Therapeutic play alleviates fears for patients and their families

Therapeutic play alleviates fears for patients and their families

Child life specialist Cathy Cheonga, shares her experiences of volunteering for Operation Smile in Malawi and explains the importance of psychosocial care for patients.

Operation Smile's child life specialist, Cathy Cheonga, comforts Gertrude, before her cleft surgery

Medical volunteers like Cathy Cheonga in Malawi, play a vital role in the comprehensive care that helps our patients to thrive. Cathy is a child-life specialist and uses therapeutic play and activities to help our patients feel calm and relaxed before cleft surgery. This psychosocial care has a huge impact on our patients, many of whom have never been into hospital and are understandably anxious.

Cathy has been an Operation Smile volunteer for five years and has volunteered on six surgical programmes, she tells us more about her role and what inspires her.  

Q: Tell us about your role – what do you do on a surgical programme?

A: “I support patients and caregivers from their first moments when they arrive on the screening day and that’s the most important time to interact with the caregivers, as well as the patients. Because for most of them, it’s their very first time and they may have never been to the city or wherever we’re holding the surgical programme. So, everything is new to them. That’s the best part whereby you become so vulnerable, so that they trust you. Then I help them and walk with them on the journey.

“Many are also scared because they’re being told stories about cleft. For example, I met a mother whose child had a cleft palate and, in that village, that child has never been seen, because people will tell them mean things, like that the child is not going to make it and these sorts of things. So this is the best part of the mission, because I love to work with the caregivers as well as the patients, just to reassure them and to tell them that there is hope, there is a smile at the end of the journey.”

Q: What do you like most about working with Operation Smile?

A: “There are so many professionals, medical and non-medical coming together, just giving it their all to create something special for the patients. I love the interaction and integrations, I’m also learning lots of new things through working together. For example, I’m learning a lot of medical terms – sometimes I’m like ‘Oh, so this is what it is’ about some specific terms, I had just maybe heard when I visit my doctor, but now I’m able to understand even more. So, yes, I’m learning a lot of things – that’s good! ”

Q: What is your favourite patient story?

A: “Ah, there’s so many but I still remember this one lady. She grew up in a village and in that community she was the only one with cleft, both lip and palate. The stigma was really severe. However, her mother was determined to not give up on her – she used to say, ‘I’m gonna keep this child!’ and she cared for that child, until she grew up into a young lady.

“Then another man asked to marry her, despite whatever the parents of this man were saying about her cleft lip. His family was worried about the kind of children they would have. When he decided to marry her, they asked him to leave their community and leave them alone because they didn’t want to have anything to do with a woman with a cleft.

“They got married and they had two children together. One day, a friend of the husband told them that there were people providing care for people just like his wife. They said, ‘Why don’t you give it a try?’ They were excited but they also concerned about how they could afford it, as they thought it would require a lot of money.

“Their friend told them that care was free and that they just had to register. They didn’t know how to register, until one day he went to the city – as he is a businessman – and he saw a poster. He then got in touch with the patient coordinator and they managed to get to the next surgical programme.

“This is when I met them and she was very worried that the outcome of the operation could be bad. I spent time with her, chatting and encouraging her as much as I could. Then she felt much better when the surgeon came to take her to the operating room.

“After surgery she called me and she said that she wanted to thank me for encouraging her. She told her husband that she wanted to go to home very late, so that they would arrive in the middle of the night so she could surprise all the ladies of the village the following morning. She said, ‘I knew they would be there watching and doing all the errands and they would be staring at me, genuinely surprised.’

“I don’t think I’ll ever forget this story. You know? How she couldn’t believe that it was her when she looked at herself in the mirror? She thought it was a video! So I told her to go and look at her new smile on another mirror!”

Q: What are your hopes for Operation Smile in Malawi?

A: “So my wish is to see that when the children are born with cleft palates, they’re attended to immediately if the mother wishes. At that same time how, I think what they’re doing bringing in different sectors – I know these young people we’re bringing in, most of them have the passion and if they helped or were mentored so that they see what is lacking in our nation, so that they help, that would be great. ”

Q: What do you think was the impact of COVID-19?

A: “COVID caused a lot of impact, whereby maybe some of our patients lost hop. Especially those that maybe have just come to realise that surgery was possible or the ones born more recently, between 2019 and now. And who knows how many maybe we lost due to COVID or malnutrition, that could have had a great new smile? ”

Q: What are the biggest problems that you see in our patients’ lives?

A: “Stigma is the biggest enemy. Because of that stigma most of those patients that we are seeing are not going to school. Only a few are going far with education. Just a handful, but the rest, they go to class one, class two, in primary school, and then they’re being bullied! When they are a bit older and they realise what is happening to them, they just opt to drop out from school. So yeah, stigma is a big challenge.”

Q: What can we do to help more children, especially from this psychosocial perspective?

A: “What I feel would help is to have mentors, psychosocial counsellors being brought up in different communities where Operation Smile is, so they can be considered like support groups, helping out the patients and families wherever they are coming from. This can actually have a great impact!

“Who knows, maybe one day, the government will actually help out in having open education to kids in their own homes, just as they do in in some countries, whereby when a child has been hospitalized, he or she doesn’t use classes, their teachers can help them in their home or hospital.

“We are losing a lot of children from education, because they shy away from going back to school, and those parents cannot afford private tutors to be teaching those students at home. So these mentors can actually help them out and maybe making the parents understand that the children can still go back to school with a cleft condition.”

Cleft care goes beyond surgery

Our volunteers provide patients with comprehensive cleft care like emotional support. With your help, we can continue to care for children who desperately need our help.

Our promise of improving health and dignity during the COVID-19 pandemic endures. Once again, we’re providing surgery and in-person care while taking stringent measures to keep our patients, their families and our volunteers safe. Hope is on the horizon. And we remain focused on what cleft care makes possible for children, helping them to better breathe, eat, speak and live with confidence.

Picturing Her New Beginning

Picturing Her New Beginning

Growing up, Akosua always felt different from the other children in her community. That feeling didn’t go away for more than 50 years. “I was never a happy woman,” Akosua said. “I never wanted my photo taken.”

