Is Bilum A Death Trap?

Carrying babies in bilums is a time honored tradition in PNG. In 2006 there was an article in the Post Courier (26th May issue) about bilums being a death trap for babies in the highlands. You can read the full story here. Briefly, a study done at the Paiam hospital in Pogera, Enga Province, concluded that bilums were a death trap. One of the reasons given was that mothers did not burped their babies after feeding before putting them back into bilums.  As a result the babies’ regurgitated milk went into their lungs and caused pneumonia, known as “aspiration pneumonia” medical terms. The story was discussed in our internet group, PNG Doctors Group, and this is what some our members had to say.

Dr Gunzee Gawain (MBBS) – currently senior registrar (specialist trainee) in obstetrics and gynecology.

“It is interesting, this “bilum = respiratory pneumonia” notion. What is the evidence? Needs something like a randomized controlled trial (RTC) or case-control studies to confirm or refute those notions. Observations are not evidence-based at all. I was raised in a bilum as a baby and proud of the tradition. All my three children grew up in bilums. It is not the bilum that is the cause of the “pneumonia or death” as suggested by the good Dr Granada, although the mechanism described may contribute. One has to consider the following. The higghlands women do not use cardboard or something level to place at the bottom of the bilum and baby blankets or tiny pillows under the babies head to raise it above the level of the chest….. So the baby is curled up like a letter “U”, if you know what I mean, thus, making it difficult for the baby to use his or her respiratory muscles for breathing easily. Try it yourself in a hammock and feel the difference. Could this practice contribute to ‘respiratory pneumonia/death’ is worth researching……”

Dr Ian Garbett – was working with the Baptist mission at Tinsley Hospital in Western Highlands province for some time before going back to England where he is currently doing training in oncology.

“Intuitively I think the causative link with bilum use and pneumonia is very very weak. More important are the nutritional and environmental factors and the lack of vaccination strategy and health education infrastructure. The data shows a decreasing incidence of pneumonia with a decreasing perinatal mortality rate, yet I can only imagine bilum use is stable so bilum carriage if a factor is only weak. In the highlands, pneumonia is very common and banning bilums is purely a cosmetic exercise and fails to tackle any of the underlying root causes. It also encourages a simplistic blame culture that targets a proud and beautiful PNG heritage and mothers which relied on this tried and tested method of baby transport. Bilums are great – save the bilum.”

Dr John Tonar (MBBS) – internal medicine registrar (specialist trainee) had this to say.

“I grew up in pandanus leaf mats and swinging bilums on the tree branches in Simbu…..We are much luckier today, thanks to improved health….in God we trust, everyone else, we need data”.

The conclusion was that bilum per se is not a death trap. There are other factors that cause pneumonia and these root causes should be addressed. Any suggestion otherwise must be supported by properly designed research data that is open for peer review.

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About rodney itaki

I am a medical doctor from Papua New Guinea. My posts focuses on current and emerging health issues in PNG.
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