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.

Surgery for the People: The Need

A single-engine Cessna 208 Caravan is filled to the brim with passengers and luggage, making its way through the clouds, up and away from the busy city of Managua toward Nicaragua’s north-east.

Soon, Lake Managua and the characteristic volcanoes are out of sight and sprawling beneath are hills, rivers, forests and a few scattered villages surrounded by farmland.

An hour later, the propeller plane lands on a strip of gravel in the middle of the town of Bonanza. This is Nicaragua’s Mining Triangle, a remote and rural area known for its mineral resources. Two other towns create the corners of the triangle – Siuna to the south and Rosita to the west.

Here, with support from the UBS Optimus Foundation, Operation Smile and Nicaragua’s Ministry of Health are working together on a pilot project at the two primary hospitals in Siuna and Bonanza called Cirugía para el Pueblo – “Surgery for the People.”

By joining forces, Operation Smile and the Ministry of Health seek to improve the surgical infrastructure of the hospitals and to spread awareness about surgically-treatable conditions to the people of the region.

Patients and families wait to be seen by medical professionals at Hospital Primario Esteban Jaenz Serrano in Bonanza, Nicaragua, one of the two hospitals that will receive improvements to its surgical infrastructure from the Cirurgía para el Pueblo project. Photo: Jörgen Hildebrandt.

“Part of the background is what is happening in the world, where more people die from conditions that are treatable by surgery than by HIV, malaria and tuberculosis combined,” explains Dr. Jordan Swanson, Director of Surgical Innovation and Special Programmes at Operation Smile Nicaragua, a plastic surgeon from the United States who is leading the project.

It all began a couple of years ago when Jordan and his colleagues at Operation Smile travelled to the Mining Triangle to search for people with untreated cleft conditions. Many people in this region live in very remote villages; the closest main road could take hours to reach by walking or by riding horseback, followed by a bus ride of several more hours to reach their primary hospital.

While spending time at the hospitals there, the Operation Smile team got to know the surgeons and anaesthesiologists and saw how dedicated, skilled and committed they are, despite working with very limited resources.

“It struck me that this was a great opportunity for us to partner together with the ministry and really figure out how safe surgery is possible also in an area like this,” Jordan says. “Many people think of us as a cleft organisation; we take care of kids with cleft. I think one can also think of Operation Smile as an organisation that achieves high-quality surgical care. We have more than 35 years of experience figuring out how to create impact and get the job done at the end of the day.”

General surgeons Drs. José Silva and Tyrone Valle consult with a patient at Hospital Carlos Centeno in Siuna, Nicaragua, one of the two hospitals that will receive surgical infrastructure improvements from the Cirurgía para el Pueblo project. Photo: Jörgen Hildebrandt.

And this is where Operation Smile can play an important role in public health.

A few years ago, the Lancet Commission on Global Surgery showed that more than half of the global population lacks access to safe and affordable surgical care when they need it, such as when someone experiences bleeding after childbirth, suffers a burn, develops cancer or is born with a cleft condition. More than 143 million surgical procedures are needed – mostly in low- and middle-income countries like Nicaragua – to save lives and prevent disability, around 5,000 procedures per 100,000 of the population.

“Well, this is very straightforward. In places like Siuna and Bonanza, only about 20 percent of the people in the region are getting the surgery they need,” Jordan says. “Many of them are referred to the capital city hospitals, and that is a tough trip to make and many aren’t going to make it.

“Now, how do we get to the rest of those patients? Part is education, part is equipment and supplies, and part is thinking through how we can connect to the patients and the community and then how to follow up on the outcomes.”

At Hospital Primario Esteban Jaenz Serrano in Bonanza, the problem is tangible. Even though in recent years the hospital has been renovated and refurbished, director Maria Isabel Flores Johnson still has a long list of needs – one being to open another operating theatre. With only one operating room, scheduled surgeries have to give way to emergencies, forcing people to wait for days or weeks. The time spent away from work or family can cause both stress and economic problems for the patient.

Patients and families wait in line at Hospital Carlos Centeno in Siuna, Nicaragua. Photo: Jörgen Hildebrandt.

Improved human resources is another need with the most imminent being the lack of an anaesthesiologist.

“We haven’t been able to hire one because after they finish university, they don’t really like to come here to work,” Maria says. “They want to have a higher salary, better conditions and more benefits.”

Yadive Ríos is an anaesthesia technician and the only person at the hospital qualified to provide anaesthesia. However, the services she is able to provide are limited.

“I can’t help out on paediatric or geriatric surgery, so if we, for example, have an 80-year old patient, he or she needs to be referred to another hospital, which means sometimes travelling almost 400 kilometres to Managua in order to get surgery,” Yadive says.

This also means that whenever Yadive has to miss a day of work, the hospital is forced to cancel surgeries.

