Following Dr. Koop’s footsteps

One day while traveling, an elderly woman holding a suitcase turned and said to a fully uniformed government employee, “Put this up for me, will ya Sonny?” The uniformed man gladly did.

Shortly after while checking into a Holiday Inn, the government employee was asked for identification although still adorned in uniform. He handed the woman ID proving his status. She picked it up with two fingers, slapped it back and said almost disgustedly, ”Don’t you have a driver’s license?”

Healthy Children Project’s Karin Cadwell, PhD, RN, FAAN, ANLC, IBCLC remembers these illustrations of former Surgeon General Charles Everett Koop (1982 to 1989.) Cadwell first knew Dr. Koop as a pediatric surgeon at Children’s Hospital of Philadelphia where she also worked.

Cadwell remembers Dr. Koop as “amazingly human,” hoisting luggage and harrassed for second forms of ID.

“He had a wonderful sense of humor,” she says. Although he held great status, he recognized that he was also an ordinary person.

Breastfeeding champion Dr. Ruth Lawrence attributes our government’s interest in infant nutrition to Dr. Koop’s initial work with breastfeeding, a not-so-ordinary accomplishment.

In 1984, Dr. Koop convened the first Workshop on Breastfeeding and Human Lactation. The workshop resulted in several important recommendations including:

• strengthen the support of breastfeeding in the health care system

• improve professional education in human lactation and breastfeeding

• develop public education and promotional efforts

• develop a broad range of support services in the community

• initiate a national breastfeeding promotion effort directed to women in the workforce and expand research on human lactation and breastfeeding. [Retrieved from: http://www.usbreastfeeding.org/LegislationPolicy/FederalPoliciesInitiatives/SurgeonGeneralsWorkshoponBreastfeeding/tabid/123/Default.aspx]

As a result of the workshop, two follow-up reports describing breastfeeding promotion activities were released. You can read them here and here.

Dr. Koop established the first neonatal intensive care unit in the United States in the mid 50s. He also focused much of his work on infants born with congenital anomalies.

He recognized the importance of breastfeeding into toddlerhood and young childhood.

“It is the lucky child who still breastfeeds past two years old,” Dr. Koop is quoted on Best for Babes’ Facebook page.

Cadwell reaffirms that he cared passionately about babies and children.

“I think his religious beliefs influenced his passion for breastfeeding and wanting the best for mother and baby.”

Referring to him as a servant leader, Cadwell tells me she always felt that Dr. Koop’s work was in god’s service.

“You just knew that he had charisma,” she says. “There was something very noble about him. He was kind and powerful.”

While many refer to Dr. Koop as “America’s family doctor,” Cadwell says she thought of him more of an old fashioned practitioner.

“You could imagine him as a member of the community getting in his horse and buggy and sitting with a laboring woman or a dying person.”

Dr. Koop served under the Reagan administration in a politically conservative climate. But Dr. Koop’s agenda was less than conservative; he issued The Health Consequences of Smoking: Cancer: A Report of the Surgeon General, an account telling the dangers of tobacco use.

Later, he focused on creating dialogue around HIV/AIDS which “once again…upset the applecart by rejecting ideas such as quarantine and insisting that AIDS be treated as a medical and not a moral issue,” according to Geoff Watts of The Lancet.

While Cadwell doesn’t believe the political landscape directly affected the work Dr. Koop did around breastfeeding, she does describe some political barriers he was up against.

In his breastfeeding workshop, Dr. Koop managed to include enactments of the World Health Organization’s (WHO) International Code of Marketing Breast-milk Substitutes, which Cadwell says was “very political.”

She tells me President Reagan refused to sign the legislation after speaking with highly influential formula companies.

“Reagan’s point of view was to not regulate things,” she explains.

It wasn’t until 1994 President Clinton delegation voted for the World Health Assembly Resolution, “which reaffirmed the 1981 WHO Code and called for an end to free and subsidized breastmilk substitutes in all parts of the health care system,” according to the New Hampshire Department of Health and Human Service’s and the New Hampshire Breastfeeding Task Force’s New Hampshire Breastfeeding Resource Guide.

Furthermore, when the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) began, breastfeeding support wasn’t included in its financial plans. In the 1970s during the  initial writing of WIC, all of the funding was based on artificial baby milk provision.

Cadwell explains that the program was primarily created to combat anemia; with the amount of people using homemade baby formula, their children weren’t getting enough iron.

It wasn’t until nearly two decades later when a separate line item for breastfeeding was added to the program. Cadwell attributes this accomplishment to Dr. Koop bringing breastfeeding “into the light.”

“Unfortunately, Dr. Koop didn’t see the immediate results of his work,” she says. “But we have the benefit of the foundation he laid.”

Dr. Koop’s belief that we can make change and progress if we go about it in a thoughtful and caring way is something all lactation professionals can commit to.

Cadwell says she is inspired by his engagement of the entire community in the process of moving breastfeeding forward.

“It’s not something to be legislated or mandated,” she says. “You have to bring people along.”