Pushpa Panadam, Asuncion, Paraguay
On 11th March, 2020, Paraguay imposed lockdown due to a new strain of coronavirus. Many countries in Latin America soon followed suit as suspected and confirmed cases of COVID-19 (the disease caused by the virus) and the associated deaths started to increase. With COVID-19 cases increasing, Lactared Paso 10, a WhatsApp group I belong to, started sharing news of what was happening in their countries. Lactared Paso 10 is a group of multidisciplinary health professionals within which I am the only representative LLL Leader (see box).
The news shared in Lactared Paso 10 at that time indicated that, in practically all health services in our countries, mothers and newborn babies were being separated. Breastfeeding was not being initiated nor supported for fear of transmission of the virus. Formula was promoted indirectly by the health services, with families not receiving the crucial help and support to breastfeed their babies. The International Code of Marketing of Breastmilk Substitutes (the “Code”) was clearly being violated in many instances including the receiving of donations. In March, due to this situation, Nair Carrasco, creator of Lactared Paso 10, suggested starting a campaign—Breastfeeding in Emergency and How to Support Mothers. Many of us volunteered, including myself. Infant and Young Child Feeding in Emergencies Operational Guidance (OG-IFE) by the Infant Feeding in Emergencies Core Group would be our starting base. The group members wanted to ensure that mothers and babies were not separated at birth and that breastfeeding would start at birth and continue with help and support.
Nair Carrasco created Lactared Paso 10 on 8th October, 2015 to provide support for the supporters. Paso 10 refers to the 10th Step in the Baby Friendly Hospital Initiative. Nair Carrasco is a nutritionist, International Board Certified Lactation Consultant (IBCLC), Ashoka Fellow,* founder of LACTARED (Breastfeeding Network), and a Co-Coordinator of WABA (World Alliance for Breastfeeding Action) Mother Support Task Force (MSTF). When Nair was invited by the Health Ministry of Paraguay in April 2015, to run a breastfeeding training workshop for directors and heads of departments of Baby Friendly Hospitals in the country, we had the opportunity to discuss the importance of mother support groups in hospitals as opposed to breastfeeding talks by health professionals. Through her network, Nair has contact with health professionals and IBCLCs in the Spanish-speaking world. Realizing the importance of informal support and sharing of breastfeeding information among health professionals, she created Lactared Paso 10 WhatsApp group.
Task Force Paso 10 With a clear plan in mind, different working groups were formed to work on specific sections of the OG-IFE. We called ourselves Task Force Paso 10. We were from Bolivia, Chile, Colombia, Costa Rica, Ecuador, Honduras, Mexico, Panama, Paraguay, Peru, Uruguay, Venezuela, Spain and Switzerland. Sensing the emergency, the groups met frequently to read and adapt incoming information and research on breastfeeding and COVID-19 as it came in from the WHO (World Health Organization) and scientific associations. The groups worked many hours online (the only way), often late through the night. It was indeed a challenge as practically everyone was still working full-time in different time zones. However, passion, love for a common cause and the seriousness of the situation kept us on our toes. The final work was done by a group of dedicated editors. Within two weeks, by the end of March, the Guide Lactancia en Emergencia COVID-19: Guia Operativa para la Toma de Decisiones en la Emergencia COVID-19 por Grupo de Trabajo Internacional Voluntario de Profesionales Expertos en Lactancia, TASK FORCE: PASO 10 (Breastfeeding in COVID-19 Emergency, An Operational Guide to Decision Making in COVID-19 Emergency by the International Volunteer Working Group of Professionals Experts in Breastfeeding – TASK FORCE: PASO 10), was ready.
On April 1st, we received an email with a link to download the Guide from LACTARED. The Operational Guide for Breastfeeding in COVID-19 Emergency can be accessed by entering the link and registering to download it. https://paso10.org
The next step was to disseminate the document to health authorities and professionals in our countries. The Task Force Paso 10 now worked in country groups to reach out to decision makers so that country protocols could reflect pro-breastfeeding guidelines. In getting the word out to as many as possible, especially health professionals, the Task Force Paso 10 promoted the Guide and its information continuously. This was done via webinar conferences, social media live and interviews in newspapers and TV.
However, it was deemed insufficient and it still continues to be so—mothers and babies were still being separated and given formula in the hospitals. Country and hospital protocols often did not come out strongly enough to protect breastfeeding and to keep mother and baby together. Even when protocols and countless research and studies supported breastfeeding and indicated how to breastfeed safely while keeping mother and baby together, the reality was different. Fear of the virus, a lack of protective gear for health workers and lack of time to read the many documents seemed to be the reasons.
An online conference
Following the Guide, Task Force Paso 10 members continued to share their work on keeping mothers and babies together, practicing skin-to-skin, and supporting breastfeeding in this pandemic. Since many in the group were already presenting online conferences individually, it was now time to take the Guide to another level – an online Congress.
The name: I Congreso Internacional Online Lactancia en Emergencia COVID-19-“El arte de actuar y acompañar desde lo cotidiano hasta el servicio de emergencias” (The Art of Supporting Breastfeeding: from Day to Day to Emergency Situations). The Congress was jointly organized by LACTARED and Task Force: Paso 10 from the 11th May to the 14th May, 2020.
