Cleft palate patients require extensive multidisciplinary care. International volunteer groups that provide cleft lip and palate surgery have to date been largely unsuccessful in accomplishing this due to a variety of obstacle. The Hopkins based volunteer / research group has partnered with a Nicaraguan foundation to provide multidisciplinary cleft palate care. The project has started to use a variety of innovative strategies, including the use of telemedicine, to address the lacking resources. The goal is to create a model of care that approaches that provided in the US. Introduction to one component can be found at:http://www.youtube.com/watch?v=Jzx3x2OHsjg&feature=relmfu

Within 20 minutes of my arrival at Aproquen, I changed into scrubs, accompanied the multidisciplinary team on rounds, assisted the surgeon with a new patient consult and was set to observe a cleft palate repair scheduled for 9am. All while struggling to interpret the Nicaragüense accent and appear un-phased by the site of infants with fresh burns and congenital malformations I had only ever seen in textbooks. Aproquen is a non-profit children’s hospital specializing in the treatment of burns and cleft palate repairs, known throughout the country as providing free care “para los niños quemados” (for the burned children). The small facility was bustling efficiently and everyone was smiling. My initial reaction: this place is great, and what am I going to do for the next month, they don’t need my help.

In retrospect, this whirlwind of a first day successfully debunked my preconceived notions that global health settings were haphazard at best and made me feel like part of the Aproquen team. From an insider’s perspective, I was able to fully appreciate the impressive interdisciplinary teamwork that was driving the organization and propose ways in which even a successful program can grow, keeping in mind the local priorities and constraints of working in a developing country.

At the end of day one, discussions with the Medical Director of the program rerouted our initial objectives for the project and led to a very successive collaboration focused on program sustainability.