Alicia Bartolay’s child poses for a photo while playing with other children who will undergo cleft operation.

Alicia Bartolay found out in 2021 that her daughter has a cleft lip condition. She thought that her Filipino superstitious beliefs of “lihi” on watching shows with odd characters contributed to her youngest child’s birth defect.

But, it is not due to her false beliefs. Members of her husband’s family also have cleft lips and palates.

A cleft lip occurs when the tissues that comprise the lip do not unite fully prior to birth. The outcome is a gap between the top lip and the teeth. Depending on the individual, the lip opening may be a little slit or a big hole that extends all the way to the nose.

Children who were born with a cleft lip, cleft palate, or both may have trouble swallowing, articulating their speech effectively, and even developing ear infections.

(From left to right) CBNC Community relations supervisor Ernesto Llacuna, Plastic Surgeon Dr. Bricio Alcantara, OSP Exceutive Director Emiliano Romano, OSP Project Manager Mark Salas, Operation Smile Country Director of Development Roberto Manzano

Alicia saw this in her own child and felt both sadness and resignation that her daughter would have to deal with it for the rest of her life.

Fortunately, her sister-in-law informed her that Operation Smile Philippines (OSP) will resume its surgical operations in Narra, in southern Palawan. Despite the municipality’s distance to Brgy. Liminangcong in Taytay, where her family lives, she brought her three-year-old daughter with hopes to see her smile through the free operation.

Bartolay’s daughter is one of 51 patients who passed the screening of the OSP to undergo surgical operations from March 13 to 17 at the Narra Municipal Hospital.

OSP Executive Director Emiliano Romano said fewer cases have been recorded in 2023 and more on cleft palate. The incidence of oral cleft in the Philippines is estimated at one in every 500 births.

“It’s a good problem na it’s lesser— One thing that we notice is maraming palate patients. More than 50 percent ng pasyente ngayon,” he said.

Aside from patients in mainland Palawan, there are also patients from the islands of Mangsee, Cagayancillo, and Linapacan. OSP project manager Mark Salas said that OSP shoulders the travel expense of patients and their companions.

Operation Smile Country Director of Development Roberto Manzano highlights the need to raise awareness for prenatal care of mothers.

“Even though we are able to deliver smiles to 51 patients, there’s still more. In every 500 births, may isang cleft patient don. That’s the number that we standby,” he said.

The operation process will help individuals who suffer from a bullying because of their physical appearance and irregular speech. Aside from physical appearance, children are also experiencing difficulty in feeding, speaking and are prone to malnutrition, infection, and other medical and health challenges.

It is the fifth year of the operation after almost two years break due to pandemic. The first operation was conducted in Taytay, followed by Brooke’s Point, and Aborlan for two consecutive years.

Need to strengthen prenatal care
In contrast to Bartolay, medical specialist IU Specialist II and Pediatrician Dr. Louise Albacete stated that prenatal care and genetics are the causes of cleft cases. There must be an effort to correct misconceptions such as falling might cause cleft and others.

“Ang problema minsan ay we cannot blame everyone for not having prenatal checkup kasi nga malalayo yong lugar ng iba. Yong iba ay galing pa ng bundok, yong iba ang galing pa ng isla. Hindi lahat ay may opportunity to see a doctor,” she said.

Operation Smile Country Director of Development, Roberto Manzano, said researchers believe that oral cleft occurs due to a combination of genetic and environmental factors. He added that obesity, diabetes, alcohol intake and cigarette smoking have also been identified as risk factors.

“Children with cleft conditions experience difficulty in feeding, and are likely to become malnourished. They are prone to developing ear infection, dental problems and speech impairment. And, unless treated early, they would face bullying that could destroy their self-esteem,” he said

Aside from raising awareness, an opportunity for a checkup in remote areas should also be given to equip mothers in their pregnancy journey.

“It has something to do with prenatal care. Kasi it has been found out that folic acid, folate deficiency may lead to facial deformity. Hindi lang naman cleft, maraming facial deformities. And infection in the first three months, exposure to chemicals,” Dr. Bricio Alcantara, plastic surgeon of OSP said.

Possibility of establishing cleft center
OSP gives an holistic approach to the patients after the surgery through providing dental care and speech-language therapy. There is also psychosocial support given to the patient and to the family.

“Tuturuan sila kung paano magsalita para maging normal as possible. Hindi siya magiging 100 percent especially sa matatanda na pero at least they can communicate better,” Alcantara said.

Chief of Hospital Dr. Maria Arlin Josue observed that cleft cases is one of the neglected concern in the community. Some of the individuals with cleft cases are residing in remote areas and isolating themselves due to fear of bullying and stigma.

Dr. Maria Arlin Josue, Chief of Hospital, Narra Municipal Hospital mentions partners and sponsors during this year’s operation

“If we thought na unti lang sila ay marami pala sila— Hindi pa ito inaugurate but we already use it for Operation Smile. We are committing as head that one of the rooms will be used for the Operation Smile— Parang very feasible na magkaroon tayo ng cleft center dahil meron tayong pedia, plastic surgeon,” she said.

The OSP is in partnership with the Rio Tuba Nickel Mining Corp. (RTN), Coral Bay Nickel Corp. (CBNC), the Palawan provincial government, the Narra municipal government and Narra Municipal Hospital, along with Security Bank and Colgate Palmolive Philippines, Inc.

RTNMC and CBNC community relations head Venice Guian and Ernesto Llacuna both shared that health support it is one of its commitments to the community aside from the social development and management program (SDMP).

The representatives of Security Bank and Colgate Palmolive Philippines were also present during the mission, said Operation Smile.

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is one of the senior reporters of Palawan News. She covers agriculture, business, and different feature stories. Her interests are collecting empty bottles, aesthetic earrings, and anything that is color yellow.