Akosua lived 52 years of her life with a cleft lip. She never knew what her condition was called, but that didn't stop people from wrongly mistreating her. Photo: Margherita Mirabella.

Despite not knowing the name of her condition, Akosua knew that the mistreatment and judgment she endured were because she didn’t have the same smile as everyone else.

It wasn’t until she was 52 years old that she learned more about her condition. For Akosua and many people in her local community, the terms cleft lip and cleft palate were unfamiliar. The idea of cleft surgery was even more unknown.

Akosua’s family accepted and loved her, but some people refused to look past her cleft condition. The bullying became so severe that she stopped attending school at Primary School age. However, leaving school didn’t stop the hurtful name-calling from continuing into her adult life.

She never let the pain or hopelessness prevent her from creating happy memories. Akosua got married and had three children who supported her through the seemingly endless cycle of abuse. But making a living for herself and her family proved to be an unexpected obstacle.

As a vegetable seller, she encountered many people at the marketplace who refused to buy produce from her because of their misguided fear of her cleft lip. With the deeply rooted stigma and misconceptions surrounding cleft conditions in Ghana, some people believed her cleft lip was a negative reflection of the quality of her vegetables. In an effort to save her business, Akosua began covering her face.

After more than 50 years fighting to be accepted and treated with decency, Akosua found out that she’d never again need to hide from those around her.

In March 2015, Akosua learned that the reason her smile was different was because she was born with a cleft lip. In that moment, she not only discovered that the cause of her sadness and mistreatment was something completely outside her control, but also that there was an organisation dedicated to providing free, life-changing cleft repair surgeries for people like herself.

Cleft conditions are more common than Akosua ever realized. It is estimated that, worldwide, a child is born every three minutes with a cleft condition, making up about one in every 500 to 750 births.

Unable to afford living apart, Akosua and 20 of her family members share one home. Even with a proper diagnosis of her lifelong condition, Akosua knew that with her family’s meager income, surgery would remain out of reach. But the more she learned about Operation Smile Ghana’s free cleft care, the more relief and happiness she felt.

There was a chance to have the life she always wished for herself and her family. Accompanied by her brother, Charles, Akosua made the 10-hour journey by bus to a surgical program in Ho. Charles expressed his sadness toward the suffering his sister experienced throughout her life, but he was overjoyed to witness her get an opportunity for a new beginning. Following her comprehensive health evaluation, medical volunteers placed Akosua on the surgical schedule.

Akosua couldn’t believe that it was her own smile she saw as she glanced at her reflection in a mirror after surgery. “Now, I am confident, always happy and love having my photo taken,” she said.

Those who once treated her badly were surprised to see the change in Akosua when she returned home. Today, she hopes her vegetable sales increase so that she can help provide a better quality of life for her children and family.  The goals she has for herself go beyond the marketplace. Having left school early in life, Akosua intends to continue her education.

But her determination to help people involves more than just her own life. “I tell people about Operation Smile,” Akosua said. “I already found a new patient with a cleft, and I will make sure they are registered with Operation Smile Ghana and come to the next surgical programme.”

Akosua’s experience with Operation Smile Ghana instilled in her a passion to help others discover the surgical solutions offered by the organization. Seeking out people living with cleft conditions, Akosua gives them hope and helps them access the life-changing care earlier in life. Photo: Margherita Mirabella.

Help Operation Smile find more patients like Akosua

With your support we can avoid the suffering of a lifetime by treating cleft on patients sooner.

Our promise of improving health and dignity during the COVID-19 pandemic endures. Once again, we’re providing surgery and in-person care while taking stringent measures to keep our patients, their families and our volunteers safe. Hope is on the horizon. And we remain focused on what cleft care makes possible for children, helping them to better breathe, eat, speak and live with confidence.

Timely Cleft Surgery, Brighter Futures

Timely Cleft Surgery, Brighter Futures

Checking his phone every chance he could while at work, Felipe anxiously waited for his partner, America, to text him with news about their son, Jack.

Six-month-old Jack with his mom, America, during a 2018 Operation Smile Bolivia surgical program in Santa Cruz. Photo: Margherita Mirabella.

The anticipation of this moment after having waited months for the opportunity of surgery was almost too much for him to endure. But whether the news was good or bad, Felipe knew that, together, their family was strong enough to persevere. Finally, a text appeared. Jack was scheduled for free cleft surgery with Operation Smile Bolivia.

With tears of joy and shaking hands, America, who was at the surgical program in Santa Cruz when she texted Felipe, reassured him that their search for a solution had come to an end. At 6 months old, Jack would begin his cleft care journey. But it had been a difficult year.

Discovering their son’s cleft condition during a fifth-month ultrasound, the family’s joy of expecting their first child quickly turned to worry and fear.  Arriving home from that appointment, Felipe and América turned their devastation into determination as they began educating themselves about cleft conditions and researching their options for help. As working college students, they both knew that no amount of love they already had for their son would help them afford the cost of future surgery.

Amid their concern, hope appeared on their computer screen when they learned that Operation Smile Bolivia existed and was created to help families like theirs. As they called the phone number on the website, América and Felipe were moments away from discovering that life-changing cleft care would be free.

Unlike many parents of children with cleft lip and cleft palate, América and Felipe not only learned of their child’s condition but also found a solution before Jack was born. This is rare for families living in low-income countries.

Most mothers don’t find out about their baby’s cleft condition until they are holding them in their arms for the first time. Many fathers don’t find Operation Smile for years due to lack of awareness of where to go or available resources in their country. And some families endure years – even decades – of watching their children grow up to experience the painful bullying and isolation associated with living with an untreated cleft condition.

But even with their early exposure to the reassurance and support of Operation Smile Bolivia’s local medical team, nothing could prepare the new parents for the impact of seeing Jack’s smile for the first time.

Loved by his entire family and friends and neighbours in Santa Cruz, Jack was surrounded by people who were prepared to do whatever was necessary to ensure a better future. And when he was first brought to an Operation Smile Bolivia programme, he was once again surrounded by people devoted to changing his life.

At 1 month old, Jack was too young to safely receive surgery, but volunteers fitted him with a feeding plate, which is a dental device that covers a patient’s cleft palate to help them feed with ease and remain strong and healthy enough during the months leading up surgery.

