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.

Hope on The Horizon: Safely Resuming Surgery and Care

Eight-month-old Elmehdi, right, 11-month-old Ouissal, centre, and another young patient await their life-changing surgeries at Operation Smile's Women in Medicine: Inspiring a Generation medical mission in Oujda, Morocco, in March 2020. These were among some of the last patients to receive surgery from Operation Smile before medical programmes were postponed due to the COVID-19 pandemic. 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.

A hallmark of Operation Smile medical missions and care centres is undoubtedly their bustling atmosphere – full of energy and full of people gathered to ensure that our patients get the cleft surgery and care that they need and deserve.

Volunteer medical professionals work side-by-side, quite literally shoulder-to-shoulder, conducting comprehensive health evaluations for scores of patients during a screening day. Those patients and their families, often numbering in the hundreds on large-scale international missions, gather and share stories of perseverance and hope. Care centres’ waiting rooms are filled with the sounds of children playing as they await their consultations.

But the COVID-19 pandemic brought these familiar and vivacious sights and sounds to an abrupt, albeit temporary, end.

In March 2020, Operation Smile made the decision to suspend international travel for medical volunteers and postpone medical missions and care delivery at care centres.

While these decisions were made with the safety of patients, volunteers, staff, their families and communities as the top priority, the postponements have left waiting more than 10,000 patients scheduled to receive treatment.

The organisation quickly pivoted to address many of the pandemic’s novel challenges, such as providing hospitals around the world donations of personal protective equipment (PPE) and providing patients and their communities with food and hygiene supplies as lockdowns stifled livelihoods.

Yet, there is hope on the horizon. Though care delivery looks, sounds and feels much different than before, Operation Smile has resumed providing cleft surgeries in Vietnam, Italy and China. In Morocco and Nicaragua, care centres are once again offering patients in-person care like dentistry, speech therapy and psychosocial care.

The 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.

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

Dr. Ruben Ayala, Operation Smile’s chief medical officer, said that while he stands behind the decision to postpone activity, it’s important to consider the long-term consequences that untreated cleft conditions can cause.

“The choice to not provide care to people, either surgery or comprehensive care, is not a benign one. Children are still suffering because of it,” Ruben said. “The reality is that the longer we wait, the longer more children are going to have difficulty eating, speaking and there will be issues in their growth and development.

“You’re going to have to weigh the pros and cons. We need to step back from the all-or-nothing approach to one that is based on the knowledge that is constantly evolving and the awareness.”

In May 2020, the first Operation Smile country to resume providing surgery was Vietnam, a country that imposed strict lockdown measures at the onset of COVID-19’s spread in neighbouring China. As a result, the country avoided a major outbreak. When the decision was made to host a medical mission conducted entirely of Vietnamese volunteers, there were only around 300 confirmed COVID-19 cases and zero deaths.

Viet Nguyen, the chief representative for Operation Smile Vietnam, said that volunteers are closely following both Operation Smile and health ministry guidelines to reduce the risk of spreading the virus during missions, including mask-wearing, temperature screenings, socially distanced waiting areas and increased sanitation measures.

Patients and their families wait for their comprehensive medical evaluations in a physically distanced waiting area during Operation Smile Vietnam's medical mission in Ho Chi Minh City in May 2020. Operation Smile photo.

“In the past at missions, we would gather about 100 patients and their families; there would be a few hundred of them at the hospital. Right now, we’re only able to bring in about 10 to 20 patients to the hospital each day,” Viet said. “We have to do the screening process as usual. It takes more time, but actually that’s a very good way for us to ensure the safety of our patients, families and also our medical volunteers.”

From May to September 2020, more than 500 patients have received cleft surgery at six Operation Smile Vietnam local missions.

“It’s positive progress,” Viet said. “We feel safe. We strictly follow the guidelines, and we’re making appropriate decisions. We’re actually doing a great collaboration with our in-country partners and also with the headquarters of Operation Smile in the U.S., and we did it at the right time.”

Operation Smile Vietnam volunteer surgeons perform a procedure during the May 2020 medical mission in Ho Chi Minh City. Operation Smile photo.

In Italy, a country that was hard-hit by COVID-19, Operation Smile has also resumed providing surgery and cleft care services at its three Smile House locations in Rome, Milan and Vicenza.

Dr. Domenico Scopelliti, a long-time Operation Smile volunteer cleft surgeon and the director of Smile House Rome, explained that the Italian context differs greatly from that of Vietnam.

“The project here is how to face a journey before the time of a vaccine,” Domenico said. “I very often use terms of navigation, because when we describe our journey, imagine that we’re going from point A to point B and the COVID pandemic moved our boat to point C. The route is totally different – we need to project another route.”

