When All Seems Lost, Hope Appears

Photo: Marc Ascher

Shocked and heartbroken when her baby Valeska was born with a cleft lip, Zorida received more discouraging news within the first moments of her daughter’s life.

No sooner than learning that surgery was possible to repair Valeska’s cleft lip, the young Nicaraguan mother was told by doctors that the procedure would be far too expensive for her and Valeska’s father to afford. The couple was informed that more affordable, possibly even free, surgical treatments could be found in Managua — a six-hour bus trip from their hometown.

Every six weeks after the birth of her bright-eyed daughter, Zorida travelled to Nicaragua’s capital only to return home dejected. Each time she sought help for her baby, she realised surgery cost much more than the family could afford. One round trip cost the family 1,800 córdobas (£45) — a massive drain on their average weekly income of 1,000 córdobas (£25) — making it so Valeska’s father couldn’t afford to accompany 17-year-old Zorida and his baby on their journeys.

“I was so sad,” Zorida said. “I felt that there was no solution for my baby.”

Back at home, Zorida experienced ridicule from neighbours who blamed her for her daughter’s condition. Drawing from deeply-rooted local superstition, they said that Valeska’s condition resulted from Zorida walking outside during an eclipse.

Photo: Marc Ascher

“People laugh at my baby,” Zorida said. “They taunt her and I hear others talking about her. They tell their children that she’s horrible and if they stare at her, they could look that way too.”

Zorida couldn’t help but to feel a sense of guilt that Valeska was born this way.

“I thought it was somehow my fault,” she said. “I thought that somehow this was God’s judgment on me.”

As hope and resources dwindled after 10 months of searching, a call from the local hospital provided relief for the young family. Operation Smile was conducting a medical mission in Estelí — three hours away — and that free surgery was possible for Valeska.

Again, Valeska’s father struggled to earn the money to pay for the bus fare. Like each of the previous trips to Managua, he was unable to embark on this life-changing trek.

Anaesthesia resident Anna Bengsston of Sweden comforts Valeska. Photo: Marc Ascher.

At the medical mission’s site, Hospital San Juan de Dios, Zorida waited nervously while holding Valeska. Naturally, she remembered her unsuccessful attempts to access safe surgical care for her daughter and the disappointment that inevitably followed. After a successful screening, Zorida beamed with pure elation when she learned Valeska was selected for surgery. Now, she could exhale knowing that the bus ride back home would be filled with joy instead of despair.

In a single surgical procedure, Operation Smile volunteers repaired Valeska’s cleft lip, giving her a beautiful new smile in time for her first birthday.

Since Valeska’s surgery, Operation Smile Nicaragua opened the doors of its new cleft lip and cleft palate care centre in Managua in May 2016. The largest of its kind in the country, the centre serves as the administrative and educational headquarters for Operation Smile’s medical programmes as well as the treatment site for over 800 patients who regularly receive follow-up care. Its presence also helps eliminate resource-draining searches for families like Valeska’s.

Photo: Marc Ascher

Women in Medicine: Mentoring the Next Generation

Our promise of improving health and dignity during the COVID-19 pandemic endures. We’re helping frontline health workers stay safe, nourished and empowered to better serve their patients by providing life-saving supplies and equipment, as well as remote training to bolster their response. We’re also providing nutritional assistance, hygiene kits and virtual health services to support people and their health needs so they can thrive. If you can, when you can, help us keep our promise to care for children and create hope for tomorrow.

Standing alongside the women who mentored and inspired them, our instructors became mentors themselves, passing on their knowledge, passion and expertise as volunteers to their students who will lead future generations for years to come.

The female volunteers who serve pivotal roles in delivering high-quality surgical and multi-disciplinary care to patients affected by cleft were celebrated during our first international medical mission comprised entirely of women: Women in Medicine: Inspiring a Generation.

“On average, an Operation Smile medical mission team is comprised of 60 percent female volunteers,” said Kathy Magee, Operation Smile Co-Founder and President. “We already know that our work simply wouldn’t be possible without their talent, generosity and compassion.”

Two-year-old Radouane smiles wide as he waits with his mother to receive his comprehensive health evaluation during screening day. Photo: Jasmin Shah.

In Oujda, Morocco, the female-led team of more than 50 medical volunteers from 25 countries joined forces to efficiently and collaboratively provide 286 patients with comprehensive health evaluations.

Of that total, nearly 130 children like Radouane received life-changing surgeries and brighter futures.

Nearly three years ago, Radouane’s mum, Safia, gave birth alone at home. But even after seeing his cleft lip, the love she had for him never faltered.

“I was not afraid. I’d seen kids like that before, and I knew that this was the gods’ fate. I’m grateful for what the gods gave me,” she said. “He’s my son. I love him, no matter what.”

While once bullied for having an unrepaired cleft condition, Radouane now has a renewed chance at a dignified and healthy life thanks to the dedicated women who volunteered their time and skill to the mission.

But changing lives through surgery wasn’t the only accomplishment the all-female medical team achieved during this mission.

