Global Cleft Care in Low-Resource Settings

Cleft lip and palate represents the most common congenital facial anomaly. Congenital anomalies are one of the top 10 causes of disability and suffering in many low and middle income countries (LMICs.) Further, an estimated 30% of the global burden of disease is treated primarily through surgery, and among surgical conditions, treating clefts conveys disproportionately large benefit relative to cost because suffering can be halted at a young age and deliver a lifetime of health. Over the last 50 years, cleft care has advanced in low-resource settings through international surgical missions and the efforts of sparse local providers. While exciting anecdotes of impact abound from these efforts, recent studies have identified a complication rate that often exceeds 50% and there is concern about the sustainability of foreign volunteer missions.

This book serves as a thorough resource for providing medical and surgical care of cleft lip and palate deformities in low-resource settings, geared to the context of those settings. The content is consensus-based and evidence-based, with emphasis on treatment that is appropriate to a low-resource context and how this differs from that in higher-resource environments. It is authored by recognized cleft experts in close partnership with providers who practice in low-resource settings. It is heavily pictorially based through illustrative figures, photos and diagrams, to be facile for those who speak English as a second language.  

Following the introduction, Complete Cleft Care in Low-Resource Settings has six main sections: patient workup, surgical treatment, comprehensive care, educational innovation, care delivery models, and finally a series of illustrative case studies. Uniquely, the book’s breadth encompasses cleft care comprehensively, but does so through a practical “how to” format with many “from the field” examples of what has worked. 

Dr. Swanson is Assistant Professor of Surgery at the University of Pennsylvania and a pediatric plastic and craniofacial surgeon at The Children’s Hospital of Philadelphia. A graduate of Harvard College and the Johns Hopkins School of Medicine, he trained as a plastic surgeon at the University of Washington and completed his cleft and craniofacial surgery fellowship at Penn. He also holds an MSc in International Development Management from the London School of Economics, and was the Tsao Fellow in Global Surgery. He previously lived and worked in Nicaragua, collaborating with Operation Smile and the Nicaraguan Ministry of Health to build a joint Comprehensive Cleft and Craniofacial program and to expand rural access to surgical care through the Surgery for the People program. He partners with cleft teams in several countries to develop adaptive solutions for improving access to care, training, and quality of outcomes.

Dr. Low is Professor of Surgery at the University of Pennsylvania and an attending physician at The Children’s Hospital of Philadelphia where he has more than 30 years’ experience in treating patients with cleft lip and palate. A graduate of Harvard College and Harvard Medical School, he completed all of his surgical training at Penn under the guidance of plastic surgery giants Don LaRossa, Linton Whitaker, and Peter Randall. He serves as the medical director for his CHOP-based team, Smiles for Guatemala, which provides multidisciplinary cleft care biannually to the indigent population of Guatemala.

A certified medical illustrator, Dr. Low has contributed to many publications through his artwork. His personal experience in cleft care has provided a unique advantage in the creation of the many illustrations in this book.