As a founder member of Cape Town's donor milk bank, Milk Matters, I've been 
reading with interest various opinions about sustainability in projects and
the roles/responsibilities of donors and those who receive the gifts.  At 
times I have felt frustrated at hearing impossible 'solutions' blithely 
given and unjustly criticised by some who have not walked in our shoes.  At 
other times, I realise there is room for thought and perhaps reassessment of 
our current and future
goals, so a discussion like this is worth enduring.

There is at least one gross misconception regarding how far the milk 
stretches at our milk bank, since we serve the NICUs at low-income public 
hospitals.

"assuming that babies take 8 bottles per day or assuming that they drink an 
average of 30 ounces per day."

Since we are feeding tiny prems who take just a few mls per feeding, one 
bottle will go a long way.

"You could only feed 45 [B] or 49 [O] babies exclusively for six months. Or 
to round off, less than 50 babies"

Yes, you could if you were deciding to cut the mother out of the equation 
altogether (and in any case, can you put a price on the well-being of "only" 
50 babies?).   But we decided early on that one of our goals of our milk 
bank is to get the mother to take over the feeding as soon as possible, with 
education and care.  Feeding a prem for 2 weeks (which might be all we are 
able to supply) will usually allow for the mother to build up her supply. 
Admittedly there are many cases where the mother has died, and while the 
situation is tragic, we simply cannot provide breast milk to anyone for the 
long term, nor to any baby that will survive without it.  Horrid, is it 
not?!.  All we can do is offer a better start than otherwise, according to 
doctor's prescriptions.  Of the three major milk banks in the country, one 
has a strict 2-week-supply policy, and one supports AIDS-affected orphans 
(who will probably be getting large quantities of milk, yes, but in 
small-institution numbers.) and our milk bank that tries to supply for a 
little longer if there is no other option.

I think that part of the confusion in this discussion (even allowing for 
'IBMP' being red rag to a bull on this list) is that Milk Matters is a tiny 
grassroots organisation formed from nothing and learning as it goes along, 
not an organisation with power and layers of structure and certainly with no 
government support.  Every one of our volunteers has turned her hand to 
whatever task was at hand - to even consider us investigating donors for 
their ulterior motives is laughable.  Let me try to illustrate the 
difference between living in an ivory tower and on the ground in Africa.

When the beggars come to my door with a request for food, cash, or 
piece-work (and they do this a lot, since I'm on a main road in a South 
African town), they do not ask me for my financial statements. They decide 
to ask for whatever is going, and I have a conversation with myself - do I 
have an extra R10 or leftovers in the fridge, am I feeling generous or a 
little bit fed up with cadgers.

I can imagine the response if I tell them that I have a degree in Botany and 
I am going to come and teach them how to grow their own food instead....
because they just are not at that stage of their lives (those particular 
beggars.....I might assist an organisation in teaching about food gardens if 
I wasn't so involved in supporting, protecting and promoting breastfeeding).

I doubt that when IBMP donated milk to Milk Matters, either party believed 
it was intended as a sustainable effort and that anything more would be 
expected of either party by outsiders.  I gather it's called the 
International Breast Milk PROJECT, not FOUNDATION.  Our charity is 
registered with the Dept of Social Welfare as a non-profit and also as a 
public benefit organisation, and submits annual reports and financial 
accounts to the relevant authorities, so we are tracked by officialdom. 
When organisations gave us money to buy pasteurisers and freezers, they 
merely expected accountability through this process and I guess hoped that 
we would keep going, but it was left to us to do so.

It occurs to me that we have never asked anyone to help us sustain and grow 
our milk bank.  To all of those who have been there before- can you suggest 
a direction?  We have grown in fits and starts as a community effort, and it 
worked (for us and the babies we helped along the way, and for the mothers 
who are feeling good about the babies they helped).   We have asked for 
milk, we have asked for money, we have asked for consumables, and have 
received free help in design and printing of logo, pamphlets and posters. 
The media has given us free publicity and hospitals and laboratories have 
provided staff and blood tests.   Rather like the beggars at the door, we 
received what we asked for (or didn't receive it), and nothing more.  Who 
gives organisational structure development assistance? (I never knew there 
was even such a thing before now).

