Updates from India – An interview with Abhishek Sengupta

In the past weeks we have all witnessed with concern how the second wave of Covid-19 was unfolding in India. Here’s an update about our programmes in the country from Operation Smile India Executive Director, Abhishek Sengupta.

How is the current situation in India?

The second wave of the pandemic have been brutal on India. In terms of absolute number of new infections per day and number of deaths per day, the second wave has been devastating, much more severe and sudden than the first wave. Health systems were on the verge of a collapse with a shortage of drugs and oxygen. The government of India scrambled all resources to plug the gap due to increased need for oxygen beds and ICU beds. At some places even military personal and doctors were deployed. Also several armed forces hospitals have been opened up for the general public to address the sudden increase in demand for hospital beds.

How has India’s second wave affected Operation Smile India’s medical missions and care centres?

After the first wave, we were able to restart our centres in November/December 2020. We had just gotten into the groove and the month of April was hugely successful month for us. We provided surgery to over 170 patients in April. However, unfortunately we had to completely shut down two of our centres from May 1. We have a total of four year-round care centres. Durgapur and Mumbai has been shut down till the end of June. The Bangalore and Srinagar centres continue to operate, but under reduced capacity. This decision was taken keeping in mind the surge in number of new infections per day and regional level lockdowns imposed by the government. Hospitals were instructed to increase their capacity to treat patients with Covid-19. Thus a lot of resources (especially manpower) from our cleft centres was diverted to meet this demand.

We are currently watching the situation very carefully. We hope to have all centres up and running from July, however a lot will depend on how things progress with Covid-19.

How have your teams been able to respond so far?

Throughout these tough times (for us as well as for our patients and volunteers) we have continued to stay in touch with our patients. In spite of the lockdown, our teams have been able to make home visits to deliver necessary food supplements and formulas to patients enrolled in our nutrition programmes. We have also been in touch with patients whose appointment for consultation (speech, orthodontics and dental services) had to be pushed. We have ensured that there isn’t any inconvenience to patients and the ones that are on a treatment pathway receive necessary advice and support virtually.

Given the massive shortage of oxygen in the country, Operation Smile has donated 100 oxygen concentrators to our partner hospitals in India. Purchasing oxygen concentrators in such a short time has been a challenge because of the sudden increase in demand and limited supply, but we were able to cut through a lot of the red tape and ensure there were purchased on time and delivered to partner hospitals. These 100 concentrators are being used in Covid-19 wards of 7 different hospitals today and have been instrumental in saving lives.

What is the current situation for children and adults with cleft conditions who were scheduled for surgery?

We have postponed all surgeries for now. We have been in touch with all such patients and are providing necessary guidance and advise virtually. These patients would be prioritised for surgery as soon as the centres reopen.

Do you have a personal message for Operation Smile donors?

These are difficult times, not only for the organisation but also for each of us personally. Almost everyone on the Operation Smile India team has either had Covid-19 themselves or have had close family members who have suffered. Most people on the team have also lost loved ones in this pandemic. The last year and half has been tiring. However, as a team and as an organisation, we all remain committed. During the first wave we stood by our partners and patients by providing food to over 15,000 families, this time we are supporting partner hospitals, patients and their families. In the future we wish to ensure safe and prompt vaccination for our patients and their families. It’s important to understand that we would not be able to do any of this without the help and support of our amazing donors and sponsors. In difficult times, as these, its generally the poor and marginalised that suffer the most and we at Operation Smile India are committed to stand beside them, but to be able to do this we need the continued support of kind-hearted individuals and like-minded organisations.

We hope that these tough times are behind us soon and we can quickly reopen out centres and start providing clinical services. Patients are waiting.

Scenes of hope and healing: Guatemala City surgical programme

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.

Photo: Rohanna Mertens.

Alongside his mother, Carmelina, 10-month-old Juan Elias was examined by volunteer dentist Dr. Vilma Arteaga at screening during Operation Smile Guatemala’s May 2021 medical mission​ in Guatemala City. Juan Elias, who was later deemed healthy enough to undergo surgery, was one of 26 patients to receive comprehensive health evaluations.

Photo: Rohanna Mertens.

Three-year-old John Kenneth listens to anaesthesiologist Dr. Emilio Peralta’s heartbeat during his own health evaluation.

John Kenneth’s mom, Yesenia, left; paediatrician Dr. Samantha Wilts of the U.S., centre; anaesthesiology resident Dr. Ligia Atz of Guatemala and anaesthesia team leader Emilio join in on the fun and laughter.

Photo: Rohanna Mertens.

Yesenia and her husband felt many emotions when they learned their middle child, John Kenneth, was born with a cleft lip and palate. Looking at their son after his birth, John Kenneth’s mum and dad were scared, uncertain and sad.

But they also felt hopeful.

Unlike many of the parents we meet, Yesenia knew that surgery was possible for her son. Her mother’s cousin, who had also been born with a cleft condition, received surgery from another organisation.

While Yesenia connected with Operation Smile Guatemala’s volunteer team soon after giving birth, John Kenneth’s road to a new smile was long and full of unforeseen challenges.

Photo: Rohanna Mertens.

John Kenneth undergoes his cleft surgery and becomes one of 15 patients to receive life-changing care during the medical mission. Plastic surgeons Drs. Labib Samarrai of the U.S., right; Pablo Ramazzini of Guatemala, left; and operating room nurse Grecy Queche work together to ensure the highest quality of care possible.

Years before his surgery, when John Kenneth was just 15 days old, Yesenia took a four-hour bus ride to the Operation Smile Guatemala clinic, determined to get her son care she knew he needed. Driven by love and hope, she made that same journey every month until the local staff informed her of an upcoming mission in April 2020. It wasn’t until she learned that all medical missions had been cancelled due to the pandemic that Yesenia began to fear the worst.

