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Northwestern takes a field trip to a Baby-Friendly hospital

Students in Professor Sera Young’s class met with some of Advocate Trinity Hospital’s staff as they toured the facility. (Photo courtesy of Advocate Trinity Hospital)

Early in March, a group of Northwestern students in Professor Young’s “Ecology of infant feeding” class had the chance to visit Advocate Trinity Hospital on the southeast side of Chicago. From the outside, it looks like a regular clinic, but the hospital is really quite special–it’s Baby-Friendly.

Shouldn’t all hospitals where mothers deliver be “baby friendly”? Turns out, out of thousands of hospitals in the United States, approximately 418 hospitals and birthing centers carry a Baby-Friendly designation, according to Baby-Friendly USA.
Trinity Advocate Hospital is one of 17 Baby-Friendly hospitals and clinics in Illinois.

So what does it mean to be Baby-Friendly?

“’Baby-Friendly’ means that the hospital has adopted the practices set forth by Baby-Friendly USA,” said Mary Ann Neumann, A.P.N, M.S.N., R.N.C.-O.B., an advanced practice nurse at Advocate Trinity Hospital.

Baby Friendly USA is an organization that helps implement the WHO’s Baby Friendly Hospital Initiative. Part of the initiative requires adopting ten steps for successful breastfeeding, including allowing the mother and baby to remain together in the hospital, educating women about the benefits and management of breastfeeding and helping mothers initiate breastfeeding within the first half-hour of birth. Through these steps, health workers aim to increase the number of women who breastfeed.

“It is a culture; it takes a lot of work,” said Michele Roe, R.N., B.S.N., M.B.A, N.E.-B.C, the nurse manager at Advocate Trinity Hospital. “Many of our patients come here adamant that they are not going to breastfeed because their families do not support it, in their culture they don’t breastfeed or [they] have never breastfed; so many times it’s a battle for us to change that perception from the family support system and their beliefs…it’s a way of life, so to speak, here at the hospital – you have to live it in order to maintain and sustain it.”

Advocate Trinity Hospital promotes breastfeeding as much as possible, even for babies that must spend time in the nursery, away from their mother. They give mothers recliners and chairs to assist them with breastfeeding. (Photo courtesy of Advocate Trinity Hospital)

Advocate Trinity Hospital was Baby-Friendly designated in January 2016. The process for certification took four years, according to Roe, but already, the community is seeing increases in breastfeeding rates. Such an increase means that more mothers and babies are experiencing the benefits of breast milk, including lower infection rates for babies and reduced cancer risks for mothers, among other benefits. In the long-term, breastfeeding is thought to decrease the risk of diabetes and obesity, two conditions that affect many people in the community surrounding Advocate Trinity Hospital, as well as other areas with limited resources. It’s one of the key reasons why the hospital decided to become Baby-Friendly.

“Where the incidence of diseases are highest and the resources are the lowest is where you see the least amount of Baby-Friendly hospitals and we just wanted to set about changing that in our community,” Neumann said. “If it can be done here then it can be done anywhere –and really that’s where we started – we wanted our community to be healthier from the very first moment of birth.”

Professor Young’s class had the opportunity to hear a little bit about Advocate Trinity Hospital before seeing the structure behind its mission, touring the site’s labor and delivery rooms, C-section recovery rooms and the level 2 nursery. On the path to becoming Baby-Friendly, the hospital had to make some changes, training nurses and physicians on new procedures, creating resources for mothers and modifying the facilities. The level 2 nursery is one example. Most of the windows are covered with pictures and quotes. Inside, the space contains only a few beds, and even fewer babies.

Mary Ann Neumann adjusts a baby warmer in a maternity suite. (Photo courtesy of Advocate Trinity Hospital)

“The most important thing is our goal of keeping moms and babies together from birth to discharge, so where you see on TV shows people going to the window and all the babies are lined up in their cribs at the nursery window – we try to do away with that,” Neumann said. “We don’t just send the baby to the nursery so mom can get a nap or things like that, we keep them together and we promote that bonding breastfeeding and family togetherness.”

Such a short trip, though it didn’t cover full array of resources Advocate Trinity Hospital gives women, before and after delivery both within and outside the hospital itself, provided a new perspective into the world of Baby-Friendly procedures and challenges for all the students. Many of them plan to go into the medical field, including Ann Oler, who wants to become a perinatologist, helping high-risk mothers and babies with the birth process.

“This was my first time being in like a labor and delivery ward and like a nursery which is super exciting because that is probably where I am going to end up spending most of my career,” Oler, a Weinberg sophomore, said. “I got emotional while we were there I almost started crying.”

Neumann and Roe said they appreciated being able to promote breastfeeding practices for another audience, expanding the number of people familiar with Baby-Friendly goals.