Smile Houses are creating physical pathways that are designed to drastically reduce the risk of the virus entering their facilities, alongside bolstered PPE that includes ventilated surgical helmets.

Dr. Domenico Scopelliti, a long-time Operation Smile volunteer cleft surgeon and the director of Smile House Rome, wears a specialised surgical helmet to prevent the spread of COVID-19 during surgery. Operation Smile photo.
Dr. Domenico Scopelliti, a long-time Operation Smile volunteer cleft surgeon and the director of Smile House Rome, wears a specialised surgical helmet to prevent the spread of COVID-19 during surgery. Operation Smile photo.

Anyone entering a Smile House must have tested negative for COVID-19 within 48 hours of their visit. They then change out of their clothes, place them into a seal bag, and into PPE garments provided by the centre. Entrances and exits are separated, and medical staff change their PPE and fully decontaminate the operating rooms between each patient. Only one parent can accompany a child into the facility, and mask-wearing and physical distancing are practised.

“Timely surgery is very important, because if you do the right job at the right time, you reduce the risk of a patient having functional consequences,” Domenico said. “It’s important to respect that time because if we promise to operate all the newborn kids in the first years of age, we have to maintain our promise.”

In August 2020, Operation Smile also hosted its first two local missions in China. Though the pandemic originated in Wuhan in the country’s east in late 2019, the mission sites of Meigu and Zhaotung are in China’s western region, which was spared the brunt of the disease due to strict lockdowns. Sixty-two patients received surgery at the missions, and four more missions are planned through the end of 2020.

As teams around the world are working within the guidelines of their ministries of health to continue serving patients through telehealth services and nutritional support, our care centres in Nicaragua and Morocco were cleared to reopen their doors to patients for non-surgical services in July 2020.

While the Moroccan team hopes to be able to resume cleft, bone graft and orthognathic surgeries before the end of 2020, it’s been able to provide most of the other services it offers to help patients live more fulfilling lives. Each of Morocco’s centres in Casablanca, Oujda and El Jadida are offering pre-surgical screenings, post-operative care, dental and orthodontic care, psychological and speech therapy workshops and nutrition support.

In the early stages of the pandemic, the Operation Smile Nicaragua team recognised the need to stay connected with its patients by offering them virtual consultations for speech therapy and psychological counselling. Today, they continue to offer virtual care alongside in-person services like speech therapy, psychology, plastic surgery, paediatrics, nutrition, periodontics, odontology and nursing, averaging about 130 consultations per week.

According to Ruben, though COVID-19 will continue to pose challenges for the foreseeable future, those obstacles are surmountable.

“There’s a whole world ahead of challenges, but if we focus on that commitment to children, we will unavoidably become really innovative in how we address the challenge,” Ruben said. “We look forward to partnering with other organisations, to partner with governments, to partner with private entities, civil society and especially with the communities and the families and, most importantly, the patients to see a way forward and an opportunity for all.”

Help us keep our promise to our 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.

A Frontline Hero: Remembering Nurse Carlos Armas

Volunteer nurse Carlos Armas screens a patient during a 2015 Operation Smile medical mission in the Dominican Republic. Photo: Marc Ascher.
Volunteer nurse Carlos Armas screens a patient during a 2015 Operation Smile medical mission in the Dominican Republic. Photo: Marc Ascher.

Serving as one of Operation Smile Peru’s most beloved and admired volunteer nurses, Carlos Armas leaves behind a powerful legacy etched in the hearts and minds of those who knew him.

It is with great sadness that, on June 29, we learned Carlos lost his battle with COVID-19 after bravely fighting on the front lines of the pandemic. He was 63.

His commitment to patients was deeply ingrained in his spirit of wanting to care for people in need.

“Carlitos will always teach us about passion and selfless devotion to others in need.”

Silvana Espinoza, Volunteer Patient Imaging Technician for Operation Smile Peru

Despite knowing the risks, Carlos proudly led a team of selfless medical professionals and delivered much-needed care to people impacted by the coronavirus in his country.

“I still remember my last conversation with Carlitos,” said Anyela Quintanilla, Programs and Student Clubs Manager for Operation Smile Peru. “He said that they told him he could take leave because he was part of the high-risk group, but he refused to stay home. He decided to work at his hospital’s COVID area, passionately and lovingly caring for his patients.”

Motivated to help others at a young age, Carlos began his career as a nurse technician when he was 20 years old. But deep down, he always aspired to do more in his field.

