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National cleft mission teams may be most cost-effective option in countries with limited resources

According to researchers, the development of locoregional cleft mission teams may be the most cost-effective and robust way to provide access to care in countries where expertise is available but resources are scarce.

In an article published in the Plastic and Reconstructive Surgery — Global Open journal, the researchers presented a case series in which a cleft mission protocol was carried out in Khairpur, Pakistan, during a 1-week period in March 2014, where 145 patients underwent cleft lip surgery and 167 patients underwent cleft palate surgery. Patients’ mean age was 7 years.

The mission began with a public awareness campaign 1 month prior to the surgical period, during which time banners, posters and pamphlets were hung and distributed. Radio and cable TV ads were also used to educate the public on cleft care, and advertisements were published in local papers.

Three operating tables were set up in two operating rooms (ORs), with all of the equipment required to set up the ORs brought in from a cleft center approximately 300 miles away. OR staff comprised four anesthesiologists, five surgeons, six surgery assistants, two anesthesia paramedics and two circulating faculty members to assist the team members.

On the seventh day of the surgical period, the patients’ sutures were removed. One month later and again at 3 months, the team visited the hospital for follow-up visits.

All patients with cleft palate were also visited by a speech therapist to help improve their speech, and additional follow-up was scheduled for 6 months and 12 months postoperatively. Overall, 16 patients developed fistulae/dehiscence after cleft palate repair, according to the researchers.

The researchers reported that this type of system is perfect for countries like China, India, Indonesia, Brazil, Pakistan, Iran and Thailand, where surgical expertise and services are available, but the health care system cannot handle the influx of patients.

Additionally, the researchers stated that cleft missions can be organized in a more-effective way so that international missions can solely be directed to serving the poorest and most-deserving countries only. – by Abigail Sutton

Disclosure: The researchers report no relevant financial disclosures.