International Humanitarian Cleft Surgery: Commitment Beyond Borders

Cleft lip and palate is one of the most common congenital conditions worldwide, yet access to comprehensive treatment remains unequal. In many regions of the world, patients may wait years without surgery due to financial constraints, lack of trained specialists, or limited health care infrastructure. Untreated cleft conditions can lead to feeding difficulties, challenges with speech, social stigmas, and reduced educational and economic opportunities. While humanitarian surgical missions can help, meaningful impact requires more than a primary surgery — it requires commitment to multidisciplinary and longitudinal care.

International humanitarian cleft surgery is one of many meaningful aspects of my surgical practice. Through work in Vietnam with the Facing Futures Foundation and in Guatemala, India, and Peru with the Free to Smile Foundation, I have had the privilege of caring for children and adults affected by cleft lip and palate who face significant barriers to treatment. These experiences continually reinforce a core belief that all humans should have access to health care, and that geography and socioeconomic status should never determine the quality of care a patient receives.

A guiding principle of my humanitarian work is that international surgical care must meet the same standards we have in the United States. Ethical global surgery is not defined by a single outcome or surgical volume; it is defined by long-term results, sustainability, and accountability. This includes thorough preoperative evaluation, appropriate case selection, and structured postoperative monitoring. It also means ensuring patients have access to multidisciplinary services such as speech therapy, dental and orthodontic care, and ongoing surgical follow up.

I volunteer with organizations that prioritize comprehensive care models and maintain strong in-country partnerships to support this continuity. Providing treatment that expands beyond the operating room is essential to improving speech, facial form, function, and enhance their quality of life. My work with Facing Futures Foundation focuses on delivering safe, high-quality cleft care while collaborating with local providers. This partnership model emphasizes sustainability, skills exchange, and long-term patient support. Similarly, through Free to Smile Foundation, I work within well-organized mission frameworks that prioritize patient treatment, perioperative safety, comprehensive care as well as continuity of care on multiple aspects of patient needs across disciplines. Each country presents unique logistical and cultural challenges, but the underlying need — and the responsibility to meet it thoughtfully and thoroughly — remains present.

Collaboration with local health care professionals is important to providing quality care. Humanitarian surgery should strengthen local capacity, not replace it. Working alongside local surgeons, anesthesiologists, nurses, and trainees foster shared learning and helps build sustainable systems of care. Over time, these partnerships can reduce reliance on visiting teams and expand access to high-quality cleft treatment within the country itself.

When done responsibly, the benefits to patients and communities are tangible: improved feeding, speech development, and social integration. Beyond individual outcomes, this work can also strengthen health care infrastructure in the country — whether through equipment procurement, teaching surgical techniques, improving sterilization capabilities, or advancing anesthesia support systems — these entities remain in place long after the visiting team departs.

Professionally, this work sharpens surgical acumen and enhances surgical armamentarium. These missions often bring together surgeons and health care providers from diverse specialties and institutions. The collaborative environment fosters meaningful professional exchange, shared learning, and enduring collegial relationships. Additionally, global surgery is exceptionally rewarding. I can recall numerous patients with an unrepaired cleft lip who I have had the honor of treating internationally. They present with a face covering, too embarrassed to be seen, and with stories of never leaving their home as they have been ostracized by their community. After surgery, that same patient stands differently, engaged, with no face covering and a smile of gratitude. As surgeons, we understand the anatomy we reconstruct; moments like these remind us of the dignity we help rebuild.

Global surgery is not intended to unseat local health care systems, but to support them — through training, partnership, and care of patients. By holding global surgical efforts to the same standards as domestic practice and advocating for comprehensive, patient-centered models of care we ensure that humanitarian cleft surgery is not only compassionate, but responsible.

This work serves as a powerful reminder of why I entered the profession. Surgery restores function. At its best, it also restores confidence, opportunity, and human connection. It is an honor to extend that impact beyond borders.

Ashley Manlove, DMD, MD, FACS

Dr. Manlove is a clinical associate professor and residency program director at the University of North Carolina Adams School of Dentistry, where she also serves on the cleft and craniofacial team. Before joining UNC, she spent eight years at Carle Foundation Hospital as residency program director and medical director of the cleft team. Her work focuses on pediatric cleft and craniofacial surgery, resident education and multidisciplinary care for children with complex craniofacial conditions.

She earned her dental degree from the Harvard School of Dental Medicine and her medical degree from Case Western Reserve University School of Medicine, followed by residency training at University Hospitals–Case Medical Center. She later completed a fellowship in pediatric craniomaxillofacial surgery at Wolfson Children’s Hospital.

As residency director and a member of the Cleft and Craniofacial Team, Manlove is committed to fostering a positive learning environment while maintaining high standards of care for patients and families affected by craniofacial anomalies.