Stories from the Road: Children’s Surgery International in Mexico

Brianne B. Roby, MD

Brianne B. Roby, MDI have the privilege to serve as director of the Cleft Lip and Palate Program at Children’s Minnesota. When asked about my favorite part of this role, I always answer that I get to know my patients often before they are born and get to see them throughout childhood until adulthood when they finally graduate from the cleft team! Similarly, I have been fortunate enough to travel on many global surgery trips involving cleft care in different regions of the world. Although those trips are rewarding, I also always leave feeling like it wasn’t enough. For those of us involved in the care of patients with cleft lip or palate deformities, we know how much care is required in addition to the surgical repair of the cleft.

Over the past few years, I have been incredibly fortunate to serve on the board of directors for Children’s Surgery International (CSI), a Minnesota-based nonprofit volunteer organization that provides free medical and surgical services to children in need around the world.

One of the many locations served by CSI is the Sonora State region of Mexico. CSI partners with St. Andrew’s Children’s Clinic in Nogales, Arizona, and Hospital CIMA Voluntariado in Hermosillo, Mexico, to provide ongoing cleft and craniofacial care to children throughout the Sonora State region. This partnership began in 2004 and has continued at least yearly, except in 2020 due to the pandemic.

A Global Partnership for Continuing Cleft Care in Mexico

The model of this unique collaboration has developed into what is essentially an international cleft team. The patients return year after year, and often the same surgeon who did the cleft lip surgery at six months of age will be the same surgeon to perform the cleft palate surgery a year later. Patients are followed through St. Andrew’s Children’s Clinic to ensure other testing, such as genetics, audiology, and labs or imaging can be completed. Hospital CIMA Voluntariado coordinates patient outreach and patient recruitment. St. Andrew’s Children’s Clinic covers the medical costs for surgery and continued rehabilitation. CSI provides surgical and medical care and expertise through its vast volunteer base. Logistics are shared by all three partners. All care, including travel, is provided at no cost to the patient and family.

What began as surgical repair of cleft lip and palate deformities eventually expanded as the children grew up. Speech therapy is an integral part of care for these patients, and with the diligent efforts of our partners, a clinic now exists in Hermosillo to provide this service. If patients receive the necessary speech therapy and still have velopharyngeal insufficiency (VPI), surgical repair of the VPI is offered during a subsequent trip.

Many years ago, an oral surgeon became an integral part of the surgical team to provide alveolar bone grafts. Since this is ideally performed after orthodontia care, steps were taken to develop a relationship and work on additional training with a local orthodontia team. Children receive palate expanders, braces, and other orthodontic care in the 12-18 months before our normal fall trip. The local orthodontist, who also volunteers her time, sends X-rays and photographs to the CSI oral surgeon on the team as the trip approaches. 

The final step prior to graduation from the cleft teams in the United States is often a cleft rhinoplasty. These can be fairly extensive rhinoplasty cases involving either auricular or rib harvest. For many years, teams performed only the most severe rhinoplasties. But this year, the program’s partnerships supported an additional trip solely dedicated to cleft rhinoplasty surgery. Providing the final surgery for these patients further enhanced the partnership between CSI, St. Andrew’s Children’s Clinic, and Hospital CIMA Voluntariado.

Location, Need, and Sustainable Solutions

Since 2004, together with our partnership, this program has changed the lives of more than 1,000 children. Additionally, through our unique collaboration, we’ve provided thousands of hours of education and training to families, patients, and the local medical staff, developed a comprehensive speech therapy program, and expanded orthodontics care throughout the Sonora State region. In Hermosillo, there are some local surgeons who are well trained in cleft care. However, the local medical system is not set up to provide the in-depth type of care that is required for complex cleft lip and palate patients without financial means.

The unique model of international collaboration and partnership between CSI, St. Andrew's Children’s Clinic, and Hospital CIMA Voluntariado has established a sustainable solution to provide access to life-changing care for children and families. This relationship has allowed us to provide children in the Sonora State region of Mexico the same high level of long-term cleft lip and palate care that they would receive in the United States. It is a goal that I hope other organizations can use as a template to provide more long-term continuity of care in other parts of the world where cleft lip and palate care is lacking.