KARACHI: This is Dr Ulrike Lamlé’s fourth trip to Pakistan and her mission is clear – to accompany local teams of pediatricians, orthodontists, speech therapists and surgeons and perform cleft lip and palate surgeries.

Dr Lamlé is doing this in association with the German Cleft Children’s Aid Society (DCKH) and Al-Mustafa Welfare Society in Balochistan and Sindh. These efforts have been financed by the German government since December 2020, with one surgery costing about Rs 35,000.

A cleft lip is when the tissue that makes up a child’s lip does not join together entirely before birth. The opening could be small, or large enough to extend from the lips all the way to the nasal cavity. Meanwhile, a cleft palate may develop if the tissue that makes up the roof of a child’s mouth fails to join completely.

One in 600 children worldwide are born with a cleft lip or palate – and this problem is particularly acute in Pakistan, not just because of health complications that arise from cousin marriages but also malnutrition and a lack of folic acid in expecting mothers.

“DCKH’s intention is not to send teams of German people to different countries but to support local surgeons,” Dr Lamlé told Business Recorder in an interview on Wednesday.

“The second idea was to build up centres where children do not only get surgery but get speech therapy” and can be seen by orthodontists, dentists and ENT doctors.

Social workers are also on hand to ensure these kids go to school and “have the possibility to work in skill development centres so they can get a job and be really, completely integrated in society.”

The condition, which can be seen in an ultrasound, occurs around the sixth to eighth week of pregnancy. Some have difficulty breastfeeding and are often chronically malnourished. Other than being bullied for their appearance, an untreated cleft can cause serious speech impediment, as well as dental or ear problems.

But it’s entirely possible for such children to have “normal intelligence” and lead a “normal life”, said Dr Lamlé.

It is best to perform the surgery after the child is about one year old – at a later stage, it gets harder to fix their speech issues and enroll them in school.

In Pakistan, around 10,000 new cleft babies are born ever year. Only about half of them receive surgery, and the backlog caused by the pandemic hasn’t helped. DCKH hopes this number can improve, as it looks to expand its work to the northern regions of the country.

Dr Lamlé is in the country for one week and can perform as many as eight surgeries in one day when she heads to towns like Tando Muhammad Khan in Sindh (a trip to Khuzdar in Balochistan was cancelled due to unrest in the area) with a local team.

She believes Pakistan has “excellent plastic surgeons” – top among them is Dr Ashraf Ganatra, who heads Al Mustafa’s efforts in this space.

For governments, cleft babies are not a priority, Dr Lamlé explained, and government hospitals have long waiting lists for those who want to get this surgery done.

In Pakistan, Dr Ganatra and his team are trying to tackle this - they perform about 1,000 surgeries a year and head out to town and villages in the region once a month. One of their main goals is to spread awareness of the work they are doing as many patients or their parents do not know they can get this surgery done for free, with travel and accommodation paid for.

They put up posters behind rickshaws and are trying to rope in the help of Imams of local mosques to make announcements regarding the services they offer. After her one week in Pakistan, Dr Lamlé will head to Saudi Arabia where she is currently based, before making her way to Morocco and then Somalia as she continues on her mission.

Copyright Business Recorder, 2022