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Initiative
Bringing Back the Smile
The Smile Train Shija Cleft Project initiated by Manipur-based
Shija Hospital has been instrumental in bringing smiles back on the faces of
many children with cleft lips and palates. Sonal Shukla takes a look
Dr KH Palin with patients who have undergone cleft lip surgeries at Shija
Hospital |
In an age where physical appearance is deemed important, a
physical deformity like cleft lip and palate can wreak havoc in one's life.
An urge to treat the children and adults who can't afford corrective surgery
for cleft lips and palates inspired Manipur-based Shija Hospitals and Research
Institute to start 'Smile Train Shija Cleft Project' in association with Smile
Train Inc, USA, an NGO. Started in 2006, a part of the Corporate Social Responsibility
of Shija Hospital and Research Institute, this project has so far successfully
performed 1,115 surgeries.
Clefts, a congenital physical deformity of the lips or palate,
are mainly witnessed in developing countries. In India, over 35,000 children
are born with cleft lips or palates every year. One cleft is born in every 600
to 800 live births and there is said to be a backlog of 8 lakh patients without
any treatment.
Identifying the Need
According to experts, the overall incidence of the problem in North East is
higher than in the rest of the country. "The reason why the incidence of
cleft is higher in the North Eastern populace is not exactly nor conclusively
known, and our team is involved in finding out the facts," shares Dr KH
Palin, Managing Director, Shija Hospitals.
There are no Smile Train centres except in Assam, Meghalaya, Tripura and Manipur
in the North East. What aggravates the situation is a dearth of plastic surgeons
and equipped hospitals in this region. Thus, general surgeons end up doing cleft
lip surgery, which leads to improper repair of the deformity and a blemish on
the face, often requiring a re-operation for better cosmetic effect.
Shija Hospital's endeavour to address this problem began in 1992, when Dr Palin
identified many children with cleft lip and palate problems in the OPD. "From
then, we were thinking of helping these patients. Finally, we got the opportunity
through Smile Train," recollects Dr Palin.
After two meticulous inspections of the hospital infrastructure (Anaesthesia,
PICU, NICU, OT and post operative results) by Satish Kalra, Director, Smile
Train, South Asia, Shija Hospital was recognised as a Smile Train Centre. The
project was rolled out on June 10, 2006. Under this Project, which is in its
second phase, the Hospital has signed an agreement with Smile Train Inc for
an initial period of one and a half years or 750 cleft surgeries, whichever
is earlier.
While the private sector charges Rs 15,000 to Rs 50,000 for treatment for cleft
lip and palate, the Smile Train Shija Cleft Project provides treatment absolutely
free. "Right from the initial visit of the patients to the OPD until the
patient is discharged from the hospital after the surgery, we do not charge
for anything including the investigation, surgery, medicine and all other treatment
related cost," states Dr Palin.
Smile Train Inc grants a consolidated amount of Rs 9,000
per case to the Hospital. The amount takes care of the cost of medicine, consumables
and all other treatment related expenditure. It does not pay the doctors anything.
The Smile Train also sponsors training for surgeons and anaesthetists. Shija
Hospitals has two full-time plastic surgeons recruited for the project.
The Bare Facts
The aetiology or causation of this problem is not known but higher incidence
is noted with German measles, steroids, X-rays, tranquilisers, or vitamin deficiency
during the first trimester. The chances of the child having the problem are
four per cent if one or both the parents suffered from the same disease. Patients
with cleft lip and palate require integrated treatment including surgery, orthodontic
dentistry, speech therapy, clinical psychology and rehabilitation. Not a life
threatening condition, but a congenital physical deformity of the most visible
part of the body, it deforms the face in a horrifying manner and the effects
on the individual are devastating.
"A cleft lip is visible on the face and if untreated, damages the child's
growing self esteem. It is best repaired as early as four months. A cleft palate
causes defective speech. An untreated cleft lip affects a person's personality
and badly impedes his/her prospects in life," shares Dr Palin.
Dr Jugindra Sorokhaibam, Director and Medical Superintendent, Shija Hospitals,
concurs, "It greatly affects the psychology of a patient if society is
not made aware about the disease and its causes and effects, as it leads to
a form of social stigma."