“Biomed techs, nurses, surgeons, dentists all come together and, with their different skills, teach everybody something new,” said volunteer dentist Dr. Carmen Kamas-Weiting from the U.S.

Volunteer cleft surgeon Dr. Wafaa Mradmi (right) instructs a fellow surgeon during the cleft lip and cleft palate surgical training workshop Photo: Jasmin Shah.

The team engaged in training and mentorship activities, including an innovative cleft surgery simulation workshop for plastic surgery residents.

The training and education components of the mission provided enrichment opportunities for female physicians that might not otherwise be available to them.

Cleft surgeons Drs. Wafaa Mradmi of Morocco, fellow mentor Irene Tangco of the Philippines and Saloua Ettalbi of Morocco led the surgical simulations. Thanks to their expertise, medical students as well as certified plastic surgeons learned techniques unique to performing surgery on people with cleft, resulting in improved surgical outcomes for patients.

These simulations not only enhanced skills and empowered the medical professionals involved, but they also acted as another step toward these women one day becoming a credentialed volunteer surgeons for Operation Smile.

“I think, as a surgeon who has technical skills, we are really blessed,” Wafaa said. “We have this unique chance to help people, to pass on our skills to the new generations for them to be able to give this cure and this care to those kids. I had this chance with Irene many years ago, and I’m still learning from her.”

Malnourished due to her cleft lip and palate, 1-month-old Janat arrives at Operation Smile Morocco's care centre in Oujda to be fitted for a feeding plate by the volunteer female dental team. Photo: Jasmin Shah.

Dental training workshops also took place at the Operation Smile Morocco year-round care centre in Oujda, which allowed the dental students involved to enhance their knowledge of the intricacies that go into delivering high-quality pre- and post-surgical dental care to patients living with cleft.

When 1-month-old Janat arrived with her parents, Carmen alerted her fellow dental volunteers after realising that Janat was severely malnourished due to her cleft lip and palate.

Volunteer dentist and leader of the workshops Dr. Teresita Pannaci of Venezuela sprang into action and transported Janat and her family to the centre to be fitted for a feeding plate.

A few of the dental students were given the real-life opportunity to apply what they learned from the workshops during Janat’s two visits to the centre.

It was there that Teresita demonstrated how feeding plates are measured and moulded and why the plates can be life-saving for patients with severe cleft palates like Janat.

“For me, being an instructor or teacher in this is extremely important because … we need a generation to inherit this and inspire generations,” Teresita said. “It’s what we’re doing here. When I see this new generation that we’re beginning to train, they’re working, they understand what their role is, they are committed to the lives of patients.”

The soft mould of Janat's cleft palate which eventually became her feeding plate. Photo: Jasmin Shah.

Since being born, Janat had lost nearly half of her birth weight by the time she arrived to the mission. Her undernourishment was due to the challenges her mother, Fatima, faced when attempting to feed her.

Janat’s cleft palate would cause her to choke with milk coming out of her nose. Not knowing who to talk to or what to do, Fatima felt helpless and feared for her daughter’s life as she saw Janat’s health start to decline.

“I was afraid that I was going to lose her,” Fatima said.

Thanks to the feeding plate that Janat and one other child received at the centre from Teresita, Carmen and the dental team, eating, breathing and drinking became easier for her.

Fatima shared that Janat would only drink an average of 3 ounces of milk throughout a day. After testing out her new feeding plate, Janat drank 2.5 ounces in 10 minutes. According to Fatima, it was the first time she’d ever seen her baby drink without suffocating.

Volunteer dentist Dr. Teresita Pannaci, left, looks on as Janat's mom, Fatima, feeds her daughter for the first time with the addition of the feeding plate. Photo: Jasmin Shah.

“It was lovely to see our volunteers coming from the 25 countries, from five continents,” said Operation Smile Morocco Co-Founder Fouzia Mahmoudi. “Sharing their know-how with our residents and our surgeons, sharing it with the same love, with the same dedication, from the bottom of their heart. We are just a university without walls.”

Team photo on the second day of screening for Operation Smile's Women in Medicine: Inspiring a Generation medical mission at Hospital Al Farabi in Oujda, Morocco. Photo: Jasmin Shah.

For people interested in joining the medical field, hoping to one day impact the lives of patients like Radouane and Janat, volunteer post-anaesthesia care unit nurse Florence Mangula has a message.

“I would tell them, “Take up your position, do it with all your heart, so that you’re able to help the less fortunate people in the community. Do it with the passion to see somebody smile, the passion to see a family united, the passion to remove the stigma from the family and make a child smile.”

Help us keep our promise to more patients amid the COVID-19 pandemic. Your support today means we can continue to help them through these uncertain times and provide them with the surgery they deserve when it’s safe to resume our work around the world.

Post-anaesthesia care unit nurse Florence Mangula of Kenya checks in on a patient and their mother after surgery in the recovery room. Photo Jasmin Shah.

Meet Our Patients: Mossoró, Brazil

In 2017, 67-year-old Dona Maria received surgery during an Operation Smile Brazil medical mission. Photo: Marcelo Braga.

