Establishing cleft malformation surgery in developing nations: A model forthe new millennium

Cleft management in developing regions of the world lags behind that of the United States. Many well-intentioned groups export surgical expertise to d isadvantaged regions, but the models on which these organizations are based may be outdated. Guaranteeing patient safety, preserving indigenous cultur e, and teaching local surgeons the multidisciplinary approach to cleft care are key goals. In this article, a three-stage philosophical model (observa tion, integration, and independence) is presented for establishing safe, mu ltidisciplinary cleft care in developing regions. Important factors include the recognition of interested local hosts and identification of funding. A ggressive assessment and recognition of negative forces, including misdirec tion, stagnation, and medical colonialism, is required. This model has been implemented in Nepal with success.