title: Flood, disaster, and turmoil: social issues in cleft and craniofacial care and crisis relief.
abstract: OBJECTIVE
  To examine social issues in the conduct of cleft and craniofacial care through relief programs in disrupted crisis contexts.
  
  
  METHODS
  Social, health policy, and ethical analyses.
  
  
  RESULTS
  At best, craniofacial team care is multidisciplinary, coordinated, and sustained, requiring a long-term relationship between team members, patients, and families. Disasters and societal turmoil interrupt such relationships, causing craniofacial care to become a secondary concern. Providing craniofacial team care in a crisis setting requires rebuilding disrupted coordination and communication. Crisis relief care involves a complex set of expectations and responsibilities and raises issues such as (1) quality assurance, infection control, appropriate standards of care, and follow-up care/continuity; (2) equity of access to services and clinical ethics in the context of war and/or deprivation; (3) training of visitors in the local nation or site; (4) disciplinary composition of teams, interprofessional communication/rivalry, and credentials of clinicians; (5) ownership of the site and local visitor relations; (6) fundraising and marketing strategies; and (7) ethical issues in the doctor-patient relationship.
  
  
  CONCLUSIONS
  Specific ethical standards for international cleft and craniofacial care delivery also apply to domestic and global crisis relief contexts. Guidance on issues related to professional experience, informed consent, and continuity of care will help care providers address social and ethical issues raised in crisis relief programs. This paper proposes that the Position Paper of the American Cleft Palate-Craniofacial Association (ACPA) on International Treatment Programs should be used as a template to develop and disseminate a set of standards that apply to crisis relief.
authors.forename: Ronald P
authors.initials: RP
authors.lastname: Strauss
authors.forename: John A
authors.initials: JA
authors.lastname: van Aalst
authors.forename: Lynn
authors.initials: L
authors.lastname: Fox
authors.forename: Margot
authors.initials: M
authors.lastname: Stein
authors.forename: Michael
authors.initials: M
authors.lastname: Moses
authors.forename: Cynthia H
authors.initials: CH
authors.lastname: Cassell
mesh_terms: D002648:Child; D002675:Child, Preschool; D002971:Cleft Lip / Q000628:therapy*; D002972:Cleft Palate / Q000628:therapy*; D003695:Delivery of Health Care / Q000458:organization & administration*; D004189:Disaster Planning; D004190:Disasters; D004992:Ethics, Medical; D005260:Female; D055868:Floods; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007400:Interprofessional Relations; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration; D010817:Physician-Patient Relations; D011785:Quality Assurance, Health Care; D012066:Relief Work / Q000458:organization & administration*