*Optimizing Outcomes in Cleft Surgery DOI: http://dx.doi.org/10.5772/intechopen.89882*

#### **Figure 2.**

*Current Treatment of Cleft Lip and Palate*

of techniques over high volumes of cases.

effort to build local capacity.

**3. Patient-centered care**

illiterate patients (**Figure 2**).

nity-specific beliefs and practices.

were halved. These changes are attributable to multiple factors, including the presence of a permanent facility to provide systemized and chronological care, standardized protocols, training of permanent staff in all disciplines, and evolution

GCCCC was designed from the outset to provide the highest level of care to the people it would serve while integrating the local community into its operations. As the center evolved, various quality metrics began to improve, and this is discussed below. The success in Guwahati highlights the effectiveness of the diagonal model of cleft care delivery, in which surgical missions are initiated with a concomitant

An effective model of care delivery emphasizes patient-specific needs, and an essential component of such patient-centered care is an intimate understanding of the socioeconomic environment and cultural background of patients' communities. India represents one of the most apparent examples of the growing dichotomy between the rich and the poor. India has the world's 7th largest gross domestic product but ranks 129th in the world with regards to overall standard of living [24, 25]. As of 2018, the per capita income in India was \$2036, and severe disparities exist in terms of income, literacy rates, life expectancy, and living conditions [24]. Access to health care and health care literacy naturally succumb to the same disparities, and

OS conducted two cleft missions to Guwahati in December 2010 and January 2011. During the first mission, it became apparent that there was

widespread patient and parent misunderstanding of post-operative instructions. Instructions were given at the discretion of individual surgeons and pediatricians, and patient understanding could not always be confirmed. In response, a standardized, culturally-focused patient education program was initiated during the second mission. Nurses provided individual and group teaching sessions to patients and their parents, going over specific wound care, diet, and hygiene instructions. Additionally, a standardized post-operative instruction sheet was provided to all patients. The instructions were written in Assamese, the local language, and dietary instructions pertained to specific foods that were common in the region. The form also included easy-to-comprehend pictographs for

Of the 220 patients who presented for early follow-up after the first mission, 3.7% had developed lip wound infection and 9.6% developed lip dehiscence. Of the 252 patients who presented for follow up after the second mission, 0.4% had infections and 6.4% developed dehiscence [26]. Logistic regression revealed that patient education was the only covariate that contributed significantly to the decrease in wound infection rates. This demonstrates the powerful impact of addressing disparities in literacy and providing patient-centered care that accounts for commu-

Patient-centered care was also a cornerstone for the design of GCCCC. The center was purpose-built to provide consistent and easy access to multi-disciplinary care for patients with cleft lip and palate. The state-of-the-art facility includes a modern operating suite with an open layout, sophisticated anesthesia and monitoring capabilities, central medical gases, and sterilization facilities (**Figure 3**). Inpatient units were also designed to provide focused pediatric care, education, and rehabilitation. The full breadth of cleft-relevant medical specialties is available

this posed a substantial challenge to initial work in Guwahati.

**38**

*Standardized post-operative instructions were printed and provided to patients in the local language, Assamese. Easy-to-understand pictographs were also included for illiterate patients.*

#### **Figure 3.**

*The Guwahati comprehensive cleft care Center was designed with a modern operating suite with an open layout. This layout facilitates collaboration and teaching among the surgical team.*

within the building, facilitating efficient interdisciplinary care for patients. Due to the restraints of providing care in a resource-limited environment, patients undergoing cleft lip repair at GCCCC do not receive preoperative orthodontics. However, post-operative care is provided in all specialties in a longitudinal manner.
