Even as a board-certified facial plastic surgeon, I do not commonly see or treat cleft lip and cleft palate in my Richmond practice. These severely disfiguring congenital anomalies are routinely treated at an early age at academic medical institutions. However, in other parts of the world, access to plastic surgical care is not available. Patients will live with severe congenital deformities without treatment unless surgeons have the courage to step up.
Fourteen years ago, Jim Wade, a general otolaryngologist from the rural town of Abington, Virginia, had the courage to travel to Africa to address the burden of cleft lip and cleft palate. With the guidance of colleagues in facial plastic surgery and a confident faith that his mission would succeed, he has developed a program which now evaluates and treats approximately 300 patients per year during three two-week trips to the missionary hospital at Kijabe, Kenya.
I consider myself most blessed to have served on the 2009 ENT cleft lip/palate team to Kijabe. Other surgeons included Jim Wade, Grady Arnold, Cameron Kirchner, and Cindy Gregg. The experience was reminiscent of residency. I was a little uncertain but excited about the opportunity to discuss each upcoming case with more experienced physicians. We had three well-equipped operating rooms in a small pediatric hospital which was not entirely dissimilar to an American ambulatory surgery center, except for the 40-50 people sleeping in one room at night and the unreliable electrical service. Although we had steady work the first week, we had more patients than we could treat the second week, after we initiated a telephone appointment reminder policy. It was somewhat ironic that, despite significant poverty, most families had access to mobile telephones. In two weeks we evaluated 102 patients and operated on 82. Patients ranged in age from 10 weeks to 46 years. The majority of the patients were many years beyond the ordinary time for correction of these defects and some were too ill for surgery or were malnourished from the inability to chew and swallow appropriately. All of those treated appeared to heal well and were discharged without any significant complications.
My daughter Meredith accompanied me to Africa. The teenagers were instrumental in helping coordinate patient care outside of the operating rooms. They kept the children entertained in the days of waiting before surgery. They assisted in the recovery room, providing oxygen and supporting the airway. When the lights went out, they held the flashlights. They returned the children to their parents after surgery. They prepared the discharge medications, along with instructions and a small gift bag.
During the weekends, we had the opportunity to see the beauty of the African countryside including the diversity of animals in their natural habitat. We climbed the summit of nearby Mount Longonot, an active volcano, and circled the rim of the crater before hurrying down at nightfall. The next day, we visited Crescent Island, the setting for the movie “Out of Africa.” Touring on foot, we saw herds of wildebeest, gazelles, zebras and giraffes. We spent two nights at Lake Nakuru, where jeep safaris took us to see rhinos, lions, hyenas, giraffes, diverse herds of antelopes and millions of pink flamingos. Returning to Nairobi, we toured the animal orphanage, where we were allowed into to pet adult cheetahs and lions.
This mission is funded primarily by the volunteers, all of whom donated their time and traveled at their own expense. Hospital expenses were supported, in part, by generous donations World Medical Missions, a division of Samaritan’s Purse and The Smile Train. If you wish to make a contribution or learn more about any of these organizations, visit:
This article was also published in the Collegiate Spark , Spring, 2010