This is reference project for welingkar Hybrid program student

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SUBMITTED BY: NIKHIL DILIP DAUND
ADMISSION NO: HPGD/AP15/2063
SOCIAL CAUSE: CHILDREN BORN WITH CLEFT LIP, CLEFT
PALATE AND OTHER FACIAL DEFORMITIES.
NAME OF THE NGO: “MISSION SMILE ”
PRIN. L. N. WELINGKAR INSTITUTE OF MANAGEMENT
DEVELOPMENT & RESEARCH
YEAR OF SUBMISSION: AUGUST 2016

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DECLARATION
I, Nikhil Daund, student of Prin. L.N.Welingkar Institute of Management Development &
Research, with admission no. HPGD/AP15/2063, hereby declare that I have completed this
project ISR- CHILDREN BORN WITH CLEFT LIP, CLEFT PALATE AND OTHER
FACIAL DEFORMITIES, in the academic year 2016. The information submitted is true and
original to the best of my knowledge.

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Table of Contents
Executive Summary ....................................................................................................................4
Declaration Page........................................................................................................................2
Type chapter title (level 3) ......................................................................................................3
Type chapter title (level 1) ..........................................................................................................4
Type chapter title (level 2) ..........................................................................................................5
Type chapter title (level 3) ......................................................................................................6

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EXECUTIVE SUMMARY
The project attempts to give an idea about the various Individual Social responsibilities (ISR)
and awareness about the requirement of how we as individuals can perform our social
responsibility.
The social cause on which I have worked on in this project is “Physical Impairment due to
Children Born with Cleft Lip, Cleft Palate and Other Facial Deformities”-
A brief insight is given on NGO –Mission Smile, working on children with Cleft lip and
Cleft palate. The aim of Mission Smile is to help these children so that they could have a
normal living and be included in the society. The same is the subject of the project.
Finally an attempt is made to capture the doing of Mission Smile in a video, highlighting their
work.
Mission Smile is NGO which provide free surgery to CLP children. Corporate office is
located in Mumbai.

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SOCIAL RESPONSIBILITY
Social responsibility is an ethical theory that an entity, be it an organization or individual, has
an obligation to act to benefit society at large. Social responsibility is a duty every Individual
has to perform so as to maintain a balance between the economy and the ecosystems. A trade-
off may exist between economic developments, in the material sense, and the welfare of the
society and environment. Social responsibility means sustaining the equilibrium between the
two. It pertains not only to business organizations but also to everyone who’s any action
impacts the environment. This responsibility can be passive, by avoiding engaging in socially
harmful acts, or active, by performing activities that directly advance social goals
Social responsibility is sub divided into broadly two:

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1. Corporate Social Responsibility:
We make a living by what we get, but we make a life by what we give.” – Winston
Churchill.
Being Socially Responsible means that people and organizations must behave ethically and
with sensitivity toward social, cultural, economic and environmental issues. Striving for social
responsibility helps individuals, organizations and governments have a positive impact on
development, business and society with a positive contribution to bottom-line results.
Corporate social responsibility or CSR is "Making Good Business Sense". The continuing
commitment by business to behave ethically and contribute to economic development while
improving the quality of life of the workforce and their families as well as the local
community and society at large." CSR is one ofthe newest management strategies where
companies try to create a positiveimpact on society while doing business. Evidence suggests
that CSR taken onvoluntarily by companies will be much more effective than CSR mandated
by governments.

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Corporate Social responsibility comprises of 3e’s
Economic Responsibility – Education of employees and young technicians is promoted by
organizing on-going training and qualification courses. TheCompanies have an apprenticeship
program where students can learn in order togain professional experience. Means of economic
responsibility ensure one ofthe most important aspects of the Company‘s activity strategy –
the highestqualification for its employees.
Ethical Responsibility – Taking care of employees, their families, communitiesand society.
Corporates prepare annual events together; they also supportsthose in the communities. They
provide leisure opportunities for their employeesand as well as opportunities for self-
expression: They support employeeinitiatives to form clubs, and to establish professional
unions. The corporates areinvolved in projects for socially vulnerable community members
(for example,children from orphanage). Implementation of ethical responsibility helps
theCorporates to get closer to its personnel and surrounding communities.
Ecological Responsibility – The Corporates takes part in initiatives onenvironmental
management and also promotes initiatives, related to the rationaluse of energy resources,
sorting and recycling waste, etc. Labor and healthsafety requirements are in force in the
workplace.

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2. Individual Social Responsibility:
The International Organization for Standardization (ISO) states:
“In the wake of increasing globalization, we have become increasingly conscious not only of
what we buy, but also how the goods and services we buy have been produced.
Environmentally harmful production, child labor, dangerous working environments and other
inhumane conditions are examples of issues being brought into the open.”
The individual social responsibility includes the engagement of each persontowards the
community where he lives, which can be expressed as an interesttowards what‘s happening in
the community, as well as in the active participationin the solving of some of the local
problems. Being "socially responsible" is aboutall individuals behaving ethically and
sensitively towards social, economic, andenvironmental issues. It is about being accountable
for our actions and beingconscious of the impact your actions have on others, our
communities, and theenvironment. The individual social responsibility also could be
expressed inmaking donations for significant for the society causes – social,
cultural,economic or ecological
Pillars in ISR:

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FEW NGO’S WORKING TOWARDS CHILD DISABILITY
1. SMIL TRAIN :
Smile Train is an international children’s charity with a sustainable approach to a single,
solvable problem: cleft lip and palate.
Millions of children in developing countries with untreated clefts live in isolation, but more
importantly, have difficulty eating, breathing and speaking. Cleft repair surgery is simple, and
the transformation is immediate. Our sustainable model provides training, funding, and
resources to empower local doctors in 85+ developing countries to provide 100%-free cleft
repair surgery and comprehensive cleft care in their own communities.
Smile Train use the “teach a man to fish” model focusing on training local doctors to perform
cleft repairs in their communities. Those doctors then go on to train other doctors creating a
long-term, sustainable system.
Patients see their smile for the first time, parents cry tears of joy, lives and communities are
changed forever.
As a result of their efficiency and with the support of the donors and partners around the
world, Smile Train has transformed the lives of more than one million children by giving
them the power of a smile.