Our promise of improving health and dignity during the COVID-19 pandemic endures. We’re helping frontline health workers stay safe, nourished and empowered to better serve their patients by providing life-saving supplies and equipment, as well as remote training to bolster their response. We’re also providing nutritional assistance, hygiene kits and virtual health services to support people and their health needs so they can thrive. If you can, when you can, help us keep our promise to care for children and create hope for tomorrow.

In the densely populated city of Mossoró, Brazil, Dona Maria spent her entire life living with an unrepaired cleft lip.

While she undoubtedly faced challenges and overcame obstacles because of her cleft, 67-year-old Dona Maria consistently dreamt of one thing.

Though seen by many as a simple pleasure, what she wished for most was to wear lipstick.

During a 2017 Operation Smile Brazil medical mission, Dona Maria passed her health evaluation and underwent her long-awaited surgery, feeling closer than ever to reaching that dream.

Dona Maria 2

Moments after waking from the operation, Dona Maria felt eager to see her new smile.

After 67 years of living with a cleft condition, she proudly showed the entire medical volunteer team who were thrilled to be a part of that special moment.

After allowing her lip to properly heal from surgery, Dona Maria could finally live out her dream of putting on red lipstick for the first time in her life.

Laine Paiva, a volunteer photographer for Operation Smile Brazil, was so moved by Dona Maria’s story that she arranged a photoshoot with her, capturing images of her dreams becoming reality.

Thriving thanks to timely surgery

Olga and her daughter, Lungile, before surgery. Photo: Zute Lightfoot.
Olga and her daughter, Lungile, before surgery. Photo: Zute Lightfoot.

When Olga gave birth to her daughter, Lungile, her joy lasted only for a fleeting moment before she was overwhelmed with shock.

Lungile was born with a cleft lip, a condition that Olga had never seen before.

Distraught and heartbroken, Olga and members of her family struggled to understand why Lungile was born with a cleft lip*. They also struggled with the uncertainty of whether or not she would be able to receive treatment.

“I was scared the first time I saw her,” said Lydia, Lungile’s grandmother. “I thought there would be no one to help her.”

But as the family’s initial feelings of shock faded, their unconditional love for Lungile only grew.

Olga said that while the doctors and nurses at the hospital assured her that surgery to repair Lungile’s lip was possible, they also explained that the waiting list was very long and that it may take years before she could receive an operation.

Photo: Zute Lightfoot.

It’s critical that babies born with cleft conditions receive surgery as soon as they are old enough and healthy enough to undergo anaesthesia. The longer Lungile’s wait for surgery, the longer her condition could put her health at risk. Her speech and dental development could become impaired. She could suffer from emotional hardships, such as bullying and social isolation, throughout those precious, formative years.

Soon after receiving this discouraging news, Olga met Dr. Vanessa Soares, an Operation Smile South Africa medical volunteer and dentist at the same hospital where Lungile was born. Vanessa told Olga that Operation Smile provides free surgeries for children born with cleft conditions, like Lungile, and provided her with the organisation’s phone number.

Immediately, Olga called Operation Smile South Africa and learned that a medical mission would be coming to the family’s home town of Mbombela just after Lungile’s first birthday – within the ideal time frame for cleft surgery.

Fortunately for Lungile, her cleft lip did not prevent her from feeding properly as it does for so many babies born with cleft conditions. Difficulty in feeding can lead to life-threatening malnutrition which also prevents potential patients from being healthy enough to undergo anaesthesia. To combat this barrier to surgical care, Operation Smile has established nutrition programmes in places where malnutrition is prevalent, such as Madagascar, Ghana and Malawi, to help children gain weight and become healthy enough for surgery.

When the medical mission arrived to Mbombela, Olga was surprised to see so many children with cleft conditions. The Operation Smile medical team conducted comprehensive health evaluations to determine which patients were healthy enough to receive surgery. Olga was elated to learn that Lungile was among those selected to get an operation during the medical mission.

Naturally, Olga was anxious as her daughter was wheeled into the operating room. In less than an hour, she was reunited with Lungile in the recovery room as she woke from anaesthesia.

She couldn’t believe her eyes when she saw her daughter for the first time after surgery.

Olga and Lungile, after Lungile's cleft lip surgery. Photo: Zute Lightfoot.

Olga’s anxiety was replaced by joy and gratitude as she reflected on the compassion of the Operation Smile medical team and Vanessa.

“What she has done for me –” Olga said of Vanessa, pausing as her emotions welled up. “I love her.”

A year after her surgery, 2-year-old Lungile is thriving.

“Lungile loves to dance hip hop, listen to Rihanna and play her brothers’ musical instruments,” said Olga, who has become an advocate for Operation Smile South Africa in her community.

“I was out shopping with Lungile, and I met a lady who burst into tears because her daughter also had a cleft lip, and so I told her she would be OK,” said Olga, who accompanied the mother and her child to the next Operation Smile medical mission to Mbombela. “The baby, Ntando, and Lungile have become great friends.

