Rarely seen elsewhere

Most Westerners outside the medical profession have never seen children with cleft lips or palates in their home countries.

That's because surgical intervention to repair the flaw is conducted in the first three months of the child's life -- and in some countries within a week.

The deformity varies from mild, with just a small split in the upper lip, through to great gaps in the roof of the mouth.

Reasons can include genetic faults, sometimes exacerbated by marriage between close relatives, and poor diet. The lack of folate (a water-soluble vitamin found in fruit and vegetables), and essential mineral trace elements during pregnancy is also believed to cause the condition.

Apart from the unsightliness, babies cannot suckle their mother's breast because their deformed mouths can't generate a vacuum. This can lead to malnutrition.

Pelssers said the incidence of cleft lips and palates was higher in Indonesia than most Western countries. In East Java alone more than 1,000 babies a year are born with the defect, usually in villages and underprivileged areas.

Parents were often reluctant to get medical help because of the shame of having a less than perfect infant and the cost involved in treatment. Some parents find it difficult to accept the deformity and may react with feelings of guilt and horror, so expert emotional support is vital.

Early surgery is critical. Babies more that three months old can't always fully recover and the strain on the whole family increases significantly. Which is why the Tulips are planning education programs.

Through donations of cash and services, the only expenses involved in the surgical repair of clefts conducted for the poor through the Tulip Foundation at the International Hospital in Surabaya are for anaesthetics and surgical dressings.