Years later, after incredible determination and effort, Carlos graduated from Universidad Ricardo Palma at the age of 50 with a degree in nursing.

With pride, he would say, “I am Licentiate Carlos Armas,” a term meaning “graduate.”

Carlos with a patient during a 2018 medical mission in Lima, Peru. Photo: Margherita Mirabella.

After becoming a pre- and post-operative nurse for Operation Smile Peru in 2008, Carlos constantly demonstrated how much he loved being a volunteer and how helping people was his greatest passion.

When the pandemic first impacted his country and his people, Carlos was fiercely determined to care for patients – even if that meant sacrificing his own health and safety.

“I’m a nurse who has started from the bottom,” Carlos said to people who asked him why he accepted the position on the COVID-19 response team. “I’m not afraid.”

Carlos wasn’t the kind of person to stand by and watch as people suffered. His selflessness shined, not only with Operation Smile Peru, but wherever he felt that he could make a difference.

“This is a great loss to Operation Smile Peru’s family. You worked with us until the end. You could have stayed home. Yet you decided to stay and continue working. You wanted to be a part of this fight.”

– Maribel Obeso, Volunteer pre- and post-operative nurse for Operation Smile Peru

In addition to the COVID-19 pandemic, Carlos provided his services to care for families affected by the 1991 cholera outbreak and devastating earthquake that hit Pisco, Peru, in 2007.

Even in the face of adversity during his time on the front lines, Carlos refused to lose hope.

“Our patients are going back home walking now,” Carlos had shared with his team. “Things are getting better.”

On a medical mission in Lima, Peru, Carlos performs a comprehensive health evaluation on 3-month-old Gael during screening day. Photo: Margherita Mirabella.

People were drawn to Carlos’ optimism and kindness, not only on the front lines but during every Operation Smile medical mission.

“They say that friends are those who stick with you through the ups and downs. And under these circumstances, you’ve become part of our family. My dad will always be in our memories.”

– Karla Armas Moreno, Carlos Armas’ daughter

While Carlos is no longer with us to help create new smiles, his impact lives on through his friends, family and patients who were touched by his commitment and enthusiasm to do what was right.

Carlos and volunteer Nidia Ruiz during a 2015 Operation Smile medical mission in Puebla, Mexico. Photo: Marc Ascher.

EMEA Recruitment podcast with Dr Phil McDonald

We are thrilled to launch our new partnership with EMEA Recruitment. Starting with a special podcast episode featuring Co-Founder of Operation Smile UK and UK Medical Volunteer Dr Phil McDonald hosted by CEO of EMEA Recruitment Paul Toms. In this episode we will learn more about Dr Phil’s commitment and also about Paul’s personal connection with cleft and the reason he chose to collaborate with us.

Transcript

Paul Toms: Morning Phil, great to see you today. How are you?

Phil McDonald: Very well thanks, very well. Down in sunny Chichester.

Paul: I was going to say, what part of the world do we find you in? I guess with the current situation [COVID-19 pandemic], the travel has been a bit reduced recently, hasn’t it?

Phil: Yeah, so I’m spending most of my time in Chichester – there can be a lot of worse places to be, so we’re very happy here actually.

Paul: I really appreciate you spending the time with us today, because I know how busy you are, and I think it’s a great opportunity to take the time to speak with you.

As I mentioned in the introduction, clearly the work that Operation Smile does is very close to my heart, so it’s great to have you on the podcast today, and it’s hopefully an inspirational piece for me and for the listeners.

Obviously, in terms of the background, I know you’re the Co-Founder of Operation Smile UK, and it’s a charity that’s been running for 18 years now. So I thought as a general summary to start off with, if you’d be able to tell us a bit more about how the charity was founded and your role within the organisation, that could be a good starting point to kickstart off.

Phil: Well I first started volunteering with Operation Smile back in 1995, which is 25 years ago now, and there were very few volunteers in the UK.

In 1999, I was called totally out of the blue by a journalist from The Guardian called Tim Radford. He was writing an article about Operation Smile in The Guardian and he asked me a couple of questions, I gave a couple of quotes, and in this article – a lovely half-page article – it basically said, ‘Dr. Phil McDonald, Consultant Anaesthetist from Chichester, said…’ and there was some quote from me.

The day the article went out, I was contacted by quite a significant number of companies – film companies – wanting to do documentaries. There I was, I was a simple doctor in Chichester, and all these companies wanted to suddenly do a documentary. Fortunately, we ended up going with the BBC, and did this documentary called The Facemakers, which was filming a mission and following some patients in Davao in the Philippines. It was a lovely, 50-minute documentary, which went out prime time on BBC One in 2000.

