Guided Reflection #8

  1. What does Smile train do that makes them a successful global health initiative? How could you improve Smile train’s global initiative for treating CL & CP?

Cleft lip and palate are affecting millions of children every single day all around the country. It can affect a child’s ability to breastfeed properly, eat properly, isolates them from society, and can cause a variety of other health issues, some even fatal. In developed countries, the problem is corrected quickly and easily at birth, but people in the developing world don’t have it nearly as easy. Smile Train is a global health initiative aimed at providing cost effective and successful surgeries to repair cleft deformities for those in the developing world. I believe Smile Train is a very successful global health initiative for a variety of reasons. The first and most obvious reason in my opinion is that their services are provided free of charge. The cleft repair surgery is done pro-bono so that the families in developing countries who are struggling just to get by are able to give their child a chance at a healthier, more normal lifestyle. Cost effectiveness is a very important component of any global health initiative and when the services can be provided free of charge, it makes it even more helpful to families around the globe. Second, their “teach a man to fish” model is another great aspect of their initiative. Not only do they have their own doctors that do the cleft repair procedure, but they train local doctors in 85+ countries how to do the procedures as well. This allows members of the community to become involved, and families can trust the doctor even more if he or she is a member of their own culture and community. These doctors then train other doctors creating an ever-expanding network of resources and doctors with the skills necessary to repair cleft deformities (Smile Train 2015). The third and final main component of their initiative that is successful is their aim at reducing the stigma of children with cleft deformities. Not only do they recognize that this is a huge medical issue, but they recognize the culture aspect of it as well. Many people believe cleft deformities are a result of being “cursed” and young children are afraid of others with these deformities. Smile Train makes it a part of their mission to reduce the stigma associated with CL and CP and attempts to make children more comfortable with those suffering from them. They show pictures and explain that its not a curse and that they are normal just like you and I. It is very difficult to change a culture’s beliefs, but Smile Train makes the effort to reduce as much of the stigma and discrimination as they can. The combination of these three factors, plus many more, makes it a very successful global health initiative. In terms of improving their initiative, they are already doing so well so that is difficult to answer. However, it was said that the families must provide means to get to the facility for the treatment and they are in charge of food when the child stays there for upwards of 7 days. That can be extremely difficult, if not impossible, for families that don’t have the money or food to do so. If Smile Train had the ability to provide families with meals while they stayed for the course of the treatment, which would help them greatly. Also, if there was a way to perhaps pick up the patients and bring them to the facility instead of them paying for transportation, it could increase the amount of children they help. Other than that, I can’t think of any ways to improve their initiative.

  1. How would you promote breastfeeding with babies that have CL & CP in cultures where they think it is a curse?

Unfortunately, culture is not something that is easily changed, if even possible at all. I believe that we need to take a step back and ask: who are we to judge and change a person’s culture and beliefs? What seems strange/cruel to us is custom for someone else, and could be said for anything we believe in as well. It is important to stop thinking of people in developing countries who share different beliefs as an “other” and start thinking about how we can help improve their quality of life in a way that is parallel to their culture. In this situation, many people in developing countries believe it is a “curse” or something the mother did that caused the baby to be born with CL &/or CP. They often do not want to associate with the child or are ashamed to breastfeed and interact with the baby due to embarrassment and guilt. The first step is to try and normalize it as much as possible. Perhaps show examples of successful people that once had CL or CP, or show successful families with children who have CL or CP. If someone they respect and trust can be afflicted with this condition, perhaps it is not so much a curse and more just an inconvenience that can be fixed. I believe the introduction of some education on safe and effective breastfeeding techniques could greatly increase the likelihood of a healthier baby and outcome long term. We learned that methods like blocking the hole of the cleft lip with your finger, and doing shorter but more frequent feedings are two ways to increase the nutrients your baby is receiving. If an education portion could be implemented in these countries that included free and simple ways to keep the baby healthier, I believe it could increase the amount of breastfeeding that occurs. There are also nipples and attachments that exist to make sucking and latching easier for a baby with CL & CP that could be handed out to mothers after the education portion. This is assuming funds were already provided, but it would be very helpful for them. Overall, you can’t change culture, but you can help make the lives of those who are in that culture a little bit easier.

Works Cited

“A Single, Solvable Problem: Cleft Lip and Palate | Smile Train.” Smile Train. 2015. Web. 02 June 2016.