Although América felt saddened that Jack couldn’t receive surgery yet, she left the programme feeling confident in the local volunteer team and comforted by the fact that she was not alone. After several months of waiting, the day Felipe and América had been hoping for finally arrived.

Back in the care of Operation Smile volunteers, Jack passed his comprehensive health evaluation and was deemed healthy enough to undergo anaesthesia. For Felipe and América, despite the trust they’d placed in the volunteers, they couldn’t prevent the anxiety and worry from sinking in as they waited to see Jack’s new smile on surgery day.

Fear gave way to joy and relief when the family was reunited once again. On that day, one surgery changed the lives of three people.

Jack now feeds without difficulty and no longer requires a feeding plate. Their community was thrilled with his new smile and loves watching Jack laugh freely and continue to grow.

The transformation from a cleft repair surgery is seen immediately, but it wasn’t the end of Jack’s cleft care journey with Operation Smile Bolivia. A few months later, he was scheduled to receive his second surgery to repair his cleft palate.

In 2020, the pandemic interrupted Jack’s kindergarten classes, but Operation Smile Bolivia remained committed to providing patients like him with health that lasts. Staying in contact with the local volunteer team, Jack, Felipe and America embraced his ongoing care through virtual therapy sessions that worked to improve his speech.

A healthier and brighter future awaits for this loving family.  “We will be forever grateful,” América said.

Change a life today

Jack and his family received the vital support to help him thrive and grow strong to have his cleft surgery. You can help more families like Jack’s.

Our promise of improving health and dignity during the COVID-19 pandemic endures. Once again, we’re providing surgery and in-person care while taking stringent measures to keep our patients, their families and our volunteers safe. Hope is on the horizon. And we remain focused on what cleft care makes possible for children, helping them to better breathe, eat, speak and live with confidence.

Nourishing Her Country: Q&A with Nutritionist Monica Arredondo

Nourishing Her Country: Q&A with Nutritionist Monica Arredondo

In Guatemala, where one in every two children suffers from chronic malnutrition, Monica Arredondo’s lifelong passion is not only saving lives but helping alleviate a need in the country she loves.

Volunteer nutritionist Monica Arredondo during a surgical program in Guatemala.

“I chose nutrition because it’s a very important issue,” she said. “I wanted to contribute to Guatemala, my country, to be able to contribute my grain of sand to the children and achieve a better nutritional state for them.”

Living in impoverished areas around the world, the threat of malnutrition is severe for many families who are facing food insecurities and lacking easy access to resources they need. These risks become even more dire for children born with cleft lip and cleft palate because living with an untreated cleft condition can sometimes make it impossible for children to breastfeed, bottle-feed or eat solid foods.

And when children don’t receive proper nourishment or timely nutritional support, they can’t qualify for cleft surgery and continue to face life-threatening health consequences – even sometimes death.

Seeing her patients arrive to a surgical programme after having received ongoing nutritional care, Monica feels in her heart that she’s made a difference in their life and her own.

“To these patients who are here … it’s very exciting,” Monica said. “Everything we do with nutrition, everything is for them to be able to qualify for their surgery, and this definitely changes their lives in all aspects.”

We recently caught up with Monica to hear more about her dedication to serving the needs of her country and how Operation Smile Guatemala is confronting the impact of malnutrition head on.

Q: Can you go into more detail about the nutritional care Operation Smile Guatemala provides to patients and their families?

A: “First, children are evaluated to identify their weight and their size. To evaluate them, to identify whether they have chronic malnutrition or acute malnutrition, and also determine if they have a growth delay. Depending on the diagnosis that’s given, we can then choose the children who have malnutrition and enter them into the nutrition program. This is a program that Operation Smile Guatemala has to support families and provide them with baby formulas and other products to improve the nutritional state of their children.”

Q: Why is this specific discipline of comprehensive care vital to patients?

A: “It’s very important because, as I said, there are many children who have chronic malnutrition. This is also related to several factors, among them being the economic situation of the families, so this greatly influences the nutritional state of the children and as a country. Nutrition is very important because chronic malnutrition is a pretty big problem here in Guatemala and also for our patients with cleft lip and cleft palate.

“It’s important that patients have the right weight and size so that they can qualify for surgery. For parents or guardians, because sometimes it’s also other people who take care of the children, it’s very important to them. They are very grateful to Operation Smile Guatemala because we support them through ongoing consultations. Parents have many questions about what food they can give to their children. So for them, the first appointment is very important, but also the follow-up that’s given by Operation Smile Guatemala in terms of how they can be supported by nutrition.”

Q: What challenges did the COVID-19 pandemic create for you and your team?

A: “In relation to the pandemic, it was a hard situation for Operation Smile Guatemala because it’s very important for us to have in-person consultations to evaluate weight, size and how the children are feeding. When it was done virtually, it was a problem because many of the families didn’t have this ability. So not having in-person consultations really affected us. It was hard because we didn’t have the opportunity to see the patients, so it was really difficult for us to have a follow-up with them.

“However, virtual consultations were carried out. It was about calling all patients who had scheduled appointments so that our team could collect the weight and size information. Nutritional education was greatly strengthened by these virtual calls for parents to also feel the help of how to continue to support their children.”

Q: There was a recent Operation Smile Guatemala surgical programme in Petén. How did it make you feel to see patients arrive to the programme healthy enough to receive surgery after having battled malnutrition?

A: “To these patients who are here, the truth is that it’s very exciting because it’s something that families expect. It’s very exciting for both the families and for us who are following the growth of all these children so that they could be here. Everything we do with nutrition, everything is for them to be able to qualify for their surgery, and this definitely changes their lives in all aspects.”

Providing nutrition care where it’s needed the most

Your support enables Operation Smile’s continue to provide nutrition programmes in countries such a Guatemala.

Our promise of improving health and dignity during the COVID-19 pandemic endures. Once again, we’re providing surgery and in-person care while taking stringent measures to keep our patients, their families and our volunteers safe. Hope is on the horizon. And we remain focused on what cleft care makes possible for children, helping them to better breathe, eat, speak and live with confidence.

