Hello Fay

Thank you, and all who wrote, for your kind words.   I'm a tiny cog in this 
lovely milk bank, living far away as I do, but I forwarded your comments and 
we all appreciated your enthusiasm for our work

In South Africa, there are still pockets of badness regarding breastfeeding, 
and pockets of goodness and niceness :-)   Mostly lip service bordering on 
ignorance.   There is certainly a strong *government* promotion of 
breastfeeding.  In fact, I should have been arriving in Johannesburg in this 
past hour for a National Breastfeeding Consultative meeting, but sadly it 
was postponed on Friday till September.

It is going to be an exciting meeting, involving civic society as well as 
government officials, and I hope we will be able to build on the policies of 
BFHI, and breastfeeding promotion to all with antiretrovirals for the HIV+ 
mothers as in the new Western Cape protocols.  We are also hoping that more 
breastfeeding training will be incorporated into medical and nursing 
schools, and more IBCLCs will be employed in hospitals - "we" being the 
IBCLCs, who have to put ourselves on stage as major players, not just the 
anonymous chorus line.

I'm not sure how BFHI operates in the rest of the world, but our policy 
incorporates an extra 3 steps above the 10 Steps.....Mother-Friendly care; 
the Code of Marketing of Breast Milk Substitutes and subsequent, relevant 
WHA resolutions; and issues around HIV+ mothers.

A fact that astounded me when I heard it on radio the other day is that 
South Africa (with a fairly low uptake of treatment; we were celebrating an 
unprecedented 80% of uptake in our province) uses 25% of the world's 
antiretroviral drugs. HIV lives with us; it was the reason why we started 
the milk bank, which is an irony in that so many milk banks globally were 
closing at the time because of HIV.

We quickly realised that a healthy HIV-affected-but-not-infected baby (ie 
AIDS orphan) would use more milk than is sustainable, and so now we are 
supplying mostly the state hospitals for the most needy of premature babies. 
We don't get to choose, of course; the doctors prescribe and we supply what 
we can.  In almost all cases the mothers will be providing some milk if they 
are not too ill, and the policy is to get them fully breastfeeding their own 
babies as soon as possible.

The private hospitals do not "allow" breastfeeding yet, as far as I know.  I 
recall a premature baby boy at my local hospital who was fully supplied for 
some weeks with donor milk until he went home with his HIV+ mother, and then 
he went on to formula.  But he was gorgeous when I saw him at his later 
check ups.  It was a touching time because his mother somehow was not always 
able to be there in NICU, but the local donors would come and visit, and 
seeing 'their' baby kept them supplying milk beyond the normal period.  None 
of them were very copious donors, but they soldiered on because they 
believed that Baby M needed them.

There is something about milk banking that I find so very emotive.  We have 
to be hard-headed about screening forms and tests and hospitals paying for 
milk, but underneath all that is a strong bond (in our committee certainly) 
that we simply have to keep on doing this because it's RIGHT.  And the donor 
mothers seem to feel it even more strongly.

Best wishes to all for this lovely week.
Jacquie Nutt IBCLC
Milk Matters
www.milkmatters.org

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