Original Research Electronic Follow-Up of Developing World Cleft Patients: A Digital Dream? Tom W.M. Walker, MBChB, BDS, DOHNS (RCSEd), MRCSI, MFDRCSI, AKC, 1 Ambika Chadha, BA(Hons) BMBCh Oxon, BDS Lond, MRCS, DOHNS, MFDS(ad eundem) RCSEng 2 William Rodgers, MBBS BDS MRCS 3 Caroline Mills, FDS FRCS 3 and Peter Ayliffe, FDS FRCS 3 1 Department of Oral and Maxillofacial Surgery, School of Oral and Dental Science, Bristol Dental Hospital, University of Bristol, London, United Kingdom. 2 Department of Perinatal Imaging and Health, King’s College London, London, United Kingdom. 3 Department of Dental and Maxillofacial Surgery, Great Ormond Street Hospital, London, United Kingdom. Abstract Objective: To identify potential access to telemedicine follow- up of children with clefts operated on a humanitarian mission. Methods: A cross-sectional study of parents of children presenting to a humanitarian cleft lip and palate mission in a Provincial Hospital in the Philippines. A purpose designed questionnaire was used to assess access to electronic and digital resources that could be used to aid follow-up. Forty- five (N = 45) parents of children having primary cleft lip and or palate surgery participated. There were no interven- tions. Access to the Internet was through Parent Perceived Affordability of Internet Access and Parent Owned Devices. Results: Thirty-one (N = 31) respondents were female. There was 93% mobile phone ownership. The mean distance trav- eled to the clinic was 187 km. Majority (56%) were fluent in English. Thirty-one percent accessed the Internet daily. Six- teen percent reported use of e-mail. Fifty-one percent accessed the Internet on a mobile device, and short message service use was the most affordable means of communication. Conclusions: Due to perceived unaffordability and low levels of access to devices with cameras and the Internet, as well as issues with privacy, we cannot recommend relying on elec- tronic follow-up of patients in the developing world. Keywords: telesurgery, telemedicine, teledentistry, pediatrics, rehabilitation Introduction T here is an increasing evidence base to support the benefit incurred by patients treated on cleft lip and palate surgical missions undertaken in the devel- oping world, particularly of a psychosocial nature. 1 It is acknowledged, however, that the main difference in the care delivered by such missions as compared with that available in the developed world is the lack of regular follow- up 2 and full multidisciplinary input. 3 Several publications have documented the logistics and efficacy of addressing this disparity using information and communication tech- nology (ICT). According to a report published by the World Health Organization 4 in 2009, telemedicine signifies the use of ‘‘In- formation and Communication Technology to improve pa- tient outcomes by increasing access to care and medical information’’ whether asynchronous, involving the exchange of prerecorded data, or synchronous involving the immediate and real-time exchange of information. As such, various forms of ICT such as computers, the Internet, and mobile de- vices are involved in the delivery of telemedicine and thus ICT literacy represents a barrier to telemedicine diffusion. 4 While several human and cultural factors influence ICT literacy, basic access to ICT devices is one such factor and fundamental to the success of any telemedicine endeavor. Organizing routine follow-up, informing patients and their relatives of the next available surgical mission, and allowing communication about simple concerns can be undertaken through text message, e-mail, or private message (12). The provision of speech and language therapy and individual consultations would need video messaging in a private en- vironment. 3 Many charitable organizations have Twitter ac- counts, and these are also a potential way to disseminate generic information to patient groups. Assessing access and connectivity to these is key. This study set out to establish platform usage and access to ICT devices, and their perceived affordability by patients undergoing treatment on a Cleft Lip and Palate Surgical Mission to the Philippines, or by their families where ICT literacy could not be expected. We believe that it is the DOI: 10.1089/tmj.2017.0012 ª MARY ANN LIEBERT, INC.  VOL. 23 NO. 10  OCTOBER 2017 TELEMEDICINE and e-HEALTH 1