NUTRITION IN EMERGENCIES

Dispelling myths about breastfeeding in emergencies Myths about breastfeeding can undermine both a mother's confidence and the support she receives. The four most common myths are: Stress makes milk dry up While extreme stress or fear may cause milk to momentarily stop flowing, this is usually temporary. Breastfeeding produces hormones that reduce tension, and calm the mother and the baby. Malnourished mothers cannot breastfeed Foods should go to the lactating mothers so that they can feed their babies and maintain the strength to care for older children. In severe malnutrition, the use of a breastfeeding supplement can ensure increased breastmilk production. Babies with diarrhoea need water or tea As breastmilk is over 90% water, exclusively breastfed babies with diarrhoea do not usually need additional liquids. What is more, water is often contaminated in emergency situations. In the case of severe diarrhoea with dehydration, oral rehydration therapy administered by spoon may be required. Once breastfeeding has stopped, it cannot be resumed With an adequate relactation technique, it is possible to help mothers to restart breastfeeding. This is sometimes vital in emergencies. Women in displacement and emergency situations are at increased risk of breastfeeding problems. They need help, not just motivational messages. Source: BFHI News, UNICEF, September/October 1999. www.unicef.org/bfhi/sepoct99.pdf

Interagency collaboration to address infant feeding in emergency situations

The importance of breastfeeding is well recognized in emergency and relief situations. Artificial feeding in these conditions is difficult and hazardous and leads to increased infant mortality rates. The basic resources needed for artificial feeding such as water, fuel and breastmilk substitute products, are scarce in these situations. Breastmilk substitutes donated as humanitarian aid often end up in the local market and can have a negative influence on feeding practices of infants.

The changing context of humanitarian crises have presented relief workers with new challenges. For instance, there may be a high prevalence of HIV infection and this may affect breastfeeding practices and make wet nursing less advisable; there may be infants without mothers or carers; the crisis may have occurred in an already bottle feeding culture; or some therapeautic feeding programmes may have been admitting significant numbers of malnourished infants under six months for whom traditional treatment regimens are not appropriate.

Many agencies face problems with the appropriate management of infants in emergencies. The Emergency Nutrition Network (ENN) ran a special issue of Field Exchange on this topic in its first publication in May 1997. Many of the common problems experienced by field workers were covered in that issue, for example:

Lack of experience and technical training in emergency work especially on appropriate maternal and child care practices.

Lack of interest in the special challenges of infant feeding in emergencies.

Lack of guidelines in the field for appropriate infant feeding practices in emergencies.

By then, a huge gap was evident in the areas of training and disseminating guidelines for humanitarian workers. One of the key recommendation from the meeting in Split was that training materials be developed.

Work on these training materials began in 1999, facilitated by WHO and by LINKAGES. A core group took the main responsibility; the group included staff from LINKAGES, WHO, UNICEF, IBFAN and the ENN. A first module training pack was produced by March 2001. The Module is intended for all relief staff, both international and locally recruited. It is appropriate for decision-makers, regional managers, logistics officers, camp administrators and all those whose work involves caring for mothers and children. The training pack was presented to the ACC/SCN Working Group on Nutrition in Emergencies in Nairobi in April 2001. UNICEF has since distributed the packs to its country offices. The pack is available for downloading from the ENN web site or in hard copy directly from ENN.

The core group responsible for the development of the training pack was later joined by UNHCR and WFP. It met in September 2001 and is now completing Module 2 for health and nutrition workers. The objective of this second set of materials is to provide this personnel with up to date technical knowledge on appropriate infant feeding, as well as equipping them with the knowledge and skills to positively effect feeding practices.

Another important step in this work has been the development of an Operational Guidance on Infant and Young Child Feeding in Emergencies (often called the Inter-agency Operational Guidance). This document was drafted by members of the Inter-agency Working Group (SCF/UK, LINKAGES and IBFAN). It provides quick and accessible references for non-technical personnel on the “do’s and don’ts” in infant feeding in emergencies.

In the interest of strengthening best practices, agencies were asked to show their support for the Operational Guidance - this can be done on line.

