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Subject:
From:
Karleen Gribble <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Tue, 23 Jun 2015 13:37:43 +1000
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>> For the last week I have (by phone) been supporting a mother in the Nauru immigration Detention Centre who is struggling to feed her 5mo baby. The Australian government seemingly sent this baby to Nauru without real plans for how she would be fed and the response since her arrival had been deplorable. She went without any milk for 2 weeks and even now her mother is attempting to wash baby bottles in a bucket without detergent and without brushes. The first time I spoke to this mother she asked me to help her baby and I am doing what I can. Please join me. A summary of the situation and suggestions for action are below.
>> Karleen Gribble
>> Australia
>> 
>> Save Baby Asha
>> Right now there is a baby whose life is in danger. She is in a detention centre on the island of Nauru because her parents, Abhaya and Vijay, sought asylum in Australia. Her life is in danger because the Australian government is not giving her mum what she needs to feed her safely
>> 
>> The way an infant is fed is important to their health. In a country like Australia high levels of literacy, good hygiene, easy availability of clean hot water and electricity and well established primary health services, mean that while babies that are formula fed still get sicker than their fully breastfed counterparts very few die.
>> 
>> However, in resource poor settings, including in refugee camps, the difference between outcomes for formula fed and breastfed infants is much greater. In resource poor settings formula fed infants are up to 60 times more likely to require hospitalisation than breastfed infants as a result of gastroenteritis and respiratory tract infections. They are also six times more likely to die from such infections than breastfed infants.
>> 
>> The Nauru Detention Centre is a resource poor setting.
>> 
>> This means that support for infant feeding in the Nauru Detention Centre is extremely important. Mothers in the detention centre should be supported to exclusively breastfeed and if they are not breastfeeding or they are formula feeding in addition to breastfeeding that should be provided with intensive support for formula feeding. 
>> 
>> Baby Asha’s mum has not been provided with this support as the below timeline shows.
>> 
>> 2013 Abhaya and Vijay arrive at Christmas Island by boat
>> They remain on Christmas Island for only a brief period of time
>> 
>> October 2013 Abhaya and Vijay taken to the Nauru Detention Centre
>> 
>> Late 2014 Abhaya and Vijay brought to Darwin to the Bladin Alternative Place of Detention
>> Abhaya is heavily pregnant with her first baby.
>> 
>> Early 2015 Baby Asha born healthy in a Darwin hospital
>> Critically Asha is born after a cut off that would have enabled her to stay in Australia and not be sent back to Nauru.
>> 
>> Early 2015 Family lives in the Bladin and then Wickham Point Alternative Place of Detention Centres
>> Inadequate support for breastfeeding provided and Abhaya begins supplementary feeding of Asha with infant formula. Asha has a bad reaction to the first infant formula given to her at the Centre and is advised to use a different formula by a doctor at the Centre. A different infant formula is provided. Asha remains a healthy and normally developing baby.
>> 
>> April 2015 Family taken from Darwin to the Melbourne Immigration Transit Accommodation Centre
>> The transfer was traumatic. Abhaya sustained bruising from being roughly handled and Vijay cuts from the cable ties he had been restrained with. The family’s room was entered at approximately 5am, at which time Asha was removed by a security officer and taken to an unknown location. Abhaya was separated from Vijay and taken to a room in the centre and left there in her nightgown and with no shoes. At approximately 11am, Asha is returned to her. Abhaya is not brought clothing until late in the afternoon. Asha and Abhaya are then placed in an interview room on a mattress on the floor, to sleep the night before being taken to the airport for the transfer to Melbourne the next day.
>> 
>> Upon arrival in Melbourne Abhaya describes flashbacks, persistent crying, an inability to sleep, nightmares when she does sleep. Vijay is described by Abhaya as ‘staring at the wall and not speaking’. Both are displaying significant impacts of trauma and a decline in mental health. They are referred to a specialist torture and trauma counselling service and are placed on a waiting list but are transferred to Nauru before they can be seen.
>> 
>> 4 June 2015 Family taken from Melbourne to the Nauru Detention Centre
>> This transfer is also traumatic as the family is awoken in the early hours of the morning without warning and flown to Nauru. Abhaya tries to breastfeed Asha but is so distressed that her milk let down is prevented. No other food or liquid is available to Asha during the 16 hour journey to Nauru (probably via Brisbane but unsure).
>> 
>> 
>> Feeding Baby Asha in the Nauru Detention Centre
>> Abhaya and Vijay are very distressed upon their arrival in Nauru. Abhaya again tries to breastfeed Asha but again is so distressed that her milk letdown is prevented. She believes that her milk supply is gone. She is seen by a midwife who says that this is normal and is given some powdered infant formula. It is the same formula that Asha had a bad reaction to in Australia.
>> 
>> Abhaya refuses to give the formula to her baby as she believes it will make her sick again. Periodically she tries to put Asha to the breast but her milk does not flow and both Abhaya and Asha cry in distress at each attempt. Abhaya gives Asha some water in a bottle and some rice cereal. Asha lives on this for almost two weeks during which time she becomes increasing lethargic and dehydrated. Wet nappies decrease to less than one a day. Abhaya is desperately worried for her baby but feels powerless to help her.
>> 
>> Attention to the plight of Abhaya and her baby is drawn by individuals who write to their Members of Parliament and to the Minister for Immigration. Abhaya is provided with a different brand of infant formula. She starts feeding this to her baby and Asha becomes less dehydrated. Abhaya is doing her very best to care for her baby but she has been traumatised by her experiences and spends much of the day crying. Those speaking to her from Australia encourage her to smile and engage with her baby. Clearly the mental health of Abhaya and Asha are also of concern. The mental health of Vijay is also of great concern.
