To know is to do: retired nurse dedicates time to humanitarian aid in East Africa bringing awareness to the paradox of direness and vibrancy

Some days Susan Gold, RN, BSN, ACRN misses her ignorance. Since 2003, Gold has embarked on over 30 trips to various locations in East Africa where she teaches sexual and reproductive health and offers humanitarian aid.

Recalling one of her first visits to a clinic in Nairobi, Kenya, Gold describes a young mother, around 18-years-old, who arrived holding her severely malnourished infant against her breasts infected with such severe mastitis that her skin had split. This mother had been thrown out of her home for being HIV-positive and was breastfeeding and formula feeding her baby.

[Some background: Infant feeding has been complicated by the HIV epidemic. In the early 2000s, Gold explains that HIV-positive women were taught to formula feed to lower the risk of transmission to their babies, but with little to no access to clean water, babies were becoming severely ill. What’s more, in societies where breastfeeding is the norm, exclusive formula feeding is often an indication of one’s HIV status, which remains highly stigmatized. And formula is expensive, so many mothers choose mixed feeding, increasing the rate of HIV transmission, because formula irritates the GI system and gives the virus a pathway. By 2010, WHO issued new recommendations that stated that all mothers who tested positive should receive effective antiretroviral treatment (ART) which could lower risk of transmission during exclusive breastfeeding to virtually zero. In 2016, WHO extended the recommended duration of breastfeeding for HIV-positive mothers to 24 months. Effectiveness is dependent on consistency though, and Gold explains that mothers can develop resistance because there isn’t always access to ART.]

Gold was able to give the mother antibiotics, but the care that she and her infant required was beyond what Gold could offer. Considering the dyad’s condition and Gold’s limited resources, she says she’s certain that they died.

Reflecting on the suffering she witnessed and lives lost, that’s when Gold misses her ignorance most, but she says, “To know is to do.”

“For me it’s not a news story I can ignore, it’s names and faces,” she remarks.

In 2007, Gold received a Fulbright Grant to evaluate a reproductive health curriculum for HIV-positive adolescents. In 2017, she was awarded a Mandela Washington Fellowship Reciprocal Exchange Award to collaborate with Sicily Mburu, a Kenyan physician who co-founded AIDS No More. [Read more: https://ghi.wisc.edu/talking-health-out-loud-how-volunteering-led-to-life-saving-strategies-for-teens/]

Most recently, Gold spent several weeks in Dar es Salaam, Tanzania on a Nelson Mandela Fellowship Reciprocal Exchange Fellowship Grant where she partnered with Dr. Omari Mahiza, a pediatrician at Amana Regional Referral Hospital, focusing their efforts on combating pediatric malnutrition and education on family planning.

 

Shattering stereotypes 

Gold has found that most Americans hold a “shallow view” of the continent. Her frustration with the stereotypes associated with Africa runs deep.

“It’s either starving children or a safari,” she begins. “It’s so painful for me to see that displayed so many times. There is such a tendency [in America] to dehumanize people who are not like us… We set ourselves as the standard. Their culture is not a failed attempt to be our culture. Success doesn’t have to look like us or be measured against us.”

Alongside her humanitarian work, Gold hopes to shatter the stereotypes, to bring awareness to the paradox of direness and vibrancy in East Africa.

Gold reminisces: “I love the African sun on my face, the bright colors and motion, the culture that is built around the family and friends, that you’re never expected to do it alone, the  generosity of spirit,  the sounds and smells, the warm welcomes and the optimism.”

Acutely aware of “an inherent imbalance of power” and the concept of White Saviorism, Gold uses the Swahili term Tuko sawa, which means “We are all the same”, as the foundation of her work.

We all want healthy children and families and a future with opportunities to provide long, healthy, prosperous lives, she expounds.

Beyond this core belief, Gold says that she always develops relationships with the people she works with.

