Give them back their smiles
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Craniofacial problems may seem frightening but there is a solution to them, says Dr. S.M. Balaji in an interview with R. KRITHIKA.
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Dr. Balaji.
THEY say beauty is only skin deep. "Try telling that to a child who has a cleft lip and palate or has half the lower jaw missing," remarks Dr. S.M. Balaji, dental and facio-maxillary surgeon. He specialises in repair of cleft palate and cranio-facial surgery.
People with congenital deformities like cleft lip and palate, half the lower jaw missing, misshapen nose and missing ears or acquired problems like TM Joint Ankylosis (also known as lockjaw) and facial paralysis face ridicule and rejection. "Their sufferings are three-fold: physical, social and psychological," points out Dr. Balaji.
Babies with a cleft lip and palate cannot be fed in the normal fashion because they cannot suckle. There is also the danger of the food entering the windpipe. To add to their problems, they face speech problems later in life. Those with lockjaw also have speech problems and are unable to eat normally since they cannot open their mouths properly. The good news is that these problems can be set right by surgery. The bad news: costs are prohibitive.
Making a difference
The majority of the people cannot afford these surgeries. So the doctor makes it a point to reach out to as many as he can by operating at medical camps, trying to find sponsors for poor patients and also operating free. "I make enough money with other patients," he says candidly. "I don't come from a rich family with a medical background. I worked my way up, got the admission on merit. I started out as a dentist and got into this because I wanted to be in a field where I could make a visible difference."
Dr. Balaji has conducted camps in South India, Andamans and Maldives ("The government provides excellent support," he says, "and there is a good follow up system too"). He has published papers in journals like International Journal of Oral and Maxillofacial Surgery, Implant Dentistry, Journal of Maxillofacial and Oral Surgery, Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery and Indian Journal of Oral and Maxillofacial Surgery.
Dramatic difference after surgery for cleft lip and palate.
His interest lies in research and improving surgical techniques. Even as a student, he was interested in experiments. "As a senior resident, I tried applying gutka and betel nut to the lips of rabbits and observing them. After about three months, I noticed changes in the tissues."
Now his research leans towards surgical techniques. He has researched and presented papers on surgical techniques for deformed noses (rhinoplasty), facial paralysis and lesions that may lead to oral cancer, TM Joint Ankylosis and other topics. He has authored books in Tamil and distributes them at the medical camps. "People in remote, rural areas have no idea that a cleft lip and palate or a missing ear can be repaired. Such books and pamphlets will create some awareness."
Spreading awareness
One more attempt at spreading awareness was a film on facial deformity. "We got a Sri Lankan girl, who had to be operated on, to play the lead. The storyline was simple: a girl has facial deformities and is not able to get married. After the surgery, she is hounded by suitors." The film was screened at the Berlin International Film Festival in 1996.
To a suggestion that the storyline is regressive, the doctor is unrepentant. "Let's face reality. I have parents bringing babies a few months old and telling me, `how will she get married?' That's the kind of society we live in."
Beginning as a dentist, Dr. Balaji went on to study oral and maxillofacial surgery in Germany. Why Germany? "Germany was the best place to be in for Oral and Maxillo-facial surgery. Top specialists like Prof. Schlegel (Orthognathic Surgery, University of Munich Dental School); Prof. Peter Brabant (Implantology, Mannheim); Prof. F. Khoury (Implantology, Olsberg) and Prof. Hoffmeister (Distraction Osteogenesis Benjamin Franklin Free University of Berlin) were there and I wanted to study under them. I also underwent training under Prof. Steolinnga, Rijnstate Hospital, Arnhem, The Netherlands in Cleft-palate surgeries."
Asked to compare his experiences as a student in India and abroad, the doctor unhesitatingly plumps for India. "I suppose you could say it's a fall out of our population explosion but all dental house surgeons in General Hospital, Chennai, and medical colleges are encouraged to perform minor operations on actual patients. In Germany, house surgeons could not actually get patients to operate. Some students used to bring their friends, parents or someone they knew so they could practise what they learnt. I feel that our system gives us greater practice, makes us more dexterous."
Dr. Balaji is very clear that his focus is not only to create awareness about cranio-facial problems but also that there is a solution to it. Quiz him about his clinic in a posh area of the city, he exclaims, "I don't want people to look at the exterior and think `it will be expensive if we go to this doctor.' I want the man on the street to approach me, the financial angle ... we can work it out."
The most important thing, he says, is to make people aware that there is a solution to these problems, frightening though they may be.
"Think of a person who's unable to open his mouth because of lockjaw, or a child facing rejection because of cleft lip or one born without ears ... surgery may be scary, not just in terms of pain and mental agony but also in terms of money. Especially if they're from the poorer sections of society. That is why I want to reach out to them. People who can afford it will get the treatment somehow."
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