closure for these families any time soon.

Ultimately Hermann expressed his hope that I would return to Haiti after this trip, because he knows that my work is important to the mothers and the babies and the future of Haiti. He warned me to be careful about whom I trusted in his country, because many were trying to take advantage of relief workers and humanitarians. When we parted he took my hand and gave me his business card. I am sure that I have been long forgotten, just another of a long line of visitors to Haiti, but his willingness to share a brief acquaintance will remain with me for a long time.

Much of my time in Haiti was spent with Nahomie. Nahomie translated for me during the classes I gave to nurses and women who were pregnant or had just delivered. She was always smiling or laughing, and was an amazing resource for me as I attempted to convey how important breastfeeding is and can be to the women of Haiti. She worked hard to translate not only the words, but also the meaning of my message to those we spoke with. When she translated their questions to me, she worked just as hard to impress upon me the cultural nuances behind the questions. We attended births together, cooed over new babies, and discussed her plans to become a midwife someday. Before I left Haiti, we hugged and cried – the intensity of emotion involved with our work leaving us with no other option.

There really are too many stories to tell in one brief post. So many people have asked me so many things about my trip and I have tried to answer all the questions. But there is one question that has been asked only by a few:

“What now?”

I asked myself that question every day for months after I returned home before I was able to answer. Unfortunately, my answers are, quite often, more questions.

The father who kept asking if it was all right to feed his infant table food as the infant’s mother was dead and the family could not afford formula. What now?

The woman we spoke with who had lost both of her teenage daughters in the earthquake and, though trying, was unable to get pregnant again. What now?

The woman who labored in silence for hours – the father not present at the birth because he had no intention of acknowledging or supporting his child. The baby was born with an abnormally formed foot and ankle. Though there was a hospital capable of performing surgery on the baby, it was many hours away and the mother had neither the funds nor the capacity to get him there. What now?

All too often I was left feeling like I had no answers, no solutions for the people who found their realities to be full of “What now?” situations.

But then, there were happy endings, too. The woman we worked with who was hemorrhaging after birth, her baby unable to breastfeed. We were extremely concerned when she left the maternity clinic, mere hours later. But the next day, the father called to let us know the baby was breastfeeding fine and the mother was well, we were all relieved and we knew we had helped, at least a little.

But what do we do next?

Every day there are new disasters affecting people all over the world. Climate change, earthquakes, floods, mudslides, erupting volcanoes – the list goes on and on. Caught, and often unseen, in each of these disasters are mothers and babies – families—who need support to start and continue breastfeeding. I envision a network of lactation support personnel who work with NGOs and relief agencies before, during, and after emergency situations, so that every mother has the resources she needs to breastfeed—the resources she needs to give her baby the best chance at survival.

This is, of course, more than any one person can do and something that will take more than just time, volunteers or money.

When I think back on my time in Haiti, I see a parade of faces in my mind, all of them with unique stories to tell, all of them with unique needs. And while we can rush in with supplies and medicine and food, sometimes it takes more than that. As Hermann told me, sometimes the healing must come from within. Breastfeeding support is one way to give women in need the ability to take care of her needs and her baby’s needs without waiting on shipments of aid from the outside. Some might say this is too small a need to matter, but listening to the women I spoke to in Haiti, it is clearly vital. We can learn far more about our world and the people in it, if we only take the time to listen.

Haiti, Hell, Good Intentions, and Breast Milk Donations

A few days after the earthquake in Haiti, my Facebook account was flooded with suggestions to become a “Fan” of an organization I do not trust. I wondered why people who should know which organizations are actually helping breastfeeding women and their children would think I would want to support this particular organization. And fairly soon I knew: this organization had a heart string pulling photo of Haiti on its home page and a claim it was helping get donated breast milk to Haiti. My response? Not a chance.

I was dubious not only because of my distrust of this particular organization but because of the practical realities of transporting and distributing human milk in a country with no electricity, no refrigeration, and no hope of widespread access to either any time soon. I also knew that the first priority in feeding babies in an emergency is to feed from the breast. And I knew that the U.S. has a long and shameful history of harming the people of Haiti.

If you live in the United States, chances are good you know little about Haiti. I am no expert but I have some book recommendations. Look in the left hand sidebar for links (and please click through them to buy books at Powells and support this blog). The Rainy Season: Haiti Since Duvalier by Amy Wilentz is the first book I read about Haiti. I read it the year it was published, 1989, when I was 26 and a year out of law school. It is a beautiful, horrifying, well-researched book about the history of the country grown out of the first successful slave revolution in the western hemisphere. By the time Brother, I’m Dying was published I knew a good bit more about Haiti, in part having read all the previous works of that book’s author Edwidge Danticat. Brother, I’m Dying is the true story of the death of Danticat’s beloved uncle in the custody of the U.S. Department of Homeland Security (DHS). If you are wondering why there would be any issue about accepting refugees from Haiti, you need to read Brother, I’m Dying, not only because you need to learn more about how the U.S. treats Haitians regardless of whether there has been an earthquake but all of us in the U.S. need to know the nightmare a U.S. citizen of Haitian descent can go through trying to find the truth about the unnecessary death of a loved one who simply disappears into DHS custody while legally entering the U.S.

