The Last Mile Initiative w/ Smile Train

I am a Kenya-based oral and maxillofacial surgery specialist with a focus in craniofacial malformations, specifically cleft lip and palate. Growing up, I had friends affected by various forms of congenital malformations and weren't able to receive treatment and experienced high healthcare costs and lack of the technical expertise to manage their problems.

As I progressed through my schooling, I realized I had to bring change to Kenya and Sub-Saharan Africa for those who are suffering from cleft lip and palate malformations. While I’ve dedicated my time to combating cleft in my communities, I developed the “Last Mile” care model that helps provide affordable and quality healthcare to those in need while also educating local health professionals. Ultimately, I want to be the best leader I can be for my teams so they can bring hope and their specialized skills to provide care to communities that would otherwise be inaccessible.

The Last Mile Initiative is dedicated to offering quality healthcare in rural areas and educating healthcare professionals about cleft care. I developed the “Last Mile” care model that helps provide affordable and quality healthcare to those in need while also educating local health professionals. This two-pronged approach is important in a holistic approach to raising awareness and treating cleft lip and palate malformations. 

I am proposing to take the "Last Mile" care model further that it's reaching now by connecting with communities in remote areas. Those who experience congenital malformations often experience stress and isolation while leaving their families with so many questions. This project can truly impact the livelihood of so many families by offering specialized healthcare. 

Overall, the work on this project would elevate humanity by impacting someone's life through a quick surgery and comprehensive care, while raising awareness about these conditions.

In Africa, there are over 32,000 children born with a cleft lip annually. A cleft is a common birth difference that occurs when certain body structures around the mouth do not fuse during fetal development. They can involve the lip and/or the roof of the mouth, which is made up of both the hard and soft palate. 

The causes of a cleft remain unknown but risk factors include environmental factors, lack of proper nutrition before and during pregnancy, as well as genetics. Many children with untreated clefts around the world live in isolation, making it difficult to make friends and go to school, but more importantly, many have difficulty eating, breathing, and speaking - which could be life-threatening. 

Since many live far from cities and resources like healthcare, we take our specialized skills to remote communities to provide the care that would have been otherwise inaccessible. Additionally, we strive to provide an educational platform to ensure such endeavors are sustainable for the future. I have partnered with Smile Train which has enabled me to execute my vision of Last Mile by helping provide cleft lip, palate care and surgeries.

Last Mile is a project focused on bringing quality and specialized healthcare to those in rural communities. Specifically, Last Mile operates in Sub-Saharan African countries and beyond. 

The project has two components - educating and training healthcare providers about identifying and surgically treating craniofacial malformations, and helping those in rural communities suffering with cleft by introducing them to comprehensive cleft care. Specifically, surgeries we perform at no cost are focused on maxillofacial/reconstructive surgery and oral surgery.

Because specialized healthcare is limited, and insurance companies don’t always cover these procedures, I am committed to extending safe, free safe cleft lip/cleft palate surgeries to restore hope and dignity to the victims. This is often achieved through the huge pool of dedicated and experienced volunteer surgeons who are involved with us during the several surgical missions we extend to communities within Africa.

The goal of Last Mile is to serve those communities in more rural and remote areas - for both patients and those looking to learn more about the surgical process for cleft treatments. Those who live in these areas have more disadvantages with access to healthcare resources, especially those needing live-saving specialized care for cleft lip and palate. Specifically, Last Mile has helped those in Somalia, Democratic Republic of Congo (DRC), Angola, Zimbabwe, South Sudan, Cameroon, Rwanda and remote areas in Kenya. My goal is to serve those who don’t have access to these kinds of surgeries due to location or because of financial challenges. 

Beyond serving my patients, I serve the teams that I lead who help me make these life changing moments happen. In addition to providing free cleft lip and palate surgeries to thousands of patients, I have also included training as part of this program. The training covers pediatric anesthesia, surgical safety and post anesthesia care. I take my leadership role very seriously, as I know I’m passing along knowledge that can change many more lives.  

Through a two-pronged approach, my goals with The Last Mile are to raise awareness about the life-threatening issues surrounding cleft palate and lip conditions, while also driving action by treating those who are most vulnerable and at-need, and training those who can help in the future. More specifically, my mission is to provide free, quality and safe cleft lip and palate surgeries. The second part of my mission is to educate local healthcare professionals and share my knowledge about sustainable surgical practices.

Throughout my residency in oral and maxillofacial surgery, I always wondered how to give back to my communities. Lots of opportunities availed themselves, and I still felt that I was not doing enough to impact the community. Soon I realized that the best possible way to give back was to provide my skills to those in most need. I volunteered with many international surgical missions and learned so much from my interactions with different people/healthcare professionals.