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2. OPERATION SMILE :
"EVERYWHERE WE TURNED
... People pushed their babies at us, tugged at our sleeves with tears in their eyes
and begged us to help
their children.”
- Kathleen Magee, Operation Smile
Co-founder & President
Operation Smile was founded in 1982 when Dr. William (Bill) P. Magee, Jr., a plastic
surgeon, and his wife, Kathleen (Kathy), a nurse and clinical social worker, traveled to the
Philippines with a group of medical volunteers to repair children's cleft lips and cleft palates.
What they found was overwhelming. "People pushed their babies at us." recalls
Kathy. "They tugged at our sleeves with tears in their eyes and begged us to help their
children." In Naga City, approximately 300 families arrived hoping their children would
receive surgery, but the team could only treat 40 children. As they prepared to leave, the
Magees made a promise they would return to help more children.
They began soliciting donations of surgical equipment and supplies from manufacturers,
threw themselves into grassroots fundraising and assembled a volunteer team of 18
doctors, nurses and technicians for their own medical mission to the Philippines. They helped
approximately 100 more patients, but again, hundreds still waited.
They saw the need and Operation Smile was born.
"THE NEED IS GREAT ...
we have the courage to take on that challenge. There are not enough human beings to take
care of the need ... We have to continue to do more, we have to challenge ourselves to do
more.”
-Dr. Bill Magee, Operation Smile
Co-founder & CEO

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3. CLEFT PALATE FOUNDATION (CPF) :
The mission of the Cleft Palate Foundation (CPF) is to serve individuals and families
affected by cleft lip/palate and other craniofacial conditions by connecting them to team care,
providing education, and offering personal support. CPF is a 501(c)(3) nonprofit organization
founded in 1973 to be the public service arm of the American Cleft Palate-Craniofacial
Association.
The Cleft Palate Foundation is supported solely through tax-deductible contributions. Your
tax deductible gift can help ensure that the valuable services CPF provides to families today
will continue to be available in the future.

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INTRODUCTION
India is one of the developing nations of the modern world. It has become independentcountry
but the nation still facing social problems like poverty, unemployment, Discrimination, health
and many more.
We are in 21st century, where standard of living has been improving. We are in the
Technological age even though we are facing various issues in health sector. The Large
portion of India is facing various Health problems. Such as -
 Child malnutrition
 Forms of malnutrition
 High infant mortality rate
 Diseases
 Poor sanitation
 Safe drinking water
 Female health issues
 Rural health
 Physical disability
There is several major health problems prevent in society. Some of the health problems are
eradicated and some problems are still preventing in the society. Some national health
programs like Malaria control programs, AIDS control programs has been launch in India.
Such health problems can be classified into different categories such as -
 Communicable disease problems
 Nutritional problems
 Environmental sanitation problems
 Medical care problems
 Communicable disease continues to be major problem in India. Diseases considered
being of Great importance’s are -
 Malaria
 Tuberculosis
 Diarrhea
 acute respiratory disease
 AIDS

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 India consist of small group of well fed and a very large group of undernourished.
 The specific problems in the country are -
 Protein energy malnutrition
 Nutritional anaemia
 Low birth weight
The most difficult problem to tackle in this country is environmental sanitation problem,
which is multifactorial and multifaceted. In India national health policies are made but
financial resources are considered inadequate to furnish the cost of running such services. In
rural area 74% population doesn’t get benefit of modern curative and preventive health
services. Approx. 80% of health services are concentrated in urban area but with uneven
distribution of doctors. Thus major medical care problem in India is inadequate distribution of
available health resources between urban and rural area, lack of penetration of health services
to social periphery.
Fundamentally, my project is based on Cleft lip and cleft palate born children and their life.
Cleft lip and cleft palate are birth defects that range in severity, and may causeserious
physical and social challenges to those who are born with them. This project soughtto
determine the socioeconomic factors that influence the lives of people with cleft lip andor
cleft palate in India, and the treatment, or lack thereof, which they receive.

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What is Cleft lip and cleft palate?
Cleft lip and cleft palate, also known as orofacial cleft, is a group of conditions that includes
cleft lip (CL), cleft palate (CP), and both together (CLP). A cleft lip contains an opening in
the upper lip that may extend into the nose. The opening may be on one side, both sides, or in
the middle. A cleft palate is when the roof of the mouth contains an opening into the nose.
These disorders can result in feeding problems, speech problems, hearing problems, and
frequent ear infections. Less than half the time the condition is associated with other
disorders.
Cleft lip and palate are the result of tissues of the face not joining properly during
development. As such, they are a type of birth defect. The cause is unknown in most cases.
Risk factors include smoking during pregnancy, diabetes, obesity, an older mother, and
certain medications (such as some used to treat seizures).Cleft lip and cleft palate can often be
diagnosed during pregnancy with an ultrasound exam.
A cleft lip or palate can be successfully treated with surgery. This is often done in the first
few months of life for cleft lip and before eighteen months for cleft palate. Speech therapy
and dental care may also be needed. With appropriate treatment outcomes are good.
Cleft lip and palate occurs in about 1 to 2 per 1000 births in the developed world. CL is about
twice as common in males as females, while CP without CL is more common in females. In
2013 it resulted in about 3,300 deaths globally down from 7,600 deaths in 1990. The
condition was formerly known as a hare-lip because of its resemblance to a hare or rabbit, but
that term is now generally considered to be offensive.

