All this indignation about whether pumps should be re-used, or handed 
down - or not - might need to be put into perspective.  The original 
question was about the possibility of sending a pump to 
Afghanistan.  I must say I wondered whether there would be regular 
electricity supplies in Afghanistan, and if the voltage would be the 
same as in the USA (115 vs 220 as in many other parts of the world - 
might need one of those adapter thingies....), but it seemed to me to 
be a generous thought, and I imagined - electricity supplies 
permitting - that the recipient would be inordinately grateful.

When I practised in Zimbabwe and pumps were so incredibly difficult 
to get hold of, a kind and generous LACTNET colleague sent me a whole 
box of easy-to-clean, used, plain old cylinder pumps.  I forget now 
whether she had replaced them, or collected them especially for me 
from other donors.   Did I feel insulted because I was comparatively 
"poor" and very needy, and such luxuries were absolutely 
unobtainable?  Not at all, I was delirious with joy!  I donated them 
to a colleague at the City Health department, for use in difficult 
situations in the little clinics that had been assessed as 
baby-friendly.  Of course, it could be that the "modern" recommended 
single-user pumps are less easy to clean, and consequently there are 
risks, making it unethical to endorse donating them.  The simpler 
pumps I had used to lend out in emergency situations in those 
compromised days were scrubbed, then soaked in sterilizing solution, 
and then steamed and air-dried, before being re-packed into ziplock 
bags.   Once I was able to interest an importer in ensuring a steady 
supply of the same type of pump (electricity supplies were erratic, 
so electric pumps would have been useless) I was able to stop lending 
them out, and sell pumps to needy mothers at cost - they were a tool, 
not a means of generating income.   I find myself pondering the 
ethics of re-using a pump, or having the means to preserve lactation 
and _not_ using it so that lactation fails.....  It's easy to 
maintain very high standards from a position of privilege, but it's 
different when you live in a place where every old tyre, piece of 
string, container, cardboard box or plastic bag is pounced on to be 
re-used again and again.  In the throw-away society I now live in I'm 
appalled at the waste. It's all relative ...... right?

Pamela Morrison IBCLC
Rustington, England

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