“I will tell people in my community who have children born with cleft lip that their children can be fixed and they will look nice.”

Photo: Zute Lightfoot.

* Editor’s Note: While it’s difficult to determine the exact cause of an individual’s cleft condition, research from Operation Smile’s International Family Study shows that cleft conditions can be caused by genetics, environmental factors or a combination of both.

Voices From the Front Line: Q&A with Nurses Rodney and Marijose Kapunan

Volunteer nurses and frontline healthcare workers Marijose and Rodney Kapunan. Photo courtesy of Rodney Kapunan.

Our promise of improving health and dignity during the COVID-19 pandemic endures. We’re helping frontline health workers stay safe, nourished and empowered to better serve their patients by providing life-saving supplies and equipment, as well as remote training to bolster their response. We’re also providing nutritional assistance, hygiene kits and virtual health services to support people and their health needs so they can thrive. If you can, when you can, help us keep our promise to care for children and create hope for tomorrow.

Learning that a family member received surgery from Operation Smile initially inspired Marijose and Rodney Kapunan to become volunteers, but it’s their selfless desire that motivates them to risk everything today in an effort to support patients through these challenging times.

“Growing up poor in the slums of Manila, I always dreamed of getting out of poverty and being able to practice in a caring and well-respected profession, travel the world and give back to my country and community,” Rodney said. “I’m not rich financially, but I feel abundant that I’m able to share my blessings.”

Bonded as nurses, parents and devoted volunteers, the duo feels united as they serve a role in confronting the devastating impacts of the COVID-19 pandemic together.

Having delivered care to children on more than 25 Operation Smile medical missions combined, Marijose and Rodney are now applying that commitment, skill and unwavering compassion to touch the lives of patients affected by the coronavirus.

“We nurses are in the front, centre and back in the fight against this global pandemic,” Marijose said. “Nurses are valuable assets in formulating plans and processes to better manage the disease and prevent future outbreaks.”

We recently sat down with Marijose and Rodney to hear more about what precautions they’re taking to protect the ones they love as well as where their eagerness stems from when they speak about one day getting back into the field for Operation Smile.

Photo courtesy of Rodney Kapunan.
Photo courtesy of Rodney Kapunan.

Q: What inspired you to become a nurse?

Rodney: “I get a lot of accomplishment and pleasure in helping people and the community in any way I can. It gives me an opportunity to positively impact patients by providing comfort to people throughout their most vulnerable moments, being an advocate, confident and a trusted adviser. I also like talking to people, making genuine connections and being able to inspire and motivate my patient to be able to overcome their illness and be a productive member of society. Lastly, I always wanted to be in a profession that is well respected, trusting and where I can exercise compassion on a daily basis. I can easily do that in this profession.”

Q: With both of you working on the frontlines in your hospitals, what precautions do you take to ensure the safety of patients, your children and other members of your family?

Marijose: “When Rodney or myself comes home from work, we strip off our clothes in the laundry room, separate our laundry from our children’s and shower before we even see our kids.”

Rodney: “I work in the emergency room, which is still receiving a lot of patients. The ER has to be restructured because of the coronavirus. So, aside from working, we’re also formulating ways to make our patients safe and us as well. Entering this profession, I always knew that there was going to be a risk. We have to be more vigilant. It’s scary. We’re trying to not only find ways to be safe in the hospital, but at home as well so that we will not spread it to our kids. I don’t blame people for being scared. We try to be a good resource for friends and family.”

Q: What is the environment like in your hospital? What limitations have you and your other medical professional faced?

Rodney: “We are still on lockdown, visitors are still restricted, we are still screening, checking temperatures and masking everyone who comes inside our facility. We’re required to wear level one masks all the time and complete personal protective equipment (PPE) and an N95 mask if patients check in with flu-like symptoms. Especially now, all the hospitals are on heightened alert for a possible outbreak.”

Marijose: “The most obvious limitation we had during this pandemic was a lack of preparedness on this kind of situation. Guidelines were changing almost every day and morale and confidence of the employees were low because they were scared of the disease and scared of losing their jobs. We also had problems with PPE distribution and inventory because we’re masking everyone that steps in the hospital. I just hope that after this pandemic, processes will be established to better prepare ourselves if anything like this happens again.”

Q: What have you learned or experienced from being a volunteer with Operation Smile that’s helped prepare you for responding to COVID-19?

Marijose: “Before the start of every mission, safety is emphasised. Safety of volunteers, patients and their families take priority. Once safety is established, take a deep breath, and gather as much information as possible and collaborate with team leaders for the course of action. Lastly, trust the plan and processes in place and evaluate the appropriateness of the plan.”

Q: In the light of this pandemic, why do you feel it’s so important to recognise nurses and the role they serve in the medical field?

Marijose: “As the largest sector of healthcare workers in every country, we nurses are in the front, centre and back in the fight against this global pandemic. Nurses are on the frontline triaging patients and sorting out possible patients with the virus and quickly moving them to be quarantined and protecting other patients who may not have the disease. Nurses are also in the middle of the action, taking care of patients in the intensive care unit, assisting in medical and surgical procedures, making certain medical supplies and PPE are maintained and protected.

