Little Changes Does Matter

I have seen great men. One of them is Nyoman Suartanu. He – for some reason – has put big interest in breastfeeding. He is willing to do what common male not choose to do: becoming breastfeeding counselor. This is – of course – way beyond his task as a chief of public health section in North Jakarta District Health Office. As government person who work closely with Healthy Start Project since 1,5 years ago, he supports the SOS project – competition on Ten Steps to Successful Breastfeeding for Health Facilities in North Jakarta. The seriousness showed clearly not only when he assessed these health facilities, but also when he escorted SOS Project Winners to Faroe Islands.

He felt so blessed to be part of this visit as he got so much lessons of life. “I can see that in Faroe Islands, life is so peaceful that people appreciate nature as the teacher of life” as he told me on the journey back to Jakarta. Our visit to Faroe Islands was in the middle of cold weather, nevertheless, Nyoman saw that its people still do whatever they have to do. “They go along with the rhythm, don’t mind the weather!”

 

Moreover, he said,

 

“I have witnessed that Faroe Islands’ Officials are the one who serve its people. That fact leads me to provide better service to community in North Jakarta. This experience was such a reminder. I am hoping that all the representatives of winning health facilities could implement  what they have been doing in compliance with the Ten Steps, and could get lots of lesson learn from Faroe Islands’ experience to keep trying to make the best efforts for healthier citizens.”

 

I met him again at his office not too long ago and I saw changes. He served his guesses with offering drinks and prepared it himself, he came early to the office only to greet his colleagues – scenes that rarely seen in a leader.

 

He did not leave his heart in Faroe Islands, but he brought back his heart – that has been sharpened there, to be shared to others in his country.

Fine Friendly Faroe

I was there — at a breastfeeding workshop last Wednesday — sitting in the back row, observing the six people on stage as they presented each and every step they had taken to be champions. These six people are representatives of health clinics in North Jakarta who, earlier this year, won a competition about breastfeeding awareness and practices. In this workshop, each representative gave presentations on how they achieved success in the Ten Steps to Successful Breastfeeding at their health facilities.

Their auras were pouring out into the whole room. Their eyes were glowing. Their words were full of spirit. And as they spoke, driven by their hearts — let me tell you, they were amazing!
All six representatives from the winning health facilities, Indonesian government health officials and Mr. Jørgen Niclasen, Faroe Islands’ Minister of Public Affairs, proudly showing certificates of accomplishment. Photo: Irma Sitompul/Mercy Corps

It all started when the Faroe Islands Government implemented a project called Setuju Oentoek Sepuluh (SOS) — which, translated from Bahasa Indonesia means “Agree for the Ten,” referring to the Ten Steps to Successful Breastfeeding. With help from Mercy Corps’ Healthy Start Program and the North Jakarta Health Office, the SOS Project was implemented in 67 health facilities, hospitals, puskesmas (government health centers that include midwives), maternity clinics and midwifery stations. These health facilities joined the SOS competition to promote the Ten Steps to Successful Breastfeeding in the pilot area, North Jakarta.

Out of these 67 entrants, six health facilities were chosen as the most compliant after six months of assessments. These six delegations got the chance to receive an exposure study trip to health facilities and training institutions in the Faroe Islands —a reward that they’d never imagined! I was fortunate enough to accompany them.

Faroe Islands, an island country with a population of not more than 50,000 people, was just outstanding. The 7,400-mile flight from Jakarta really paid off, with beautiful panoramas of green hills, hundreds of waterfalls and the ocean laid in front of us. The enthusiasm grew bigger when we finally met the warm, friendly people of Faroe. Ávirkan nummar eitt! (This is Faroese for “Impression Number One.”)

Our team, which consisted of six representatives from the leading health facilities, four government leaders and four Mercy Corps Healthy Start staff, were all covered with winter coats. It was 4 degrees Celsius and not even winter. For those of us from Indonesia, that was the most freezing experience of a lifetime, yet exciting!

