Treating patients during Covid-19: Q&A with UK volunteer Nur Lubis

volunteer anaesthetist holding a child

In September 2021 anaesthetist Nur Lubis became the first UK-based volunteer to attend a medical mission since the start of the Covid-19 pandemic. We sat down with Nur to talk about her experience of working at a mission in these challenging times.

Q: How did you feel during this mission? Was Covid-19 an issue? Was it different than the missions you were used to?

A: I felt really privileged to be the last person who went on a mission before Covid-19 and the first one from the UK volunteer pool to go again now as I’m sure everybody is just waiting to go on a mission. It’s been such a long time. I know people are really enthusiastic about going out again, so I was just super excited. It just reminds me why I do it really.

Q: In terms of Covid-19 protocols, what was the situation like? Was the mission really different than the ones you attended previously, such as the all women’s mission?

A: I think with regards to how we work, we have changed a lot based on Covid-19. That’s not just with the mission, but also how we work in our normal hospital. So in a sense that’s nothing different and nothing unusual. So obviously, the mission was very Covid-19 compliant. We could see that a lot of effort had been made to make it very compliant with the regulations.

We received a document that was very clear beforehand. Then we had detailed briefings from the programme coordinators and the local team about the Covid-19 protocols in place. Obviously, the hospital also has its own additional protocols. We are always the guests in the hospitals wherever we work in, so we also have to comply with their protocols. Essentially, these protocols made everyone feel really safe, from the patients to the family and also the volunteers. Some of the children did find the masks and PPE quite scary so I drew happy faces on the gown.

Operation Smile also have additional volunteer roles, dealing with logistics in terms of the Covid-19 protocols and PPE. They had someone whose job it was to make sure that we have everything that we needed in terms of PPE and also that everyone is compliant with the protocols. In some work areas such as the operating theatres we are used to wearing PPEs but we also had access to them at the hotel so we all felt very safe.

Group of medical volunteers

Q: How many patients did you treat?

A: We screened 92 patients and operated on 66. We saw less patients on the screening day, but the team leaders continued screening throughout the week. So patients were coming in, and the team leaders were able to then screen them pretty much every day and put them on the surgical schedule.

The numbers were lower than the usual pre-Covid-19 mission for a combination of factors. It was a new site for Operation Smile Egypt, so the local team still need to gain visibility and raise more awareness about cleft conditions in the area. There was also pre-screening already done in advanced both to optimise patients and to avoid crowding on the screening day. Perhaps some parents were still anxious due to Covid-19.

The nice thing about this mission was that we were able to operate on everybody that needed surgery, so we didn’t have to delay anybody or to turn anybody down because usually we have way too many patients compared to the slots that we have for surgery and some patients have to wait. This is obviously very difficult for the patient and their family so it’s just nice that we didn’t have to do that this time. So I guess that’s an advantage of having a smaller number.

It also means that we were less stressed with being compliant with the Covid-19 protocols and we had the time to get used to them. The local team was very seasoned, as they’ve managed to do some local missions throughout the last year. It was just nice when it’s not so overwhelmingly busy, especially on screening day as patients, guardians and volunteers had to have a Covid-19 lateral flow tests and the patients and their guardians can only come in small groups to the waiting area. All these measures added more time to the screening, but we managed to do everything very smoothly and without time pressure.

Q: How does screening work now? Usually the patients start with medical records and then they are seen by the different specialties (nurses, anaesthetists, surgeons etc.).

A: Operation Smile Egypt organised the pre-screening and they also asked the patients to come at different times. This meant we could do all the processes smoothly and without big crowds. The first step was to attend a Covid-19 screening station, where they were tested (both patient and parent). Only one parent was allowed in the hospital, which was very difficult for some of them. Then we did the usual screening process, but with small numbers as we had just 5 patients at a time, so there wasn’t a big number of people in the waiting area.

Q: What was your favourite memory from this mission?

