Dear Natalie:
While I do have an academic background I spent 18 years working with programs in developing countries, living for two years in Africa and a half year in Peru and the rest of the time traveling about 30% of the time -- which ends up to be a lot of time in the countries I visited frequently.  So, mostly I was writing about the environment in which I lived and worked for 18 years.  

First, you mention the historical and cultural context of industrialized countries and while that it certainly important in terms of the academic understanding of the historical roots and led to the uprise of companies such as Nestle, it certainly does not negate the fact that Nestle capitalized on that historical moment by exporting a marketing tactic to Eastern Africa whereby women dressed as nurses promoted formula.  I mentioned this in the context of the real life experience of one of my professors who happened to have been quite vigorous in promoting breastfeeding for all of his professional life.  My comment was meant in that specific local environment that he encountered.

Second, you completely misconstrued my comment about pathogens.  And quite frankly, I am trying to remind myself that perhaps you didn't really read my message carefully.  Of course infection by pathogens doesn't always mean that a child is in danger of immediately dying and if you reread what I wrote you will find that I never said that.  And of course not all pathogens require treatment, but some do.  And of course not all treatments work, but some do.  The type of situations I was talking about were those situations in which the pathogens were severe enough to be likely to cause death.   Yes some pathogens do cause death and I've witnessed far too many.  

Third, the screening for dehydration is having a sunken fontenelle, dry skin, dry lips, no urine.  This is not the least bit a rhetorical question; it is a pragmatic question.  And I can testify as a witness that this does indeed happen in breastfed babies.  I've seen the dehydration and I've witnessed deaths as well.  It also occurs in areas of the world where industrialization never entered -- areas where there is not a cow in sight or a tin of milk. Actually, I did see one skinny cow that was barely able to walk that the nuns purchased immediately.  I never saw a bottlefed baby the entire time I lived there, including the children of the one and only Belgian couple in town.  Unless you wanted to try to milk a chimpanzee -- there was no other source of milk for your baby than your cowives or your neighbors.  I personally lived through a cholera epidemic in then Zaire in the early 1980s.   In fact, every single day there were funeral processions for dying children and infants some of whom happened to children of friends. 

Fourth, during the time that I was working in developing countries, breastfeeding was heavily promoted and often mentioned first.  I did not keep all the pamphlets from all the nutritional programs I visited, but I guarantee you that breastfeeding was front and center -- breastfeed more often was the central key.  Never once was there any mention of fasting on any educational materials in any clinic I have ever visited on three continents.  Since I haven't traveled since my trip to Madagascar when I was pregnant with my son in 1999, perhaps all those materials disappeared during the HIV years.  But I was a witness to many many materials that did include breastfeeding.  And at the time it was generally recognized that breastfeeding was number 1 on the list.  It was even number 1 on the list when it came to vitamin A deficiency.

Finally, as for the protein gap - that had been debunked by the 1980s and everyone was into calories alone -- forgetting that micronutrients are needed.  Hence, the food distribution programs which are different from true nutritional programs were dumping foods that merely had calories but no nutrients and were actually exacerbating vitamin A deficiency.  Micronutrients became trendy and then everyone forgot about calories.  Again, I worked in an area where kwashiorkor and iodine deficiency both prevalent, it is painful to witness. In that area of Africa there was certainly no "dumping" of powdered anything.  About the only time anyone from WHO came into the area was the year before I was in Peace Corps for the Ebola virus outbreak -- which happened about 100 kilometers away from where I was stationed.  There were no antibiotics, there was no ORS, there was no powdered milk, everyone breastfed and babies still died.

Sincerely, 
Susan Burger, MHS, PhD, IBCLC

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