“Enforcing sanitation and hand-washing, answering calls from the public and giving up-to-date information regarding the disease. And increasingly, nurses are valuable assets in formulating plans and processes to better manage the disease and prevent future outbreaks. Nurses are such a valuable part of the medical team and thus deserving of all recognition for what they do.”

Q: It’s a very stressful time in our world right now. How are you and your family doing personally with the impact this virus has placed on you? What emotions are you feeling as you continue to face this crisis head on?

Rodney: “Right now, we are staying positive and optimistic. We keep our faith to God and always pray for protection and strength. We as a family are staying humble and grateful, that despite my wife and I are both working in the hospital, we are both in good health and have not brought the virus home.”

Marijose: “We are staying vigilant with our hand-washing and infection control plans for home. We are also adjusting to home schooling our kids, doing more indoors activities, like sewing masks and learning a new language to occupy our time. We’re also educating our family that this virus is with us now and that social distancing and wearing masks is the new world once society starts opening up.”

Q: What motivates you to continue volunteering for Operation Smile even after the pandemic ends?  

Marijose: “I believe in this organisation. There is always hope. I’m encouraged and touched by the outcomes because I work in the operating room for Operation Smile missions and I see the before and after.”

Rodney: “It’s always a blessing to be a part of it. It’s hard work, we leave our family behind, but I always tell my wife, ‘We always go back thinking that we receive more than we actually give.’ I still find joy and accomplishment in what I do, I feel that I still have a lot of love and care to give to my patients. I still enjoy detective work, seeing a wide variety of patients, having more autonomy in their care, learning new life-saving techniques and most importantly, I still love making a difference in a single person’s life and my community.”

Photo courtesy of Rodney Kapunan.
Photo courtesy of Rodney Kapunan.

This Radio Programme Is Saving Lives

Editor’s note: Since Operation Smile’s founding in 1982, delivering safe surgery to people living with cleft conditions in low-resource settings around the world has been – and will continue to be – its driving force. 

But as the organisation expanded into more and more places of dire need, it has been met by the devastating effects of hospitals operating with inadequate infrastructure and equipment. 

Fuelled by the foundational belief that everyone in need of surgery deserves exceptional care, Operation Smile is applying its expertise in treating cleft conditions to create sustainable solutions that will bring safe and essential surgery to people where it’s needed most.

In rural northeastern Nicaragua, this life-saving work is already underway through a pilot project called Cirugía para el Pueblo – “Surgery for the People.” For deeper context on the problems that this initiative is addressing, follow this link to watch the video and read more.

Throughout many homes in the rural town of Bonanza, Nicaragua, radio speakers erupt with the sound of a woman’s voice.

And people are listening.

By reaching out into the community, Dr. Brenda Tinoco is helping knock down the physical and economic barriers that prevent people from travelling to the hospital.

Single mothers like Rosa Emilia are learning about cervical cancer. Working men like Javier are being educated on how to stay healthy. And so many others are feeling supported, knowing that they will have access to surgery and healthcare when they need it.

“What we want to achieve with the radio programme is to relieve the community’s fears,” Brenda said. “So that they know more and can identify warning signs in time and make the decision to go to the hospital to seek help.”

Drs. Brenda Tinoco and Alvaro Martinez use the radio programme to inform the community. Photo: Jörgen Hildebrandt.

As a general physician and site coordinator, Brenda is providing knowledge of treatment opportunities through a pilot project called Cirugía para el Pueblo – “Surgery for the People.” With support from the UBS Optimus Foundation, Operation Smile and Nicaragua’s Ministry of Health are working together at the two primary hospitals in Siuna and Bonanza. By joining forces, Operation Smile and the Ministry of Health seek to improve the surgical infrastructure of the hospitals and to spread awareness about surgically treatable conditions to the people of the region.

Before the radio programme, an overwhelming hurdle for patients and their families was lack of knowledge about the cause of their symptoms which inhibited many people from receiving crucial care at the right time.

“Sometimes they think that they have been cursed, so coming to the hospital won’t help,” Brenda said. “Others are scared to have surgery, mainly because of the anaesthesia.”

Javier listens to the radio as he mines for gold. Photo: Jörgen Hildebrandt.

Men, women and children were dying from treatable illnesses because they were not being informed. But through education and awareness efforts, more patients are being treated and more lives are being saved. Yet, even when people recognise the need to pursue medical care, they are being confronted with the cost and hardship of travelling to a hospital while leaving their families behind.

“There are many barriers in our community that keep people from coming to the hospital in time. One of those is distance,” Brenda said. “There are communities where it can take up to two days to reach the hospital.”

With this project’s location, nothing stood in Danisa’s way when her son needed surgery for his umbilical hernia. For her, having this project close to home saved her son’s life.

“There are some people who don’t have money to go to Managua,” Danisa said. “And some children die, so it is important for the benefit of all to have this project here.”

