Breast milk bank

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0 height="100%"><tr> <td valign="top" width=177 BGCOLOR="#CCCCFF" TEXT="#080000"> <bR> <div> <B><U>Site Index</U></B></div> <bR> <div> <IMG SRC="3890e0e0.png" border=0 width="14" height="14" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"> <FONT SIZE="2" COLOR="#0000FF" FACE="Arial" ><A HREF="id7_breast_bank2.htm" TARGET="_top" TITLE="Babies: Now"><B>Babies: Now</B></A></FONT></div> <div> <IMG SRC="3890e0e0.png" border=0 width="14" height="14" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"> <FONT SIZE="2" COLOR="#FF6600" FACE="Arial" ><B>Breast milk bank</B></FONT></div> </td> <td valign="top" width="100%" style=" border-left: 1px solid #000000;" BGCOLOR="#FFFFFF" TEXT="#080000"> <div>  <script language="JavaScript1.2">  </script><script> if (document.all) document.write('<p align="center"</p><a href="javascript:addbookmark()">Click here to Bookmark this site!</a>') </script>  </div> <bR> <div> <TABLE BORDER="1" CELLPADDING="1" CELLSPACING="1" WIDTH="581" HEIGHT="1%" BORDERCOLORLIGHT="#C0C0C0" BORDERCOLORDARK="#808080" FRAME="BOX" RULES="ALL" HSPACE="0" VSPACE="0" BGCOLOR=#FFFBF0 > <tR> <tD VALIGN=TOP HEIGHT= 111 ><NOBR><div> Beryl Thyer</div> <div> Memorial Africa Trust</div> </NOBR></tD> </tR> </TABLE></div> <bR> <bR> <bR> <div> <B>Go back to:</B><FONT SIZE="3" COLOR="#111111" FACE="Arial" ><B> </B></FONT><FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><A HREF="id7_breast_bank2.htm" TARGET="_top" TITLE="Babies: Now"><B>Babies Now</B></A></FONT></div> <bR> <div> Breast milk bank</div> <bR> <div> <B>ESTABLISHING A BREAST MILK BANK IN A CAMEROONIAN HOSPITAL:</B></div> <div> <B>A REPORT FOR THE UNITED KINGDOM ASSOCIATION</B></div> <div> <B>FOR MILK BANKING </B></div> <bR> <div> <B>Introduction:</B></div> <div> There is no doubt that breastmilk is best for babies. There is no doubt that it is even more important for sick, small for dates, and preterm babies. There is no doubt that it prevents death from diarrhoeal and respiratory diseases in infants. We know that antenatal care is patchy in sub-Saharan Africa, that the health of pregnant women is often compromised, that intrapartum complications are frequent, that resuscitation techniques for the newborn are inadequate, that puerperal infection is common, and that the NMR, IMR, and MMR are ten times worse there than in the developed world . It has recently been written that `the Maternity Units of developing-world hospitals are a hot-bed of infection'. Curious and sad it is therefore, to know that early and exclusive breastfeeding is by no means universal in sub-Saharan Africa - including Cameroon.</div> <div> The postpartum playing field is thus well-prepared for a neonatal survival match in which the odds are stacked heavily against the newborn. It has been said that it is safer to be born a Japanese cow than an African baby, since the subsidy for the welfare of those cows is greater than the amount spent on the African newborn. </div> <div> It is easy to make a list of interventions that would result in a more favourable outcome for the newborn. It is beyond the scope of this article to enumerate them, and beyond the power of the author to address most of them. It has however been possible in one Cameroonian hospital to address the Care of the Newborn - and in particular the early and exclusive breastfeeding of babies whose mothers are able to do it. Moreover it has been possible to arrange breastmilk for babies whose mothers - for whatever reason - are unable to breastfeed. The year 2006 will see the inauguration of two further facilities in the North West Province of Cameroon. Much emphasis was placed upon this at the recent Countdown to 2015 Child Survival Conference in London, December 2005.</div> <div> A web search for `breast milk banking' throws up close on half a million hits. The news has got around; but not to Africa. As far as I could determine, only South Africa has  breastmilk banking facilities, and this is wholly down to Professor Anna Coutsoudis, Durban, and her tenacious battle to assist AIDS orphans.</div> <div> When I first proposed such a facility in Cameroon I was regarded with bemused amazement; the most highly-placed colleagues had never heard of breastmilk banking. Talking to staff however, soon convinced them to become involved. I took advice from UKAMB, modified guidelines to suit the resource-poor setting, and, in January 2003 went ahead with the project.