“I was scared that they would never operate again and John Kenneth would have to live with his face like this for the rest of his life,” she said.

Happily, Yesenia’s hopes were realised and John Kenneth now has a new smile and brighter future.

Photo: Rohanna Mertens.

Christopher’s mom, Lesli, received five ultrasounds during her pregnancy, but she didn’t learn her son would be born with a cleft condition. It wasn’t until the day of his birth when the doctor hesitated to let her see him that Lesli knew something was wrong. Upon seeing Christopher’s smile for the first time, she was scared and shocked. With having relatives from both her mother and father’s side of the family receive surgery for their cleft conditions, Lesli knew surgery was possible. But she never imagined it would affect her child.

Christopher was born after the COVID-19 pandemic had began spreading across the country. When Lesli called Operation Smile Guatemala, the organisation had already postponed upcoming medical missions and was closed to in-person visits. But the local volunteer team never gave up on Lesli or Christopher. Over the phone, they explained to Lesli how to tape his lip, which would help with feeding and preparation for future surgery. From then on, she received calls from our team every two weeks.

Months later, when the Operation Smile Guatemala clinic reopened in March, Lesli began making the five-hour trip every 15 days to bring Christopher in for his appointments and evaluations. It was during one of these visits that she learned about this upcoming medical mission in Guatemala City. Following his comprehensive health evaluation during screening day, Christopher was scheduled for surgery.

Photo: Rohanna Mertens.

Training and education opportunities are vital components to increasing surgical capacity and building sustainable solutions that address the backlog in the countries we serve.

This programme was volunteer plastic surgeon Dr. Labib Samarrai’s 30th medical mission with the organisation. Labib, left, mentors Dr. Pablo Ramazzini of Guatemala, right, during surgery as part of his credentialing process with Operation Smile. Empowering medical professionals like Pablo instils a confidence in them to practice their new skills and perform the techniques they’ve learned to deliver safe and effective cleft surgery in their local communities.

Photo: Rohanna Mertens.

Operation Smile Chief Development Officer Kendra Davenport shares a special moment with 15-month-old Gerson Eduardo in the recovery room after surgery.

“I feel like my team in Virginia Beach is tremendous and people have done a lot to educate me about what happens on a mission and what the obstacles and challenges are. But to see it up close is to really believe and understand,” Kendra said. “I think certainly the obstacles and challenges are huge, but the joy that the whole team feels when a child comes out of the operating room is palpable. For me, as a parent of a child who had to be operated on, it’s a tremendous leap of faith to hand over your child for that operation.”

Photo: Rohanna Mertens.

Justa, 11-month-old Luis Antonio’s mum, sees her son for the first time in the recovery room right after his surgery. It’s the determination and resilience of parents like Justa that enable and inspire us to overcome seemingly impossible challenges amid the pandemic.

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.

With surgery, a weight was lifted

Zafilahy, 32 years old, before surgery. Photo: Rohanna Mertens.

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.

While routine in much of the world, surgery for many people living in low-income countries has misconceptions surrounding it, which can cause some to be fearful when it comes to receiving treatment.

That’s why when Virginie saw her husband, Zafilahy, for the first time after he returned home from his cleft lip operation, she had to be reassured that the doctors hadn’t stolen a part of his body during the procedure.

Instead, what the Operation Smile Madagascar volunteers had given him was a new smile.

Before his surgery, Zafilahy believed that he and the two other people from his community born with cleft conditions would be forced to live with an unrepaired cleft lip for the rest of their lives. None of them learned that a solution existed.

Throughout his life, Zafilahy was often called “Telo Moloha,” which translates to “three lips.”

But he never let the harassment prevent him from living a life of happiness.

During the 32 years he lived with an unrepaired cleft lip, he became a farmer, married the love of his life and had six children. But amid his joy, Zafilahy felt as though something was holding him back.

That was until Fidelis, a patient advocate with Operation Smile Madagascar, arrived in Zafilahy’s village spreading awareness about the non-profit’s work throughout the country.

Fidelis explained that all expenses from the surgery to repair Zafilahy’s cleft lip would be covered by Operation Smile. He felt immense relief because he knew it was a cost he wouldn’t be able to afford otherwise.

Alongside his brother and a large group of families, Zafilahy made the 13-hour bus trip to Antsirabe for the upcoming surgical programme.

It was the first time in 32 years that he’d left the comfort and familiarity of his village.

But Zafilahy wasn’t fearful of the long journey ahead. Instead, he felt eager because he knew something special awaited him at the destination.

Once they arrived, medical volunteers performed a comprehensive healthcare assessment to confirm Zafilahy was healthy enough to undergo anaesthesia.

For Operation Smile, patient safety is the greatest priority. To ensure that they receive the highest quality of medical care, each patient is screened for potential health issues that could impact their procedure or put them at risk.

When he was finally scheduled for surgery, Zafilahy was ecstatic.

A surgery that often lasts as little as 45 minutes changed Zafilahy’s life forever.

Zafilahy, after surgery. Photo: Rohanna Mertens.

Today with his new smile, Zafilahy is very happy and feels as though a weight has been lifted. He couldn’t wait to return home to his family and live a life free from the stigma of a cleft condition.

“Thank you, Operation Smile,” he stated. “Now, I do not worry about my health. I will be a happy man with no more worries.”

Help us keep our promise to patients like Zafilahy 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: Rohanna Mertens.

His dream is within reach

Cosmas, 21 years old. Photo: Margherita Mirabella.

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.

If any of Cosmas’ 12 brothers and sisters were in need of medical care growing up, the closest health clinic to their home was a 30-minutue walk. As for the closest hospital, that was a three-hour walk.

