Beyond The Single Operation: An Adapted Framework For Sustainable Cleft Surgery Missions

Short-term surgical missions (STSMs) have emerged as a response to global surgical inequities, offering high volumes of operations in low-resource settings. While they provide immediate benefits, their episodic structure raises ethical and practical challenges for conditions such as CL/P that require staged, multidisciplinary care. This thesis uses CL/P as a case study to examine the limitations of current mission models and to propose an adapted framework for sustainable, patient-centered care. Chapter 1 situates STSMs within the global burden of surgical disease. Chapter 2 outlines the epidemiology and long-term consequences of CL/P, showing why single-operation models are insufficient. Chapter 3 critiques ethical frameworks such as the Brocher Declaration and WHO guidelines, then develops an adapted framework grounded in the American Cleft Palate–Craniofacial Association (ACPA) Parameters of Care. This framework emphasizes four pillars: continuity of care, local capacity building, accountability and oversight, and patient-centered communication with longitudinal consent. Chapter 4 applies the framework to a cleft mission in Khairpur, Pakistan, identifying strengths such as host-led leadership and structured follow-up, as well as gaps in outcome tracking and consent processes. The thesis concludes by recommending pilots of key elements (such as patient registries and longitudinal consent protocols) and exploring their relevance to other staged conditions. By shifting evaluation from surgical volume to long-term patient outcomes, cleft missions can move beyond one-time interventions toward a more sustainable and accountable model of care.