</div> <div> The aim was to provide breast milk to those of our hospital neonates who would otherwise be deprived of it. This would include all small/preterm babies whose mothers are not yet lactating; whose mothers are sick, or febrile, or anaesthetized, or eclamptic. It would also include babies whose mothers absconded or had died. It was envisaged that the service would be for the first week or so of the baby's life, whilst a longer term solution was sought.</div> <div> Provincial Hospital Bamenda (BPH) is the main referral hospital in the Anglophone NW Province of Cameroon. It is a general hospital of about 250 beds, with the usual specialties.</div> <div> <B>The Children's ward</B> (50 beds) accepts children from 1 month  to 15yrs age. Adjacent to the ward is: </div> <div> <B>The Kitchen; </B>this is staffed by two qualified nurses, who advise and give practical help about nutrition, to the mothers of children. </div> <div> <B>The Nursery</B> - located about 50m from the Children's ward - accepts acute admissions of babies less than one month old. It also receives at-risk newborn babies from the adjacent Labour ward. A refrigerator/freezer was appropriated at the start, and a donated electric stove also arrived in 2003.</div> <div> <B>The Maternity Unit</B> deals with about 1500 to 2000 deliveries per year. The Labour ward  has a recently donated low-tech Radiant Heater and neonatal bag and mask.</div> <div> <B>The Laboratory</B> is located at the opposite end of the hospital to the Nursery/Mat Unit; about 100 m away. A competent bacteriology technician is available. She was happy to co-operate.</div> <div> <B>The electricity supply</B> is fairly reliable. There is no telephone connection between Nursery/Children's ward/Kitchen/Laboratory. Tedious. </div> <div> <B>The Hospital Director and his Assistant</B> were in agreement that we should go ahead.  Nursery staff were enthusiastic. Kitchen staff - who it was thought would be the most appropriate people to perform the pasteurizations - were also enthusiastic.</div> <div> <B>Nurse in charge of the Immunisation Clinic</B> (conveniently held twice weekly in a room close to both Nursery and Labour ward) was also happy to have an input to the project. This Clinic would become the major source of breast milk donors for the Bank..</div> <div> <B>The Meeting</B>. Try getting half a dozen dear African colleagues together on any one day, for a discussion of the project, at any one time! It was not easy, but it finally happened, and the result was positive, and we moved forward.</div> <div> <B>The cost implication for the hospital</B>; The Director wanted (reasonably) to know this for his overstretched, understaffed hospital. The following is my note to him:</div> <div> <B>Charles; [Dr Awasom Charles, Assistant Director and Medical Advisor, Provincial Hospital, Bamenda].</B></div> <div> <B>The breastmilk bank is now up and running; </B>[<B> </B>NOTE that we got on with it before all the political problems were resolved. The equation was that we knew we were right; and whereas Politics are for days or weeks, Equations are for<I><B> </B></I>ever!<I><B> </B></I>(Albert Einstein)]<I><B>. </B></I><B>I suppose we have about 200cc of milk ready for pasteurization - or that may already have been done by our excellent and enthusiastic colleagues in the Kitchen. </B></div> <div> <B>Something I hadn't thought through properly - it was a very last-minute brief from Child Advocacy International (CAI)  </B>[for whom I was Country<B> </B>Director at the time]<B> - is the cost implication in the necessary bacteriological clearance of each batch of donated milk.</B></div> <div> <B>It looks as though we will be testing 4 samples of donor milk each weekday. Sister Agnes in the Lab is highly co-operative in this. It does look however as though we shall be using one petri dish of blood agar culture medium every week day, (one dish can easily cope with four plated samples).  I understand the medium is made up from raw materials in the Lab. Someone has to pay for that. I believe that from my own CAI allowance, I can underwrite these costs during the three months I am here. In the meantime I wonder if you have any other suggestions. Clearly we cannot ask donor mothers to pay, and neither can we expect the mothers of recipient babies to pay. CAI may pay in due course, but I cannot commit them to that at present. I have got myself into trouble with them before for doing just such ad-hoc things!