Updates from India – An interview with Abhishek Sengupta

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

How is the current situation in India?

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

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

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

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

How have your teams been able to respond so far?

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

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

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

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

Do you have a personal message for Operation Smile donors?

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

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

Scenes of hope and healing: Guatemala City surgical programme

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

Photo: Rohanna Mertens.

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

Photo: Rohanna Mertens.

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

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

Photo: Rohanna Mertens.

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

But they also felt hopeful.

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

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

Photo: Rohanna Mertens.

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

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

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

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

Photo: Rohanna Mertens.

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

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

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

Photo: Rohanna Mertens.

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

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

Photo: Rohanna Mertens.

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

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

Photo: Rohanna Mertens.

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

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

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 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.

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.

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.” 

Amid the Pandemic, Nairobi Orphanages Face Food Shortages

At 7 months old, Alex was one of the 229 patients who received a comprehensive health evaluation at the medical mission in Nyeri, Kenya, in October 2009. Photo: Margherita Mirabella.

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

In Kenya, we’re committed to the health and wellbeing of the community in which we work. We recently learned from Operation Smile Kenya’s programme manager, Roy Kariuki, that 335 children relying on five orphanages and children’s homes in Nairobi are facing food shortages as a result of strict COVID-19 lockdowns in the city. That’s why we’re mobilising rapidly to provide immediate relief for these children.

We caught up with Roy to learn more about the emergency unfolding right now in Nairobi.

Roy Kariuki, programme manager of Operation Smile Kenya, helps conduct a post-operative assessment of a young patient during a 2008 medical mission in Nakuru, Kenya, where he served as a programme coordinator. Photo: Keith Bedford.

Q: Could you tell us more about how COVID-19 has impacted Kenya to date? 

A: “As of July 29, we have 18,581 confirmed cases with 299 mortalities (source: WHO Coronavirus Disease Dashboard, accessed July 29, 2020). Experts project our peak to be around late August to early or mid-September. Our health facilities are already overrun by patients, and the government is now directing home-based care for asymptomatic patients and those with mild symptoms. The virus is now firmly in the community. It is difficult to really speculate on the number of people already infected, as our testing capacity is very low. Most government services are still unavailable with employees being requested to stay home or work from home. The private sector has declared unprecedented redundancies. Schools are shut down. The economy is on its knees.”

Q: How are our Kenyan medical volunteers fairing? Are many of them on the frontline of the pandemic? 

A: “We are regularly in touch with our volunteers, and despite hardships of working in very resource challenged environments – lack of PPE, short-staffed hospitals – we are thankful that, thus far, none of our people have been directly affected by the pandemic and we pray it stays so.”

Q: Could you tell us more about our connection to the orphanages and children’s homes to which we are donating? 

A: “I came across the news of the hardships of these five homes through charity and investment clubs that I belong to. Every Christmas or on various holidays, my friends and I would fundraise and buy foodstuffs and clothes for these homes and spend the day with the kids. It was never all at the same time, as we could only afford to do so one home at a time. They are actually many more homes than the five we are focusing on. But at this point in time, I felt it best not to overstretch the resources we have.”

Q: Why are COVID-19 lockdowns preventing these homes from being able to get food for the people they support? 

A: “These homes, even though properly registered by the government through the Ministry of Social Services, rely on corporate and individual donors to feed, clothe, educate, accommodate and provide medical care for the children under their care. With the economy on a downward spiral, companies sending employees home and shutting down their factories, corporate social responsibility initiatives also abruptly came to an end. The homes were left to fend for themselves. When (Operation Smile Co-Founder and President) Kathy Magee learned of their predicament, it was simply amazing how the entire organisation was galvanised into action.”

Q: What has the reaction been from the leaders of these homes been to the promise of our outreach? 

A: “They have been very excited that we have shown an interest. I am collecting lists of their needs so that we can be able to start providing nutritional support next week.”

Q: Beyond providing food and shelter to their children, what other benefits do these homes provide for those who rely on them? 

A: “They provide schooling, accommodation, counselling, psychiatric support and rally sponsorship for higher education. They also find sponsors for kids who require serious medical interventions.”

Q: What would you say to anyone who contributes to this initiative? 

A: “To quote one of the directors at one of the homes – he was an orphan himself, and someone took care of him throughout his childhood – ‘We cannot cure all the ills in this world, but we can certainly try heal the ones closest to us.’”

Q: Could you tell us more about Operation Smile’s work in Kenya?

A: “Operation Smile has been in Kenya since 1987 and is Operation Smile’s second international foundation after the Philippines. We have provided free surgical care to over 10,000 needy Kenyans and provided AHA training to over 1,000 healthcare providers in the country. We are currently in the process of strategising on provision of free comprehensive cleft care to both former and new patients affected by cleft conditions. We are also looking to playing a part in strengthening the health systems in Kenya. Over the last six years, we have been a volunteer resource country for the region as well as for international education and surgical programmes.”