A: Probably my favourite one was a patient waiting for surgery who was a little bit upset and didn’t want to leave his mum which sometimes can be really emotional. What really touched me was that one of the other patients’ who was around the same age and waiting for his operation, ran to the boy and gave him a couple of toy cars he was playing with just to console him.

I just thought that it was such a kind and selfless thing to do because obviously he himself must be really scared, but at that moment he was able to set aside his own feelings and see that someone else needed comfort. It was a touching moment seeing that act of kindness at the time when he himself was vulnerable. It was just very sweet. It makes you think that children are very innocent aren’t they? These things remind you as an adult that you should be a bit more childlike and be kind to everybody.

Group of medical volunteers with a child

Q: Did you do some training to local medical professionals?

A: We supervised and trained the new volunteers so they can become familiar with Operation Smile’s protocols and standards of care as well as having the right skills such as such as performing nerve blocks for analgesia so the patients are comfortable after surgery.

Coincidentally I have met the Palestinian anaesthetist when I was teaching in Ramallah in 2017 so it was lovely to see him again and work together. Speaking to one of the other Palestinian volunteers, I don’t think they get a lot of opportunities training in Palestine. So they really appreciate these chances, especially the surgeons. It can also be difficult for them to get out of Palestine and attend training so they were very enthusiastic. They can bring back the skills to help Palestinian patients with cleft lip and palate.

Q: How was the mission from the patient’s perspective?

A: I think Operation Smile Egypt did a great job with the pre-screening. That makes a huge difference as you identify patients with other conditions (e.g. malnutrition or other diseases) early. You can then do something about them in good time. The mission was also done at a really good time of year, because it was still relatively warm. Sometimes, what we see is patients with chest infections, especially if the weather is a little bit colder. These kids can then infect each other and we unfortunately ended up having to cancel their surgery until they have recovered which usually means the next mission. So it was good that none of that happened this time, which was amazing. I don’t think we had to cancel a single one and we managed to provide surgery to everybody, which is satisfying.

Q: Is there anything else you’d like to share?

A: Donors should know that even during the pandemic, the local teams did a massive job with the patients and many of the care provided such as nutritional support and speech therapy was able to continue safely.

Although there was no international medical mission for a year the headquarters used the time to update and improve processes and systems so that programmes can now run more smoothly.

Help us to continue keeping our promise to patients amid the Covid-19 pandemic. Your support today means we can help patients through these uncertain times and provide them with the care and surgery they deserve.

Life-changing partnership in Egypt: Q&A with Dr. Mohamed El-Shazly

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.

Amid political turmoil in Libya, two neighbouring countries united to spread peace and healing for families affected by cleft conditions.

Local Operation Smile Egypt volunteers and staff welcomed nearly 30 patients from Libya who were born with cleft lip and cleft palate. This was no small feat, as Libya is still in the process of recovering from a decade of suffering and instability.

According to regional director of the Middle East and North Africa region and CEO of Operation Smile Egypt Dr. Mohamed El-Shazly, the goal of bringing children in need to Egypt for care has been in the works since February 2021.

“The Operation Smile Egypt teams have been working on this programme with Libya for a long time through pre-screening sessions by way of virtual resources, sharing photos, lab results and health history for more than 30 patients,” Mohamed said. “Twenty-four patients were physically screened at Operation Smile Egypt’s cleft centre.”

Libya is an area of the world where conflict and war have left its healthcare system on the verge of collapse, and 1.3 million people living in the country struggle to access the most basic of health services.

“There are a lot of patients suffering from cleft conditions. The specialised surgery programmes like plastic surgery in this country are not yet fully developed,” Mohamed said. “Children often can’t receive surgery due to the current unsafe situations, war and political instability.”

This programme was the first of its kind with respect to children and families from another country travelling into Egypt to receive care. With the support of both Libyan and Egyptian ministries of health, 24 patients were screened, 17 underwent surgical care and seven Libyan medical professionals received training.

