Jackie Matthews: a catalyst for change in cleft care

Jackie Matthews is a long-standing Operation Smile UK volunteer and member of our Medical Sub Committee. We caught up with her after her return from a surgical and training programme in Ethiopia, where she’s once again been sharing her skills as a nurse, and an educator, to help local teams improve care for our patients.   

Jackie is a passionate advocate for early intervention, training teams around the world in how to identify cleft conditions, and how to improve cleft care for mother and baby. Here she tells us more about her recent work in Jimma and Addis, Ethiopia:  

“I was there as an educator, and the impact from that has been amazing. For example, I went up to theatre to observe a baby having a cleft lip repair and then I followed and tracked that patient back from the operating room (OR) to the recovery room (PACU). I realised it was such a long walk from the OR and when we arrived, things weren’t ready, and they struggled to get the monitor to work. So, I was able to make some recommendations for how we could improve care. One of these was to suggest that the PACU nurse could anticipate the theatre list timings, and go to speak to the anaesthetist and get a detailed clinical handover for each patient. Then the nurse could accompany the child back to recovery, to a bay that has been fully prepared and equipped with a monitor. I also suggested the inclusion of a tray containing whatever medical supplies might be needed, including water for the child. That’s just one example, and they’re already putting it into practice.”   

A key skill for medical volunteers, is the social etiquette and emotional intelligence to understand cultural differences among the teams they work with around the world. Jackie explained to us that in Ethiopia, because of these cultural differences, some of the nurses weren’t comfortable going into the OR or speaking to the anaesthetist, so it was important for her to understand these challenges and be sensitive with the suggestions she made for improvement.    

Raising awareness of cleft conditions is a vital part of Operation Smile’s work around the world. In many countries, there is still superstition and fear around the causes of cleft conditions, which sadly sometimes puts the lives of babies born with cleft conditions at risk. Jackie tells us about one mother she met during the programme whose baby’s life hung in the balance before intervention from the local team.   

“One lady had delivered her baby in the community. The baby had a cleft – mum was devastated and frightened, not understanding a cleft condition, and she put the baby in a room to die, because she thought, ‘What am I going to do? How am I going to feed it? I’ve been cursed!’ After the birth, she had a medical issue, a retained placenta which needed treatment, so she had to go and seek medical help. They asked her, ‘Where’s your baby?!’ And she explained that there was something wrong with her child. Thankfully the local team had heard about Operation Smile and we were able to go and rescue the child, put our support in place and bring the baby to the hospital for care. 

“That was a story in direct comparison to another lady who delivered her baby in the hospital in Jimma. There they had the Operation Smile network set up. The comprehensive care was ready for the people who needed it and that patient was immediately referred to Operation Smile. So bridging this gap between babies born in the hospital and those born in a community setting is so important. Raising understanding of cleft and awareness of Operation Smile in remote areas is vital so that people in the community know that help is available.” 

Jackie tells us she also made further suggestions for improving response times for the team when they respond to the news of babies born with cleft conditions, she explains, “What I suggested was that instead of waiting 24 hours or 48 hours for the team to review baby, that actually once a baby with a cleft is delivered, they come straight away if they’re in the hospital and deliver the support and feeding advice to the mother in those first few hours. I was there to help join the dots, make those connections, and ensure the people on the ground knew that actually, it’s ok for them to go and speak to somebody in the maternity wing or in the OR or wherever it was. So I was just enabling them to have more of a comprehensive approach and a multi-disciplinary team approach.  

“During our Jimma training, we realised that all babies born with a cleft, both lip and palate, are given a nasal gastric tube (ngt) to deliver milk directly into their stomach); babies born with a cleft lip only can breast feed (when safe to do so), and do not routinely need the ngt. This change of practice means babies can be put to the breast immediately, giving comfort to both mum and baby, less medical intervention and a shorter stay in hospital. This is another practice improvement, which is being implemented as a direct result of our visit to Jimma.”

Improving cleft care networks and community awareness has always been a key focus for Jackie, with 10 years’ experience as a clinical nurse specialist. She previously joined a workshop in Madagascar where she trained local teams from nine Sub-Saharan African countries. Cleft recognition, feeding techniques and psychosocial care were all key elements of her teaching, and her emphasis on ‘training the trainers’ ensures that vital knowledge cascades through local healthcare teams. 

So what’s next on Jackie’s agenda for improving care for Operation Smile patients?  She’s already planning joining the Comprehensive Care Conference in Cape Town and then teaching on a  programme in Malawi. Follow up training in Ethiopia is also being arranged with the SSA team. Jackie plans to collaborate with her colleague, friend and UK volunteer Lindsay Allen and we look forward to catching up with them both in the near future to find out more.