“I am glad I have prepared two coats and two pairs of boots to protect me from the cold!” whispered my colleague Yogiana, from Puskesmas Tugu Utara District, on the day we landed.

But cold did not stop the spirit even a bit. It was like we were entering an amusement park, wanting to try all the rides. We visited government hospitals, clinics, community centers and even houses where Faroese mommies had just delivered babies.

We listened.

Asked.

And learned.

“All the health systems here are integrated. Here, all health services are free,” Barbara á Tjaldrafløtti, our host, mentioned.

The Faroe Islands’ Minister of Foreign Affairs, Mr. Jørgen Niclasen, was the one who greeted us on our first night in Faroe. It was such a pleasure and an honored moment. Ávirkan nummar tvey! (“Impression Number Two”)

“I am fully aware that being here must be cold for all of you, do not blame on the weather, but blame on the clothes,” he smiled. He made us smile. That really broke the ice for the 14 awkward, don’t-know-how-to-act Indonesians who were visiting Faroe Islands for the first time!
An old town in Faroe Islands. They still maintain the traditional culture, growing grass on the rooftops. Photo: Farahdiba Tenrilemba Jafar/Mercy Corps

While eating the very special dishes of Faroe, delicious lamb chops and fine fish, I saw how two different worlds melted together because of our similarities. Both Faroe Islands and Indonesia are formed of islands, which makes the character very similar: friendly, family-oriented and religious. I found Faroe Islands simply unique. Unique because they keep their tradition and mix it with modernity. Unique because it’s nearly impossible for trees to grow and unique because they grow grass on the rooftops instead. Ávirkan nummar trý! (“Impression Number Three”)

The experience will always stick in our minds and hearts. The experience where togetherness is important, where love has to be shared, where appreciation is held high, where responsibility is highly respected, where efforts are highly valued.

“I’ve seen with my own eyes how they appreciate their beautiful nature as they worship their God. I’ve learned how they revere life as their basic ground of living,” said Nyoman Suartanu, one of team members from the North Jakarta Government, over and over again as he was really emotionally moved.

And so — as witnessed by us — there were six agents of change, standing at the podium, their commitments was being transferred. The three memorable days they spent visiting Føroya were being disseminated to other health facilities, government and key community members that are willing to change. These champions were communicating change to give preventative services to their communities, change to be supportive for breastfeeding and change to be compliant with the Ten Steps to Successful Breastfeeding.

 

can be read also here

 

Ask Me, and I Will Follow You Down

How do you recognize a midwife who’s already trained to be a breastfeeding counselor? And who do you ask about breastfeeding if you go to puskesmas, local health facilities around Indonesia?

Those two questions became apparent when Mercy Corps’ Healthy Start Program had already trained several midwives as Breastfeeding Counselors. How would we differentiate them with the ones who had not been trained? After all, there are many midwives around the neighborhoods and villages where we work, and not all of them have been trained.
A press conference, held jointly by Mercy Corps and the North Jakarta government, launches the “Kasih ASI? Tanya Saya!” poster and badge campaign to support the Healthy Start Program, raising awareness of proper breastfeeding. Photo: Elpido Soplantila/Mercy Corps

So last year, with the help of a graphic designer and communication consultant, we invented a badge that can be pinned on every Breastfeeding Counselor’s shirt. Designing and making the badge took more than a year, just to make sure that everything was right. We took lots of steps along the way.

First, we had to match the objective of the badge-making with the design. The objective of the badge is to be the sign of a trained Breastfeeding Counselor. It is to recognize their existence and importance in the community. It communicates that, now, there is a trust person who can answer all questions about breastfeeding for mothers.

Second, the design. The logo and tagline needed to be catchy enough to grab people’s attention. The combination of color was also an important aspect. I conducted several focus group discussions just to measure accuracy and perceived meaning of the logo and design. We wanted the badge to capture the image of bonding between a mother and her baby, as well as support from the mother’s environment, such as family, counselor and health provider, and government.

