1:700




A Mama and her baby

  Clefts affect 1:700 births world wide. Is is a common birth defect that in the western world is addressed at an early age. A cleft lip can result in malnourishment due to the lack of ability to breast feed or drink from a bottle. Another type of Cleft is of the hard pallet (oro-facial cleft) these are 1:1000 births resulting in communication between the nasal cavity and mouth. The oro-facial cleft often results in a very malnourished baby and often will not survive. These sweet babies who have clefts are not spared from social judgment. Some are considered cursed and even abandoned as infants for this congenital condition.

Often these surgeries are done by our Maxillo-Facial surgeon Dr.Parker throughout the entire course of our field service (for the last 26 years). Over the past month however the past month the Plastics Surgeon on board has preformed a couple cleft lip repairs. It is a surgery that takes 2-3 hours and repairs the gap in the lip and bone to create a seamless lip. The children who we have had on our unit have been 5-9 years old. As the patients arrive to the ship they are shy, and cautious of everything new that they are experience. How strange it must be to walk onto a giant metal ship, down into a windowless hospital, with nurses and doctors speaking a foreign language. Using our translators is essential to be able to describe all the details of what to expect during their stay. I have cared for two of our Cleft lip patients over the past month.They only stay for 2-5 days.



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The first little boy was 9 but looked more like a 7 year old in his tiny malnourished frame. He was a shy little one, who disliked the liquid Tylenol and took a lot of coaching and encouragement when doing his exercises. After the surgery the patient practices smiling, saying ooooo, eeeeee, and making fishy lips, this stretches the new tissue so the healing scar tissue does not become taught. After a couple days of being his nurse i finally got a genuine smile from him. When passing by the unit on time off i would make fishy lips at him through the window. He was so adorable and i pray that he is able to gain weight, return to school and grow into a fine young man in the future.

The Cleft Palate patients are done by Dr Parker and go through Ward D (our high acuity and ICU ward). These surgeries are more extensive, the cleft goes through the soft pallet and sometimes even into the hard pallet resulting in feeding, speech and hearing problems. The surgery takes a flap graft covering the cleft area. This graft comes from the pharyngeal wall or cheek to close the cleft. The patients can experience respiratory distress due to the newly corrected airway. These patients have nasal trumpets through a nostril to maintain their airway, and a nasal-gastric (NG) tube to provide nourishment while the repair starts to heal. 


This Little Girl had a Cleft Lip and Pallet
The tube is an NG tube for the first
few days after her operation.

 (Side story about the NG feeds here, we have been using ensure and peidasure for the tube feeds however as the field service winds down and containers are delayed at times our supply of Ensure and Peidasure has run out a couple times. For the weeks when we do not have any canned NG feed the wonderful nutritionist here on board has put together a recipe for self made tube feed! As nurses we blend together 60 ml Peanut butter, 1 L whole milk, sugar, 10 ml Multivitamin liquid, and 6 tsp of fiber. After becoming smooth we store it in the fridge and give it as we would Ensure! To those nurses out there, can you see yourself fitting in a blending session into your busy day just prior to one of your 6 tube feeds of the day?! On my unit we have only had 3 patients requiring an NG and as a result this wonderful need to make our own feeds. However, on Ward D where the majority of complex cases and Max facial cases recover they are tirelessly making NG feeds throughout the day. But hey this is Africa and its a wonderful solution that works!)



My friend Jessica with one of
her Cleft Lip patients.

 Cleft Lip and Pallet is a surgery performed by aid organizations around the world and is a life saving surgery to so many rescuing them from a life of malnourishment and even death. It is a great part of my job to go up to a little one to tickle them make them laugh and make fishy faces as part of their lip exercises! I love my Job. I enjoy working with the children and seeing the quick change of a cleft lip repair. Last month i saw a little baby headed into surgery and just thought of how blessed that they were born here in Guinea while the Africa Mercy was here and was able to receive the care they needed. Timing in that little ones life that we were in the right place at the right time. 

My roomate Jillian with a little one she was caring for on Ward D