Stories from the Road: Lambayeque, Peru

Left: Lisa M. Morris, MD, a facial plastic surgeon, performing nasoendoscopy with speech therapist Chelsea Sommer, PhD, CCC-SLP, on a patient prior to surgery for velopharyngeal insufficiency.
Right: Speech therapist Natalie Galvan, MS, SLP-CCC, Lourdes Quintanilla-Dieck, MD, a pediatric otolaryngologist, and Jessyka G. Lighthall, MD, a facial plastic surgeon, with a patient and her family after a speech therapy session, prior to surgery for her cleft lip and palate repair.

Lourdes Quintanilla-Dieck, MD, on behalf of the Humanitarian Efforts Committee

The Mission of FACES

The Foundation for the Advancement of Cleft Education and Services (FACES) is a non-profit organization led by co-founder and oral and maxillofacial surgeon Tom Albert, MD, based in Portland, Oregon. FACES volunteers have performed hundreds of cleft lip and palate surgeries on medically isolated patients. I am proud to serve on the organization’s Advisory Board. 

FACES has been going to the same region in Lambayeque, Peru, since 2008. Returning to the same location and seeing our patients every year provides continuity of care, which is instrumental for ensuring good outcomes and for recognizing and treating complications. We have patients who we have followed since young childhood who are now adults, returning to show off their speech and physical results.

In addition to surgeries, we also provide speech therapy both in-person during our trip and year-long with virtual sessions, social services, dental and orthodontic care, and scar management by way of an esthetician on our team. Over the years, FACES has provided over 800 surgeries and 500 speech therapy sessions. The key to our ongoing involvement has been partnering with the local Lions Club, who are there with us every step of the way during our surgical trips. The Lions Club also helps coordinate new patients and follow-up encounters during the entire year. We also work with local affiliates including Ernesto Robles, DMD, an orthodontist based in neighboring Chiclayo, who provides orthodontic care for our patients. We have been invited to multiple hospitals in the area—most often Hospital Belen and Hospital Regional in Lambayeque and Hospital Mercedes in Chiclayo.

The staff are volunteers, offering our time freely, covering all costs for patients during their surgery and receiving no financial benefit. In addition to medical volunteers' generous support, FACES receives financial backing from many individual donors. Furthermore, FACES covers half of the airplane ticket for many team members, the hotel cost, and two to three meals per day for the entire group. 

Location and Needs

Lambayeque and neighboring Chiclayo are located in rural, northern Peru near the Pacific coastline. Access to medical and especially surgical care is limited in many parts of Peru, particularly rural areas that are difficult to get to. There is a public health system, Seguro Integral de Salud (SIS) Gratuito or “Free SIS”, that is “free” for vulnerable populations. In reality, there are numerous costs for these patients that are often unreachable, as I will explain below.

Visit the AAO-HNSF Humanitarian Efforts map to see where humanitarian efforts campaigns are happening around the world.

Many years of conversations between our Board Chair and Managing Director Kelly Jensen, MBA, and local doctors, administrators, and patients have revealed the reality of the situation for Peruvians of lower socioeconomic status. Like “safety net” government health plans in many countries, Peru’s SIS does not have sufficient funding to meet all the needs of its members. There is an emphasis on primary care, and it is a substantial struggle to find funds for specialty care, especially when specialists earn much more in the private sector. Lima has excellent plastic and craniofacial surgeons but the more remote areas in Northern Peru have very few. Indigent families cannot afford a trip to Lima.

Even if patients can secure a spot for surgery with a local surgeon, their families must provide materials (e.g., drapes, needles, syringes) as well as medications, food and drink, and room and board. Many of our patients’ families are so impoverished that they do not have enough funds to cover these costs, even though the surgery itself may be free of cost. Oftentimes, the entire family must join the long journey to the hospital, starting with hours on foot, followed by transfers to the back of a truck and ending with a bus ride.

Our foundation provides all materials for surgery, intra- and postoperative medications, and food and drink needed during their hospital stay. The Lions Club helps many of these families with room and board. 

