The transformation of Diraj Lackan began one day in his village in Guyana, a place of palm trees, colorful houses and tropical heat.
A dental hygiene student working at a church clinic on a mission trip heard about a baby born with a severe cleft palate.
Nearly a year later, on a winter morning in snow-covered West Michigan, a surgeon at Spectrum Health Helen DeVos Children’s Hospital repaired the gap in the roof of Diraj’s mouth.
Three thousand miles lay between Diraj’s home and the bright lights of the operating room. But a thread connected them: The family of the dental hygiene student served as his loving host family in the U.S.
“Everything has turned out wonderfully,” said Roxanne Bareman, Diraj’s host mother, as she cuddled him before his operation.
Diraj wrapped his arms around her and lay his head on her shoulder. He tucked his thumb in his mouth, wedging it into the gap in his lip.
Just 15 months old, he didn’t know the cleft would interfere with his ability to speak, eat and breathe as he grew older.
He had no idea of all the steps that had to fall into place to make the surgery possible. And he certainly didn’t know why he had to leave his parents, Mandy and Suraj Lackan, to come to this land of snow boots and car seats.
“There are no surgeons in his country that can help him,” said Helen Salan, director of the Michigan-Ohio chapter of Healing the Children. “There was no other way for him to get help.”
The Guyana connection
Bareman’s 22-year-old daughter, Andrea, learned about Diraj in March 2015 during a weeklong trip with Ferris State University. The Ferris dental hygiene program runs a one-week clinic every year in Guyana, an English-speaking country along the northern coast of South America.
While cleaning teeth at Hampshire Bible Church, Andrea learned the missionaries hoped to arrange for surgery for a baby with a cleft palate.
She asked where. They said they planned to contact the Healing the Children chapter based in Grand Rapids, Michigan. Andrea’s eyes lit up. Her parents, Roxanne and Tim Bareman, have served as host parents for four kids from Healing the Children.
As soon as she returned to the U.S., Andrea called her mom to tell her about Diraj.
“Can you host him?” she asked.
“Sure, I think I can,” Bareman said.
Salan went to work to make it happen. She contacted Robert Mann, MD, a pediatric craniofacial surgeon and director of the Oral Cleft Clinic at Helen DeVos Children’s Hospital.
Dr. Mann has pioneered a surgical technique for fixing cleft palates. He and fellow surgeon John Girotto, MD, have a long history of providing care for children in need—in the U.S. and in countries around the world. The doctors readily agreed to care for Diraj.
“It’s the right thing to do,” Dr. Mann said. “You get a chance to serve.”
The question remained: Would Diraj’s parents send their baby to a far-away country for surgery?
“Diraj is a very much loved and cared-for child,” said Kathleen Girwarnauth, a missionary from Lowell, Michigan. She and her husband, Andy, run the Association of Bible Churches in Guyana.
In an email, Girwarnauth discussed the sense of shock that Diraj’s “very young” parents experienced when they had a baby with a birth defect.
“In this culture, handicapped and ‘different’ children are hidden,” she said. “They are hard to find, as the families are ashamed of them. Rarely do they go to school or out in public.”
Diraj’s mother overcame that, she said. She began to trust others and brought her baby out in the open, so he could play with other children and get used to being with people. The Girwarnauths met him when the family came to church one Sunday morning.
When Girwarnauth proposed the idea of surgery in the U.S., the parents hesitated at first.
“Soon they decided to do what’s best for their only child,” she said.
They had one condition: They wanted Diraj to stay with the family of the student who had worked in the dental clinic.
On January 14, Diraj arrived at the Baremans’ home in Jamestown Township. Thanks to garage sales and generous friends, Bareman had plenty of winter clothes and toys for a 1-year-old. She also had a large supply of burp cloths—small pieces of fabric used to wipe up drool.
They quickly became Diraj’s “lovey.” He would take one from the pile, put it on Bareman’s shoulder, climb onto her lap and lay his cheek against the cloth.
