Global Surgical Outreach for Cleft and Craniofacial Conditions

Ryan H. Belcher, MD, MPH, Steven Goudy, MD, MBA, and Travis T. Tollefson MD, MPH, on behalf of the Cleft and Craniofacial Committee

Otolaryngologists and Global Surgical Care

International volunteer surgical humanitarian work in low- and middle-income countries (LMICs) has continued to rise over the last several decades. However, the global burden of surgical disease is often overlooked owing to the prioritization of global health efforts in infectious disease and nonsurgical efforts. American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) members and trainees are increasingly contributing to needed surgical outreach. Otolaryngologists are well suited to participate in global surgical efforts—along with other public health initiatives—as the specialty that blends care of the communication senses (hearing, speech, sight, smell) with surgical expertise in the restoration of head and neck form and function.

Recently our group—comprising members of the AAO-HNS Cleft and Craniofacial and Humanitarian Efforts committees together with the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS)—have endeavored to establish a "hub" of information on otolaryngology teams' efforts across the globe. Our aim is to enable each volunteer organization to efficiently and accurately identify other teams that are aligned in their goals, their collaborations, and their region of interest.

Challenges in Cleft Care Access

Patients affected by cleft lip and cleft palate in LMICs often lack access to specialized surgical care owing to lack of awareness, financial burdens that prevent families from seeking care, and inadequate numbers of trained surgeons in their region. A recent survey of the otolaryngology-head and neck surgery global workforce showed that the otolaryngology-head and neck surgery workforce in LMICs is less than one surgeon per 100,000 population, compared to over five surgeons per 100,000 in high-income countries.¹ Otolaryngology-head and neck surgery specialists were reported to perform 20% of the cleft lip and palate surgical care in the LMICs that were surveyed, indicating the significant global impact of otolaryngology-head and neck surgery in cleft care.¹

Models of Care Delivery

There is no one-size-fits-all model for global surgical humanitarian work, and approaches are often shaped by long-standing personal relationships combined with the dynamics and needs of each country. There are certainly instances where a humanitarian surgical endeavor is unidirectional, in which patients receive surgical care from a volunteer team that has traveled to deliver the care with limited local interactions. This unidirectional or vertical model of care delivery has been de-emphasized over the last two decades in favor of a bidirectional model. The bidirectional model involves collaboration with local medical personnel with the aim to educate, empower, and equip to fill the necessary local voids. Partnerships between high-income countries and LMICs should be designed to be sustainable with capacity building for the local healthcare delivery systems.

Work by Otolaryngology-Head and Neck Surgeons

Recently, the AAO-HNS Cleft and Craniofacial Committee developed a survey to gather data on outreach efforts in the cleft and craniofacial space. As an initial assessment, 37 respondents from 30 US-based institutions were recruited from the members of the AAO-HNS and the AAFPRS. These respondents performed surgical outreach efforts in 19 countries across Africa, Europe, the Caribbean, Asia, and Central and South America. Most of the outreach efforts were sponsored by nonprofit organizations.

Many of these efforts can be found on the AAO-HNS Humanitarian Efforts interactive map here: https://www.entnet.org/get-involved/humanitarian-efforts/map/.

We ask that you submit information about your global surgical efforts and organization at this website if it is not already listed.

Survey Results and Findings

Diving further into the data from the survey showed the duration of each global surgery outreach had a median of seven days (range 5–14 days). The exception was a surgeon who is working to build capacity in a hospital in East Africa, where 210 patients underwent surgery over 162 days. Table 1 shows the organizations involved with each humanitarian trip and the surgical concentrations for the trip.