Stories from the Road: Operation Restore Hope USA in Cebu, Philippines

Shane Zim, MD, on behalf of the Humanitarian Efforts Committee

The author, Shane Zim, MD, is a pediatric otolaryngologist at Kaiser Permanente Oakland Medical Center.It has been said that timing is everything, and it certainly was for me. I happened to be on my pediatric otolaryngology rotation during my third year of residency when Robin A. Dyleski, MD, one of the pediatric otolaryngology attendings, had just returned from her first medical mission to Cebu, Philippines. Jubilation exuded from her as she described her experience and shared photos from the trip. I immediately knew I wanted to incorporate care of patients with congenital anomalies into my career. Fortunately, Dr. Dyleski invited me to join her team as soon as I completed my fellowship in facial plastic and reconstructive surgery in 2002. I have had the pleasure of participating annually since then, barring during the pandemic.

Operation Restore Hope (ORH) began as an Australian-based nonprofit to provide surgical care to patients with cleft lip and palate in the Philippines. The group was founded in 1993 by Sydney plastic surgeon Darryl Hodgkinson, MD. Trips were first undertaken near Manila but expanded to include Cebu with a separate team of providers. In Cebu, care was originally provided at Lapu Lapu City District Hospital. ORH partnered with the Rotary Club of Cebu, which coordinated patient outreach and recruitment. There were two operating tables in a single operating room, for which electricity was often interrupted. Over time, our Cebu team grew to the point where it separated from Operation Restore Hope Australia.

The Care Team

Members of the visiting care team together with local care providers and patients.Our current group, Operation Restore Hope USA, consists of four pediatric otolaryngologists, each often accompanied by a resident or fellow, and a pediatrician (who happens to be my wife). ORH USA collaborates with Smile for ME Australia and All Terrain Medical Relief Organization (AMRO). Smile for ME Australia comprises volunteer anesthesiologists (termed anesthetists in Australia), recovery room nurses, and surgical nurses. Surgical scrub techs and pediatric hospital inpatient nurses are typically local Filipino volunteers. AMRO is an NGO based in the Philippines that was founded in 2009 by Wyben Briones, MD. Many members of AMRO are also involved with the Rotary Club of Cebu. They conduct medical relief operations, including minor surgical and general healthcare, and distribution of supplies in rural and mountainous communities and disaster-affected areas. AMRO provides patient recruitment and outreach in addition to transportation for patients and families. All care is provided at no cost to the patients at the Allied Care Experts Medical Center in metropolitan Cebu, for which Dr. Briones serves as medical director.

One of many particularly rewarding aspects of caring for children with clefts is the camaraderie created through a team approach. The core members of ORH USA, Smile for ME Australia, and AMRO have been working together for over 20 years. As a result, close bonds have been formed between team members to the point that we function as a family unit. This environment allows for the exchange of ideas and information essential for optimal patient care, a key ingredient for sustainability.

Location, Need, and Sustainability

Cleft lip and/or cleft palate is the most common congenital malformation of the head and neck, with an overall incidence of about one in 700 live births. Cleft deformities impact low-resource countries disproportionately, where socio-economic factors prohibit patients from receiving appropriate care. Further, cleft lip with or without cleft palate has a higher incidence in the Asian population. Thus, there is a significant burden of patients with untreated cleft lip and/or palate in the Philippines. A paucity of local surgeons well trained in cleft care, as well as a lack of medical infrastructure required to provide comprehensive treatment necessary for these patients without access, only compounds the problem.

In addition to lack of access to healthcare, most of our patients have limited or no access to dental care and therefore suffer from significant dental pathologies. Fortunately, one of the members of our team is a retired Australian dentist, who works with local Filipino dentists to provide dental treatment, including necessary extractions and cleaning, to patients while under general anesthesia. A “dental van” serves as a mobile dental clinic for patients able to cooperate and tolerate treatment under local anesthesia.

The care team performs one of many surgical procedures during their annual visit to Cebu, Philippines.Each year, more than 100 patients with cleft lip and palate are screened and 60 to 70 surgeries are performed. Over 2,000 patients’ lives have been transformed over the past 25 years. The excessive number of patients with untreated cleft deformities in the Philippines, combined with the long-standing collaborative nature of our team, which travels to the same location each year, allows for the enduring sustainability of our mission.

In fact, many patients who undergo cleft lip repair return the following year for cleft palate repair. This continuity allows for critical evaluation of surgical outcomes to optimize care for these patients, just as it does in our practices back home in the US.

The Experience

After traveling over 24 hours to reach Cebu, any fatigue or jetlag is quickly exchanged for exhilaration when we arrive at the hospital on screening day and are greeted by over a hundred patients with cleft lip/palate and their families. It is undeniably rewarding to transform the life of a baby or young child with surgery. We are also fortunate to provide care to a handful of teenagers and adults each year. The gratitude expressed by these older patients is overwhelming. Kathleen, a 13-year-old with a bilateral cleft lip and palate, was too ashamed to attend school. Further, she would cover her mouth with her hand when she smiled to hide her cleft. When she returned a year after her lip repair for palate surgery, her transformation was remarkable; her smile and personality were now radiant. Alondra, a young adult in her mid-20s with a repaired bilateral cleft lip and palate, presented with a protruding, visible premaxilla. After careful deliberation, she and our team decided to remove the premaxilla and fit her with a partial denture. She was able to find employment, and often returns to visit our team during subsequent missions. One year, she sang during our end-of-trip celebratory dinner. During this year’s trip, Dominic, a 19-year-old, underwent primary left cleft lip repair and could not contain his smile after surgery, despite feeling the expected postoperative discomfort.

Quotes from Our Team Members

“Having grown up in Zimbabwe and South Africa, I have always had a compassion for the underprivileged living in third world countries. So, when an opportunity arose to go on a mission to the Philippines, I needed no persuasion. Since my first trip in 2000, I have been back a dozen times to help the children of Cebu. It is one of the most rewarding weeks of my year and I hope to keep going for years to come.”

 "Having been a scrub nurse for over 20 years, I had wanted to volunteer overseas for a long time and finally got a chance to go and be part of the team. Providing this surgery is so rewarding when you see how it radically changes patients’ lives. I come back feeling on top of the world, being part of such an amazing team that does such great work. It literally transforms the patients’ lives—they get to go to school, get an education, get a job, and become a contributing member of their communities. Just seeing their beautiful faces transformed is amazing as they are such lovely people. For me, it’s also about showing my son how rewarding it is to help others less fortunate than us. He loves seeing the photos and hearing about the kids. It’s given him a fantastic sense of social justice that can’t be learned in school.”

“I am lucky enough to be part of this amazing team that has been formed to come to Cebu each year to do wonderful work on the children in need of surgery for their cleft lips and palates. My first mission was in 2007; I was nervous, excited, and then hooked. I am now going on my 12th mission, and it is the highlight of my year. It is endlessly rewarding, and I feel very grateful and privileged to be involved with the children, their families, and the incredible team that comes together each year.”

 “I first heard about the amazing team that travels to the Philippines each year helping the kids of Cebu through my workmate, Maureen Eddison, sharing her photos, stories, and experiences. I thought I too could contribute my time and skills to this great cause. After my first trip in 2005, I was hooked because the transformation to these young kids is simple and life changing. I feel privileged and rewarded to be included as part of the team each year and hope to continue well into the future.”

— Catherine Quinlan, anesthetic nurse