Section 2 Surgery in Clefts

**35**

**Chapter 3**

**Abstract**

**1. Introduction**

Surgery

Optimizing Outcomes in Cleft

*Eugene Park, Gaurav Deshpande, Bjorn Schonmeyr,* 

Children born with cleft lip and palate in low- and middle-income countries (LMICs) have limited access to surgical care and suffer substantial morbidity as a result of delayed treatment. Charitable organizations have sought to tackle this problem through high-volume surgical missions, but these efforts have been fraught with high rates of complications and variable esthetic results. Over the past decade, Operation Smile (OS) has placed considerable emphasis on improving the quality of care delivered to patients in LMICs. By establishing an outcome evaluation program among other interventions, OS has achieved measurable improvements in complication rates and post-operative follow-up. The founding of the Guwahati Comprehensive Cleft Care Center in India has been pivotal to the success of OS's work in this field and is the evidence of the impact that an optimized model of care delivery can make. Here we describe OS's efforts to improve the quality of care delivered to patients in LMICs with a focus on the organization's work in India.

**Keywords:** cleft lip and palate, low and middle-income countries, global surgery,

Clefts of the lip and palate are among the most common congenital deformities, occurring in about 1 in 500 to 1 in 1000 births worldwide [1]. In many areas of the world, the number of patients with clefts far exceeds the capacity of the healthcare system to treat them. Consequently, only a fraction of the affected population receives treatment, resulting in a global backlog of over 600,000 untreated patients, with 72,000 in India alone [2]. Clefts of the lip and palate can have devastating consequences. Children with cleft palate have difficulty with speech and feeding, which can lead to malnourishment and developmental delay [3, 4]. Children with cleft lip face social stigma and often have lower levels of education and greater unemployment compared to their peers, despite having normal intellectual capacity [5–7]. The global response to this problem over the past several decades has been immense. Charitable organizations have provided more than 1 million free cleft repair surgeries and trained local surgeons to perform these procedures [8].

Historically, the success of these outreach efforts has been measured by the number of patients served, and little emphasis has been placed on the quality of care delivered. Research related to surgical missions is needed but seldom performed, often due to limited funding, manpower, and time [9, 10]. The logistical challenges of

*Carolina Restrepo and Alex Campbell*

models of health care delivery, quality improvement

**Chapter 3**
