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.