Smile Train aims to empower local doctors and professionals to treat patients : Dr. Alvaro Figueroa

In an interview with ETHealthworld, Dr. Alvaro Figueroa, Co-Director, Rush Craniofacial Center, Chicago and also Member, Medical Advisory Board, Smile Train, talks about the various protocols followed by Smile Train in providing effective cleft care. Edited excerpts:


What is the role and impact of the team that is required to provide effective cleft care?
Effective cleft care cannot be provided by just one professional, it needs to be done by a group of professionals because patients that are born with cleft lips and palates have many needs that one specialist cannot treat by himself/herself. Usually the team is composed of several members, a surgeon, a paediatrician, anaesthesiologist and many medical support professionals.

At Smile Train, in addition to providing cleft repair surgeries, we focus on comprehensive transformation with expert interventions for pre and post-operative care. Hence, we have specialists from dentistry, orthodontics, speech therapy, hearing aids, psychology and mental health, and social workers. We at Smile Train believe in not just providing surgery to heal the cleft visibly, but also provide comprehensive cleft care to improve speech so that children born with clefts can lead a normal life. Speech therapists and orthodontists play an integral role in ensuring that quality comprehensive care is provided to all.
The impact at the end of the entire process, is a complete transformation in the patient who emerges as a confident and beautiful individual.


What services are being provided by Smile Train in India?
Smile Train is a charity that was started in 1999 and since then, has provided help and assistance in cleft care across 85 countries. India and China are two of the biggest programs and recipients of this support. Smile Train aims to empower local doctors and professionals to treat patients with cleft lips and palates and enable them to provide treatment to people in their own communities. Smile Train does not rely on professionals coming from other countries to do the treatment. This ‘teach-a-man-to-fish’ model is also helping build capacity in these countries to enable local hospitals and doctors to provide free cleft care to children throughout the year, rather than flying in missions from abroad, intermittently. It has also enabled us to provide ancillary services such as speech therapy and orthodontics to ensure comprehensive cleft care.


How can doctors and hospitals become a part of this movement?
Through a fair and totally transparent but highly rigorous process of screening, Smile Train credentials hospitals and surgeons who deliver safe, quality treatment to children. An independent, voluntary team of very senior and celebrated plastic surgeons and anaesthesiologists form the Smile Train Medical Advisory Board which credentials hospitals that apply to become a partner.
Once the Board is convinced that the hospital is equipped with safety protocols and has experienced surgeons and associated medical staff to provide safe surgeries to children, the hospital enters into a formal agreement with Smile Train. As of today, Smile Train works with close to 1100 partner hospitals in over 85 countries. In India, Smile Train works with 160 partner hospitals and over 250 partner surgeons.



How important is it to document surgeries?
At Smile Train, safety and quality come first. All treatment partnerships are strictly required to follow Smile Train's Quality Improvement Protocol, which lays down the basic elements needed to ensure safe surgeries and provide ongoing improvement of the quality of outcomes. The surgery of every patient is closely evaluated, and follow-up surgeries or ancillary treatments and therapies, such as orthodontics, speech therapy, etc., are provided accordingly. When a team has been approved by Smile Train, there are different requirements that partners need to fulfil, and one of the requirements is documentation of what they are doing.


We document our patients’ progress for two reasons – firstly, to evaluate and assess what the team is doing to ensure there is proof of effective utilization of grants. The second and important factor is that documentation of patients especially at the critical stages of surgical care or other services, allows teams to monitor the progress of their patients on a long term basis.
Eventually, this information will help us improve our services across teams around the world, and would help individual teams to determine how well they are performing, since Smile Train grades some of these records that the teams are sending. If we determine the quality of surgeries do not meet the global quality standards, Smile Train will find ways to train and upskill doctors and facilitate access to additional support.


Doctors are provided with opportunities to attend international conferences, engage with well-known partner surgeons to adopt and implement best practices in the field. Our partner doctors ensure that protocols set by Smile Train are adhered to at all times. Visits by an independent team are conducted to maintain a close check on the surgeries being performed at our partner hospitals.