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Signs and symptoms
Cleft lip
If the cleft does not affect the palate structure of the mouth it is referred to as cleft lip. Cleft
lip is formed in the top of the lip as either a small gap or an indentation in the lip (partial or
incomplete cleft) or it continues into the nose (complete cleft). Lip cleft can occur as a one
sided (unilateral) or two sided (bilateral). It is due to the failure of fusion of the maxillary and
medial nasal processes (formation of the primary palate).
Unilateral incomplete unilateral complete Bilateral complete

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Cleft palate
Cleft palate is a condition in which the two plates of the skull that form the hard palate (roof
of the mouth) are not completely joined. The soft palate is in these cases cleft as well. In most
cases, cleft lip is also present. Cleft palate occurs in about one in 700 live births worldwide.
Palate cleft can occur as complete (soft and hard palate, possibly including a gap in the jaw)
or incomplete (a 'hole' in the roof of the mouth, usually as a cleft soft palate). When cleft
palate occurs, the uvula is usually split. It occurs due to the failure of fusion of the lateral
palatine processes, the nasal septum, and/or the median palatine processes (formation of the
secondary palate).
The hole in the roof of the mouth caused by a cleft connects the mouth directly to the inside
of the nose.
Note: the next images show the roof of the mouth. The top shows the nose, the lips are
colouring pink. For clarity the images depict a toothless infant.
Incomplete cleft palate unilateral complete lip complete lip and palate

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CAUSES OF CLEFT LIP AND CLEFT PALATE
In most cases, the cause of cleft lip and cleft palate is unknown. These conditions cannot be
prevented. Most scientists believe clefts are due to a combination of genetic and
environmental factors. There appears to be a greater chance of cleft in a new-born if a sibling,
parent, or relative has had the problem.
Another potential cause may be related to a medication a mother may have taken during her
pregnancy. Some drugs may cause cleft lip and cleft palate. Among them: anti-
seizure/anticonvulsant drugs, acne drugs containing Accutane, and methotrexate, a drug
commonly used for treating cancer, arthritis, and psoriasis.
Cleft lip and cleft palate may also occur as a result of exposure to viruses or chemicals while
the fetus is developing in the womb.
In other situations, cleft lip and cleft palate may be part of another medical condition.
How Cleft Lip and Cleft Palate are diagnosed?
Because clefting causes very obvious physical changes, a cleft lip or cleft palate is easy to
diagnose. Prenatal ultrasound can sometimes determine if a cleft exists in an unborn child. If
the clefting has not been detected in an ultrasound prior to the baby's birth, a physical exam of
the mouth, nose, and palate confirms the presence of cleft lip or cleft palate after a child's
birth. Sometimes diagnostic testing may be conducted to determine or rule out the presence of
other abnormalities.
What are the impact of Cleft Lip and Cleft Palate?
Cleft lip is far more than a cosmetic issue; it has far-reaching impacts on aspects of life that
most would take for granted. Cleft conditions can create serious difficulties with eating and
speaking, while also preventing communication through facial expression, including the
ability to smile. Cleft can also lead to hearing impairment and other auditory disorders.
Perhaps worst of all, cleft is surrounded with a terrible stigma that causes sufferers to receive
abuse, neglect and ultimate social isolation from others who misunderstand what cleft is, and
may attribute it to karma, or a curse from a god.
To address these issues, a child and family can work with a team of specialists - a
paediatrician, a plastic surgeon, a dental specialists, an otolaryngologist (ear, nose and throat
specialist), a speech-language pathologist, an audiologist (hearing specialist), a geneticist and
a psychologist/social worker. It is with an understanding for the complex web of issues
associated with cleft that the Comprehensive Cleft Care Centre has been established, to treat
the whole child for long-term rehabilitation.

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CL/P IN INDIA
As per NDTV online news column India has over 72,000 with Cleft Lip and Palate.
 India has more than 72,000 children and adults with unrepaired cleft lip or cleft palate,
says a new study significantly highlighting the unmet need for cleft lip and/or palate
(CL/P) care in India.
 The findings showed that there are 72,637 cases of unrepaired CL/P in India. The
percentage of individuals with unrepaired CL/P who were older than the respective
target age group of 1-2 ranged from 37.0 per cent in Goa to 65.8 per cent in Bihar.
 Also, infants in low and middle-income countries face significant barriers to
treatment, leading to prolonged disfigurement, social stigma, speech impairment as
well as trouble of feeding food that can result in malnutrition and death.
 Safe, timely and effective surgery can result in successful outcomes, the researchers
noted, in the paper published online by JAMA Facial Plastic Surgery.
 However, poor states like Bihar, with less health care infrastructure were found to
have with exceptionally high rates for the surgery.
 The rate of unrepaired CL/Ps ranged from less than 3.5 per 100,000 populations in
Kerala and Goa to 10.9 per 100,000 populations in Bihar.
 "The results describes the prevalent unmet need for cleft surgery in India by each state
and includes patients older than the surgery target ages of 1 and 2 years for cleft lip
and cleft palate repair, respectively," said Barclay T. Stewart from the University of
Washington.
 Substandard nutrition and a lack of prenatal care are known to be the likely reasons for
these congenital disorders.

