Daniel’s patient wait for transformative surgery

In September 2016, a volunteer Interplast team visiting Samoa repaired six-year-old Daniel’s bilateral cleft palate.

It was a great outcome for the young boy, opening up a brighter future that will include less chance of social exclusion, better speech development, ease of eating and drinking, and more.

But his story illustrates the challenges of treating conditions that in countries such as Australia and New Zealand are dealt with quite early in a child’s life.

Daniel was born with a bilateral cleft lip and palate, which requires a number of stages of surgery. He was first seen by an Interplast team in September 2013 at the age of three, and was scheduled for an initial operation, but he then developed a bad chest infection and his surgery was cancelled.

The following year Interplast volunteer surgeon Dr Damian Marucci operated on Daniel, repairing the cleft lip and anterior palate.

In 2015 Daniel and his family arrived at the hospital too late to be included on the Interplast team’s operating schedule, and although Dr Marucci was able to check his progress, he had to wait for yet another year.

Thankfully, Dr Marucci was able to complete the majority of the required surgery in September 2016, finalising Daniel’s bilateral palate reconstruction. Dr Marucci said the operation went very well, and on the next visit he will check to ensure that Daniel is eating and drinking properly and that no fistulas have formed.

Quality of life with a cleft palate takes much more than surgery. In Australia, Daniel would have been admitted to hospital much earlier to ensure he was in good health for surgery, and his recovery and ongoing development would have been attended to by a comprehensive medical approach, including audiology, speech pathology, nutrition experts, ear, nose and throat experts and more. It’s why we’re exploring ways to support the process in countries such as Samoa. Find out about Sarah Florisson’s visit to Samoa last year.

Many factors also contributed to the length of time it took for only the basics of Daniel’s condition to be treated, but a significant one is the lack of adequately trained local surgical staff. It’s for this reason that Interplast trips usually include training and mentoring for local surgeons so they can operate year-round and people such as Daniel don’t have to wait for the next Interplast visit.

Dr Marucci said that on this most recent trip, his team were also mentoring local staff.

“We have a great team that all work well together, two surgeons, two nurses and one physio. I think it’s great for the staff at the hospital to also see how the different fields cross over and work together,” he said. “We have basically the same team going every year and have built up a good a relationship with the staff at the hospital.”

Along with providing mentoring on Interplast visits to our program countries, we also support medical professionals to attend training and development opportunities in other countries. Dr Marucci highlighted Samoan surgeon Dr Dyxon Hansell, who has attended a training program in New Zealand and Australia, along with taking part in a surgical skills workshop in Apia in April 2016.

Dr Marucci said the local surgeons were all very keen learners and the relationship between the Interplast team and local staff is a very strong one, helping to build their skills over time.

During this latest visit to Samoa, Dr Marucci and his team were focused on repairing cleft lips and palates and attending to burns injuries.

“We were there for eight days this time and I think it was the busiest time we have seen with clefts and palates, 14 in four days,” he said.

“There is an Australian speech therapist that has been working there at the hospital and has done a fantastic job. She got all the contact details of the families, rented a car and basically went and hunted the families down in the villages and other islands.”

Dr Marucci has been volunteering for Interplast since his first program in 2009.

“It’s such a positive, rewarding and invigorating experience,” he said. “Team Samoa is an honour to be a part of. I have learnt so much as well as seeing the staff at the hospital take on new skills.”


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