New smiles and new voices thanks to Dr Elliot
Volunteer cleft surgeon Elliot tells us more about his work to bring new smiles and new voices to children with cleft conditions in Ghana and beyond.
We often ask our medical volunteers what inspired them to choose a career in medicine. Dr Elliot Arko-Boham, was just a young man when he first decided he wanted to be a surgeon. He was touched by the experiences of a family who had struggled to conceive. He saw their joy at pregnancy, and then the despair that came when their long-awaited baby was born with a cleft lip. Elliot witnessed the family’s journey to cleft surgery and the transformation of their child, and their lives, as a result. He tells us: “That whole process excited me so much, I wanted to know how to fix people like that.”
Today, shaped by those experiences and the ambition to help others, Elliot volunteers for Operation Smile as a cleft surgeon, and has been since 2014. We caught up with him at the Korle Bu Teaching hospital in Ghana to find out more. Elliot discovered Operation Smile during his residency training as a general surgeon. at the time Operation Smile was expanding its efforts in Ghana and working closely with local health services. Elliot’s interest in specialising in plastic surgery increased and in 2014 he took part in his first Operation Smile surgical programme in Egypt, shadowing cleft surgeons and gaining valuable experience.
Elliot says the surgeon he remembers most as a guiding influence in his training as a plastic surgeon was long-standing Operation Smile volunteer Dr. Walter Peet. He explains:
“I would say that the person who has really helped in terms of our training and building speed and confidence has been Walter Peet. If you have someone who’s done it before and who knows the anatomy of the area, he says ‘If you go a millimeter more here you’d be better’, it directs you, minimises complications and builds your confidence.”
Thanks to Operation Smile’s global footprint, Elliot has also been able to share his skills and work with colleagues in other countries like Malawi and Jordan. He tells us: “Operation Smile has done very well in terms of team integration. Here in Ghana we have volunteers come to us for surgical programmes from all over the world, and it works well. The same sentiments, the same teamwork goes on when I’m in other countries, so it wasn’t difficult working away from home. It just gave another perspective of how certain cultures do certain things. In the end, we all have a particular aim to make people smile and we make things work. The team and the togetherness, the focus on the objective for why we are there, has cut across all of the surgical programmes I’ve been on outside of this country.”
We ask Elliot to tell us what motivates him to continue to volunteer for Operation Smile and he says:
“It’s the desire to see the result of what you’ve done. Not all people are born with the same opportunities. Often people don’t even know that a cleft can be repaired. So to be able to sacrifice a bit of time and go to remote areas and get the opportunity to see people smile. People who came probably didn’t have any hope at all. To be able to give your time to those people and know you’ve made a whole change in somebody’s life.”
One of Elliot’s most memorable moments was a 67-year-old man who had come to hospital where Elliot was working during his surgical residency. The man was there not because of his untreated cleft, but because his child was ill with malaria. Elliot says:
“My first response was ‘Oh this should have been done when you were young!’. He has lived through his life, 67 years of it! I asked him, ‘Would you want to have your lips fixed?’ Obviously, the trauma or the stigma of his condition meant at first he just put a hand over his mouth and didn’t want to talk, but eventually when I was able to tell him that it can be done and wouldn’t take much more than 40 minutes, he said, ‘Are you sure doctor?’ and I said ‘Yes, it can be done for you!’
“I called and arranged for one of our senior colleagues to have it done for him and when he had the surgery it was one of the most satisfying moments that you could have. That’s what inspires me and pushes me to continue to give my help to Operation Smile.”
Elliot is now involved with training other Ghanaian general surgeons in plastic surgery, his part in helping to meet the shortfall of trained specialists in the country. He says: “Now Operation Smile has become quite an integral part of the services we run in terms of cleft services in Ghana. I think the future is great because I know that with these education programmes before long, there will be a cohort of surgeons who will be able to handle cleft services.
“There are certain areas that do not have surgeons so we are trying to train other people who are not primarily plastic surgeons. I’m working with a skilled general surgeon, he can do many surgeries, but his ground of play is not around the head and neck area. So if we take a bit of time to guide him towards how a lip or a palate is done, he will get the skills he needs and be able to serve the people around his locality.”
Surgery is one part of a comprehensive journey of care for patients with cleft conditions and Elliot describes the other specialties that can be involved in more complex cleft cases:
“When you treat a patient with a cleft you’ve often touched 18 years of the patient’s life, because at various stages you will have to do things for them. It’s a holistic approach, we don’t just go and close the lip or close the palate. Complex cases may need bone grafts or rhinoplasties, and with time we will be able to cater for all of them.”
Part of this more complex care comes in the form of speech surgery. Sometimes after repairing a child’s cleft palate a secondary procedure is needed to make further adjustments to the back of the mouth, Elliot explains further:
“The back of your throat has a little space that the back of your palate – the softer part – will butt up to. This flap should close, but when it doesn’t you have a lot of air escaping and that’s why you hear a patient with a cleft palate sounding nasal when they speak. It’s because the air escapes down the back of the throat. When we repair it, we make it so that when the muscle flexes or contracts and the flap will seal the gap. This way air won’t escape and the patient can speak as clearly as you and I.
In many communities in Ghana there is still a strong stigma about surgery, which is an issue Operation Smile teams encounter on a daily basis Elliot explains things are improving but the fear comes from stories where people had gone in for surgery and not come home – either because of anaesthesia related issues, or sometimes because a long-term health condition had become so bad by the time surgery came, it was too late. He says:
“Gradually people are getting to understand how safe surgery can be. Now we’re having people even come forth and ask for surgeries, even cosmetic surgeries. I think people have realised that there are good surgeons, there are good doctors. They can go and have surgery and wake up and go home even the same day. That fear, it’s gradually dissipating.”
For Elliot, one of his precious memories is of a man he operated on whose wife was so overwhelmed by her husband’s transformation, she could barely believe it was the same man she married. Elliot recalls fondly:
“The whole family brought him after Operation Smile had promised that they could fix it. I think they had doubts about whether it was really going to be free. But the whole family came round to see him. And when it was done and they saw him and he looked so different, the joy and the celebration that happened around the operating area, was dumbfounding. His wife cried, ‘Is that you?!’ and I will always remember that moment. There are many more such stories.”
There’s no doubt about the incredible difference Elliot is making to the lives of patients, both in Ghana, and beyond. We look forward to hearing more about his inspirational work in the future.