On Tuesday, Feb 11, 2003, at 02:40 Australia/Perth, Pamela Morrison wrote: > Lara - I see the point you make about the need for screening of milk > donors > in spite of pasteurization - because of human error, or failures in the > pasteurization process, mentioning the occasional errors that are made > with > screening blood and sterilizing instruments and suggesting that we > need to > be realistic about the limits of technology. The thing is, does this > prevent donated blood being used at all, or surgery taking place, > "just in > case"? No, it doesn't. Like anything else, it's a risk-benefit analysis - not just by the medical staff, but by the patients themselves (much of the time, anyway). > Donated breastmilk is not the same as donated > blood which cannot be pasteurized, and should we accept that sloppy > practices in handling and pasteurizing it should prevent us using it at > all? Not at all! I'm sorry if you thought I was suggesting that. The post I was responding to seemed (maybe I read it wrong) to say that there was no need to screen donors at all if the milk was being pasteurised. I disagree with this - I can't imagine our current society accepting completely unscreened donor milk. Relying on one process only to make the milk "safe"[1] - pasteurization - puts all the eggs in one basket, as it were. Having a donor screening process as well as pasteurization reduces the risk by requiring multiple points of failure for transmission to occur. [1] The assumption being made here is that it is possible to transfer HIV via breastmilk. I think it's a reasonable assumption in the case of a real-life milk bank, as you have no way of knowing whether the donor has active mastitis/subclinical mastitis/cracks/fissures/etc. > It just seems that the need for screening is put up as one more > obstacle to the use of donated breastmilk, making it more difficult to > obtain for those who might benefit from it. Do you think screening donors for HIV & hepatitis would dramatically reduce donor numbers? Does anyone have any data on this? On the other hand, do you think having only unscreened donor milk available would reduce acceptance by the parents of children who need donor milk? I'll put myself in the shoes of a parent of a potential recipient here and say: I wouldn't accept it. Like many people, no matter how low authorities tell me the risk is - it could be one in a hundred thousand for all I know - it's not a risk I'm prepared to take. Maybe that's irrational in the face of ABM risks, but that's the way people are. They'd rather take a higher risk of diarrhoeal illnesses, ear infections, and the many other diseases associated with ABM, for their child than even a tiny risk of HIV. We as statisticians or epidemiologists might find that hard to accept, but we as mothers/fathers... it can be a very different story. > For several years I have been trying to suggest the use of the > HIV-infected > mother's own home-pasteurized breastmilk - not as a replacement for > breastfeeding, but as a replacement for formula for those women might > be > coerced into not breastfeeding. I think this is a fantastic idea, and support you in it. I believe it is a different situation from mass donor milk in countries with safe water supplies, however. (and I'm presuming the pasteurisation education comes with information on how to wash bottles safely, etc despite a contaminated water supply). > The resistance to this logical, > physiological, free, healthy alternative is almost pathological. > Responses > have ranged from: > > - "It's not possible to express breastmilk long-term" (sheesh) > (so I collected from > Lactnetters 48 separate testimonies showing that this IS, indeed, > possible) Make that 49. > - "It's not possible to manually express breastmilk for long, mothers > might > get mastitis" (please come and see mothers doing this for days, weeks > or > months in neonatal units in Nairobi and Harare) Is there a reason the milk must be manually expressed (cracked nipples?), or is this because the families you're talking about might not have access to good quality breast pumps? > - "It's not safe" (studies in Puerto Rico and South Africa show that > there > are two methods of killing the virus in breastmilk by > home-pasteurization; flash-boiling, and Pretoria pasteurization - but > now > I'm receiving third-hand responses about the latter method that suggest > that the author herself might be retracting her findings because if the > size of the pot holding the boiling water is different, or if the > thickness > of the glass in the jar containing the milk is different then this > might > invalidate the findings). > - "Oh, but it's not cultural". (we had someone who came to Zimbabwe > and > found that there was *not* a lot of resistance to this idea amongst > women > themselves, particularly if communities were to receive education about > this possibility). Is ABM "cultural"? Lara *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [log in to unmask] The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html