Veng Chet faced a daunting journey when his son Veng Chi Meng was born with microtia, commonly known as “small ear”, an abnormal formation of the outer ear. 

Amid the disruptions caused by the Covid-19 pandemic, Chet’s determination led him to contemplate seeking surgical options in Thailand. However, the prohibitive cost prompted a return home. 

Fortunately, Smile Cambodia, in collaboration with US medical specialists, brought renewed hope. In 2022, the Khmer-Soviet Friendship Hospital in Phnom Penh provided the little boy his first operation, bringing tears of joy to Chet and his wife.

“We witnessed his new ear, and my wife and I were moved to tears, thanks to the doctors and the organisations. We feel immense gratitude,” he says.

As a parent, there’s nothing more rewarding than supporting your child and urging them on to a brighter future. Grateful to those involved, their story mirrors parents’ unwavering love and commitment to their child.

Similarly, Meas Rumduol, mother of sisters Sodalis and Sokhema, recalls her child’s unique ear formation from birth, expressing shock at encountering such a condition.

“Discovering my child’s condition brought profound sadness. I wept and withdrew, spending a year in isolation with my daughter,” she says.

Undeterred by challenges, Rumduol didn’t lose hope and yearned for another child, a pursuit fulfilled after a few years. Unfortunately, her second daughter also shared the same anomaly. Yet, rather than weakening her, it bolstered her emotionally.

While she remains concerned about her daughters’ learning and future, the support of doctors brings hope and smiles. 

Rumduol’s eldest daughter is now in Grade 12, and the younger one is in Grade 7, thanks to the surgery by doctors through Smile Cambodia that shaped their ears.

Sodalis, now 17, shared that she wasn’t happy with herself at one point, but her confidence grew after receiving a new ear.

“I’m incredibly grateful to feel normal now. My mother worked tirelessly to find specialists to address my issue. Learning about Smile Cambodia’s free assistance for people with this condition gave me a chance to have a normal ear,” Sodalis says.

Feeling comfortable, confident and brave with two ears, she appreciates the doctors, the organisations and her family for providing hope and a smile.

Mok Theavy from the Ministry of Health notes that this family belongs to Smile Cambodia, governed by a board of directors led by Pich Chanmony, the wife of Prime Minister Hun Manet.

“The coordination of this programme reflects the unity among those receiving treatment at Smile Cambodia. We have endeavoured to establish a Cambodian Smile Centre at the Khmer-Soviet Friendship Hospital, fostering connections with international associations to facilitate such surgeries,” Theavy explains.

Surgical altruism

Smile Cambodia, with assistance from US-based medical volunteers of Northwest Medical Volunteers and Standish Foundation for Children, offers free microtia and cleft palate surgeries at Khmer–Soviet Friendship Hospital in Phnom Penh, running from January 7 to 12.

“The team of volunteers, including skilled surgeons, anaesthesiologists, child life specialists, paediatricians and nurses, is highly experienced and qualified,” states Chan Kok Choy, the vice-chair of Smile Cambodia.

“We prioritise patients with ear malformations as volunteers visit annually. Our goal is to treat 50 patients with microtia and 20 with cleft/lip and palate,” he shares with The Post.

Northwest Medical Volunteers, a US nonprofit, offers medical care for patients with congenital, traumatic or post-cancer facial deformities. 

During a gathering on January 6 in Phnom Penh, Kok Choy shared that the event fosters interaction among individuals affected by microtia.

“At Smile Cambodia, we’re thankful to be supported by the Standish Foundation for Children, to provide free surgery for Cambodians,” he says.

The team collaborates with local medical volunteers and started providing operations in 2006. Over 12 surgical missions, they have brought relief and hope to 286 individuals in partnership with Smile Cambodia, formerly known as Operation Smile Cambodia.

Nou Sarom, a plastic surgeon and Smile Cambodia director, highlights the impactful involvement of US doctors, bringing renewed hope and smiles to families in Cambodia.

“Teaming up with the Standish Foundation, Smile Cambodia hosts a group of doctors whose surgical skills match those sought by Cambodian patients unable to travel internationally for treatment,” he says.

Ear’s tiny canvas

Mai Thy Thruong, a paediatric otolaryngologist in Palo Alto, California, explains that microtia is a congenital condition resulting in underdeveloped external ears, ranging from smaller ears to complete absence. 

