It’s clear why donating to charities that fix cleft palates and other deformities – such as SmileTrain or Interplast – is popular among donors: the donation’s impact seems extremely tangible. A donor can see “before” and “after” pictures of children, and feel that the donation helps a child with serious problems become a “normal” child. But in our view, those “after” pictures don’t fully represent what’s going on.
To see why, consider these profiles of cleft repair patients in the U.S. Going through the profiles starting with “A” (33 of them), we see 11 mentions of multiple surgeries (including nine in one case and seven in another) and 6 other profiles that mention the prolonged use of equipment such as a NAM device. An additional 3 mention other major birth defects, and one states that a single surgery “has not helped [the child's] speech.” One child’s treatment is chronicled in a 27-page journal.
By contrast, it appears that cleft palate charities (both those that conduct surgical missions and those that pay local doctors to perform surgeries) often provide only one surgery for each child, with no follow-up. (See, for example, question 26 of our interview with a surgeon.)
How much good does performing one cleft surgery actually accomplish?
I think it probably accomplishes some good, but I think it’s fair to say that it probably doesn’t accomplish what donors expect: transforming a child that would have lived a very difficult life as something of an outsider into a fully “normal” child.