Scrolling through my Facebook page, I came across a post from Tracy about a woman who needed breast milk for her brother’s premature quadruplets who could only digest breast milk.

Being a Rhesus negative mother and my spouse positive, not only have my births been difficult but the babies have had severe jaundice. Consequently, I have been a neonatal intensive care unit (NICU) mother. One of the hardest times was with my second born who suffered severe jaundice that almost killed her. Owing to a caesarean birth and the stress of a very sick child, my breast-milk supply betrayed me. At some point, the doctor said all had failed and we needed an O negative blood donor but failed to get one, not even from the blood bank. It was after posting my WhatsApp status that a friend’s friend agreed to donate. Having been in a place when I cannot feed my baby, when I saw the call for breast milk, which I had in plenty, I decided to give back. I called the number, had my blood tested and started pumping for that family.

Asher N Faikah, was ATTA’s first donor mother. Her four-month-old son Jahan Jaheed, the third of her four children, shared his breast milk with preterm quadruplets. Between June 9 and July 3, 2021, she was able to donate 180mls every day, helping the quadruplets gain more than 2kg each.

According to World Health Organisation (WHO) and the United Nations Children’s Emergency Fund (UNICEF), babies should start breastfeeding within the first hour of birth and be exclusively breastfed for the first six months. Exclusive breastfeeding in this case means giving the baby no other foods or liquids, including water.

However, in some cases, the mother may not be in position to hold the baby, which may delay the production of breast milk. Unfortunately, even with enhanced lactation support, a mother may fail to produce sufficient breastmilk for the infant’s needs; in which case WHO recommends safely donated human milk, preferably from a milk bank, which Uganda does not yet have. This is one of the reasons Tracy K Ahumuza started ATTA; a combination of the initials of her daughter’s name, Alyssa Marie Taha and hers; Tracy Ahumuza.

Ahumuza gave birth to a little girl who needed surgery at birth. However, she had no idea the baby would require exclusive breast feeding yet due to the C-section, nature and frustration, her breast milk production delayed, and she was advised to find a donor, which she did. “Unfortunately, Alyssa passed away when she was three days old. A few days later, my milk started flowing and I wanted something good to come of this tragedy thus the desire to donate the milk. I searched online for the only milk bank I knew but found out it was not operational and if I wanted to donate, I had to drive to the hospital on the other side of town and there had to be a baby in need at the time. With no baby at hand, I was given a pill, bromocriptin, to dry up the milk,” she shares the genesis of the idea for ATTA Breastmilk Community.

Upon hearing her idea, Ahumuza’s bereavement counsellor, Denise Kekimuri ‘Kecho’ of Vessel is Me, who is in contact with many mothers encouraged Ahumuza to start ATTA. Kecho’s first assignment was the set of preterm underweight quadruplets on June 9, 2021. The donor, an old school friend, Faikah, reached out, agreeing to donate to the babies.

Going forward, after testing, ATTA matched donors to families. Overtime, it became more realistic to protect the donors. “Donations are free of charge. It did not make sense for a mother to suffer the extra inconvenience of leaving their houses and new-borns to go to hospitals during a pandemic-induced lockdown. We, thus, employed the services of Rocket Health who go to the donor mothers and test them in the safety of their homes. After the results are shared with us, mothers are taken through the donation process,” she shares.

On the flip side, some mothers, especially those in lower income communities or even in hospitals want payment for their milk. However, according to international standards, breast-milk is considered to be human tissue and thereby illegal to sell. “We reach out to people the same way the blood bank does and request for donations. Once money is put in the equation, it is easy for donors to contaminate breast milk with, say, cow milk to get more ounces,” Ahumuza says.

That said, currently, ATTA is working with Mbale Hospital’s Neonatologist, Dr Kathy Burgoine, while doctors and mothers have reached out directly to find milk for the babies in their care. They are still working around partnerships with Kampala hospitals in order to work directly to assist mothers in need. “We have also donated nine litres as a one-off to a private hospital in Kampala,” she says. Currently, they have about eight low birth weight babies under their watch, while three graduated, last week.

The community gets donors when they sign up via a google form on social media or they reach out via WhatsApp then the community sends them the form to fill out.

The process consists of recruiting a donor, testing them, collecting milk and sharing it with the mother or babies in need. A boda-boda rider does the collection with a cooler box having icepacks dedicated to this. “He picks the milk and then delivers it to the mother who must sign consent forms to receive the milk. After three months of donation, donor mothers are let go or retested if they are interested in continuing. On the other hand, the recipient mothers are encouraged to get support from a lactation consultant to breast feed because donation is a temporary measure,” Ahumuza clarifies.

ATTA is raising awareness of breast milk through social media and presentations to relevant mom-dominated communities, as this is a mother-led initiative. “Our lactation Consultant, Dr Doreen Mazakpwe also speaks on the value of breastfeeding and donation because the two feed into one another. We will keep using social media as we work on recruiting donors during the antenatal process,” she shares. The ATTA team includes a lactation consultant, paediatrician, physician pharmacologist and a neonatologist, among others.

Challenges

Ahumuza says one of the challenges they are facing are hospitals that insist on making donors go to their premises thereby exposing them to potential health risks such as Covid 19. She adds that the cost of testing donor mothers is high at Shs90,000 per donor.

There is also no guarantee that the donor will be able to donate throughout the three-month donor period window and high transportation costs from homes of donors to recipients (recipients cover this cost). In such cases, it would be best if the milk came from one location, such as a milk bank.

Future

ATTA aims to have a milk bank that recruits and tests mothers for pathogens, has milk pasteurisation and storage so milk is available on demand and equitably accessible for the smallest babies who need the milk the most.

Between July 9 and September 2021, ATTA has acquired 15 approved donors, helped 24 new-borns, shared 38 litres of milk, worked with nine specialists, had six hospitals matched to donors while they have raised $3,313 for the milk bank.