After an enlightening and promising meeting earlier this year between the Newcastle Cleft Team and Dr Shakya, head of cleft surgery at the Nepal Burns & Cleft Centre, plans were made for future collaboration between the teams. The Nepali and UK clinicians have since been holding online monthly meetings where they take it in turn to present on topics such as 22q11 deletion syndrome and orthodontics in cleft care. Discussions have also been held about collaborative research and audit projects. It’s been an amazing opportunity for inter-disciplinary learning on both sides and provided the chance for the teams to really get to know each other.

This week, a group of seven clinicians were invited to visit the Kirtipur Hospital by Dr Shakya and Dr Rai. Pictured below are some of the team members arriving in Kathmandu to a traditional welcome:


Left: Christine Couhig and Hayley Llandro; Centre: Peter Hodgkinson and David Sainsbury with Dr Shakya; Right: the Kirtipur Hospital in Kathmandu.

The purpose of this visit is mostly educational but it was also an opportunity to bring some supplies. Each member of the team filled their cases with items that are difficult to get hold of, including some scalpel blades and surgical instruments that CLEFT paid for using donated funds. They also included speech and language resources, toothbrushes, baby bottles, anaesthetic equipment, educational books and colouring pencils, used in sessions with the psychologist.


Teaching sessions

In the last few days, teaching sessions have been held across all the disciplines. 

An excellent meeting was held with nurses. Christine Couhig is a Clinicial Nurse Specialist in Newcastle and is pictured above (centre right) sitting next to Kate le Marechal (centre), Consultant Clinical Psychologist.

The cleft nurse has a key role in advising new mothers  of cleft babies on feeding - an especially important job in rural and remote parts of the country where access to bottles and baby milk might be difficult. Christine was able to provide an interactive session on the difficulties a cleft baby might have feeding. By taping three straws together and getting each member to have a go at drinking from them, they were able to understand how hard it is getting liquid up the straw with the air escaping. This replicates how hard it is for a cleft baby to get milk from the breast/ bottle.

Siobhan McMahon (above), Speech & Language Therapist from Alderhey Children's Hospital in Liverpool, is pictured here teaching health care workers about what toys can be used in speech and language therapy sessions. Toys are an essential part of a speech therapist's tool kit, especially turn taking games - Pop Up Pirate was a firm favourite here!

Hayley Llandro, Consultant Orthodontist, provided a session on basic dental health and hygiene for cleft patients, including why fluoride toothpaste is good for teeth and dispelling some myths that baby teeth shouldn't be exposed to fluoride toothpaste. Education on why frequent sugar causes decay was also on Hayley's teaching agenda. Dental hygiene is important for everyone, but for children born with clefts, having healthy teeth is particularly important. Teeth can grow in unusual places when the structure of the jaw is altered by the cleft, and so sometimes teeth can be difficult or even painful to access.

Hayley is pictured above holding one of the many toothbrushes she was able to donate to the hospital. 


Kate is pictured here at the end of a psychology session with the health care workers (left). The health care workers do everything related to cleft care other than surgery - nursing, psychology and theatre scrub nurse - so they are very important members of the team. Kate has also given a very well received and interactive session on the role of psychology in cleft care (right).

Caron Moores is pictured above in the hospital library giving a great overview of the lessons learned from a career in paediatric anaesthesia at Alder Hey Children's Hospital in Liverpool, and how they might be applied in the Kirtipur Hospital.

Although the majority of patients seen in clinic are children, adults are seen too and come from all over Nepal. The team spoke to a young man (age 26) who was first assessed by Siobhan on his speech. The local orthodontist was keen to prep him for orthognathic (jaw) surgery for his bite, but the patient already has speech difficulties and this is his priority. He is a pharmacist and struggles to be understood socially and professionally. He understood that jaw surgery would potentially make his speech worse and was keener to have surgery to improve his speech. This will make the biggest difference to him and the team will try to fit him in for surgery this week.


David Sainsbury and Peter Hodgkinson (both cleft surgeons in Newcastle) are pictured above left with Christine examining a young baby. In the picture on the right, you can see Peter teaching the trainee surgeons a cleft rhinoplasty and lip revision.

The team are in Nepal for another few days for more teaching sessions. A group of 10 speech and language therapists will be spending time with Siobhan next week - CLEFT is funding this visit from all round Nepal as this is a wonderful opportunity to learn new techniques for assessment and therapy itself.