Birthing and Building Nascent Cleft Teams in Developing Countries

Abstract

Facial clefting disproportionately occurs in developing countries: among 164 million annual births, only 10 million occur in developed countries; of the 250,000 children born annually with clefts, only 17,000 are born in developed countries. This disproportion means that most developing nations cannot keep pace with the birth of children with clefts and, secondarily, cannot catch up with the backlog of patients with unrepaired clefts. This has led to a major trend emerging from developed countries: the export of cleft care. Based on good intentions and will, this export has largely been unregulated and disjointed. Practitioners often go to foreign settings without adequate preparation, inability to communicate with local practitioners, and no long-term plan for education of these local professionals. The major need in developing countries is to build local teams to care for local patients. If this single goal is not met, then the simple exportation of cleft care by practitioners from developed countries will never meet the needs of patients in developing countries. As a result, the exportation of cleft care needs to focus, not so much on the number of surgeries but more exclusively on teaching team cleft care to the various local practitioners who are interested in building the infrastructure to care for local patients. In order for visiting professionals to accomplish this single goal, foreign providers need to understand the local context and unique demands of the community they are visiting, should exclusively train local care providers, and aim to establish sustainable community-driven and community-operated resources for cleft care.