We recently connected with Mohamed to learn more about the care and training provided during this mission and how he hopes it will be the first of many surgical programmes Operation Smile Egypt will host in the future.

Dr. Mohamed El-Shazly giving a presentation
Regional director of the Middle East and North Africa region, CEO of Operation Smile Egypt and surgeon Dr. Mohamed El-Shazly. Photo: Marc Ascher.

Q: This programme was a beautiful display of the compassion and solidarity between Operation Smile Egypt and Libyan families and healthcare workers. Could you provide more context behind the orchestration of this surgical programme?

A: “It was an amazing start to Operation Smile Egypt’s fiscal year activities with a new type of programme providing healthcare for neighbouring countries, especially countries that are suffering from health, war and political problems. There are a lot of patients who need help and support who will lose the ideal timing of surgery due to their country’s problems.

“We have some connections in Libya through plastic surgery and anaesthesia residents who were trained in Egypt. They were the main contact with the authorities in Libya. The minister of health and the health coordinator in the temporary Libyan government were very enthusiastic and supportive of this programme.”

girl wearing a mask colouring on the floor
A Libyan patient plays in the child life area while they wait for cleft surgery during Operation Smile Egypt's July 2021 surgical programme. Operation Smile photo.

Q: Could you describe the need for cleft surgery for these Libyan children? Why weren’t they able to receive surgery in Libya? What’s the overall environment like for these patients and the Libyan health system?

A: “There are a lot of patients suffering from cleft conditions, and they are existing in different sites in Libya from the far desert areas to the main cities. The specialised surgery programmes like plastic surgery in this country are not yet fully developed. Many Libyan patients seek medical advice and management in Egypt and Tunisia. Children born with cleft conditions often can’t receive surgery due to the current unsafe situations, war and political instability.”

Group of men standing in front of an airplane
Libyan volunteers and trainees at Benghazi airport before boarding the plane to fly to Operation Smile Egypt's July 2021 surgical mission. Operation Smile photo.

Q: Did Operation Smile Egypt see a need and extend a helping hand to Libya? Or did Libya seek help from our team?

A: “Libya did seek help and asked us to travel into country, which isn’t possible nowadays due to the unsafe conditions. The Libyan ministry of health and the Medical Attaché of the Libyan Embassy in Egypt – who visited the mission – had delivered and expressed his appreciation to the medical team and the support of Libyan and Egyptian ministries of health for this programme. He expressed his willingness to continue the cooperation in the near future with a huge programme for treating Libyan children and training of Libyan volunteers.”

Q: Which partner organisations and government agencies helped make this programme possible, and how did they contribute to its success, respectively?

A: “The Libyan non-profit Drawing Smiles was the responsible body to recruit and screen patients and prepare all logistics. The International Organization of Migration connected us with the same foundation in Libya who helped in patient recruitment. UNICEF Libya also served a role in patient recruitment.

“While the Egyptian ministry of health assisted with the needs to cross borders, the Libyan ministry of health funded air tickets for patients and their families. Assiut University provided free medical supplies, discounted accommodation and food supplies for the families and free management in the new and old Assiut University hospitals for non-Egyptian citizens.”

Volunteers posing for a team photo outside the hospital
Operation Smile Egypt volunteers and Libyan volunteers come together and pose for a team picture in front of the Assiut University Paediatric Hospital. Operation Smile photo.

Q: Could you provide us with more detail on the logistics behind the transportation of 30 Libyan patients across the border?

A: “Transportation was made possible with the support of the Libyan and Egyptian ministries of health and foreign affairs and a private plane transporting Libyan children with their families, who landed in Assiut Airport to find our staff and student team welcoming them and presenting them our gifts.

“Libyan citizens didn’t need a visa, but there was a security agreement which was done virtually weeks before the event with the state securities. Vaccination status and Covid-19 testing were performed in Libya, repeated during the mission and before flying back.”

surgeon performing a cleft surgery as two volunteers look on
Libyan surgical volunteers observing Operation Smile Egypt volunteer surgeon Dr. Mostafa Elsonbaty. Operation Smile photo.

