21st Anniversary Celebration at PMC

It's been almost 1 week since I last posted something - mostly because I've been swamped with WABA assignments.  Pretty boring as a blog entry for all but the most die-hard lactation consultants, I'm afraid.  WABA staff wanted to put together a special handout commemorating their 21st anniversary and thought that it would be really good if we could launch the handout's release at our anniversary event scheduled for today, 28 February, at Penang Medical College.  So, in addition to having to put together a stimulating yet academically respectable powerpoint presentation on  the "Evidence for a Life Time of Health" (the research behind breastfeeding's benefits), I was asked to help put together a front-&-back document on "21 Dangers of Formula"  (21 dangers for our 21 years as an international breastfeeding advocacy organization).  Needless to say, it took me a LOOONG time to search via George Mason University Library's research databases for published articles of research studies on all of the 21 dangers. I bet I downloaded and carefully reviewed over 150 articles before including over 50 citations in the final document.  I must say - I am pretty proud  of the final publication.  A young reporter from the regional newspaper, The Sun, was there covering the event and he was very interested in my lecture as well as the 21 Dangers publication.  (His wife is still  breastfeeding their 1 yr old).  Anyway - I think that he plans to do an article for the paper - we'll see.....

As far as the actual event goes: there were about 75 folks in attendance including about a dozen teens involved in the youth action division of WABA, a dozen student teachers from a nearby teachers' college, nurses, government nutrtionists, med students, assundry medical professors, and even some from the general public. Several other speeches related to WABA and breastfeeding advocacy were delivered prior to my lecture, and Aida (WABA staff person) led the teens in a dance routine especially put together to commemorate the day.  So it was already 4pm by the time I got up to speak (the event was scheduled to begin at 3pm but actually started at 3:15 - 'Malaysian time').  I was VERY conscious of not talking too long- but I tried to get the audience to interact with me some, and I tried to intersperse my lecture points with entertaining illustrations....  The usual 'Nancy Forrest' type of lecture, judging from the photos that our IT person Sam posted on our organization's Facebook page. (note my facial expression as I speak)  I think it went fairly well - people graciously said so, anyway.

the Youth performing their dance entitled
"Feed the Future"

We ended with a big chocolate cake for everyone to enjoy. It was delicious!  (Even though it gives its' eaters blue tongues & lips! )

Seberang Jaya Government Hospital, Penang

 I've passed the half-way point of my 6 week stay here in Penang.  And the many tasks I've been asked to do seem to continue to loom in front of me no matter how many things I accomplish.  Yesterday,

standing room only @ my SJH lecture

21 February, was my big debut as lactation lecturer at the district government teaching hospital located on the mainland about 15 km (actually, I have no idea how far it is from me!) from our office.  Seberang Jaya handles 7000+ deliveries every year - almost double what INOVA Fair Oaks hospital handles back home in northern Virginia where I work.  We (Pei Ching, nutritionist from the WABA secretariat, and I) were invited to observe the labor and delivery staff's newly established practice of placing newborns skin-to-skin on their mother's chests within minutes of c/section deliveries.  So Mr Suresh picked me up at my flat at 6:55 am so that I could catch a ride across the bridge to the hospital with one of the OBs, and PeiChing (who lives on the mainland) met me at the OR at 8am.  We were able to observe 2 deliveries and accompanying 'skin-to-skin' experiences - both times the infant was delivered, wiped dry and placed skin-to-skin high up on the mom's chest (above the sterile field barrier) for several minutes before mother discomfort (not infant) caused the infant to be moved to the infant warming table on other side of the OR room, weighed, and given its routine immunizations and vit K shot.  Placing babies skin-to-skin within minutes of birth is one of WHO's recommendations to improve 6 month exclusive breastfeeding rates and decrease infant mortalityrates.  We also were privileged to see one of the mothers reunited with her newborn in the recovery room, approx 30 minutes following the delivery - the baby was placed at her mom's breasts and nursed well for more than 30 minutes.

my lecture - note the IT person(the sole male)

