KARACHI: 9,000 born with cleft lips, palates every year: Three-day workshop begins
By Faiza Ilyas
KARACHI, May 22: Nine thousand children are born with cleft lips or palates every year in the country and their proper rehabilitation remains difficult in view of the availability of a few plastic surgeons and lack of team approach for multidisciplinary management.
These facts were highlighted at the inaugural ceremony of a three-day workshop ‘Recent Trends in Cleft Lip and Palate Management’, which was held at Arag Auditorium, Dow University of Health Sciences. The workshop was organised by the plastic surgery department in collaboration with the professional development centre of the university.
Giving details of the cleft lip/palate incidence in the world and Pakistan, DUHS plastic surgery department’s head Dr Mohammad Ashraf Ganatra said 132 million babies were born with cleft lip/palate or both in the world annually. Its incidence rate in Pakistan is one such patient in 400 births. Twenty five babies are born with cleft lip and/or palate daily out of 10,000 babies and that makes 9,000 new clefts just in a year.
“According to a rough estimate, there are around 1.2 million untreated cleft patients in the world, of which around 300,000 are in Pakistan. In Sindh, their number is estimated around 50,000 to 60,000,” he said.
In an ideal situation, he said, cleft surgeries should be conducted by plastic surgeons. But, he said, there was a dearth of plastic surgeons in the country. “There is no plastic surgeon outside Karachi and Hyderabad,” he added.
Dr Ganatra said paediatric surgeons working in the interior areas of Sindh were doing a great job. But, he said it was necessary for doctors to learn new techniques to avoid complications and secondary surgeries. “A single operation if done properly can change the life of a child,” he said.
Stressing the need for creating awareness, he said there were misconceptions about the birth defect as many people still linked it to lunar or solar eclipse.
He said all such misconceptions needed to be removed. He underlined the importance of timely medical intervention and said that in cases of cleft palate, delay in treatment could cause irreversible damage to speech. Cleft patients were as common in urban localities as in rural areas. The only difference was that there was no awareness and facilities for treatment in villages, he said.
Apart from physical disabilities, he said, people with this birth defect go through a lot of psychological and social problems which are more severe in cases of girls.
About the causes of this deformity, he said that genetic factors were thought to play an important role. He said genetic influence was more common in cleft lip/palate combined, then in cleft lip or cleft palate alone. “The risk of a cleft lip or palate is increased if the mother takes alcohol or certain medicines during pregnancy, such as the anticonvulsant or steroids. Other factors include folate deficiency, exposure to radiation and cigarette smoking during pregnancy,” he added.
In international studies, he said, clefts were found to be more common in oriental group, medium in caucasians and the lowest in blacks. In Pakistan, there was no study conducted to identify particular groups with this deformity. “However, cleft lip/palate seem more common in males and cleft palate alone seems to be more in females,” he added.
In the last three years, he said, a team of doctors and technicians from the Civil Hospital Karachi and the Services Hospital, Lahore, had organised cleft camps in Sukkur, Nausheroferoz, Hyderabad and Tando Adam in different hospitals where 160 operations were conducted free of cost with philanthropists’ support. “The oldest patient treated in the camps was a 52-year-old man with bilateral cleft lip,” he added.
Dr Ganatra stressed the need for establishment of a cleft centre having all disciplines involved in the management under one roof.
Underlining the need to adopt a team approach for complete rehabilitation of cleft patients, Dr Ghulam Qadir Fayyaz from the Services Hospital, Lahore, said cleft surgery needed multidisciplinary management which might involve assistance of pediatrician, ENT surgeon, maxillo-facial surgeon, orthodontist, speech therapist and psychologist. “Unfortunately, there is no concept of this strategy in Pakistan,” he said.
Dow varsity vice-chancellor Dr Masood Hameed Khan said the country had an excellent pool of doctors and there was a dire need that they should make combined efforts to transfer their skills to junior doctors. Training workshops, he said, should be held every three months to bridge the gaps in professional development.
Medical Superintendent Dr Kaleem Butt also addressed the participants of the workshop. Five medical and health experts will give lectures and training to 73 postgraduate doctors and consultants during the three-day workshop.
