Francesca Achieng' knows that when she speaks, her listeners sometimes have trouble understanding what she is saying.
Ms Achieng', 35, who works as an office manager, says she is sometimes forced to delegate duties or grab a piece of paper and write down her message.
A gap in the roof of Achieng's mouth makes it difficult for her to articulate words clearly.
Achieng’ was born with cleft lip and palate. This is a congenital condition that affects a newborn's lips and roof of the mouth and results in a deformity.
While some babies are only born with cleft lip, for those with cleft palate, a split extends from the lips and jaw to the roof of the mouth where it exposes the nose.
Meshack Ong’uti, a reconstructive surgeon at Nairobi Hospital, describes the deformity as traumatising and life-threatening.
“Such people will not eat in public because they have to chew carefully lest the food comes out of their nose,” Dr Ong'uti said.
The trauma increases as the child grows up, something Achieng’ has experienced.
“Growing up, every time I met other children they would make fun of me saying I look funny,” says Achieng’, who is now married with three children.
Achieng’ underwent surgery in 2012 to correct the condition. But it did not go well and on Saturday she was back at Nairobi Hospital to have another procedure to close her palate.
Ong’uti says correcting cleft lip and palate is not for all surgeons and requires specialists. But such doctors are few. “There are patients who go through even 20 procedures before they get it right."
The downside of repeated operations, he says, is that insurance firms categorise cleft lip and palate as a congenital defect hence a reluctance to pay for reconstructive surgery.
The cost of repairing a cleft lip and palate is between Sh150,000 to Sh250,000.
Ong'uti says repeat surgeries are not uncommon, especially if the patient is a child.
There are some whose faces 'collapse' when they heal due to growth of muscles, or the shape of the nose changes and another surgery has to be done.
“While this is a surgery like any other, why we insist on specialists is because of the outcome,” he said.
Ong’uti advises that if a child is born with the condition, it is wise to have surgery early in their infancy. This should be done preferably before they start learning how to talk or it may end up affecting their speech.
The surgery can also be done on a child as young as three days if all vital signs are stable.
The surgeon says many children born with the condition in the country - about one in every 700 - do not survive the first week as they are unable to feed.
“Because of the hole in the palate, these children are not able to create enough pressure in the mouth to swallow food,” he explained.
While a clear cause of the condition is not known, experts point to how a pregnancy is handled in the first few weeks.
“This is the most critical time since the face develops in the first four to six weeks,” Ong’uti said.
He notes that the deformity happens when cells do not join properly during this period, which is what happens when a child is born with a hole in the heart.
“These are some of the reasons why we advise expectant mothers not to smoke or drink alcohol,” said Ong’uti.