Each day consists of rising early for the 6:30 AM breakfast and then off to the hospital for a hopeful first incision time of 8:30 AM. Patients who were screened on our first day are either kept on the ward the hospital so generously provided to us. Thus far, we’ve had little problem with parents maintaining their children NPO (prior to surgery nothing to) for 6 hours prior to surgery.

While a minor geographical inconvenience, patients are housed on a ward apart from the main hospital, but only a minute or two walk away. From this ward, the patients are then escorted to the main hospital, and then up the elevator to the OR. We’re we provided with 4 very modern operating rooms, outfitted with ample storage space, good lighting and local nursing assistants who have been very helpful in providing all manner of support.

Each surgeon has between three and four cases per day with the case mix of cleft lip and/or palate. On this trip, there are a significant number of cleft palates (both in- and complete) and only scant few more cleft lips. Since the full functionality of a cleft palate repair should usually be performed before 12 – 18 months of age, it doesn’t really do the patient much good to perform the repair for the children greater than 4 years of age. Furthermore, some of these palates would subsequently require additional more extensive or adjunctive surgical procedures, palatal obturators with long term follow up and speech therapy, so that attempting to repair these palates would be only marginally successful.

It’s disheartening to both patients and families to travel so far and not be able to provide the gift of a palatal repair. It’s even more difficult to explain through an interpreter why it’s not in the patient’s best interest to surgically repair the defect and that an obturator is probably a better option. Like other experiences gained from a mission like this, one realizes (again) the uncontrollable limitations imposed on your ideal of how things should work – often just like what happens at home.