Fiona O’Reilly, ENN: fiona@ennonline.net

Module 1 and the Operational Guidance can be found at www.ennonline.net

Plans for revising the Sphere Project Manual SCN News 22 reported that a workshop was held in Oxford in July 2001 under the auspices of the Sphere Project. Participants included representatives from NGOs, UN agencies, donors, and academic and independent institutions. Attempts were made to determine the need to set minimum standards for food security and what the nature of them should be. The interface between food aid and food security was also explored. All agreed that minimum standards for food security are necessary. Some standards were formulated and indicators for monitoring and evaluation identified. It was clear to all that immediate food needs and livelihood support were two different challenges. Food security in emergencies is somewhat different. Information needs to be analyzed quickly and specifically to determine the severity of the food insecurity. Both food and non-food interventions are needed to address food insecurity and save lives. Some of what was discussed will form the basis of future food security standards and indicators. There was general agreement on the need to revise the food aid chapter of Sphere’s Humanitarian Charter and Standards in Disaster Response. Food aid issues may be incorporated in the food security chapter. However, some participants felt that there are some unique aspects to food assistance programmes, in particular logistics, which need to be covered in a separate chapter. The revised Sphere Handbook will be available late 2003. Next steps will include the identification of a focal point for revising the chapters, the establishment of a working group and peer review group, the production of draft chapter and field testing in 2002, and a final review by the first quarter of 2003. Nan Buzard: buzard@ifrc.org www.sphereproject.org

DORIS HOWES CALLOWAY 1923-2001 teacher, mentor scholar, humanist, friend

On August 31, 2001, in Seattle, Doris Calloway passed away after a long battle with Parkinson’s disease; she was 78. Doris Calloway was an outstanding nutrition scientist, perhaps most widely known for her work, often with Sheldon Margen, on protein and energy metabolism and requirements. That was only one of Doris’ many contributions and perhaps not the most important heritage she leaves behind.

At a Memorial Service held in Berkeley on October 7, it was clear that another of her contributions was the role model she set - for her students and for her colleagues - both in terms of personal values and scientific rigor. Doris had an encyclopedic knowledge and the ability to apply information to real human needs. While holistic in her outlook, she was noted with envy as a meticulous scientist, highly respected for honesty and objectivity in her work. She led the development and application of new methodologies for the quantification of intake and for the collection of body losses in balance studies. Many of her innovative approaches were subsequently adopted in research facilities around the world. The results of the research conducted under her direction have had marked impact on human requirement estimates.

Doris also championed the issue of nutrition and human function, moving out of the laboratory to ask what “adequate nutrition” really meant in terms of the life and function of individuals and households in the developing world. This led her to also ask “what is the human cost of inadequate food and nutrient intake?”. She broke new ground at a time when conventional science was still entrenched in highly-controlled laboratory experiments. Earlier, she had spent a sabbatical working with a native Indian population in Arizona, assessing dietary intakes and attempting to preserve those dietary and other practices that favored health and survival. This was an activity and contribution in which she took considerable personal satisfaction.

As Dr. Janet King said of her, “One of Doris’ missions in life was to improve opportunities for women and members of minority groups. The scientific issues she undertook were often linked to their needs.” Doris Calloway was the first woman to break into the senior administrative ranks at UC Berkeley where she became Provost for the Professional Schools and Colleges (1981-87). Throughout her career she sought equality of opportunity for women. She was also concerned with human rights. During the anti-war protests at Berkeley, Doris Calloway jeopardized her staff position by arguing for students’ right to peaceful demonstration.

Born in Canton, Ohio, in 1923, she earned her BS degree at Ohio State University and her PhD, at the University of Chicago. Her initial research, on protein and energy, was conducted in Chicago. She was persuaded to move to California by a telephone call in the midst of a Chicago winter storm. After a brief period at the Stanford Research Institute, in 1963 she joined the Department of Nutritional Sciences at Berkeley and remained on staff until her retirement in 1990.

In 1972, she was appointed to the WHO Expert Panel on Nutrition and to the Technical Advisory Committee of the Consultative Group on International Agricultural Research in 1989. She served on many other international committees and advisory groups as well. In the United States, she participated in several revisions of the National Research Council Recommended Dietary Allowances and, in 1995, was appointed chair of the USDA Dietary Guidelines Advisory Committee.

Doris Calloway was elected as a Fellow of the American Institute of Nutrition and received the prestigious Conrad Elvejhem Award of that Institute; she was elected to membership in the US National Academy of Sciences Institute of Medicine and was recognized with the Bristol-Myers Squibb/Mead Johnson Award for Distinguished Achievement in Nutrition. With both wry humor and pride, she hung her first award (for work with the US Army labs in Chicago) on the wall in her office for many years: it read “Outstanding Man of the Year”.

Doris is survived by two children from her marriage to Nathaniel Calloway, and by her husband of 20 years, Robert Nesheim and his two children, as well as by nine grandchildren.

George H. Beaton