Breastfeeding in Times of Crisis - Caring for Mothers and the Littlest Survivors
By Friena Guerrero
A full month after tropical storm Ondoy struck the Philippines, many people remain homeless. As flood waters rushed into their homes, many people had no choice but to flee with only the clothes on their backs. Many of those displaced were families with young children, pregnant mothers and newborn babies.
At the Alabang Elementary School in the southern part of the capital region, some 450 families live side by side in classrooms and on any available floor space. They have been here since Sept. 26, the day tropical storm Ondoy dumped a month's worth of rain on the country. About 180 families call the school's basketball court home. Here, families mark their areas off with their children's school bags, tarnished pots and ragged boxes, which provide them a sense of ownership of their allocated space. With each day that passes, many are losing hope that they will still have a home to return to when they leave the evacuation centre.
The flood waters are stubborn and refuse to recede. In addition, the skies show no sign of satisfaction with the destruction it's wrought and without warning, release buckets of rain on the still flooded streets. Despite the conditions, life goes on. In the day, children play on the sidelines while babies sit on mats ogling the chaos. Older children and fathers line up at the health centre to get medicines and relief goods for their families. Clothes dry on wires stretched around the school and large barrels of water, many uncovered, dot the campus. Somewhere, a young voice pleads with a baby to nurse.
Among the sea of people and scattered boxes, Analyn Escalano sits on flattened pieces of cardboard upon the cold concrete floor and cradles Jenalyn, her 5-month-old niece. Jenalyn's mother, Bernalyn, has just left to bring the infant's twin sister, Joralyn, to the health centre. Joralyn has been suffering from diarrhoea, Analyn says. "She seemed listless but she's always crying," Analyn says in Filipino as she bounces Jenalyn on her shoulder. "Her stool is like water and it's difficult to clean her well. We don't have much for diapers and there are not enough donated diapers to go around for all the babies in the centre. It's especially hard on my sister because she has twins to take care of." Meantime, Jenalyn is alert and eyeing her surroundings curiously. Although still an infant, she seems to know that the thin pillow she sleeps on each night is not her crib and that the chatter around her is not the usual cooing that would usually lull her to slumber.
The Escalano family fled their homes in sitio 7-A when the water reached waist high and the rains showed no signs of abating. Carefully, yet urgently, the little twins were carried to safety like so many other babies and children who were held high above the rising waters – they are the littlest survivors. While many babies and children were lucky to have survived the deadly floods, their lives are still in peril. Joralyn is just one of many babies in hundreds of evacuation centres across the capital who have developed diarrhoea and other sicknesses in the aftermath of the storm due to unsanitary conditions, stretched health resources and the lack of many basic necessities. Joralyn, however, is lucky to have her family. Many children were orphaned as a result of Ondoy's fury. Bernalyn returns carrying a crying Joralyn. She sits wearily on the cardboard and takes Jenalyn from her sister. Bernalyn is a strong believer in breastfeeding.
However, since evacuating, she has found it difficult to feed both twins and usually keeps Jenalyn to her breast while giving Joralyn a bottle of infant formula. She also worries that the stress of her situation is making her milk weak. "It is difficult to sleep in the basketball court," Bernalyn says. The nights are cold and crowded and the corrugated roof of the basketball court amplifies each drop of rain – a hard but hollow sound, which serves as an accompaniment to the cries of children for whom Ondoy's physical and psychosocial wounds are still fresh. The thunder resonates deeply, especially for many mothers like Bernalyn who worry about their children's health and future. "We don't even know if we still have a home waiting for us when we have to leave the centre," Bernalyn says as she adjusts each twin on her shoulders. "Life was hard already before the storm, now it's like we're starting over again with even less. But at least, we're still together."
Meantime, in another area of the basketball court, 16-year-old Jennifer Serrano* is struggling to get her 3-month old son Gabriel to breastfeed. Gabriel is in one of his moods and refuses to nurse from his young mother's breast. Jennifer is close to tears herself and in frustration, rolls her soiled t-shirt down over herself. She would like to hand the baby over to her mother to breastfeed but right now, she is busy nursing Jennifer's younger brother. "I get so worried when he doesn't want to eat," she says. "I don't understand why sometimes he won't stop crying." The Serranos also live in sitio 7-A, but in a lower part of the community. The floods reached neck high in their neighbourhood, Jennifer said, gesturing with her hands. The family tried to return home once when the skies were deceptively clear, but had to retreat back to the school when new rains threatened them again. A new mother, Jennifer is also still very young. Like Gabriel, she too is frightened and hungry.
