Returning Smiles to the Community

Chula medical volunteers treat cleft lip and palate cases nationwide

Approximately one in every 650 babies in Thailand is born with a cleft lip and one in every 2,500 with a cleft palate. These facial abnormalities are the most common of all birth defects in the country.

Cleft lip and palate are not exactly the same. A cleft lip is characterised by an opening in the upper lip that may extend into the nose. The opening may be on one or both sides, or in the middle. A cleft palate occurs when the roof of the mouth contains an opening into the nose.

However, both are birth defects that occur when a baby’s lip or mouth do not form properly during pregnancy, particularly in the first three months after conception. There are many causes of cleft lip and palate, from genetic inheritance, malnutrition or viral infection to drug or chemical side effects.

If left untreated, children with cleft lip and palate will have difficulty living a normal life, while the psychosocial health impact on the children and their families can be severe. Physically, babies with cleft lip and palate will have slow development, particularly problems with feeding and speech.

Problems with feeding can often lead to slow physical development, nutrition deficiency and risk of various infections and complications such as pneumonia and otitis media, an inflammatory disease of the middle ear. Psychologically, an inferiority complex arising from a child’s physical appearance will make them socially withdrawn and depressed, with the risk of falling victim to abuse and bullying.

Surgery is the only answer to cleft lip and palate. It is a simple task yet a costly one, at about 25,000 baht for an operation. This is why untreated cleft lips and palates are mostly found in rural areas where access to medical treatment is still limited and poor people simply cannot afford it.

Chulalongkorn University has stepped in to fill the gap, providing medical volunteers to perform operations for the needy and produce trained specialists to cope with the shortage, especially in provincial areas. A course on cleft lip and palate has been included in the Higher Graduate Diploma Program, while medical residents are sent into the field two to three times a year to learn from real-life experience.

Asst Prof Dr Anantachote Vimuktanandana of the Department of Anesthesiology in the Faculty of Medicine, is one of the medical volunteers. He is part of a team of specialists that comprises an anesthesiologist, plastic surgeon, orthopedic surgeon and nursing volunteers, who join with other hospitals in arranging a mobile medical team to perform operations for children and adults. They treat not only cleft lip and palate cases but also other deformities such as fibrous connective tissues caused by burn wounds, and other facial and lip deformities.

“Some provinces have just one or two specialists. Sometimes the caseload is overwhelming. When the waiting list is far too long, they cannot simply refer every case to a medical school in larger provinces since some patients cannot afford it,” explains Asst Prof Dr Anantachote. “It’s not only the medical fee, but also accommodation and other expenses. What we do can really helps resolve this issue.”

To address this issue in particular, the Chulalongkorn University Faculty of Medicine is an active supporter of two projects: the Thai Red Cross Society’s Plastic Surgery for Cleft Lip and Palate and Other Deformities Project, and the Operation Smile Foundation.

In cooperation with the Thai Red Cross, the medical volunteer team sets out to treat patients in various provinces six times a year; one is specifically dedicated to the three southernmost provinces of Thailand. The provincial Thai Red Cross chapters coordinate with provincial public health offices, provincial hospitals and village health centers in screening for cases that need surgery and providing travel expenses for those receiving treatment free of charge.

Working with the Operation Smile Foundation, the medical volunteers from Chulalongkorn travel to designated hospitals three times a year, and they also visit Myanmar once a year.

“The foundation works closely with a border town hospital in Mae Sot district of Tak province. There are a lot of refugees there. Once they hear the news of our coming, they will cross the border and come to see the doctors. Whether an operation can be performed, that’s another issue,” says Asst Prof Dr Anantachote.

As time is limited on each trip, the first day is dedicated to medical check ups and screening. Patients with suitable conditions will be admitted a day prior to the operation and will rest for one or two days after surgery before being discharged. The medical volunteers will then follow up with provincial medical staff to ensure treatment continuity or further referrals as needed.

“Our work can really change lives and return a smile to their faces,” says Asst Prof Dr Anantachote.