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 "Significant efforts must be made to relieve the prevalent unmet need and strengthen
health care services to meet the demand of new cases so that the surgical backlog does
not grow," Stewart added.
 For the study, the data were used from patients who received care at Mission Smile
programmes -- a non-government supported campaign to provide surgical care to
affected babies, indicators of surgical care capacity, wealth, and infrastructure across
different states -- in 12 low-and middle-income countries from June 1, 2013, to May
31, 2014.
 Using state-level economic and health system indicators, the total number of
unrepaired CL/P cases in each state was estimated.

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ATTITUDES TOWARDS CLP IN INDIA
 Most children who have their clefts repaired early enough are able to have a happy
youth and social life. Having a cleft palate/lip does not inevitably lead to a
psychosocial problem. However, adolescents with cleft palate/lip are at an elevated
risk for developing psychosocial problems especially those relating to self-concept,
peer relationships and appearance. Adolescents may face psychosocial challenges but
can find professional help if problems arise. A cleft palate/lip may impact an
individual’s self-esteem, social skills and behaviour. There is research dedicated to the
psychosocial development of individuals with cleft palate. Self-concept may be
adversely affected by the presence of a cleft lip and/or cleft palate, particularly among
girls.
 Research has shown that during the early preschool years (ages 3–5), children with
cleft lip and/or cleft palate tend to have a self-concept that is similar to their peers
without a cleft. However, as they grow older and their social interactions increase,
children with clefts tend to report more dissatisfaction with peer relationships and
higher levels of social anxiety. Experts conclude that this is probably due to the
associated stigma of visible deformities and possible speech impediments. Children
who are judged as attractive tend to be perceived as more intelligent, exhibit more
positive social behaviours, and are treated more positively than children with cleft lip
and/or cleft palate. Children with clefts tend to report feelings of anger, sadness, fear,
and alienation from their peers, but these children were similar to their peers in regard
to "how well they liked themselves."
 The relationship between parental attitudes and a child’s self-concept is crucial during
the preschool years. It has been reported that elevated stress levels in mothers
correlated with reduced social skills in their children. Strong parent support networks
may help to prevent the development of negative self-concept in children with cleft
palate.[16] In the later preschool and early elementary years, the development of
social skills is no longer only impacted by parental attitudes but is beginning to be
shaped by their peers. A cleft lip and/or cleft palate may affect the behaviour of pre-
schoolers. Experts suggest that parents discuss with their children ways to handle
negative social situations related to their cleft lip and/or cleft palate. A child who is
entering school should learn the proper (and age-appropriate) terms related to the cleft.
The ability to confidently explain the condition to others may limit feelings of
awkwardness and embarrassment and reduce negative social experiences.
 As children reach adolescence, the period of time between age 13 and 19, the
dynamics of the parent-child relationship change as peer groups are now the focus of

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attention. An adolescent with cleft lip and/or cleft palate will deal with the typical
challenges faced by most of their peers including issues related to self-esteem, dating
and social acceptance. Adolescents, however, view appearance as the most important
characteristic above intelligence and humour. This being the case, adolescents are
susceptible to additional problems because they cannot hide their facial differences
from their peers. Adolescent boys typically deal with issues relating to withdrawal,
attention, thought, and internalizing problems and may possibly develop anxiousness-
depression and aggressive behaviours. Adolescent girls are more likely to develop
problems relating to self-concept and appearance. Individuals with cleft lip and/or
cleft palate often deal with threats to their quality of life for multiple reasons
including: unsuccessful social relationships, deviance in social appearance and
multiple surgeries.
 The incidence of CLP in Indiawas found to be 1.09 in every 1,000 live births. This is
comparable to theincidence in other Asian countries such as China and Japan and
higher than in Africa.
 However, it is still lower than the figures in the West. There is a predominance of
male in CLP individuals in India. Another unique feature of the CLP incidence in
India is that a large proportion of it arises from consanguineous relationships.
 There is an inverse proportion between the levels of education of the individual on one
hand, and the tendency to attribute the causation of CLP to spiritual causes or to hold
folk explanatory models for it. As in many traditional societies, the literature shows
that there is a difficulty in interviewing the mothers about their attitudes towards and
perceptions of CLP. Often during the clinical interview it is the father who is doing all
the answering and when in doubt, he will turn to another male relative rather than the
mother.
 In one study among the rural Gujarat community consisting of mainly manual
labourers, with Hindu being the predominant religion, 84% of them believed that CLP
is due to the “act of fate” There was also a belief that CLP was a punishment due to a
previous sinful act. Other perceived causations included a solar eclipse occurring
during pregnancy and starvation in the village during pregnancy .Another study was
done amongst the rural parts of Gujarati in Mumbai, India. It was an area where there
were high poverty rates, unemployment and illiteracy.
 The study populations consisted of patients whose parents have not largely accepted
Western methods of clefttreatment as the norm. It was found that almost all parents in
this cohort of India blamed thebirth of a CLP child on a curse or an act of evil spirits
and similarly, retribution for past sins. This may be related to the Hindu beliefs about
reincarnation.