“I think for everyone to be exposed to what were doing, what we are trying to do with breastfeeding, it would not only normalize breastfeeding to the general population but [also] focus on health from the very beginning of life,” Neumann said. “Instead of trying to take care of it after the health problems start let’s start by preventing.”

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GlobeMed Panel Discusses Health Challenges of the Syrian Refugee Crisis

GlobeMed at Northwestern hosted a panel Monday to discuss the continuing Syrian crisis and its impacts on the health of Syrian refugees as part of its aims to learn about health and social justice issues locally and internationally. The student group invited Sufyan Sohel from the Council on American-Islamic Relations and Dr. Mufaddal Hamadeh of the Syrian American Medical Society for a brief roundtable in Fisk Hall. Professor Peter Locke asked both individuals questions about their work assisting Syrians in the crisis and actions students can take to advocate for Syrians.

Students at the panel enjoying dinner from Mumbai Indian Grill

Students attending the panel enjoyed dinner from Mumbai Indian Grill.

For nearly five years, fighting and unrest has plagued Syria. Hundreds of thousands have died in the conflict, and many more are now displaced, forced to leave their homes to avoid the violence.

According to the United Nations High Commissioner for Refugees (UNHCR), more than 4.9 million Syrians are registered as refugees. Countries like Turkey and Lebanon have taken in the most Syrian refugees to date, but countries in Europe as well as Canada and Australia are also working to resettle displaced people. America’s involvement in helping resettle these refugees has become less certain. Although the Obama administration aimed to increase assistance to world refugees, Trump’s recent executive order banning travel from seven countries including Syria has cast doubt upon America’s dedication to assisting Syrian refugees.

Sohel and Dr. Hamadeh’s firsthand perspectives on the crisis were sobering. Dr. Hamadeh, whose organization provides care for Syrians, said that nearly endless challenges exist for doctors in the country that used to offer citizens a stable health system.

“The regime, and the Russians also, have targeted health care facilities in the war,” Dr. Hamadeh said. There is a deliberate targeting of clinics, hospitals, healthcare workers…using health as a weapon of war. It was used in an unprecedented way in the Syrian conflict and its very unfortunate because it’s led to a total devastation of the health care system.”

Dr. Hamadeh presented slides on the state of health in Syria.

The direct targeting of health care has led to an underground hospital movement, but the doctors still struggle to find adequate resources to care for the Syrian refugee population, which continues to have a high birthrate.

Many refugees understandably attempt to get out of the situation. Working as an attorney in the Chicago area, Sohel deals with the difficulties Syrians face trying to reach America.

“What people don’t understand is the lengthy process it takes for someone who applies for refugee and asylum status before they’re allowed in, an 18 to 24 month process as it is,” Sohel said. “Those who get on a plane and get refuge once they get here, even for them, they’re getting temporary protected status if they qualify and then it’s a multi-year process for them to become citizens so these are individuals who are heavily, heavily vetted by the government already.”

Trump’s recent attempts to ban travel and heighten security will likely make asylum application even more arduous.


Sufyan Sohel discusses the challenges of applying for asylum in the United States

“We’re seeing the real effects of what this executive order created…the empowerment of a lot of our federal agencies to make these anti-immigrant, anti-minority decisions of not allowing people in and speeding into this mentality that certain groups of people are no longer welcome here and that we aren’t this land that is…open for all communities,” Sohel said.

Once in America, things are still far from easy. Though all Syrian refugees are covered by Medicaid, they have few resources and face large amounts of discrimination, according to Dr.Hamadeh.
Locke asked the panelists how Americans, especially students, could make a difference in light of such a negative picture.

“Everybody can do something it can be something simple by donating five bucks or 10 bucks or maybe giving up your…allowance to help a Syrian refugee kid,” Dr. Hamadeh said. “It could be by spreading awareness and talking to your politicians; it could be by volunteering on medical missions or other missions.”

“Share what you are learning today,” Sohel said. “Speak out against injustices and use the power that you have, collectively use your education, use your influence, to really advocate for these marginalized communities.”

With such a bleak picture painted by the presentation, one student asked how it’s possible for humanitarian groups to carry on their mission. Despite the challenges and seemingly insurmountable obstacles to helping all those displaced, Dr. Hamadeh said he believes that organizations will remain optimistic.

“I can tell you from experience…there’s nothing [more] exhilarating and fulfilling than saving a human life,” Dr. Hamadeh said. “When you go there and deal with the people in need and refugees and you see how much relief you give them and what you can do for even one single life you can never stop–you’ll be addicted to it.”

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Participating in the 4th Annual Intramural Global Health Case Competition

Participants and judges of the 2017 Global Health Case Competition.

