Oral Health Promotion Initiative: Fighting cleft lip in rural communities through surgery and awareness

The joy of welcoming their newborn son was dampened when Delight Sunday’s parents saw the child had a big tear on both sides of his mouth. According to Mr Sunday, after visiting many medical facilities, unable to afford the cost of treatment, they “decided to accept their fate”. Delight faced a lot of rejection at school and at home, kids avoided her. “At the age of 2, and then until he was 3, he didn’t understand why people chased him when he approached them in the community where we lived,” he added. It didn’t help that he also had trouble speaking.

When Delight was three years old, her parents heard about a surgeon who performed free surgeries for people with cleft lip and palate.. “We had the opportunity to meet the surgeon and saw a number of cases worse than ours. The operation was successful and we didn’t have to pay a penny. My 8 year old boy is now in excellent health and has good speech.”

Overcoming Barriers to Care
Worldwide, 1 in 700 babies are born with a cleft lip. The causes of birth defects like split lips and the palate in most infants is unknown. However, in some cases they are thought to be caused by a combination of genes, environmental factors, or a lack of essential vitamins.

Health Surveillance in Nigeria

According to Dr. Ngutor Ver-or, Executive Director, Oral Health Promotion Initiative (OHAI) Sokoto, Zamfara, Jigawa, Kano, Katsina and Yobe states report the highest number of cleft lip births in Nigeria. Due to factors such as barriers to care and poverty, a significant number of these cases go untreated.

However, non-governmental organizations like smile trainthe world’s largest charity works to overcome these barriers by providing information, assistance and free surgery to children in 77 different countries, including Nigeria.

Conceptualization of OHAI
The Oral Health Advocacy Initiative (OHAI) is another such organization. As a resident physician in the oral and maxillofacial department of Aminu Kano University Hospital in Kano, Dr. Ver-or found that most people who came to the hospital with oral and maxillofacial conditions Complicated facials always presented too late for effective intervention. He then decided to carry out advocacy and enlightenment campaigns with the communities.so that people know that they need to see a doctor immediately if they have any oral health problem or face,” he said.

Over time the vision evolved and since 2012 – when the organization was legally registered – OHAI has worked in over 750 communities in Nigeria and Africa providing free cleft lip and palate surgeries and other services medical services to underprivileged populations. In addition to cleft lip repair, OHAI also offers oral health care for women and children and an oral cancer program, among others.

They have worked in 34 states nationwide, treated more than 10,000 patients, and performed more than 7,000 cleft lip repairs. In each state, they partner with the state government which provides hospitals and health centers in designated local government areas (LGAs) where surgeries are performed.

The Oral Health Advocacy Initiative (OHAI) has worked in over 750 communities in Nigeria and Africa providing free cleft lip and palate surgeries and other medical services to underprivileged populations. image source: OHAI

Reaching rural communities
Each community-based approach has a two-step approach. First, an advance team is sent to liaise with community leaders and mobilize community members before the surgical team arrives. Upon arrival, the surgical team first carries out a general assessment of all the cases identified, namely”whether a person is fit to undergo surgery. If they are, “we welcome them and prepare them. If this is not the case, we advise or refer them to seek adequate medical care so that they are qualified to come for surgery.said Dr. Ver-or. They currently have eight surgical teams and sometimes have multiple teams working simultaneously in different states. Jeremiah, an anesthesiologist at OHAI, said each team works in one LGA per day and operates on 18 to 20 patients each day.

Although repairing cleft lip and palate is important for cosmetic reasons, its benefits are not limited to the skin. It’s also a question of health and survival. Photo credit: The Oral Health Advocacy Initiative (OHAI)

OHAI has adopted the strategy of extending awareness activities to rural communities, as the stigma associated with the disease often causes people with cleft lip to withdraw from public activity. According to Dr Ver-or, parents have been known to send children with cleft lips to the village, throw them away or even bury them alive. So they come out with the goal of not only fixing cleft lips, but also educating members of the community that this is a medical condition that can be easily fixed. “It helps that we go to their villages. They have a sense of security being close to home. It is also helpful to show them before and after pictures. These help them decide to have the operation. he added.

Besides the usual medical supplies, one item that is a constant on their list of essentials is Ankara fabric. They stock up on these”because when we go to treat patients in the villages, the women come with their children, and sometimes the clothes they wear are worn out and in a way you know that’s the best they have. So if you as a woman are going to have an operation, we give you a wrap. If it’s a man, we give him a cape for his wife or his mothersaid Dr. Ver-or.

Overcoming obstacles
Security issues in the country have made it harder for OHAI teams to travel as easily as before. But they have found a way to meet this challenge by working with people in all the communities in which they work. Community members themselves provide safety blankets as well as information on where to go and where to avoid. Additionally, when they arrive in a state, they officially notify state security officials of their presence. These also provide them with the necessary security support.

While they love the work they do, the teams also recognize that there is not much they can do without adequate funding. Currently, partners provide 60% of the funding; the remaining 40% must be increased. Partnerships with state governments sometimes help reduce the cost of outreach because they provide the facilities. They also work with volunteers. However, this does not completely solve the problem because not having a full surgical team readily available makes planning difficult.

More than on edge
Statistics show that with 1 case of cleft in 1,200 births, Africans have the lowest incidence of split births. However, this remains a concern as untreated cases lead to stigma, discrimination and difficulty eating, breathing, hearing and speaking. Therefore, although cleft lip and palate repair is important for cosmetic reasons, its benefits are not limited to the skin. It is also a matter of health and survival. The surgery and treatment help the child get the nutrition he needs, improve speech development, ease breathing problems, and generally give him a chance to live a stigma-free life.

Health Surveillance in Nigeria

But beyond surgery, intense awareness campaigns should be conducted in states with the most reported cases of cleft lip. Constant campaigns to raise awareness and correct misinformation and cultural beliefs about babies born with a cleft lip could be the reason a child has the chance to thrive in life.

Treat birth defects
At Sixty-third World Health Assembly (2010), Member States agreed to promote primary prevention and improve the health of children with birth defects. They are committed to raising awareness of the importance of newborn screening programs and their role in identifying infants born with birth defects, and supporting families who have children with birth defects and related disabilities, among others.

Health Surveillance in Nigeria

Globally, approximately 240,000 babies born with birth defects die within 28 days of birth each year. Birth defects also cause 170,000 deaths in children aged 1 month to 5 years. Statistics show that 9 out of 10 children born with a serious birth defect live in low- and middle-income countries.

As the government strives to address newborn and child health, it is essential that it takes note of this resolution and works with private organizations like OHAI and Smile Train to address the threat posed by birth defects and their contribution to neonatal and infant mortality.

Christine E. Phillips