Now, because of that, it obviously generated a lot of interest in this country about Operation Smile, and so we thought, well we need to set up a charity in this country so that we can raise funds and get more volunteers. So I was introduced to a few financial entrepreneurs and we had our first meeting in London – I remember it to this day – in the Royal Ocean Racing Club, where I met all these financial entrepreneurs, people in a totally different business to me, and we decided to set up the charity and eventually it became registered in 2002.

And, since 2002 till now – that’s 18 years – we’ve raised over £35m, which is quite incredible really, because, back in 2002, we had an office, which was leant to us by Netdecisions, we had one employee. Now we have 19 employees and an office in London. As I say, I’m very proud, as a Trustee for 18 years and also Medical Director for 18 years, we’ve raised all that money over that time.

Paul: It’s a huge achievement, as you say, it’s something you must be very proud of. In terms of the reasons why you did it in the first place, was there something that was close to your heart, as to why you wanted to do this right at the beginning? Was there something really driving you on to do that, because I suppose there’s a number of ways you could have taken your skills and a number of causes you could have helped, so is there a specific reason why it was the Operation Smile route that you went down?

Phil: It did all start as a bit of an accident, because when I started working with Operation Smile, I was working in Adelaide in the Children’s Hospital in 1995, and it literally was a total accident. There I was as a senior anaesthetic trainee in the coffee room, and one of my colleagues, a consultant, came in and said, ‘I’m meant to be going away with Operation Smile in two weeks’ time, but for family reasons I can’t go, can anyone else go?’ and I thought, put my hand up, two weeks in Bogota seemed like a good idea and I went.

And I suppose from that moment of seeing the difference that we made on a two-week medical mission with Operation Smile, all the children’s lives we changed – we operated on about 200 children that  medical mission – it just seemed such a valuable type of organisation. Obviously, there’s a great need around the world, and it’s so valuable that it’s very infectious; once you’ve been on one mission, you can’t stop going on them really.

When the opportunity came to actually being able to make it happen in this country, again, it was taking those opportunities, and I suppose that’s always been a bit of a mantra in my life is, if an opportunity comes along, it may only come along once, you take that opportunity, and it’s just grown from there.

Paul: I know you’ve talked about the great work you’ve done in terms of the setting up of the foundation and the fundraising behind it. In terms of your role, what else do you do? Because I also think that’s quite important, in terms of the more hands-on, day-to-day things you’re involved in. It’d be quite good to understand how that works from your point-of-view?

Phil: My normal workdays? I work as a Consultant Anaesthetist, which means I anaesthetise patients to have operations, so from an Operation Smile point-of-view, I anaesthetise the children for the surgeon to do the operation.

My full-time, normal day job is working at a local hospital, which I’m very fortunate is only about a mile away, so I normally cycle to work in the morning, which is lovely. Just take yesterday for example, I was doing children’s operating lists, where in fact we were doing investigations of MRI scans. Now, we’ve got little babies, they don’t lie still for half-an-hour to do the scans, so you have to anaesthetise them, but one of the main parts of that job is actually spending time talking with the parents, who are extremely anxious that the child’s going to have the scan, what they’re going to find, they worry about the anaesthetic, so a lot of my time is spent actually preparing the parents and the children for the operation.

Come the afternoon, I was anaesthetising patients for bariatric surgery, which is weight-reduction surgery, so in the morning I was anaesthetising the smallest people in the hospital, in the afternoon I was anaesthetising the largest people in the hospital! It’s a really varied job and that’s what I love about it. For me, going to work on a day-to-day basis just isn’t a chore. I just love my job really.

Paul: When I look back at the operations that I had as I was getting a bit older, I think the last operation I had on my cleft lip and palate was when I was 13. I can still remember the anaesthetist from that time, because obviously when you’re younger, you don’t really know what’s going on, but I think as you get a little bit older, you’re more conscious of what’s about to happen. That moment when you’re in the operating theatre, you’re just waiting and you know, in those days – showing my age a bit now – there used to be a huge mask that goes over your mouth; I’m not sure they still do that now or whether there are different ways of anaesthetising people. But it’s quite a scary thing to go through, counting down from one to ten, and I just remember the people that were doing that, the anaesthetists that worked with me then, really helped massively in that five-minute period before actually being under. It’s a huge job to do really, to put the patient at ease before the operation actually starts.