Not once during any of his regular check-ups to the clinic was Cosmas told that his cleft condition could be repaired with surgery.

Cosmas grew to accept that his cleft as God’s will but was still unhappy. He believed that he’d live with the burden of an unrepaired cleft lip forever. For 21 years, he did.

But on a day that Cosmas expected to be like any other, a friend in his community told him that he wouldn’t have to live the rest of his life with his cleft condition because Operation Smile Malawi had an upcoming medical mission.

Unfortunately, he learned about the upcoming mission too late. Even if he and his dad had the money to pay for travel, they never would’ve reached the mission site in time. But both men refused to give up.

Ganizan, Cosmas’ father, was a 70-year-old subsistence farmer. Cosmas earned a small salary as a farmer, but he also learned that neither he nor his father could pay for surgery through the local hospital.

Cosmas was hopeful that he would receive another opportunity to get safe surgery for free through Operation Smile Malawi.

When Cosmas was 21 years old, Ganizan was determined to find a way to get his son the surgery that he knew would change his life. Walking the three hours it took to reach the district hospital in Dedza, Ganizan sought out more information about the process of getting his son to the next Operation Smile Malawi mission.

He was told to arrive back at the district hospital in August where a bus provided by Operation Smile Malawi would be waiting to take them to Lilongwe at no cost.

After much waiting, the day finally arrived, and Cosmas and his father left their community to begin the long 7-hour trip to the mission site.

After passing his comprehensive health evaluation, Cosmas and his father learn that he's been placed on the surgical schedule during a 2015 Operation Smile Malawi medical mission in Lilongwe. Photo: Margherita Mirabella.

Following their journey, they arrived in Lilongwe, and Cosmas felt at peace seeing others like him. For the first time, he knew that he wasn’t the only one living with a cleft condition.

As many as nine in 10 people around the world can’t access basic, surgical care and can endure years of bullying, social isolation and severe health problems from an untreated cleft condition. For Cosmas, a lack of education and awareness about cleft conditions in his community proved to be a barrier that lasted two decades.

Although he was often teased, all Cosmas wanted growing up was to be treated like everyone else. He had friends and loved to watch soccer and his favourite player, Malawi’s own Fisher Kondowe.

On the verge of undergoing a surgery that he waited on for more than two decades, Cosmas was looking forward to enjoying the activities of his peers without being burdened by his cleft condition.

His experience at the Operation Smile medical mission was much different than life in his community. There was no worry about being harassed or teased. For once in his life, he was around people who accepted him.

“When I go home people will stop making fun of me,” Cosmas said.

He walked into the operating room with confidence, knowing that he’d come out with a completely new smile – he couldn’t wait for the opportunities his future would hold.

Cosmas, one year after his surgery. Photo: Margherita Mirabella.

Ganizan didn’t stop smiling when he saw his son for the first time after surgery.

He had spent 20 years watching his son struggle to come to terms with his cleft condition and now his life is renewed. Both Cosmas and his father gave a big thumbs up when asked if they were satisfied with the surgery.

When he saw his reflection for the first time, he could not believe the change he saw in the mirror.

Since returning home, Cosmas feels like he is now free.

Although he always had friends, he didn’t like to go out in public with them for fear of being teased. Now, he feels excited to go out with friends because nobody stares at him or calls him names.

Interacting with others is something that Cosmas now embraces. He is currently in his first year of high school, and his favourite subject is social studies with dreams of becoming a police officer.

“I am very happy and thankful to Operation Smile, and I hope they will keep helping others,” Cosmas said.

Help us keep our promise to patients like Cosmas 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: Margherita Mirabella.

Her name is Jane Rose

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.

Jane Rose longed to be called by her name. Writing it repeatedly in her notebook, the spirited 7-year-old hoped that the dream she wrote on paper would eventually come true.

But in reality, she faced almost constant bullying because of her cleft condition from many children in her community who refused to call her anything besides “bungi,” a derogatory word for cleft.

Seven-year-old Jane Rose, before. Photo: Jörgen Hildebrandt.

“My heart breaks every time I hear them bully her. The only way to stop it is to get her cleft lip repaired. They will not stop otherwise,” said Eutigio, Jane Rose’s father.

Jane Rose loves going to school and is very intelligent. She refused to give in to her abusers.

With big dreams of one day becoming a teacher, she felt determined to attend school each day despite the constant bullying.

Jane Rose's father, Eutigio, watches as his daughter completes her homework. Photo: Jörgen Hildebrandt.

Her family lives in a house made of bamboo in Cebu City, Philippines. With no access to electricity or water in their home, Jane Rose and her family share the only nearby well with the many neighbours in the area.

Southeast Asia, including the Philippines, is a region where cleft conditions are more common than the rest of the world – around one in 500 children are born with a cleft condition. The global average is closer to one in 750 births.

Even though there are skilled plastic surgeons in the country – some who volunteer with Operation Smile – most families can’t afford the cost of surgery.

It broke Eutigio’s heart knowing that as a garbage collector, the cost of surgery for Jane Rose was beyond his means.

In the past, he’s tried twice to get his daughter this life-changing surgery for free through other organisations.

But both times, Jane Rose was denied because of health issues.

With each failed attempt, Eutigio’s anxiety and worry for his daughter deepened.

“My biggest fear is that she’ll grow up being bullied all her life,” he said.

Photo: Jörgen Hildebrandt.

It wasn’t until Eutigio learned about Operation Smile Philippines that he believed and hoped their third attempt at surgery would be different.

Upon arriving at the medical mission, Jane Rose and her father felt excited at the thought that this could be the opportunity for which they’ve been waiting.