The Baremans’ two younger children, 12-year-old Alisa and 15-year-old Ryan, provided much entertainment. They played “Pat-a-cake” and “So big” with Diraj and taught him to blow kisses.
Diraj made himself at home as only a toddler can. He learned how to empty the recycle bin and unroll the toilet paper. He grew to like baths and got used to riding in a car seat.
Palate repair and ear tubes
After several medical checkups, the doctors cleared Diraj for surgery on February 22.
Dr. Girotto performed the operation, using a technique developed by Dr. Mann over the past 30 years. He used tissue from the cheek—a buccal flap—to build the section missing from the roof of Diraj’s mouth.
“Our cleft palate technique adds tissue to the palate rather than just working with what’s there,” Dr. Girotto said. “It leads to decreased scarring, better long-term growth and better speech outcomes.”
In the U.S., surgeons usually repair the child’s lip at 3 months of age and repair the palate at about 1 year. Because of the complexities involved in bringing Diraj to the U.S., they waited until he was 15 months so they could repair his lip and palate in a single operation.
The buccal flap technique especially works well for children from undeveloped countries, where kids have little chance at follow-up surgery. In fact, while Dr. Girotto performed the surgery on Diraj, Dr. Mann was teaching the technique to surgeons in India through the international charity Smile Train.
In addition to the palate repair, Diraj got ear tubes during the surgery.
“He had what’s called a ‘glue ear,’” said Andrew Heaford, MD, the ear, nose and throat surgeon who inserted the tubes.
The open palate had allowed fluids to move from Diraj’s throat to the middle ear. They thickened and blocked the ear drum and hearing bones that amplify sound, leaving Diraj with a 35-decibel hearing loss.
“It’s equivalent to walking around with ear plugs,” Dr. Heaford said.
The tubes will help Diraj in several ways: They will prevent infection and improve hearing, speech and balance.
Diraj came out of surgery with an upper lip that looked as if it had never had a gap. Teeth that appeared to grow sideways in the cleft were no longer visible. The front teeth eventually will fall into place.
“When you put the lip and the muscle back together, it’s like external braces,” Dr. Girotto said.
Most American kids with cleft palates get braces when they are older. Although that is unlikely for Diraj, Dr. Girotto said the surgery will greatly improve the way his teeth come in as he grows.
Five days after the operation, Diraj toddled around the Bareman home. He didn’t seem to notice the soft bands that kept his arms straight—so he couldn’t touch his still-healing mouth. He played with the six furry puppies born to one of the family’s two dogs.
At snack time, he sat on Bareman’s hip as she fed him through a sippy cup. When she moved the cup away, Diraj waved his arms and swung his legs.
“More? More?” Bareman said, giving him another sip. “You’re such a good boy. You’re such a trouper.”
At a checkup a week after surgery, Dr. Girotto examined Diraj’s mouth and said it was healing well. He could soon start eating pureed foods.
“He looks perfect,” he said.
His recovery impressed Diraj’s parents, as well.
With help from the Girwarnauths, they talked to him and the Baremans in a video call via Skype.
“The doctors and nurses did a wonderful job,” they said in an email sent later by the missionaries. “We are so excited that he came out of surgery and is getting better every day.
“Tell Diraj we love and miss him.”
Diraj will remain at the Baremans’ home until late April, when Girwarnauth plans to escort him home to Guyana.
Andrea, who has lived in Chicago since her graduation from Ferris, visited two weeks after Diraj’s operation.
He warmed to her slowly, as she smiled and clapped and played with him. Soon, he smiled as they tossed a tennis ball back and forth. Andrea marveled at the difference in Diraj’s smile.
“It looks good,” she said.
“You almost have to look at the pictures to remember exactly what he looked like,” her mom agreed.
Bareman is glad her daughter made the connection that brought Diraj to West Michigan and to her home.
“I’m thrilled,” she said. “I’m blessed to be able to take care of him.”