After Cony Puac delivered her daughter Evany, birthing attendants placed the newborn in her arms and cleared the room.
Born in a remote Guatemalan village surrounded by snow-capped volcanoes, even in the first moments of life, children born with facial clefts are ostracized from society. Evany was diagnosed with a severe midline cleft palate by an orthodontist in her community. An opening at the center of her face spanned from her bottom lip to the space between her eyes. On either side of the opening, her eyes were separated by 38 centimeters — 20 centimeters wider than that of an average child’s. Evany’s nostrils were pushed to the left side of her face in cluster of tissue. At the crown of her head, Evany suffered from several holes in the cranium bone beneath the skin.
Evany also lacked an upper lip, which she needed to receive nourishment early in life through breastfeeding.
When we see cleft in popular media and hear about it in daily conversation, it is usually focused on developing nations and how we can help provide care to those who have none. Along those lines, I’d like to provide a little information about the mission trips both Henry Vasconez, MD, and I do since we both feel cleft care should be something all children and parents should have access to, no matter where in the world they are.
Dr. Vasconez has a mission trip to Ambato, Ecuador, with the Medical Mission Ecuador (MME). There, he corrects cleft lips and palates, but he also repairs many other congenital anomalies including microtia (small or misshapen ear). Other surgical services go as well, including OB/GYN, pediatric orthopaedics and neurosurgery.
I have been to several other countries besides Ecuador. These include the West Bank, Palestine; and Zacapa and Retalhuleu, Guatemala.
Children of the Americas (COTA)
The trips to Guatemala are with a group from Lexington called the Children of the Americas (COTA), which is based out of Lexington. The focus of this trip goes beyond cleft care and includes OB/GYN, orthopaedics, pediatric general surgery, pediatric cardiology, general pediatric medical care, orthotics and dentistry. It is a great group, and you can visit their website to learn more about them.
Sharing my blessings
Personally, there are multiple reasons why I do mission trips, but an overwhelming one is that I’ve been very fortunate. My parents blessed me with the opportunities and the resources to go to medical school. I’ve been blessed with a great, supportive wife and family who tolerated me during six years of residency and then an extra year of pediatric and craniofacial training.
Without the opportunities, support and good fortune, I may not have achieved the ability to do cleft care. I feel very grateful for what I have and want to give back to others as I best as I know how.
This goes beyond the state of Kentucky and extends to other places where they don’t have the resources even close to what we enjoy here in the United States. No matter how different the culture, people’s world views, socioeconomic levels, or resources available, it is always humbling to see to what lengths parents and families will go to in pursuit of the best care for their children.
Traveling abroad really brings into focus how fortunate we are in the United States and shows me how much we owe to our infrastructure and resources around us. With this in mind, although these mission trips can be exhausting both physically and mentally, it renews my desire to help. I find this important in the bureaucratic jungle of health insurance companies, institutional rules and electronic medical records. None of these are bad things – in fact, they are necessary to run the system we are fortunate to have – but they can be taxing and feel very removed from my goals of caring for children.
The logistics of mission trips can be formidable, thus the need to go with an experienced group, such as COTA or MME. Although I may be fixing clefts, none of this is possible without the rest of the team to help provide the necessary support and resources to allow quality care.
Who should be doing clefts overseas?
This leads to another topic: Who should be doing clefts overseas?
Realistically, many people overseas in developing nations require help. If people are willing to donate their time, finances and efforts, then that is a good thing.
However, in the craniofacial world, we firmly believe that unless you do clefts and pediatric craniofacial work routinely in your own practice, doing them overseas may not be in the best interest of the patient.
Unfortunately with cleft care, the best time to get it right is the first time to get it right. Corrections afterward are much harder to accomplish, especially when there is no follow-up, like we would have in our own practices.
Complications are not really acceptable in a mission trip overseas, and the ability to achieve this comes from team and surgeon experience. Unless you do them routinely in your practice at home, you should not be doing them overseas.
Cleft care is my passion and dedication. I draw on experiences and practice to benefit all my cleft kids.
James Y. Liau, MD
Pediatric Plastic Surgery