</B></div> <div> <B>As far as I can judge, this is the only cost we will have to bear for the breast milk bank programme; much else is in place; the donor bottles are already here; the lab sample bottles are here - and both these items are sterilizable and re-useable. The pasteurization kit is here, and should have a long life. The fridge</B>/<B>freezer has already been provided by CAI for the Kitchen, and two very excellent electric cookers arrive soon in the container. I have bought sterilizing equipment for the Nursery; all necessary documentation (much of which you have already seen) is on floppy disk and readily reproducible at minimum cost. I am delighted at the high degree of enthusiasm and co-operation I have been shown from all members of BPH staff in this lovely initiative. Quite apart from the benefits for recipient infants, it is also very satisfying that as a spin-off we might exclude the evil NESTLE empire from the Nursery at BPH!</B></div> <div> <B>I look forward to your thoughts. Kind regards; Peter; January 23</B><FONT SIZE="1" COLOR="#000000" FACE="Arial" ><B>rd</B></FONT><B> 2003</B></div> <div> <B>RESULT OF THIS NOTE: The hospital agreed to bear the cost of bacteriological screening, since the BM Bank Project was seen as being very important by the Administration.  February 2003.</B><B> </B></div> <div> From the outset it was clear that to succeed we needed teamwork. The team was drawn from the above workers at BPH. Having agreed in principle what we hoped to achieve, and being happy that the basic ingredients were inexpensive, and that the cost of bacteriological testing would be covered - we moved on again.</div> <div> <B>The necessary basic apparatus</B>; Pasteurization kits; from ACE Intermed, Andover, Hampshire; one at the start and another one later as the project gained momentum. 50cc glass bottles; necessarily small since small volumes of milk needed for small babies. These were given by the hundred from a hotel in Kettering, Northants; breakfast conserve bottles, washed in Kettering and carried to Bamenda. EDTA bottles; these were purchased from Durbin plc, South Harrow, Middlesex, at low cost. Other inexpensive items available locally in Bamenda; felt tip pens for writing on bottles, Klingfilm for interposing between bottle lids and bottles.</div> <div> <B>Screening of donated milk</B>. </div> <div> A serious consideration, which we found impossible to implement to developed world standards. HIV we know is destroyed by the process of pasteurization; it is thermolabile. Therefore theoretically we could use pasteurized donated milk from an HIV positive mother. In any case who will fund the cost of the ELISA test (available at BPH)? Not the donor and not the recipient baby's mother, not the hospital and not CAI and not me. A few salient facts: not all women in labour have been screened for HIV. About 12% of all women presenting at antenatal clinics in other hospitals are found to be HIV positive. Many women are known to Maternity staff, and their life-style suspected. Women in labour unknown to staff may be suspected clinically of being HIV positive. The decision arrived at was as follows; we will not accept donated milk from any woman known to be HIV positive. We will not accept donated milk from any woman suspected of being HIV positive. We will accept donations from all other women whose questionnaire answers were satisfactory.  </div> <div> Hepatitis viruses: Hep A is not transmitted through breast milk, and in any case it is widespread in Africa. Hep C might or might not (according to your sources of information) be transmissible via breast milk. But if it is, the risk is immeasurably small, so that breastfeeding is not considered to be contraindicated..</div> <div> Hep B is transmissible through breast milk, but in small amounts. Hep B surface antigen can be found in breast milk, but this does not necessarily mean the virus is there.</div> <div> Hepatitis viruses are relatively thermostable. Pasteurization does not destroy them. It is however likely that any small risk of causing liver disease in the newborn is eliminated by the effects of the pasteurization process. The risk of hepatitis to the baby of a Hep B positive mother is far greater (especially if the birth is traumatic) than to a baby receiving her donated pasteurized milk. We have found no references in the literature in relation to Hep B infection in an infant being due to transmission of the virus through breast milk.