Debi, I'm still catching up on back Lactnets, and came across your
heart-tugging story of the baby whose mother was killed by rebels in Uganda
and was subsequently being foster-nursed by your missionary email friend.  I
don't see any replies, except one addressing the injectable contraceptive issue.

I lived in Kampala in the sixties and I remember Uganda as a very beautiful,
albeit troubled country, even then. I am sure that your friend values her
contact with you in a (comparatively!) sane and safe place.

To address one or two of the points forwarded from your friend. Although I
would imagine that formula feeding is neither financially possible nor safe
in the environment you describe, in some African societies there are
cultural taboos against orphaned babies being wet-nursed by other family
members or friends.  That your missionary friend is prepared to do this is
wonderful and generous, but IMHO risky, bearing in mind that until very
recently HIV prevalence in Uganda was very high and the status of this baby
cannot be known.  My concern would be for the risk of transmission to her
from the foster baby, and also to her own nursing baby and to the other
friend and her baby (four people). A common ailment of HIV infected infants
is oral thrush, and if the wet-nurses were to get cracked thrush-y nipples a
route of transmission would be facilitated.

If this were my client, or my friend, I would recommend that a safer feeding
option would be to provide expressed breastmilk.  If there was any
uncertainty as to the HIV status of any breastmilk donors, then the milk
should be boiled, cooled and then fed to the baby.

I wonder how the people in the community feel about expressed breastmilk? In
Zimbabwe there can be taboos about this too, but if several of the nursing
mothers in the village could be persuaded to donate a small amount of
expressed breastmilk 3 - 4 times per day, it would be probably be a good
option for the foster-mother of an orphan to pool it and boil a small batch
say three times per day when she cooks for her family, and feed this boiled,
cooled EBM to the orphan.

What a tragic situation, with no good solutions.  My best wishes to them all.

Pamela Morrison IBCLC, Zimbabwe
[log in to unmask]

Debi wrote -

Last Sunday, Aug  6, 2 women left the Internally Displaced Peoples Camp with
military escort.  They were going back to their villages to collect food from
their gardens to eat.  One woman walked ahead, and was shot and killed by
rebels.  It is a horrible story. She left behind a lame husband and 3
children.  Kobusinge was her youngest, less than 4 months old.  Formula
feeding in such camps is not a possiblity and usually such children are left
to die.  For some reason, maybe the lack of food,  no one nurses them.
This little girl was bought to the mission in Bundi and we got word of it 24
hours after the mom died.  We sent Michael to go get her (at that time not
even knowing if she was a boy or girl).  Seven hours later she was in my arms
and was sucking beautifully.  JD, also with World Harvest, and I have been
nursing her.  JD has a 4 month old, and Liana turned a year in July.  It is a
gift from God to be able to do such a thing...and especially after all of the
struggles with Acacia's nursing.  We figured that together we could get a lot
of breast milk into her, but would also need to supplement with formula.
(JD's first child began dropping wieght percentiles at 4 months and she had
been concerned about it happening again).  ..... Sometimes Kobusinge and
Liana nurse at the same time, it is neat.... We are also looking into
encouraging wet nursing in the communities.  Babwisi culture has strong
family ties,  people will quickly pick up their relative's children after the
parents pass away.  The problem is nursing infants, though.  They die.
People are reluctant to wet nurse.  On a few, rare occasions, Jennifer Myhre,
the team pediatrician, has gotten a family member to wet nurse successfully,
with some monetary assistance for extra food and lost production in their
fields. ... I am sure Kobusinge will not be the last infant brought to the
mission, especially with the attention we are giving her.  We want to
encourage the community to embrace these infants....

    -Debi Page Ferrarello, RN, IBCLC
    Breastfeeding Resources, Inc.

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