Operation Smile Assam — Free Surgery for Children with Cleft Lip and Cleft Palate

What is Operation Smile Assam?

Operation Smile Assam is a free surgical care programme for children and adults born with a cleft lip or cleft palate, run by the Department of Health & Family Welfare, Government of Assam, under the National Health Mission. The department, NHM and Operation Smile jointly began the special drive in January 2009, and the work is carried out through a public-private partnership with Mission Smile.

A cleft is a gap in the upper lip, the roof of the mouth, or both, formed because the tissues did not join fully before birth. Left untreated it is not a cosmetic matter. A child with an unrepaired cleft palate struggles to feed properly and is frequently underweight, has repeated ear infections and hearing loss, cannot form many speech sounds, and is very often kept out of school because of stigma. Surgery closes the gap, and the follow-up care that goes with it restores feeding, hearing and speech.

The scale of the problem in Assam is large. According to the Health & Family Welfare Department, the estimated backlog of clefts in the state has been placed in the range of 20,000 to 30,000 patients, with roughly 1,000 to 1,200 children born with a cleft every year. Against that backlog, the department's stated goal is a "Cleft Free Assam".

Key features

• Surgery, anaesthesia, hospital stay and follow-up are completely free to the family.
• A dedicated Comprehensive Cleft and Child Care Centre operates at Mohendra Mohan Choudhury Hospital, Guwahati, with six operating tables running simultaneously and capacity for about 4,000 patients a year.
• Care is delivered through two channels: the permanent Guwahati centre, and periodic surgical camps called missions that reach patients who cannot travel.
• Recorded achievement: 11,860 children with cleft lip operated as of 14 July 2014 since inception.
• No specific eligibility restriction is applied, the stated target is all individuals living with an untreated cleft.

Who can get free cleft surgery in Assam?

You can register if:

• The patient has an untreated cleft lip, cleft palate, or both.
• The patient has had a previous cleft repair that needs revision, or needs a secondary procedure such as an alveolar bone graft or palate fistula repair.
• The patient is medically fit for general anaesthesia on the day of the surgical assessment.
• The patient lives in Assam or the wider North East. The centre in Guwahati has historically served patients from across the region.

There is no income test, no BPL card requirement and no upper age limit published by the department. Adults who never had the operation as children are treated.

Who cannot be operated on immediately, and why:

• A child who is underweight or malnourished is not taken up on that visit. Anaesthesia in an underweight infant carries real risk, so the team stabilises weight first.
• A child with anaemia below the safe haemoglobin threshold is treated for the anaemia first.
• A patient with an active infection, fever, cough, chest infection, skin infection near the operative site; is deferred until it clears.
• A patient with an uncontrolled heart, lung or other systemic condition is assessed separately, and may need the condition managed before surgery.
• A very young infant who has not yet reached the accepted age and weight standard for lip repair is scheduled for a later date.

None of these is a rejection. Each of them is a postponement with a plan, and the family is called back. The one genuine exclusion is a patient who is not medically fit for anaesthesia at all, and those cases are handled individually by the surgical and anaesthetic team.

When is cleft surgery done?

Timing follows medical convention rather than a scheme rule. Cleft lip repair is generally done in the first year of life once the infant meets the weight and health standard, and palate repair somewhat later, because the palate repair has to balance surgical safety against the need to close the palate before the child starts forming speech. Secondary procedures — fistula repair, alveolar bone grafting, nose and lip revision, orthodontic work, come later in childhood and adolescence.

Speech therapy after palate repair is the step families most often skip and most often regret. Closing the palate makes normal speech possible; therapy is what makes it happen.

What documents should I bring?

Treatment is not refused for want of paperwork. Bring what you have.

How to get free cleft surgery in Assam

1. Speak to your ASHA worker, ANM or the nearest health facility as soon as a cleft is noticed, ideally in the first weeks of life. Frontline workers under the National Health Mission are the main channel for identifying cleft children in Assam.
2. Get a referral or a camp date. The district hospital, the Rashtriya Bal Swasthya Karyakram (RBSK) mobile health team that screens children, or a Mission Smile screening camp will note the child and give you a date.
3. Go to the Comprehensive Cleft and Child Care Centre at Mohendra Mohan Choudhury Hospital, Guwahati, on the given date, or walk in directly. The centre runs year-round and does not require a referral.
4. Complete the pre-surgical assessment. The team records weight and haemoglobin, examines the child, and the anaesthetist clears the child for surgery or gives a plan to make the child fit.
5. Take the surgery date and admit the child as instructed. Surgery, anaesthesia and the hospital stay cost the family nothing.
6. Attend every follow-up. Wound review, feeding advice, dental and orthodontic review, ENT check for hearing, and speech therapy after palate repair are all part of the programme.

How do I find out when the next surgical camp is?

1. Ask your ASHA worker or ANM, who receives camp schedules through the block health office.
2. Call the 104 Sarathi health helpline of Assam for guidance on where cleft services are available.
3. Contact your District Health Society or district hospital, which coordinates NHM camps locally.
4. Check the Health & Family Welfare Department page at hfw.assam.gov.in/schemes/operation-smile and the NHM Assam site for programme updates.

Common reasons a child misses treatment

• The cleft is identified late. Families in remote and tea-garden areas often learn of the free programme only after the child is several years old.
• The child is too underweight on the camp day, and the family does not return for the rescheduled date.
• Travel and wage loss. Families put off a trip to Guwahati because of the cost of getting there, even though the surgery itself is free.
• Only the lip is repaired and the family stops, leaving the palate open and speech unaddressed.
• Speech therapy is skipped after palate repair, so the child still cannot speak clearly and the family assumes the surgery failed.

The single most useful thing a family can do is to keep the follow-up appointments. Cleft care is a sequence of steps over years, not one operation.

Help and contacts

• Comprehensive Cleft and Child Care Centre, Mohendra Mohan Choudhury Hospital, Guwahati. The permanent centre for cleft surgery in Assam.
• 104 to Sarathi health helpline, Assam, for general health service guidance.
• National Health Mission, Assam, Office of the Mission Director, 1st floor, ICMR Building, Khagen Mahanta Path, Hengrabari, Guwahati 781036.
• District Health Society / District Hospital in your district for referral and camp information.
• ASHA worker or ANM in your village, the fastest route into the programme.

No payment is due to any person for cleft surgery under this programme. If anyone asks you for money to arrange the operation or to secure a place in a camp, report it to the District Health Society.