Esther Wawire, 23, delivered her daughter at Kenya's Punwani Hospital two weeks ago, but was unable to breastfeed due to complications arising from the delivery. "I had high blood pressure, so my baby was born earlier than expected, weighing 800 grams," she said. "My pressure didn't go down immediately, and I was bleeding excessively, so I was transferred to another hospital for admission and my baby was taken to the nursery."
When Esther recovered 10 days later, she said she found her baby being fed breast milk, donated by other mothers at the hospital.
"It sounded very strange to me and I even called my mother to complain about it. But the nurse explained that the milk was safe and was very ok for my baby," she said, adding that she had never heard of anything like it before.
Esther's baby is among the over 500 babies at the hospital who have benefitted from the breast milk bank at the hospital over the last one year.
At the breast milk Bank, Millicent Maina, 25, is waiting her turn to express breast milk, not for her own baby, but for other new babies at the hospital.
"When my baby was born a month ago, she developed breathing problems. She had to be admitted for treatment. During this time the baby wasn't taking much milk," said Millicent.
"The nurse asked me if I could donate my milk for the other babies who didn't have. I didn't fully accept at first until she explained that it was safe and was meant for the babies who were sick."
One of the mothers at the hospital who was also a donor at the hospital she said convinced her even more, why she should donate breast milk.
She donates her milk twice every day.
"I breast feed my baby first then donate the rest. It is enough," she said adding that she will donate her milk until her baby is discharged.
"The doctor said the baby is likely to be discharged in two weeks' time once the baby stabilises. So, I will donate to help other babies until my last day here."
Pumwani Hospital has Kenya's first and only Breastmilk Bank. It was set up in 2019 to help preterm babies whose mothers had died or were not present, full-term babies who are sickly and those whose mothers are unable to breastfeed, due to lack of breast milk.
The hospital sees the largest number of deliveries in Kenya, an average of 70 babies everyday according to Kezia Njau, a nurse and counsellor at the hospital. "During the peak months (April to October) the hospitals delivers over 100 babies in a day while the rest of the months it varies from 50 -80 babies. The majority of these mothers are teenagers," she added.
The Kenyan Ministry of Health set up the Milk Bank Unit in Partnership with the Program for Appropriate Technology in Health (PATH), and the United States Agency for International Development (USAID) African Population and Health Research Centre (APHRC) in order to reduce the number of newborn deaths in the country and at the hospital.
Kenya is the first East African country to develop a breast milk bank. The only other countries in Africa that has similar interventions for mothers who are not able to breastfeed their babies, are South Africa, Mozambique, and Cape Verde.
Breast milk is good for maintaining a steady and fast growth of the newborn child and it helps sick babies recover faster as it contains antibodies, white blood cells, stem cells and protective enzymes that fight infections and help faster healing. The World Health Organisation (WHO) recommends exclusive breastfeeding for newborn babies for six months, but if it is not available WHO recommends donor milk. The breast milk boosts the baby's immunity with antibodies, and it is more tolerable by the baby and thus prevents them from gastrointestinal conditions.
Catherine Mumo, 26, delivered her daughter who weighed one kilogram prematurely at Pumwani Hospital.
"My baby was too small for me to be discharged. I was told that I will be discharged after she gets to 1.8 kilograms," Mumo said. "The baby doesn't take much milk and because I have a lot of milk that make my breasts painful when they are full, I was asked to donate for other babies."
At first, she said she was hesitant because she had never imagined or heard of such an idea. But after the nurse explained that the milk would save another baby if she donated, she agreed.
"I express at least 150 millilitres two to three times a day," she said proudly with a smile on her face. The milk bank unit is part of the hospital's lactation unit operated and run by a counsellor, nurse, and a nutritionist. It has two expression units. According to Njau, these two units are sufficient to meet the hospital's current needs for donating mothers and will be expanded if need be.