A Woman Who Inspires: Q&A with Surgeon Dr. Gladys Amaya

A Woman Who Inspires: Q&A with Surgeon Dr. Gladys Amaya

Like so many of the men and women who donate their life’s passion to Operation Smile, Dr. Gladys Amaya feels that the transformation she creates in the lives of people born with cleft conditions doesn’t compare to the impact they have made on her in return.

Gladys Amaya assists during surgery at the Operation Smile Cleft Lip and Cleft Palate Integral Care Clinic in Tegucigalpa, Honduras. Photo: Rohanna Mertens

Learning about Operation Smile Honduras during her medical residency, Gladys never looked back after witnessing the need for high-quality cleft care from medical professionals and surgeons like herself.

“I did not imagine the magnitude of the health problem we had in Honduras,” she said. Gladys hopes to inspire future surgeons just as her family encouraged her to never let anything stand in the way of going after her ambitions and goals.

“My dad was a man who stood up for women. They told him not to send me to the capital city to study,” Gladys said. “Today, Honduras has a woman president. I am currently the president of the Honduran Association of Plastic Surgeons. I think I am the third female plastic surgeon in Honduras.”

We recently caught up with Gladys where she spoke about the pride she feels serving as a female medical professional in her home country and how learning from her fellow volunteers shaped her into a better surgeon.

Q: How did you feel attending your first surgical program with Operation Smile Honduras?

A: “The first time, I was a resident, and I felt like I was a foreigner in my own country. They all knew each other and yet I was very well received. The good thing is that, as a resident, you work with doctors who already had 25 years repairing cleft conditions. One thinks that they know everything, but standing before a teacher, you realize that much remains to be learned. I was lucky as I worked with good people who guided me, explaining things to me step by step. All in a very loving way. I felt that it was a family. It was very impressive.

“I had the opportunity in that first program to work in the pre-operative ward. Around 300 patients came. At the end of the day, I was so tired. I didn’t imagine the magnitude of the health problem that we had in Honduras.”

Q: Do you think that volunteering for Operation Smile Honduras programs helped make you a better surgeon? 

A: “Completely. But it’s not just about surgical skill. Everyone becomes more sensitive. I love it because I have contact with surgeons from different cities and we meet and share. Every program is different. Even if you are the lead surgeon, a little tip from a colleague can make all the difference. Someone may think that it is something repetitive to operate on a cleft lip or cleft palate, but no, it’s about the patients.

“When I started in Operation Smile, I already had a son, and this generated an enormous empathy for children with cleft lip and cleft palate. Someone told me, ‘Charity starts at home,’ and I learned to have a little balance between the programs and my home.”

Q: How does it feel to be part of a team with other volunteers? Do they acquire knowledge that they later transfer to their communities? 

A: “In Operation Smile, we operate with an instrumentalist only. So you learn to work with both hands. The instrumentalist already knows everything they have to do and they already knows my rhythms during surgery.

“Teamwork is the best. The beauty of Operation Smile is that there is no competition. We just do it the best way we can, and in the end, we all achieve almost the same results. We create a standard.”

Q: You recently ran an all-female surgical program. What inspired you to do that?  

A: “Most of the volunteers and staff at Operation Smile Honduras are women. Operation Smile carried out a ‘Women in Medicine’ program in Morocco, and we had the idea of doing something similar to commemorate Honduran Women’s Day on January 25.

“We women felt empowered that we could do it. And it was possible because most of the team are women. One of the volunteers has to travel three to four hours to get to the program. She has a son born with a cleft palate. She said, ‘Operation Smile operated on my child, so I’m going to be a volunteer for Operation Smile.’ And she has reached out to more volunteers.”

Q: What is the difference that a program carried out only by women can make? 

A: “The benefit is because we know each other. We are a team. The women-only program went great, but it’s not about excluding men. For me, it was a coincidence that we were only women. The result does not depend on us being women. No matter the gender, every professional learns to do it one hundred percent.”

As stewards of Operation Smile’s mission to improve health and dignity through access to safe surgery, the women who served on this programme changed the lives and futures of 70 families.

As one of the 70 patients who received life-transforming care, 3-year-old Chaoui departed from the women’s mission with a brighter and healthier future ahead of her.
For many patients like Chaoui, surgery is the first milestone along their journey with Operation Smile Morocco. Additional orthognathic surgery, speech therapy, psychosocial care and more are a few of the ongoing comprehensive services the local team delivers at their multiple care centers across the country.

“I really try to do as much speech therapy and train the parents to do the therapy and encourage them so that their child can go to school or go back to school,” said volunteer speech therapist Candace Myers of Canada.

“I often tell the parents, ‘With quite a bit of work, they can improve their speech, and then they can be a doctor, a surgeon, a nurse, a teacher. Your child can do anything.’”

Strengthening local health care systems

Your support enable Operation Smile’s work with local health care professionals to build capacity and create long term sustainability for cleft care.

Our promise of improving health and dignity during the COVID-19 pandemic endures. Once again, we’re providing surgery and in-person care while taking stringent measures to keep our patients, their families and our volunteers safe. Hope is on the horizon. And we remain focused on what cleft care makes possible for children, helping them to better breathe, eat, speak and live with confidence.

Women Brighting Futures and Empower Lasting Change

Women Brighting Futures and Empower Lasting Change

Courageously leaving the comfort and familiarity of their local communities, more than 100 patients and their families traveled countless miles to arrive in Marrakesh, Morocco, seeking cleft care.

families waiting for health screening in Morocco

Taking place two years after Operation Smile Morocco’s final surgical programme before the COVID-19 pandemic swept across the country and around the world, the second Women in Medicine programme and its all-female team of volunteers welcomed these families with a promise of providing high-quality surgery to as many as possible.

Similarly to the Women in Medicine: Inspiring a Generation programme back in March 2020, this programme celebrated International Women’s Day by bringing together a volunteer team comprised entirely of women. These medical professionals from all around the world donate their passion, time and skills, serving pivotal roles in delivering surgical and multidisciplinary cleft care.

More than 80 women from over 15 countries including Guatemala, Morocco, Peru, Brazil, Sweden, the UK, Norway and many others joined together to form one team ready to provide expert-level cleft care to children who — without it — may never have been given the brighter and healthier futures they deserve.