Third, the tagline presented another challenge. Our aim of making the badge was to make people start asking while they see or read the words “Kasih ASI? Tanya Saya!” In English, this means “Breastfeeding? Ask me!”

We are fully aware that the challenges of breastfeeding cannot be countered with just a badge. These challenges need specific and tailored answers for the questions, problems and situations of each mother. But we hope that this badge will make people start asking these trusted Breastfeeding Counselors about breastfeeding.

Today, the badge has become the true sign of every Breastfeeding Counselor and Motivator. They wear it with pride and honored.

“People recognize me as the woman on the train who’s received training as a Breastfeeding Counselor,” said Ibu Ita, who always rides the train to get where she needs to go in Jakarta. As a member of the Midwives’ Association who received training through Mercy Corps, mothers now recognize her as someone who knows a lot about breastfeeding and is willing to answer any kind of question about breastfeeding.

“People started asking me, ‘what is that badge that you are wearing? And what’s the meaning?’” another midwife told me.
Ibu Tatiek Fauzi Bowo, the wife of Jakarta’s Governor, wears a Breastfeeding Counselor’s badge in support of Mercy Corps’ Healthy Start Program. Photo: Julisa Tambunan/Mercy Corps

Even if people don’t know the meaning of the badge, at least they are questioning about it. That’s also the purpose of the badge, to make people start to wonder about it. Once the Breastfeeding Counselor realizes that people are staring at the badge, then they can start talking about their work. Interesting, eh?

On a few occasions, we’ve even pinned the badge to Ibu Tatiek Fauzi Bowo, the wife of Jakarta’s Governor. Two years ago, she became an ambassador for Breastfeeding Counselors in Jakarta. We also pinned the badge to Jack Newman, a breastfeeding expert from Canada who came to Jakarta to give seminars in celebration of World Breastfeeding Week 2009. He wore it with pride every day during his time at Jakarta.

If they lose the badge, the Breastfeeding Counselors immediately ask for a new one. Because now, they would feel empty without the badge on the right side of their uniform.

There are 239 Breastfeeding Counselors spread throughout Jakarta, as well as 458 breastfeeding motivators in North Jakarta, who have been trained by Mercy Corps’ Healthy Start Program and its partners.

“We are ready to answer anything about breastfeeding, here is the proof!” said many motivators and counselors, pointing to their badges, when I met them during World Breastfeeding Week, which took place last month. It was the first event that gathered all the counselors and motivators in Jakarta.

Let’s hope that the more people see the badge, the more questions they’ll ask.

posted also here

Being a Lactation Counselor: A Dedication to Your Proffesion

Ibu Lilis Ratnasari, a private midwife, received a 40-hour training in lactation counseling through the World Health Organization (WHO) and UNICEF about a year ago. More recently, she shared her experience at the first Jakarta Counselor Forum, which was conducted by Mercy Corps in cooperation with the North Jakarta Government.

Her enthusiastic gestures filled the 14th floor of the North Jakarta Mayor’s office, as she began to tell not only of her achievements but also about her challenges as a Lactation Counselor.

After she trained to be lactation counselor, Ibu Lilis says she never forgets to remind every mother she meets to breastfeed. Not only that, she has made time to give counseling to each of them, in order to make the mothers around her confident in breastfeeding.

“I realize my neighborhood has not given full support to breastfeeding practices yet, but at least I am doing my part as counselor, which is to give counseling one by one to every mother that comes to my clinic,” she said.
Ibu Lilis (with microphone), a Mercy Corps-supported midwife and lactation counselor, talks about the challenges of her job at a recent forum. Photo: Farahdiba Tenrilemba Jafar/Mercy Corps

So naturally Ibu Lilis, 33, who opened a clinic called “Sunter Jaya Baru” in Jakarta’s Tanjung Periok neighborhood a month ago, was sad to see one of her patients drowned in a lack of confidence in breastfeeding.

“I told her everything about early initiation (for breastfeeding) while she still pregnant. She‘s the smartest patient I’ve ever met. She was so confident to give her child breastmilk and willing to do the six months’ exclusive breastfeeding once she delivered. I never thought she would give up just like that,” Ibu Lilis explained.