Q: You mentioned that seven trainees from various Libyan universities and hospitals received training. Could you provide us with more detail on that? Why do you believe this training was important?

A: “Three surgeons, one anaesthesiologist, one paediatrician, one dentist and one patient imaging technician (PIT) received training.

“It’s a good start to building a team there following Operation Smile global standards, and the feedback was amazing from them and from the Medical Attaché of the Libyan embassy in Egypt. Also, our educators had presented the most possible experience and training modules to the Libyan volunteers in surgery, anaesthesia, paediatric care, dental care and PIT. They were serious and very keen to get the maximum knowledge possible to follow up with their patients in their home county and to start a nucleus for this service in Libya.”

Q: Could you share the sentiments that the patients and their families shared with you and your team?

A: “Most of them couldn’t believe we would provide surgery for their patients. They were more than welcomed in Egypt, and they hope that there are people still caring for them, even people not inside their country. A lot of appreciation to the foundation that gave what they needed for free. They were very happy to find this care in Egypt.”

Help us to continue keeping our promise to patients living in places like Libya and Egypt amid the COVID-19 pandemic. Your support today means we can help patients through these uncertain times and provide them with the care and surgery they deserve.

Volunteer nurse caring for a child awaiting cleft surgery
Operation Smile Egypt volunteer operating room nurse Manal Ramsis cares for a Libyan patient before their surgery. Operation Smile photo.

Updates from India – An interview with Abhishek Sengupta

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

How is the current situation in India?

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

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

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

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

How have your teams been able to respond so far?

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

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

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

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

Do you have a personal message for Operation Smile donors?

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

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

Scenes of hope and healing: Guatemala City surgical programme

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

Photo: Rohanna Mertens.

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

Photo: Rohanna Mertens.

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

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

Photo: Rohanna Mertens.

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

But they also felt hopeful.

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

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

Photo: Rohanna Mertens.

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

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

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

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

Photo: Rohanna Mertens.

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

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

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

Photo: Rohanna Mertens.

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

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

Photo: Rohanna Mertens.

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

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

Photo: Rohanna Mertens.

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

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

Updates from Malawi: New bicycles for outreach volunteers

It was this time last year that Kentown Wizard Foundation CEO Margaret Ingram returned from Malawi to the news that coronavirus had made its way to the UK. It was not long after this announcement that countries all around the world including our amazing partners in Malawi were struck with the same devastating news.

The initial impact of the virus on the Cleft Free Malawi programme was huge, by spring the country was in lockdown and Operation Smile was left with no choice but to halt international medical missions and much of their in-country work while health systems battled to get on top of the virus.

Operation Smile instantly began to adapt their services to continue supporting the people that need them the most. During July and August, the staff worked from home playing proactive roles in supporting patients, partner hospitals and the wider health system. They delivered donations of PPE to hospitals, introduced soap making empowerment projects and continued with their outreach programme, so that their patients were kept fully up to date with the evolving situation and how it was affecting their care.

Continuing patient outreach throughout the pandemic was vital in order to reassure patients that whilst they could not undergo surgery during this time, they would be called on as soon as it became safe to do so.

It was during Margaret’s last visit to Malawi that she became aware of the major challenges this outreach programme faces daily. The volunteers travel mostly by foot and the distance from village to village within these rural areas is daunting. It was with this in mind that The Kentown Wizard Foundation agreed to fund the purchase and distribution of 100 bicycles to enable the community volunteers to expand their outreach and patient recruitment programmes.

After receiving our last update from the Op Smile team, we were delighted to hear that the bikes had arrived and to receive these wonderful images of the inspiring people who will be using them.

Karen Jaques, CEO, Operation Smile UK says: “The past twelve months have been very challenging for those of us working in global health. The continued support of Kentown Wizard Foundation throughout this time, whilst many of our programmes have been put on pause, has been invaluable.