Once again the organization took hours of dedicated work and meetings online to identify topics, themes and speakers. Speakers from within Lactared Paso 10 shared their work during this pandemic in their workplaces and in their communities.
This academic Congress had 12 keynote presentations by eminent breastfeeding authorities and 17 round tables (academic discussion) with the participation of more than 80 professionals—experts in breastfeeding from Latin America, Spain and the United States. All the speakers had to declare a no conflict of interest prior to the Congress. This was important to avoid any violation of the Code.
The Congress is free and is available digitally and online. Anyone interested can view the Congress by clicking on this link https://bit.ly/2X4ax26 to register. Participants receive information to create a username and password to watch and listen to the Congress at their convenience.
In the production of the Guide and the participation of the Congress, LLL Colombia played an important role. Leaders Claudia Patricia García López, Eugenia Ramírez Jiménez and Monica Ramírez Morales contributed in general but also specifically to the section on the Human Milk Bank. These Leaders also shared the information in various social networks, encouraging and supporting mothers to breastfeed safely during this pandemic. One of the videos that Eugenia Ramirez produced explains colostrum therapy from the Guide. It is available at https://www.instagram.com/tv/B-xyzVKJhaY/?igshid=s4qgs09zx2xe. In the Congress, Eugenia Ramirez presented the breastfeeding support system that LLL offers to mothers worldwide. She traced the history of LLLI up to its present day and how LLL Leaders worldwide and in Colombia, are supporting mothers and babies and young children during this pandemic.
At the closing of the Congress, Heidi Guzman, LLL Leader from Guatemala and LLLI Board member spoke on behalf of LLLI.
Fanny Mora, a Leader with LLL Switzerland, shares her experience participating with the Task Force Paso 10:
2020 has been an unusual year for everyone. The devastating and unimaginable consequences of the pandemic COVID-19 hasn’t stopped surprising us and bringing tears to our eyes. We have yet to see the full impact of this pandemic to our world and above all its disastrous impact on breastfeeding.
It was emotional for me as an LLL Latin American Leader to be part of Nair’s amazing, brave and decisive group. Various work teams were formed quickly to achieve the objectives set in the short time span we had to update the recommendations of the Feeding of Infants and Young Children in Emergencies. specifically for COVID-19. It was intense multidisciplinary work to search, revieWe managed to write an extraordinary document at the right time: the Guide of the Task Force Paso 10 for health professionals in COVID-19 emergency. It dealt with a previously unknown virus; the questions and fears were enormous and continue to be so. However the evidence suggests there is no vertical transmission of the virus from the mother to the fetus and it is not transmitted through human milk, unlike the antibodies to COVID-19 if the mother is positive.
In this context of evidence, we could say with certainty that human milk is not only food par excellence but also that it is the best protection for the baby and breastfeeding children. We have an enormous responsibility to disseminate accurate information to parents. But beyond that we must also share the document to all health professionals to guide their daily work.
We continue to circulate the document and also continue to be united as a humane group in sharing not only successes and joys but also sadness. Yes, sadness when we find that there are still health professionals who separate newborns from their mothers prioritizing fear instead of breastfeeding which increases survival and protection of babies against COVID-19.
There is still a lot of work to be done. We shall not falter, our work as LLL Leaders is vital in this moment of immense vulnerability.w and update scientific evidence. What stands out most in my memories are the energy, enthusiasm and the meeting of ideas regarding breastfeeding.
As LLL Leaders we offer information and support to pregnant women, mothers and families. We can also form alliances with other like-minded groups and organizations to protect breastfeeding. It has been heartening to be part of a group of healthcare professionals who pooled their talent, knowledge and time to overcome uncertainty and fear that the COVID-19 emergency created to protect and support breastfeeding. It was the reason that the Guide and the Congress happened in record time. It is indeed a gift that ensures in this COVID-19 emergency that mothers and babies are not separated and are able to breastfeed with help and support. The work is far from finished and is ongoing.
Pushpa Panadam, LLL Leader Paraguay
*Ashoka identifies and supports the world’s leading social entrepreneurs, learns from the patterns of their innovations, and mobilizes a global community that embraces these new frameworks to build an “everyone a changemaker world”. https://www.ashoka.org
Nair Carrasco founded LACTARED as an Ashoka entrepreneurship to work on the social impact of breastfeeding.
TASK FORCE PASO 10 Video created for World Breastfeeding Week 2020 (in Spanish). https://www.facebook.com/108697217454045/videos/2862031327236965
Pushpa Panadam, a Malaysian has been an LLL Leader in Paraguay since 2000. She’s married to Manuel Velázquez, a Paraguayan and they have two children. Pushpa facilitates two mother support groups (a group in pediatrics that started in 2007; and one prenatal group which began in 2009) with another Leader Cyntia Leon, in Hospital Cruz Roja, Paraguay. She was co-editor of WABA’s Breastfeeding Mother Support E-Newsletter from 2003 -2017.