Natalie:
I'm totally confused.  

To be honest, I spent most of my time hanging out with professionals from other countries.  When I did my doctoral dissertation, most of my colleagues were from other countries, predominantly developing.  When I worked overseas, many of our country reps were from that country or a neighboring country.  I've been to plenty of meetings which were run by nationals.  So really clearly I have no clue what you are talking about politically.  

Notions about breastfeeding were very different where I worked in developing areas for so many years from the country of my birth. I had no idea how different until  rude awakening when I delivered my son in a Manhattan hospital.  The support for breastfeeding was abysmal and not at all what I had been used to in my observation of care in the countries where I worked.  

And yes, during the years I was out in the field, ALL the materials I came across IN the field from the diarrheal management folks included breastfeeding.  I WAS talking about my colleagues who worked in diarrheal managment and at that time we actually looked upon each other as TEAM members.  I clearly remember all the drawings of sunken fontenelles as well as real live babies with sunken fontanelles which is why I freaked out on day 2 in the Manhattan hospital when I saw my son's fontenelle start to pulse.  He was not dehydrated in the least, but the fear of the outcome struck terror in my heart.  

I guess the reason why I find your question so perplexing is that most mothers breastfeed in developing countries.  Unfortunately even in areas where formula never penetrate, many are also otherwise fed - and I can think of a lot of different types of foods and liquids that are being used. 

So my question to you, if you encountered a baby with a sunken fontanelle suffering from cholera who hadn't peed in the last 24 hours, would you really want a health care worker to spend the amount of time it takes to really figure out if that child's lips had ever touched a bit of tea given by the curendero, or a ritual taste of rice, or some camel's milk millet gruel that the mother doesn't really want to tell you?  Or even some "traditional" treatment that never ever came from a WHO pamphlet?  

The one thing I can tell you that is consistent between my work in public health internationally and my clinical work here in the United States is that mothers are reluctant to admit that they gave anything other than breastmilk.  I routinely ask mothers whether they are feeding exclusively and probe about formula in the hospital -- and often find out hours later in the conversation that, well, there was that one night when I sent the baby to the nursery and I don't think the baby was fed formula, but the baby really didn't want to feed after that.  Or they might admit near the end of a visit -- oh yes, I was really tired the night I got home from the hospital so we did give that little bit that first night. 

Plus the biggest killer of the pristine categorization really falls apart when you ask what mothers did in the past.  I've worked with my colleagues in many developing areas and it is NOT easy to get clean separation between feeding categories when you're doing surveys.  

By the way, which countries have you worked in? 

Best regards, Susan Burger

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