Surgery for the People is a reason why people like Danisa, Rosa Emilia and Javier can trust that they will receive the safe and effective care to which they’ve never had access before.

Photo: Jörgen Hildebrandt.

Complete Care from Start to Finish: Q&A with Anaesthesiologist Nur Lubis

Volunteer anaesthesiologist Dr. Nur Lubis of the UK during the Women in Medicine: Inspiring a Generation Operation Smile medical mission in Oujda, Morocco. Photo: Jasmin Shah.

Our promise of improving health and dignity during the COVID-19 pandemic endures. We’re helping frontline health workers stay safe, nourished and empowered to better serve their patients by providing life-saving supplies and equipment, as well as remote training to bolster their response. We’re also providing nutritional assistance, hygiene kits and virtual health services to support people and their health needs so they can thrive. If you can, when you can, help us keep our promise to care for children and create hope for tomorrow.

From screening to the operating room to the post-operative ward, anaesthesiologists like Nur Lubis ensure the safety and health of every patient at all phases of care.  

Born in Malaysia and now working in the U.K., Nur has attended eight medical missions including Operation Smile’s first mission comprised of all female volunteers: Women in Medicine: Inspiring a Generation.

“It’s really inspiring,” Nur said. “Working with a big group of women and learning about each other’s roles. I’m hoping that being on this all-women’s mission will enable me to empower my trainees, especially the female ones.”

For Nur, it’s the skill-sharing and collaboration between a diverse team of people who want to achieve a mutual goal that reinforce her love and devotion of a career in medicine.

“I’m always learning something new,” she said. “That’s something that I can bring back to my work in the U.K. That makes me feel really proud to be a part of the team.”

We recently caught up with Nur to learn more about participating in our women’s mission in Morocco as well as hear about special moments she’s shared with patients and their families.

Photo: Jasmin Shah.

Q: What inspires you in your profession as an anesthesiologist?

A: “Ever since I was a resident, I’ve always wanted to volunteer with Operation Smile. I actually went as a resident to a mission in the Philippines in 2012, while I was still training in anaesthesia. I had a brilliant mentor and was encouraged to continue being a volunteer once I qualified as a consultant. Ever since then, I’ve done a mission a year or two missions a year. I hope to continue being a volunteer with Operation Smile.”

Q: What keeps you coming back?

A: “What keeps me coming back is the energy and the enthusiasm of working together with different professions, also with different colleagues from all over the world. I’m always learning something new in each mission. That’s something that I can bring back to my work in the UK. Often, there’s better ways of doing things that we haven’t thought of, and working in this kind of environment is such a brilliant way to meet different colleagues and share different ideas.”

Q: How does it feel to be surrounded by so many leading women in their fields during the first-ever Operation Smile all-female medical mission?

A: “It’s really inspiring. Everyone’s making a huge difference in their little way. Everyone is able to work together in a very positive way. I think we’ve managed to work really, really well as a team. We’ve been very encouraging to each other, we’ve learned lots from each other as well. It’s been very empowering, looking at women in different areas within Operation Smile. They’re each amazing in their own way and in their profession. That’s been really wonderful to see.

“It’s a very highly skilled workforce because everyone is at the height of their career. The surgeons are fully trained and so are the anaesthesiologists. But at the same time, we’ve also got residents who are here with us. We hope to empower them as well and to be their mentors. The same with the biomed, which is usually a very technical specialty. There are usually men on the missions, and it’s great to see the two women biomeds who are brilliant at their jobs. It’s just been really amazing. There’s a lot of sharing of information, which is great and very clear communication. I think everyone’s very much rooting for each other.”

Q: Do you think the volunteers at this mission feel energetic and motivated because they’re all working toward one common goal?

A: “Yes, you can see that everybody is enthusiastic to be here. We’ve got the nurses, paediatricians, dentists that look at their teeth and the obturators. Then in the operating room, there’s anaesthesiologists, the surgeons, and the biomed tech, who makes sure all our equipment works well. Not to forget the medical records team, and they’re there to make sure that we are vigilant in recording all the information so that when they [the patients] come again for follow-up, everything’s very clear and safe.

“We’re all working together for the common goal of providing cleft lip and cleft palate surgery safely for the children here in Morocco. Our focus is to get the best care for those children and to make sure that they have a good experience, not a scary one.”

Q: The theme of this women’s mission is to “inspire a generation.” What does that mean to you?

A: “I’m hoping that being on this all-women’s mission will enable me to empower my trainees, especially the female ones, to volunteer with an organization like Operation Smile. There’s always been a lot of interest in wanting to get involved. I think it’s good being a mentor to these trainees and showing them the way to do it, that it’s possible to have a career and do voluntary work at the same time, especially if you’re a woman.

“I would say that a career in medicine is great, it’s really rewarding. It’s really hard work, but I love it. When you love your job, it’s not really a job, it’s fun.”

Q: What is it about Operation Smile missions, not just the women’s mission, that you look forward to or that really touch your heart when you’re delivering care?

