3 ways to get breast milk to babies who need it

Up to a quarter of premature or low birth weight babies cannot get enough breast milk from their mothers, often for reasons of illness or low supply. This leaves them vulnerable to life threatening conditions such as diarrhoea, pneumonia and neonatal sepsis. In South Africa — where I live — there are nearly 1 million births each year with a low birth weight rate of 13 per cent. That equates to nearly 105,000 low birth weight babies, of which about a quarter will require donor milk at some point during their care. Additionally some of these infants may be abandoned or orphaned and should continue receiving donor milk when they are discharged into community care. So how can we help these babies get the breast milk they so desperately need? Human breast milk is far superior to formula for these tiny and vulnerable infants. At the University of Kwazulu-Natal, we are using a mobile phone app called FoneAstra which allows for the safe pasteurization of donated breast milk. This FoneAstra pasteurization system was developed by our partners Rohit Chaudri, from University of Washington’s Department of Computer Science and Engineering, and PATH. The app guides you step-by-step through the pasteurization process of heating then cooling the milk using a temperature probe placed in one of the bottles. Its simplicity and low cost makes it possible to set up milk banks in poor and remote locations, even places without electricity. The idea is that this will allow us to roll out a network of milk banks along with a wider campaign to increase the number of women breastfeeding and donating their milk. Six months ago, my colleagues and I won a $350,000 Healthcare Innovation Award backed by GSK and Save the Children — to take forward our work to promote breastfeeding in as a way of tackling infant deaths. What are the lessons we’ve learned about scaling up innovations like this? Create an infrastructure In keeping with our belief that human milk banking should be part of a comprehensive breastfeeding promotion campaign, we have been laying the groundwork for what we hope will be a model for a larger scale network of community-based milk banks. Our desire has always been that these milk banks should operate within what we call a “family health post,” where mothers will be trained as breastfeeding counsellors and in basic primary health care. This will enable them to support families and train others in breastfeeding and good family health practices. We will also concentrate on general nutrition education, growth monitoring, early childhood development, parenting skills, and especially the importance of the role of fathers in childhood health and development. We plan to set up four such family health posts with human milk banks. In order to make these banks sustainable, we will be working with faith-based organizations that are operating within communities. These organizations have the trust of community members, and this makes our work easier. The first community we are planning to work with is in KwaDukuza, a rural area north of Durban, where there are a large number of orphans. Get the right staff As important as the right locations, are skilled, knowledgeable milk bank staff. We are currently recruiting and training them so they will be able to facilitate the training of community members. Building a repository of training materials is an essential task. Along with manuals and videos, we have developed a “talk tool” — a well-illustrated step-by-step guide that the mothers can use as they teach others in their community. Win hearts and minds Of course, winning hearts and minds is crucial for the success of the project. Milk banks will be bereft of donors if not enough women are breastfeeding to start with. Breast milk and breastfeeding — never mind a foreign concept such as human milk banking — is a bit of a tough sell in a region like ours. We are burdened with the legacy of HIV and a perception among communities and some clinical staff (thanks to decades of very effective marketing), that formula is the healthy, caring, scientific choice for those who desire to give their children the very best. Changing this mindset requires us to be creative, engaging and ever mindful of the multigenerational and increasingly multilingual nature of our society. We are targeting not just the women but health workers, families and peers. We have produced a series of comedic plays which are being performed in clinics, hospitals and community centres to much praise from audiences. Our public service announcements on radio, featuring male celebrities talking about how they have supported the mothers of their children to breastfeed, have been very well received. The Healthcare Innovation Award money is also helping us to take forward another ambition: to expand human milk banking beyond our national borders. We have had repeated requests by doctors in other African countries to come and assist them to set up human milk banks. This award will enable us to set up three banks in Ethiopia and one in Namibia. The mobile nature of the FoneAstra pasteurization system makes it very easy to transfer the technology. To read additional content on innovation, go to Focus On: Innovation in partnership with Philips.