But more challenges were presented with the 25th patient that came to her clinic. This patient’s baby’s body temperature got higher on his second day of life.

“I convinced the mother to keep breastfeeding, that would make the temperature go down. But the grandmother was worried, then pushed me to give formula instead,” Ibu Lilis said.

After the mother’s family pushed to switch the newborn baby to formula, Ibu Lilis suggested that the mother go to a pediatrician at the nearest hospital to check on the baby and give another opinion. As a lactation counselor, she never wants to give formula, ever. The clinic where she works does not even have any correlation with a formula company, as she learned from her last experience working at Maternity Hospital, which had a contract with a big formula company.

“I learned from the training that we can not have any collaboration with formula company. It’s against the code that I’ve now taken,” Ibu Lilis explained.

Through committed women like Ibu Lilis, Mercy Corps’ Healthy Start Program is trying to touch mothers willing to change the behavior and commit to a healthier beginning for their infants. Together with the Midwives Association and North Jakarta District Health Office, Healthy Start is not only conducting training for health providers and government staff, but also training for community volunteers to become Lactation Motivators and run Mother Support Groups in some of Jakarta’s poorest neighborhoods. Last but not least, the program also fights for policy changes to create a more supportive environment for breastfeeding.

“I feel so blessed for being able to join the training,” Ibu Lilis said. “I got the networking that I’ve been waiting for, including connections with pediatricians. It makes my work easier. It was also easier for me to get the legal authorization to open myprivate midwife practice. I will pass this breastfeeding knowledge to everyone I know for the rest of my life.”

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Introducing a New Way of Promoting Breastfeeding

The data from countdown to 2015 maternal, newborn and child survival in Indonesia said that the intervention coverage for exclusive breastfeeding is decreasing from 42% in the year of 1997 to 40% in 2003 (based on DHS). That led us to a big question why is it falling? – while the data from KPC Survey[1] mentioned that children 0 – 23 months who ever breastfed is 97%; which means in Indonesia, breastfeeding is such a culture, no body doesn’t know about breastfeeding and everybody knows that breastfeeding is the best for babies. These two facts are so contrary. What happen on breastfeeding here in Indonesia? Is it because the advertising on formula milk so bombastic? Is it because parents lose their sensitivity of the importance of breastfeeding? Don’t they recognize that in Indonesia, neonatal deaths represent more than 40 percent of under-five mortality[2]? Don’t they realize that 10 babies died every hour?[3]  Don’t they notice that out of 22 cans of formula got checked, 20% contaminated?[4]

 

There were uncountable promotions on how good breast-milk is. There were excessive advertising on breastfeeding could save more money. There were massive campaign that breastfeeding is better than cow-milk, and so on, so forth. For the past 20 years these information had drove people to understand ONLY it. No digging further. No probing more on the essential meanings of breastfeeding. In the other side of the world – sadly, the formula companies keep bombarding trough interesting, sophisticated and explosive advertising on their “cow-best-formulated” milk. People are getting groggy and unsteady. People are getting lack of motivation and self-confidence. People are worried more and more on giving breastfeeding, which again led them to choose a save and easiest way, that is: preferring human-invented milk over the human-milk.

Aware of this “fun” fact – and to address the missing parts in promotion breastfeeding for such a long time – the invention of a different approach of promotion and campaign needed.

 

Another fact needs to be revealed – which put a big intervention on why the past promotion didn’t succeed – behavior of ASKING is not a common, frankly, is not a norm for Indonesian. Many got scared of questioning some doubts. Many worried got stamped unintelligent in their forehead if asking too much[5]. Indonesian is raised not to be courageous enough when they meet difficulties, particularly personal matters, including breastfeeding.