Whilst we are unable to perform surgery at our normal capacity, it is vital we continue our outreach work – these bikes will help our volunteers reach patients all over Malawi and will ensure we are able to quickly resume our surgical programmes when it is safe to do so.”

Find out more about Kentown’s work with Operation Smile here

Driven to Lead: Q&A with Abhishek Sengupta

Abhishek Sengupta, Operation Smile India’s executive director and regional director for India, Russia and Italy. Photo: Lorenzo Monacelli.

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

First beginning his journey as a translator during medical missions, Abhishek Sengupta has continuously climbed the ranks within Operation Smile, holding many roles including programme coordinator, programme manager and regional programme manager.

Today, he uses his knowledge and expertise of the organisation to execute the role of executive director for Operation Smile India and the regional director in India, Russia and Italy.

“I grew up in a very small town where, since you were a kid, you were told that you have to either be a doctor or an engineer or a lawyer,” Abhishek said. “What Operation Smile exposed me to is that you can help people, and that can be a career.”

Pausing all medical programmes in India was an incredibly difficult decision, especially after having just wrapped a successful mission in Durgapur, but Abhishek knew that he needed to do everything in his power to protect his team, his patients and his country.

“For us, the biggest point of discussion that we had at that point of time was, one, patient safety and, second, volunteer safety,” he said. “That is what we championed in Operation Smile, and that is something that we would never compromise.”

We recently connected with Abhishek to hear more about his journey with Operation Smile and how his team in India strives to overcome COVID-19 challenges in the communities where they work.

Abhishek Sengupta, then the lead programme coordinator for Operation Smile India, poses with the translating team in Nagaon during a 2010 medical mission. Photo: Kieran Harnett.

Q: When did your involvement with Operation Smile begin?

A: “I actually started with Operation Smile as a student volunteer way back in 2005. That’s when I was getting my bachelor’s degree in English literature. Operation Smile had been working in India for just one year before that. They were doing a mission, looking for translators because, as you know, on a mission, the international volunteers need translators to communicate with local staff as well as patients. We took a van because our Operation Smile team that had sent a van for all the translators, and there were around 25 of us. There were like more than thousand people there. We got out and then we realised these are our patients. That day, we screened more than 600 patients. We went at 7 a.m. and came back to our dorm rooms at around 10 at night. We were exhausted, but we loved it.

“I think that’s when it clicked. Since then, I volunteered for a few more missions. We were doing missions in Bolpur, we’re doing missions in Deesa. Whenever they would come back to Bolpur for a mission, I’d help with patient recruitment, I’d help with some of the logistics with the hotel, lunch, dinner, as well as some of the hospital relationships. I would handle all that. That’s how it started. Believe it or not, the reason I was getting a bachelor’s in English literature was because I wanted to be a journalist. But then Operation Smile happened. Since then, I’ve been working in the development sector. After my graduation, I was offered a job as a programme coordinator in India, which I readily took. I love doing what I do. It’s been an amazing journey.”

Q: What was it specifically that drew you in to working with Operation Smile India?

A: “I think what really inspired me was the idea of helping people. I grew up in a very small town where, since you were a kid, you were told that you have to either be a doctor or an engineer or a lawyer. When I decided to be a journalist, that was actually going off the track. What Operation Smile exposed me to is that you can help people, and that can be a career. This was something that I didn’t know. That was inspirational. In my job right when I was a programme coordinator, I used to travel to rural India, I used to travel to small villages, meet patients, meet their families. At the same time, the next day, I would be sitting in an office in Bombay and meeting a corporate donor.

“That’s the interesting part, you meet policymakers, you meet health ministers, you meet health secretaries. The entire spectrum of people and the job is very interesting, it’s very dynamic. Every day is different. I’ve done over 100 missions in my life, and I still learn from each and every mission because it’s not the same. I think one is the element of dynamism with the job. The second, you get all that while you’re making a difference in someone’s life. I think you really don’t need anything more than that to choose, I think it was an obvious choice.”

