Giving Children New Reasons to Smile: Sidney Eisig, DDS, Volunteers his Surgical Expertise
By Andrea Kott, MPH
A military cargo plane carries the contents of several hospital operating rooms—hundreds of boxes and duffel bags stuffed with surgical instruments, monitors, antibiotics, analgesics, anesthesia agents, sutures, gloves, gowns, masks, and gauze—along with Sidney B. Eisig, DDS, who spends a week every May correcting cleft lips and palates in children who otherwise would go untreated.
For the past 17 years, Dr. Eisig has traveled with a multidisciplinary team of 65 medical providers to the Hospital Universitario Hernando Moncaleano Perdomo in Neiva, Colombia. While there, he works with an interdisciplinary group including Columbia University faculty at the College of Physicians & Surgeons and Teachers College for a Healing the Children Missions Team headed by David Hoffman, DDS, an oral and maxillofacial surgeon who directs the cleft team at Staten Island University Hospital.
Cleft lip and cleft palate repair may seem like a relatively straightforward task. But treating the condition, which occurs in approximately one in 700 live births and has physical, as well as psychosocial ramifications, is a complex endeavor. That’s because clefts may impede children’s breathing, hearing, and ability to eat, while also dampening their self-esteem and inhibiting them socially. Treatment, therefore, is multifaceted, entailing a sequence of interventions as children grow: from primary lip and palate surgery during infancy to bone grafts to corrective jaw surgery; to nose, or ear repair; to orthodontics; to speech therapy and psychotherapy.
“We do all of this,” says Dr. Eisig, the George Gutmann Professor of Craniofacial Surgery, director of the Division of Oral and Maxillofacial Surgery, and chief of the Hospital Dental Service at Columbia Dental. “Most cleft teams operate and leave. We go back to the same hospital yearly. We follow the kids to give them continuity of care.” Dr. Eisig knows this whole-person approach well; whether in Neiva, Colombia or Washington Heights, it is one that regards dental health as key to physical and emotional well-being.
“I can’t get enough of it”
Dr. Eisig has always been community service-oriented, but it wasn’t until the mid–1990s, when his friend and HTC’s Northeast team leader Dr. Hoffman invited him on a medical mission to El Salvador, that he considered volunteering his professional services. That first mission was memorable, in part, because he got Montezuma’s revenge. “I was sick as a dog,” he says chuckling. Spiritually, however, he was transformed. “I closed a cleft palate and lip on a 16-year-old kid who’d never had surgery and wouldn’t have had it otherwise. It was life-changing.”
Since then, Dr. Eisig has been accompanying the group to Hospital Universitario Hernando Moncaleano Perdomo, a state-of-the-art trauma center that is the major teaching hospital in Neiva. Faculty from Columbia Dental and other dental schools, speech therapists from Teachers College, Columbia University, and orthopedic surgeons from Boston Children’s Hospital spend five, 12–hour days operating on approximately 180 children after first screening and some 800 children who need cleft, ear reconstruction for microtia,orthopedic, or other surgical procedures in addition to rehabilitation. The participation of plastic surgeons from Bogota and Neiva and an oral and maxillofacial surgeon from Villavicencio, Colombia, are also critical to the success of this team. It is a huge undertaking for the volunteers who finance their own trips, pack their own surgical supplies, and together fly Avianca Flight 21 to a Colombian military airstrip in Bogota where they board the awaiting cargo plane that delivers them and their equipment to Neiva. It is also a huge undertaking for the families, many of whom travel for hours or days with their children in 90–plus–degree heat and 90 percent humidity to see a doctor. “Some families travel eight, nine, even ten hours to get to us,” Dr. Eisig says.
The team typically arrives on a Thursday and spends the next full day evaluating children for surgery. Of the 800 children they screen, some 40 percent will need a craniofacial procedure; of these, 125 will need cleft repair. “Kids may come for lip or palate repair, scheduled revisions, bone grafts, or orthodontics,” Dr. Eisig explains. Some patients come to have the shape of their dental arch corrected, some for preparation for upper jaw advancement, some for nose repair, and some for speech therapy.
