DEPARTMENT OF PLASTIC SURGERY
International Outreach
Plastic and Reconstructive Surgery News
Speech-language pathologist speaks at cleft lip and palate symposium held in Beijing
June 22, 2000
LLUMC TODAY
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| At a children's hospital in Bangkok, Thailand, Dr. D'Antonio (left) demonstrates to a speech-language pathologist how to use new instrumentation providing a child with biofeedback measuring the nasal quality of the speech. |
Linda D'Antonio, PhD, was honored in March with the distinction of being the only speech- language pathologist invited to speak at the First International Smile Train Cleft Lip and Palate Symposium, held March 2 to 4 in Beijing, China.
Smile Train is a nonprofit organization dedicated to teaching medical teams in developing countries the latest techniques in the treatment of cleft lip and palate, unlike traditional nonprofit cleft organizations that rely on sending teams of American surgeons and medical professionals to perform surgery.
Dr. D'Antonio addressed the symposium on the importance of team care and speech rehabilitation in treating children with cleft lip and palate.
"Surgical repair of a cleft lip normalizes a child's appearance, but it doesn't normalize their ability to communicate," Dr. D'Antonio says. "Lots of therapy and habilitation is needed to get children with cleft palate to where they are not only normalized physically but also normalized and integrated back into society."
Because of the extensive care needed, professionals from a host of different fields participate in caring for such children here in the United States. However, because clefts are not a life-threatening condition, children in developing countries often do not undergo reconstructive surgery.
For those who do have their clefts repaired, other issues arise. For example, they may need orthodontic care to properly align their teeth. They usually also need extensive work with a speech-language pathologist in order to learn how to shape words correctly. This, says Dr. D'Antonio, is why it is so important to not only involve all of the necessary specialists in cleft care, but to put the latest treatment techniques into the hands of local health-care professionals.
A major barrier to full rehabilitation for these children is that in many developing countries surgeons do not have the training to do cleft surgery. In countries where surgeons do undertake such repairs, other services, such as speech-language pathology, are usually not available because there is no education offered in that particular specialty.
Through organizations like the American Cleft Palate Craniofacial Association and Smile Train, Dr. D'Antonio advocates for a team approach to cleft care and stresses the need to educate health-care professionals at the local level. In the time it takes to visit a country and perform multiple surgeries or provide speech therapy, a team of specialists can instead teach the techniques to local doctors and therapists, thereby benefiting children far into the future.
Dr. D'Antonio began her advocacy for team care in developing countries in 1988 on a trip to Nepal. Eventually, she developed a video tape to teach mothers and community-based health workers how to feed a baby with a cleft lip and/or palate. The video was distributed around the country. She also assisted in training personnel from Nepal to deliver speech-language pathology services.
In the early 1990s, as chair of the international relations committee for the American Cleft Palate Craniofacial Association, she helped develop the Visiting Scholar Program, which sponsors medical professionals who come from other countries to learn more about interdisciplinary cleft care. One of the first surgeons who participated returned to his native Thailand and began to develop the concept of team cleft care at his hospital. In spite of these great strides, speech-language pathologists are still only available in cities. Dr. D'Antonio and her colleagues are trying to counter this problem by developing materials that a teacher, parent or nurse could use to provide the ongoing therapy a child needs to be able to learn to communicate.
Also, by partnering with a cleft care teacher at the university in Thailand, Dr. D'Antonio has been able to ensure that future speech-language pathology students will receive the proper training.
"By focusing on teaching, I'm touching hundreds and hundreds of kids as opposed to going abroad and seeing 20 kids on my own," she says. "In the same amount of time I'm assuring that the education is there for people who can then train others."
Dr. D'Antonio hopes to continue her advocacy for team care through future projects. One project will take her to India, where she will work to acquaint speech-language pathologists and other cleft care professionals with the latest treatments and techniques for evaluating speech disorders. Dr. D'Antonio estimates that it will take approximately a three- to five-year commitment to provide the training that has been requested by her colleagues in India.
Up to this point, Dr. D'Antonio has been able to finance all of her work overseas through the American Cleft Palate Craniofacial Association, the Smile Train, her department and with the help of generous people who have donated supplies. This traveling has become increasingly difficult, however, and Dr. D'Antonio hopes to raise future traveling expenses through donations.
"Dr. D'Antonio exemplifies our mission to make man whole," says J. David Killeen, MD, director and CFO, Loma Linda University Surgery Medical Group. "She has been able to make a substantial contribution to the developing world's children with very little outside support. For Dr. D'Antonio's work to continue, further support is required. We encourage any interested individuals or groups to contact Dr. D'Antonio for further information concerning her projects."
Dr. D'Antonio continues to receive requests from countries worldwide to help them develop their cleft care programs.
"I'm invited to go all over," she says, "but where is the place that's ripest for a team approach? You can do something anywhere, but I think the important thing is that you only have so much energy, so picking the place where you can make the biggest difference [is important]."