Mercy Malaysia UK Cleft Lip and Palate Surgery Mission to Myanmar

Mercy Malaysia UK (registered charity 1155997) proposes carrying out a charitable mission to Myanmar to deliver cleft lip and palate surgery to patients at the Sitagu Ayudana Hospital. We propose taking a surgical team from the United Kingdom to Sitagu, Myanmar. We will have a specialized team all experienced in delivering high quality cleft care in the United Kingdom to openly published audit standards, standards that makes the United Kingdom’s system of cleft care highly regarded in international cleft surgery.

Cleft lip and/or palate is one of the commonest birth defects and the commonest congenital malformation of the head. It results in differences in appearance that have a profound impact of social and psychological functioning when not repaired. Cleft palate has a major impact on feeding and speech. Surgery to a cleft can hugely impact the lives of children with a cleft, allowing them continue with near normal lives, potentially after just one operation. Worldwide it is estimated to have an incidence of 1.4 per 1000 live births. In Myanmar, the incidence is estimated to be 1-1.2 per thousand live births, with a population of around 54 million in 2016, this represents 1000-1250 children born with cleft lip and or palate in Myanmar per year. Myanmar has centres performing cleft surgery in Yangon, Naypyitaw, Manadaly and Toengy, but large areas of the population remain without access to cleft lip and plate surgery, due to a combination of geography, distance to a cleft centre and poverty. This means many children born with cleft lip and/or cleft palate have no access to cleft surgery and are therefore significantly handicapped by their cleft.

In the UK, Cleft Lip and Palate Surgery is a defined subspecialisation from Plastic Surgery and Maxillofacial Surgery. There are 10 nationally recognized centers of comprehensive cleft care throughout the UK. Each centre manages the complete specialized care of a child born with any form of cleft lip and/or palate. The centres provide lifetime care for patients with cleft, each providing the full range of treatments that may be required including pediatric, surgical, nursing, anesthetic, speech therapy, audiology, feeding, dental, orthodontic and orthognathic care. The services were defined following the Clinical Standards Advisory Group report in 2000, which recommended the formation of the specialized centres, there is an effort to similarly designate centres in the USA. The United Kingdom system of comprehensive cleft care embeds quality of care by mandating the careful and open publication of outcomes, so that it in the United Kingdom it is not just the provision of cleft surgery, but the provision of quality in cleft surgery that is developed.

This preliminary mission will be founded by a team from the Trent Regional Cleft Network based out of Nottingham University Hospitals, a large teaching hospital in the East Midlands. Trent Regional Cleft Network is one of the 10 designated cleft centres in the UK. Trent Regional Cleft Network provides Cleft Care to the counties of Nottinghamshire, Derbyshire, Leicestershire, Lincolnshire and South Yorkshire serving a population of over 5 million. This represents 100-110 new born children per year with a cleft lip and/or palate. Nottingham University Hospitals has the fourth highest volume of cleft surgery operating of any hospital in the United Kingdom. The team has 2 surgeons operating on babies and soft tissue revisions, and 2 surgeons operating on bone grafts and orthognathic cases. There are 5 specialist pediatric anesthetists with extensive experience of cleft. Surgery takes place at the Queens Medical Centre in Nottingham in the Nottingham Children’s Hospital with an experienced specialist theatre staff. Specialist post-operative care is provided on a specialized children’s surgery ward. The team has one of the best performance records in the UK for achieving timely surgery for babies born with cleft lip and/or palate, and one of the shortest length of stay post-surgery at 1.5 days with a low fistula and revision rate. Recent review of surgical speech outcomes by the exacting CAPS-A audit tool showed an 80% rate of structural normality at 5 years of age, which is within the top quartile of the UK Cleft Units based on 2016 data. We believe that we are well equipped to both deliver surgical care to a population unable to access it, but to also input into a training initiative to increase the whole team specialized cleft care skills in the local system.

Our Mission

The primary aim of our mission will be to provide free reconstructive cleft lip and palate surgery to those with with cleft lip and palate in Mandalay, Myanmar. Our mission will also focus on contributing to longer term development of a viable local cleft service discussing with local partners how best to achieve this is the context of local initiatives, previous charitable missions and training. We will provide teaching on postoperative care, feeding in the newborn cleft baby and general pediatric care of the sick patient.

Since 2012 Mercy Malayasia has conducted reconstructive cleft surgery missions to Sitagu in partnership with Sitagu Ayudana Hospital. The hospital hosted the Mercy Malaysia team, providing accommodation, wards and operating theatres. The project has allowed a total of 227 patients to have their cleft lip or palate corrected. We propose to lead a preliminary mission organized by Mercy Malaysia UK with Sitagu Ayudana as the partner hospital. We would undertake surgical correction on over 30 people suffering from a cleft lip or palate, including their postoperative care supervision.

Aims.

1. To treat upwards of 30 patients with cleft lip and or palate anomaly improving their standard of life.

2. To provide postoperative supervision of care for the operated patients on the mission

3. To understand how Mercy Malayasia UK can use the UK Cleft Care experience to contribute to a sustainable corrective cleft surgery service in Mandalay, by meeting with local representatives, and any useful future training opportunities that could be programmed.

4. To undertake local teaching activities based on the UK Advanced Pediatric Life Support format and postoperative ward care.

Our proposal is that this is a preliminary mission, and will involve a needs assessment for future missions, which would involve a higher volume of patients and a more formal training content as agreed with partners.