“I educate myself on the origins and current status of their culture. I don’t tell people what to do, I share my experiences and expertise. I always learn from them.”

 

Doing more with less 

Ingenuity is something she’s gathered from working alongside East Africans.

For instance, Gold was struck by the engineering of incubators for very sick babies at  St. Joseph’s Hospital in Moshi, Tanzania.

If there is electricity, she explains, the heat is controlled by the number of light bulbs lit. The wood absorbs the heat, the aluminum components absorb and reflect heat, the mattress absorbs heat but also protects the baby, and the lid retains the heat but allows for monitoring of the baby. Mosquito netting is fashioned around the system.

Gold notes that Kangaroo Mother Care (KMC) is practiced for almost all premature babies, but it’s not common among sick babies. [Read about skin-to-skin efforts just north of Tanzania here:  https://www.ourmilkyway.org/skin-skin-gulu-uganda/]

 

Hunger: hidden and stark 

A recent Lancet Global Health Publication, Revealing the prevalence of “hidden hunger”, released estimates of two billion people worldwide with one or more micronutrient deficiencies, noting that this is a gross underestimate. The hunger and deficiencies that Gold and her colleagues witness are rarely hidden and often quite obvious.

A severely malnourished child holds onto one of the toy cars that Gold collects and brings for the children at the clinics.

Breastfeeding is important in the prevention of different forms of childhood malnutrition, including wasting, stunting, over/underweight and micronutrient deficiencies. Tanzania scores quite high in the World Breastfeeding Trends Initiative (WBTi) World Ranking.

Gold observes that all of the women breastfeed in the low-income neighborhoods she visits.

The struggle, she says, is getting enough nutrition for the women to sustain milk production and have energy to feed their babies. During her most recent visit, Gold reports that almost none of the 35 families had food in the home.

Reporters of the new estimates for micronutrient malnutrition point out that processed fortified foods and micronutrient powders can be an easy answer to hunger, but they don’t create sustainability of local and indigenous foods and create conflict of interest issues with industry.

Gold adds that low income community members can’t afford to buy industry developed foods consistently. Lack of access to clean water is also a barrier.

“And you can’t depend on outside groups to sustain you,” she continues.

“We didn’t see any processed food at all because there is no market for it,” Gold says of visiting seven different neighborhoods in the low income region of Dar es Salaam. Instead, small markets with locally-grown fruits and vegetables prevail, but access to protein is a challenge.

As medically indicated, ready-to-use therapeutic food (RUTF) packets of fortified peanut butter issued by UNICEF are given out through health clinics. But Gold notes that sometimes parents sell these packets for money.

 

A challenge but not insurmountable 

North of Dar es Salaam, in Moshi, Gold brings a portable printer that doesn’t require Wifi to the small hospital where she volunteers. She gifts each postpartum mother a printed 4×6 photo of herself and her baby.

“You don’t know how many of these babies are going to survive due to the high infant mortality rate.”

There’s a long moment of silence between us on the video call.

Then Gold expresses her frustration and anger,  “The world can fix this, but chooses not to.”

She urges us to educate ourselves and others. Vote for people who have a vision of the world as one world, she says.

Last month, the President signed into law H.R. 4693, the “Global Malnutrition Prevention and Treatment Act of 2021,” which authorizes the United States Agency for International Development to undertake efforts to prevent and treat malnutrition globally.

For those interested in making financial contributions or donations like baby clothes, children’s  books, or toy cars, email Gold at talkinghealthoutloud@gmail.com.

Follow Gold’s organization Talking Health Out Loud on Facebook here.

For an interesting discussion on Numeracy Bias, check out this episode of Hidden Brain. Numeracy bias is described this way: “…When you see one person suffering, you feel like, ‘Oh, I can do something for that person.’ But when you hear that a whole country has a refugee crisis, you tend not to get involved because you feel like, ‘Well, this is overwhelming. I don’t think I can do anything about this, so I’m not going to engage.’…It turns out that people who have experienced a high level of lifetime adversity are immune to this bias.”