Dr Palin says, "The only time we advise to postpone the surgery is when
pre-anaesthesia clearance is not obtained. If the patient doesn't get the clearance
during the pre-anaesthesia check, then the surgery is postponed until the clearance
is obtained." Both the surgeries are relatively quick surgeries with cleft
lip surgery taking 30 minutes, whereas cleft palate surgery takes 45 minutes.
 It
was launched in 1998 with the goal to eradicate the global problem of cleft
lips and palates. The initiative boasts of a comprehensive approach-free
training for doctors, free surgery for children and research to find a cure-and
is supported by thousands of individuals and private foundations. Smile
Train currently has 120 'partner hospitals' and over 200 surgeons under
its wing in India. |
The Breadth of the Project
As Manipur is located in the easternmost tip of India bordering Myanmar, the
project can cover the whole of North East India. Besides the North East, the
project's target is to cater to patients in Myanmar, Bangladesh and even South
East Asia. "In neighbouring states, the project operates with the help
of Government, the Rotary Club and the Lions' Club. For example in Nagaland,
we did camps with the help of the State Government. In Silchar, we are doing
the screening with the help of the Rotary Club," explains Sanzib Roy, Deputy
GM, Administration, Shija Hospitals.
According to Dr Palin, with implementation of 'India Look East Policy', now
the project can cater to the populace of Burma. "Due to the relaxation
in the border trade practices between India and Burma in the town of Moreh,
we can visit and invite the Burmese to avail of our service. If needed, special
permission can be sought for the medical and non medical teams of the project
to visit Burma to carry out our mission," says the doctor. The Hospital
is now planning to spread the activities of the project in Dimapur (Nagaland),
Jorhat and NC Hills (Assam).
The Smile Train Shija Cleft Project completed 765 surgeries in the first year
itself. Reaching out to the needy was not so easy. To make it possible, the
Hospital has utilised the local media. "The media played a very important
role in spreading awareness of the project. We have intensive campaigns and
outreach programmes by the doctors in different district hospitals of Manipur
and in neighbouring states," reveals Dr Palin.
The Incentives
 "We
do not charge for anything including the investigation, surgery, medicine
and all other treatment related cost"
- Dr KH Palin
Managing Director
Shija Hospitals
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 "In
neighbouring states, the project operates with the help of Government, the
Rotary Club and the Lions' Club"
- Sanzib Roy
Deputy GM, Administration
Shija Hospitals
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Anyone between the ages of 4 months and 40 years can avail
of the services under the project. Patients are not just given free treatment,
but they and attendants are helped with to and fro conveyance. Also, they are
offered free lodging inside the Hospital building, food at subsidised prices
and small gifts at the time of discharge. The Hospital encourages one attendant
per patient. Patients coming from far away are extended a travel incentive ranging
from Rs 750-Rs 1,250. "No specific fund is earmarked for this and we are
arranging for the expenses out of the nominal Smile Grant we receive from Smile
Train Inc and partly out of our own account," reveals Roy. The Hospital
has already spent around Rs 95 lakh of its own on this project.
For patients and their attendants from Silchar, the Hospital has started a bus
facility. "We have successfully operated on 76 patients from Silchar in
March 2008," shares Dr Sorokhaibam.
Challenges
Though the project is catering to many pockets, many rural
areas are yet to be addressed. The reasons are many, including poor socio-economic
conditions. People in the interiors of North East India are desperately poor
and most families have a single daily breadwinner who finds it difficult to
take time off to visit a distant hospital. In some places, there is no transport.
There is also a lack of awareness of general health and about the project.
Future Plans
Given the roadblocks, the Hospital is planning for an induction of the Smile
Train mobile operating room units to cover many interior places of the North
Eastern states. "We can reach the patients by using the mobile unit rather
than asking the patients to visit our centre for the treatment of cleft- related
deformities," believes Dr Sorokhaibam.
The Hospital is also drafting plans to cover the Sylhet district of Bangladesh.
The small sapling of the Smile Train Shija Cleft Project is on its way to become
a big and strong tree of hope.
sonal.shukla@expressindia.com
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