This wasn’t always the case. Sitshengisiwe tells me that there used to
be a working ambulance for referrals to the district hospital 46
kilometres away.
But as with many things, this is no longer functioning.
Lack of transport dealt a serious blow to one family that Sitshengisiwe
managed to support. Following childbirth at home, a young mother had
suffered post-partum haemorrhage. In attempt to get his wife to the
nearest clinic, her husband tried to sell one of his goats to pay for
transport, but nobody he asked could afford to buy his goat. He tried
to take her in an ox-cart instead, but sadly she died before they made
the 10-kilometre journey.
The husband then chose to brave the 46-kilometre walk to the district
hospital, to register his wife’s death at the district hospital. This
is where Sitshengisiwe was informed of his case. She visited the family
soon after – walking only a 12 kilometre round trip this time.
On arrival she and her Ministry of Health counterpart provided health
and nutrition advice to the family, and gave them a ‘baby kit’ that
contained essential items for caring for newborns, including a
baby-grow, warm clothes and a hat, nappies, towels, soap and Vaseline.
Diluted goat's milk will have to do
She also discussed options for feeding the baby with the husband, aunt
and grandfather who are now left to care for him. They resolved to feed
the baby with modified goat’s milk using a cup and spoon as it was seen
as the only sustainable option for them.
Save the Children feels strongly about the importance of infant feeding
and actively supports the "Operational Guidance on Infant and Young
Child Feeding in Emergencies" which provides the do’s and don’ts in
this area. The current international guidance is that modified animal
milk should not be promoted as it lacks some important nutrients.
I was interested to find out more about this so I spoke to Ali
Maclaine, an Infant Feeding Consultant who is working for Save the
Children in this area.
Her role in Zimbabwe is work with the Zimbabwe Nutrition Cluster (a
group of organisations involved in nutrition) to ensure that
breastfeeding is supported and that agencies know and follow the
international guidance.
She told me that breastfeeding, especially in emergencies, saves lives
and protects infants from diseases such as diarrhoea, malnutrition and
death. In fact, non-breastfed infants in non-hygienic conditions are
6-25 times more likely to die than breastfed infants. Moreover, breast
milk specifically helps protect infants from cholera. When infants are
not-breastfed pre-crisis or when the mother dies usually a "breast
milk" option is looked at as a first resort as it is such a life-saving
intervention.
Other options include wet-nursing (breastfeeding by someone other than
the mother), milk banks or re-lactation (re-starting breastfeeding – if
the mother had stopped pre-crisis or by a grandmother if the mother has
died).
In places like Zimbabwe where there is a high prevalence of HIV, the
guidance is that wet-nurses should be counselled and have an HIV test.
Breast is still best
Where a breastfeeding option is not available infant formula should be
provided for as long as the infant required needs it – along with
additional support such as education on making up the formula as safely
as possible, provision of additional materials e.g. cooking equipment
and it should be fed to the child by cup as bottles and teats are very
hard to clean.
Yet even if the care-givers get formula and extra support it is not easy:
The child must be monitored and health care provided as they are likely
to get sick more often and more severely than a breastfed child,
collecting the additional water and fuel to make the formula and then
feeding the child takes time, etc.
As part of her routine work, Sitshengisiwe carries out infant feeding
support sessions for young mothers. In these sessions they talk about
things like the importance of exclusive breastfeeding, the reduced
risks of HIV transmission with exclusive breastfeeding compared to
mixed feeding and how to breastfeed successfully.
She also talks to them about when to introduce other foods/fluids and
what foods they should use. The sessions are generally a mixture of
sharing experiences and concerns, and providing mothers with
information.
It is hard not to get angry at the unfairness of what the people
Sitshengisiwe works with have to face. Cholera and malaria are easily
preventable illnesses and the vital information and resources health
workers like Sitshengisiwe and her Ministry of Health counterpart can
provide saves lives.
But, with the terrible road conditions making each home visit into a
cross-country trek, the amount of families benefiting from such
services is never enough. – Save the Children