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| Two doctors from the University of Arkansas for Medical Sciences (UAMS) Otolaryngology Department recently traveled to Guayaquil, Ecuador, on a surgical mission that provided care to cleft lip and palate in more than 90 children.
The trip was part of a Global Smile Foundation project that began over three decades ago and aims to make comprehensive cleft care accessible to all patients, regardless of geographic or socio-economic barriers.
But after the mid-September trip, it wasn’t just the children and their families, some of whom had traveled on buses for 24 hours to take advantage of the free surgery, who were smiling.
Larry Hartzell, MD, associate professor of otolaryngology, and Jeffrey Dorrity, MD, pediatric otolaryngology researcher in the department, couldn’t help but smile to themselves as they described how they too. benefited.
âIt’s definitely emotionally rewarding,â Hartzell said. âYou really see the impact. “
Dorrity, who prior to coming to UAMS was an otolaryngologist in private practice in South Dakota, pursued the pediatric fellowship at UAMS largely because of the opportunity to learn how to perform cleft surgeries and going on mission trips like this one.
“This is my first time participating in a mission focused on cleft care,” he said, although as a senior resident of Minnesota he took a mission trip to Ethiopia to train residents to ear surgery, and as a medical student he visited Panama with a cardio-thoracic team.
âIt was different from any trip I have been on and it was better than anything I had expected,â he said. âThe Global Smile Foundation has done a really good job of finding experts across the country and bringing them together. So it was really good for the patients, and as a fellow there was an added benefit that I was able to learn from people all over the country besides caring for these patients. I was in seventh heaven the entire time I was there.
A slit is an opening in the upper lip and / or palate (roof of the mouth) that occurs in early pregnancy when the developing facial structure does not fully merge. They can occur together or separately.
The Global Smile Foundation aims to treat patients born with a cleft lip at 3 months of age and patients born with a cleft palate between 12 and 18 months, to avoid future developmental problems of speech and social integration.
In this case, Hartzell said most of the patients he and Dorrity treated in Ecuador were babies as young as 3 months old, but some other patients were between 2 and 4 years old, having had no access to surgery for. a year and a half due to the covid19 pandemic.
Hartzell, director of the cleft lip and palate program at Arkansas Children’s, was trained in complex pediatric otolaryngology. He is also a missionary travel veteran to provide life-saving surgery that allows children to breathe, eat, speak, and hear normally, as well as grow up without being bullied into having facial deformity.
Although he had taken mission trips to other countries to provide specialist ear, nose and throat care, he had not been to Ecuador since 2016.
âThese are people who don’t have the option of receiving care otherwise,â Hartzell said. âMany of them have been waiting for years for these surgeries to be performed and in many cases they stay at home and go into hiding because they are fundamentally rejected by society. When they are finally able to have the operation, it really has a huge impact on them.
While cleft lip and / or palate is one of the most common birth defects in the world, even in the United States, the lack of organized health care in poor countries, where there is also a shortage of surgeons. plastic surgeons and the appropriate training to become plastic surgeons, makes it particularly difficult for patients to obtain treatment.
âThere aren’t enough people trained to do it, and the system isn’t as well in place to provide them with the same quality of care,â Hartzell said.
In addition, poor prenatal nutrition is more prevalent in Third World countries. Hartzell said developing countries were less aware of the effects of smoking and alcohol consumption on a developing child, adding that other conditions that affect a baby’s development, such as diabetes, are not. generally not as well controlled.
âHere in the United States, we really emphasize the importance of prenatal vitamin use and prenatal care,â Hartzell said. âIt’s really during the first four to eight weeks of life when the baby is growing up that he needs that extra folate, extra vitamins. If you don’t even know you’re pregnant until one or two months old, it’s often too late, âhe said.
Hartzell also invited former UAMS Otolaryngology Fellow Robert Glade, MD, who is now a pediatric otolaryngologist in Oklahoma City, on a trip to Ecuador.
He said he liked taking fellows because âit’s just a great training opportunity to be able to do a lot of the same procedures in a short period of time which can really help improve your skills. Plus, it’s just a great experience to provide that kind of service and really see the impact it has on families.
Hartzell and Dorrity arrived in Ecuador on a Saturday and spent the next six days working with patients, five of which in a row typically performing three to four major surgeries per day. Some surgeries lasted 1.5 to 2 hours, while others lasted 3 to 4 hours, depending on the procedure.
âIt was physically exhausting, but definitely emotionally rewarding,â Hartzell said.
The group included five treating surgeons, including Hartzell, and three interns, including Dorrity, who were able to use the operating rooms and beds at Leon Becerra Hospital, a cooperating local facility dedicated to pediatric care for low-income families. .
Most patients stayed in the hospital for a night or two, then returned a week later for follow-up care from health workers who remain for some time after the surgeons have left.
While there are other groups that visit Ecuador to provide cleft care, the Global Smile Foundation is the largest comprehensive cleft care provider there. His long roots in the city help the operation run smoothly, with experienced volunteers, including some former patients, organizing screening clinics to assess potential patients to ensure they do not have COVID- 19 or other medical conditions that could prevent them from having surgery.
Although Hartzell is fluent in Spanish, Dorrity said he appreciated the team including interpreters to facilitate communication with patients and families.
âBut seeing their joy, seeing their tears of joy, you don’t need to speak the language to understand the emotion they share,â he added. âJust to see this change for parents is really a humbling thing to be able to be a part of it. It was certainly the most rewarding part.
Hartzell said he was so impressed with the professionalism of the group under the leadership of Usama Hamdan, MD, its founder and chairman, that he hopes to return every year.
âHe has such a passion for what he does and he makes sure he has good people who are committed and who will provide great care. It’s just a great organization, âsaid Hartzell.
He and Dorrity said they also enjoy the camaraderie of working alongside other doctors, sharing knowledge and comparing techniques.
âIt benefits the patients there, but it also benefits my patients here,â Hartzell said.
Hartzell said he was excited to pilot new technology by wearing a blindfold with a camera on it that allowed an expert from another location to see what he was doing while he was doing it and provide feedback in real time. Using this technology, he was able to perform a new type of cleft lip repair.
In turn, Hartzell said, he then shared his experience at an international conference.
In addition to learning, the group of volunteers – doctors, nurses and cleaning technicians – also had time to network and make friendships.
âYou are really connected to each other because you are all there for the same reason, to take care of the less fortunate and change their lives,â Hartzell said. âWhat’s amazing is how much your own life changes in the process. “
Dorrity said the experience also strengthened his belief that “this is absolutely what I want to do with my life and my career.”