Dr Jayshree Mondkar, Professor and HOD – Neonatology; & Director, Human Milk Bank, Lokmanya Tilak Municipal Medical College and General Hospital, Sion, recently visited Brazil to understand how they run their milk bank and understand their guidelines. Raelene Kambli meets Dr Mondkar to know more about her learnings from the trip
What is the significance of a human milk bank?
A human milk bank is vital for premature babies and for babies whose mothers are not able to provide them milk due to delayed lactation, illness or even abandonment.
How many milk banks in India?
Currently, we have 20 milk banks across India.
What was the purpose of your visit to Brazil?
The reason why we visited Brazil is because they have the largest human milk bank networks in the world. They have about 213 milk banks and 199 collection centres. Not only this, but they are also in cooperation with 23 countries especially, Latin American, Central American, Portugal and South African regions. Brazil provides these countries with technical know-how for milk banking. It follows a low-cost, milk banking model which is what India requires. From India, we were three neonatologists, one dietician who looks after the milk bank in Pune and three people from PATH, an NGO.
What are differences in the milk banking techniques of Brazil and India? What were the learnings from your visit?
We saw their system and realised that it is similar to ours. They were very happy to hear that we have been banking milk for the past 25 years now. The difference lies in the way milk is collected. Our mothers donate in the hospitals and their mothers collect the milk at home, freeze it and drop it at collection centre.
Milk banking is ancillary support to breastfeeding when mothers are not able to provide breast milk to their babies. The whole focus should be on breastfeeding and that’s what Brazil is doing. They have a very good breastfeeding support programme as a result of which they have this network of milk banks across the country. They also have a lot of community mobilisation process in place. Also, in Brazil, this network of milk banks are instituted by the government.
Our other aim in visiting Brazil was to convince the Indian government to have an MOU with the Brazilian government to promote breastfeeding and milk banking in India.
The other interesting learning from Brazil is that they have already met the MDG goals in this area two years in advance.
So, we are just hoping that our government supports this cause and we can increase the number of milk banks in India.
Do you see a reduced rate of lactation among Indian mothers?
At the time when mothers deliver their babies and they are in the hospital, they do breastfeed their babies. But it’s only after they return home that the problem begins. If mothers face a problem in breastfeeding the babies at home, some of them stop feeding their babies due to ample number of advisors who actually confuse the mother.
Human milk has anti-infection properties that can reduce neonatal mortality.
Are there any guidelines so far in India?
Guidelines have been formulated in 2013 by the Indian Academics of Paediatrics and now the government is in the process of drafting initial guidelines. According to PATH, an NGO, the Ministry of Family and Health has been preparing a zero draft (initial draft) for milk banking. PATH is negotiating with the government on this.
What is the process followed for storing milk in India?
Milk is first pasteurised and then it is stored at -20o C. We use the low temperate, long time method which is the older pasteurisation technique. So we pasteurise the milk at 62.5o C for 30 minutes and rapidly cool it at 4o C and then store it. Milk that is stored at -20o C can last for six months.
Are there any states in India that have done better in terms of milk banking?
Maharashtra has done well. Nine out of the 20 milk banks are in Maharashtra. Six are in Mumbai only, followed by Gujarat and the rest of the Western region of India. Rotary Club runs the maximum milk banks in India.
Is there enough government support in this area?
Till now we did not get enough support but slowly there is an awakening.
What are the challenges in running a milk bank?
There is a need for more trained nurses in this area. We also need to establish collection centres. We need not have have many milk banks but if we have many collection centres, milk can be easily transported to all neonatal care centres. This could also be cost saving.
Is it difficult to find donors?
At Sion Hospital, we collect around 1200-1400 litres of milk each year. But this only suffices for our babies. So, if we need to share this milk with our neonatal centres then we need more donors. Here comes the role of media who should spread awareness about this concept and encourage more mothers to come and donate milk.
What should be the standard operating procedures (SOPs) for milk banking?
In India, each milk bank has a standard protocol. We follow a Hazard Analysis & Critical Control Points (HACCP) protocol which includes every aspect of milk banks right from screening of mothers, to testing the milk to storing and donating it.
So, how do we get the private sector also be part of the human banking system?
Private sector hospitals who have mother and child units can serve as collection centres, provide donors as well as space for milk banks etc.
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