My lecture was scheduled for an hour during the regular monthly meeting time whent all of the OB and pediatric staff gather for policy updates and continuing education events.  My presentation included 3 brief breastfeeding videos embedded into my powerpoint.  Getting the downloaded videos to play for the lecture required the assistance of the hospital's IT person - the guy ended up staying and running my entire presentation for me - so he got to hear a whole lot more stuff about breasts than he ever imagined possible!  And, of course, he had to deal with me - a lecturer who can't stand still or stay in front of a microphone!  At one point I accidentally stepped directly on top of the on/off button of the power strip for the entire presentation - shutting everything off and necessitating a 're-boot'.  "Sorry, Sir.  It was an accident."...
The lecture room was packed - standing room only.  I think there were 60-75 people there.  Although I tried my best to engage them, I couldn't get the participants to offer much information or to ask questions.  But after the lecture, SCN (special care nursery) staff came up and requested that I return in a few days and teach them and mothers of premie patients how to implement Kangaroo Care ( placing stable premature infants skin-to-skin on their mom's chest for several hours every day to enhance their growth and health).  I'm not sure that I can squeeze another such program into my schedule, but I plan to at least send some helpful articles and handouts to them on the topic.

Penang Hill

This weekend I decided to once again use my time away from WABA work to do some sightseeing.  This time it was to take the cable car ride up to the top of Penang Hill, one of the highest points in the small mountain (?is that in congruent?) range that runs along one side of this island.  Penang Hill was originally established by Frances Light (East India company) as Flagstaff Hill in the late 1700s.  The top of the  mountain offers cooler temps (2410 ft) and magnificent views.  I originally planned to travel to Penang Hill on Saturday afternoon and then travel over to the beach area of town on Sunday afternoon.  But Saturday was cloudy and when I headed out the door at about 4 pm on Saturday afternoon the skies looked ominous.  So instead of taking Bus #204 from Komtar as planned, I ended up doing some window shopping at the malls nearby. - There is a French based supermarket called Cannefore (don't know if I've spelled that correctly) and I decided to splurge on some imported REAL ground coffee for myself.  (Delicious, by the way) 

So, after a nice time at contemporary worship Sunday morning, Sunday afternoon was bright and sunny and Penang Hill here I come.  Taking the local buses is really quite easy and inexpensive.  the cable car trip up the mountain cost me 30 Ringgit (about $10 U.S.) but I don't think that I would have made the steep hike up the mountain on foot - mostly because the trail is very poorly marked....  And besides, the cable car ride was fun.  I spent about an hour up on top - very pleasant.  There are old, historic hotels from the days when the colonists got away from the heat by getting to higher elevations.  And there is a mosque and a Buddhist temple.  I wish I had had more time to explore the botanical gardens located at the base of the mountain - they are the oldest (1880s) and most well-maintained gardens in Malaysia. (so says the guide book!).  While I (once again) wished that I had someone to share the adventure with - i met several friendly tourists, including a couple from Singapore who rode back on the bus with me.  Got home, tired and sweaty, just as it began to get really dark and difficult to see.  Another blessed day.

anyway - here are some of the spectacular views from the top - Enjoy!

WABA's 21st Anniversary

WABA secretariat plus me (in my punjabi)

This has been a very active week for me at the office.  Tuesday, February 14th, was the organization's 21st anniversary.  In celebration of the event, Sarah (executive director) threw us a lunch party of U.S. style Pizza -very American-like, I must say - salad, and icecream.  And I was asked to provide the staff with a 30 minute inservice on a lactation topic of my choice - something that would fit into WABA's mission statement: protecting, promoting and supporting breastfeeding.  So I put together a powerpoint presentation entitled WABA's 21 Years of Advocacy: The Global Case for Breastfeeding.  The presentation included the most recent breastfeeding statistics available and some interesting facts were highlighted: Optimal breastfeeding practices (exclusive breastfeeding x 6 months plus complementary foods and breastfeeding x additional 1-2 yrs) could reduce worldwide Under 5 Mortality rates by 19%; Malaysia has a lower Under 5 Mortality rate than the U.S.(6% as compared to 8% USA), but have almost equal childhood obesity rates (24% of Malaysian children and youth are overweight or obese as compared to of U.S. children ages 2-19); and while over 95% of Malaysian mothers breastfeed their infants while in the hospital following birth, only 14% are able to achieve exclusive breastfeeding for the first 6 months of life as recommended by the World Health Organization WHO) - an even greater reduction in rates than the U.S. where 75% initiate breastfeeding but only, similarly, 15% achieve exclusive breastfeeding to age 6 months.  I tried to gear the presentation to the reasons and possible solutions that women worldwide do not sustain successful breastfeeding.  Working and breastfeeding is one of the big challenges worldwide - employers around the world are seldom supportive of a mother's need to breastfeed.  And then there are cultural issues, complicated by zealous infant formula marketing.  I included some humorous and inspiring 'You Tube' public service ads:  you can check some of them out: http://www.youtube.com/watch?v=I1OItm7mA48;  http://www.youtube.com/watch?v=egPSVtID-iA