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 On reviewing the available literature, it is not clear whether the CLP is believed to be
caused by the mother looking at certain animals or consuming the wrong food during
pregnancy. Given the ideas the families have about CLP, it is understandable that the
CLP child would experience strained relationships with family members and poor
exposure to the outside world. There is a tendency for the CLP child in India to have
limited social interaction due to the family’s shame and concern. There are always
raised anxieties and unique concerns when exposing the child to a new environment
such as a new school. There are also families who choose to isolate their children,
perhaps as a way of protecting them.
 Some extreme examples include parents abandoning the child and leaving them to be
raised by the grandparents. Many of the parents and family members in India are
receptive to the idea of treatment for CLP. The idea that the CLP child, after repair
surgery, may have a better self-esteem, more confidence and better acceptance by
peers appealed to the Indian families studied . Interestingly, the predominant concern
was the possible improvement in marriage prospects amongst the female CLP
individuals.
 In this society, the family bears the responsibility of ensuring that the female child is
married, and gainfully done so. The female child with CLP is thus considered an even
greater liability and economic burden to the family until she is married, as it may be
more difficult to find an acceptive family for her, given her CLP.
 There are also many incidences of the CLP child being refused entry into schools.
Thus, there is also hope that there will be a better chance of a proper school education
after the CLP repair through surgery. However, there are also concerns about upsetting
the supernatural forces, given that CLP is understood to be a ‘Will of God’ or evil
spirits.

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CHALLENGES
1. PHYSIOLOGICAL CHALLENGES :
Malnutrition– Malnutrition or malnourishment is a condition that results from eating a diet
in which nutrients are either not enough or are too much such that the diet causes health
problems. It may involve calories, protein, carbohydrates, vitamins or minerals. Not enough
nutrients is called under nutrition or undernourishment while too much is called over
nutrition. Malnutrition is often used specifically to refer to under nutrition where there are not
enough calories, protein, or micronutrients.
Drinking- Babies with only a cleft lip are likely able to breastfeed and/or use a typical bottle.
Babies with a cleft of the palate often require special bottles and nipples and likely will work
with a cleft palate feeding specialist (often, the team speech-language pathologist) to ensure
adequate feeding method and nutrition. A lactation specialist may also be consulted to
monitor successful feedings and growth. The craniofacial speech-language pathologist,
occupational therapist, nurse, and lactation specialist can assist in choosing the best bottle for
your child. See feeding and Swallowing Disorders (Dysphasia) in Children for additional
information.
Breathing- In the initial period after birth, it is critical for the child to breathe and feed
well. Neonates with cleft palate may demonstrate some degree of respiratory distress,
especially if micrognathia is present. The otolaryngologist is often involved with the
evaluation and management of the airway.
Ear Infection- Kids with cleft palate can have hearing loss. This may be caused by fluid
building up inside the ear. They usually need very small special tubes placed in their eardrums
to help them hear well. Therefore, children with cleft palate should have their ears and hearing
checked about once or twice a year.

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Communication- If a child has only a cleft lip, speech development should be typical or very
close to typical. Children with cleft lip and palate or cleft palate only often need speech
intervention to monitor speech development and to treat any speech delays or errors that
theymight develop. Some children will require speech therapy. Others will require further
surgery. And others may require both. Some craniofacial teams may incorporate a temporary
“speech appliance” in addition to speech therapy. These are all decisions guided by your
child’s cleft palate craniofacial team.
2. PSYCHOLOGICAL CHALLENGES
Low Self Esteem -
Society can sometimes have lower expectations, socially and intellectually, of someone who
looks different. A pupil may have a low expectation of him/herself if he believes his peers or
teachers have low expectations.
Teasing and Bullying -
A child born with a cleft may be subject to teasing and bullying because he or she looks or
sounds different. He/she may find it harder to make friends and be a reluctant speaker in class
or the playground, which may lead to withdrawal. Some children might be aggressive or
disruptive to assert themselves.
Absences -
Cleft children may need to be regularly absent from school to attend medical appointments or
have surgery. This disrupts school life and creates pressures to keep up-to-date with work.
Anxiety about being forgotten and left out by friends, and worries about what effect a change
in appearance or speech due to surgery will have on how peers accept them, are common
among cleft children.

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3. SOCIAL CHALLENGES
Communication -
A child who cannot make him understood may become tactile in his efforts to communicate.
This may result in fighting. Teachers and other children may not understand that this behavior
stems from a simple desire to communicate.
Lack of friends and support network -
Due to this deformity the child feels ashamed of coming out of their house, so they lack in
making friends and also lack of support network.
Associated blind beliefs: Lets have some interesting superstitions followed in India -
If the mother drinks more milk, then the complexion of the baby will be light.
After the baby is born, the umbilical cord falls off after some time, and when it falls it should
not touch the ground.
The expectant mother should not look at the eclipsed moon, as it can cause deformities to the
unborn child such as cleft lip or club foot.
Lack of Confidence -
It is evident that with various limitations that individuals with cleft lip and palate experience,
they are bound to encounter various social problems. Anxiety and depression have also been
reported to be twice as prevalent in adults with cleft lip and palate compared with normal
controls. Difficulties are also experienced in relation to behavioural problems and satisfaction
with facial appearances.

