Stories about: cultural competency

Along with “fixing” cleft lip comes correcting misperceptions about its causes

OP-Smile-IThroughout the world, a child is born with a cleft lip or palate nearly every three minutes. In resource-poor areas, many of these children die before their first birthday, and those who survive have difficulty eating, speaking and being accepted by their peers.

Lauren Mednick, PhD, a pediatric psychologist at Boston Children’s Hospital, knows this all too well. As a child life specialist with Operation Smile, she was part of a medical missionary team that traveled the world providing safe, effective reconstructive surgery and treatment to children with clefts and other facial deformities.

Working closely with these children and their families, Mednick was amazed at how many of them blamed the child’s condition on themselves, the supernatural or a combination of the two. She listened as a mother in Morocco “confessed” that her baby had been born with a cleft lip, because she looked at an animal with a cloven hoof during her pregnancy. She sat with a Haitian woman who attributed her child’s cleft lip to an afternoon when she spent too long looking at a child in her village with a facial deformity.

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Treatment abandonment in childhood cancer: Are we willing to face this challenge?

(Photo: The Advocacy Project/Flickr)

Though the diagnosis is overwhelming for patients and families to receive, many childhood cancers have become “curable diseases.” At major U.S. centers like mine, the Dana Farber/Children’s Hospital Cancer Center, research efforts now largely focus on survivorship, refining risk stratification, minimizing treatment toxicity and developing more effective salvage therapies upon relapse.

But the situation globally is quite different. The technologic and resource gap between our centers and centers in the developing world is widening. Only a fraction of the children diagnosed with cancer around the world have access to therapy, either curative or palliative.

Treatment abandonment is another significant barrier to cancer care in the developing world. The reasons aren’t only economic, but are complex and multifactorial, including limited education, fatalism surrounding a cancer diagnosis, magical thinking, mistrust of the health care system,

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