While she would like to breastfeed, the way she has seen her mother do it, she feels that she cannot produce enough milk to satisfy Gabriel and soothe his crying. Instead, she bottle-feeds him with powdered milk after boiling some of the water from the centre's uncovered barrels. Young children and infants like Gabriel, Jenalyn and Joralyn are the most vulnerable in emergency situations. Because their immune systems are still developing, they are especially at risk of malnutrition and even death from food which is improperly prepared in unhygienic conditions.
While they have specific nutritional needs, these can be fully met even in the middle of a disaster. Aside from providing nourishment that is tailor-made to an infant's needs, breastmilk also provides comfort and support, not only to babies, but to mothers as well. The skin-on-skin contact strengthens the mother-child bond and infants receive a healthy stream of reassurance that they are protected and cared for. Unlike other substitutes, breastmilk contains a special ingredient – the love that flows directly from a mother to her baby.
In line with its commitment to children's welfare, UNICEF has partnered with local government and non-government agencies as well as other international organizations to address the continuing emergency. Together, they conduct counselling sessions to encourage mothers to continue breastfeeding their children and distribute donated breastmilk to evacuation centres. Recently, the Philippine General Hospital's milk bank received a shipment of about 200 four-ounce bottles of breastmilk from international donors. "The milk was collected by moms in the U.S. who support our organizational goals of providing milk banks with assistance and ultimately saving lives," said Amanda Nickerson, Executive Director of the International Breast Milk Project. Ma. Asuncion Silvestre, head of the PGH's Lactation Unit and Human Milk Bank said the milk is going to those who need it most. "We are supplying milk for the UNICEF coordinated breastfeeding missions, for orphaned infants, infants with diarrhoea/dehydration in a few hospitals, for mothers who drip the milk on their breasts during relactation procedures and mothers of twins who need a boost of milk," Silvestre said.
One of those who received the donated breastmilk is Gilbert. His mother, Jennifer, pours a little of the milk on her fingers, letting Gabriel taste it. Her eyes plead anxiously with Gilbert but she breathes a sigh of relief as her son happily approves and drinks the milk from a small cup. "It's easier with cupfeeding," she says. "You don't have to fix the milk anymore and I can be sure that Gilbert is fed. The cup is also easier to clean. It's difficult to fight for the water and sometimes we have to go out of the centre just to wash our things. " Delia Gernali, a counsellor with the Pembo Breastfeeding Group, is one of about 20 women who visit evacuation centres to educate mothers like Jennifer and Bernalyn about the benefits of breastmilk, particularly in times of crisis.
"We're trying to show them that it's important that they keep breastfeeding," Gernali said. "Some think that they don't have enough milk or that breastmilk isn't enough for their babies. They also think that infant formula is better because of the advertisements they see on television." Counsellors tell Jennifer she can drink the powdered milk herself to make sure that she is strong enough to breastfeed Gabriel when the time comes. Bernalyn and other mothers learn that breastfeeding can actually lower stress hormone levels. They all learn that despite what they have lost in the flood, there is still so much they can give their babies from their own bosom. However, the group does not only target mothers.
They also reach out to many pregnant women in the evacuation centre, encouraging them to exclusively breastfeed once their children are born and they also get fathers involved, teaching them how important it is to support their wives' breastfeeding. "Breastmilk is still the most complete food a mother can give her child, especially in a disaster situation like this," Gernali says. "Aside from providing everything a baby needs, they don't have to buy it, they won't run out of it and it's always available."
While rains continue to batter the country, life goes on in hundreds of evacuation centres as many families struggle to get through another day. Among them are the littlest survivors upon whom the water from the sky fell harder and for whom the water from the earth rose higher. The nights are still filled with uncertainty over what the future holds but tonight at the Alabang Elementary School, under the dim lights of the basketball court and amid the jostling of bodies; Gabriel, Jenalyn and Joralyn nod off to sleep, comforted and content against their mothers' breasts.
"We may live a hard life and I might not be able to give my babies everything they deserve, but I can still make sure they have the best chance to grow up strong and loved despite everything we've been through," Bernalyn says softly, careful not to disturb Jenalyn and Joralyn, who are both now back at her breast. Jennifer meantime observes her son as he rests. Her own childlike eyes watch as Gilbert's tiny chest gently falls and rises. In this crowded basketball court at the mercy of the skies, she is learning what it means to be a parent. She says nobody ever sat down with her before to tell her what she had within her to offer her son.
"I just want to be a good mother," she says, her voice finding strength.