Friday, January 13, 2006

Infant Feeding in Emergencies after Tsunami in Aceh


Earthquake and tsunami in Nangroe Aceh Darussalam (NAD) and North Sumatera had asked for more than 100.000 victims perish. Recent data on 18 January 2005 revealed that the disaster had caused 594.688 people became refuges, 166.080 people died and 6.220 people missing. The most suffered from the disaster were women and children.

Considering this situation, it is important therefore to put forward the principle of the best interest for the children in undertaking the life sustainability and the welfare condition of infant and children in the disaster area. The 47th World Health Assembly Resolution in 1994 stated that in order to cope with the disaster condition, functionaries in field should protect, promote and support mothers to breastfeeding their babies. At the national context, health affair ministry decision No 237/MENKES/SK/IV/1997 on the market distribution of food complementary to breastfeed Section VI article 13 sub article (3) states that “public health services are prohibited to receive sample or donation of baby and infant feeding milk formula for the interest of research and regularly needs. Sample and donation allowed only in the emergency situation by the license of the local Health Department. UNICEF, WHO and IDAI, on 7 January 2005 had made a joint statement on the recommended infant feeding in the emergency situation. Indonesian government had also issued letter that was designated to Chief Agency of Health affair of NAD and North Sumatra dated on 6 January 2005 related to the Manual for infant feeding milk formula in the disaster area.

Indonesian Breastfeeding Center or Sentra Laktasi Indonesia with the support from Health affair department of Indonesian Republic and UNICEF initiated several activities to respond the tsunami disaster from 23 January to 5 February 2005. The activities that were designated for the local level of Aceh and for the national level are:

Consultative Meeting, Jakarta, 27 January 2005

This meeting was attended by 62 participants (89% of the invited person). Participants were consist of 12 persons from government, 32 persons from national and international NGO, 12 persons from print and electronic media, including 11 breastfeeding counselor facilitators who would go to Aceh. The discussed topics in this meeting were:

  1. International Policy on Breastfeed delivered by Dr. David Hipgrave from UNICEF.

  1. Situation and condition of infant feeding in Aceh, presented by Eko Bambang Subiyantoro from Jurnal Perempuan Foundation.

  1. National Policy and Program Plan for Aceh, presented by Dr. Rachmi Untoro from health department.

  1. The effective infant feeding in the emergency situation delivered by Dr. Utami Roesli from Sentra Laktasi Indonesia.

  1. Confines and Benefit of Breastfeeding for infant in Aceh presented by Dr. Hardiono D. Pusponegoro SpA (K) (PB IDAI).

ToT on the Infant feeding in the emergency situation

ToT on the infant feeding in the emergency situation was given by expert facilitators on the topics; they were Dr. Utami Roesli, SpA, MBA. IBCLC., From Sentra Laktasi Indonesia. Dr Utami Roesli used participatory method in giving ToT, the ToT itself referred to the 2 part modules entitle “Infant Feeding in the Emergencies”, published by WHO, UNICEF, LINKAGES, IBFAN, ENN and also referred also to the additional contribution. The ToT could in turn produced 12 trainers for infant feeding in the emergency situation in Aceh.

Training on infant feeding in the emergency situation

Next to the consultative meeting and ToT, Sentra Laktasi also conducted IFE training in Aceh Besar regency. The training was followed by 607 persons who came from PTT and state official midwife, village’s cadres, local volunteers, and mothers form refuges camp and person from Health agency of Aceh Besar residency. Training was conducted from 1 to 4 February 2005 using in class and out class method. The In Class training conducted at Jantho II elementary school building for about 3 hours (session before lunch) and the Out Class itself was conducted at refuges camp for three hours (session after lunch). In addition, direct training was conducted on 5 February in the Seulimuem refuges camp. The total five days training could successfully reach out 18 refuges camp. Brief illustrations on the exercised method in those training are as follows:

  1. Introduction and problem identification

This method bridged rapport between participants to participants and between participants to facilitators as well as revealed problem that is faced up by participants related to breastfed and breastfeeding

  1. Presentation and Discussion on the Training Material.

As follow up from the previous session, this presentation session gave facilitator a chance to respond the emerging problem as faced up by participants in their daily life. Facilitator began this session by unraveling the common problem faced by participants.

  1. Mid-evaluation

Next to the presentation on the training material, facilitator carried out a brief evaluation on the participants understanding of the delivered material.

  1. Presentation and Discussion on Module II and on Additional training material

Following the mid evaluation, facilitator delivered session on policy of infant feeding in the emergency situation. Facilitator also enriched participants with counseling skill material and with material on the manual to make a proper milk formulation in condition if the available milk formula is not proper for the baby’s age.

  1. Camp visit as a form of practice in field.

The visit was done after the lunch session, before participants visit the refuges camps, the destination camps were defined first. A common problem related to the breastfed was that mothers were too early giving their baby food complementary to breastfeeding. Therefore babies were rarely getting exclusive breastfeeding. Moreover there also babies whose age above 6 months but they had not yet given complementary food. Others constraint for mothers to breastfeeding their baby was the over exposed camp. This condition was not conducive for them because mothers need a private room to breastfeed their baby. Other problem was that IFE, medical and doctor expert as well as medical access from refuges camp to public health centre is not available. A trained midwife informed that there were 6 orphan babies who get breast milk not from their natural mother because their natural mothers pass away by tsunami.

The most unbearable condition was found by the team in the fourth day of their first visit to the refuges camp. There were 8 babies in the worse condition of lacking nutrient. Lately the team heard that one of the babies died even though the baby had gotten the treatment in hospital.

The condition of pregnant and breastfeeding mothers were very apprehensive. Most of them complained for the unavailability of sterile water for drink. Food supplies that available were only rice, instant noodles, and desiccated fish. Mothers should buy with their own money if they need vegetables and eggs, meanwhile they didn’t have any money to buy a thing. Pregnant mothers in one of the refuges camp ever been distributed by Lactamil milk and green peas, but the supply had already stop to operate when the team visit the camp.

  1. Infant feeding Monitoring in the refugees camps

According to the interview both to the official at the camp and to the mothers, supply for infant feeding such as milk formula and food complementary to breastfeeding were available, but data of the baby and of the available infant feeding from the refuges camp were not accessible. The camp official also could not get the assertive data; they also didn’t want to be transparent on the availability of food supply at the warehouse. Mothers who have baby informed the team that the food supply for baby often did not proper for the baby’s age. Beside this condition, food complementary to breastfeeding was sometime caused diarrhea to baby, therefore mothers choose not to give them food complementary to breastfeeding.

IV. Leaflet, booklet and poster publication on Infant Feeding in the emergency situation.

To support breastfeeding campaign, Sentra Laktasi published and distributed 1000 exemplar posters, 50000 exemplar brochures, and 1000 exemplar books on exclusive breastfeeding written by Dr Utami Roesli. The publication and distribution was supported by Health Department of Indonesian Republic.