The COVID-19 crisis has deeply affected the treatment of diseases and birth defects that require timely attention. One of them pertains to facial tissues, especially cleft lips and palates.
In India, more than 35,000 babies are born every year with cleft lips or palates. According to Dr Krishna Kumar, a Kozhikode-based plastic surgery expert who has been treating cleft problems for several years, almost one baby in every 350 live births has a cleft lip or palate.
A cleft refers to a gap or split in the upper lip and/or palate, which is the roof of the mouth. It is present from birth. Babies can be born with a cleft lip, a cleft palate or both.
Thousands of such babies are left untreated in India due to lack of access to proper medical care and financial assistance. A comprehensive cleft treatment includes a series of surgeries and speech therapy to be performed within a specific period after birth.
According to the UK’s National Health Service, babies can have the following issues before surgery, and which could persist if the surgeries aren’t performed on time (quoted verbatim):
- A baby with a cleft lip and palate may be unable to breastfeed or feed from a normal bottle because they cannot form a good seal with their mouth
- Some babies with a cleft palate are more vulnerable to ear infections and a build-up of fluid in their ears, which may affect their hearing
- A cleft lip and palate can mean a child’s teeth do not develop correctly and they may be at a higher risk of tooth decay
- If a cleft palate is not repaired, it can lead to speech problems such as unclear or nasal-sounding speech when a child is older
Some charity organisations provide assistance for comprehensive cleft treatment – but the COVID-19 crisis disrupted all that this year.
Though experts say the treatment for cleft problems should not be delayed beyond a certain time, hospitals around India have had to suspend this procedure to deal with COVID-19 patients as well as comply with safety protocols. State governments also selected many hospitals that treat cleft problems to focus their diagnostic and treatment efforts towards COVID-19.
So from March this year, cleft treatment surgeries ground to a halt.
In some states, including Karnataka and Kerala, these surgeries have only just resumed as they also cautiously exit the 77-day nationwide lockdown. But doctors in some other states, like Maharashtra, where the COVID-19 epidemic continues to be severe, have no idea when they can resume treatments for cleft issues.
Dr Nitin Mokal, a plastic surgeon from Mumbai, said there still are “risk” and “cost” factors. “We need to have more PPE to restart the surgeries, since this is a routine surgery,” he said.
According to him, he alone had been handling 25 cleft surgeries per month on average before lockdown. But since then, none of the 15 hospitals and centres equipped to treat treat cleft patients in Maharashtra have been performing the surgeries.
Dr Vikram Shetty, a plastic surgeon with the K.S. Hegde Charitable Hospital in Mangalore, said his hospital had restarted cleft surgeries. Dr Kumar, the plastic surgeon in Kozhikode, also said surgeries have resumed at the Aster MIMS hospital in Kerala, where he works.
Smile Train is a charitable organisation that helps parents and children dealing with cleft issues. Mamta Carrol, its vice-president and Asia regional director, said the organisation’s financial support continues to be available to all their partner hospitals. According to her, many of these hospitals “have already resumed cleft surgeries in states such as Karnataka, Kerala, Uttar Pradesh, Punjab, Odisha, Haryana, Jammu and Kashmir and Uttarakhand”.
But this isn’t the end of the road. Even at hospitals where surgeries have recommenced, many patients still have a hard time accessing treatment due to restrictions on interstate transport.
Dr Padmakumar Gopinath, a plastic surgeon who handles cleft surgeries at the Ananthapuri Hospital, Thiruvananthapuram, routinely meets patients from Tamil Nadu and hoped they will be able to access the hospital as before as movement restrictions ease.
In addition to these issues, many members of the cleft treatment community are already mourning the passing away of two leading surgeons, Dr Hirji Adenwalla and Dr Jyotsna Murthy, this year.
Muhammed Sabith is an independent journalist currently based in Kozhikode, Kerala. He tweets at @MuhemmadSabith.