Breastfeeding is known as a culture, even from old era – back then, no other choice except to breastfeed. Mother knew that they could provide the prestigious liquid coming out from their breast that could make their children healthy and alive. It is also known as a tradition – a natural intuitive of every woman. Even though at the end of the day, those women could only predict instead of comprehend why must breastfeed. The problem would be more complex if a person goes along with the tradition without knowing the reason why she does it. That is why more and more people confused and fall into a wrong hole – the distraction of comprehensive and persuasive promotion on formula milk.

Aware of another “fun” fact above, the invention of a different approach of promotion and campaign AGAIN needed.

 

The findings on Mercy Corps formative research done on March 2007, mothers – more than 50 randomly-chosen-mothers in Northern Jakarta Indonesia – intend to have frequently asked questions: “why my breastmilk is not coming out?” “Why my breastmilk is not enough so my baby keep crying?” “Is it okay to mix-feeding breastmilk and formula milk?”, and many more. Of all questions, nothing would have the same answer. Nothing could get the same counseling. No prescribe messages of each question of each mother.

This finding guides to one more “fun” fact about what happen on breastfeeding in Indonesia. Again, need different approach.

 

The existence of breastfeeding counselor was not popular enough that even they are among the community, still people don’t recognize them. People intend to ignore that there is help available in their area. In Northern of Jakarta, the number of those breastfeeding trusted source approximately 89 persons from health facilities by the year of 2008. Not only that, spreads in four villages in North Jakarta, there are 96 women (and keep growing up)[6], who are willing to be motivator voluntarily and be facilitators for mother support group in their own neighborhood. This fact lead to the need of promoting these trusted sources as the best way to communicate about breastfeeding. The result is, more and more mothers know what they wanted on breastfeeding, so it creates more demands, for example, the demand on doing early initiation (breast-crawl). So then, it overcome health provider’s knowledge, competence, and practice on helping mother’s deliveries.

 

Combining all the fun-facts that could not be resisted, the reconciliation of special tailored campaign is introduced. Holding to a belief that whoever heard the deeper information on breastfeeding must be interested to know and learn more about it.

 

The invention on “BREASTFEEDING? ASK ME!” revealed. It is made to stimulate people to ask more about breastfeeding. It is made to disseminate the information that there are trusted source as their local support. Why “breastfeeding? ask me!”? refer to characteristic of asking was such an uncommon habit, no prescribe messages on countering breastfeeding challenges, because there were no such generic answer which make people wanted to ask more and to know more.

 

The word of “ask me” refers to breastfeeding counselors as their trusted sourced to give optimum information, support, and counseling to mothers. Meeting with breastfeeding counselor becomes a private moment for mothers to counsel or even share their stories and experiences. Moreover, counseling could boost mother’s confidence to stay breastfeed.

 

To deliver the right messages, trying a new, different and tailored poster among the existence ones is the first step of creating this supportive change. The purpose of the poster is to suggest action. The design of the poster is also costumed, like no other poster who used to put many sentences, this poster is with no detailed and long information. Another costumed design is the chosen color, no baby pink or blue – again like other existing posters – other than two contrasted colors – black and light orange. The meaning behind no soft colors was showing how breastfeeding could also be a challenge until you ask and figure solution.

 

Completing the poster, to recognize the existing trusted sources – breastfeeding consultant / counselor / motivator – as referring to “ask me” line, “breastfeeding ask me” badge invented. People would know whom to ask and be the “friend” of finding solution of breastfeeding concerns and challenges.

 

Therefore, with this new way of promoting – “breastfeeding? ask me” poster and badge – the willingness of asking about breastfeeding to counselor would improve, and the expectation of the optimum breastfeeding period would be created as the way of protecting, promoting and supporting breastfeeding around the world.

 

[1] Done by Mercy Corps Indonesia 2006

[2] http://www.unicef.org/infobycountry/indonesia.html

[3] SDKI Survey 2002-2003

[4] IPB University Research. February 2008.

[5] Formative Research of Mercy Corps Indonesia. March 2008.

[6] Monitoring and Evaluation’s Healthy Start Project of Mercy Corps Indonesia. December 2008.