</div> <div> It would of course, in an ideal resource-rich world, be necessary to screen all potential donor mothers for all Hep viruses. We live and work however in the resource-poor world. The decisions we make are based on our information, our financial constraints, and the risk/benefit equation in relation to the needy newborn. We will change our practice when/if confronted with positive evidence that our practice is unsafe; when shown convincingly that the risk is greater than the benefit.</div> <div> What of bacteria? They too are destroyed by the pasteurization process. Two issues arise however; first, though breast milk should not contain any bacteria, contaminant skin bacteria may be an important matter. Second; if bacteria are found to be present they might contain endotoxins. Endotoxins are not destroyed by pasteurization. Arguably donated pasteurized milk might thus be more dangerous since the endotoxins in it are more readily available to the recipient newborn. Therefore all donated milk must be bacteriologically screened, and any samples showing colonies after 24 hours incubation must be discarded.</div> <bR> <div> QUESTIONS TO PUT TO PROSPECTIVE BREAST MILK DONORS</div> <div> <I><B>Do you smoke cigarettes?</B></I>         If yes - cannot donate</div> <div> <I><B>Do you drink alcohol?     </B></I>            If to excess - cannot donate</div> <div> <I><B>Do you drink a lot of coffee?     </B></I> If yes - should reduce it, or not donate</div> <div> <I><B>Do you have a present medical condition requiring regular medicines?</B></I> If yes - may still be able to donate - but discuss with doctor. Oral progesterone pill is no bar to donation, nor is regularly inhaled asthma treatment. </div> <div> <I><B>Do you have a chronic medical condition</B></I> - ie of longstanding - e.g tuberculosis? If yes - unlikely to be able to donate - but discuss with doctor. Cocktail of anti-TB drugs is not acceptable in donated breast milk. If the mother takes regular herbal remedies (ask her) she should not donate - because little is known about their effects on the newborn.</div> <div> <I><B>Have you had any vaccinations in recent past</B></I> - especially for Rubella or Yellow Fever? If yes, should not donate</div> <div> <I><B>Are your breasts and nipples healthy?</B></I> If evidence of mastitis or abscess, cannot donate.</div> <div> <I><B>Do you use any drugs for non-medical reasons</B></I> - e.g marihuana. If yes - cannot donate</div> <div> <I><B>Have you ever been tested for HIV ?</B></I>  If patient says yes - cannot donate. If staff have good reason to suspect yes - cannot donate. If no test done as far as is known, and no suspicion of HIV - can donate</div> <div> NB - ALTHOUGH PASTEURIZATION OF BREAST MILK DESTROYS THE HIV VIRUS, IT WOULD BE UNETHICAL TO ACCEPT DONATED MILK FROM A WOMAN KNOWN IN ADVANCE TO BE INFECTED. SUCH A WOMAN'S OWN BABY COULD HOWEVER BE FED HER OWN PASTEURISED BREAST MILK</div> <div> <I><B>Have you ever tested positive for syphilis? (VDRL).</B></I> If so cannot donate. Treponema pallidum passes through breast milk.</div> <div> PROPOSED PROTOCOL FOR BREASTMILK DONATION AND PROCESSING </div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Questions to all potential donors - see separate paper.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Consent from donor and recipient infant's mother; </div> <div> Verbal only - unlikely to be refused.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Expression of milk - see separate paper.</div> <div> Use glass graduated bottles in Nursery.</div> <div> Discard first few ccs of expressed milk</div> <div> First one or two drops of donation into pink sample bottle</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Label sample and donor bottle with donor mother's name;</div> <div> Use black felt tip pen in Nursery for this.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Fill in Lab form for donor milk bacteriology screen.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Sample and lab form to Microbiology in the Lab as soon as possible.</div> <div> Find Agnes or Eileen; do not leave the sample with any other person; it might get lost or inadvertently neglected.