Four-month-old Robert and his mother await his comprehensive health evaluation at the medical mission in Nyeri, Kenya, in October 2009. Photo: Margherita Mirabella.

Going Far Together: A Future for Women in Healthcare Around the World

By Dr. Naikhoba Munabi, plastic surgery resident at the University of Southern California and former Global Surgery Fellow at Operation Smile.

Dr. Naikhoba Munabi, left, stands beside Fouzia Mahmoudi, Operation Smile Morocco Co-Founder and Vice President, centre, and Operation Smile Co-Founder and President, Kathy Magee, during the 2020 March all women's 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.

When asked how I’ve been able to climb the ladder of success to where I am today, my answer is always simple: I didn’t do it alone.

I come from a family of physicians, including women such as my mother and grandmother. On the occasions that people have said my race or gender would limit my ability to succeed in my chosen career, I looked to my family to confirm that these opinions were wrong.

My inspiration and support came from outside of my family, too. Female teachers, coaches, lab directors and classmates mentored and helped me believe in my capabilities. Even when I entered the arena of surgery where few women exist, I always had sources of encouragement to continue pushing forward in pursuit of my dreams.

Cleft surgeon Dr. Luca Autelitano of Italy, left, examines a patient with Dr. Naikhoba Munabi. Photo: Lorenzo Monacelli.

Unfortunately, not all women in the world are so lucky.

Almost 1 billion women globally do not have formal employment because they lack access to education, encouragement to continue persevering in a career of their choice, or do not know what a woman can achieve. But 18 million more healthcare workers are needed in the world. It is vital that women enter and continue in medical careers to help address the needs of some of the poorest and most disenfranchised individuals worldwide.

Better mentorship can help get more women into healthcare. Earlier this year during Operation Smile’s inaugural Women in Medicine: Inspiring a Generation medical programme in Oujda, Morocco, 25% of female volunteers said they struggled to find mentorship and guidance in their career despite wanting it.

Team photo of the female medical and nonmedical volunteers during the Women in Medicine: Inspiring a Generation medical mission. Photo: Jasmin Shah.

In male-dominated careers, such as medicine, societal norms are not always encouraging of women. The presence of a mentor can be the difference between a woman entering and staying in healthcare or turning away from adversity.

25% of female volunteers said they struggled to find mentorship and guidance in their career despite wanting it.

Bringing 95 female medical professionals from 23 countries together in Oujda helped establish those critical mentorship contacts. During the programme:

  • 73% of women who weren’t able to find a mentor in their home countries were able to identify one during the mission.
  • 100% wanted to maintain those professional relationships in the future.
  • 97% of women were more confident in their ability to perform their jobs.
  • 100% felt inspired to mentor women in their home countries.
Graph showing how mentorship during the mission had a trickle-down effect for participant home countries. 100% of participants established professional contacts to maintain in the future and 100% felt empowered to mentor working women at home. Graph courtesy of Naikhoba Munabi.

The Women in Medicine medical programme also inspired women to become leaders. Despite only 29% of volunteers having leadership experience with Operation Smile, 93% felt inspired to become a leader in the organisation and 97% felt inspired to become leaders in their home country. Through this desire to lead, 99% of women felt they would also advance professionally and 97% hoped their careers would involve working with other women in the future.

Simply put, creating a collaborative environment for female healthcare professionals encouraged women from all around the world to continue advancing and forging the path for more women to follow.

One of the best parts of being a global surgery fellow has been finding commonality with so many people of diverse origins around the world. The world is brimming with talent, including exceptional female talent. Operation Smile’s female volunteers are role models to other young aspiring and ambitious women in their communities. The women I have met worldwide have been an inspiration to me. The Women in Medicine medical programme was an ode to those female volunteers, their capabilities, their perseverance and their will to care for others.

Help us to continue doing everything we can for patients impacted by the COVID-19 pandemic. When it’s safe to resume surgeries, the support you give today will not only provide more children with the life-changing care they need but enable the next generation of healthcare workers to deliver care where it’s needed most.

Dr. Naikhoba Munabi pictured with volunteers from the all women's mission after completing the cleft surgery simulation workshop. Photo courtesy of Naikhoba Munabi.

About the author: Dr. Naikhoba Munabi is a resident physician in plastic and reconstructive surgery at the University of Southern California. She took two years away from clinical training to work with Operation Smile as a Global Surgery Fellow. During her time with Operation Smile she worked with teams in multiple countries with a focus on sub-Saharan Africa. Dr. Munabi’s public health interests include education, health systems strengthening, and women’s empowerment. Clinically, she plans to continue training to be a craniofacial surgeon.