I am working with a group of nurses from Bahia, Brazil to improve maternal
and child health care in that area. The two major problems they have
related to breastfeeding [this does not include the fact that they really
need to increase their breastfeeding rates!] are mastitis and "bad nipple
fissures."  The mastitis problem is easy and I have provided them with all
of the information.  The nipple fissure problem appears to be more than
just "cracked" nipples.  I checked MEDLINE, the LACTNET archives, and Jan
and Kathy's book and haven't been able to find the information I need.

I am looking for research-based information on the treatment of severe
nipple fissures.  Perhaps, it doesn't exist.  If you have any information
or protocols that you believe would be helpful, please e-mail to me
privately <[log in to unmask]>.

Does anyone have a clue as to why severe nipple fissures would be such a
problem in this area - - besides the usual causes of sore nipple?  It is a
problem both in the urban area and in the small rural villages.   One
interesting fact is that insufficient milk supply is NOT a problem -
everyone has "lots and lots" of milk, especially in the rural area.

Thanks for your help.

Francine Nichols
Washington, DC