On the 19th of August, President Bidhya Devi Bhandari inaugurated the first human milk bank in Nepal. Launched and operating at Paropakar Maternity & Women’s Hospital (PMWH), it was established in cooperation between the Ministry of Health and Population (MoHP), UNICEF and the European Union.

The milk bank has been of benefit to preterm babies or any new born infant. It is of paramount importance that babies be fed their mother’s breast milk for which the babies are usually given to the mother within an hour of delivery for skin-to-skin contact while feeding.

According to Dr Kalpana Upadhyaya Subedi, Head of the Department of Neonatology at PMWH, “Currently in Nepal, babies are given breast milk within an hour of delivery only in 42% of cases. Although this is much higher in our hospital, we still have a long way to go and we hope that the start of this milk bank can help set us in the right direction.”

Following an interview with her, information on the different processes behind the workings of Amrit Kosh has been obtained.

Some babies may be born preterm and in these cases, even the mothers’ physiologies may not be fully developed to the requirement of the baby. In such cases, mothers may have complications that lead to the baby not being able to receive her breast milk, so then the next best alternatives are explored.

If a baby is not able to suck the breast milk out for whatever reasons but the mother is producing milk, then the mother may have her milk artificially sucked out by either an automatic pump or a manual expression pump. Mothers can choose whichever one they prefer. In this way, breast milk can be collected and fed to the newborn.

In some cases, the mother may not be able to produce her breastmilk and in these cases, the next best alternative is using the breast milk of donor mothers. “Although formula milk is an option and has been widely used, research says that human breast milk is the best for human babies,”

“We cannot give the milk from cows and other animals because the newborn baby’s developing digestive system cannot process it and can lead to swelling of the intestines and other complications. This is also a factor resulting in child mortality. So we prioritize human breast milk,” said Dr Kalpana.

First, donor mothers must go through counselling in order for them to give their informed consent. After this, their medical history is screened and they are put through serological testing in order to ensure that there are no cases of infections of HIV, HPV or any other antibodies. If these tests come negative then they are eligible for milk donation.

Milk is collected either through the automatic pump or the manual expression pump, is labelled and stored first in a regular freezer anywhere between 1 – 8 degree Celsius. At this temperature, the milk can be stored for up to 24 hours. When milk from 3 to 4 mothers is collected, they go through something called “milk pooling” where they are put in the same container and are mixed together.

If milk from enough donors has not been collected before 24 hours, the milk may be stored in deep freezers at -20 degree Celsius. Milk pooling can have various benefits. A mother’s milk has a lot of immunoglobulins that will get passed to the baby in order to build up the baby’s immune system.

Some mothers may not have a lot of immunoglobulins, or they may be lacking in calcium or other necessary nutrients. Milk pooling helps homogenize the nutrient contents and increase the quality of the milk to an extent. After being pooled, the milk is set for pasteurization – a process to kill any antibodies that may exist in the milk using heat.

Before going through pasteurization, the pooled milk is put through pre-pasteurization testing to see if any toxic substance from viruses can be found. Although pasteurization kills the antibodies, the process may not get rid of the toxic substances that are secreted by certain antibodies, so if such substances are found then the milk has to be discarded. If the tests come negative, the milk is pasteurized. Around 1700 ml of milk is pasteurized at a time.

In the pasteurization process, milk is heated at 62.5 degree Celsius for half an hour and then for 10 minutes, it is cooled at 4 degrees Celsius. This helps kill all the foreign organisms such as bacteria or viruses in the milk without affecting its nutritious value.

A point to be considered is that immunoglobulins may also be denatured but by the end of pasteurization, most immunoglobulins usually survive. After that, the milk is put through post-pasteurization testing to check for any remaining antibodies. If the tests come negative, then it is finally labelled and stored in the deep freezers.

UNICEF has provided the hospital with deep freezers that are able to create temperatures as low as -60 degrees Celsius. All equipment is frequently cleaned and sanitized, and the multiple testing of the milk ensures that everything needed is done to maintain the quality.

It has been a little over a month since the inauguration of the milk bank and by 25th September, 65 babies had received milk from Amrit Kosh. A milk bank is beneficial in hospitals that have a high number of deliveries every month, so hospitals like Patan Hospital and Teaching Hospital are also planning to create similar services in cooperation with Paropakar Maternity & Women’s Hospital.

With this great, long-needed and long-awaited initiative finally operating, it will hopefully inspire other hospitals in other parts of the country to move forward with such important facilities.