The future of cleft care

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Tim Campbell Medical Elective

Elective report from the Charles Pinto cleft lip and palate centre, Jubilee Mission Hospital, Thrissur, Kerala, India.

Tim Campbell – 5thyear medical student Manchester University

After qualifying as a dentist from Glasgow University in 2013, I am now in my final year at medical school in Manchester, with the intention of pursuing oral and maxillofacial surgery as a career (for which you need both degrees!). I was given the opportunity this Summer through Professor Markus and the Future Faces charity, to spend some time learning about cleft lip and palate surgery, and the burden of this disease on patients and their families. I am delighted to provide a report of my time.


This Summer I spent 6 weeks with Dr Adenwalla, Dr Narayannan and their cleft team in the Charles Pinto cleft lip and palate centre, Thrissur, Kerala, India.

A patient can be born with a cleft lip, a cleft palate, or both, and it is a facial disfigurement that has the potential to dramatically affect their lives and even cause a premature death if left uncorrected. Having a cleft lip (or “hare lip”), is more of an aesthetic problem for the patient but one that can lead to a huge amount of social stigma and bullying for children. Having a cleft palate however, while not so visually obvious, means that there is essentially a hole between the child’s nose and mouth. This prevents the baby from being able to feed properly, and the affected children fail to thrive. If left uncorrected, the children suffer from a nasal quality to their voice, leading to social isolation and difficulty finding employment and enjoying relationships as they grow up.


In the UK, around 2 in 1000 babies are born with the disfigurement. In India however it is as high as 6 in 1000. The actual cause is not fully understood, genetics undoubtedly plays a part, but it is linked to higher rates of smoking and alcohol consumption in the UK, the use of anti-epileptic drugs during pregnancy, and consanguineous marriages (of which there are more in India).


My week consisted of spending Monday Wednesday and Friday in the out-patient’s clinic, and Tuesday Thursday and Saturday in the theatres (Saturday is a working day in Kerala!). On Indian terms Thrissur is not a large city, but patients would come from hundreds of miles away to see the cleft lip and palate team, as the treatment is free (paid for by the smile train charity) and the unit has a very good reputation throughout India. Although I don’t speak the local language of Malayalam, the doctors and nurses would kindly translate, and it was a privilege to meet the child and their family and go on both a physical and emotional journey with them, observing the surgery and the transformative results afterwards. Quite often whole extended familes would turn up to outpatients, making it a very busy place! The patients would generally spend a week in hospital after the surgery, which is much longer than the UK and not always necessary, but was the way this unit had been set up – mainly to ensure that the charitable donations it received were going to those patients most in need. I was also lucky enough to spend time with the oral and maxillofacial team, and the speech and language therapists, all key components of the many disciplines involved in the ongoing care of the patients.


I learnt a huge amount, not just about the complex procedures involved in this surgery but also about an attitude to patient care and medicine itself. I feel like the experience has taught me many things that I will endeavour to take forward in my career. It was a humbling experience to spent time with Dr Adenwalla, who at 88 years old is still operating, and listen to his stories of successes and failures, and learn from his team. He actually was taught by Sir Harold Gillies, founding father of plastic surgery. If you haven’t heard of him, please look him up!


I also spent a couple of afternoons in the hospitals A+E department, where they specialise in the treatment of snake bites, something I definitely haven’t seen in the UK! The health care system in India consists of three types of hospital. Private (where the patient pays all the fees), mission hospitals (where patients fees are subsidised, often by a religious body), and government hospitals where the state pays – where health care often leads much to be desired. The hospital of this department was a Jubilee hospital, and while their funding is significantly less than the budget the NHS has, their standards were very high and it reminds me as a medic and a patient that cutting edge technology cannot replace the basics of good, clean, respectful and caring patient care.


The experience I have had has been one I will never forget and I hope to remember the lessons I have learnt this year in 60 year’s time. But I am not sure I will still be working – if I get to 88 years old!


Cleft lip and palate is a condition that irreversibly affects children and their families. Untreated, children just cannot flourish. It’s an expensive treatment, and patients require follow up care until they become an adult. There is often more than one surgical procedure, and patients with a cleft palate require speech therapy after surgery. It requires surgeons, nurses, counsellors, speech and language therapists, and whole theatre teams.

The work that Future Faces and the Smile Train does around the world transforms people’s lives, and I hope will continue to do so in the future. It’s been a pleasure and a privilege for me to be a part of that.