Transforming Faces had a very special visitor stop by our Toronto office last week! Dr. Francisca Salazar, Orthodontist, Pediatric Dentist and friend of TF, practices at the Hospital Dr. Exequiel González Cortés in South Santiago, Chile. We connected her with our friends at Toronto’s Hospital for Sick Children (SickKids), where she spent four days shadowing one of the leading cleft lip and palate repair teams in the world.
Dr. Salazar sat down with the TF team after her training to share some of the lessons she learned at SickKids and to tell us about her experiences treating patients with cleft lip and palate at one Santiago’s major hospitals.
Treating patients in one of Chile’s busiest public hospitals
Dr. Salazar, Head of Dental Service, is part of the team of cleft repair specialists working in a public hospital in South Santiago, a low-income area serving approximately one million of Santiago’s nearly seven million people. As one of the primary hospitals treating cleft lip and palate, she explains that at least 80% her patients come from low-income families, and that the hospital truly treats individuals from all walks of life.
Working here is not without its challenges. Space is a major obstacle, and her team currently operates out of a series of small annexes connected to a very old building. However, they will soon be moving to a new hospital with much better conditions, including a meeting area for her team.
And they are a young, enthusiastic team! They have grown very close, coming together about ten years ago when they were all in early stages of their careers. The team has a lot of energy and great communication – which Dr. Salazar cites as one of their biggest strengths.
Transforming lives in Chile
When asked how she ended up working in cleft care, Dr. Salazar explained that she happened upon a Pediatric Dentistry job treating cleft patients right after medical school. She fell in love with the work instantly.
“I love the team approach,” she says, noting that she gets to collaborate with a multidisciplinary team, when often dentists end up working alone in a clinic. She also loves working with children. “You can do and teach them a lot,” she says. “You can help them in their life, not only in the clinic.” She tells a story of an 18-year-old patient she’s been treating for years. During their last appointment, he reminded her that when he was eight years old, she’d given him a toy car for Christmas. “It was a small car,” she said and couldn’t even remember giving it to him, “but he remembered it.”
“You’re a big part of their life and you have an impact on people,” she explains.
You’re also working closely with the patients’ families. Her team, while talented and energetic, do lack key team members that hospitals like SickKids rely on. For example, they have limited access to a social worker. Without a full-time social worker on board, the whole team takes on pieces of that role. They often have to provide emotional support to families while treating a patient.
She tells us that when parents arrive in the hospital for the first time, it can be a very trying time for everyone. They bring grandparents and other children with them, and the parents are often in great distress. Many families at her hospital come from low-income neighbourhoods and might have limited knowledge about what cleft is or how it’s treated. She remembers one family who didn’t want to tell their other children that their newborn son had a cleft palate because they were embarrassed. Often, she tells us, mothers are crying and “holding their babies like the world will end.”
But when this happens, her whole team rallies together to explain that cleft lip and palate is treatable, and that their child “will grow up as a normal kid that can do the same thing as others.” You see the parents change, she says, “they become less anxious… You do all that work to try to make their family function again.”
Learning valuable lessons from the cleft care team at Toronto’s Hospital for Sick Children
When asked what stood out during her four day visit with the cleft care team at Sick Kids, Dr. Salazar lit up. It was a “very good experience…it was my first time I was able to visit a hospital in a developed country and see a cleft team working [there].”
She commented on the size of the team, noting that they were dynamic, functional and systematic in their approach. “It’s good to see we’re doing some things in Chile that are done here,” says Dr. Salazar, mentioning the NAM technique as an example. She admired their efficiency and procedures, describing how every team member is interconnected, and how the focus of team discussions and decisions consistently centre around the patient.
One thing that really stood out was the SickKids team’s regular group assessments of each patient. She would like to bring that concept home to her hospital in Chile, where currently each specialist books an appointment with a patient individually every few months, rather than booking appointments and assessing the patient as a team. She hopes the team can meet together to create a comprehensive treatment plan, as she observed during her time in Toronto.
“I saw a lot of good things we can take and try to do in our service,” Dr. Salazar says, adding that “we are doing some things right. We are trying to protocolize – it’s not an easy job. It requires time and patience. But we are doing some things right.”
Thanks for the visit Dr. Salazar, we look forward to an update from your team down the road!