A: “I think the most special moment of the mission is, two moments, really. One is when the mums or the parents give their child to you to be taken into the operating room. You can see that there are a lot of emotions there. To them, it’s a big responsibility to take the child and to keep that child safe during surgery. The other special moment, which is even better, is to hand that child back to the mum and for the mum or the parents to see that the child is okay.

“For me, it’s more the fact that the procedure is actually a very safe surgery and that can be done over a short time. It makes such a big difference to them. I think that’s what really strikes me. These kids often don’t have that option available to them if Operation Smile was not operating in their country. Giving them that opportunity and opening up the rest of their life, I think that’s something really special.”

Help us keep our promise to patients amid the COVID-19 pandemic. Your support today means we can continue to help them through these uncertain times and provide them with the surgery they deserve when it’s safe to resume our work around the world.

Photo: Jasmin Shah.

This Man Turns “Junk” Into Lifesaving Equipment

Editor’s note: Since Operation Smile’s founding in 1982, delivering safe surgery to people living with cleft conditions in low-resource settings around the world has been – and will continue to be – its driving force.

But as the organisation expanded into more and more places of dire need, it has been met by the devastating effects of hospitals operating with inadequate infrastructure and equipment.

Fuelled by the foundational belief that everyone in need of surgery deserves exceptional care, Operation Smile is applying its expertise in treating cleft conditions to create sustainable solutions that will bring safe and essential surgery to people where it’s needed most.

In rural northeastern Nicaragua, this life-saving work is already underway through a pilot project called Cirugía para el Pueblo – “Surgery for the People.” For deeper context on the problems that this initiative is addressing, follow this link to watch the video and read more. 

Henry Parrales opens the metal gate that leads to a small plot of land behind the primary hospital in Bonanza, Nicaragua.

Just around the side of the building lies twisted piles of what appears to be garbage at first glance.

A closer look reveals that it’s anything but trash.

“Before I started here, they just said, ‘This equipment doesn’t work,’ and the health workers threw it away,” Henry says as he surveys the tangled masses of discarded medical equipment.

Henry Parrales stands among the piles of discarded equipment from the primary hospital in Bonanza. Photo: Jörgen Hildebrandt.

Exposed to the harsh Nicaraguan elements, these devices’ days are numbered. But today, Henry is making sure that no more pieces of critically needed medical equipment suffer the same fate.

As a biomedical technician, Henry is part of a project called Cirugía para el Pueblo – “Surgery for the People.” Supported by the UBS Optimus Foundation, the private/public partnership between Operation Smile and Nicaragua’s Ministry of Health is improving the surgical infrastructure of two primary hospitals and spreading awareness about surgically treatable conditions to the people of Nicaragua’s remote and impoverished north-eastern region.

Henry’s role in the project is to perform maintenance on medical equipment and ensure that each machine is functioning properly.

Between March and September 2018, Surgery for the People’s biomedical team repaired more than 200 pieces of medical equipment, saving more than $316,000.*

For many patients in this area of the country, their survival may depend on the equipment that he repairs.

Henry performs maintenance on hospital medical equipment. Photo: Jörgen Hildebrandt.

In the hospital’s workshop, Henry lends his masterful touch to a piece of equipment that would have likely ended up in the pile behind the building before he began working on the project.

“What I am fixing now is a nebuliser, which is used to relieve children’s breathing difficulties,” Henry says. “We use this daily, especially in emergencies, since the climate here is varied and breathing difficulties are common.”

Every day, Henry applies his knowledge and skill to ensure that the hospitals are the safest possible places for their patients.

He monitors and repairs crucial equipment like defibrillators, which are used to save lives during cardiac arrest. By prioritising neonatal equipment, Henry ensures that the hospitals’ youngest patients receive the care that they deserve.

“Also, I check the operating theatre and the emergency room so that surgery can be safe,” says Henry. “It is my job to check that all of the equipment works perfectly.”

And thanks to Henry, the “junk” that would once be tossed aside is now being turned into equipment that will function as designed: to help save lives.

“I am very happy with my work,” Henry said. “There is less waste and the money can be used to buy medicines and improve other areas.”

Photo: Jörgen Hildebrandt.

* These figures were derived from field reporting and are dynamic and subject to change.

Reflection on Workplace – Lindsay

LINDSAY MISSION

NHS practitioner Lindsay explains what it’s like working on a COVID ward and how her experience on Operation Smile missions has helped her dealing with the pandemic.

Whilst attending our shift handover in the operating theatre department tearoom, I felt a strong sense of Déjà vu.

It reminded me so much of the morning meetings on an Operation Smile mission. The ‘buzz’, anticipation and the many questions being asked. Some familiar faces and lots of new ones.

As the virus became more prevalent in our workplace our shift patterns changed and our teams as well. We have been placed in teams of about 23 practitioners, Team A (that’s me!), B, C, D, E. Our shifts have also changed to 8-9 (13 hours) day and night. I recently was able to reduce my hours to part-time and so returning to these long difficult shifts is a challenge.