 

Other resources

Micronutrient Deficiencies

UNICEF Child Food Poverty

UNICEF No Time to Waste

UNICEF Fed to Fail

Exploring language among gender nonconforming individuals and nontraditional partners

 June is notoriously known as Pride Month, but October features other observances that bring awareness to a variety of health issues and topics that impact LGBTQIA youth. October 11 was National Coming Out Day, October 20 was International Pronouns Day and last week, individuals and organizations recognized Intersex Awareness Day

In Breastfeeding Priorities: Safe Sleep, Bias, Gender Equitable Norms, and Paid Leave— Q&A with Internationally and Nationally Recognized Breastfeeding Expert, Lori Feldman Winter, MD, MPH, NICHQ poses the questions: How can we acknowledge the need to be inclusive of all types of parents and caregivers?  How do we promote gender-equitable social norms to better support breastfeeding?”

Photo by Karolina Grabowska

Feldman Winter offers, “… We need to ask, ‘how do we better support breastfeeding among gender nonconforming individuals and nontraditional partners?’ so we don’t alienate anyone when it comes to breastfeeding. It starts with being more inclusive and acknowledging that the benefits of breastfeeding aren’t all tied to the concept of the ‘breast’ itself. Breastfeeding is a complex compilation of systems including biological benefits from skin-to-skin touching and nurturing; nutrients from human milk that can be breast- or bottle-fed; and benefits that come directly from the flora on a lactating/nursing breast.

There are multiple ways to look at breastfeeding and understand its benefits, Feldman Winter continues. 

For instance “a chest that may not be able to produce milk can still nurture babies through the benefits of skin-to-skin contact,” she’s quoted in the NICHQ piece. “People who don’t produce breastmilk can still provide human milk through donor milk and bottle feeding. Transgender men and gender nonconforming parents and caregivers may still breastfeed safely if they choose to, and may prefer the term chestfeeding over breastfeeding because it respects their identity. All kinds of arrangements can be made to truly provide an equitable support system. As clinicians and scientists, we need to keep an open mind as we look at breastfeeding and explore how to optimize the health and well-being of all babies and families.” 

The authors of Effective Communication About Pregnancy, Birth, Lactation, Breastfeeding and Newborn Care: The Importance of Sexed Language present their thoughts about the risks of using desexed language in perinatal care.

Photo credit: PNW Production

The authors acknowledge that “Desexing the language of female reproduction has been done with a view to being sensitive to individual needs and as beneficial, kind, and inclusive.” 

They go on, “Yet, this kindness has delivered unintended consequences that have serious implications for women and children. These include: decreasing overall inclusivity; dehumanizing; including people who should be excluded; being imprecise, inaccurate or misleading; and disembodying and undermining breastfeeding. In addition, avoidance of the term ‘mother’ in its sexed sense, risks reducing recognition and the right to protection of the mother-infant dyad.”  

As part of this discussion, NICHQ has released statements in regard to the use of its language.

Photo by Mikhail Nilov

Heidi Brooks, Chief Operating Officer at NICHQ writes,  “NICHQ is not abandoning the traditional use of the terms ‘mother’ and ‘maternal.’ We are embracing the inclusive language of ‘birthing person/people’ across our work. A move toward inclusive language does not force us to stop using language that so many people identify with; at its core, inclusion is about creating more space for one another. We are taking care to expand the use of these terms in our communications, on our website, in our resources, and eventually, in all our projects. This evolution is another aspect of NICHQ’s commitment to equity in all forms, including race, nationality, gender identity, sexual orientation, and ability.” 

The Academy of Breastfeeding Medicine (ABM) put out its Clinical Protocol #33: Lactation Care for Lesbian, Gay, Bisexual, Transgender, Queer, Questioning, Plus Patients in May 2020 to help guide lactation care providers through items like language, creating a respectful health care environment, through the effects of transition-related health care on pregnancy and breast/chestfeeding, fertility options, induced lactation and colactation and milk sharing, as well as put out a call out for future research to better inform practice.