Penang Ferry - pedestrians ride on top level

In addition to work at the office, I've had the privilege of traveling over to the mainland (via the 8 1/2 mile long bridge, or the bright yellow ferry - I've done that twice now - it costs about 40 cents and takes 15 minutes - a wonderful experience!) to work with obstetrical nurses and physicians at Seberang Jaya Hospital to help them set up their newly established Lactation Department.  It's quite exciting as they are assigning 4 experienced OB nurses to be the lactation specialists there.  Their department is one of the first of its kind in the region (currently there are only 4 internationally board certified lactation consultants in all of the state of Penang!) and 3 of the nurses plus one OB physician all plan to sit for the certification exam this summer, thus doubling the total number! I've spent 1 1/2 days at SJH so far, toured the OB, NICU, and pediatric units and observed the nurses' providing one-on-one consultations, antenatal breastfeeding classes ,and cup-feeding of premature infants.  I will be offering a special powerpoint lecture to all of the OB and peds staff this coming week and providing additional guidance with transitioning premature infants to suckling at the breast. I also learned how to make my own breastfeeding doll and 'demo' breast out of towels, nylon stockings, and cotton batting.  I feel quite accomplished!

Weekend Sights

I asked the hardware store owner to snap my pic

Friday evening I looked at my calendar and realized that I had NOTHING planned to do all weekend.  So I got out my tour guide and some city maps, and made a plan to do the World Heritage site walking tour of the historic Georgetown area of Penang.  And, though I rose from my bed early enough, by the time I did a load of laundry Saturday morning and hung it all up, the sun was high in the sky and i was just heading out the door armed with sunscreen and a full water bottle.  The walk down to Komtar (tallest building in the city) was easy, but I quickly realized that it was HOT!  I stopped at a small hardware store in Chinatown and purchased the only straw hat I saw - which actually worked out fairly well as the brim is very wide and it at least kept me from burning on my face, neck, and upper arms.  First I walked to the ferry, then on down to Fort Cornwallis (built in the late 1780s), and then I continued on into Little India where I purchased a punjabi suit (long tunic type shirt dress with baggy, drawstring matching trousers).  I walked to St George's (oldest church here) and to several Chinese temples and the original colonial state house.  All in all, saw 18 of the 21 sites highlighted on the map.  But it was really hot.  And I was exhausted.  So I waited for almost an hour to catch the free shuttle from the Georgetown historic area back up to the city shopping centre - and the Komtar building.  Then a straight walk back to my flat where I basically collapsed onto the couch (did i mention that it was HOT?!) for a while before getting up the energy to take a luke-warm shower, then off to bed.

Fort Cornwallis

Sunday morning i got up leisurely and headed down to the Methodist church for the 11am contemporary service.  The Australian couple was there and very graciously invited me to join them for lunch at a very nice restaurant in of all places, the Georgetown area!  So I ended up spending a 2nd afternoon seeing more of the historic sites.  Narelle and Craig Collas are both ordained clergy in the Uniting Church of Australia, but it is Craig's position as a chaplain for the Royal Airforce that has brought them here to Malaysia for the next 3 years (they arrived in mid-December).  Narelle will not be 'gainfully employed' while here due to visa restrictions.  We spent a very pleasant lunch time getting to know each other, and then Narelle wanted to take Craig and me to see several artisans' shops that she had recently discovered.  Unfortunately, only the joss stick maker, Mr Lee, and a Vietnamese tile shop were opened on Sunday afternoons.  But we did tour another of the famous chinese temples - Leong San Tong Khoo Kongsi, "The Heritage Jewel of Penang". Following the tour, it was HOT! again, and so we stopped for cool drinks at another really nice spot, The China House.  All in all, a delightful day spent learning more about the rich history of this city with new Christian friends.  I am blessed.

