Cleft management in developing regions of the world lags behind that of the United States. Many well-intentioned groups export surgical expertise to disadvantaged regions, but the models on which these organizations are based may be outdated. Guaranteeing patient safety, preserving indigenous culture, and teaching local surgeons the multidisciplinary approach to cleft care are key goals. In this article, a three-stage philosophical model (observation, integration, and independence) is presented for establishing safe, multidisciplinary cleft care in developing regions. Important factors include the recognition of interested local hosts and identification of funding. Aggressive assessment and recognition of negative forces, including misdirection, stagnation, and medical colonialism, is required. This model has been implemented in Nepal with success. (Plast. Reconstr. Surg. 106: 886, 2000.)
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Zbar et al. (2000) studied this question.