Dr Armida Fernandez, former professor and head of neonatology at Lokmanya Tilak Municipal General Hospital (LTMGH) and dean for three years, has worked untiringly to ensure the availability of breast milk for premature, poor, and sick babies. Past president of the National Neonatology Forum and the founder trustee of Sneha, Dr Fernandez speaks on how the good work should spread, in the second part of her two-part interview.
Are there other hospitals in the country with milk banks?
In Mumbai, there are milk banks in KEM, JJ, Nair, and Cama hospitals. There are also milk banks in Pune, Surat, and Hyderabad.
Do private hospitals charge for the facility?
No, they do not charge for the facility in India.
Why aren't more hospitals doing this?
It is not viable for small hospitals, where there are very few deliveries per week, as you need sufficient demand as well as a reasonable number of donors. All large hospitals, however, especially those that have an intensive care unit must have a milk bank, as babies in intensive care or premature babies require human milk. Doctors in those hospitals should encourage breastfeeding. It starts from there. The sad part is that while they do tell mothers that they should breastfeed, they don't try to help the mothers go about it the right way, as it needs a lot of time and commitment. It is easier to prescribe formula milk.
What is the solution to this?
The solution is that the promotion and support for breastfeeding should move out of the hands of medical professionals and into the hands of support groups for mothers. We do not have mother support groups in India. In Mumbai, we have lactation consultants who charge approximately Rs 600 for a visit to a hospital to support newly delivered mothers.
Are there any courses and how long are they?
There are certification courses in India for lactation consultants these days. Dr Prashant Gangal is known for training women to be lactation consultants. You don't have to take classes every day, but there are some practical things that need to be considered-Dr Prashant Gangal has a film on this at www.breastcrawl.org.
What do they charge for?
Trained counsellors are certified only after they pass an exam, so they come in their professional capacity and have to be paid for their services. You also have forums and websites like www.birthindia.org, where expecting mothers, mothers of newborns, nurses, and counsellors, come together to seek and give related services and support.
I would love to help. This is something I have dreamt of all of my life. It is my mission to help mothers to breastfeed. Parents, however, are unwilling to pay for support for breastfeeding. A couple came to me the other day. The baby had been born at Lilavati Hospital, where they had to pay a small fortune for her delivery by Caesarean section. They spent almost an hour with me. I don't charge for this kind of help. I told them they could seek help from a breastfeeding counsellor; I assumed that since the baby had been born in an expensive private hospital they would be willing to bear the cost, but they said that they found the arrangement quite expensive. So, when it comes to breastfeeding, people just don't want to spend.
Why aren't more hospitals doing this?
When it comes to milk banking, it is a process that will help you for a lifetime but there is no immediate result. Also, though there is research saying it will help the baby, there are no specific figures. Thirdly, though the equipment does not cost much, the cost is high, as a lot of people need to be employed.These people need to go around and counsel mothers. In terms of equipment, you only need a freezer; a refrigerator to thaw; a generator in case the electricity fails, a water bath shaker to pasteurise the milk; and of course pumps and containers.
At Sion Hospital, I started the concept of a lactation management nurse-she simply helps mothers breastfeed. She is not a milk bank nurse. She goes from mother to mother asking them if they need help. She deals with everything to do with breastfeeding and if mothers are ready to donate, she also helps them express milk.
Is there a way to reach out to these hospitals and encourage them?
Having a milk bank is a medical issue. A lot of people from Delhi, Chandigarh, Chennai and Kolkata have called me saying they want to start a milk bank but have never started any. It is not easy to convince the administrative authorities of its benefits, viability, and cost-effectiveness. I think the Indian medical profession has to take this up. If I could say that because of milk banks, mortality in babies has dropped from say 5 per cent to 1 per cent, then I could show people the big difference but I do not have statistics like that. There is no research quantifying how helpful milk banking is. We can imply that they help but we don't have figures.