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NGO: MISSION SMILE
Introduction
 MISSION SMILE is a Medical Charitable Trust dedicated to provide free life
changing cleft care and surgeries to children born with Cleft lip, Cleft palate and other
facial deformities.
 Since our inception in 2002, we have screened more than 40,000 cleft affected
children and have performed more than 27,000 safe corrective surgeries in India.
Mission Smile provides Comprehensive Cleft Care and Surgeries FREE of cost to all
patients, in India.
 High standards of care and stringent safety protocols are followed by Mission Smile
ensure that we provide the best possible and safest care to the poorest of the poor.
 Mission Smile has created a Unique Public Private Partnership with the Government
of Assam and National Health Mission, Tata Trust towards creating ‘Cleft Free’
Assam & North East India. Assam is very close to become the first ‘Cleft Free’ state
in India.
 Mission Smile is led by a Team of dynamic Board of Trustees and Executive Team
who are distinguished in their own fields.
 Mission Smile has following board of trustee -
1. Dr.RashmiTaneja, M.D: Dr.Rashmi is Chairperson and medical director of Mission
Smile of India. She has 13.5+ experiences in medical. And she is also Senior
Consultant, Plastic & Reconstructive Surgeon Fortis Healthcare, New Delhi
2. Dr. Manish MukulGhosh, MBBS, MD, MS (General Surgery:
Dr.Manish has more than 28.5+ experience in medical. He is also part of Mission
Smile India management. He is Consultant in Fortis, Kolkata of plastic and cosmetic
Surgery department.

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3. VenkatRamaswamy :Mr.Venkat is Co-Founder and & Executive Director. He is part
of Mission smile of indiamanagement.
4. Dr.TarunSahani : He is director at Advent Health Care Pvt. Ltd.
5. Col. ShivajiSamaddar (Retd.) :Mr.Shivaji is Chief Operating Officer at Mission
Smile of India. He is taking care of
6. Mr.DalipPande :Dalip has over 21 years of marketing experience with VST
Industries, a British American Tobacco associate company. He was instrumental in
helping the organization popularise its Brand inIndia and build a Distribution Network
through various Sales & Marketing campaigns.Currently he heads the Public Affairs
division of Netdecisions. He is also one of the Directors in Mission Smile, a partner of
GMS.
 Mission Smile has a Medical Charity so our medical protocols are established and
monitored by a medical council who bring with them years of expertise and
experience.
 In this team Dr. Pervez Ahmed is chairmen and under his team there are 3 members.
All three members are very well having experience in their field. In this team
Dr.RamkumarVenkateswaran who has Professor, Department of Anaesthesiology
Kasturba Medical College, Manipal. Second member is Dr.AnjanaMalhotra,she is
plastic surgeon South Eastern Railway Hospital, Kolkata. Third member of team is
Dr.RashmiTaneja, she is Senior Consultant, Plastic & Reconstructive Surgery Fortis
Healthcare, New Delhi.
 This team taking care of medical process and protocol follow properly. They also
provide medical advice to NGO.
 Mission Smile since its inception in 2002 has been supported by various corporates
and Govt. Supporters help them to bring Smiles for Miles on various faces. They have
support like Tata Steel, Rajasthan Royals, Max Bhupa, Marriot, ONGC, Boeing etc.
and many more top ventures and government organization.

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 Mission Smile, in its Comprehensive Cleft Care Centre at Guwahati has participated
and contributed in many research papers in the field of Comprehensive Cleft Care
delivery model for a developing country like India.
 Mission Smile is accredited by some of the International Charities like Give India
USA, CAF, and we have International Tie-ups with leading Cleft foundations like
Smile Asia and Future Smile Charitable Foundation.
 Mission Smile is having International Tie-ups with leading International foundations
like Give India USA, Give India UK, CAF, Smile Asia and Future Smile Charitable
Foundation. They helpsMission smile India for following:
(a) Support Mission Smile to perform more surgeries in India
(b) Giving opportunities to medical volunteers to participate in Medical Mission outside
India.
(c) Coordinating with doctors and medical team to participate in missions in India. Thus,
helping in Knowledge transfer and sharing of best practices.
 As per the study of Ministry of Health & Family Welfare, 1 in 700 children in India is
born with a cleft lip, cleft palate or other facial deformity. The approximate incidence
of cleft lip and cleft palate is 1.4 per 1,000 live births in India.But more recent studies
put the number at 1 in every 700 births – Journal of Indian Society of Periodontics and
Preventive
 There is existing backlog of 1 million untreated children and adults in India alone.
There is many more NGO has finding this people and helping them to live happy life.
Mission smile is one of them NGO.
 Mission Smile has Some donors of include – Govt. of Assam and Meghalaya, NHM
Assam, Sir Dorabji Tata Trust and Allied Trusts, Johnson & Johnson,
MuthootPappachan Foundation, Srei, Boeing, GMS, Singh and Associates, Jindal
Steel & Power, BUPA, Abbott India Ltd., UPS Foundation, Numaligarh Refineries,

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NHPC, GMS, Quasar Growth Group, APPL Foundation, Apeejay Trust and J Thomas
& Co.
 Mission Smile has completed more than 15000 surgeries in Assam and neighbouring
states. Mission Smile has over 1200 volunteers from 36+ countries have participated
in their missions. They help to Mission Smile spread smile on million faces.
 Mission Smile has established mission of Comprehensive Cleft Care Centre at
Guwahati in 2011.
 Mission Smile first inaugural Medical Mission in Visakhapatnam in the month of
August. The mission was sponsored by MuthootPapachan foundation. The venue of
the Medical Mission was Gitam Dental College & Hospital. In this Medical Mission
we have screened 117 children and have provided much needed surgery to 57
children.
 Mission Smile First Mission in Noida (February 2015) which was organized in ITS
Dental College, was sponsored by Phoenix Lamps. In this Mission NGO have
Screened 60 children & performed 43 Surgeries.
 Mission Smile Third Mission in Kerala (April 2015) which was organized in
Kottayam, was sponsored by MuthootPappachan Foundation. In this Mission
NGOhave screened 58 children & performed 43 Surgeries.
 Mission Smile 10th Kolkata Mission was organized in May 2015 with Support of
Apeejay Trust, J Thomas & Co., APPL foundation, & Quasar Growth Group. In this
Mission NGO have screened 169 children and performed 106 Surgeries. Employees
from over 8 corporates volunteered in the mission. The medical volunteer team
comprised of over 38 medical professionals from around 6 states who joined hands to
gift 100 Smiles to Kolkata.