During Operation Smile India's February 2020 medical mission in Durgapur, 130 patients like Shahid received life-changing care. Photo: Lorenzo Monacelli.

Q: What shocked you the most about the need for cleft surgery in India?

A: “I think when I started with Operation Smile, we were pretty much the only charity in India doing providing free surgery to children with cleft lip and palate. I had never seen a child with a cleft in my life. Even today, when I walk on the streets, I don’t see a child with a cleft lip and palate. Now imagine, while this is the reality, you end up on a mission or you come to an Operation Smile centre and you see hundreds, sometimes thousands of kids with cleft lip and palate. What that means is that there is something wrong. Why do we not see these kids in regular life?

“I started to engage with patients and patients’ families, hear their stories. Once you hear these stories, you just understand. How these kids are shunned away, and then you hear stories about the taboo and the superstitions that are associated with cleft. Something needs to be done about it. I think that’s what’s very critical, and that’s what I think people like us want to do and we have dedicated ourselves to doing and same with Operation Smile, I think that is what we champion, and that is what we want to continue doing.”

Photo: Lorenzo Monacelli.

Q: Although we’ve had to postpone many surgical missions due to COVID-19, could you speak a little bit about what your team has done to provide food and relief items to families and migrant workers in India?

A:We are very proud of what we have done. Of course, we believe that it is our responsibility to stand beside communities even in times of hardship, especially in times of hardship. Once we shut down our programmes, we realised that this is going to stay and our teams were there and we wanted to help people. One way was to collaborate with hospitals and provide them with PPE, get our volunteers to help supporting as frontline workers in COVID wards and all of that, but then we realised that there were already people doing that. Plus, at that point of time, there was a huge shortage of PPE, so even for us to buy, it was difficult.

“Then we realised that because of the lockdown, there was another challenge. India has more than 4.5 million migrant workers. These are people who come from small villages to smaller towns or bigger cities in search of jobs. They would work at restaurants, pubs, bars, factories, small businesses. Most of them are daily wage earners. Depending on the number of hours they worked a day, they would get paid at the end of the day. That’s how they sustain. What happens is these factories, these restaurants, these businesses where they work, that’s where they stay. At night, they would sleep at the restaurant once it’s closed down. Because of the lockdown, suddenly all these businesses were shut. Suddenly, none of these people were being paid. They lost their jobs overnight. Most of them also didn’t have a place to stay because they were still living in the place where they work, or even if they were paying rent in a big city, once their daily income is gone, they were not able to pay that rent. There were no trains to go back home. There were no buses. You would see migrant workers walk for seven days, 12 days, 14 days on the highways trying to go back home because there were no transport.

“The other problem that happened is because these are people who pretty much live on a day-to-day basis, they don’t have any savings. Once they lost their jobs, there were a huge number of people who were living hungry. They didn’t have money to have two meals a day, leave aside three meals a day. We saw this as a problem, and we decided that that is a space we want to work in.

“We picked up two cities where we run centres. We started giving out food supplies. Overall, in about four weeks, we were able to support about 2,500 families, providing them food supplies. In each packet, there would be rice, potatoes, lentils or cooking oil, enough for about 20 days for each family. Then, of course, we also gave some hygiene kits, which is masks, sanitisers, soaps, buckets and mugs, because we felt that is important in these times. We hope that, socially, as we accept this as a new reality, I think people’s health-seeking behaviours are also influenced. Those are some challenges that, as a country, we can overcome.”

Help us keep our promise to patients living in India 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: Lorenzo Monacelli.

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 north-eastern 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.

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 north-eastern 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.

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.

Scenes of Hope: Guadalajara Medical Mission

Photo: Laura Gonzalez.

The programme coordination team for Operation Smile’s February 2019 medical mission in Guadalajara, Mexico, works together to guarantee that every detail of the mission is executed correctly so patients and their families receive the best possible care.

