The COVID-19 pandemic has caused crises in every sector of life, especially the health sector, including other non-COVID-19 diseases that still require urgent treatment. There are many patients of various diseases or disorders that must be treated with extra care in order not to be exposed to the COVID-19 virus. Medical measures that were previously carried out with standards must be supplemented with health protocols to protect health workers and patients.

One disease or disorder that requires surgery is cleft lip. A cleft lip or cleft palate is a condition where the left and right sides of the lip or palate are not fused, resulting in a gap on one or two sides. The causes can be many factors, for example, genetics, nutrition, radiation, or drugs. This disorder is not only experienced by newborn children, but also adults who never received treatment since they were children.

So how do we conduct cleft lip or cleft palate surgeries during a pandemic? Is it possible? This was the main topic for an informal online discussion called Philanthropy Sharing Session (PSS) entitled “Giving to Bring the Smiles Back on Indonesian Children” on Thursday, November 26, 2020. In this PSS session, Filantropi Indonesia and its members, Smile Train Indonesia, a charity that focuses on cleft lips treatment in Indonesia, invites participants to see what the challenges of handling cleft lip or palate during the pandemic are.

Dr. Denny Irwansyah, SP.BP-RE, MMRS, MH, Chair of the Indonesian Society of Reconstructive and Aesthetic Plastic Surgeons (PERAPI), said that, “During a pandemic, surgery practices must follow strict health protocols. For example, usually, before a pandemic, patient screening was done with the Rule of Ten (weight, age, hemoglobin level). So, during a pandemic, you must be extra careful, for example, before the action, you have to do a PCR swab on the patient and the medical personnel who carry it out. In addition, the number of patients should be limited to avoid crowds. As a comparison, in the past, during the free cleft lip surgery events, we could manage 50 patients per day. Currently, 1-2 patients are sufficient in 1 day or alternating. This means, cleft lip surgery is still very possible.”

Cleft Lip Issues in Indonesia

Deasy Larasati, Country Manager of Smile Train Indonesia, said that cleft lip and palate are still one of health problems in Indonesia. The incidence of untreated children with this disorder in developing countries is still high. In her presentation, Ms. Deasy described that based on their data, it is estimated that there are around 150 births of cleft lip and cleft palate in Indonesia every month. Meanwhile, according to Smile Train Global, there are 540 births every day in the world with cleft lip and palate.

Physically, people with cleft lip and palate have difficulty eating, breathing, and speaking. However, social stigma and myths in society are stronger than ever, making families with children with cleft lip and palate suffer more. Often, they have to live in isolation and are treated unfairly by the surrounding community, including difficulties to get a job for a decent living.

In fact, surgery for cleft lip and palate is relatively simple and the transformation is immediately visible. In addition, access to support, be it operations or assistance, is basically quite easy. As an illustration, in one month, the number of operations can reach 600 patients. Unfortunately, the perception in society that cleft lip and cleft palate is a taboo problem are spread more widely than information regarding the disease and access to treatment.

At the end of the session, Smile Train and its celebrity ambassador, Bunga Jelitha Hebrew, Putri Indonesia 2017, invited participants to raise awareness about the issue of cleft lip. They shared that since 2002, Smile Train Indonesia has provided free cavity surgery. In carrying out its program, Smile Train Indonesia Foundation collaborates with more than 85 partners in Indonesia, including the TNI, Polri, social workers, local NGOs, media, local government, and volunteers. As an international charity, it aspires to provide comprehensive programs in a sustainable manner to give life to a new generation that is more deserving, especially those with cleft lip and palate.