Home
Current Issue
Past Issues
Support
About IJME
Apr-Jun2002-10(2)
LETTER FROM NAGPUR
Breast-feeding: right policy,
wrong target
Avinash Deshmukh
It was a moment of glory for two doctors and pride
for the medical fraternity in Vidarbha and Nagpur as national honours were
conferred on Dr Vikram Marwah and Dr Prakash Amte.
Dr Marwah, ex-professor of surgery and dean of the
government medical college, Nagpur, is a crusader of sort, having immersed
himself in teaching and applying independent thinking and indigenous method to
surgical and orthopaedic specialities. He was the driving force behind the
artificial limb centre which was started along with the physiotherapy school in
the 1970s. He was known for developing below-knee prostheses from simple bicycle
stands; these were hugely popular. After his retirement he devoted himself to
corrective surgery for polio-afflicted children and along with his team has
performed nearly 10,000 surgeries. A man of literature, he has contributed
to Hindi prose and poetry and is actively involved in the Hindi literary
movement. He is also a recipient of the BC Roy award.
Dr Prakash Amte, alumni of GMC Nagpur, along with
his wife Dr Manda took inspiration from his illustrious father and Dr Albert
Schweitzer and started Lok Biradari Prakalp, a project for tribals in the
remotest forests of Gadchirolli district in 1973. Despite the lack of roads,
electricity and equipment, and despite being cut off from life in the city for
six months of the year, he and the local people have been working relentlessly
to improve health and educational services for tribals in this district. He is a
simple man who takes his principles seriously and applies them rigorously to
himself and his work.
These doctors have different personalities,
attitudes and methodologies but they have a common goal -alleviating suffering
of the poor. Both of them have been immensely successful in their efforts; the
honours may have been conferred a shade late.
Another important event was the annual conference of the Academy of Medical Sciences, Nagpur, on January 19 and 20. This conference gives its members a platform to present their research work. The award and free paper sessions generated a good response from speakers and audience alike. In all, 20 papers were presented. Interestingly, the jury bypassed some highly technical papers to choose a simple paper meant to judge specialists' knowledge. Fifty obstetricians - the first contact for new mothers - were interviewed by a paediatrician on their knowledge of current breast-feeding practices.
The results of analysis were quite interesting.
Perhaps all specialists should be evaluated at regular intervals on their
awareness of appropriate health care practices. This could be produce some very
interesting analyses, besides becoming an ongoing education programme.
I reproduce, below, Dr Meenakshi Girish's paper on
the "breast feeding promotion programme: right policy, wrong target": Though the
medical fraternity has been bombarded by costly technological advances, none of
these so-called sophisticated interventions have had as great an impact on
morbidity and morbidity as have low cost interventions. A classic illustration
is the oral rehydration solution which has transformed mortality statistics in
children in the last few decades.
Another low cost intervention is the policy of
promoting exclusive breast feeding till the age of five months, and its
continuation till one to two years. Unfortunately, this policy has not realised
its true potential. Who is to blame? Should we point a finger at the
pharmaceutical companies for aggressively promoting formula fees, or should we
hold a mirror to ourselves? To address this issue, a study was conducted
with the aim of assessing the knowledge of breast-feeding management among
obstetricians. About 50 obstetricians were asked to respond to questions which
were based on several popular misconceptions held by the general public which
were detrimental to successful breast milk secretion and feeding.
While 100 per cent of obstetricians agreed
that breast milk is best for the baby, the percentage of obstetricians with a
good knowledge of the various aspects of breast-feeding management was
appallingly low. Only 20 per cent of respondents knew that the baby should be
allowed to suckle in the first hour after delivery, 86 per cent of
respondents believed that since mothers need rest after undergoing a Caesarean
section, breast feeding was not a priority for these women. There was almost
universal lack of awareness of the adequacy of colostrum for an uncomplicated,
full-term, appropriate for date baby. Most obstetricians (72 per cent) would
supplement breast milk with top milk in the first few days of life. While 72 per
cent believed that water supplementation was not needed even in the peak summer
months, there was still an unacceptably high figure of 29 per cent who believed
that water must be given to quench the baby's thirst. Use of nipple shields in
retracted nipples increases the risk of infection in the baby and also causes
lactational failure. Yet 72 per cent of respondents advocated nipple shields for
the treatment of retracted nipples.
Among all the mammalian species, only Homo Sapiens
require breast feeding education or management. No other species needs it
because they don't have an alternative. Popular misconceptions, the availability
of alternative nutritional sources and the impact of advertisements
combine to make the topic of breast feeding management mandatory for all
prospective mothers. It is disturbing to note that even medical professionals
who have the greatest influence on these prospective mothers need to be educated
about various issues pertaining to breast feeding.
Dr Avinash Deshmukh, 70
Abhyankarnagar, Nagpur 440010. Email:avidesh@nagpur.dot.net.in