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Tuesday, May 16, 2017

Write about the first days, she said. The tea party celebrating the 40th anniversary of The Breastfeeding Association of Trinidad and Tobago (formerly TIBS) was almost over; greetings from the Minister of Health through the director of Education, Ms Yvonne Lewis; affectionate cheers for our long-time patron, the gracious Mrs Zalayhar Hassanali, and for the founder of TIBS, nurse Marilyn Stollmeyer; applause for the skills of Pedro Lezama saxophonist/flautist and for Laura Pierre-Escays for her original songs. Time to look forward but first, a look back? Write about the first days she repeated, 40 years is a long time for any organisation to exist, especially in a short turn country.

So it was off to the second ever publication of the old TIBS News, December 1978 for a read of “Notes taken by Annette Telfer at a lecture on gastroenteritis given by Dr Bratt at the TIBS monthly meeting of 9th November 1978”. TIBS was just one year old, in operation since January 1977. At that time the core members were Mrs Stollmeyer, Helen Pasea, Gaby Owen, Donna Chang, Annette and Bernadette Price. TIBS had been set up to assist nursing mothers with the usual problems which were causing many to give up breastfeeding. The core members of TIBS had noted that “these problems were very rarely physiological but more often emotional or just lack of education and confidence.”

Despite all the progress made in breastfeeding knowledge it’s the same today: lack of confidence.

Here’s what was being said about gastroenteritis in 1978. “The incidence of gastro amongst the poorer classes in T&T is greater than in the middle and upper classes. More cases are reported in the months of February and July and August, although the reasons for these peak periods are not really known.” (We now know that the February outbreaks were due to a virus, rotavirus. July and August to overflowing cesspits from rain.)

“The following average annual statistics show that gastro is the most common cause of infant deaths (under one year old) in T&T. Of the 25,000 children born each year, about 1,000 die before they reach 14 years. Of these 250 aged over one year, die of gastroenteritis, whilst a further 200 under age one year, also die of gastro. There are about 4,000 children admitted annually to hospital for gastro in T&T and of these about 75 per cent are under one year of age. In addition, there are about a further 4,000 under one year of age who do not go to hospital. Thus there is at least a one in three chance of a newborn getting gastro in their first year of life. It is interesting to note that gastroenteritis is totally preventable by complete breastfeeding.”

“Gastroenteritis can be described in simple terms as an infection of the stomach, small and large bowels which become inflamed with a pus-like substance. The stool is frequent and watery with mucus and blood sometimes present if the gastro is in advanced stages. Vomiting also occurs as the stomach rejects any food that is ingested. The body becomes dehydrated by the diarrhoea and vomiting and the baby can lose approximately three ounces of water per stool, depending on it size. It is this loss of water and the salts it contains that is dangerous. The child loses water, salt, potassium and bicarbonate as a result of the vomiting and diarrhoea, which must be replenished, thus the use of coconut water and equivalents which contain glucose, potassium, salt and bicarbonate.

The common cause of gastroenteritis are: a) foods introduced too early, a baby’s system is immature. b) too much food. c) an infection in any part of the body. d) germs ingested via the mouth causing inflammation in the stomach and intestines. This is the most common and important. The majority of gastro cases in T&T are caused by viruses (80 per cent). Antibiotics are useless against viruses. e) not breastfeeding the baby.

General treatment of gastroenteritis. (For specifics, your doctor must be consulted.)

Coconut water. The gut should be rested completely for at least 24 hours with coconut water being given, one to two teaspoons every five minutes. “(We now know that you do not need and should not starve the baby for so long, four to six hours of resting the gut is enough and that only young coconut water should be used).

“Coconut water is sterile so it can be used safely. After the stomach and gut have been rested and allowed to heal, half-strength milk is given for 12-24 hour and full strength milk is then given if the diarrhoea is improving.”

(This worked well compared to the unsound advice that was being given by other doctors but we now know that while you should never stop breastmilk, you do need to stop cow’s milk or formula but you do not need to dilute it and today the advice would be to start back regular milk and/or easily digestible foods like banana, boiled pumpkin, carrots, rice etc, as soon as possible and certainly within six hours of resting the stomach and gut.)

Mrs Telfer then continues, “GESOL. Gesol is another oral solution which is used in countries where no coconut water is available. Gesol is not yet available in T&T but is being used at the Port-of-Spain and San Fernando hospitals in carefully controlled studies to see if it can be used here.”

Well it can and it did and together with enhanced breastfeeding, ten years later, by 1988, gastroenteritis had been eliminated as a cause of hospital admissions and deaths in children.


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