For many volunteers, this was their first women’s mission. But for Moroccan surgeon Dr. Misk Meziane, who attended the March 2020 program, she not only left an impact on the lives she changed through surgery, but also through sharing experiences, mentorship and skills with the future surgeons of the world.

“You have to love what you do. If you don’t love what you do, you are not giving the best of you,” Misk said. “Second important thing is to think about the patient. If it was someone in your family there, you have to keep that in mind, and you have to do the best for this patient.”

Surgical and dental residents felt empowered as they participated in mentorship and training opportunities where certified medical professionals like Dr. Ase Sivertsen of Norway shared skills and techniques during interactive cleft surgery simulations and oral health workshops.

By participating in these training opportunities, dental students learned knowledge about life-saving pre-surgical dental care while surgical residents gained skills through practicing techniques unique to performing cleft surgery.

Alongside other certified female medical professionals, cleft surgeon Dr. Wafaa Mradmi of Morocco and dentist Dr. Vilma Arteaga of Guatemala led the interactive surgical and dental workshops.

Vilma and Wafaa both volunteered in the training and education components during the first women’s mission. As they witnessed the continuation of this global educational exchange, they once again felt like they were a part of something greater than themselves. From increasing the local capacity of local communities around the world to improving the surgical outcomes for patients, the women who participated in the workshops left the programme eager and ready to utilise their newfound knowledge and skills.

“I’ve had a lot of experience of mentoring residents, whether in my country or from abroad. When you train them, it’s not just giving them the medical knowledge, but also providing them with the ability to be compassionate,” Wafaa said. “You have to have some spirit, soul and heart to be with these patients and to know that their families will always be there behind them, and you have to treat, not only the patient, but also the family.” 

Our female-led team of surgeons, anaesthesiologists, nurses, dentists and more became a fierce and purposeful force providing 100 patients like 9-month-old Yasser with comprehensive health screenings.

Although his mom, Siham, received a prenatal ultrasound, Yasser’s cleft lip went undetected. So, the first time Siham saw her newborn son was also the first time she had ever seen another person with a cleft condition.

Gazing down at her son, Siham’s shock and worry nearly overwhelmed her. But with Operation Smile Morocco’s well-known existence across the country, doctors at the hospital where Yasser was born spoke highly of the organisation, knowing that a solution for his cleft condition was possible. After learning that there was an upcoming surgical programme in Marrakech, Siham and Yasser journeyed from Tangier. It took them six hour by bus to reach Marrakech.

For many of the patients like Yasser who arrived, this programme was their first attempt at receiving the life-changing surgery that proved so elusive while withstanding the challenges amid the last two years.

As stewards of Operation Smile’s mission to improve health and dignity through access to safe surgery, the women who served on this programme changed the lives and futures of 70 families.

As one of the 70 patients who received life-transforming care, 3-year-old Chaoui departed from the women’s mission with a brighter and healthier future ahead of her.
For many patients like Chaoui, surgery is the first milestone along their journey with Operation Smile Morocco. Additional orthognathic surgery, speech therapy, psychosocial care and more are a few of the ongoing comprehensive services the local team delivers at their multiple care centers across the country.

“I really try to do as much speech therapy and train the parents to do the therapy and encourage them so that their child can go to school or go back to school,” said volunteer speech therapist Candace Myers of Canada.

“I often tell the parents, ‘With quite a bit of work, they can improve their speech, and then they can be a doctor, a surgeon, a nurse, a teacher. Your child can do anything.’”

Training the next generation

Operation Smile women in medicine programme is part of our mission to build health care resilience in the countries we work

Our promise of improving health and dignity during the COVID-19 pandemic endures. Once again, we’re providing surgery and in-person care while taking stringent measures to keep our patients, their families and our volunteers safe. Hope is on the horizon. And we remain focused on what cleft care makes possible for children, helping them to better breathe, eat, speak and live with confidence.

A Reflection of Hope – Ziyalesi’s story

A Reflection of Hope

As they grow up, some children become curious about what their smiles would look like if they weren’t born with a cleft condition.

Ziyalesi didn’t have to wonder. All she needed to do was look at her twin sister, Rutia.

Rutia not only represented what Ziyalesi’s smile could be, but also the potential of how differently people in her community might treat her.

But unfortunately, her reality was more painful. With the cost of surgery beyond her family’s means, a new smile seemed to be an impossibility, and Ziyalesi endured the harmful stigma and isolation that can come with living with an untreated cleft condition.

She was oftentimes tormented by people on the streets whenever she left the safety of her home. Even the bullying she endured from her classmates sometimes went beyond verbal insults – Ziyalesi was also occasionally physically abused.

Seeing her daughter come home from school in tears was heartbreaking for Angela, Ziyalesi’s mom. To a certain extent, she understood her daughter’s pain, as she and her husband, Samuel, were also on the receiving end of their community’s torment and oppression.

When Ziyalesi was born with a cleft condition, Samuel and Angela believed they were being punished. Rather than providing the family with support or solace, their community mocked and taunted them. Lacking access to knowledge of the causes and treatment of cleft conditions, Angela believed that her daughter’s cleft condition would eventually heal on its own.

But, of course, it never did.

When Samuel and Angela were informed that surgery was available to help Ziyalesi, they were thrilled.

But their excitement was soon lost when they learned how much it would cost the family to pay for surgery. Yet, amidst the seemingly unending uncertainty and pain, Ziyalesi could always turn to the support and compassion of her sister. One day, Rutia and Ziyalesi hoped that they would look just alike.

Everything changed when Angela saw a poster for Operation Smile Malawi. Filled with relief, Angela read about how the organisation had teams of medical volunteers capable of providing free life-changing surgery.

Operation Smile made travel arrangements for Ziyalesi and her mother to reach Lilongwe, where the surgical programme would take place. Following their long journey, Angela felt reassured as she glanced around and saw other children who looked like Ziyalesi. For the first time, they felt like they weren’t alone.

Ziyalesi and Angela met with the compassionate volunteers at the programme site who conducted a comprehensive medical evaluation and determined that she was a candidate for surgery. After a cleft lip surgery, a procedure that can take as few as 45 minutes, the course of Ziyalesi’s life was changed forever.