The condition can also affect the ear canal, causing hearing issues. While the exact cause is unclear, a combination of genetic and environmental factors is suspected. Treatment typically includes surgical reconstruction and may also require hearing aids.

“This condition occurs in one out of 10,000 births, with 90 per cent of cases impacting only one ear, typically the right one, and it is more prevalent in males,” she explains.

Microtia can result in an absent or closed ear canal, known as ear atresia, affecting hearing. Types range from a tiny canal to its complete absence, requiring a two-step surgical process.

“Why does this condition happen? In most cases, we do not know. Microtia occurs in children worldwide,” Thruong says.

She mentions that in 95 per cent of children with the condition, there is no family history of microtia. In most cases, it is believed to occur randomly, as a minor gestational error.

In cases of identical twins, if one twin has the anomaly, the other often does not. In about 5 per cent of cases, microtia can be present in multiple family members, indicating a likely genetic component.

“It’s important to understand that this condition isn’t a result of anything anyone did wrong during pregnancy,” she reassures.

She says that children with conditions affecting the external ear can pursue any career—they can become doctors, musicians or athletes. It won’t hinder their abilities. 

She notes that parents play a vital role in teaching their children that microtia makes them unique, assuring them that they are not less but simply different.

“They can hear, but it’s weak since the nerve inside the ear typically functions, yet the sound struggles to get in,” she says.

Age of transformation

Microtia reconstructive surgery uses the patient’s cartilage, usually harvested from the ribs, to form a new ear framework.

“We carefully carve and shape the harvested cartilage to create a new framework, aiming to closely match the patient’s opposite, normal ear,” Thruong says.

The procedure is most effective on children aged eight to 10, utilizing their more developed rib cartilage. Typically, two procedures are needed for complete ear reconstruction. This technique, known for natural tissue integration, has evolved with modifications tailored to specific needs and conditions.

Thruong notes that the first stage of surgery typically takes three weeks to heal, followed by another three weeks for the second stage. However, she acknowledges potential issues post-surgery, mainly infection causing swelling, necessitating elevation with skin grafts. 

Despite successful cosmetic surgeries, individuals with microtia don’t experience improved hearing as the procedures focus solely on external aesthetics.

Due to a surplus of registrations for individuals with requiring surgery, there’s a backlog. Some patients, particularly those either underage or underweight, must await their turn. 

Yulay Win, an 11th grader with microtia, shares a blend of fear and excitement as he anticipates surgery, which was previously delayed due to the Covid-19 pandemic.

“I’ve seen others with microtia enhance their ear shape successfully, and now I’m excited to look as beautiful as everyone else,” he tells The Post.

Young mother Park Dalin shares that upon delivering her baby, she received information regarding her son’s condition.

“I took my son to the doctor when he was one year old, but they mentioned the surgery could only occur if he weighed 30 kilograms,” she tells The Post.

She has decided to wait until he is 10 to see if he wants surgery or prefers to embrace life without it.

Knowledge exchange

The medical team aids local volunteers in performing surgeries for microtia, cleft palate and other facial deformities, fostering annual knowledge exchange with US-based professors.

“Northwest Medical Volunteers initiated missions to Cambodia in 2006, collaborating with the Khmer-Soviet Friendship Hospital, a key medical teaching centre,” says team leader Sam Most.

Andrea Mangione Standish, founder and president of the Standish Foundation for Children, expresses gratitude to all involved in the project that brings US physicians to Cambodia.

“Gratitude goes to the compassionate doctors who dedicate numerous years to performing surgeries for these children,” Standish says.

This free surgical mission aligns with Smile Cambodia’s commitment to enhancing the health of patients with facial deformities. Their dedication to expanding reach and offering life altering interventions aims to provide individuals the opportunity to lead normal lives. 

Khmer-Soviet Friendship Hospital director Ngy Meng notes global acclaim for their surgical outcomes and states increasing expertise in otological surgery.

“Cleft lip and palate procedures in Cambodia have earned international recognition, while local microtia specialists receive training from international professionals, including doctors from the US,” he tells The Post.

Meng highlights the valuable contributions of US volunteer doctors and expresses hope for enhanced resources and skills development in Cambodia, particularly in ear surgery.