As easy as pie: how telecare is helping Brazil's health care workers

Nutritionist Rosana Macedo uses videoconferences and WhatsApp during the pandemic so parents can make sure their babies with cleft lip and palate can eat properly.

Dusk set in as nutritionist Rosana Macedo, 50, sat down at her desk in her apartment in Vila Isabel, a middle-class neighborhood of Rio de Janeiro. She turned on her laptop, tapped on the keyboard, and began a videoconference. Smiling at her screen, she greeted Analie Duarte, 28, the mother of baby Kalebe Duarte Moraes, who was born with a cleft lip and palate, birth defects that occur when a baby's lip or mouth do not form properly during pregnancy.

“How is Kalebe doing? You’ve got the larger baby bottle, right?” Macedo asked. “Yes, thank God,” Duarte replied, as she tried to steady her cellphone in one hand while bottle-feeding 3-month-old Kalebe in the other. Duarte had just arrived home where she lived with her family in Taquara, after spending the day rushing around visiting clinics with her baby.

Kalebe Duarte Moraes was born on May 21, at the peak of the pandemic in Brazil. Since then, the Center for Treatment of Craniofacial Anomalies team has provided online consultations on cleft care to ensure patients still get the support they need.

Despite their evident closeness — Duarte calls Macedo “auntie” — the pair have never actually met in person. Duarte gave birth on May 21 at the peak of the coronavirus pandemic in Brazil. Around 5 million people have been infected there, and over 148,000 have died so far — a death toll second only to the U.S. The Brazilian government responded by delaying nonessential health services and putting nonemergency surgeries on hold.

Kalebe could not be breastfed or drink from a standard bottle when he was born. For the last four months, Macedo has been walking the first-time mother through feeding techniques and adjusting the type of bottle, nipple, and milk formula to keep his weight healthy. Children with clefts can face difficulties eating, breathing, hearing, and speaking. Reconstructive surgery closes the gap, but clinical treatments such as speech therapy and orthodontic and nutritional care are also required during treatment.

Nutritionist Rosana Macedo explains why babies born with cleft lip and/or palate often have problems with feeding, and how she and other staff at CTAC overcame the challenges of reaching patients during the pandemic.