“I am so happy because they won’t tease her anymore,” Angela said.

As she looked into the mirror after receiving surgery, Ziyalesi saw the new and beautiful smile she would have for the rest of her life. She smiled and said, “Now I look like my sister, Rutia.”  

Today, Ziyalesi lives a happier life, free of the burdens associated with cleft conditions, and is no longer bullied by those who misunderstood her condition. Following the family’s return home, many members of their community never expected to see such a drastic change to Ziyalesi’s smile. Some shared how they felt ashamed by the things they said and how they had treated the family.

One of the many people who was most excited to see Ziyalesi was Rutia, who said, “We have a new Ziyalesi now.”

Change lives today

Surgery is only one part of the comprehensive care we provide to our patients. We support children, like Ziyalesi that without your donation, wouldn’t have a chance to repair her cleft lip.

Our promise of improving health and dignity during the COVID-19 pandemic endures. Once again, we’re providing surgery and in-person care while taking stringent measures to keep our patients, their families and our volunteers safe. Hope is on the horizon. And we remain focused on what cleft care makes possible for children, helping them to better breathe, eat, speak and live with confidence.

Care for Brighter Futures: Iris’ Story

Care for Brighter Futures: Iris’ Story

As soon as Iris gets off the bus and, together with her mother, moves through the crowds of people at a bus station in Managua, Nicaragua, she hides.

Walking behind her mother, she holds one hand on her mother’s shoulder and the other covers her mouth. Her eyes are locked on her mother’s back, as if she doesn’t want to meet the eyes of any of the strangers staring at her.

Iris is 11 years old and was born with a cleft lip and cleft palate.

In a certain way, she’s lucky. Her mother loves her no matter what. She thinks she is beautiful – the best thing that happened to her.

So many other children born with cleft conditions experience the opposite; their mothers and fathers feel shame and fear instead of happiness and love when they see their children for the first time. Iris has felt love from the very beginning.

But what Iris shares with nearly every child affected by cleft is the feeling of being different, not fitting in and not feeling equal to her peers. Though Iris goes to school with her friends, she always hides her face whenever she is among strangers. She’s used to living life in the shadows of her friends and family.

Iris and her mother, Sandra, have taken the bus for five hours from their hometown of Matagalpa to the capital city of Managua, where an Operation Smile cleft care center is located. They’re coming so Iris can finally receive surgery after so many years without treatment. Sandra has tried before to have her daughter treated at a regional hospital. The first time, Iris got sick. The next time, they just couldn’t afford the trip.

“My husband works in the fields as a farmer for anyone who can offer him some work. I am a housewife,” Sandra explains. “We are a poor.”

But this time they were fortunate. A woman who happened to see Iris decided to help the family by giving them information about Operation Smile and money for the bus trip. Now, they’ve arrived at the Operation Smile care center in Managua – eager, full of expectations but also nervous.

“What makes me very proud about this center is that we not only offer surgery to fix a cleft lip and cleft palate, but that we see the patient not as a surgical case, but as a family member,” says Indiana Siu, Operation Smile Nicaragua’s executive director. “They come here normally as babies and stay under our care until they are 16 or 17 when they are fully treated. It is not enough to just give them surgery, but to also help them integrate in to society so they can talk and communicate with other people.”

Operation Smile has a 25-year history in Nicaragua. With the support of the Nicaraguan Ministry of Health, it all started in 1993 with brigadas – “brigades” – of international medical volunteers coming in to perform surgeries at state-owned hospitals.

“At that time, we had no idea of the need. There were no mobile phones; announcements were made through radio,” says Eliza Maria McGregor Montealegre, Operation Smile Nicaragua’s co-founder and vice president of its board. “Soon, we discovered this was just the beginning of trying to solve a huge problem. Many other organizations came from abroad, but they all left after a while and we stayed.”

Indiana adds: “We have grown exceptionally in all aspects. When I started in 2010, we did 100 to 200 surgical procedures per year. Now, we are up to 500 per year. We have almost 14,000 visitors per year (at the care center). And by cooperating with the Ministry of Health, we can reach out to the population of the whole country and offer them safe surgery.”

In 2016, Operation Smile Nicaragua opened its new care center in Managua.

Named after the founding MacGregor family, it has brightly-colored walls, big windows and a welcoming atmosphere. A playground in a small outdoor square is full of children waiting for their appointments with the medical specialists. Here, Operation Smile offers consultations with anesthesiologists, pediatricians, orthodontists, speech therapists, psychologists and nutritionists. Surgeries are performed at Hospital Alemán Nicaragüense, a state-owned hospital nearby.

Now, it’s Iris’ turn to meet psychologist Dr. Maria José Chevéz. She shows Iris drawings of a child who’s about to have surgery – how the anesthesia mask is placed over the face. Then, Maria brings out a real mask and Iris tries it on for herself. She breathes as instructed.

“I try to explain to Iris and her mother what the steps are during the process. She feels nervous – it is her first time to be so far away from home for so long,” Maria says. “Many parents have questions, specifically about the anesthesia, if there are side effects. There are so many myths that it might have effects long term, so we try to explain and answer all the questions.

“If the mother feels calm during the process, the patient is very likely to feel calm as well,” she adds.

Iris and her mother spend nearly the whole day at the center and consult with all the necessary specialists. Tomorrow is her big day – Iris will finally receive the surgery that she’s always deserved. And here, with all the other children affected by cleft playing around her, she no longer hides her face.

Early in the morning, Operation Smile Nicaragua’s volunteer medical team arrives at Hospital Alemán Nicaragüense to prepare for the two surgeries to be performed that day.

Iris is one of those patients. In a bed in the pre-operative ward, Iris is lying face down, not wanting to talk to anybody.

“She is nervous and afraid because it is the first time she is at a hospital, undergoing surgery,” says Sandra, Iris’ mother, as she sits on the bed next to her daughter. “I am praying to God that everything will go well and that she feels better after.

“She is beautiful as she is, but I think she will be a happier person when this is over,” Sandra says as she strokes Iris’ hair carefully.

