**3. Protocols**

Generally, competent surgeons, anesthesiologists, craniofacial orthodontists, and nursing staff each have their own particular way of doing things. This is especially true for professionals who work in different parts of the world. This presents a unique challenge when the team is composed of healthcare providers with diverse backgrounds. In these circumstances, setting priorities and following protocols during different phases of care can help focus the personnel into a more coherent group. Protocols also ensure consistency and decrease the margin of error in most circumstances. For instance, operative protocols could recommend certain procedures to be used by all surgeons for patients with cleft lip and palate (e.g., assuming acceptable blood reports, primary lip repair at age 10 weeks, followed by Furlow double opposing Z-plasty at the age of 10 months). Nasoalveolar molding, craniofacial orthodontic, and dentofacial orthopedic protocols could be standardized in terms of biomechanics and timing of treatment. The anesthesiologists might suggest protocols on intra- and post-operative pain management. The nursing team might recommend certain staff to patient ratio in the post-operative recovery ward. Compliance with these protocols is imperative to the success of a mission trip or permanent craniofacial care facility, and should be well articulated to each team member from the start. However, it is important to keep in mind that changes in the protocol are permissible under circumstances where it does not apply properly.

#### **4. Equipment**

In general, the equipment and supplies needed in a developing world hospital are not different from the ones needed in a modern hospital. Acquisition, preparation, shipping (in case of cleft mission), deployment, and maintenance of equipment are a big challenge for both permanent craniofacial care centers and organizations that aim to provide cleft missions. At minimum, complete surgical trays, sutures and dressings, reliable anesthesia equipment, resuscitation packs, perioperative monitors, and sterile materials are necessary for the cleft repair operations regardless of the practice setting. Care should be taken when using medications and instruments purchased in the host countries, especially if the instructions are not in English or if they are unfamiliar pharmaceutical formulations. A partial list of recommended supplies and equipment for orofacial cleft care centers are listed in **Table 1**.


• Blood supply

• Defibrillator and other appropriate emergency equipment

	- Arrangements for glucose level measurement
	- Oxygen and suction equipment at each bedside
	- Vital sign monitors with pulse oximetry
	- Suction equipment
	- Documentation system
	- Hard acrylic
	- Soft acrylic
	- Water bath
	- Boley gauge
	- Orthodontic spatula
	- Utility wax
	- Three-prong plier
	- Light wire plier
	- College plier
	- Scalpel
	- Orthodontic wire
	- Dental impression material and cast
	- Appropriate suture material
	- Sterilization material
	- Illumination
	- Suction machine
	- Electrocautery capability
	- Electronic monitors
	- Respiratory ventilators

team is composed of healthcare providers with diverse backgrounds. In these circumstances, setting priorities and following protocols during different phases of care can help focus the personnel into a more coherent group. Protocols also ensure consistency and decrease the margin of error in most circumstances. For instance, operative protocols could recommend certain procedures to be used by all surgeons for patients with cleft lip and palate (e.g., assuming acceptable blood reports, primary lip repair at age 10 weeks, followed by Furlow double opposing Z-plasty at the age of 10 months). Nasoalveolar molding, craniofacial orthodontic, and dentofacial orthopedic protocols could be standardized in terms of biomechanics and timing of treatment. The anesthesiologists might suggest protocols on intra- and post-operative pain management. The nursing team might recommend certain staff to patient ratio in the post-operative recovery ward. Compliance with these protocols is imperative to the success of a mission trip or permanent craniofacial care facility, and should be well articulated to each team member from the start. However, it is important to keep in mind that changes in the

protocol are permissible under circumstances where it does not apply properly.

supplies and equipment for orofacial cleft care centers are listed in **Table 1**.

**Screening and assessment** • Vital sign monitors

**Anesthesia** • Anesthesia machine

In general, the equipment and supplies needed in a developing world hospital are not different from the ones needed in a modern hospital. Acquisition, preparation, shipping (in case of cleft mission), deployment, and maintenance of equipment are a big challenge for both permanent craniofacial care centers and organizations that aim to provide cleft missions. At minimum, complete surgical trays, sutures and dressings, reliable anesthesia equipment, resuscitation packs, perioperative monitors, and sterile materials are necessary for the cleft repair operations regardless of the practice setting. Care should be taken when using medications and instruments purchased in the host countries, especially if the instructions are not in English or if they are unfamiliar pharmaceutical formulations. A partial list of recommended

• Camera

agent

• Medical records

and dosage schedules

• Lab facility for blood tests

• Lights, tongue blades, and other examination material

• Resuscitation boxes with updated, unexpired drugs

• Airway equipment including masks, endotracheal tubes, airways, laryngoscopes, positive pressure ventilation systems, suction devices, non-invasive monitors, difficult airway management items, anesthetic

**4. Equipment**

46 Designing Strategies for Cleft Lip and Palate Care


**Table 1.** List of minimum supplies and equipment required for proper cleft care [8, 9].