Mr. Lee, jos stick maker

Leong San Tong Khoo Kongsi

WABA

WABA Offices

I've been here in Penang 2 weeks, and I've begun to establish a routine.  Every weekday morning I get up at 6am, have my daily quiet time while the bath water is heating, shower, dress, have breakfast (either hot oatmeal, or a fried egg sandwich, plus some type of fresh fruit), straighten up the flat, pack up and head down at 9am to meet Mr. Suresh, who is ALWAYS waiting for me by the time I get down there.  Traffic is always crazy, but Mr. Suresh gets me to WABA's headquarters always at the same time  - a 15 minutes journey.

the first floor front office with Harjeet & Devi

My upstairs office with Aida & Sam

My desk is up in a large back room office on the 2nd floor of headquarters.  Our building was once the combined office and home of a physician, so it has multiple rooms, a full kitchen and 2 full bathrooms.  I share work room with 3 others of the staff: Aida works on youth and gender issues, Sam handles all the IT aspects of WABA's work, and Jennifer coordinates WABA's development programme.  Most of my day is spent in front of my laptop, researching information, writing documents.  Additionally, I've met with several local physicians to explore ways in which I can provide lactation education and clinical assistance to the health professional community here in Penang.
When Sarah, WABA's executive director, and I set up my practicum objectives, we listed some 'teaching' objectives involving my instruction of local mother-peer counselors as well as medical and nursing students, an objective involving my development of several breastfeeding fact sheets on frequently requested information by breastfeeding women, and an objective involving my review and updating of other health-related breastfeeding information available on the WABA website .  I've gotten a good start on the development of the fact sheets, and I now at least have a topic for both of my upcoming presentations.

This Tuesday, 14 February, is WABA's 21st anniversary as an organization. In honor of this date, the staff have asked me to prepare a presentation for them on recent advances in lactation education. This coming week I will also be traveling across the bridge to the mainland to spend some time at the government hospital, rounding with the staff and developing clinical recommendations for improving their facility's lactation services.  Currently there are only 4 board certified lactation consultants in the entire greater Penang metropolitan area.  And although all Malaysian government hospitals are 'Baby Friendly' and therefore do not provide any artificial milk substitutes to newborns unless clearly medically indicated, the national breastfeeding rate has dropped over the past several years from 29% down to 14% exclusve breastfeeding for the first 6 months.

On every wall of WABA's office,  I see artistic depictions - paintings, sculptures, photos, batiks - of breastfeeding women. Every piece of artwork inspires me to give this professional opportunity my very best effort for I am reminded that women throughout the world share the common struggle of providing the best life for their children, life that is biologically meant to begin with breastfeeding but that often encounters all sorts of overwhelming breastfeeding challenges - challenges that are frequently rooted in cultural biases and political & economic injustice.   Basically stated, overcoming and eradicating these challenges is WABA's purpose.

Needless to say, we (notice that I include myself as part of the WABA 'team') have our work cut out for us.

Party Hearty Penang!

Kek Lok Si Temple of Supreme Bliss

The IlCA/WABA Fellow usually arrives in Penang in late October, early November and stays working with secretariat staff until Christmas or the New Year.  But I requested holding off on arriving until my residency here coincided with my practicum site requirements - I am only able to count hours spent working with the Secretariat that occur within George Mason University's official spring semester calendar.  ILCA and WABA graciously accomodated my request, so I arrived here just in time to take in all three of the country's major religious holidays: Chinese New Year, Mohammad's Birthday, and the Festival of Thaipusam.