"We identify donor mothers during the maternity ward rounds when we educate mothers on how to breastfeed their babies. Only mothers who produce excess milk are encouraged to donate their milk," said Beatrice Marube, Head of Nutrition at Pumwani hospital, adding that donating milk to the milk bank is voluntary.
Marube explained that once the mothers agree to donate their milk, they are referred to the lactation centre where the hospital counsellor takes them through the process and requirements of donating milk.
"At this point a mother would know if she really wants to donate or develops cold feet and turns it down," noted Maribe, adding that because it is a new thing to most mothers, it is important for them to understand that it is a voluntary service to assist other mothers' babies.
Njau said once a mother agrees to donate her milk she is screened for HIV/AIDS, Hepatitis B, C, and syphilis. If she tests negative to all of these, she then fills a questionnaire that provides information about whether the mother has pre-existing conditions like Tuberculosis, diabetes, high blood pressure, or is on any medication.
"Once it is clear that the mother is healthy, she signs a consent form that indicates that she is voluntarily donating her breast milk and that the information she has provided is correct," said Njau, adding that the mother is then given a registration number that is used instead of her real name.
At the expression unit, the mother is shown how to express her milk by the hospital nutritionist.
"The date of donating the milk, the mother's registration number and time of donating the milk is registered in a book," Njau said, adding that the milk is then packed in a 120-millilitre sterile bottle ready for processing. "From the expressed milk, a sample is taken for testing to ensure that the milk has no microorganisms that can contaminate it."
Once the milk is confirmed good for use, it is pasteurized at 63 degrees centigrade for 30 minutes then it is cooled suddenly at 4 degrees centigrade. The process kills any harmful bacteria and viruses in the milk. This process is automated.
As soon as the process is over, a sample of the milk is again taken to the laboratory for testing before it is stored in the ready to use freezer at 20 degrees centigrade.
Dr. Mary Waiyego, a neonatologist at the Pumwani Maternity Hospital and Head of the Milk Bank Unit, said the donated milk is given mostly to preterm babies. She said priority is given to babies born at the hospital who have lost their mothers, preterm babies that are not stable, very sick babies and those whose mothers struggle to produce milk.
"The donor mothers have to be healthy and must have delivered at the hospital before being allowed to donate her milk. She must be producing a lot of milk that is enough for her baby and for donating," said Dr Waiyego. "As soon as the donating mother is discharged from the hospital, she stops being a donor. Also, as soon as the benefiting child is discharged, he or she stops taking the donated milk."
Marube said one of the challenges with the solution is that the hospital currently relies on the donor milk from mothers only admitted at the hospital because there is no established system for collecting and transporting breast milk from mothers outside the hospital.
"Breast milk is very fragile and so it needs a lot of care and attention from the point of expressing it to the storage. At the moment the hospital does not have a mechanism of collecting and transporting milk from mothers outside the hospital," she said.
Dr Waiyego said when they are able to establish a way to transport the milk, they will be able to let mothers outside the hospital donate their breastmilk. The hospital is the biggest maternity hospital in the country.
Dr Waiyego said the human milk bank is a new concept in Kenya, and there are many misconceptions and concerns about donating milk, including concerns about the hygiene of the milk as some people think it can spread diseases to the babies. Also, the solution is still limited to only mothers and babies born at the hospital and so very few mothers can donate milk and few babies benefit from the milk.
Still it has proven to be an innovative way to care for those most vulnerable babies who may not have survived without this intervention. "The milk is only dispensed on the basis of need," Njau said, adding, "What these mothers are doing to donate their milk to other babies is an extraordinary thing. It has saved many lives of babies and has given a good health to them."
Countries like Nigeria which have endemic child malnutrition problems have an opportunity to leverage on the continent's sharing culture and set up breast milk banks. This could help reduce the proliferation of breast milk substitutes and reduce malnutrition in country. Lessons being learnt by Kenya to combat contamination of donated breast milk ampoules, as well as increase donor-culture and reception could help countries considering breast milk banks set up an effective roadmap for action.