By Fiona MacGregor and Shwe Yee Saw Myint | Monday, 17 March 2014
To be a child and to approach the world innocently only to be greeted with disgust and contempt because no one sees your heart, just the horror of your deformed face, is a misery most of us struggle to imagine.
Ma Khine Mo Shwe with her son, Tu Cha Aung, after surgery. Photo: F MacGregor
But for those born with the relatively common birth defect of a cleft lip and/or palette (around one in 700 births worldwide) and without access to skilled medical repair, the usual human hopes for friendship, acceptance and, later, work opportunities and intimate relationships can be remote possibilities.
The volunteer surgeons and staff of Interplast, who recently visited Sittwe General Hospital in Rakhine State to carry out surgery on young patients with cleft lips and palettes as well as burns and other disfigurements, understand that.
In a project organised by the Myanmar Chef Association branch of World Chefs Without Borders, in conjunction with the doctors of Interplast Germany, as well as other INGOs and community organisations and a local Buddhist monastery, the medical staff carried out roughly 100 life-changing plastic surgery operations over two weeks.
Even when viewed through eyes of compassion and understanding, some cleft-lip disfigurements are shocking.
With incomplete lips to hold gums, teeth can end up protruding far out of gaping mouths, turning childish laughs into unintentional snarls and grimaces.
“It only takes an hour or so to change a face completely…to turn a baby [perceived as] a little monster of whom other people are scared into a normal handsome child,” said Dr Caius Radu, head doctor on the project, as he waited for the anaesthesia to take effect on his next young patient so he could start his next transformation.
The Interplast surgeons said a combination of genetics and external factors, including foetal exposure to smoking, alcohol and various other external pollutants, can play a part in the development of cleft lips and palettes, which begins as early as the fourth week of pregnancy.
According to Dr Radu, cleft lip and palette surgery is one of the best-regarded facial surgeries. It is extremely rare to see an older child or adult in Europe who has not had the condition treated. In the West it is usually repaired when a child is around three months old and weighing the 5kg required for anesthesia to be safe.
But in Southeast Asia, where malformations can be twice as prevalent as in Europe – averaging 1 in 500 per births compared to 1 in 1000 – many families are unable to access or afford surgery, which is where Interplast comes in.
The organisation describes its aims this way: “We exist to repair bodies and rebuild lives.”
The intent might be simple, but to a non-medical person watching the surgeons at work, their intricate moves seem anything but.
A baby, around five months old, laid sleeping on an operating table. He had a complete bilateral cleft – wide slits running from each nostril creating flaps of flesh and gummy gaps where a top lip would normally lie.
The surgeon took a soft toy rabbit from beside the now-unconscious child as another doctor covered the infant with an operating sheet until only his mouth was visible. The surgeon worked with a head-lamp around his forehead: In Rakhine, electricity supplies are notoriously unreliable.
First he inked tiny temporary tattoos along the parts of the mouth to be repaired, then with intricate cuts tidied and reshaped the flesh. Finally, with delicate sutures, he brought the flaps together to form a recognisable top lip. Stitch by tiny stitch the incomplete is made whole, and the reviled becomes acceptable to the public gaze.
A few minutes later, bandages in place, staff moved the baby to the less-than-pristine corridor outside the operating theatre and onto the crumpled sheets of a trolly bed beside a woozy toddler who was also recovering from surgery.
The surgeon placed the toy rabbit back in the baby’s hands. The infant wriggled, starting to wake from the operation that saved him from a life of ostracisation and shame. His newly connected tissues couldn’t quite form a smile yet, but in the recovery wards on the floor below proud parents grinned as they ushered in passersby to show off their babies’ new faces.
Ma Khin Mo Shwe, 38, showed off her 11-month-old little boy, Tu Cha Aung. A narrow red line and a few black sutures are the only remaining evidence of his former cleft lip. Soon the stitches will be gone and the line just a small scar.
Ma Khin Mo Shwe, somewhat overcome with excitement and delight, spoke rapidly in her native Rakhinese: “I did not ever imagine he’d be able to have this operation,” gushed the mother of five from Sabatha Village.
“Before he was born I just wanted a beautiful boy, and then when I saw what he looked like I felt very sad, and when I thought that he wouldn’t be normal in the future I was concerned,” she said.