What you probably do know about Haiti is that on January 12th it was devastated by an earthquake killing hundreds of thousands of people and nearly two weeks later the death toll is still rising. You may also, particularly if you are an advocate of breastfeeding, think that getting breast milk to babies orphaned by the quake is urgent. Well, yes and no. All international aid organizations know that bringing artificial baby milk (also known as “formula”) to an area without clean water is sure to lead to more dead babies. Mixing powdered formula with contaminated water is an obvious danger. So what is the problem with liquid formula? The nipple (teats) and bottles needed to feed babies other than from the breast must be sterilized – impossible without clean water, electricity, refrigeration, and fuel. Well then, donated breast milk becomes all the more important, right? No. Haiti has no milk banks and even if it had them, without uninterrupted electricity and refrigeration – something it will not have for the foreseeable future – there will be no milk banks. Donor milk is also not sustainable. An unknown number of Haitian babies have been orphaned by the earthquake, however they must be fed by Haitian women who can continue to feed them.

Prior to the earthquake Haiti was already the poorest country in the hemisphere. Its infant mortality rate was the highest in the western hemisphere (nearly 60 out of every 1,000 babies died before the age of one compared to 6 out of every 1,000 in the U.S.) Maternal mortality was also the highest in the hemisphere (670 women out of every 100,000 died of pregnancy-related causes as opposed to 11 out of every 100,000 in the U.S.) However, breastfeeding rates in Haiti were far better than the U.S. According to UNICEF, 41% of babies under the age of six months are exclusively breastfed in Haiti compared to 13.6% in the U.S. When considering the availability of breast milk in Haiti, there are some other critical statistics. The rate of non-exclusive breastfeeding of children between 6 and 9 months is 87% and the percentage of children still breastfeeding at 20-23 months is 35%. What these numbers mean is the one thing that Haiti has a lot of is lactating women.

Still a number of breastfeeding advocacy organizations in the U.S. – the Human Milk Banking Association of North America (HMBANA), United States Breastfeeding Committee (USBC), International Lactation Consultant Association/United States Lactation Consultant Association (ILCA/USLCA), and La Leche League International (LLLI) – issued an “Urgent Call for Human Milk Donations for Haiti Infants” on January 25th. The U.S. Navy Ship Comfort, a medical vessel currently anchored off the coast of Haiti, had been shipped frozen donated breast milk and the “Urgent Call” urged lactating women in the U.S. to donate more breast milk to HMBANA milk banks, some of which would go to Haiti. Reading this “Urgent Call,” something didn’t feel right to me. The donor milk was going to the ship NICU and can not be sent to any facility on land as there is no facility that can maintain and distribute it. So I did some research on the Comfort. It took seconds to discover that the Comfort NICU has two incubators. Yes, two. Any baby born prematurely on the ship will have to be able to breastfeed exclusively before leaving the ship because breast milk from the breast is the only way Haitian babies can survive conditions there.

In short order, it was discovered that there had been no request for donor milk and aid organizations were asking that the milk shipments stop. The Emergency Nutrition Network explains why: the first priority has to be relactating women not currently nursing and making sure Haitian babies are feeding at the breast. That “stressed or malnourished women cannot breastfeed” is listed as one of the “myths that put babies at risk.”

One organization that is helping women in Haiti breastfeed is Circle of Health International (COHI). This non-profit – the one that has been getting my donations – has sent midwives, lactation professionals, and birthing supplies to Haiti for the estimated 37,000 women currently pregnant as well as the women and children who survived the quake.

So why did these U.S. breastfeeding organizations send out this “Urgent Call”? Perhaps it was ignorance. Perhaps it was well-intentioned. Perhaps it really did not occur to them that any feeding of babies in Haiti other than from the breast could decrease the total amount of breast milk available in Haiti because it discourages Haitian women from building their own milk supplies by breastfeeding babies (their own or orphaned ones) or relactating. And perhaps some non-profits see exploitation of the Haitian crisis as an acceptable way to raise funds that will be used elsewhere. There may be explanations but there is no excuse. Haitian women and children need our help urgently and we can help by sending money to aid organizations like COHI.

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