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 Missions are the primary mode of intervention and though they are short term, they
are effective as large numbers of patients are given medical assessments and receive
surgeries in a particular mission. A location is chosen and volunteers from India and
abroad spends 10 days making it possible to conduct medical evaluation and surgeries,
followed by post-operative check-up. Till date Mission Smile has conducted 80
medical missions in India.Medical Missions are participated by volunteers & experts
from various corporate from the region.

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KOLKATA MISSION - 2015

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OUTREACH CENTRES
Outreach is an activity of providing services to any populations who might not otherwise have
access to those services. A key component of outreach is that the groups providing it are not
stationary, but mobile; in other words they are meeting those in need of outreach services at
the locations where those in needs are.
Mission Smile has 7 Outreach Centres in all over India. This is run in partnership with local
hospital.
Mission Smile Credentialed surgeons and experts, with approved equipment and
infrastructure: Mission Smile has outreach centre in Bhopal, Bhubaneswar, 2 in Kolkata,
Siliguri, Delhi NCR &Kottayam.
Mission Smile has following outreach centres which is run in run with partnership.
 Delhi:
o Fortis Memorial Research Institute. Sector – 44, Opposite HUDA City Centre,
Gurgaon, Haryana 122002
o Contact Person: Dr.GaganSabarwal, Mobile: 09711112290
 KOLKATA:
 Kalpataru – “Narayana Multi Speciality Hospital 78, Jessore Road, Barasat – N 24
Parganas, Kolkata – 700127.
o Contact person – SubhankarSaha, Mobile: +91 9432684976
 Park Clinic, Gorky Sadan, Gorky Plaza, Kolkata – 700017
o Contact person – Dr. Manish MukulGhosh, Mobile: +91 9830106321
 BHUBANESWAR:
o D.B. Cleft & Craniofacial Foundation, “OM”, Plot No. 778, Brahmeswar
Patna, Tankapani Road, Bhubaneswar – 751 018.Odisha. Contact person – Dr
SwarnavPatnaik, Mobile: +91 7873809549
 KOTTAYAM :
o Muthoot Life Brigade Hospital Vadavathoor, Kottayam, Kerela, India.
o Contact person – SubhankarSaha, Mobile: + 91 9432684976

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 BHOPAL
o Lahoti Hospital and Research Centre, Sector A/14, Shahpura, Bhopal (M.P.) –
462016.
o Contact person – Dr.KapilLahoti, Mobile: +91 9826426470
 SILIGURI
o Kejriwal Stone Clinic & Kidney Care Centre, ParnamiMandir Rd, Ward 40,
Hakim Para, Siliguri, West Bengal 73400
o Contact person – Dr.Kejriwal, Phone: 0353 652 6345, Mobile:+91 983291448

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GUWAHATI COMPREHENSIVE CLEFT CARE
CENTRE ( GC4)
Mission Smile has created a Unique Public Private Partnerships of this magnitude in
the world, in collaboration with the Government of Assam and National Health
Mission, Tata Trust and Allied Trusts, Max BUPA towards creating a ‘Cleft Free’
Assam & North East India.
On February 2011, the state- of- art facility was inaugurated by the Hon’ble Chief
Minister of Assam, Shri. TarunGogoi, in the presence of the Hon’ble Ex- Minister for
Health and Family Welfare, Dr.HemantaBiswaSarma and ShriRanjitBarthakur ( Imm.
Past Chairman Mission Smile).
Following images are the GC4.

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Mission Smile undertakes medical missions throughout India and North East to
identify needy cleft children for corrective surgeries. Special screening camps are
organized to select cleft children for life changing surgeries. We select patients form
our screening camps undergoing medical tests to judge their fitness for surgeries.
Especially we also provide free dental care and speech therapy who need teeth
alignment and also provide free nutritional care to the children suffering from nutrition
problem.
Since 2011, more than 15000 safe corrective surgeries have been conducted by the
centre. It has become a centre of excellence in Comprehensive Cleft Care not only in
India but also in the world.
Apart from over the time, PSUs like NHPC, NEEPCO, ONGC, NTPC have supported
this initiative of the government. It has been acclaimed by Shri. GhulamNabi Azad,
Ex- Health Minister, Government of India as a model to be replicated by other states
too.

