**Strategies to Optimize Global Cleft Care Strategies to Optimize Global Cleft Care**

Mairaj Ahmed, Yunfeng Xue and Ayisha Ayub Ayisha Ayub

Mairaj Ahmed, Yunfeng Xue and

Additional information is available at the end of the chapter Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/67186

#### **Abstract**

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42 Designing Strategies for Cleft Lip and Palate Care

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Orofacial clefts represent the most common congenital craniofacial anomaly worldwide. This condition is best managed by an interdisciplinary team of specialists, often with gratifying results for both the patient and the care providers. Despite recent advances in the management, it remains a challenge today to provide cleft care in low- and middleincome countries (LMIC) due to the lack of basic health care infrastructure and long-term follow-up. International cleft mission trips have traditionally been successful in providing reconstructive plastic surgery to communities with limited resources. More recently, there has been a global effort in the cleft care community to facilitate development of sustainable local cleft care centers that are capable of providing longitudinal, comprehensive care to the indigenous population. This chapter focuses on the elements that are necessary for running a successful international cleft mission and a local cleft care facility, which include the essential personnel, operational protocols, equipment, logistics, patient selection, and follow-up. The challenges and future directions of providing cleft care in LMIC are also discussed.

**Keywords:** cleft, craniofacial, global health care, international missions, sustainable health care models

#### **1. Introduction**

Orofacial clefts represent the most common congenital craniofacial anomaly, with an estimated prevalence of 1.2 per 1000 people worldwide [1, 2]. Although the treatment of orofacial clefts and other craniofacial anomalies has improved dramatically in developed countries, this is not true for most low- and middle-income countries (LMIC), where the capacity of cleft treatment facilities is lacking and the overall care remains insufficient [3, 4]. More than 160,000 new patients with orofacial clefts are born globally each year [5], placing a significant

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2017 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

economic and psychosocial burden on the individual and the families involved. The burden of care for children with orofacial clefts in LMIC is disproportionally immense due to the severely limited access to basic care. People in these resource-limited regions regularly live with untreated clefts their entire lives, battling with prejudice and social ostracism [6]. A large number of humanitarian cleft care missions have provided corrective treatments to patients in LMIC who would not otherwise have had access to such care. However, it remains difficult to provide global care to these patients due to a number of obstacles, including security issues, logistical obstruction, lack of reliable social service facilities, unsustainable or short-lived local cleft care centers, less qualified local personnel, and long-term follow-up [7].

Until recently, there had not been a set of commonly accepted standards for cleft care in less developed countries. Aiming to fill this gap, in 2006, the Volunteers in Plastic Surgery Committee of the American Society of Plastic Surgeons/Plastic Surgery Educational Foundation undertook the project of creating universal guidelines to improve quality and safety for providing reconstructive plastic surgeries in developing countries. Experienced international cleft surgeons along with representatives from Society for Pediatric Anesthesia created and published a set of guidelines, and the final document has been reviewed and approved by the boards of both organizations [8]. During the same year, Operation Smile, the largest American international cleft organization, independently convened its own conference of experts from each specialty around the world to ensure that every child receives the same first world standard of care in an international mission. The product of the conference was "Operation Smile's Global Standards of Care," which was adopted by over 60 member countries within Operation Smile network [9]. Both documents included comprehensive outlines for each aspect of cleft treatment, including site preparation, team make up, equipment, logistics and traveling, and safety standards so that every cleft child and their family can expect the same level of quality care no matter where they live [8, 9]. They have also provided foundation to the new paradigm of international cleft care, which is the creation of free-standing, sustainable cleft centers around the world, staffed, and operated year-round by both local and international personnel [10–13].

This chapter will briefly focus on the strategies that can help optimize global standards for cleft care, which should be followed when planning a cleft mission or building a selfsufficient cleft care facility to provide optimal and longitudinal care to patients with craniofacial anomalies.