Photo courtesy of Glenis Decuir

Check out past Our Milky Way coverage on LGBTQIA health

Uplifting transgender and non binary parents 

On becoming transliterate 

Working to close the gaps in LGBTQ care 

Blurring the binary 

Skin to skin image goes viral 

Wives co-breastfeed son for two-and-a-half years

Explore youth.gov’s page for other past and upcoming events celebrating Sexual Orientation and Gender Identity, Expression, and Well-Being.

Father holds son born prematurely skin-to-skin, facilitates bonding and steps up for breastfeeding

Eight years ago, Dennis Gaynor Jr.’s son Samuel was born at 28 weeks gestation weighing 1 lb. 6 oz. Mr. Gaynor was encouraged to hold his baby skin-to-skin during their hospital stay to help improve his baby’s blood oxygen levels, sleep, temperature, breastfeeding and weight gain. Kangaroo Care was a new concept for Mr. Gaynor.

Photo courtesy of the Gaynor family

“[I] didn’t realize that this is such a great way to bond with Sam. But I did it with no hesitation and I’m enjoying every minute, second, and hour,” Mr. Gaynor shared. “The thought of my heart beat going into my sons’ ears brings a melody to my heart.”

Samuel’s mother also held him skin-to-skin and provided her milk which helped them endure several surgeries throughout his first few years of life. 

Mr. Gaynor says that he continued to hold Sam skin-to-skin after they were discharged from the hospital. “He was so small, I was scared to hold him, but that was the only other method,” he explains. “To this day, he lays on my chest; everyone else gives me a normal hug, but this is what we’ve always done.”

Photo courtesy of the Gaynor family

Mr. Gaynor and his wife run a 501(C)3 nonprofit organization called Young Men on a Mission: YMOM (pronounced why mom) established in the inner city of Milwaukee, Wis.  Their programming includes mentoring, sports and work training intended to help young men “gain hope in themselves to create goals that extend beyond their daily existence; retain hope when it appears that the odds are stacked against them; and dare to be somebody.” Find out more about YMOM here: https://www.youngmenonamission.org/about-us  

Check out Healthy Children Project’s Kajsa Brimdyr’s The 9 Stages of Premature Infants film which shows the nine stages demonstrated by premature infants. Find more here.

For a collection of research on skin-to-skin contact visit: https://www.unicef.org.uk/babyfriendly/news-and-research/baby-friendly-research/research-supporting-breastfeeding/skin-to-skin-contact/ 

You can read Facilitating the bond between children and fathers or male-identifying partners which covers the positive effects of skin-to skin contact on paternal attachment here.

Facilitating the bond between children and fathers or male-identifying partners

 There’s quite a bit of literature on why it is important for fathers to support breastfeeding, and robust recommendations on how fathers can be good support people.

Photo by Anna Shvets: https://www.pexels.com/photo/a-man-in-blue-long-sleeves-playing-with-his-baby-11369399/

Specifically in Black communities though, there’s a “lack of resources for men to learn about and advocate for breastfeeding.”  George W. Bugg, Jr, et al. write in Breastfeeding Communities for Fatherhood: Laying the Groundwork for the Black Fatherhood, Brotherhood, and Manhood Movement  that “Black men deserve to be educated in culturally competent ways about prenatal and postpartum care to advocate for their partners. This is not happening in a systematic way in the Black community. In the Reproductive Justice space, Black men are basically being treated as if they are invisible.” 

As a whole, our nation lacks support for fathers and male identifying partners to bond with their babies. The father–infant relationship should be honored “in its own framework rather than as an alternative to mother–infant theory.” (Cheng 2011

Author Carolynn Darrell Cheng, et al points out in Supporting Fathering Through Infant Massage that “fathers may feel dissatisfied with their ability to form a close attachment with their infants in the early postpartum period, which, in turn, may increase their parent-related stress.”