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Donated milk in its glass bottle to Kitchen of Children's ward, to be kept in the freezing compartment of their fridge until microbiology result known ( in 24 hrs time). Best to hand it to Susan or Veronica. NOTE: they are not there at weekends, but key for Kitchen available in the ward, so that you can place the donor milk in the freezing compartment yourself in their absence.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Expect, and pursue Lab if necessary, for the result of the bacteriological screen on the sample.</div> <div> Result should be 24 hrs after delivery to the Lab. NOTE: there may be unavoidable delay at weekends - when no staff in Microbiology. But see Modification to Protocol.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">If Lab result was bacteriologically clear - inform Kitchen staff. This milk may then be unfrozen, and added to other bacteriologically cleared milk, and is ready for pasteurization  by Kitchen staff. If the Lab indicates there was a bacterial growth on culture, that donated milk must be discarded.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Kitchen staff will start a pasteurization run once a minimum of 100 cc donor milk is with them. Pasteurization only takes half an hour. After completion of that process the milk can be cooled, and is ready for use. Alternatively it can be kept in the fridge for up to 24 hours - but should then be used. The pasteurized milk can be returned to the freezing compartment of the fridge - where it will keep indefinitely until needed.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Nursery staff should request banked milk as and when required, from the Kitchen staff. It will then be kept in the Nursery fridge or freezer.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Used sample bottles will be re-sterilised by microbiology staff, and can be acquired for re-use in the Nursery, on request.</div> <div> <IMG BORDER="0" SRC="Symb075c00b700f000000000.png" HEIGHT="16" WIDTH="24" ALIGN="bottom" HSPACE="0" VSPACE="0">Used donor bottles should be reclaimed from the Kitchen as and when required, for re-use in the Nursery.</div> <div> <B>NOTE: THE ABOVE PROTOCOL IS PROVISIONAL; AS WE GAIN EXPERIENCE WE WILL LEARN BY OUR MISTAKES, MODIFY THE PLAN, AND STREAMLINE THE OPERATION. ALL STAFF INVOLVED IN THE INITIATIVE SHOULD CONVERSE FREELY WITH EACH OTHER. THE EVOLUTION OF A DEFINITIVE PLAN WILL IN THE END BE OF BENIFIT TO THE FRAGILE PREMATURE BABY AND ITS MOTHER.</B></div> <div> Peter McCormick; Child Advocacy International, UK.             January 2003</div> <bR> <div> The acquisition of milk from potential donors requires strict supervision. Manual expression is preferred to the breast pump, due to the elimination of a source of bacterial contamination. We employed the following technique:</div> <bR> <div> <B>EXPRESSION OF BREAST MILK FOR DONATION</B></div> <div> Hand expression is preferable to breast pump. The pump is a potential source of infection.</div> <div> Hand washing is essential before expression of each donation, and milk produced this way has been shown to be less contaminated than when a pump is used.</div> <div> Washing of breasts and nipples must precede each expression, and must be done thoroughly and meticulously. The nipple after cleansing must not thereafter be touched until after the donation is completed. There is no proven advantage in using antiseptics rather than water</div> <div> It will probably be found that donating immediately after mother has breastfed her own baby, will result in a better flow of milk than at other times.</div> <div> The first 5 - 10 ccs of expressed milk must be discarded. It has been shown that the first milk expressed is more likely to be contaminated than the rest.</div> <div> Next, a tiny amount of breast milk is put into a pink sample bottle - one or two drops only. This will be sent at once to the Lab for microbiological clearance.</div> <div> A Lab slip is filled in for the sample; the slips are in the Nursery.</div> <div> Next, the expressed  milk donation is received only into the glass bottles provided for this purpose. Those bottles are sterilized in Milton solution in the Nursery.</div> <div> As much milk as the mother can comfortably donate is received. It is important to include colostrum; this should never be rejected.