It’s almost time for Iris’ cleft lip surgery and Dr. Maria José Chevéz, the psychologist who she met yesterday at the center, is there to keep her calm. They walk towards the operating room and sit on a bench for a while, playing and talking.

But now it’s time to go. He takes Iris’ hand and they together walk into the operating room, leaving Sandra outside to pray and wait. “I have been waiting for this since she was a little baby,” Sandra says. “Ever since I got in touch with Operation Smile in January, we have been treated well. Everybody has been so nice and accommodating. Now I feel so happy that this moment is here”.

An hour later, the moment has arrived for Sandra to see her daughter for the first time after surgery. As Iris is brought to the recovery room on a rolling bed, Sandra can’t hold her tears back. She cries openly, embraces her daughter and talks to her with so much love in her voice:

“Thanks to God everything went well, my darling. You can relax and just recover now. I am crying because I want to thank God and everyone who has been working with you.” 

With tears in her eyes, Maria is also there to witness this emotional moment.

“After this surgery, Iris will be able to come back to her village and feel and look like the rest of the children there,” Maria says. “She will be able to feel confident and overcome her shyness a little at a time so she won’t feel the need to cover her face anymore.”

Change lives today

Surgery is only one part of the comprehensive care we provide to our patients. We support children, like Iris, by providing excellent centres of care, with specialisms in anaesthesiologists, paediatricians, orthodontists, speech therapists, psychologists and nutritionists.

Iris after her cleft lip and cleft palate surgery smiling at the camera

Our promise of improving health and dignity during the COVID-19 pandemic endures. Once again, we’re providing surgery and in-person care while taking stringent measures to keep our patients, their families and our volunteers safe. Hope is on the horizon. And we remain focused on what cleft care makes possible for children, helping them to better breathe, eat, speak and live with confidence.

Nutrition Programme: Q&A with Operation Smile’s Nutrition Council

Nutrition Programme: Q&A with Operation Smile’s Nutrition Council

It’s heartbreaking to witness hopeful families arrive to our surgical missions only to leave disappointed after learning their child is too malnourished to receive cleft surgery.

This is happening to far too many families, in far too many countries where access to breastfeeding education and early nutrition intervention is limited. Our Nutrition Council, unified by people with an unrelenting commitment to save lives, aims to knockdown the barriers that stand between our patients and surgery.

Baby cup feeding technique for babies with cleft palates during screening.

Throughout this Q&A, you’ll hear from key voices on our Nutrition Council, including Adriana Olivera, nutritionist and Operation Smile Paraguay Program Coordinator; Dede Kwadjo, nutritionist and registered dietician for Operation Smile Ghana; Elsa Nel, dietician from the United Arab Emirates; and Helen Kinigopoulos, credentialed speech language pathologist from the U.S.

“I wanted to be part of the larger vision of Operation Smile’s mission,” Dede said. “The Nutrition Council provides a valuable platform where I can use my expertise as a dietitian, along with other dedicated colleagues, to ensure that no child is left behind because of poor nutrition.”

The group addresses the connection between breastfeeding, nutrition and speech development and how they are all key components of Operation Smile’s mission to deliver the highest quality of care to those who need it most.

We recently connected with Adriana, Dede, Elsa and Helen to learn why prioritizing nutrition is vital to better surgical outcomes and how serving on the council gives them a direct path to creating positive change.

Q: In your own words, why is nutrition an important part of comprehensive care for our patients?  

Adriana: “Nutrition is the base for good health. Good health gives you quality of life. Without good health, the body isn’t suitable to receive surgery, the body doesn’t recover from injuries, and a person can’t go through post-op without a good nutrition.”

Dede: “Nutrition is a vital connection between a healthy child and a successful surgical outcome. Good nutrition not only ensures that the child is healthy enough to be selected for corrective surgery, but also provides a basis for a good surgical outcome in terms of post-surgery healing.”

Elsa: “Babies and children with cleft lip and cleft palate face challenging nutrition issues from failure to take nutrition to malnutrition and failure to thrive and failure to recover after surgery. Nutrition therapy should be part of standard care for all Operation Smile patients. Early resolution of feeding problems will contribute to the vision of Operation Smile to bring hope, joy and smiles to all.”

Helen: “Without adequate nutrition, surgery is denied or delayed, surgical outcomes may be compromised, development of dentition impacted, infections become more likely, cognitive development compromised, the likelihood of a successful life imperiled.”

Q: Operation Smile will begin credentialing nutritionists for the first time in the coming year. From your experience, how do you think this will impact teams’ abilities to provide nutrition care and guidance?  

Adriana: “It would definitely be a motivation for receive more volunteers in the nutrition area. It will help highlight the nutritionist’s work and will help others see that nutrition isn’t just about giving diets or performing assessments. It has a lot of fields of action: for health improvement, the preparation of a patient for surgery, recovery and food education for a healthy life.”

Dede: “This would provide uniformity in nutritional care provided across teams and countries. It would also serve as a key factor in ensuring high standards of patient care and professional outputs across board. Thirdly, nutritional intervention is a key factor in providing care for children affected by cleft, and this would ensure it gets the attention it deserves.”

Elsa: “My first reaction is to congratulate Operation Smile for expanding the team to be more multidisciplinary and adding nutrition as an integral part of patient care by professionals with the correct training and experience.”

Helen: “Including credentialed nutritionists on Operation Smile teams is long overdue. The importance of adequate and appropriate nutrition for overall development and for improving safety and successful outcomes of surgery has been undervalued by those who haven’t experienced the consequences of malnutrition.”

Q: Why is breastfeeding so important for the nutrition of our patients?  

Adriana: “Breastfeeding has so many benefits. Human milk is the most important food for babies during the first six months of life. It provides vital protection, decreases infections, gases, diarrhea, and strengthens the immune system. This food is so complete that it’s recommended as the only source of nutrition for the baby for six months, and after the introduction of other foods, it’s recommended the continuity for two years.”

Dede: “Breast milk remains the gold standard in meeting the vital nutritional needs of our patients, especially children under 6 months. Its characteristics of being free, safe, hygienic, having the right nutrient composition for age are major determinants when it comes to the health of the vulnerable population of children born with cleft conditions. Breastfeeding, when done well, is a game changer in fighting malnutrition among our patients.”