“I am very happy to be here,” Eutigio said. “There are so many children here with the same problem. I thought it was only our family.”

After the screening process, medical volunteers were thrilled to tell Eutigio the good news.

Operation Smile medical volunteers check Jane Rose's vitals during screening to ensure that she's healthy enough to undergo anaesthesia for her surgery during a 2015 medical mission in Cebu. Photo: Jörgen Hildebrandt.

“I am so happy she passed all the health examinations since this is the third time we’ve tried. I am very happy and very thankful,” Eutigio said.

It was finally time for Jane Rose to receive the surgery she always deserved.

A surgery that can take 45 minutes changed her life forever.

The day after her cleft repair surgery, Jane Rose stared at her new smile in the mirror, not taking her eyes away from what she saw.

“I’m so happy that she looks so beautiful. Thank you!” said Eutigio.

Eutigio sees Jane Rose's new smile for the first time. Photo: Jörgen Hildebrandt.
Photo: Jörgen Hildebrandt.

Years have passed since Jane Rose’s surgery, and so many aspects of her life have changed during that time.

Today, Jane Rose continues to excel in her studies at school. According to her teacher, Jane Rose is very involved and intelligent. She even received a medal for the time she spent studying.

With her newfound confidence after surgery, Jane Rose participated in a school mini pageant and has gained many friends.

But the greatest and most noticeable change is how the children who once bullied her now call her by her real name. At last, she’s living out her dream that once occupied the lines of her notebook.

Jane Rose plays with friends at her home one year after receiving surgery from Operation Smile Philippines. Photo: Jorgen Hildebrandt.

Eutigio hopes that Jane Rose will now be able to follow her dreams, finish school, and become a teacher.

“She will have a better future now,” he said.

Today, nobody bullies or teases her – many have no idea that Jane Rose was born with a cleft lip.

“I am not a ‘bungi’ anymore, I am just beautiful,” Jane Rose said.

Help us keep our promise to patients like Jane Rose 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.

Jane Rose, today. Photo: Jörgen Hildebrandt.

Training surgeons: Q&A with Dr. Ravaka Rakotorahalahy

Cleft surgeon Dr. Ravaka Rakotorahalahy of Madagascar. Photo: Lorenzo Monacelli.

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 cleft surgeon Dr. Ravaka Rakotorahalahy’s home country of Madagascar, there are many obstacles that prevent patients from getting the surgery they need and deserve.

Before the country was gripped by COVID-19 lockdowns, one of Ravaka’s last patients he served lived with an untreated cleft lip for 19 years.

In many communities, people may not know that surgery can treat cleft lip and cleft palate. While not an emergency condition, cleft surgery is time-sensitive, and often children suffer long-term speech, nutritional and aesthetic complications if they don’t receive surgery early in life. Many people can’t afford to pay for an operation or live very far away from a hospital and lack the means to get there.

Also, some of the most significant barriers to surgical care are the lack of healthcare workers, trained surgeons and physical infrastructure needed to meet the demands of Malagasy people living with cleft conditions.

That’s why Operation Smile is committed to helping patients and their health systems overcome these daunting challenges so that everyone who needs cleft surgery can receive effective treatment as soon in their lives as possible.

Established in 2017 and funded by Stryker, Operation Smile’s Cleft Surgeon Training Programme (CSTP) addresses the fundamental need for more – and more highly trained – surgeons to provide ongoing quality cleft care in their communities.

In addition to rapidly elevating the skills of cleft surgeons in resource-limited settings which lack specialised training opportunities, the programme creates a pathway for candidates to become credentialed Operation Smile medical volunteers.

CSTP candidates are paired with mentors – experienced Operation Smile volunteer surgeons – with whom they train during two to three surgical programmes per year in their home country.

Dr. Ravaka Rakotorahalahy with mentor Dr. Pernille Lindholm of Denmark during a 2019 Operation Smile medical mission in Madagascar. Photo: Rohanna Mertens.

“I quickly discovered that Ravaka had dexterous hands that were precise and steady. His brain was sharp, and he quickly picked up the art of cleft surgery with remarkable attention to detail that cannot be taught. You just have it. And Ravaka had it,” said Dr. David Chong, one of Ravaka’s mentors and chair of the CSTP. “Most of all, I noticed Ravaka’s heart. Filled with compassion and kindness, he was incredibly gentle with patients and families. He loved caring for his people. One of the great highlights of my work with Operation Smile has been to see the wonderful cleft surgeon that Ravaka has become and rejoice for what that means for the people of Madagascar.”

So far, the eight graduates of the CSTP have provided more than 300 cleft surgeries in their communities outside of Operation Smile medical programmes.

Currently, Operation Smile is preparing for a second cohort of CSTP candidate surgeons to start the programme in July 2021. We’re working closely with our teams around the world to identify and designate local educators and partner with local hospitals to provide quality cleft surgery training despite challenges presented by the pandemic.

We recently caught up with Ravaka, a recent CSTP graduate, about his experience in this unique training programme and how its empowering him to deliver world-class cleft care in a place of dire need.

Cleft surgeons Drs. Irene Tangco of the Philippines, left, and Ravaka Rakotorahalahy of Madagascar repair the cleft lip of 14-year-old Irongany during a 2018 Operation Smile Madagascar medical mission in Antsirabe. Photo: Rohanna Mertens.

Q: What inspired you to pursue a career in cleft surgery?

A: “Since I was a student, I was a fan of surgery. In general surgery training, I realised that I am quite comfortable in soft surgery. Then, I had the opportunity to learn about Operation Smile when I was in Antsirabe. I participated and loved it so much.”

Q: Could you describe the need for more trained cleft surgeons in Madagascar? What are some of the challenges that young medical professionals can face as they pursue their specialty?