Phil: It is really particularly important – it’s important with everyone – but particularly children, like yourself, you would have had a number of operations over the years, so if the first operation you go to, you’re really scared of the anaesthetist, it’s a complete nightmare after that, because the patient is only scared about coming in, and therefore it’s so important we get it right and actually make the children feel very relaxed. And as you say, we sometimes use the mask, we sometimes use IV, but we put special cream on so that they don’t feel the needles going in. Sometimes I use a bit of sedation to settle them, but it’s quite interesting because sometimes it’s actually the parents who are more anxious and the children are an absolute dream.

We always bring the parents in, but it’s quite interesting because most parents hold it together until the moment the child goes off to sleep. And the moment the child goes off to sleep, you just see the parents suddenly burst into tears, all the stress goes out of them. And I always find – I’ve taken my own children to the operating theatre – and when you’re on the other side, it’s a different story altogether.

Paul: It’s good you’ve been on the other side of the theatre, so the fact you can empathise with what people are going through is important. You know how to put people’s minds at rest and make the situation more comfortable for everybody involved on that side. Obviously earlier on, you mentioned a bit about the great work you guys have been doing in the fundraising for Operation Smile, £35m raised to date, because obviously EMEA are going into partnership with Operation Smile, we’re going to be hopefully adding to that number over the years. I thought it might be good for you to explain to the listeners how the money is spent and where the money goes really.

Phil: Well we obviously try and direct as much of the money to the frontline as possible and we have different models, but our main model is running a mission model. We used to run a lot of international medical missions. If I just take you through the very basics of what our medical mission involves, and where the money is being spent and why people may realise it does cost money for these things to happen.

First of all I would say that all the medical practitioners and all the nurses, doctors, any healthcare assistant who goes with us on these missions, does it on a purely voluntary basis, so none of us are getting paid, none of the volunteers get any money out of it whatsoever. The money goes into the organisation of our programmes, so a typical medical mission is all about the team and it’s really exciting.

We have a team of about 40/45 people and we all fly to a centre where we’re going to be working. Sometimes we know a few people on the team – on the whole, quite often – we won’t know any of the other people on the team. We’re all high-skilled healthcare professionals who know our job, but it’s bringing a team together on a day. The following day we’re working straight off; we can’t waste any time. This isn’t a holiday.

So, I’ll give you an example of a medical mission we did to Addis, the first mission we did to Ethiopia, in fact. We arrived there, we got all the gear to the hotel, met all the people coming from all over the world, we met all the local people who were going to help us as well, and the next day we started screening.

Screening involves looking at all the patients who have been recruited to come for the operation, and so we go to the Black Lion Hospital and there we were faced with 600 children waiting. Now, 600 children, that’s all very well and good, but they’ve all got a parent, or two parents, or a brother or sister, so there was approaching 2,000 people lined up around the hospital in the middle of Ethiopia, in the middle of Addis, waiting to be seen by us. And what we do do is that, in the team, there will be surgeons, anaesthetists, nurses, speech therapists, dentists, ENT specialists sometimes, and paediatricians, so that every patient that comes to a mission site will get seen. It’s crucial that everyone gets seen. And they’ll get seen by everyone in the team. So, you can imagine the logistics of that in two days, we have to screen 600 patients.

And then we have to decide who we’re operating on. The really heart-breaking, devastating side of all this is that these aren’t just numbers, these are 600 real patients who need operations, and we know that in five days’ operating that we’re going to be doing, that we’ll only be able to operate on 200. And that’s really heart-breaking when you start off in that position. The idea is that, whenever we go to a site, that we keep going back time and again, and the idea is that we train the local people to do the operations, so we see all of the patients and, over these two days, this is where a lot of the really amazing stories come out.

We’ve travelled for days to get there and it’s so hard for us to decide who we’re going to operate on. We have a very set criteria to how we do it, and to give you an example of the stories we hear, just a very simple example of a 16-year-old boy, who was called Sam, who lives in Ghana, I remember sitting there in front of him a couple of years ago, and there was Sam, who’s wearing a Manchester United football top, he looked like my son, my son was the same age – maybe it’s one of the reasons these stories often resonate, very similar to yours – and this child, 16 years with a cleft lip, not being operated on, and I just said, ‘How’s it affected you over the years? How have you felt about it?’, he just said four words, ‘I have no friends’. And you just sit there, and it brings a tear to my eye now just even thinking about it, and I just think, if that had been my 15/16-year-old son going to school every day, and being in the playground in the corner, no one talking to him, it’s just devastating. And that week we changed that child’s life. His life was changed. He would actually be able to go and play football with other people.

