The first time I really get to visit with people is in pre-op. It’s a time when parents are nervous, kids are scared, restless, and hungry, and there’s a general drive to get patients double checked and the first batch into the operating room. Sometimes, at that moment, someone in the crowd catches your eye. Sinthuja caught my eye.
Sinthuja is an adorable little eight year-old whose eyes tell you up front that she trusts you. She’s quiet yet expressive with her hands and her expressions. Her mother tells me that Sinthuja really hasn’t been able to speak due to the cleft palate and lip. She’s a high performing third grader who loves school but has difficulties communicating with her teachers and fellow students. Her family and close neighbors can understand her but communicating is very difficult for a shy little girl.
Her family heard about the Rotaplast mission from a local Rotary club and traveled the 100 km and five hour trip to be here. Travel here in southern India is slow at best.
I caught up to the family while in the recovery ward and I asked what the Rotaplast mission means to the family and Sinthuja.
For starters, she’s hoping to be able to speak better. At this point, Sinthuja beckoned me to lean down so she could whisper to me. The voice was soft and a bit nasal as cleft repairs tend to be but I was clearly able to distinguish her words. I don’t speak Tamil but the sounds of words were clear. Her mom says that the surgery was an immediate improvement and they couldn’t be happier. I asked if she would be getting speech therapy and her mom proudly declared that, as a mother, she would be the speech therapist.
It was at this point that the conversation took a turn I hadn’t expected. Her mom asked me what I thought the causes of cleft palates were. I talked about how there’s a genetic component as well as a link to a lack of folic acid. She thought that the folic acid link wasn’t as key as environmental causes. Sinjutha was conceived in the first month after the tsunami of 2004. Sinthuja’s mom knew of three other women who conceived during that time frame and all of them had given birth to children with significant birth defects. She wanted to know if we were looking at clusters of cleft lips/palates that some of the towns experienced and the environmental factors post-tsunami.
As a matter of fact, we have one team member that is exploring that very question.
Dr Namrata Upadhyay, our team dentist, has been collecting DNA samples to explore the causes of cleft lips in the Indian population. Research has suggested that in the Indian population folic acid deficiency may not be the only key variable so she is collecting DNA samples from our cleft patients as well as DNA samples from a control group of other hospital patients. Additionally, she’s exploring the methods of DNA collection and making an evaluation of which method provides the greatest DNA sample by the least invasive means. Other members of the genetics team from Pacific University, San Francisco are exploring the geographic clusters and the soil, air, and water, looking for environmental variables.
The idea is to isolate the environmental or other components that are specific to this population in order to reduce the incidence rate of cleft palates and lips.