A: “In Madagascar, there are many cases of cleft lip and cleft palate, so it is really essential to have more well-trained surgeons in this specialty. There are fewer cleft surgeons in Madagascar because this specialty is not offered during residency. Here, paediatric surgeons and maxillofacial surgeons are trained for cleft lip and cleft palate surgery.”

Q: How did you learn about the opportunity to participate in the CSTP? What were your initial thoughts when you learned about the programme?

A: “When I was in Antsirabe as assistant surgeon in the surgery field, Operation Smile carried out a medical mission in our hospital. Then, Dr. Romain Raherison, a paediatric surgeon who already worked with Operation Smile, asked me if I was interested in joining the organisation. Without hesitation, I accepted … He introduced me to country manager Mamy Ramamonjisoa, and since then I was there as an observer. After two missions, I was asked to join the CSTP.

“When I was informed about this programme, I was really happy to be among the participants. There, I said to myself that I will develop my knowledge, my skills and experiences. Once I am able to operate, I will help my compatriots who suffer from cleft lip and cleft palate.”

Q: Has the CSTP provided you with training and education that you may have otherwise not received?

A: “Certainly, the CSTP provided me an exceptional training and education. Maybe I could access training like that in another country, but I would never have the financial capacity.”

Cleft surgeons Drs. Ravaka Rakotorahalahy of Madagascar, left, Luca Autelitano of Italy, centre, and speech pathologist Angela Rezzonico of Italy examine a patient during a 2019 Operation Smile Madagascar medical mission in Antsirabe. Photo: Margherita Mirabella.

Q: Who were your CSTP mentors? Could you tell us more about your relationship with them and how they worked with you?

A: “My mentors are Drs. El Hassan Boukind (Morocco), Christie Smit (South Africa), Beto Herrera Ruelas, Desi Mwepu (Democratic Republic of the Congo), Irene Tangco (Philippines), David Chong (Australia), and Pernille Lindholm (Denmark).

“With my mentors, we got along well. They shared with me their techniques, some tips and even the way of life for a plastic surgeon. Everyone has their own pedagogy, but it is not difficult to adapt. They have become both friends and family to me. I will never forget them.”

Q: What are the skills that you feel the programme helped you most improve?

A: “The CSTP helped me a lot in terms of precision and accuracy. My mentors taught me the principle of flaps and suturing techniques in plastic surgery and to have soft hands with each gesture. In short, the CSTP also helped me develop skills in general surgery because, currently, I practice them in every operation.”

Drs. Briand Michel Rakotomanga, left, and Ravaka Rakotorahalahy, third from the left, observe as cleft surgeon Dr. Lora Mae de Guzman of the Philippines operates and Hasina Ramiakajoto, right, translates as part of the Cleft Surgeon Training Programme. Photo: Rohanna Mertens.

Q: Could you share one of your most powerful or poignant experiences with a patient/family while training? After graduation?

A: “When I graduated, during the last mission before COVID-19 lockdowns in February 2020 in Antsirabe, I had a case of incomplete bilateral cleft lip in a 19-year-old girl from Mananjary in the southeast of Madagascar who had a lot of difficulty in her social life and in her studies. I operated on her cleft lip while she was under local anaesthesia (older patients can received cleft lip surgery with an anaesthetic injected at the surgical site, similar to how anaesthetics are used for dental procedures). She was very good during the operation; I always spoke to her throughout the operation.

“When we were done, she was really happy when I showed her a photo of her new smile. She couldn’t smile right away, but her tears flowed when seeing her photo. The next day, I saw her, she insisted on taking a picture with me. Six months after, Operation Smile decided to do mobile post-operative checks, and I was among the team going. I had the opportunity to meet my patient and her family in Mananjary, the result is impeccable. There, I asked her why she was really good during the operation and she replied that she just wanted to have a smile like the others and to be able to live without problems.”

Q: What would you say to another Malagasy surgeon who would be interested in joining the CSTP?

A: “To Malagasy surgeons who wish to join the CSTP, it is a very interesting programme in which we acquire a lot of skills not only in plastic surgery but in all types of surgical management. Good luck and work hard. The Malagasy people are waiting for us and need our support.”

Q: Why are you passionate about practising cleft surgery in Madagascar?

A: “Given the high number of cleft cases in Madagascar, I want to give hope and a smile to the lives of these people … I am very passionate about plastic surgery. God gave me all the assets to do it.”

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.

Cleft surgeon Dr. Ravaka Rakotorahalahy of Madagascar. Photo: Margherita Mirabella.

A long-awaited transformation

Rong Zhen, 57. Photo: Zute Lightfoot.

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.

Looking around, Rong Zhen stared in wonder at the children who surrounded her during a medical mission in Dafang, China.

Part of her felt sorry for them. Undergoing a medical procedure is scary, no matter what age, and many of the children she saw were just a few years old.

But at the same time, she was overjoyed that their families found Operation Smile. It meant that they wouldn’t be forced to grow up and endure the consequences of living with an unrepaired cleft condition, an experience that Rong Zhen was all too familiar with.

Worldwide, it’s estimated that every three minutes, a child is born with a cleft condition. Barriers to care cause many patients in developing countries with cleft conditions to go untreated – patients like Rong Zhen, who lived 57 years with a cleft lip.

Until just a few months before attending an Operation Smile China mission, Rong Zhen never knew that surgery to repair her cleft lip was even a possibility.

She lived every day believing that her cleft lip – and the harmful mistreatment she received from others – was permanent.

Rong Zhen was often laughed at and teased because of her appearance. Finding work was a constant struggle. She suspected that many employers refused to hire her because of her cleft condition.