So anyway, we see a lot of patients, we see a lot of really heart-breaking stories, and then of course we have to decide who we can operate on. And that day’s a very difficult day, because you have to talk to everyone and say, ‘Well I’m really sorry we can’t do it this time around, but you will come back’, we give them a piece of paper to say, we were here last year, will you come next year, we’ll be here again. As a parent, that isn’t very helpful, but we can only do what we do, and we’ve got to do it safely and we can only do so many patients.

Then we have a day when we tend to set up the operating theatres and do a bit of education for the people who are helping us while we’re there, and then we have five days of operating. And we normally run five or six tables. So, we’ve set off 5/6 o’ clock in the morning, operate until we’ve finished all the patients that we’ve planned to do for the day. Sometimes that may take us on until 8, 9, 10 o’ clock at night, but it’s absolutely crucial that we only do it in a safe manner and we do it to the same standard that we would do in our own countries.

And the thing that I always go back to is that I always look at every operation we do as being a training opportunity. We have the local surgeons, local anaesthetists, local nurses, so when we’re doing the operation, we’re also training them to do the operations, so that, ultimately, they’ll be able to take over that role for us.

Then post-operatively, the kids – it’s really sweet – in the evenings, the older ones who can appreciate it the most, obviously the babies can’t, you have a 6/7-year-old, you give them a mirror to look in at the operation and how their face has changed. And the change in the face, the glowing smile that comes out is just amazing really and it‘s incredibly rewarding for us to see that afterwards. You’re never too old to have the operation, I mean, another story of an Ethiopian that’s in the Addis mission that we did. This guy was about 70, and he’d been very fortunate, he’d had a cleft lip all his life, he had got married, he had children, and the first thing he said after he had the operation, he just stared into the mirror for ten minutes, he just said, ‘I can now kiss my granddaughter for the first time’. And when you hear stories like that, it just really hits you and I get emotional thinking about it. I’ve told that story about 1,000 times, but it doesn’t stop really having quite an impact.

And then of course, at the end of the two-week medical mission, we usually have a big celebration, everyone lets their hair down, and then we all go back home, changed people.

Paul: Some of the stories you’ve mentioned there, I know some of the stories are online on the website as well, and personally it was one of the reasons why I picked up the phone to reach out to you guys, because I just realised how lucky I was going through this situation in the UK and it was almost expected that it was going to be sorted. Whereas in these types of countries you’re helping in, there’s a lot of people who have to wait a long time, as you’ve mentioned.

The waves of emotion you must go through in that two-week period, you go from one side where you’ve got to sit down with the child and the family and say, ‘Well you can’t have the operation this time around’, and then the other side when the operation is done, looking back at the photos and so on, emotionally it must be really draining for you to be in that situation. Because, even talking about it, that’s got to be really tough – rewarding, but a really tough few weeks. Is there a way you try to deal with it yourself, I guess emotionally, it’s very tough?

Phil: It is emotionally very tough. For me, the thing which is really fantastic about it is that you have a group of 40/50 people coming together and there’s only one answer, and it’s yes. And it’s a real can-do attitude. It’s a team of people, there’s no blockers there, it’s only solutions. And I think this is what I take home back with me, that actually if someone says, ‘I can’t do this because of this’, well let’s find the solution, we’ll find a way of doing it. I think that’s what I’ve really learnt from the whole Operation Smile projects I’ve been on, is this real can-do attitude. You take it back to the NHS, to your own workplace.

And your overriding emotions are that, when I talk to people who are raising money for us, I say, ‘Our part’s the easy part, the hard part is for you guys, who are raising money for us’. Because we go there and we’re the tip of that iceberg, and we’re actually doing the work and seeing the results and getting instantaneous rewards for it, whereas you guys in the background, without you guys raising the funds and supporting us, we wouldn’t be able to do the work. Our part, in a funny sort of way, working on the frontline, is the easy part.

Paul: You’ve mentioned about when you’re on the missions, it’s helping to educate the people to do the work locally as well. Is that the ultimate aim for Operation Smile, where the skills are available locally so that people can have these operations on a local scale?

Phil: Absolutely, Paul. This is the most incredibly important part of the programmes. I’ll give you a few examples. Firstly, I go back to when I went on my first medical mission to Bogota in 1995. The whole team was from outside of Colombia, so we have 45 healthcare professionals going in and they were all non-Colombian. Now, we did that mission, we operated on 200 children. We have the local nurses and doctors coming in and helping us during that time. And we started doing education programmes and teaching.

They have their own cleft centres, they even raise their own money, they have Colombian surgeons operating on Colombian children, being anaesthetised by Colombian anaesthetists, being looked after by Colombian nurses. And that is job done. It means, going forward, they are looking after their own people, and we’re not having to go in and do the extra stuff.