The Chinese New Year celebration lasts 15 days - this year it began on 23 January, which means that the 15th day,  and day of the Lantern Festival, was this past Monday, February 6th.  In traditional Chinese families, the day is spent worshiping the Heaven Officer and praying for luck.  Traditional lanterns are made of paper with candles inside. 

Kek Lok Si

Pagoda of 10,000 Buddhas

After spending the afternoon with the Mother-to-Mother Breastfeeding Support group at the local YMCA, I came back to my flat, sticky with sweat and weary.  If I had given into my inclination to take to my bed, I would have missed an amazing experience.  Luckily, my adventurous spirit won out and I hired my weekday taxi driver, Mr Suresh, to drive me over to the largest Buddhist temple of Penang, and even, perhaps Malaysia, Kek Lok Si(Temple of Supreme Bliss). Begun in 1893, the temple continues  today to add to its remarkable pagodas and statues.  Arriving at 6:00pm, I was quite impressed with the sight.  But then, at dusk, the lights came on and WOW - truly amazing!  I spent over 2 hours just walking around.  Only two things were lacking:  a guide to explain what all the shrines meant, and sharing it with my family!  My camera battery ran out halfway through the tour, and I ended up using my Iphone camera.  I also ended up asking a young Chinese girl to take my picture so i could prove that I really was there!  My taxi driver said to meet him at the bottom of the hill at 9pm.  The flow of cars journeying to the temple was almost more amazing than the temple! - Mr Suresh couldn't get back to me to pick me up at our agreed-upon location until 10:20pm.  So I decided to make myself useful by standing there at the walkway entrance on the side of the street, and directed the1st time visitors to the correct path!  I must have pointed the way to over a hundred tourists before Mr Suresh waved me to his taxi.

The Year of the Dragon!

I awoke Sunday morning and truly said "Hurray!  I am going to church today!"  I got up, put on my best sundress and enjoyed the 10 minute stroll down to Wesley Methodist Church, which, although it sports a bright unmistakable UMC logo (apparently a 'blast from the past'), is not a United Methodist congregation: Malaysia Methodism became an autonomous denomination in 1968.  Wesley Methodist has a traditional (English) service at 9am and a contemporary (English) service as well as a traditional (Hokkien) at 11 am - I chose the contemporary service held in the Fellowship hall.

Wesley Methodist Church

And within minutes of entering the worship service, I felt as if I had stepped back into a contemporary service in a small-town church in Virginia - except for the fact that I was 1 of 3 'Anglos' in the congregation.  Most of the songs were about 10-15 years old so i recognized almost all of them.  There were drums, keyboard, and one guitar.  a praise band of 4 young adults, and the worship leader was a young Indian female.  We had to alter the service's order of worship so that the pastor could get there - he was over at the Hokkien service serving communion.  His message, when he finally arrived,  was more 'teaching' than 'preaching',  - I missed hearing David (husband)'s sermon, but I was happy to be a part of Christian community.  Everyone was super friendly, and I had a brief conversation with the middle-aged couple from Australia sitting farther down my row.  The husband is a chaplain with the Australian Royal Airforce, and they have just been here a month.  We exchanged phone numbers and perhaps I'll be able to develop a friendship with the wife, Narelle.  The pastor, Rev. Hwa Jen, invited me to a brief Friday morning 7 am chapel service at the Methodist Girls' School which is located just down the street from my apartment building.  I hope to attend.