“After the operation I feel very happy, because he is normal, beautiful,” she said proudly holding him up for photographs.
Back in the operating theatre, more plastic surgery continued. With just two weeks to undertake around 100 operations the surgeons had little time for rest.
Childhood burns are common in a region where open fires rage frequently and hands and faces often come to close to the flames.
In one operating theatre a 13-year-old boy underwent surgery on a badly burned right hand. The accident happened years ago and the skin on his thumb and ring finger contracted as it healed, pulling them inward across his palm so that the hand was virtually unusable.
His little finger was entirely fused to the hand and the surgeon decided it must be amputated.
In a practical feat of medical recycling the skin from the amputated finger helped cover the wounds made by freeing the thumb.
“We discussed the amputation with the boy and his parents before this and they agreed,” said the surgeon. The loss of one finger is a comparatively small price to pay, they all decided, for regaining functional and pain-free use of the rest of the hand.
It is remarkable to see: flesh released, bone removed, skin excised, patched, repaired, and mobility returned so a disabled child will soon be able to reach out and grasp the future with both hands again.
Asked whether the patient would require physiotherapy and, if so, how that would be possible in his poor and remote home village, the surgeon explained that in his experience young people, particularly those living traditional lifestyles, are far quicker to adapt than adults in more developed regions. “Children have good [body] sense. If that were not so (and physio was necessary) I would not operate,” he said.”Of course a new adaptation is necessary, but these children adapt extremely quickly.”
Outside the operating theatre, nervous parents waited in the corridor. Every time the door opened and a person appeared garbed in surgical robes they leapt up anxiously hoping for news of their children.
Wai Ma Oo, 35, however, was not worried. She trusts the surgeons, she said, and just wants to see her 11-month-old son Aung Ton Kya’s face when he comes out from the operation on his cleft lip.
“I have five children and they are all boys. When this last one was born and I saw his face I was so disappointed. None of the other children in my family were like that, and it made me very sad.
“We are a very poor family and make our living from farming. The older children in the village make fun of him and say he looks like an animal.”
Inside the operating area, the surgeons had already worked their magic. No one can say Aung Ton Ja looks like an animal any more.
Thanks to an international joint Medical Mission in Rakhine State Interplast Nuernberg – Munich,- Dr Caius Radu team, World Chefs Without Borders – MCA & Drs Without Borders ( MSF )
The Boy 11 years old, from Mrauk – North Rakhine State, Myanmar was also before the operation always happy and smiling, regardless his since born deformation. He is also excellent in school as his father told us on 23.2.2014 at the Alodawpye Monastery, where most patients screened and could stay before and after the medical mission of Dr Caius Radu Interplast team, a missing financed by Interplast Munich Dr Heinz Schoeneich. Organized by MCA World Chefs Without Borders, MSF Doctors Without Borders and Rakhine Civil Societies. Under permission of Union Ministry of Health and Union Minister Dr Pe Thet Khin. One man is to highlight, Dr Aung San, tireless, proactive best support of Sittwe General Hospital Superintendent,- regardless of race, face or religion,- a right person at the right place. 120 operations at 95 patients were done free of charge.
Thanks to Sittwe ENT surgeon Dr Kyaw Khaing Win, Yangon surgeon Dr Linn Naing and all nurses at operation theater and at the wards. Thanks to the MCA volunteers and all Rakhine donors for all food cost to Alodawpye Monastery in Sittwe. MSF arranged and financed all patients & Drs daily transfers between Hotel, Hospital and Monastery,- MSF arranged & paid also for all Rakhine nationals feedings of patients at Sittwe Hospital. Sittwe Ophthalmic (Eye) surgeon Dr Moe Kyaw committed to take care at his cost for the left eye of the small boy to fulfill this as a WCWB & partners, “ Mission Accomplished “ ……
Thanks to all positive, based on equality treatment to any human in medical need, thinking people. Only through equality we can achieve a better World. Give time to some people in Rakhine, which are not ready for equality, to learn about a global world in peace. Oliver E Soe Thet, President Myanmar Chefs Association – World Chefs Without Borders. Yangon, Myanmar 3.3.2014