And that, if I were to encapsulate what we’re trying to achieve, that’s what we’re trying to achieve. And every country is a little different in how developed they are, and obviously it takes shorter or longer periods of times in different countries, and often there are huge backlogs, but that’s our aim, that we’re no longer needed. It’s beautiful to see that in somewhere like Colombia, where I went on my first mission.

We don’t only do education in our programmes – I’ve got to go there for a few other schemes as well, and just looking at Ethiopia, for example. In Ethiopia, back in 2005, when I first went, virtually all anaesthetics were given by anaesthetic nurses, so there were only 23 doctors who gave anaesthetics at the time in the whole of Ethiopia. I met one of those, Yumani, in Jimma, where I spent an awful lot of time.

Over the last 15 years, he’s become a very good friend, a very dedicated doctor, who’s an anaesthetist there, and his dream was to train more doctors to become anaesthetists and have a whole residency programme, so that all the anaesthetics in his hospital were being given by doctors. So we got together and we were trying to work out a way of doing this, and I suggested that – I give a lot of talks at home to my trainees all around the country, and they come to me and say, ‘I’d really like to help’, they get really excited about it, and they can’t go on normal Operation Smile medical  missions, because they’re not fully trained – we put together this scheme, a five-year programme, where my senior trainees would volunteer to go to Jimma for three to six months, and would help to encourage and train the doctors in Jimma to become anaesthetists, and help set up a residency programme.

So, over that period of five years, I had nine of my senior trainees go out there, and every single one of them has said it’s the most rewarding thing they’ve ever done. They’ve all gone back and helped out later on, as well. And now, in Ethiopia, we have a residency programme where there are 30 doctors training to be anaesthetists over a three-year programme. And every year, there’s another ten doctors signing up to train to be an anaesthetist.

We consider that, 15 years ago, there were only 23 doctors in the whole of Ethiopia who were anaesthetists, now we’ve got 30 training to be anaesthetists in Jimma alone. And it was very touching, I was very humbled, when Yumani asked me to go over and help do the examinations of the first cohort coming through, and it was just lovely after three years of seeing these people come through to be able to examine them, and they all passed with flying colours, and now Yumani has a residency programme. He has colleagues and he has a sustainable programme going forward, which is going to make a huge difference.

We’ve done it as well, we’ve tried to do it with surgeons, in the same kind of way, and that education is so important. Me going there for two weeks is going to have an impact, but to train someone who’s going to be there forever, is going to have a much bigger impact.

When I give talks, if I were going to put one slide up, it would be a picture of this operating table in the Jimma operating theatre. At the end of the table, there’s this young trainee surgeon, Yohana, and she’s just started training to be a surgeon, and she’s operating on a child for a cleft lip. Standing next to her is Yonas, who is a trained surgeon, who we’d trained to do cleft lips on the previous year, and he’s standing there training his trainee to do the operation. Then, looking after the patient, a one-year-old child, we have Miliyon, who is an anaesthetist, who I met virtually on his first day of anaesthetic training – we’ve trained through the years – and he’s there giving the anaesthetic to this one-year-old. He’s a highly trained paediatric anaesthetist. So, you’ve got an Ethiopian anaesthetist, anaesthetising a child to be operated by an Ethiopian trainee, being trained by an Ethiopian surgeon. And that is the picture I put up at the end of all my talks and it’s what we’re trying to achieve. It’s just lovely to manage to do that.

Paul: You’ve touched on so many amazing things that yourself and the team have achieved. What is next for you? Is there a specific mission that will be lined up when you can get out or is there anything specific that you have in the pipeline for Operation Smile?

Phil: As you well know, we’re in very difficult times at the moment [due to the COVID-19 pandemic]. For example, last year (2019), we had programmes in 32 countries across the world. We ran 172 medical missions. We operated and changed the lives of over 16,000 children with cleft conditions. Obviously since March this year, we haven’t been able to do any of that. And that’s been quite devastating for us really.

I quite like my maths, and when you consider that there’s one child born every three minutes with a cleft lip or palate, that means that, every year, there are 175,000 children born with a cleft condition. Of those, one in ten will die before the age of one, which is frightening when you think about it, they don’t need to die. If they were living in the UK or the US, that wouldn’t happen. And the other really awful thing is 70% of those children won’t get an operation at all.

So, in these five to six months, there’s been approximately 80,000 children being born with a cleft lip or palate, of which 56,000 will never have an operation. Now, we would do some of those operations and we would be training people to do those operations, but not only did we have the backlog previously, we now have another 56,000 people who won’t get any operations. This is very heart-breaking for us, so what we’re doing in the interim, what we’ve been doing over the last six months, is that, because we have warehouses and offices in all these countries we work in, with a lot of medical equipment, we’ve redistributed all our equipment, we’ve given it all away to local hospitals, so that they can use it in this fight against COVID, so at least we’ve managed to do something there.