Elsa: “Nothing beats breastfeeding in infant nutrition!”

Helen: “Given the evidence that the nutritional benefits of breastfeeding cannot be duplicated, as an organization whose main beneficiaries are infants and their families, Operation Smile can use its platform to educate, guide and mentor parents in discovering and using the best methods of providing breastmilk for their vulnerable infant.”

Q: What do you hope to accomplish by serving on the Operation Smile Nutrition Council? 

Adriana: “As a program coordinator and nutritionist, I know the importance of this specialty for patient’s selection for surgery. After working with this organization for two and a half years, I believe my experience can help promote the nutrition in Operation Smile, and by this, help our patients to be healthy by the time they have to receive their surgery and ensure a proper recovery and a healthy life.”

Dede: “I wanted to be part of the larger vision of Operation Smile’s mission in ensuring that no child is left behind when it comes to providing safe and timely reconstructive cleft surgery through strategic planning and program development. The Nutrition Council provides a valuable platform where I can use my expertise as a dietitian, along with other dedicated colleagues, to ensure that no child is left behind because of poor nutrition.”

Elsa: “To support the Operation Smile nutrition team with multiple projects to help teams, health workers and patients.”

Helen: “I represent the speech language pathologists in offering support to the Nutrition Council regarding the safety and effectiveness of feeding techniques for individuals with cleft palate and other craniofacial differences, especially those infants who have not yet had surgery.

“Nearly three decades as an Operation Smile volunteer have offered me the opportunity to learn from experience, education and personal investigation the necessity of understanding the culture, economic and living conditions in order to overcome the problems associated with feeding and nutrition of the population we serve. I hope to expand the awareness to Operation Smile speech language pathologists and other professionals of the multiple factors affecting feeding and nutrition as they relate to successful outcomes for our patients and patients-to-be.”

Q: The Nutrition Council supports Operation Smile’s nutrition team through developing educational resources for in-country teams, community health workers, volunteers and patient caregivers. How do you hope to see these making a positive impact on our patients?  

Adriana: “This is the most necessary and important action our patients need. Many of the nutrition and health problems come from the lack of information. My hope is that every person who receives these educational resources shares with their family so everyone benefits.”

Dede: “Firstly, these educational resources serve as great training materials for our nutrition teams as well as other health care professionals. This would eventually show up in the enhancement of care for our patients. Secondly, a key aspect of nutritional interventions is knowledge empowerment for the caregivers. This has been shown to increase caregiver cooperation as well as enhance care for the patients. The educational resources would serve as good knowledge empowerment tools for the caregivers.”

Elsa: “This is a great step forward in providing correct and standardized training to Operation Smile teams, which will benefit our patient population because feeding often requires extra time, patience and individualized nutrition.”

Helen: “By working with other Operation Smile volunteer professionals to solve nutrition and feeding issues, heightened awareness will help identify those who are in need of both nutritional and feeding support and interventions.”

Please include any additional thoughts you’d like to share about your experience on the Nutrition Council or serving as an Operation Smile volunteer.

Adriana: “I love that we can share our experiences working with Operation Smile in our countries. It’s very enriching and inspiring to share insights, knowledge and the same desire to help all of our patients to improve their quality of life, regardless of the specialty we have.”

Dede: “It’s been awesome working with the council and seeing how far the nutritional component of cleft care has come in the organization. I’ve enjoyed being part of development of protocols and modules. Working with other likeminded colleagues from other countries has been a great shared learning platform for me, and I’m thankful for the opportunity.”

Surgery is only one part of the comprehensive care we provide to our patients. Our established nutrition programmes around the world provide patient care, education, ready-to-use therapeutic food, formula, vitamins and more. We support families, like Elizabeth and Yaw, with supplemental food and education to optimize the patients’ growth and development before they can receive surgery.

Our promise of improving health and dignity during the COVID-19 pandemic endures. Once again, we’re providing surgery and in-person care while taking stringent measures to keep our patients, their families and our volunteers safe. Hope is on the horizon. And we remain focused on what cleft care makes possible for children, helping them to better breathe, eat, speak and live with confidence.

Women in Medicine: Clark Agno Gonzales

Women in Medicine: Clark Agno Gonzales

To celebrate International Women’s Day 2022, EMEA Recruitment welcomed Clark Agno Gonzales onto their podcast. Clark is a medical volunteer with Operation Smile.

Clark in a programme wearing an Operation Smile tshirt

“I’ve got this skill, I’ve got this talent, there’s really nothing that’s going to hold me from helping these kids.”

Clark is a nurse with the NHS in the UK. She also volunteers as a recovery room nurse on our medical programmes around the world. She explains to Paul Toms, our Founder, how many children she looks after on a typical mission and the countries that she’s visited with the charity.

Originally from the Philippines, a case that particularly stands out to Clark was in her home country. A grandfather brought one of his grandchildren for surgery, but had a bilateral cleft lip himself. When the Operation Smile team offered to operate on him, they saw an immediate transformation, which was emotional for all involved. Clark and her fellow volunteers connect after the day’s work over dinner to let their emotions out.

She was originally invited to join an Operation Smile medical programme by her university professor. Using her skills and talent, Clark sees an instant transformation in her patients.

There are up to 100 volunteers on a programme. Before the surgery day begins, they break into teams to plan, and even connect with each other before leaving for the mission. Local volunteers ensure that the Operation Smile team stays safe in each location.

Two years ago, Operation Smile organised a Women in Medicine short-term surgical programme, where 60% of volunteers were female. This teaching programme focused on empowering women to complete the surgeries on their own. Senior surgeons, nurses and dentists go along to share their knowledge with the younger generation, which aims to benefit patients and the health system in that country.

Clark reveals the challenges she faces before and during a medical mission. She also explains how she manages to fit these missions into her life, amongst a day job and new baby. It’s the “mission high” that brings joy and happiness to Clark, who even gives up her holiday time for Operation Smile.

We end the episode by finding out what Clark has learned about herself by visiting Operation Smile’s programme sites.

Listen to the full episode via your podcatcher of choice or in the link