Sustainable Cleft Care: A Comprehensive Model Based on the Global Smile Foundation Experience

Abstract

Introduction: Clefts of the lip and palate are leading congenital facial anomalies. Underserved patients with these facial differences lack access to medical care, surgical expertise, prenatal care, or psychological support. Moreover, the disease results in significant economic strains on patients and their families. While surgical outreach programs have attempted to fill this void, significant challenges facing international comprehensive cleft care persist. Objective: Propose a path toward international sustainable cleft care based on the Global Smile Foundation experience. Results: International sustainable comprehensive cleft care can be achieved by regulating surgical outreach programs. Regulation of these missions would ensure standardized care and encourage stakeholders to cooperate and adequately allocate funding and resources. Capacity building can be achieved through “diagonal” cleft care delivery models, multidisciplinary workshops, fellowship programs, research and quality assurance, as well as leveraging emerging technologies such as Augmented Reality. Conclusion: International comprehensive cleft care requires continuous collaborative efforts between visiting and local teams as well as international and national organizations. Standardizing and regulating current practices as well as promoting capacity building initiatives can contribute to sustainable cleft care.

International Cleft-Care Organizations in the United States: A Systematized Review

“…Programs such as FACES Foundation and Global Smile Foundation have begun to incorporate a telemedical component. 36,37 The incorporation of telemedicine in such programs would assist with cost-effectiveness, enable high-quality remote care both preoperatively and postoperatively, and enable professional education and collaboration.…”

Application of Safety Protocols for International Cleft Outreach Programs During the COVID-19 Pandemic: Global Smile Foundation Precaution Guidelines and Implications

“…Nevertheless, comprehensive cleft care delivery is not equitable throughout the world and has been found to be especially deficient in LMICs, where barriers to comprehensive medical and surgical cleft care are numerous and multifaceted ( Massenburg et al, 2016 ; Kantar et al, 2021 ). For decades, international cleft practitioners have attempted to alleviate the burden of disease facing those regions, most notably via outreach cleft programs to LMICs ( Kantar et al, 2019 ; Chahine et al, 2021a ). Global Smile Foundation (GSF) is a nongovernmental organization (NGO) whose volunteers and founding members have been involved in cleft care for more than three decades.…”

“…Global Smile Foundation (GSF) is a nongovernmental organization (NGO) whose volunteers and founding members have been involved in cleft care for more than three decades. By adopting the diagonal model of care, GSF's efforts are focused on delivering multidisciplinary cleft care while achieving local empowerment and long-term sustainability in resource-limited countries, including Lebanon, Ecuador, Peru, and Salvador ( Chahine et al, 2021a ).…”

“…Collaboration with our Comprehensive Cleft Care Centers, established to support long-term cleft care sustainability in LMICs ( Chahine et al, 2021a ), enabled GSF to continuously assess the regional public health situation in a bid to resume outreach programs. By integrating telehealth into its line of work, GSF was able to provide frequent patient follow-up and continuously monitor the status of new patients in need of comprehensive cleft care ( Chahine et al, 2021a ; Chahine et al, 2021b ). The backlog of untreated patients with clefts has expectedly risen following cancelation of various international outreach programs, exacerbating the existing burden of disease ( Salehi et al, 2021 ).…”

Association of Patient Factors and Follow-Up in an International Volunteer Cleft Lip and Palate Repair Clinic in El Salvador

“…This study focuses on a non-profit NGO volunteer medical care organization that provides comprehensive cleft care in several countries with limited medical resources. The NGO, Global Smile Foundation, employs teams of numerous medical specialists from various countries and partners with the local medical hospitals to treat certain more complicated cleft anomalies 9. These teams travel annually to the same location at the same time each year to provide care for new patients with CL/P diagnoses and returning patients, who need follow-up surgeries or routine checkups for their speech and dental needs 10.…”