Smiles in Gabon - Humanitarian Mission Providing Cleft Lip and Palate Surgery in Libreville

Project location: GABON, Libreville
Project start date: December 2011 - Project end date: March 2012
Project number: 2011-40

Smile Train came into being in the United States in 1999 and offers its services in 75 countries in 5 continents. Smile Train Italia was founded in 2007 thanks to a group of professionals who decided to expand the activities of the international organization with independent humanitarian missions in countries such as Afghanistan, Iraq, the Democratic Republic of Congo, Mozambique, Ethiopia, Tanzania, Pakistan, Uganda, Georgia, Haiti, Armenia and Indonesia. The mission of Smile Train is to give back smiles to children affected by cleft lip and cleft palate by means of surgeries. Since 2000 more than 700.000 children have found a smile thanks to Smile Train. Cleft lip and cleft palate are facial and oral malformations particularly common in poorest countries. Children affected by this birth defect have great eating and speech problems. In addition, due to the local culture these children are kept hidden and isolated from social life because babies with this malformation are believed to be the devil's spawn. There are many causes that determine the onset of this pathology, such as marriage between close relatives, malnutrition, and a lack of dietary folic acid for pregnant women. A cleft lip surgery takes about 45 minutes; for the child, this small operation does not represent simply the definitive solution for this pathology but above all for these children it represents the hope of a new life. As said before, the goal of Smile Train is to provide childcare in countries with fewer resources where the number of these disorders is extremely high, and there is an average of about 1 child in every 300 who is born with cleft lip and cleft palate.

Usually, Smile Train assures its help in favour of these children in two ways:

- To organize humanitarian missions with a duration of about 10-15 days
with the participation of a team of medical specialists in plastic and maxillofacial surgery, paediatrics and in anaesthesia. Moreover, the team's mission includes nurses and logistics coordinators. The team is composed of about 12 personnel units and, on average, in a 10-15 day mission the volunteers are able to operate on between 40 and 60 children;
- To organize projects that allow us to transfer in Italy groups of children,
identified by our volunteers during the missions, affected by malformations and burns. Their stay in our country has the duration of least 10 days and they are surgically treated in the best specialized hospitals.

These two different kinds of intervention always provide training and medical education for local doctors; during the mission local doctors attend surgery as "observers", accompany patients to Italy and intensive professional training courses are arranged for them in order to make them autonomous in cleft lip and cleft palate surgery. The ultimate goal of Smile Train is the creation of local specialized centres which will act as host and reference points for the treatment of facial malformation. According to the Smile Train's mandate a new mission was performed in Gabon, officially the Gabonese Republic, a state in the west central Africa, where a lot of children suffer from this defect, waiting to undergo surgery. This situation leads the country to start collaboration with Smile Train which developed into a partnership between the Association and the local Ministry of Health.

In the Gabonese Republic for children under 5 age, the mortality rate per 1.000 live births, from a total population of 1, 5 million, reaches very high levels (6, 9%). This demographic data reflects the seriousness of the country's conditions, where poverty and malnutrition also contribute to the spread of pathologies such as cleft lip and cleft palate, which particularly affect children. Moreover, the inadequacy of health facilities and the inexperience of local doctors in the treatment of specific pathologies, including cleft lip and cleft palate, highlight the lack of the country's healthcare system. Smile Train performed the surgical mission in Gabon from April 13th to April 23rd. It has been carried out thanks to the partnership between Smile Train Italia (N.P.O. - non profit organization) and the local Ministry of Health. The mission obtained also the active participation of the local Red Cross that supported the Association in the transport of the patients and in the logistic organization. The surgeries took place in the Hopital Régional de l'Estuaire Melen (Libreville).
The Director of the hospital, Dr. Eyang Elise, has been an important figure by demonstrating her availability in the organization and realization of this mission.

The team which took part in this mission was as follows:

Mario Altacera - Maxillo-facial Surgeon
Monica Turco - Maxillo-facial Surgeon
Alessandro Pettola - Resident in Maxillo-facial Surgery
Davide Cristofani - Anaesthetist
Francesca Vitale - Anaesthetist
Stefania Norbedo - Paediatrician
Elena Sorrentino - Paediatrician
Iolanda Sabrina Barile - Scrub nurse
Claudio Suetti - Intensive care nurse
Monica Rinaldi - Nurse
Maria Rosaria Miscioscia - Nurse
Sabine Mbolongo - Interpreter
Clarissa Montilla - Volunteer
Dario Marani - Volunteer
Paola Palma - Mission Coordinator

Thanks to their effort and professional skills, the volunteers of Smile Train have been able to successfully operate and thus to give back smiles to 70 children.

The mission included the following phases:

1. Phase of Screening: Smile Train doctors welcomed the children and performed an evaluation process (screening of the patients) in order to value the feasibility of the surgery. Many of these children had already undergone through a prescreening procedure by the local doctors who collaborate with the Smile Train Italia. The total patients screened were 85 of which 15, for causes related to weight and age, were not considered suitable for the surgery.
2. Phase of Surgery: During the mission n° 70 surgical procedures had been carried out. To facilitate the realization of the surgeries a complete and equipped operating room was set up within the hospital.
3. Post-operative phase and hospital's discharges: This phase is handled by Smile Train doctors together with the local collaborators.

The pathologies treated surgically were:

- Cleft lips
- Cleft palates
- Cleft lips and cleft palates
- Burns

At the end of the surgeries the Smile Train doctors organized and performed a professional training course addressed to the medical and paramedical local staff, respecting the sustainability principle which is the driving force of the Smile Train's initiatives. The training course was realized in the field of surgery, nursing and anaesthesia; it trained up 3 local doctors in the treatment of cleft lip and cleft palate and 2 anaesthetists (the 5 doctors have been following all the surgeries) in addition to 10 nurses who actively collaborated with the Smile Train medical staff in the pre- and post-surgery phases. Considering that one of Smile Train's main purpose is to continuously carry out humanitarian interventions, this mission represents the base for the realization of a continuative project in Gabon in order to enable the population to live a new life and most importantly to give them not only an immediate support but the skills and the chance to become self-sufficient in the treatment of cleft lip and cleft palate.
Once again the volunteers of Smile Train have been able to give back smiles to a lot of children and confidence in a new future to their families, as we would wish for our own children.

Smile Train's work continued to go forward, and got even stronger, involving more and more volunteers, doctors and health personnel from countries with fewer resources. Thanks to the help of the volunteers, companies and supportive foundations that believe and invest in certain values, Smile Train will continue its mission in putting back a smile on every child's face.

Smile Train Italia ONLUS
think global, act local
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