Challenges in Cleft Care in Underdeveloped Countries

Abstract

Interdisciplinary or team care is defined in the parameters document of the American Cleft Palate-Craniofacial Association (ACPA). Team care is generally accepted around the world as the best way to care for patients with clefts and other craniofacial anomalies. Ninety percent of the world’s population has access to only 10 % of world health resources. This leads to many barriers being present to providing interdisciplinary team care to children with clefts in developing countries. There are two ways to develop team care in places around the world where it does not exist. One is to travel with an interdisciplinary team to a developing country to provide care for patients with clefts and go to the same place over a long period of time. The second way is to bring providers from developing countries to the developed world to learn interdisciplinary team care for patients with clefts and help them take that care back to their home. The most important thing for a successful introduction of team care into an area by a mission trip group is a commitment to return to the same place at least yearly for a long period of time. This commitment allows follow-up of patients over a long period of time, keeping of longitudinal records, accomplishing sequenced reconstructions, introduction of speech therapy and orthodontic care as a component of treatment, and evaluation of outcomes. In addition, whenever possible, education of local providers can be carried out year after year until they can provide the care on their own without the team having to come. The ACPA Visiting Scholar Program is an excellent example of how an individual from a developing country with the knowledge and potential to bring interdisciplinary team care for cleft and craniofacial patients to that country can be nurtured and encouraged. Each year, one individual spends 6 weeks in North America visiting cleft and craniofacial teams and attends the ACPA annual meeting. The individual then returns to their home country and uses the knowledge they have gained to establish or improve interdisciplinary team care. This program has been in place now for 15 years, and numerous examples exist of how these people have brought team care back to their home countries.