We teach the Newborn Care Course in different countries of the world and although the language used is English, we do find that some words don’t travel very well. Here in Liberia we have had to change the names of the babies in the case histories because they had a French flavour to them (because of our work in Cameroon) and our Liberian colleagues couldn’t work out how to pronounce “Yves” and “Mireille”. We’ve also changed “cot” to the more American “crib” that they use here and we allow them to talk about “reflex” interchangeably with “tone” when they are assessing the newborn baby. But today’s lexicon stumped us initially until it became clear that “titty water” is in fact breastmilk.
Just about everyone breastfeeds in Liberia. I thought it was because the pregnant women were well educated in the antenatal clinic but it transpires that many women go nowhere near the antenatal clinic. It’s just that formula is expensive. Very few breastfeed exclusively for 6 months as per current WHO advice. World Bank figures for exclusive breastfeeding in babies under 6 months of age for 2013 suggest that 54.58% of these young babies in Liberia are exclusively breastfed (https://tradingeconomics.com/liberia/exclusive-breastfeeding-percent-of-children-under-6-months-wb-data.html). They are given corn cereal mixed with water to supplement the breast milk and sometimes from a very young age.
Early breastfeeding is one of the World Health Organisation’s 4 top priorities for combating high neonatal mortality rates and we talk a lot about supporting breastfeeding mothers during the Newborn Care Course and the importance of feeding expressed breastmilk to the babies on the neonatal units. Our co-instructor, the indomitable advanced neonatal nurse practitioner Kola, pits the mums on his neonatal unit against one another with his 3 hourly cry of “titty water time” when they all have to express 10mls of breastmilk to feed their premature baby down the baby’s nasogastric tube. He says a bit of healthy competition leads to better neonatal outcomes!
We have changed all the “cots” to “cribs” on the Liberian version of the slides this evening but can’t quite bring ourselves to make the required changes to “breastmilk”.