University Times

The incidence of cleft lips and palates varies among races and countries. But it is unusually high in Guatemala, where abnormal openings in the upper lip — with or without accompanying clefts in the roof of the mouth — appear in approximately 2 of every 1,000 births.

These birth defects run in certain families. Poor nutrition and environmental toxins also may be contributing factors. Whatever the causes, children with facial deformities often are shunned in developing countries. In Guatemala, they are widely believed to have been marked by the devil.

Unfortunately, plastic surgeons are few and far between in Guatemala, which lacks university-based training programs for such specialists. Many Guatemalans can’t afford even basic medical care.

To help provide basic care as well as cleft lip/palate repair and other surgery, a team of 30 doctors, nurses and support staff from the United States volunteered their services from Jan. 25 to Feb. 1 in Jalapa, a city of 286,055 in the mountains of central Guatemala.

Among them were three Pittsburghers: Frederic Deleyiannis, an assistant professor of plastic surgery at Pitt; his wife, Anna Maria Zapata, who is a master’s degree candidate in Pitt’s education school and a Spanish teacher interning at Fox Chapel High School, and Zapata’s supervisor/mentor at Fox Chapel, Joyce Bartholomae.

“We saw children with cleft lips and palates who’d had some surgery and needed additional surgery, as well as infants who hadn’t had any surgery,” Deleyiannis said. “It’s a very poor region. Some people walked for eight hours to reach the hospital where we were operating. Others hitchhiked and rode buses.”

Local radio stations announced where and when the doctors would be working, said Deleyiannis.

Zapata and Bartholomae were among the U.S. group’s eight Spanish speakers (Deleyiannis was another), and the two women served as the main translators.

“In the cases where patients spoke languages in addition to Spanish, they were indigenous Mayan languages,” said Bartholomae. “Very few of the adults could even sign their names to the consent forms for their children’s care. They just wrote an X.”

Zapata recalled, “In the morning, people would be lined up outside the hospital. We would advise people which types of patients the doctors would be seeing that day, which conditions they would be treating.”

In addition to Deleyiannis and one other plastic surgeon, the team included two pediatricians, two general physicians, an otolaryngologist, an obstetrician-gynecologist and a prosthetic surgeon.

“The need there is staggering,” Bartholomae said. “Part of the problem is that there are no social programs there for the poor. So, when a team of surgeons comes to help, people just flock there from miles around. Unfortunately, when they get there they have no place to stay the night, nothing to eat. Most of these people were in family groups with three or four little kids, at least. We would cook Ramen noodles for them in our kitchen.”

That kitchen wouldn’t meet Western sanitation standards; neither would some of the clinic’s other non-medical areas, noted Zapata. “The lights sometimes didn’t work,” she said. “You might have 100 people sharing one bathroom. But it’s the only place where the general population can go for medical treatment.”

The medical team’s visit was organized by Children of the Americas (COTA), a Kentucky-based network of volunteers who provide free medical and surgical care and treatment to needy children around the world. But most of COTA’s work is in Guatemala, because that’s where the organization initiated its efforts during the 1980s.

COTA also has brought more than 300 children to the United States for medical treatment unavailable in their home countries.

Deleyiannis hopes to continue the relationship among the University’s Department of Plastic and Reconstructive Surgery, the School of Education and COTA, so Pitt surgeons and language instruction students will regularly visit Guatemala to serve the local population.

“COTA is very well organized,” he said, “and working in Guatemala was a great experience.”

Not a remunerative one, though.

“Anna, Joyce and I paid for our flights to Guatemala and our accommodations in a small hotel there,” said Deleyiannis. “COTA provides drugs, anesthesia machines and operating facilities, but I did bring some of my own surgical instruments.”

The payoff, he said, “is the satisfaction of knowing that you provided a needed service.”

More information about COTA is available at its web site: www.childrenoftheamericas.com.

—Bruce Steele