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From Minnesota with love, surgeons heal broken smiles, deliver hope

Volunteer doctors, nurses performing cleft lip, cleft palate surgeries

by Paul Chaderjian

Published: Saturday October 11, 2008

Dr. Les Mohler during an operation at the Arabkir Medical Center in Yerevan, October 7, 2008. Paul Chaderjian

Yerevan - They came to Armenia from Minnesota and the Midwest - the American Heartland - on a medical mission. They came to heal those born with one of the most common birth defects around the world - cleft palates and cleft lips.

"Overnight we change people's lives," said volunteer Heidi Shafland, a pediatrics ICU nurse from Children's Hospital in Minnesota. "Many children with cleft lips or cleft palates don't go to school. They don't leave their house. They don't have jobs. They don't marry, and we can change someone's future overnight."

After more than a dozen hours of travel and little rest overnight, Ms. Shafland and 18 other volunteers from the United States - surgeons, anesthesiologists, nurses, coordinators, and medical record specialists - reported for duty at a local medical center last Saturday morning.

Ahead was a weeklong marathon of consultations, screenings, and back-to-back surgeries. Ahead were at least 250 patients to see and dozens of surgeries to perform.

"Since the screening process and through the end of the day Friday, we've completed 51 surgeries," said organizer Madlene Minassian, director of the Cafesjian Family Foundation's Health Outreach Program. "The surgeries have been extremely successful.  It has been an amazing experience."

Smile Project

The Smile Project is the name of this collaborative mission led by the Cafesjian Family Foundation, Hope for the City, and the Smile Network International, in cooperation with the Arabkir Medical Center, Fund for Armenian Relief, Hand in Hand, Yerevan State University, and the ministries of health of the republics of Armenia and Nagorno-Karabakh.

"It seems that Armenia has been very proactive as far as actually taking care of these patients," said Dr. Raj Sarpal, a cardiac anesthesiologist from the University of Minnesota in Minneapolis.

The Armenian government offers a stipend to help underwrite the surgical costs to repair cleft lips and palates, but some families are not able to afford the incidentals or travel costs involved in cleft care.  Some families said they did not know about the stipends. Others said they did not know these birth defects were reparable.

At least three families among those of the 250 patients screened this week had turned their children over to an orphanage because they couldn't feed or take care of them. One of those orphaned kids, a four-year-old boy, was one of the first children to be treated. He was reunited with his mother after surgery.

"We're not seeing a lot of older patients who've had unrepaired cleft palates or lips," said Dr. Sarpal. "In a lot of other countries we go to, we see a lot of older patients who haven't had the surgery."

Preparations for this medical mission began months in advance.  The medical mission team was assembled by Minneapolis-based Smile Network International. The five-year-old nonprofit organization provides cleft care to children and young adults in developing countries.

These medical missionaries started their six-day visit with two days of patient screening, examining an average of 17 patients per hour.  Patients with cleft care needs from all over the Republic of Armenia, Nagorno-Karabakh and the Javakhk region of Georgia had contacted or were contacted by the Smile Project; and after months of outreach through the medical community and Smile Project's media partners from CS Media and Armenia TV, the waiting rooms at Arabkir were filled to capacity with young and old patients with cleft-care needs.

"These trips are very rewarding because mainly you're taking a physical condition that's relatively simple to correct and in one-and-a-half, two hours, you're making a big difference," said Dr. Samir Mardini, a Mayo Clinic craniofacial and plastic surgeon from Rochester, Minnesota. "I think all of us who volunteer for these missions take off a lot of time from our jobs in order to participate. It is extremely rewarding. We get a lot out of it, almost as much as the patients get out of it."

On the first day of the screenings, there were so many families that the doors to one waiting room were locked with one nurse on each side, trying to control traffic.

In the main lobby of the Arabkir Medical Center, dozens of men, mostly dressed in black - in stark contrast to the nurses in white uniforms manning the information desk - waited in groups of three or four.

They waited without saying a word, hoping a loved one would come out of the screening with some encouraging reaction from the doctors from the United States.

World-renowned surgeons

Leading the medical mission on behalf of the Smile Network are doctors Les Mohler and Samir Mardini. They're known as two of the best cleft surgeons in the world. Dr. Mohler, now semiretired, is known for developing a cleft surgery technique that bears his name.

"We developed the Mohler technique in 1972 and didn't publish until 1987," said Dr. Mohler, "because I wanted to make sure I could follow the children and see that the result didn't change over the years."

Dr. Mohler, who averages about eight volunteer missions like the one to Armenia annually, said his technique is used in a cleft surgery to make a scar that mirrors an upper lip's natural dimple in the middle.

"In the mid-portion of the lip, we have what we call the philtrum," explained the surgeon. "On each side, you have a column. If you have a unilateral lip that's open, then I try to make the scar so that it will be a mirror image of a normal column. So, even though you have a scar there, it's in the correct position, and it basically creates that central portion of the lip that you want. There is no breakup in the line."