Surgical Anthropology & Global Craniofacial Screening and Care: Preliminary Lessons Learned

Introduction:

Understanding the cultural context in which medical and surgical care is offered in

international settings has become increasingly valued, yet few U.S.-based global

health programs include anthropological assessments in their screening processes or

perioperative care guidelines. We therefore conducted an ethnographic pilot study during

overseas medical trips to repair cleft lips and palates, with the purpose of developing

an anthropological assessment tool that aims to enhance surgical screening and care in

global health programs.

Methods and Materials:

Patients who presented for evaluation of cleft lip and palate during two surgical mission

trips to Guatemala were included in the study. Patients, their parents, and their healthcare

providers, underwent qualitative analysis regarding how their cultural beliefs informed

their experiences surrounding delivering or receiving surgical care. Qualitative methods

included (a) observations of patients, families, providers, and (b) anthropological

interviews and focus groups. Topics of interest included socioeconomic background,

distance traveled to receive care, and beliefs regarding etiology of the presenting disease.

Results:

One hundred eight patients were screened during the two trips. Of these, 120 were

deemed fit to undergo surgery. There were no perioperative complications. Hospital

stay averaged 1.5 days. A representative sample of 15 patients were included in the

anthropologic study. Ethnographic observations revealed three areas of relevance for the

development of cultural screening tools: (1) Surgeon interaction style, as exemplified

(a) during rapport building phase, (b) during questioning of the child/parent, and (c) in

consultation with other clinicians; (2) patient non-verbal indicators, including patterns/

odor of clothing as a marker of cultural group affiliation and socioeconomic status; and

(3) families’ beliefs about causation of clefting and their attitudes about surgery.

Conclusions:

Lessons learned during a pilot project in a Guatemala hospital point to novel ways of

moving beyond a mainly medically focused approach to patient screening toward one that

incorporates a cultural awareness assessment into screening for plastic surgery patients.

These observations will help establish a new paradigm of “surgical anthropology” based

on interdisciplinary approaches to optimize humanistic global surgery screening and care.