When the Philippines trip didn’t fit into Bradley’s schedule this year, a Thai-born colleague suggested his native country as an alternative; the colleague’s Thai friends became the Rush team’s hosts.
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The team members who were surgeons spent a fair chunk of their own money in order to have that experience–they paid their own transportation and incidental costs. The other expenses–for example, supplies and nurses’ costs–were paid by various foundations, including the Foundation for Children’s Reconstructive Surgery and Rush-Presbyterian-St. Luke’s Clarence Monroe Fund for Education in Plastic Surgery (Bradley named the fund for a plastic surgeon who frequently volunteered overseas). They also had help from a Thai institution, the Princess Mother’s Medical Foundation, sponsored by the mother of the king. “She’s close to 90, and she’s really a saint,” says Bradley. “She spends six months of the year in the provinces making sure that medical care is delivered in the small villages.”
“In the beginning, they were watching us,” says Bradley. “They wouldn’t just accept us carte blanche. There were political implications: ‘Do they think we’re not able to do this ourselves?’ Their medical personnel have excellent abilities; there just aren’t enough plastic surgeons for the tremendous need.” Bradley says that of the 50 plastic surgeons in Thailand, the majority live in Bangkok. “They also commit a portion of each year to do this work–but they can’t ever catch up with the new ones.”
Cleft palates and lips can mean a vast array of problems. To start with the physical: food particles can get stuck in the passages above the mouth, leading to infection that often travels up into the ears. “With an open cleft palate,” says Dr. Peter Randall in a handbook for cosmetic surgeons, Plastic Surgery, “it is virtually impossible in some patients to be completely free from tenacious mucus or even mucopurulent material in the nasopharynx.” A related difficulty is that some patients may not be entirely clear of infection for the repair operation.
Most repairs are made before speech begins, usually at 12 to 18 months. These days, only unusually wide clefts can’t be corrected with surgery; about 1 in 100 sufferers has to have a lifetime prosthesis to cover the cleft, McNally says. “It’s like the difference between false teeth and your own teeth. Children never handle prostheses very well, and I suppose that in the third world they’re not very available.” Children also outgrow their prostheses with the same appalling regularity that they outgrow everything else; new ones must be frequently obtained.
“I coached Craig Bradley through his first cleft-lip operation, and I saw his wondrous enthusiasm then. I saw the rebirth of it when he returned from this most recent venture.”