Furthermore, I'm motivated to address this healthcare gap. I envisioned that by developing local solutions, we could provide quality healthcare to those in the most remote of areas while also encouraging education to the local professionals so that these endeavors were sustainable. 

I wanted to offer free healthcare options to those who need this opportunity the most.

Every day so many children are born with craniofacial deformities, the most common being cleft lip and cleft palate. For children, clefts often interfere with eating, speech, and in unfortunate circumstances, some often die due to neglect or malnutrition. Those children that make it to adulthood loose hope and dignity because they are sometimes stigmatized at jobs or even in social settings.

As a believer in community, I knew I needed to contribute to mine by offering healthcare services. More specifically, I believe everyone should have access to specialized healthcare, especially those who are excluded from their families and communities. The stories that I hear from my patients and their families are what keep me motivated in this line of work. 

While cleft palate and lip conditions can be viewed as cosmetic issues, I knew I needed to create understanding for how critical these procedures are, and help bring these life-saving surgeries and comprehensive care to those in rural areas. From my time working on the various mission and volunteer trips, I learned the gratifying feeling of making an impact on an individual and family's lives.

With over a decade of experience of operating on the face, mouth and jaw patients and dental surgeries, I have experience working in the operating room and providing insights to comprehensive cleft care programs. Additionally, I also lecture at the University of Nairobi for the Department of Human Anatomy. 

Through my ongoing work with facial surgeries and counseling patients with a cleft, I have a specialized understanding of the holistic impacts of cleft palate and lip malformations on families. Beyond that, I’m also from these communities where I have seen these impacts ravage families and individuals. I know how to lead my teams to ensure there are empathy-based and action-focused results. 

I also know how to keep my patients' care the top priority while understanding the needs of my team. I must care about my crew of surgical volunteers, as they are the ones helping me make these life-changing impacts. I take a lot of pride in my skills and knowledge by focusing it into communities that need it the most, helping to solve this unspoken problem of craniofacial malformations.

Through my partnership with Smile Train and Bela Risu Foundation, I have been able to offer this volunteer surgical outreach program in various regions of Somalia for the past few years. As a country with ongoing tension, personal safety is an additional worry for my team of medical volunteers. Even in the country’s relatively safe capital of Mogadishu, we occasionally hear gunfire, explosions, or other hostile activities. In some cases, patient requests have brought us to remote areas where security is a local militia. While I don’t take these concerns lightly, I still believe in executing the Last Mile care for those in need. Our partnership has enabled the improvement of surgical patient care and we have provided free cleft lip and palate surgeries to over 1,000 patients in this country.

Additionally, I am proud that we’ve overcome the locational adversities by incorporating training as part of the program that covers pediatric anesthesia, surgical safety, and post-anesthesia care. Through these efforts, some hospitals have requested a review of their operating room protocols and implemented our recommendations to improve overall care.

As a leader in my industry, I take this role of training and passing on knowledge very seriously. Much of what I do with the last Mile Care approach is training healthcare providers to have the skills and knowledge to identify and treat cleft lip and palate conditions. 

Specifically, last year we had the opportunity to undertake the first-ever cleft lip and palate camp in Angola. As a country that has recently transitioned from the civil war in 2002, the health care infrastructure still lags behind other southern African countries. As such, this results in untreated cleft lip and palate conditions that leave patients dealing with life-threatening conditions and often being exiled from their communities. 

I have worked on similar “train and treat” programs in South Sudan, Zimbabwe, Rwanda, DRC and Somalia. Through this work, I’ve not only shared my knowledge with other healthcare works and continued to treat patients in remote areas, but we have also helped set a medical standard in many of these regions. My work with my team has not only shown results but encourages hospitals to improve their care methods.

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This Last Mile project is innovative because it’s a holistic approach to offering comprehensive cleft care. Specifically, because through the two-pronged approach, we treat patients, train new surgeons and bring skilled surgeons to remote areas while also driving greater awareness to cleft and craniofacial malformations.    

Additionally, this program offers new training methods to hospitals that have begun to assess their operating room protocols. While our focus is helping patients and new healthcare providers, we are also impacting those hospitals that we’re visiting by helping improve dated programs.

My work is solely based on the life changing impacts that it has one my patient, and their families, life. Through my work with offering free facial reconstructive surgeries, the responses from my patients and theirs stories are what keep me coming back. 

I grew up watching the impact from from friends who suffered from cleft lip and palate conditions and that always stuck with me. Their lack of access to specialized healthcare and observing how they were treated throughout our communities really pushed me into this line of work. 

Many who suffer from congenital malformations experience difficulty from eating, drinking and even breathing. Additionally, these people also are dealing with socioeconomic issues as well as interpersonal strains. Some never feel comfortable showing their faces in public, which lends to them having less opportunities in the long term. 