Photo by Caroline Hernandez on Unsplash

Infant massage is such a neglected modality, especially in the NICU, where it reduces both the risk of sepsis and bilirubin levels, and gets babies home sooner because their brains mature more quickly and they gain weight faster,” Nikki Lee points out. 

Beyond its benefits to infants, Cheng and colleagues have found that “infant massage appears to be a viable option for teaching fathers caregiving sensitivity.” Their work showed that “fathers were helped by increasing their feelings of competence, role acceptance, spousal support, attachment, and health and by decreasing feelings of isolation and depression. Although not all fathers saw the direct benefit of infant massage instruction, they did note they enjoyed participating in an activity that gave them special time with their infants and appreciated the opportunity to meet other fathers.” 

More broadly, skin-to-skin contact has a positive effect on paternal attachment.  

The results from Effects of Father-Neonate Skin-to-Skin Contact on Attachment: A Randomized Controlled Trial identified touching as the highest-scoring Father-Child Attachment Scale (FCAS) subscale. 

Ontario artist Lindsay Foster’s viral image of fathers BJ Barone and Frankie Nelson meeting Baby Milo captures perfectly the flood of oxytocin that skin-to-skin affords fathers and male-identifying parents.

Fathers BJ (left) and Frankie (right) embrace their seconds-old-newborn boy Milo. Milo’s umbilical cord is still attached to the surrogate in this image.
Photo by Ontario artist Lindsay Foster.
Formerly published in: http://www.ourmilkyway.org/skin-to-skin-image-goes-viral/

The World Alliance for Breastfeeding Action (WABA) identifies other ways in which fathers can be “empowered by a whole-of-society approach to fulfill their fathering capacity.” 

WABA suggests that fathers should be engaged and involved throughout the 1,000 days and health systems and care providers can provide knowledge on breastfeeding through antenatal visits, other breastfeeding classes and enabling their participation during labor and delivery and postnatally. 

Sufficient paternity or parental leave is vital to allow time to care for and bond with their new family. 

There is also “a need for greater vigilance against promotion and unethical marketing of breastmilk substitutes targeting fathers to ensure that they also get unbiased information.” [More here.] 

In our national sphere of advocacy, last month, Foundations of Fatherhood Summit hosted Wide World of Fathering  with a mission to advance fatherhood and families in Michigan communities and beyond. The speaker lineup was full of individuals passionate about fatherhood and working to shift the way we view males as parents. 

Presenter Reginald Day, CLC for instance, hosts a podcast called Get At Me Dad which reveals the true narrative of BIPOC fathers–”present, connected and raising strong families.”

Father-son duo Mark and Corey Perlman host another podcast called Nurturing Fathers based on the Nurturing Fathers Program

Last week, New Mexico Breastfeeding Task Force Board Member Francisco J. Ronquillo hosted a Hearing our Voices virtual roundtable for fathers and male-identifying partners. 

Reaching Our Brothers Everywhere (ROBE), an organization which seeks to educate, equip, and empower men to impact an increase in breastfeeding rates and a decrease in infant mortality rates within the African-American communities, hosts a monthly virtual call where males can discuss maternal child health related topics.   

In partnership with Reaching Our Sisters Everywhere (ROSE), ROBE will host the 11th Annual Breastfeeding and Equity Summit in New Orleans from August 25  to 27, 2022 where presentations center on equity in breastfeeding, maternal health, fathers and partners, and infant health initiatives.