The days are long. “We start at 7:30 a.m. and go until 6 p.m.,” he notes. However, he adds, “Most of the kids don’t need surgery at the time that they present.” Dr. Eisig and his colleagues closely monitor every child they screen, and return the next year prepared to operate. “They all get done,” he says. “And when we’re done, children can eat and smile.”
The care that Dr. Eisig and his co-volunteers provide involves more than surgery. “The mission involves people from all over Columbia University, which makes it very different from many other types of medical missions,” Dr. Eisig says. For example, Catherine Crowley, PhD, professor of practice and coordinator of the Bilingual/Bicultural Program in the Speech Language Program at Teachers College, brings her graduate students to provide speech therapy to children, while teaching their parents and other speech pathologists how to work with them. And geneticist Wendy K. Chung, MD, PhD, the Herbert Irving Associate Professor of Pediatrics in Medicine, is conducting a genomic analysis to learn about the etiology of cleft lip and cleft palate. (There is also a team of plastic surgeons from Bogotá who operate on children born with abnormal ears.)
It is an unrivaled educational experience, according to Daniel Bienstock, DMD, MD, Dr. Eisig’s current chief resident who hopes to accompany him to Neiva next May. “It’s an incredible opportunity to see how care is delivered in a different country, to see how other surgeons operate, and to help others who don’t have access to care,” Dr. Bienstock says. “You’d better be prepared to work hard and be there for long hours or what’s the point?”
The Hospital Universitario Hernando Moncaleano Perdomo is modern and well-equipped. But not all medical missions are resource-rich, as Michael A. Perrino, DDS, MD, has found. Since accompanying Dr. Eisig to Nieva in 2013, during his year as chief resident, Dr. Perrino has performed cleft lip and cleft palate surgery on children in Baja, California, with another group. He works out of an ob-gyn hospital—one of the poorest hospitals in the city. “Half of it is outside, and every room has dengue (mosquito) nets,” says the assistant professor of dental medicine who completed a pediatric craniofacial fellowship in Pittsburgh after completing his residency. Dr. Perriono has volunteered in Baja every April for the past four years. “It’s an eye-opening experience operating in a very poor hospital without many resources, orders of magnitude different from Washington Heights.”
No one at the hospital or in the surrounding region has cleft or craniofacial training, so local children do not have access to such care. “Some people will walk for 12 hours or two days just to be evaluated, not even knowing if they will get surgery,” says Dr. Perrino. Many of the 30–40 children he sees in a week have so many other health complications that he cannot always operate immediately. “If kids are sick or too young, we can’t do surgery. We won’t do treatment until we know a patient is safe.” Nevertheless, the same patients return every year. “They know we’re coming back.”
According to Dr. Perrino, the average cleft patient will have five surgeries, beginning with the initial lip repair at age 2–3 months, palate repair at age one year, a bone graft to fix the upper jaw between the ages of 6 and 12, and corrective jaw surgery during the teen years. “I’ve seen adults have as many as 40 surgeries.”
The benefits of cleft lip and cleft palate surgery are profound physically as well as psychologically, especially in cultures that ostracize children with the condition, Dr. Perrino explains. “It can be hard for parents to bond with a child when they look different,” he says. “In some cultures, a whole family can be shunned from the community.” Thus, a child with an unrepaired cleft lip and cleft palate is not likely to socialize the way others do. And yet, he adds, “When you give a child back to a mother and father, and they see the lip has been put back together, there are tears of joy in their eyes. It’s overwhelming.”
And the satisfaction among the volunteers who have boosted children’s self-confidence is tremendous. “The children feel proud and self-assured,” Dr. Eisig says. “It’s a great feeling to be able to help them.”
At the end of their respective missions, Dr. Eisig and Dr. Perrino pack their remaining supplies and return to their lives and patients in New York. Although it is a long flight, Washington Heights is, in some ways, not so far removed from the impoverished villages where they immerse themselves each year. “The work we do on a mission is an extension of the work we do in our department at Columbia,” Dr. Perrino says. “We don’t really do it for the money. “We just want to make sure that patients get the right care. We want to help.”
Next spring, both doctors will greet hundreds of children who await their help. “I treasure operating on these children,” Dr. Eisig says. “I can’t get enough of it.”