Brian Mejia, left, was a nursing volunteer in 2011 when an Operation Smile medical mission came to the hospital where he was working. He said, “I had never seen a child with a cleft before. I was surprised and asked, ‘what is this?’. I knew from that moment that I could help.” After earning his nursing degree, Brian began working at our care centre in Nicaragua. Two years ago, he moved to Mexico and has worked as a programme coordinator ever since.

Mauricio Rojas, centre, has worked with us for six years as the programme coordinator for Mexico. “What you want to offer to the patients is the best quality of care possible. That means you have to pay a lot of attention to the small details, which is a lot of work, but at the end of the week, it’s all worth it,” he said.

Kristina Grossman, right, has been a member of our international programme coordination team for less than a year, but she has already helped execute missions in India, Madagascar and Mexico. “I find that it’s a privilege and honour to serve our patients,” she said. “They deserve the best medical care we can provide, and it is a joy to serve such resilient individuals.”

Photo: Laura Gonzalez.

Operating room nurse Carol Blackler of Canada checks a patient’s vitals on screening day. During the screening process, volunteers from Honduras, Venezuela, Paraguay, Ecuador, Peru, Guatemala, Bolivia, Spain, the U.S. and Canada came together and screened 196 patients.

Photo: Laura Gonzalez.
Photo: Laura Gonzalez.

Eight-year-old Norma arrives at the medical mission with her dad, Rafael. She had never received surgery to repair her cleft lip because her mum and dad didn’t know that free surgery was available. Norma and her family are members of an indigenous group of people of Mexico living in the Sierra Madre Occidental range in Jalisco known as the Huichol people. Thanks to Operation Smile Mexico’s partnership with the local government, patient recruitment efforts are being implemented and successfully bringing more children like Norma to our missions. Rafael told us that having to travel far from home to reach the hospital made him feel worried. But after he saw the way the medical volunteers treated Norma, he quickly forgot his fears. “After I got to know the hospital and the people, I felt relieved,” he said.

Photo: Laura Gonzalez.

On patient announcement day, a group of mums whose children passed their comprehensive health evaluation listens as they are told what they can expect and what precautions they will need to take to ensure that their child is prepared for surgery the following day.

Photo courtesy of Iván Ramírez.

An incredible group of local women called Las Mamás Gallinas – “mother hens” – provide compassion and support for children waiting to receive surgery. These women also look after our medical team by preparing snacks and drinks for the team so that they can take breaks quickly and get back to treating patients.

Photo courtesy of Iván Ramírez.

While they wait to see a doctor, children have fun at a crafts station set up by Mama Gallinas in order to keep them entertained on screening day. Not only do these dedicated women create an enjoyable experience for the children, but they also calm worried families by reaching out and explaining what to expect when it’s their child’s turn to receive surgery. Mama Gallinas truly bring joy, energy and warmth to each day of the mission.

Photo courtesy of Iván Ramírez.
Photo courtesy of Iván Ramírez.

Patient imaging technician and Mama Gallina Rebeca Flores and patient imaging technician Andrea Duhcan with an infant patient.

Photo courtesy of Osvaldo Godina.

Three-year-old Luna arrives at the hospital with her grandmother, Rocío, who took her in as her own daughter when she was born. “Luna, as you can see, is so sweet and caring. She is so smart, and everyone really likes her,” Rocío said. Luna has faced many hardships during her short life, including being born with a cleft lip and palate, conjoined fingers and without two toes on one of her feet. After receiving cleft lip surgery from Operation Smile when she was 2 years old, Luna returned to receive care for her cleft palate. In August, Luna will start school and hopes to join the girls’ soccer team so that she can make friends with her new classmates. Rocío and Luna’s aunts and uncles have joined together to make sure that she lives a life full of opportunity and happiness.

The story continues in “Scenes of Healing: Guadalajara Medical Mission.”