Building capacity to deliver Comprehensive Cleft Care in Guatemala

Project location: Guatemala, Guatemala City, Peten, and Escuintla
Project start date: July 2023 - Project end date: July 2025
Project number: 2023-010
Beneficiary: Fondazione Operation Smile Italia Ets

Despite being the country’s capital, Guatemala City does not have a specialized cleft care center that delivers multidisciplinary care for patients with cleft conditions.  Operation Smile’s current clinic has limited capacity to provide care for patients from Guatemala City and the rest of the country.  Multidisciplinary care is important as most patients with cleft conditions arrive at Operation Smile’s programs never having seen a pediatrician before. In addition, Operation Smile’s nutrition program address Guatemala’s challenges with malnutrition, with stunting on 47% of children under five years old– the 6th highest rate in the world.  In the rural areas of Guatemala where most of the population is of Mayan descent, the malnutrition rate sits at 80% given the population’s corn-based diet, which has been proven to cause negative health effects in children. The northwest region has 3 times the rate of stunting in the Southwest or metropolitan regions. 
In 2020, Operation Smile conducted a needs assessment with the hospital’s leadership and developed a shared commitment to establish a Cleft Care Center to provide multidisciplinary care year-round to patients from Guatemala City and from other parts of the country where poverty is four times greater than in the metropolitan area. As a referral center for the entire country, the Comprehensive Care Center will have a patient shelter to host patients and families. 
In addition to infrastructure investments which is the focus of the Foundation’s support in Year 1, Operation Smile’s medical education programs aim to strengthen Guatemala’s health workforce to deliver specialized cleft surgery and care for which education and training programs are crucial, which is the focus of the Foundation’s support for Year 2 and Year 3. Guatemala has only one specialist surgical worker per 100,000 population, in stark contrast to the Commission's minimum of 20 providers per 100,000 people. Existing plastic surgeons have trained abroad as there are no plastic surgery training programs in the country. (The World Bank, World Development Indicators (2016). Specialist surgical workforce (per 100,000 population) - Guatemala. Last accessed September 21, 2022. Retrieved from: https://data.worldbank.org/indicator/SH.MED.SAOP.P5?locations=MG)   
American Heart Associate courses provide health workers with critical, life-saving skills such as cardiopulmonary resuscitation and airway management techniques. As one of the only mobile training units authorized by the AHA, this program has been one of our most impactful to date, training more than 22,000 health providers worldwide since inception. 

The Nando and Elsa Peretti Foundation has awarded a grant for this project.

This project aims at:
• Establishing a comprehensive cleft care center in Guatemala City will reduce the care waiting list of the Guatemalan patients in 7 medical specialties and ensure a more expeditious process, with quality treatment. The Center will provide ongoing timely comprehensive cleft care to more than 1,000 patients a year, expanding access to cleft services for people affected by cleft conditions in Guatemala.
• Providing American Heart Association (AHA) training for 134 medical workers the next 2 years, will strengthen the capacity of the staff at Operation Smile hospital partners in Guatemala City, Petén and Escuintla.

As the only provider of comprehensive cleft care in Guatemala, Operation Smile’s goal is to support the patient’s journey to better quality of life. The expansion of the Center in year 1 and the focus on education and training in year 2 and 3 goes hand in hand with Operation Smile’s formula for transformational impact which combines the delivery of medical care to address the immediate need while simultaneously building local capacity through education and training programs and infrastructure investment.  
To this end, the first year will focus on strengthening the capacity to provide cleft surgery and ongoing multidisciplinary care in Guatemala City through an expanded partnership with the Children’s Hospital Juan Pablo II to expand the hospital’s infrastructural expansion plans to establish a year-round Cleft Care Center and a patient shelter to host patients who travel from the peripheral areas of the country to receive cleft care in Guatemala City. What the expansion of access to comprehensive cleft services and the increase of quality of care mean in practical terms is that Operation Smile will be able to open a Year-round Center in Guatemala City to deliver care to 3,000 patients in the next three years and deliver training for medical providers working with our patients.