Several decades of neglect has created huge gaps in health infrastructure, medical supplies and personnel. It also fueled medical tourism, with Nigerians spending at least $1 billion per year on medical bills overseas. The density of medical professionals to the population is also abysmal. Nigeria has only 3.8 medical doctors per 10,000 people, 5.6 nurses per 10,000 population and 0.22 dentists per 10,000 people.

Poor remuneration and infrastructure, and lack of medical supplies has led to brain drain in the health sector. Nigerian-trained health workers constitute the third largest group of foreign-trained doctors working in the U.K. Over half of the estimated 72,000 doctors registered with the Medical and Dental Council of Nigeria work outside of the country and a new ‘Health and Care Visa’ policy launched on July 15, 2020 by the U.K. government and open to Nigerians, may encourage others to follow.

Current health expenditure (% of GDP) 2000-2017
Source: World Bank

Muyiwa Rotimi, consultant anesthetist and a member of LUTH’s COVID-19 response team, urges the government to prioritize funding and regular training for healthcare workers.

“If we don’t start now, we might find ourselves in the same place after five years,” Rotimi warns.

Until LUTH began a partnership with Smile Train in 2007, cleft care was largely limited to surgical repairs. But to provide comprehensive cleft care, a team consisting of surgeons, anesthetists, speech therapists, nurses, ENT or ear, nose, throat surgeons, orthodontists, nutritionists, and social workers are all needed. These specialists needed to be trained in cleft care, and cleft surgeons trained to work with them.

Professor Ronke Desalu, consultant paediatric anaesthetist at LUTH, explains how the pandemic affected the delivery of services and health worker well-being at the hospital.

Additionally, the cost of care, stigma, and lack of awareness meant LUTH treated fewer than ten cleft patients annually, says Professor Olugbemiga Ogunlewe, chief cleft surgeon and head of LUTH cleft care team. According to Dr. Adekunle and Dr. James, a cleft lip and palate surgery costs between 150,000 to 200,000 naira (USD395 to USD526), a fee that most Nigerians from lower socioeconomic backgrounds cannot afford.

Since it began its partnership with LUTH, Smile Train has improved access to training and medical equipment while funding cleft lip and palate surgeries. A survey in 2017 found that 84% of cleft surgeons interviewed were working in university teaching hospitals. Cleft surgeons in LUTH now perform at least 100 yearly cleft surgeries at no cost to the patient and work with a range of specialists to provide holistic care.

LUTH’s partnership with Smile Train, which began in 2007, has enabled it to greatly expand the scope of cleft care in Nigeria, says Professor Olugbemiga Ogunlewe, chief cleft surgeon and head of the LUTH cleft care team.

Mirabel is just one of the patients currently experiencing the benefits of this partnership and commitment to training of health professionals.

Outside the operating theatre complex, Ijeoma Nwokorie, Mirabel’s mother, waits with trepidation.

Around 1 p.m. she reunites with Mirabel, her eyes full with emotion.

Adekunle reassures her that her baby is in perfect condition and instructs Nwokorie to prevent the baby from touching her mouth.

“She will be fine,” he declares, his tone upbeat.

At the hospital ward, Nwokorie looks over Mirabel as she sleeps in her arms.

Nwokorie remembers how startled she was after noticing a hole on the roof of Mirabel’s mouth some weeks after her birth. Food and liquid leaked out of her baby’s nose, too. Doctors at a private hospital told her nothing was amiss. Her husband, too, said that was how “her own God created her”.

Ijeoma Nwokorie assumed that treatment for her daughter’s cleft palate would not be possible within Nigeria. Since first bringing her baby to LUTH in January, Smile Train has covered the cost of all consultations and the surgery itself.

A year later, when she birthed another baby who didn’t have a cleft palate, her fears heightened.

A friend told her the surgery can only be performed in the U.S. Confused and anxious, Nwokorie turned to the internet.

“What causes a baby to have a hole in her mouth,” she remembers searching on Google and breaks into laughter.

“Can cleft palate surgery be done here in Nigeria,” she recalls typing again. That was how she found LUTH, visited in January and then learnt that Smile Train covers the cost of caring for the baby, including the palate repair.

“I could not believe … that Nigerian doctors did this miracle,” Nwokorie says after the surgery.