On February 18, 2017, Northwestern held its 4th Annual Global Health Case Competition (NUGHCC). Graduate and undergraduate students from various disciplines come together and respond to 21st century global health challenges by developing innovative solutions. Every year, a different “case,” is presented: these could range from infant HIV testing in Tanzania to drug crimes in Honduras. The purpose of this competition is to cultivate awareness about the issue as well as encourage creative thinking and interdisciplinary cooperation. The 2017 Competition brought together 30 students from 8 schools divided up into six teams. The teams then presented their solutions to a panel of judges: Kara Palamountain, MBA (Research Associate Professor at the Kellogg School of Management), Sera Young, PhD (Assistant Professor in Northwestern’s Department of Anthropology) and Maxwell Akanbi, MBBS, MSCI (Center for Global Health International Fellow at the Feinberg School of Medicine).

The 2017 case focused on reducing neonatal mortality in Nigeria by adopting widespread use of an antiseptic gel called chlorhexidine. The case was authored by Kara Palamountain, one of the judges in the panel. Infection and sepsis are among the top leading causes of neonatal death in Nigeria, and the umbilical cord is a major entryway to infection. Because chlorhexidine is cheap, locally manufactured and proven to be effective, the goal was to integrate this drug into Nigeria’s healthcare institutions, culture, and maternal care regime. The six teams each developed a range of solutions, from implementing mass distribution operations to launching marketing campaigns.

The winning team was made up of five members: Maria Clark (WCAS), Sedoo Ijir (WCAS), Emmanuel Darko (WCAS), Max Wang (FSM) and Courtney Zhu (Medill).

This year, I participated in the Case Competition and had the experience of being part of an incredibly diverse, dynamic team. My teammates all came from varying backgrounds with different areas of expertise, and my most valuable takeaway was getting to learn from them. Together, we educated ourselves on the issue of neonatal mortality in Nigeria as well as the sociocultural forces that perpetuate this high rate of neonatal death.

After many group meetings and a mentor session with Peter Locke–an Assistant Professor of Instruction in Global Health Studies, we were named the winning team of the 2017 Competition. Our team’s approach centered around the creation of a birth kit, a unified package of essential items necessary for home birth including chlorhexidine. Sustainability was one of our core values: creating a demand for the birth kit and normalizing chlorhexidine in Nigeria’s maternal care culture. The three-year implementation timeline included tactics such as capturing interest of Nigeria’s key stakeholders, establishing a partnership with a non-profit, non-governmental organization, utilizing effective marketing strategies and finally, launching the production and distribution of birth kits.

From this experience, I gained insight into the mechanism of tackling modern health challenges and realized just how valuable collaboration is in a multidimensional field like global health. The Case Competition–in its entrepreneurial and energetic form–gave me knowledge a traditional classroom could never provide. I learned that every global health operation is like a machine: there are many gears and components working simultaneously in motion.

NUGHCC pushes every participant to put their existing knowledge to practice. It encourages everyone to think imaginatively about global health challenges and how to approach them. There is no single “right” answer. Rather, it is through collaborating that real innovation is born.

The Case Competition is co-sponsored by the Program of African Studies, Program of Global Health Studies, Feinberg’s Center for Global Health, Pritzker School of Law’s Center for International Human Rights and the US Department of Education.

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From Policy to Practice: Body Autonomy and Breastfeeding in the Workplace

WHO Breastfeeding Campaign Poster

How do policies surrounding breastfeeding affect women in the workforce? It is not hard to imagine the difficulties – or rather, impossibility – of breastfeeding without the proper facilities, privacy, or policies in the workplace. According to the Centers for Disease Control and Prevention (CDC), 79% of women breastfeed after giving birth, however only 49% exclusively breastfeed 6 months later (2014).

The Affordable Care Act (ACA) and Family Medical Leave Act include policies that address breastfeeding access in the workplace. The World Health Organization (WHO) recommends exclusive breastfeeding for the first 6 months of life. Breastfeeding has a strong correlation with the lifetime trajectory of individuals and populations, lowering the risk of childhood-related diseases and chronic diseases later in life. The Family Medical Leave Act indirectly supports breastfeeding by mandating unpaid time off for a short period of time postpartum. Yet, low-wage workers and unmarried women are less likely to be eligible for unpaid leave and more likely to be unable to survive on little to no income. The ACA includes a “Reasonable Break Time for Nursing Mothers” which states that workplaces are required to provide a private space (not a restroom) for women to take unpaid breaks to pump breast milk. While this amendment was created to assist women working for hourly wages, studies have shown that these women are least likely to have access to ACA accommodations.