Just like an Operation Smile mission, when days can be long, we all keep each other going, support those who are tired or sad, play music (when appropriate) teach each other new skills, have breaks when possible and get through the shift with humour and kindness.

Safety is paramount, always. There are many human factors to consider so I am grateful for my H/F faculty training and Operation Smile for allowing me the opportunity to experience surgery in developing countries which has prepared me for this pandemic.

Instead of going into work feeling confident, I feel anxious, not knowing where I will be allocated. I am finding myself working with staff from other areas and I don’t know their strengths or weaknesses, just as they do not know mine.

We also are expected to cover shifts in ITU where full PPE is worn all day (12 hours). I am completely out of my comfort zone in this intensive environment. I admire the staff who work there. Wearing PPE for so many hours is very uncomfortable, hot and difficult to communicate.

Lindsay PPE

To identify ourselves we use stickers or tape to write our name/role on and attach them to our gowns or visors, a practise close to my heart.

I bought this excellent idea back to my workplace after my very first mission to Vietnam in 2014, back in my own department this was met with varying degrees of acceptance. However, with Covid-19 and wearing PPE this has become the norm. I hope it continues! Knowing someone’s name and role can be vital in an emergency situation.

Operation Smile has taught me to ‘make things work’. To be practical and use my common sense, get creative and to use all of the expertise in the team whilst at all times being aware of the situation and keeping our practise safe. I feel that these skills have been honed in on during this pandemic.

I am finding my position at work very tough, it’s an unprecedented time. I feel emotional and often sad, but I am coping.

On the 12th of April, John my partner and I were to be married and I should be in the Maldives on our honeymoon now! Instead I am preparing for a night shift in emergency theatre.

If I can help to fight this virus I will. As a nurse there is no question about that.

I am so looking forward to an Operation Smile mission, I cannot tell you how much I miss it and my ‘OP Smile’ family.

I send love and best wishes to you all and take comfort in your support.

Lindsay

This Selfless Mother Finally Receives Lifesaving Surgery

Editor’s note: Since Operation Smile’s founding in 1982, delivering safe surgery to people living with cleft conditions in low-resource settings around the world has been – and will continue to be – its driving force.

But as the organisation expanded into more and more places of dire need, it has been met by the devastating effects of hospitals operating with inadequate infrastructure and equipment.

Fuelled by the foundational belief that everyone in need of surgery deserves exceptional care, Operation Smile is applying its expertise in treating cleft conditions to create sustainable solutions that will bring safe and essential surgery to people where it’s needed most.

In rural northeastern Nicaragua, this life-saving work is already underway through a pilot project called Cirugía para el Pueblo – “Surgery for the People.” For deeper context on the problems that this initiative is addressing, follow this link to watch the video and read more.

Surrounded by her family, Nicolasa is wheeled toward the operating room.

After passing through the door, she stands and takes a brave step toward living a life free of pain.

Enduring years of immense discomfort from a large kidney stone and its resulting complications caused Nicolasa to lose much of her strength. But listening to her talk about the dedication she has for her family proves that she is anything but weak.

Nicolasa poses with members of her family. Photo: Jörgen Hildebrandt.

“They told me that I won’t have any wounds, that it is done using a laser,” Nicolasa says about her impending surgery. “And that it will make my recovery faster so I can look after my son.”

She refused to give up after a tragic accident left her son paralysed from the neck down many years ago. Even as she dealt with the unbearable pain, she continued to make sacrifices in order to care for him.

Unfortunately, not being able to leave Suina to receive surgery was one of the sacrifices.

Leaving her son behind was never an option for Nicolasa, and surgery remained out of reach – until now.

Today, Nicolasa and so many other patients like her who suffer from treatable illnesses can access the care that they need and deserve. With support from the UBS Optimus Foundation, Operation Smile and Nicaragua’s Ministry of Health are working together on a pilot project at the two primary hospitals in Siuna and Bonanza called Cirugía para el Pueblo – “Surgery for the People.” By joining forces, Operation Smile and the Ministry of Health seek to improve the surgical infrastructure of the hospitals and to spread awareness about surgically treatable conditions to the people of the region.

Urological surgeon Dr. Augustin Mendoza. Photo: Jörgen Hildebrandt.

With a new laser technique, urological surgeon Dr. Augustin Mendoza operates using equipment that allows patients like Nicolasa to undergo surgery without invasive measures or painful recoveries. And because of its location, the project makes this care and technology accessible for more people who need it close to home.

“Surgery for the People improves access to healthcare to people who, for many years, didn’t have this access,” Dr. Mendoza said. “Surgery for the People is opening possibilities to people from the most remote areas, providing surgery that is safe and of high quality.”

Photo: Jörgen Hildebrandt.

As Nicolasa rests in the hospital’s recovery area, she grasps Dr. Mendoza’s hand.

“Thank you,” she says to him. “May God light your way.”

The day after her surgery, Nicolasa is ready to leave the hospital, return to her son and put 20 years of pain behind her.

Nicolasa and Dr. Mendoza after surgery. Photo: Jörgen Hildebrandt.