>> 
>> The resources provided to Abhaya for formula feeding are inadequate. She has two bottles and a bucket for washing them in but no detergent (apparently because people have swallowed detergent in suicide attempts), and no bottle brush. Water must be carried to her tent as there is no running water in accommodation facilities. Conditions are crowded and living in such close proximity to each other and with limited toilet facilities the risk of infection spreading is great. Nauru is a hot and humid environment, perfect for the proliferation of bacteria on milk residues in feeding bottles.
>> 
>> It is important to note that Abhaya is from a country where very few women bottle feed, over 90% of children are still breastfeeding at two years of age. Her knowledge of how to feed a baby who is not breastfeeding is therefore very limited. In the best of circumstances she would need intensive support to safely feed her baby. This intensive support is not available on Nauru.
>> 
>> Abhaya has not been provided with any support to relactate by anyone in the Nauru Detention Centre. Attempts have been made to assist her over the phone but Asha is reluctant to go to the breast and so this has not been very successful.
>> 
>> The health professional who is supposedly helping Abhaya with feeding her baby is a midwife. It is outside of the scope of practice of midwives to care for babies older than six weeks of age. And clearly the health services knowledge of the risks of formula feeding in a resource poor setting like Nauru is inadequate as indicated by the lack of support for cleaning feeding implements and the provision of powdered infant formula.
>> 
>> The life of this baby is being risked by the Australian Government. They are failing to provide the most basic support infant feeding support.
>> 
>> There are approximately 17 babies in Australia who are slated to be sent to the Nauru Detention Centre any day. Many of them are formula fed.
>> 
>> So what should the Australian government be doing to support this mother in the feeding of her baby?
>> While Abhaya is formula feeding she needs to be provided with ready to use liquid formula. She also needs to be provided with feeding implements (bottles or cups) as single use items or at the very least with enough feeding implements that she can use them for a single use for a day or two and they be taken away to be washed and sterilised. She cannot be asked or expected to clean bottles or cups. However, she needs autonomy in feeding her baby- she should not have to ask for supplies every time she feeds her baby. Abhaya needs a clean area on which to prepare feeds, a sealed container in which to store supplies, soap, detergent and steriliser wipes for washing her hands and the preparation area. The ready to use infant formula needs to be in containers that can be opened without scissors or if scissors are required she needs to be provided with enough scissors for them to be used as a single use. The danger posed by bacterial contamination and proliferation in a hot and humid environment like Nauru cannot be over estimated. Health workers need to understand that gastroenteritis is a common cause of death of infants in resource poor settings.  She needs to be encouraged to hold her baby close for feedings
>> 
>> Someone who is suitably skilled in breastfeeding counselling should be assisting Abhaya in person with relactation. She needs to be provided with a safe space where she can come to get support for feeding her baby and psychological support for parenting her baby.
>> 
>> One organisation should be in charge of delivering all aspects of infant feeding support in the Nauru Detention Centre. Given their extensive expertise in providing infant feeding in emergencies support to mothers and babies and their knowledge of the situation on Nauru Save the Children are ideally placed to provide this service.
>> 
>> So what can you do??
>> 
>> Join the Facebook Group #SaveAsha
>> 
>> There are so many things that could be done to improve this situation but this can only occur if people are willing to help.
>> 
>> https://www.facebook.com/groups/656651787801894/
>> 
>> Sign the petition
>> 
>> https://www.change.org/p/peter-dutton-mp-minister-for-immigration-and-border-protection-bring-baby-asha-back-to-australia-from-nauru-asap-and-do-not-transfer-any-other-babies-to-nauru?just_created=true
>> 
>> Tweet about Asha’s situation with the hashtags #SaveAsha and #BringBackAsha
>> 
>> If you are in Australia, write to your Federal Member of Parliament and Federal Senators (especially Ricky Muir). You can find their contact details at http://www.aph.gov.au/Senators_and_Members/Guidelines_for_Contacting_Senators_and_Members Letters/emails and calls to their office are worthwhile.
>> 
>> Write to the Minister for Immigration and call his office [log in to unmask] (02) 6277 7860
>> 
>> If you are outside of Australia you can also write to the Minister for Immigration but also consider writing to your nearest Australian Embassy or Consulate.
>> 
>> Be aware that the Office of the Minister for Immigration was telling people that Baby Asha and Abhaya were both well at a time when Asha had had only one light wet nappy in 24 hours.  
>> ·      In your correspondence raise concern for the wellbeing of Asha and her mother. If you are a mother make sure you link concern for Asha and Abhaya with your own experience as a mother.
>> ·      Express your distress that the Australian government sent her to Nauru without adequate plans to ensure she could be fed safely.
>> ·      Demand that appropriate infant feeding support systems be put into place on Nauru (the description above of what that might look like can be used).
>> ·      Ask that Asha and her parents be brought back to Australia
>> 
>> The concerns raised about Asha last week resulted in her mother being given some infant formula to feed her. Hopefully further lobbying will result in Asha and her family being brought back to Australia or, at the very least, Abhaya being given proper support to feed Asha.
>> 
>> News stories about Asha and her family
>> http://www.theguardian.com/world/2015/jun/11/immigration-department-defied-advice-not-to-transfer-babies-back-to-nauru
>> http://www.theage.com.au/comment/one-familys-brutal-journey-to-nauru-20150610-ghkwp7.html
>> http://www.abc.net.au/news/2015-06-17/nauru-detainee-loses-ability-to-breast-feed-lawyer-says/6554054
>> http://www.smh.com.au/national/fears-for-health-of-baby-on-nauru-20150620-ghr1s0.html

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