The Middle East and North Africa (MENA) have a combined population of 700 million with an annual birth of at least 14,000 patients with clefts. Given the political turmoil in the region, there are multiple subpopulations, where even the most rudimentary pieces of cleft care are not present, suggesting that the numbers of untreated, or inadequately treated, patients have already out-pacing the capacity of regional providers to care for these patients. This presentation will 1) Assess the cleft landscape of MENA, 2) Provide an overview of current work being done in the region, 3) Identify potential solutions to the shortfalls of current strategies, 4) Develop mechanisms to improve the quality of cleft care delivered in the region, and 5) Provide a roadmap for future regionalization of cleft care.
Strategies for building cleft care capacity in MENA must start with individual volunteer trips, then grows to incorporate local team development, and must also broaden into regional strategies to improve access to care for patients with clefts and their families. When preparing for individual volunteer trips, the following scheme is utilized: 1) Pre-screening of hospital capacities including the presence of an intensive care unit, 2) Clear communication with local partners, 3) Pre-operative evaluation of all patients by all team members, including, but not limited to, pediatricians, anesthesiologists, speech and language pathologists, and surgeons; 4) Clear decision making that the operation for each child is the correct operation at the right time, 5) Standard algorithms for care pre-, intra-, and post-operatively; 6) Appropriate monitoring of patients during recovery and through discharge, 7) Timely discharge with appropriate follow-up, 8) Routine re-evaluation of the quality of outcomes; 9) Developing a standard process for morbidity and mortality discussions, 10) Identifying metrics for outcomes, including, but not limited to, quality of lip repair, adequacy of bone grafting, and speech outcomes, and 11) Instituting a database to track these metrics. Individual volunteer trips must transition to local team development. These teams should conduct their cleft work with algorithms that emphasize safety and high-quality outcomes. This work must then transition to identification of regional centers where cleft care may best be delivered, and to develop mechanisms for these reginal centers to communicate with each other in order to develop an overall strategy for MENA. The co-authors will present the results of a combined 45 years' experience with cleft work in MENA, and share insights about how to address these methodological items, all with the intent of improving cleft care within MENA. In sum, sustainable improvements in cleft care must start with safety, attention to detail, a strong will to teach, and providing local and regional strategies to improve cleft care in MENA.