The Bolivian Perspective

A group of mothers with their babies that have had cleft-lip/palate surgery.

While Jayson and I have come to enjoy the different simplicities of the Bolivian way of life; it seems that the most rewarding part of our experience here in Bolivia and has been the work we’ve for our research project. In the past four days we’ve had the opportunity to interview 12 doctors, a catholic priest, the director of health, and visit various cleft-lip patients and their families. Our most interesting interviews have been with the plastic surgeons here. One of the surgeons has done 2,300 cleft-palate surgeries and is known internationally for his work. He offered some interesting insights on the best way for NGOs to offer support. He mentioned that when foreign doctors come into Bolivia and do surgeries that Bolivian doctors can and should be doing on their own it takes away their dignity. He feels that it is fine for an organization to offer financial support for a time but that should not be the final solution. He proposed an alternate solution to providing free surgeries for children. Instead of NGOs paying for local doctors to do the surgeries (as Smile Train does) or having American doctors unfamiliar with cleft palate surgeries come in (like Operation Smile) he suggested setting up a rotation. Because of the experience these Bolivian doctors have had and the techniques they have developed, the results from their surgeries are superior to the vast majority of the surgeries done by foreign doctors. If doctors wanting to specialize in cleft lip and palate surgery they could pay these specialist to teach them for a period of 3 or 4 months their techniques that have not been written in the textbooks yet. In turn, they could provide free surgeries for the patients who have no money because the doctor wanting to learn finances them. If the NGOs still wanted to help, they could provide a scholarship for the doctors wanting to learn. Just as a side note, each plastic surgeon we have met with has a photo album with pictures of patients that have had bad operations, many of which were performed by Operation Smile medical missions. It is sad because once the child has had a bad operation it is very difficult to fix and make it look good. The child only gets one chance to have a good operation.

We have also been touched by many of the families that have lived though the trial of having a child born with cleft lip. Nobody knows until the baby comes out of the womb that it has cleft lip; if you have ever seen a baby with a bilateral cleft lip, it is quite a startling sight. There are many false beliefs about the origin of the deformity and it causes many parents to leave their children with the malformation at the hospital and never come back. One lady we met with had adopted one of these children and helped her receive reconstructive surgery. This program in Tarija is quite impressive. They have helped hundreds of children receive high quality reconstructive surgery. Many of these families have absolutely nothing in US standards, yet with the help of this organization they are able to help these children live a normal life.

A mother with two daughters that were born with cleft-lip.

The great team that has helped us an incredible amount with our research. Guadalupe, the one in the green, treated us like a son and daughter. (This is quite normal to tower over everyone. We will have a reality check when we get back to the states and we are short again.)