Despite these challenges, Rong Zhen’s life was filled with family and love. As a mother of three adult children and a grandmother to three grandchildren, she feared that the people she loved most in the world would suffer from the same condition. Fortunately, none of Rong Zhen’s children or grandchildren were born with a cleft condition.

But living with the burden of an unrepaired cleft lip prevented her from being truly happy.

It wasn’t until a village leader told Rong Zhen about Operation Smile China that she learned surgery and a brighter future for herself were possible.

She was amazed at the fact that a global medical organisation was providing these life-changing surgeries for free.

This news changed Rong Zhen’s life. She had never imagined herself with a new smile.

Rong Zhen begins the health screening process during a 2016 Operation Smile China medical mission in Dafang. Photo: Zute Lightfoot.

The mission dates arrived in no time, and she and her husband, Cailong, set out on the two-hour bus ride to Dafang. Their children were overjoyed that soon their mother would have her cleft lip repaired.

When they arrived at the mission site, Rong Zhen and other patients underwent their comprehensive health screenings. This evaluation ensures that each patient is healthy enough to become a candidate for safe surgery – the highest priority for Operation Smile.

The Operation Smile China mission lasted only a few days, but during that time, hundreds of children and adults received surgery that changed their lives forever.

Rong Zhen was among them.

A huge grin appears on Rong Zhen's husband's face when he sees her new smile for the first time after surgery. Photo: Zute Lightfoot.

Rong Zhen’s cleft condition never prevented Cailong from finding his wife beautiful.

Looking at her after surgery, Cailong saw the same woman who he’d been happily married to for the last 34 years. She was still the same person who he loves and the same mother who helped raise their children. But now, there’s one significant difference.

Rong Zhen is finally, truly happy when she looks at her new smile.

Rong Zhen and her husband, Cailong, share a special moment the morning after her surgery. Photo: Zute Lightfoot.

People like Rong Zhen who don’t have access to basic surgical care can endure years of bullying, social isolation and health problems from an untreated cleft condition.

Fortunately, cleft surgery can bring immediate transformation to a patient’s life in as little as 45 minutes.

After a successful surgery, Rong Zhen could not have been happier.

“I love to smile now,” she said. “Thank you Operation Smile. I would never have been able to smile if Operation Smile had not come to Dafang.”

Help us keep our promise to patients like Rong Zhen 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.

Rong Zhen, after. Photo: Zute Lightfoot.

Celebrating the Year of Health and Care Workers

Operation Smile Nicaragua's local medical volunteers perform surgery on a patient at the care centre in Managua. The safe resumption of in-person care offers a glimpse into how medical programmes will be conducted in the COVID-19 era, informing the organisation on how to approach treating patients as conditions improve from country to country. Operation Smile photo.

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.

Throughout 2020, our world fought against an obstacle that threatened the lives and safety of people worldwide.

Throughout these times of uncertainty and fear, one factor has remained constant: the diligence of healthcare professionals on the front lines of a crisis that challenged health systems around the world.

In recognition of their dedication to providing care amid the COVID-19 pandemic, the World Health Organization (WHO) designated 2021 as the International Year of Health and Care Workers.

As a global organisation comprised of more than 6,000 medical volunteers, we’re honoured to recognise them and their talents as instrumental to the success of delivering high-quality surgical and comprehensive care to people in need.

For nearly four decades, Operation Smile has relied on the unwavering devotion of healthcare professionals including surgeons, nurses, anaesthesiologists, speech therapists, dentists and more to carry on our life-changing work.

Volunteer operating room nurse Redeat Wondemu during screening at a 2017 medical mission in Puebla, Mexico. For Red, being a part of Operation Smile goes beyond surgery. It’s a resolution for children born with cleft in low-resource countries to live happy and dignified lives. Photo: Jasmin Shah.

“The most rewarding part is that at the end of the day, I can go to sleep knowing I was able to help someone,” said volunteer nurse Redeat Wondemu. “For Operation Smile, it’s not just about making them comfortable. You’re completely changing their life, the way they grow up, and the way they’re accepted in their community.

“Whatever the role is, we do it with our whole heart. And I think that’s beautiful.”

Since March 2020, we’ve depended on them more than ever before.

Without the commitment of volunteers like Redeat to improve the health and dignity of children born with cleft conditions, we wouldn’t be where we are today.

Through these efforts, we’re proud to join the WHO in celebrating the world’s hardworking and passionate medical professionals.

Just as frontline doctors, nurses, technicians and other professionals continue to care for those in their communities, we will continue to reach and care for our patients despite the challenges presented by COVID-19.

In February 2021, Operation Smile Nicaragua carried out its first first local mission of the year, which delivered surgery to 10 patients who've been waiting for their new smiles. Operation Smile photo.

We’re continuing to work with local health leaders around the world to resume care safely at our centres and through medical missions.

After the successful completion of several missions conducted by teams of local medical volunteers in 2020, we’ve outlined a schedule of medical programmes planned to take place through June 2021.

Dr. Ruben Ayala, Operation Smile's chief medical officer, monitors a patient during a 2014 medical mission in Hanoi, Vietnam. Photo: Zute Lightfoot.

“We have watched dismayed, how the number of children needing treatment has increased during the pandemic,” said Dr. Ruben Ayala, Operation Smile’s chief medical officer. “Understanding the enormity of the challenge, we have pulled together our knowledge, people and resources. Our leaders around the world have laid out country-specific plans for adapting, evolving and creating environments where care can still be delivered safely.

“Cautiously, but optimistically, we carry on the work where possible, sending a clear message to our patients that, in spite of the pandemic, we have not abandoned them, and we never will.”

Regardless of how the pandemic slowed our care delivery on missions, our local teams continue to serve a role in the fight against the pandemic, displaying their commitment to changing the lives of patients in their home countries who still need them.