Why is policy not translating into practice in both of these cases? Dr. Elizabeth Dalianis explored this issue for her doctorate in Public Health at Drexel University. She analyzed the relationship between state laws and enforcement of the above federal laws with breastfeeding practices among working women, with a particular focus on racial disparities in breastfeeding practices. She utilized the CDC survey on infant feeding, the first of its kind, and she stratified the data into three separate categories for analysis: states with regional law on breastfeeding in the workplace that include enforcement mechanisms (California, Minnesota, and Connecticut), states with regional law on breastfeeding with no enforcement mechanisms (n=28), and states which only have the ACA federal requirement (n=19). Across the board, longer duration of breastfeeding was associated with regional law on breastfeeding and active enforcement of these laws. In California, for example, the Labor Commissioner investigates complaints from workplaces that do not uphold the standards of the ACA and the state law. If the claims are proven true, there is a $100 fine assessed per infraction. This is not a perfect solution, however, because it places the burden and responsibility on women to self-report on their employers. For those states without any enforcement specified in the law, it was as if there was no law protecting the basic rights of breastfeeding women at all.

The lack of breastfeeding policy enforcement across the United States (in 47 out of the 50 states), according to Dr. Dalianis’s work, leads to a disparity in breastfeeding practices among working women, particularly for low-income and hourly wage-working women. Without the conditions necessary to breastfeed in the workplace, women are denied the choice to breastfeed their children. Body autonomy is an important aspect of any discourse on Women’s Health. Institutions continually under-prioritize women’s rights to body autonomy– by writing laws that are never enforced, or by creating laws that make it near impossible for women to access the health resources that they need. Many women across the United States are forced to choose between breastfeeding and their career, or between breastfeeding and their livelihood. Women with low-incomes do not even have the luxury of that difficult choice due to the institutional devaluation of women’s body autonomy.

While establishing women’s body autonomy is argument enough to support better enforcement of breastfeeding accessibility laws and policies in the workplace, in terms of public health, breastfeeding a baby provides numerous health benefits that last into adulthood. Thus, low-income women’s inability to choose to breastfeed their children can become a powerful form of structural violence that perpetuates social and health inequalities on the population level.

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Can human milk deactivate Zika virus?

On February 1, 2016 the WHO officially declared the Zika virus a Public Health Emergency of International Concern after microcephaly and other neurological disorders became associated with the latest outbreak of the virus. Fifty-three countries have reported an outbreak since 2015, and the CDC reports that there have been 4973 total cases in the United States.

While the virus itself gives cause for alarm, one of the major fears connected with Zika is its ties with microcephaly and other neurological disorders for infants in utero. Pregnant women with Zika have the chance of giving birth to babies with congenital Zika virus syndrome, which can cause anything from malformation of the head to seizures, to hearing and sight problems. 
 With all the health concerns connected to Zika, as well as the growing number of reported cases in the past year, scientists have been busy researching different aspects of the disease, especially in relation to mothers and infants.

A study recently published in Virus Research took a look into the the presence of Zika virus in human breast milk. 
 Previous studies established that Zika virus is present and active in the breast milk of mothers infected with the virus. Despite the revelation, this past June the WHO recommended that mothers continue breastfeeding. According to the WHO, breast milk’s numerous benefits outweigh the risk of passing Zika to the infant. Researchers from the Virus Research study, including Dr. Stephanie Pfänder, a group member of the Virology and Immunology Department of the University of Bern in Switzerland, wanted to dig deeper into the relationship between the breast milk and the Zika virus within it. To do this, they examined the stability of the Zika virus in breast milk to explain its stability over time and find ways to inactivate the virus to make breast milk even safer for infants.

The scientists infected breast milk from three healthy mothers with different strains of Zika. They then stored the breast milk for a period of several days at 4°C. Within one to three days, depending on the donor, the virus became inactivated and no longer able to infect the baby. Researchers hypothesized that fatty acids within the milk damage the viral envelope protecting the virus.

“During the storage process over several days, free fatty acids are released which act [as an] antiviral against the virus,” Dr. Pfänder said in an email. “With our storage, we mimic the release of free fatty acids artificially, however, the same process happens in the stomach of the infant where free fatty acids are being released upon milk digestion which could then act [as an] antiviral against the virus.”

Although the finding indicates that breast milk will deactivate Zika on its own, the researchers also wanted to determine a quick, relatively cheap method to ensure breast milk is safe. They found that pasteurizing the milk at 63°C for 30 minutes made the virus unable to infect the baby.

“We sometimes hear [from] the critics that our approach is quite artificial, as milk is not routinely stored at 4°C for longer time periods,” Dr. Pfänder said in an email. “We do not suggest that mothers should routinely store their milk samples before feeding the infants. However, if a mother has a suspected or confirmed infection with Zika we provide information of how stable the virus could be in the milk sample and how to inactivate it to prevent a possible transmission to the infant.”

The recent findings could prove very important as more of the world faces the threat of Zika, and could help prevent the spread of the virus.

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