"have you received the $803,046 dollars for the in-country build up of the 
local donor milk banks?"
How strange it is to me that some Lactnet subscribers think this should be 
an expertise of other milk banks, and that we would feel in a position to go 
and demand MORE input from donors.  If a monetary value has always to be put 
on something, I suppose someone could go back and find out how much the 
city's hospitals have saved in treating cases of NEC and rotavirus due to 
the timely IBMP supplies (without counting the value of Milk Matters milk 
that became so popular when suddenly there was a steady supply of donor 
milk).

There are undoubtedly many kinds of donors - those who donate completely out 
of love, those who need to look good, those who are asked and can't say no,
and those who have ulterior motives.

When a group of us started Milk Matters in Cape Town, no one had asked us 
to.  It just seemed like a Good Thing, and we decided somehow to foist our
good intentions on to the public, trying to find a niche for our desire to 
donate.  In fact, we were perhaps among the worst kind of philanthropists, 
as we asked others to give what we could not (donor milk OR money), to those 
who believed themselves happy with the alternate product :-))

Initially we had donors and knew we could find recipients, yet the doctors 
were opposed to us.  Milk even went to waste as we tried to find ways to be
'allowed' to use our milk and expertise.  Finally one brave doctor went 
against the status quo and started using our milk and then suddenly we were 
in the invidious position of knowing how many babies were dying from lack of 
breast milk in our town and yet having to ration it among the hospitals who 
wanted it.  The IBMP milk helped us out of a hole - milk that we would never 
have received otherwise from mothers who would not have donated otherwise 
(ie a creation from nothing), and it has filled the gap when we risked 
losing credibility in sustainability.  The donation helped us along the way, 
helped us through the possible failure-to-thrive of our own premie days. 
Why is there a question on sustainability or even a long term relationship?

As I mentioned, our goals include educating the mother how to take over the 
supply of breastmilk as soon as she is able to do so (if there is a mother). 
We have also been successful in getting the hospitals we supply to form 
their own milk banks, purchase pasteurisers, attract their own pool of 
donors.  It's a slow battle, especially as the understaffed hospitals would 
usually rather see us as the supply factory than be part of the solution. 
It's often hard to see progress from day to day, but looking back on the 
journey, HUGE strides have been made.  The needs, I realise, are always 
going to be greater than the supply.

As for paying poor mothers to donate milk....  I would indeed like an 
organisation to be set up to oversee that possibility, but there is no way 
it is going to be run by us - we do what WE do.  Another milk bank in the 
country has taken a few phone calls from men wanting to know if we would pay 
for their partners' breast milk, and this week I heard a doctor talk about 
unexpected illnesses in his tertiary hospital that was traced to drug 
addicts selling their milk to desperate mothers of prem babies.   So this 
would need to be an organisation with a strong legal and social-worker 
background being able to guide and protect disempowered women from potential 
pimping (that's an I not a U) of their milk (forget the western notion of 
women's rights), protecting infants of the potential donors (we have often 
talked women out of weaning their babies so as to provide us with milk, 
argh!!!!) setting up safe places where donations could be made and stored 
until we could travel the long distances to collect it (talk about 
sustainability and environmental impact....)

At this stage, what we can do is publicise the needs to our colleagues in 
the hospitals who reach their maternity wards, who channel breast milk back 
to us, and that's as sustainable and as environmentally friendly as it gets, 
perhaps in some tiny way mitigating the dastardly actions of overseas donors 
who send pasteurised, tested milk to us for their own nefarious purposes. 
;-)

I love the idea of mothers self-organising and doing all the health-checks 
and offering of payment between themselves, direct mother to mother.  I look 
forward to that becoming the norm.

Jacquie Nutt IBCLC
Milk Matters volunteer
www.milkmatters.org
and on FaceBook

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