Smashing of coconuts to cleanse street

Knowing that Malaysia is officially a Muslim country, I expected that there would be big celebrations on Monday in honor of the prophet Mohammad's birthday - which reveals how ignorant I am concerning the Muslim faith.  Muslims do not attempt to give honor to God through any sort of partying but rather by saying special prayers at their routine daily prayer times.  So, it's not surprising that to me, an outsider here, there did not seem much difference in day-to-day activity around me on Monday.  The major markets were all open for business (perhaps because most of the store owners seemed to be Chinese!), and I was able to obtain the additional 30 day-contract I needed for my mobile modem.  My shopping outing provided me with a hot, but glorious nevertheless, walk to the downtown Prangin Mall plaza.  As I neared the shopping plaza I noticed a large crowd of people singing and dancing.  As I approached the crowds, I realized that people were picking up coconuts from a huge pile of cocunts on the sidewalk, and smashing them down onto the street.  What was this all about?  Later, on my return walk home, I just happened upon the reason for the cleansing of the road with coconut milk (milk is white = purity) -the Holy Chariot bearing the representative of Lord  Murugan, slayer of the evil demon Soorapadman and therefore Universal Granter of all Wishes, is being drawn along the road on its annual journey up to the important temple on the other side of town.  Devotees perform sacrifical acts of penance or petition, called kavadis, which involve carrying heavy jugs of milk on their heads, or piercing their bodies with skewers, spears, or hooks, in order to feel worthy of requesting the granting of a special wish.  This is a major celebration of the Hindu faith - Thaipusam.

the Silver Chariot is in the background

Tuesday, Feb 7th, was the official date of celebration, and Sita, one of WABA staff, invited me to join her family at the local sports' club (formerly the British polo club of Penang) for the traditional Thaipusam meal.  Once again - Delicious!

My First Week - Sharp Learning Curves on Both Professional and Culinary Fronts!

Within 24 hrs of my arrival, WABA's executive director, Sarah Amin, picked me up and took me to lunch, showing me some options for dining out in the immediate neighborhood of my apartment, and beginning my Malaysian culinary education.  We ended up eating at one of the ubiquitous food stalls located near the WABA office -  Due to its multiethnic composition,  Penang boasts some of the best 'local hawker fare' (street food) of southeast Asia, and I've already sampled at least 4 different ethnic dishes, each with its special Malaysian seasoning twist .  Monday,  it was Indian-Muslim cuisine - Nasi Kandar is a meal of steamed rice accompanied by assorted dishes rich in spices.
 


Inside the WABA office

Sarah then took me to WABA headquarters - a former 2-story physicians' office and private home in a suburban neighborhood about a 15 minute drive from the historic downtown Georgetown area.  I met the remaining 6 staff members (Sarah, and Jennifer, who picked me up at the airport the day before make a total of 8 staff - 7 females and 1 lone male, Sam, who is the organization's 'webmaster') and had a brief orientation to the physical layout of the secretariat.

The rest of this week I've been going into the office every morning at 9 am.  I've met with several of the staff members one-on-one so I can learn in detail their specific responsibilities - responsibilities which I am tasked to support.  For example, I am to help Peiching, who, as a nutritionist, is the 'healthcare' staffer in charge of overseeing health-related info on WABA's website, so one of my tasks is to review and update the health information included on the 'Gateway'.
This first week I met some of WABA's key advocates, including Anwar Fazal, who for years worked with the UNDP on urban governance issues in Asia and the Pacific. Anwar was one of the founders of WABA and is chairperson Emeritus.  A native Malaysian, Anwar teaches here at a local university and continues to guide and support WABA.  I also met with another of WABA's local supporters:  Dr. Khoo Siew Farn, 'Jamie' teaches medical students in Penang Medical College's Department of Public Health Medicine.  Jamie has asked me to prepare a presentation for her medical students on recent research highlights related to the health benefits of breastfeeding, specifically, how breastfeeding helps in prevention of cardiovascular disease, diabetes, obesity, and the development of osteoporosis in post-menopausal women.  I am also to present a more practical lecture to community health nurses and nursing students to better equip them in providing lactation support to new mothers in their care.


My taxi driver, Mr. Suresh

Lastly, on Saturday afternoon, WABA's office manager, Devi, picked me up and took me to the monthly meeting of a local mother-to-mother breastfeeding support group.  There I met yet another important breastfeeding advocate for Penang - Dr. Balkees Abdul Majeed, a young female pediatrician  who provides professional guidance to the peer support mother volunteers.

On the 'lighter side' - Tuesday the staff took me to lunch at a Chinese food stall, Wednesday to an Indian food stall, Thursday to a vegetarian food stall, and Friday, to a Malaysian food stall where I ate


Asam Laksa

Asam Laksa, "thick, flat rice noodles in a thick spicy fish-based gravy topped with several Malaysian herbs".  DELICIOUS!