 

Our Milky Way past coverage on fathers

Photo by PNW Production: https://www.pexels.com/photo/a-family-walking-together-on-a-boardwalk-8576210/

New CLC engages fathers, supports breastfeeding, heals communities

Fathers profoundly influence breastfeeding outcomes

Founder of Fathers’ Uplift adopted into breastfeeding movement

The Institute of Family & Community Impact hosts event to boost paternal mental health

Paternal mental health and engagement

Robert A. Lee, MA answers the call

A lasting bond 

Skin to skin image goes viral

Changing families demand changing policies

Paternal mental health and engagement

Humans are born connected. Separation is a learned behavior and in Western society, is often an accelerated process beginning just moments after birth

Photo by Kreated Media on Unsplash

If we can learn to separate, then we can unlearn those practices too. We can learn to reconnect. 

In recent time, skin-to-skin contact immediately after birth and beyond has been widely embraced as a tool to keep mothers and babies connected and to promote bonding. Skin-to-skin contact is encouraged to facilitate bonding between baby and father and other care providers too. 

As NICHQ President and CEO Scott D. Berns, MD, MPH, FAAP points out in Fathers: Powerful Allies for Maternal and Child Health, “father engagement and involvement is a critical opportunity to improve children’s health outcomes in the decades to come”… beginning in the prenatal period. 

Despite overwhelming evidence demonstrating the importance of paternal involvement, fathers are up against significant barriers “including systemic obstacles related to employment, and a lack of confidence stemming from social stereotypes about the expected role of a father—namely that their role is somehow secondary to the mother’s.” [https://www.nichq.org/insight/fathers-powerful-allies-maternal-and-child-health

Fathers BJ (left) and Frankie (right) embrace their seconds-old-newborn boy Milo. Milo’s umbilical cord is still attached to the surrogate in this image. Photo by Ontario artist Lindsay Foster. Formerly published in: http://www.ourmilkyway.org/skin-to-skin-image-goes-viral/

In an effort to address paternal mental health, Healthy Children Project faculty Eira Yates in partnership with OhioGuidestone developed the Yates Paternal Depression Screening Tool for male fathers, a first of its kind measurement. 

The tool is reminiscent of the Edinburgh Postpartum Depression Scale (EPDS) developed to screen for depression in women during and after pregnancy and childbirth, but different in that it is sensitive to fatherhood and “not retrofitted and adapted from tools developed to capture unique characteristics of depression in women and mothers.” 

Photo by Kelly Sikkema on Unsplash

The Yates tool can screen male fathers during the perinatal period (prenatal or before birth up to 12 months after birth) for signs of depression with questions related to Mood/Loss of Interest and Motivation, Aggression/Irritability, Self-Concept/Feelings of Worth, Social System Deficits and Drug/alcohol use.  

“We believe that a culturally sensitive, carefully designed tool can give insight into the particular ways depression manifests in male fathers, identify men at risk for perinatal depression, and highlight the need to tailor treatment and services to the unique experiences of male fathers,” Brittany Pope, M.S., Director of Applied Clinical Sciences and Research at OhioGuidestone explains. “Furthermore, we hope to spur opportunities to explore potential programming, treatment and policy changes, both to raise awareness of the need to screen male fathers and to offer efficient and effective services and programs to meet their clinical and parenting needs.” 

The tool isn’t yet published and due to COVID-19,  research activity has been suspended, however the team plans to reopen the study using remote telehealth videoconferencing in August/September. This method will allow for even higher recruitment and screening. 

You can learn more about the screening tool at The Institute of Family & Community Impact’s website here

Photo by Chris on unsplash

In another effort to include fathers in the conversation around birth practice, separation and support,  Lactation Specialist Lydia O. Boyd, CLE is conducting a survey to capture the experiences of Black males through the Covid-19 pandemic. The survey can be found here

Reaching Our Brothers Everywhere (ROBE), an organization dedicated to educating, equipping, and empowering men to impact an increase in breastfeeding rates and a decrease infant mortality rates within the African-American communities, is hosting its 2020 Virtual Summit June 23 & 25 featuring speakers Dr. Saturu Ned, former Black Panther, Dr. Brian McGregor, Dr. Torian Easterling, Kenn Harris from National Healthy Start and the entire ROBE team. Register here.