Marijose Kapunan and her husband, Rodney, have volunteered on more than 25 Operation Smile medical missions and are just two of thousands of our volunteers who are serving their communities during the pandemic. Photo courtesy of Rodney Kapunan.

Marijose Kapunan and her husband, Rodney, have volunteered on more than 25 Operation Smile medical missions and are just two of thousands of our volunteers who are serving their communities during the pandemic.

“We nurses are in the front, centre and back in the fight against this global pandemic,” said Marijose, an Operation Smile volunteer nurse and frontline healthcare worker in Jacksonville, Florida. “Nurses are valuable assets in formulating plans and processes to better manage the disease and prevent future outbreaks.”

Although medical missions were temporarily suspended in 2020, Operation Smile staff and volunteers around the world refused to stand aside in the face of adversity, devoting time and energy to providing care in any way they could.

We were forced to reevaluate our normal practices of delivering care in order to push forward and seek out new and innovative opportunities to reach the patients who need us.

A patient from Nicaragua receives a virtual follow-up speech therapy care consultation from Operation Smile volunteer speech therapist. Operation Smile photo.

Our organization began utilising technology to provide patients with virtual speech therapy and psychosocial consultations, essential aspects of a patient’s comprehensive cleft care.

It also provided virtual education and training opportunities for health workers in low- and middle-income countries so they could better fight the virus.

Volunteers and staff working in care centres throughout Latin America created an opportunity to come together and provide much-needed virtual care, ensuring that we kept our promise of caring for patients and their families amid lockdowns and country restrictions.

The lengths that our volunteers will go to serve patients underscores the calibre of people donating their skills and expertise to Operation Smile.

Longtime Operation Smile volunteer speech pathologist Milagros Rojas of Peru during a 2019 medical mission in Lima. She brings years of experience to our local Latin America teams. Photo: Margherita Mirabella.

“I want to give thanks to those who made this opportunity possible,” said volunteer speech pathologist Milagros Rojas. “COVID was not a limitation, because anything is possible when things are done with humanity and infinite love.”

Today, Operation Smile volunteers continue to risk their own safety to serve their communities as the pandemic persists.

We’re extremely proud to work with passionate, talented health and care workers who care deeply about the patients and families they serve, whether it’s halfway around the world or right there in their home communities.

Volunteer plastic surgeon Dr. David Orr, left, performs surgery as students observe during a 2014 surgical training rotation in Jimma, Ethiopia. Photo: Jorgen Hildebrandt.

We know that professionals in hospitals, care centres and clinics around the world will continue putting the health and safety of their patients first.

There couldn’t be a more fitting time to declare 2021 as the Year of Health and Care Workers.

“Operation Smile changed my life,” said volunteer Jackeline Nuñez del Prado. “I thank God for giving me the opportunity to be part of the foundation that I love with my life. I’ll always be grateful for being part of the magic of creating smiles in the lives of patients and in my life as well.”

Join us as we celebrate 2021 as the Year of Health and Care Workers. The compassion and commitment of our volunteers are what enable us to continue keeping our promise to patients amid the COVID-19 pandemic. Your support today means we can help children living with cleft conditions through these uncertain times and provide them with the care and surgery they deserve when it’s safe to resume our work.

Volunteer nurse Jackeline Nunez del Prado of Bolivia screening a patient during a March 2020 medical mission in Oujda, Morocco. Photo: Jasmin Shah.

Meet our patients: Nicaragua

Jimena, 11 months old, received her new smile during Operation Smile Nicaragua's first medical mission of 2021. Operation Smile photo.

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.

Marling arrived at Operation Smile Nicaragua’s first local medical mission of 2021 with her 11-month-old daughter, Jimena.

As Jimena went through the screening process, Marling was cautious but tried to remain hopeful.

This wasn’t the first Operation Smile mission Jimena and Marling had attended.

Even from the beginning, the journey toward a new smile for Jimena was long and often filled with heartache and disappointment.

None of Marling’s prenatal check-ups indicated that she should be concerned with the development of her baby.

It wasn’t until Jimena was born that everything changed for Marling.

“When my little girl was born, the doctors told me she had cleft lip,” said Marling, thinking back on the day. “This was unexpected. But they said there was a foundation that provided free surgeries for children with this type of condition.”

Marling’s doctors were talking about Operation Smile Nicaragua.

Two months after Jimena was born, Marling travelled to Operation Smile Nicaragua’s care centre. But at that time, the COVID-19 pandemic had already hit the country hard.

“I got to the centre, and I was told it was closed,” Marling said. “I only wanted information about my daughter’s condition.”

Despite the centre’s temporary closure, the local volunteer team knew there were patients like Jimena who still needed care.

The courageous volunteers and staff created opportunities to ensure that they could still reach patients and families even though they were physically apart.

“They offered me the option of virtual consults,” Marling said.

The medical volunteer team followed up with Jimena and her family digitally until the day when it was deemed safe to resume in-person consultations.

“I felt welcomed when I visited the centre,” Marling said. “The doctors gave great service and gave my daughter a small disk that helped her for feeding.”

With this additional care, Jimena’s health continued to improve while her mother’s hope grew stronger.

Following strict health guidelines and safety protocols, Operation Smile Nicaragua announced that it would host a small-scale local mission in October 2020.

After learning that Jimena was a candidate for receiving surgery during that mission, Marling didn’t hesitate to make the journey.

However, an unforeseen health issue arose on the day of Jimena’s surgery that prevented the volunteer medical team from going through with the operation.

But even after Jimena’s surgery was cancelled, Marling didn’t lose hope that her daughter’s smile would one day be healed.