</div> <div> The expressed milk in its bottle is labelled with the donor mother's name using the black felt-tip writer provided in the Nursery. The donated milk is then kept in the freezing compartment of the Kitchen fridge of Children's ward, until the result of microbiology is known. This will be 24 hours after the sample reached the Lab.</div> <div> The expressed milk must not be mixed with expressed donations from other mothers, until all have been shown to be bacteriologically clear. They can then be mixed and stored in the freezer until ready for pasteurization by the Kitchen staff.</div> <div>  <B>Laboratory request forms</B> were printed as follows:</div> <div> BREAST MILK DONOR</div> <div> NAME:</div> <div> ADDRESS:</div> <div> DATE OF DONATION:</div> <div> TIME OF DONATION:</div> <div> TIME SAMPLE RECEIVED IN LAB:</div> <div> <B>REQUEST</B> - OVERNIGHT CULTURE PLEASE</div> <div> <B>RESULT</B> AFTER 24 HR INCUBATION:</div> <div> SIGNED: M.O. FOR NURSERY:</div> <div> SIGNED:  LAB TECHNICIAN</div> <div> Please inform Nursery as soon as possible</div> <div> <B>A notice on the door of the Nursery fridge</B> is intended to keep all staff aware of movement of the donated milk within:</div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B>BREAST MILK IN THE FRIDGE</B></div> <div> <B>IN THE FREEZING COMPARTMENT IT WILL LAST FOR 3 MONTHS. SEE DATE ON BOTTLES</B></div> <div> <B>IN THE FRIDGE IT WILL LAST FOR 24 HRS; MUST THEN BE USED OR DISCARDED</B></div> <div> <B>THE KITCHEN PASTEURIZES 200cc OF DONOR MILK AT A TIME</B></div> <div> <B>200cc WILL BE CONSUMED IN 24 HRS BY A BABY REQUIRING 15 - 16cc  x 2HRLY</B></div> <div> <B>200cc WILL BE CONSUMED IN 24 HRS BY A BABY REQUIRING 25cc x 3HRLY</B></div> <div> <B>100cc WILL BE CONSUMED IN 24 HRS BY A BABY REQUIRING 9CC X 2HRLY</B></div> <div> <B>SO THINK AHEAD !!</B></div> <div> <B>KEEP IN TOUCH WITH KITCHEN STAFF </B></div> <div> <B>Failure:</B> If the bank is empty, formula milk will have to be used. Very occasionally we have to admit defeat. The following notice was to be attached to the top of a tin:</div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B>THIS MILK IS ONLY</B></div> <div> <B>FOR BABIES WHO HAVE</B></div> <div> <B>NO OPPORTUNITY OF RECEIVING</B></div> <div> <B>BREAST MILK FROM THE MOTHER</B></div> <div> <B>OR FROM THE BREAST</B></div> <div> <B>MILK BANK</B></div> <bR> <div> <B>This notice is pasted onto the lids of tins of artificial formula</B></div> <bR> <div> <B>Conclusion.</B> </div> <div> This initiative was started exactly three years ago. I followed it up in 2004 and 2005. It has been seen to be continuing by my successor as Country Director for CAI in 2006. This is extremely satisfying. A multi-disciplinary intervention that is sustainable in sub-Saharan Africa is greatly to be admired. The healthy mothers coming for EPI inoculations are a permanent source of milk. The Nursery staff remain committed. The Kitchen and Laboratory staff remain competent and co-operative. The hospital Administration remain supportive. I suspect this is the first breastmilk bank in Cameroon - if not in Africa excluding South Africa. I am encouraged to set up similar facilities in two other hospitals in the same region this year.</div> <div> I cannot provide the reader with `before and after' statistics. Reliable statistics are not easy to come by in Africa. There are infact only about 12 centres in the African continent from which reliable statistics are derived; Cameroon is not one of them. I do not know how many lives have been saved or how many serious infections have been averted. I only know that we are doing the right thing according to WHO and UNICEF guidelines. We are playing our small part, in our small corner of Africa, toward the Millennium Development Goal number 4.</div> <bR> <div> Peter McCormick MB ChB DCH DTM&H          February 2006</div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <B>Go back to:</B><FONT SIZE="3" COLOR="#111111" FACE="Arial" ><B> </B></FONT><FONT SIZE="3" COLOR="#0000FF" FACE="Arial" ><A HREF="id7_breast_bank2.htm" TARGET="_top" TITLE="Babies: Now"><B>Babies Now</B></A></FONT></div> <bR> <div> (Breast milk bank)</div> <bR> <DIV ALIGN="LEFT"></DIV> <div> <A HREF="id62_m.htm" TITLE="Breast milk bank">top of the page</A></div> <div> Beryl Thyer Memorial Africa Trust, a UK registered charity  ~  1112603</div> <bR> <bR> <bR> <bR> </td> </tr></table></body>