Milk is medicine

Staša Jordan, founder of the South African Breastmilk Reserve, tells the story of the hugely successful breast-milk donation initiative she began in 2003, writes Margot Bertelsmann

WHO IS STAŠA JORDAN?

I was born Staša Kersevan in Ljubljana, Slovenia, in 1978, to a multi-ethnic family comprising Croats and Serbs. By naturalisation after World War II we were given Italian citizenship. I studied political science at the University of Cape Town, and I went on to do a master’s degree in public policy design and research at the University of Pretoria. In 2003, I was looking at HIV-positive mothers and investigating human-milk banking, and so the South African Breastmilk Reserve (SABR) was born. Around the same time I was also becoming a mother.

YOU HAVE A 16-YEAR OLD SON, LOGAN, AND A TEN-YEAR-OLD DAUGHTER, SOPHIA.

Yes, it was with the birth of Logan that I was inspired toward maternal and child-health policy and public-health dynamics. This opportunity to engage with public health and the feeding of infants born to HIV-positive mothers is how it all began, and it is the story that today is the SABR.

SO YOU DECIDED TO ESTABLISH A MILK BANK?

My ambition was actually much more circumspect than what the SABR has become. I was able to start working full time for the SABR by 2006 thanks to the seed funding of Philips Avent. The first hospital we serviced was Kalafong, but the word spread, and we had grown to supporting 19 neonatal-intensive-care units (NICUs) by 2008. The Netcare private hospital group came on board, and until 2016 we ran their human-milk reserve, but they now run their own milk bank, Netcare Ncelisa, and donate a substantial portion of the breast milk to the public-sector hospitals. Over the years we set up collection corners with the provincial departments of health: six in the Free State, five in the Eastern Cape, four in the North West, two in the Northern Cape, two in Limpopo and in Mpumalanga, and the reserve bank in Milpark, Johannesburg. We collect breast milk for over 70 NICU public-sector milk banks now – and we keep adding to this, such as a new one at Chris Hani Baragwanath Academic Hospital.

WHAT DOES THE SABR LOOK LIKE IN NUMBERS?

The SABR moves 8 000 litres of donated breast milk per annum through the SABR network in 40 000 containers distributed throughout our facilities. We service public-sector and private banks and two satellite facilities benefitting 100 hospitals in all nine provinces. Since 2003 we have reached more than 21 000 premature infants from over a thousand donors. We employ 24 women with the view to empower HIV/AIDS counsellors with a paid job that otherwise is done on a pro-bono basis.

HOW DO YOU CHOOSE WHO GETS DONATED BREAST MILK?

We supply milk under a universal guideline: infants under 1.8kg, younger than 14 days old, get donated breast milk for a maximum period of 14 days, under the fair-allocation system.

WHY IS BREAST MILK SO IMPORTANT, ESPECIALLY FOR VERY LOW BIRTH-WEIGHT INFANTS IN NICU?

Simply, it saves lives. A lot of our recipient mommies are themselves in ICU and very low birthweight infants (VLBWIs) are at incredibly high risk of sepsis if they are fed artificially. Donated breast milk supports the tiny human while the mother recovers. This has been recognised extensively in paediatric practice. For the last 16 years, we worked closely with doctors, nurses, dieticians and regulators to build the confidence of clinical practice in favour of donated breast milk where mothers’ own milk is not available.

WHERE DO YOU FIND DONOR MOTHERS?

There are often tragic stories of infant loss. Mothers who have lost a baby sometimes decide to donate their breast milk, so that other babies can have a chance at life. It can be a way to deal with the pain and loss of bereavement. I lost a son to SIDS in 2007 when he was nine weeks old. I understand the plight of mothers who are grieving. You may think it was hard to work in the world of babies at that time, but that had been my working world for a long time, and I like to think about the fact that we feed 3 000 babies a year who are discharged alive. Obviously, I would rather have my baby back. But I learnt you can take anything in life and turn it into something better.

WAS THE SABR THE FIRST MILK BANK IN SOUTH AFRICA?

No, iThemba Lethu in Durban and Milk Matters in the Western Cape already existed. We took it to scale. Our model is to have a replicable facility that hospitals can emulate. We believe in setting up milk banks in the NICU because that emancipates the facility.

WHERE DID MILK BANKING DEVELOP AS AN IDEA?

It must have been a sort of global eureka moment. It was just a good idea, so it grew organically.

The growth of the initiative speaks to the outcome. Nowadays, we call donated breast milk a clinical intervention: it is medicine, used for VLBWIs who weigh between 500g and 1.8kg. These babies are at risk of necrotising enterocolitis (NE), which is often fatal. The care for these babies is very expensive, as they can spend up to 16 weeks or longer in the NICU. Breast milk prevents NE as long as the microbiome in the NICU is healthy. If everyone breastfeeds, and there’s no artificial milk in the NICU, then the microbiome in the NICU remains healthy, and the babies don’t become a risk to themselves and each other. It’s like a bag of apples: if one apple has klebsiella, it infects the other apples. Using donated milk in these instances, when a mother was unable to, to keep the environment formula-free, was the best possible solution.

DOES HIV PLAY A ROLE IN DONATED BREAST MILK?

Yes, human-milk banking started at the apex of the HIV pandemic. In South Africa we have one of the world’s highest concentrations of HIV infection: about 7-million people, or almost 20 percent of our population, live with HIV. We now know that mothers on antiretrovirals can breastfeed as long as they breastfeed exclusively and maintain an undetectable viral load, but at-risk premature babies should get breast milk as their gut is immature.

DO YOU HAVE TO TREAT THE DONATED BREAST MILK? AND DOES STERILE STORAGE AFFECT THE INGREDIENTS?

We do pasteurise our donated breast milk. In terms of the pasteurisation process, we have run 100 samples through an analyser, and found that the nutritional composition of the milk is not changed on a macro level. However, breast milk has at least 90 ingredients: enzymes and vitamins and hormones, oligosaccharides and antibodies. Pasteurisation does destroy four out of the five immunoglobulins (antibodies) in breast milk.

But, unlike in baby formula, the nutritional composition of breast milk is bioavailable – this means the nutrients are fully absorbed by the body. Even with pasteurisation, donated breast milk is still far better for VLBWIs than formula.

CAN YOU SHARE SOME CAREER HIGHLIGHTS AND LOWLIGHTS?

A highlight was World Breastfeeding Week in August 2019. Our Minister of Health, Dr Zweli Mkhize, and First Lady Dr Tshepo Motsepe, visited our facility at Kalafong. A low is having to fight an obstructive bureaucratic system, which really impacts my ability to do my work.

WHEN YOU DO THE SORT OF WORK YOU DO, BALANCE IS ESSENTIAL. WHAT DO YOU DO TO ESCAPE?

Bikram yoga – where I learn to deal with any situation whether I like it or not! I also like to go ice skating with my daughter. And I love cooking – you’ll find olive oil and garlic aplenty in my kitchen.