In December 2020, it appeared that Jimena’s second chance was within her grasp.

But surgery evaded Jimena once again.

After contracting a fever, she and Marling were informed by medical volunteers that undergoing surgery was too unsafe. Jimena’s family returned home disappointed but more determined than ever.

Jimena is ready to enter the operating room during Operation Smile Nicaragua's local 2021 medical mission in Managua. Operation Smile photo.

With her mother’s support and perseverance, Jimena arrived at Operation Smile Nicaragua’s first local mission of 2021.

After a comprehensive health evaluation, nothing stood in the way of Jimena and her brighter future.

She became one of 10 patients to undergo their long-awaited surgeries during the February mission.

“I feel happy because my daughter received her first surgery,” Marling said. “I thank those involved that made my daughter’s smile possible.”

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.

In February 2021, Operation Smile Nicaragua carried out its first first local mission of the year, which delivered surgery to 10 patients who've been waiting for their new smiles. Operation Smile photo.

Speech therapy programme “HablemOS” helps thousands across Latin America

Operation Smile Nicaragua's care centre in Managua was the first centre to reopen its doors to patients amid the pandemic and began providing a mix of in-person and virtual consultations. Photo: Operation Smile Nicaragua.

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.

Despite the unprecedented challenges the COVID-19 pandemic brought to our medical programmes and care delivery, we’ve refused to stand aside in the face of this adversity.  

Volunteers and staff working in care centres throughout Latin America found an opportunity to come together to make sure that we kept our promise of caring for patients and their families amid lockdowns and country restrictions.

For patients born with cleft lip and cleft palate, speech therapy before and after surgery is an essential component of comprehensive cleft care.

Most of this ongoing work was done in person with patients at centers, but with the impact of the pandemic hitting countries worldwide, providing this care suddenly became impossible.

Operation Smile Regional Director Lizet Campos. Photo: Jasmin Shah.

Working closely with her fellow regional directors, Operation Smile Regional Director Lizet Campos created the concept of the programme called “HablemOS,” a play on words meaning “let’s talk” in Spanish with the capitalised “OS” at the end of the word symbolising Operation Smile.

Cleft conditions can make eating extremely difficult, so speech therapists oftentimes conduct consultations soon after a child is born, providing families with advice on how to properly feed their child.

Hundreds of patients have received speech consultations at care centres in Managua, Nicaragua; Asunción, Paraguay; Bogota, Colombia; and Caracas, Venezuela. Photo: Rohanna Mertens.

Speech therapists also provide patients with palate-strengthening exercises before surgery that help improve the procedure’s outcome. As a child grows and begins to speak, their ongoing care helps patients be able to speak more clearly.

In collaboration with our medical oversight team, speech council, programme manager Mauricio Rojas of Mexico and programme coordinator Maria Cristina Galindez of Venezuela, Lizet and her team implemented HablemOS in mid-August of this year.

With the support of Operation Smile Sweden and generosity of the Swedish Postcode Lottery, Lizet and her team have a fully funded programme that they hope will show patients and their families that Operation Smile remains committed to them despite the current global challenges.

“So far, the programme is proving to be a resounding success,” Lizet said. “To date, our teams in Latin America have delivered speech consultations to more than 3,200 patients. There’s also an in-person component, as 629 of the consultations were given at our care centres in Managua, Nicaragua; Asunción, Paraguay; Bogota, Colombia; and Caracas, Venezuela, though this continues to be conducted on a much more limited basis than the virtual therapy sessions.”

Volunteers and staff feel inspired by the deepening of the organisation’s investment in speech therapy, which is critical to helping our patients live dignified and fulfilling lives.

Longtime Operation Smile volunteer speech pathologist Milagros Rojas of Peru during a 2019 medical mission in Lima. She brings years of experience to our local Latin America teams. Photo: Margherita Mirabella.

The HablemOS team is honoured to lead the way in developing a programme that has the potential to be replicated and implemented everywhere that Operation Smile works.

“Just imagine, in these sessions, through songs and stories, we can make our little ones exercise their speech abilities and keep them from finding it tedious,” said volunteer speech pathologist Milagros Rojas. “Instead, these sessions turn into play sessions.”

Knowing that many patients’ families had access to either internet-connected smartphones or computers, speech therapists were contacting families and resuming or beginning virtual consultations within weeks for hundreds of patients while the doors of the centres remained closed to the public.

If families lacked internet access, therapies were delivered over the telephone as well.

With a lack of certified speech therapists like Milena Cleves in Latin America, the HablemOS program provides opportunities to increase the number of qualified therapists in the region. Photo: Marc Ascher.

“There’s a lack of certified speech therapists throughout the Latin America region and in many other low- and middle-income countries,” Lizet said. “So we knew it would be critical to offer training and education opportunities to speech therapy providers so that more – and more qualified – therapists can deliver care to more patients.”

Working together with the Mexican speech and language therapy non-profit Hablarte E Integrate, the training and education portion of the programme has enrolled 61 speech therapists from 13 Latin American countries.

“Although we’re professionals, we can always grow in knowledge,” said Operation Smile Panama volunteer speech therapist Alina Navarro. “I’m delighted to be acquiring a new perspective. In terms of mentoring, it’s been useful to discuss the cases together with other professionals.”

The HablemOS programme team feels driven to keep delivering much-needed speech therapy care to patients as the world continues to cope with the effects of COVID-19.

“I want to give thanks to those who made this opportunity possible,” Milagros said. “COVID was not a limitation, because anything is possible when things are done with humanity and infinite love.”

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.

HablemOS team member and programme manager Mauricio Rojas, left, shares a special moment with Jonathan during a 2019 medical mission in Mexico. Photo: Rohanna Mertens.