We’ve also managed to keep a register of as many new children who are born with cleft, and so that when we can start going away and we can start helping the local people do the operations, at least we have a register of our patients. And one of the key things is, if you’re born with a cleft lip or palate, you’re going to have difficulty with nutrition, so we’ve been having nutrition programmes for each country, where we’ve been helping to provide these families with nutrition, so the children are fed well enough so that when we get around to actually being able to operate again, at least they won’t be malnourished and they’ll be fit enough to have the operations.

We’re hoping that, come January next year [2021], we’ll be able to hopefully start sending international medical volunteers to these countries again; it’s going to vary from country-to-country and we’re hoping that we’ll be able to start doing that.

We’re also supporting, in a similar way to this, Zoom education and things like that. Surgeons, like Ethiopian surgeons and Colombian surgeons, giving them support and encouraging them to be able to do the operations while we’re not there. So, moving the charity forward, at the moment, we’re dealing with what we’re having to deal with due to COVID.

Long-term, what I’d really like to see is partnerships between non-NGOs around the world to all work together. I’m very keen that we don’t reinvent the wheel, so that different charities work together to not only provide cleft surgery, so for every anaesthetist that I train, they might anaesthetise 1,000 children with cleft, but they’ll also be anaesthetising 10,000, 100,000 people in their own careers for other operations, and provide safe anaesthesia and safe surgery for everyone going forward. And it’s bringing organisations together to make surgery safe throughout all these countries that, at the moment, are having great difficulties.

Paul: Is it too simplistic to say that the only thing that holds Operation Smile back is the funding? If you had more funding, it’d obviously be easier for you to reach out to more countries, to educate more people and to get to where you want to be sooner. Or is that too simplistic to put it that way?

Phil: Funding is hugely important. Across the world, we have about 5,000 Operation Smile volunteers. The more funding we have, the more missions we can do, and the more people we can send out to help educate the local people. There are other issues that are involved with that as well, because you need healthcare professionals to train in the countries we go to and, therefore, we need to also work alongside countries, encouraging them to support training of their own healthcare professionals, so that we can help train their professionals.

So funding is massive, it’s absolutely massive, and obviously, the more we get, the more we can do. It’s absolutely crucial. But we also need more volunteers, and we need governments to be able to encourage and help us move forward in their healthcare systems.

Paul: I’ve found it amazing to speak to you, because clearly, as I mentioned right at the start, it’s something that I’ve got a personal connection with, and I think the work that you and the team do is amazing. There aren’t many other words I can use to describe it. The help that you’re giving to these people is unbelievable. Those stories you told today and the ones you can see online, the difference in before and after the operation is huge, and the impact it makes on people’s lives is inspiring, and I think it’s amazing work that you guys are doing.

For us to be partnering with you on this is great, and we’re obviously going to do as much as we can to keep raising awareness of it and helping to raise funds towards the cause as well. Obviously, anything we can do to help, we’ll be on the case with that, as well.

Phil: Thank you very much, Paul. It has been a pleasure talking to you and I think you very much have a very personal attachment to this organisation, having gone through it yourself. I think, as you said earlier on, the fact that you had all the support in this country and you had the operations at the right time, a fantastic outcome, you’ve been able to have a fantastic, successful career. Without us doing this work, without you supporting us, there’s people who will be like you in other countries, who would never have that opportunity, and I think it’s absolutely crucial that we give that support to as many of those children as absolutely possible.

Paul: If any of the listeners want to reach out to you directly, Phil, what’s the easiest way they can do that?

Phil: If they want to reach me directly, I am on LinkedIn, which is where you got this connection from, they can go directly to the Operation Smile UK website, and there’s a direct link there. There’s a phone number, they can phone the office if they want to speak to someone in person, there’s always someone manning the phones, virtual or not. And I’m very happy for anyone to contact me, you have my email address, phone number. If anyone wants to chat about anything, feel free to contact me. I’m always available and, personally, I love the organisation and I love talking about it.

Paul: What we’ll do, when the podcast goes out, we’ll make sure your contact details align with the podcast and Operation Smile’s details on there, as well. So if people want to reach out to you, the organisation, or indeed myself, they definitely can do on that side. All that’s left for me to say is huge thanks today again, Phil, for doing this with us. Really appreciate your time and I look forward the partnership.

Phil: Thank you very much.