“Surgery’s the easy part”

-Tom Albert, MD, President Emeritus and Co-Founder of Faces

Coordinating Surgical Campaigns and Providing Year-round Care

In the years prior to the COVID-19 pandemic, several team members would conduct a screening trip in October or November to evaluate many patients and define the candidates for surgery or other treatments during the surgical trip in January. Once the pandemic hit, things had to change. Our first trip back was during the summer of 2022. Since then, we have returned on two additional surgical trips. For these three trips, the screenings were performed virtually.

One benefit of the pandemic was the increased use of cellular phones and computers for online interactions. This has permitted us to complete virtual evaluations of the patients. Patients submit facial and intraoral pictures which are usually helpful during the video appointment, and the surgeon determines if the patient is fit for surgery, what surgery or treatment is needed, or what steps need to be taken prior to surgical approval. If a syndrome was suspected, for example, the team facilitates a pediatrics referral by way of our local social worker for a global evaluation prior to any discussion of surgery. Many of our patients have never been seen by a pediatrician.

Virtual educational session in 2021 with two of our patient families. Participating team members (from top left to bottom left): Dr. Lourdes Quintanilla-Dieck, FACES Program Coordinator Delia Delgado (based in Peru), FACES Development and Operations Manager Rae Anne LaFrenz, and FACES Executive Director Angela Jensen Kelly.

The volunteer team has always included a surgical team, an anesthesiology team, operating room nurses or surgical technicians and pre/postoperative care nurses, in addition to administrative staff and interpreters. Starting in 2017, speech and language pathologists (SLPs) have joined us during our surgical trip to provide much-needed speech therapy. The pandemic brought our surgical trips to a standstill for some time, but our speech therapists found a way to keep delivering care.

We moved to a virtual mode of providing speech therapy, and the success of this approach has led to its continuation year-round. Currently, each patient meets with a licensed SLP either in-person during the virtual trip or virtually for an initial in-depth evaluation. FACES sponsored an online program for our in-country coordinator, Delia Delgado, to become an SLP Assistant. She meets weekly with each patient in active therapy to practice the exercises recommended at the initial evaluation. Sessions are recorded for quality review by our SLPs in the US.

Speech therapists Chelsea Sommer, PhD, CCC-SLP, and Hannah Sanford-Keller, MS, CCC-SLP, carrying out an in-person speech therapy session.Education and Training Efforts

Education efforts are a big part of what FACES stands for. We typically bring between four and seven trainees from various universities in the United States on the surgical and anesthesia teams. Medical students, dental students, as well as residents and fellows have joined us. In the last two years, a medical and dental student have completed clinical research projects during the trip and are finalizing manuscripts and submitting them for publication.

During the trip, the pediatric anesthesia, surgical, nursing, and SLP teams offer educational conferences for local healthcare practitioners. Local anesthesiologists have been quite appreciative of these teaching sessions, as pediatric-subspecialized anesthesiologists are not common in Peru. Most of the speech therapists in Peru are physical therapists who do not receive subspecialized training in craniofacial pathology, such as velopharyngeal insufficiency. We have frequently had Peruvian anesthesiologists and anesthesiology residents join our anesthesiology team during surgeries. In prior years, local medical students have joined our surgery team as observers.

Dr. Ernesto Robles, local Peruvian orthodontist who works with FACES patients (far left) with FACES Medical Director Dana Smith, MD (fourth from left), and craniofacial surgeon/surgeons-in-training from Ecuador, Honduras, Panama, and Peru.On our last trip in January 2024, local orthodontist Dr. Ernesto Robles invited several Latin American craniofacial surgeons and trainees to join our team during surgeries as observers. We had surgeons from Ecuador, Honduras, Panama, and Peru sharing their perspectives and learning from our surgeons. It was eye-opening to hear from them how limited resources and high costs impact their treatment options and practices. For example, certain sutures that are used commonly in the United States for oral procedures are extremely difficult and costly to obtain in Latin American countries. We hope to continue expanding educational efforts for local and international trainees and colleagues, as this is the way to multiply our outreach with patients as well as their community.