My passion for this work and offering free services is engrained in the points of making fundamental impacts to an individual life. Additionally, through this work I also take pride is sharing my knowledge about these conditions with up-and-coming medial providers with hopes of combatting these issues in rural communities on a large scale. 

My approach through this project is complex, long term and short team, in treating cleft lip and palate conditions through comprehensive care while also raising awareness in local medical communities. 

Our project currently serves 600+ patients every year. These are the direct cleft lip and palate surgical interventions. We also have a guardian support program run by a psychologist that is directed towards the guardians / relatives to provide psychological support. Remember that a baby born with a cleft has a great impact on the immediate family especially the parents. We consider these family members to be part of the people we are serving. 

This year has been unique due to the challenges brought about by the COVID-19 pandemic which will impact on our direct services to the people. However, we anticipate serving about 400 patients this year despite the aforementioned challenges

In the next five years, we have planned to serve about 4000 cleft patients in Sub-Saharan Africa. As for the training of medical professionals, we hope to train at least 100 (at least 10 cleft surgical teams) in the next 5 years.

• Direct impact in the comprehensive management of cleft afflicted patients: In the next five years, I hope we can provide crucial surgical treatment for those in the most desolate of regions in Sub-Saharan Africa.

• Training: As we provide this crucial service, we hope also to build capacity in these regions so this program can be sustainable in the long term. We hope to serve as an inspiration to the local medical professionals in the ethos of self-sufficiency and service to all. 

• Establishment of a Centre of Excellence: Comprehensive Cleft Care And Leadership Centre - In collaboration with Smile Train, I am currently in the stages of planning a cleft centre of excellence that will enable certain aspects of cleft care that may not be amenable to an ‘outreach” type of model. This centre is envisioned to provide the following:

  • Standardized cleft training

  • Attendant services related to the cleft mechanism such as nutritional support, speech therapy, dental rehabilitation, enhanced psychological support and follow-up. The aim is to remove the stigma and bring back the confidence and strength to those afflicted with this condition

  • Complex surgical interventions such as orthognathic and craniofacial surgery: This Centre will enable the implementation of a “HUB and SPOKE” model of care where certain services can be offered at a centralized area while still providing care to marginalized communities

  • Centre for mentoring up-and-coming cleft healthcare professionals who will take up the mantle and be leaders in the field delving into new areas both literally and figuratively

• Socio-political: The areas we serve are highly volatile in terms of political stability. This together with entrenched cultural beliefs can be challenging barriers to overcome. 

• Financial: Setting up of the Comprehensive Cleft Centre will require substantial amount of resources

• Human resource: The service we provide is highly specialized and getting well qualified personnel to volunteer can be a challenge. Remember, even as we do the “Last Mile” initiative, we are still committed to providing the highest quality and safety of care.

• Infrastructural: The most desolate of regions are “desolate for a reason”. These regions are quite difficult to access with hostile terrain to traverse. The basic amenities on the ground may be unavailable

• Socio-political: By integrating our services with the local communities and running the “Last Mile” initiatives in collaboration with them, we will be able to understand the underlying cultural issues and thus be able to pre-empt and overcome them.

• By seeking partners in this endeavour, I hope to be able to raise part of the funds to set up this Centre of excellence

• By actively engaging in training and encouraging more professionals to specialize in these areas we will be able to develop human technical capacity. The Centre of excellence will go a long way to achieving this specific goal

• By engaging with local government (healthcare) can we improve basic amenities especially in health facilities.

• Self-sufficiency (to a point) in terms of medical equipment to overcome challenges on the ground.

• Terrain issues -  Our determination will help us through the physical obstacles that may present themselves

I’ve been partnered with Smile Train for the past few years. Through this partnership, I’ve been able to make The Last Mile a reality. They have helped me with volunteer surgical outreach programs to provide free cleft lip and palate surgeries in Somalia, Democratic Republic of Congo, Angola, Zimbabwe, South Sudan, Cameroon, Rwanda and remote areas of Kenya. This partnership has helped me train health professionals as well as treat patients in need.

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The Elevate Prize Foundation is built on the vision of “problem solving, community and giving back”. I believe that by participating and applying will enhance the awareness of the foundation and its prize, especially in the regions that the “Last Mile” initiative is present. Additionally, this opportunity could possibly inspire other passionate innovators and leaders to reach for the skies with the knowledge and belief that such philanthropic endeavors, such as the Elevate Prize, can be attained even for those in the remotest regions in Africa.

Without a doubt, The Elevate Prize will help us overcome the financial barrier of setting up the Centre of Excellence with the hope it will be value not only for the immediate setting but also for posterity.

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