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Educational Program by Mission Smile
Cleft Surgery Training Program :
Mission Smile has offer Fellowship program in Cleft Surgery at our Guwahati
Comprehensive Cleft Care Centre our for postgraduate Plastic Surgeons, Paediatric
Surgeon and Maxillofacial Surgeons.
The Cleft Surgery Training program is a 4-month clinical position oriented primarily
towards Cleft lip and palate surgery. The fellow will also have rotation in other
departments like Dental/Orthodontics, Speech Therapy, Nursing etc. From a clinical
standpoint, the centre’s average is approximately 150-175 cases per month. Our
Fellows are also encouraged to complete a research project during their tenure with us.
These are usually submitted for publication in a peer review journal.
This is not a paid fellowship, so you will not be entitled to any monthly salary or
stipend. You have to find your own sponsorship for your logistics for 4 four months.
Also there is no fees to be paid by you to mission smile GC4 for the.
AHA training Program:
a. ACLS (Advanced Cardiovascular Life Support):- ACLS is an advanced,
instructor-led classroom course that highlights the importance of team
dynamics and communication, systems of care and immediate post-cardiac-
arrest care. It also covers airway management and related pharmacology. In
this course, skills are taught in large, group sessions and small, group learning
and testing stations where case-based scenarios are presented.
b. BLS (Basic Life Support):- The Basic Life Support (BLS) for Healthcare
Providers Classroom Course is designed to provide a wide variety of
healthcare professionals the ability to recognize several life-threatening
emergencies, provide CPR, use an AED, and relieve choking in a safe, timely
and effective manner.
c. PALS (Pediatric Advanced Life Support):- Pediatric Advanced Life Support
(PALS) is a classroom, video-based, Instructor-led course that uses a series of
simulated pediatric emergencies to reinforce the important concepts of a

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systematic approach to pediatric assessment, basic life support, PALS
treatment algorithms, effective resuscitation and team dynamics. The goal of
the PALS Course is to improve the quality of care provided to seriously ill or
injured children, resulting in improved outcomes. Following images was from
educational programme.

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STUDENT PROGRAMME
Mission Smile running student programme from last three year successfully in India.
The overall goals are:
To inculcate values of community, compassion, empathy, social service and
dignity of labour in students.
To empower students through leadership development
To provide opportunities for action for students in a way that affirms their self-worth
and builds their confidence and sense of responsibility
The core of the student programs is to focus on the four pillars of philanthropy: these
are leadership, service, awareness and education.
Leadership: In terms of leadership, we encourage students to participate in missions
and be the best of their ability. In 2012 RBKI school in Mumbai organized and lead a
Ulead conference as well as went on a mission, they paid for their own trip and hotel
to Aurangabad as well as raised money for 60 smile bags and 80 shirts. Another
notable student initiative was when two students and a teacher from American School
Chennai went on a mission in November 2012 to Orissa.
Education: Under education student teams teach children and adults at the hospital
and in the surrounding community about nutrition, burn care and prevention, oral
rehydration, and oral hygiene. Students encourage teaching within their communities
as well, whether it is about facial deformities, Mission Smile Youth Programs or
Mission Smile itself.
Service: Service is the backbone of the student program, students are encouraged to
give back to their local community, this is done by going on missions.
Awareness: Lastly awareness is a necessary element to keeping the student programs
going, this is more directly linked to fundraising; this is done through fliers, posters
and pamphlets. As people become more aware of Mission Smile and its program, they
are more likely to give up their time and money for the cause. Awareness can be as
simple as wearing a Mission Smile button or t-shirt. With all of this implemented, the
Mission Smile students raise a lot of money through Fundraising, the process of
soliciting and gathering voluntary contributions as money or other resources, by
requesting donations from individuals, businesses, charitable foundations, or
governmental agencies .

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NUTRITION PROGRAM
Mission Smile also provide nutrition program for CLP children’s.
Cleft lip and palate children and Malnutrition -
Studies suggest that children with poor nutrition are at risk of poor surgical outcomes.
Children with Cleft are more prone to nutritional problems because of the different
degrees of cleft and difficulties in breast feeding, and lack of knowledge of the parents
in different methods and positions to feed the cleft babies. Malnourished cleft children
are more prone to infections such as pneumonia, skin diseases, measles and diarrhea
due to nutrition related immunity.
If malnourishment in cleft patients is not addressed through helping them with
education, emotional support, provide Complementary food and micronutrient
supplements and treatment, the possibility of their undergoing surgery or even survival
becomes very remote.
In view of the above, we at GC4 have a Nutrition Program with the following
objectives.
Issues/ challenges faced by cleft malnourished patients
Infants with clefts have a difficult time breastfeeding/eating.
Due to very poor economic background these Cleft Children are deprived of proper
diet.
Feeding is a constant challenge and unless the cleft is rectified by surgery, the
malnourished condition continues.
Due to low weight and very low immune system, these children are unable to receive
surgeries on time and the cycle continues.

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Objectives of Mission Smile Nutrition Program:
To identify, evaluate and monitor the severity of malnutrition in children with cleft in
the age group of 0-5 years.
To provide adequate micronutrients and to treat any associated medical condition.
Timely referral of SAM (Severe Acute Malnourished) patients to tertiary care centres
or Nutrition Rehabilitation Centres.
Assurance and possibilities, testimonials
Provide emotional support to the family and motivate them to take on the challenge of
caring for the child.
Educate parents/care givers about food habits (locally available) feeding methods and
frequency, food and personal hygiene
Maintain patient data to monitor and evaluate their progress periodically until they are
fit for surgery.
Subject to availability of funds/ donations, patients are also provided with infant
formula feeds, special feeding bottles for cleft.

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BIBLIOGRAPHY
1. https://en.wikipedia.org/wiki/Cleft_lip_and_cleft_palate
2. http://www.webmd.com/oral-health/guide/cleft-lip-cleft-palate?page=2
3. http://www.wcprr.org/wp-content/uploads/2014/04/2011.02.127-134.pdf
4. http://www.ndtv.com/health/india-has-over-72-000-with-cleft-lip-and-palate-
1417759
5. http://www.slideshare.net/isabasuki/cleft-lip-and-palate-27041461?qid=ebfc7459-
6f73-4d2c-87ff-2a692d979a36&v=&b=&from_search=5