Columbia Facial Plastic Surgery, Mizzou

CW David Chang, MD in Kenya - 2005

Some travel for miles, and some travel for days, for the opportunity to have their faces, lives, and spirits restored to them . Twice a year, patients afflicted with cleft lip and cleft palate from the countryside of Kenya palate make the journey to Kijabe, a town 25 miles west of Nairobi, to see a traveling team of medical personnel from the United States. The team—comprised of facial plastic surgeons, pediatricians, nurses, and cardiologists—volunteer their timeand money to serve these patients at Bethany Crippled Children’s Hospital. I was honored to be asked to be a member of this team last July.

Cleft lip and cleft palate are birth defects that occur as result of abnormal fetal development during gestation. A complex ballet of tissue growth, migration, and fusion is required to bring the necessary elements together to form the human face. Sometimes these processes go awry because of genetics, environmental insults (drugs, vitamin deficiencies, etc), or just happenstance. A cleft lip occurs from improper fusion of parts responsible for forming the upper lip, creating the appearance of a split lip, also nicknamed “hare lip.” Likewise, a cleft palate occurs when the roof of the mouth fails to fuse in the midline. As a result, the mouth and nose are not well sealed off.

Cleft lip and/or cleft palate occur in about 1/1000 Caucasian births while only 0.4/1000 African births. While these statistics seem to be in favor of the Kenyans, access to healthcare by the Kenyan poor is prohibitively expensive. No national health insurance or medical care system is currently in place. The poor are often forced to choose between either food or medicine. Therefore, quite a few cleft lip and palate patients are unable to seek surgery in a timely fashion. Here in the United States, it is unusual to see an untreated case beyond one year of age. However in Kenya, we had many patients 3-7 years of age, with the oldest being 15 years old.

While the deformity itself is not typically life threatening, the social ramifications of a cleft lip are devastating. These patients bear a visible stigma—a scarlet letter on their face—that prevents them from being valued members of society. They cannot marry and have a difficult time holding a job.

During my two week mission trip, our team performed 95 cases in 8 operating days. Many of our patients were too young to appreciate their experience; however happiness, joy, and astoundment could be readily seen in the eyes of their parents. One teen-age boy, clearly embarrassed by his cleft lip, sat waiting for his surgery with his hands covering his mouth from view. The day after surgery, he happily drank broth from a cup through his new lips.

Donations to support this endeavor can be made to
Samaritan’s Purse, c/o Dr. Chang