“I am the only one here on the staff to do this and they need me, so I ask myself how ill I am on a scale from one to 10, and if I have a fever or a flu, I still go to work,” Yadive says. “But everyone in this hospital makes these kinds of efforts. We are a small hospital and the population has increased a lot these last years, so it is difficult, it can be very dense.”

Yadive shows us the operating ward, where the entire water piping system is to be upgraded to a new and modern one. Co-sponsored by a local mining corporation, it will be the first renovation of the Surgery for the People project.

By hand, she turns on the tap where the surgeons wash their hands before surgery. In most operating rooms, taps are operated by doctors’ feet or knees to make sure their hands remain as sterile as possible. Worse, the water that comes out of the tap is brown and full of mud.

“Our problem with the water is not just that it is unhealthy and not drinkable, but also sometimes that there is no water at all,” Yadive exclaims. “Because it comes directly from the river, it is not cleaned in a water plant, and sometimes there is so much mud in the water that it plugs the entire system.”

As of the publication of this story, anaesthesia technician Yadive Ríos is the only person qualified to administer anaesthesia at Hospital Primario Esteban Jaenz Serrano in Bonanza, Nicaragua. Photo: Jörgen Hildebrandt.

At Hospital Carlos Centeno in Siuna, the situation is just as bad. The lack of proper surgical equipment, operating theatres and staff means that delays and cancelled surgeries are common. Patients who have travelled for days often have nowhere to stay because of lack of beds and wards. Many also arrive with acute illnesses that turn deadly because they never knew that their ailment could be treated by surgery.

“If someone ignores what is an infected appendix, believing it is a parasite, this person will die. It is no one’s fault, it is just the lack of knowledge,” says Dr. Tyrone Valle, a general surgeon at the hospital.

He’s very excited about the project and the education and awareness it will bring for the hospital staff and the community alike. For example, a manual of surgical diseases is being developed, in which the most common surgical diseases are outlined. These manuals will be used at the local health clinics in the remote villages, so people will be able to understand that their condition can be cured by surgery – as long as they visit a doctor as soon as they experience symptoms.

General surgeons Drs. José Silva and Tyrone Valle perform surgery at Hospital Carlos Centeno in Siuna, Nicaragua. Currently, only 20 percent of people in their region receive safe, effective and timely surgery. Photo: Jörgen Hildebrandt.

“When I first came here 20 years ago, we were 20 employees. At that time, there were still armed conflicts here and we received many patients with injuries from guns and pistols, in the stomach or thorax, and injuries by knives because of conflicts over land,” explains Tyrone. “Now, there are almost 200 working here and we have peace in the country, so the causes of death have changed. We don’t have to treat wounds but instead diseases that are curable by medicine or surgery. So, this project can really help people, just by giving them the message that we can treat them and educate them as long as they will come here in time for surgery.”

Scenes of Healing: Guadalajara Medical Mission

Photo: Laura Gonzalez.

Child life specialist Alejandra Canales of Honduras sits with a patient before they receive surgery. Having been on more than 10 missions, Alejandra understands the vital impact that the child life area can have. For many children, arriving at a mission can be a frightening experience, especially if it’s their first time travelling away from home. Child life specialists help those patients relax as they play fun activities with other children who have cleft conditions.

Photo: Laura Gonzalez.

Uriel catches and blows bubbles in the child life area before entering the operating room. Both Uriel and his sister, Diana, travelled to our mission site with their mother, Rebeca, from Mezquitic. While Uriel filled the room with his contagious laugher, Diana was much more reserved with a gentle, creative spirit. She passed the time before her surgery by making bracelets and decorating dolls for the other children.

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

A local staff member checks the vitals of a patient before they receive surgery.

Photo courtesy of Iván Ramírez.

Cleft surgeon Dr. Humberto Aguirre of Mexico and an operating room nurse from the local hospital work together to perform surgery during the mission in Guadalajara.

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

Dr. Hector Lino of Mexico works with a surgical resident from the Instituto Jalisciense de Cirugia Reconstructiva to perform surgery on a patient.

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

Post-anaesthesia care unit nurse Zunilda Dominguez of Paraguay checks on a young patient in the post-operative ward.

Photo courtesy of Iván Ramírez.

Electronic medical records team leader Lorena Arellano gently wakes up a patient after their surgery. For Lorena, attending our mission in Guadalajara was very special to her. “I’m so happy to be back in my country, helping my people. And to be back in the city where I grew up,” she said. Lorena is originally from Guadalajara, but she currently lives in California with her wife, Kristi Loveridge. Her role is very important because our team of doctors, anaesthesiologists and nurses rely on each patient’s medical record to administer medicine and customise their care plan. Lorena hopes to continue to volunteer her time on medical missions for as long as she can. “It’s a part of me that I didn’t know I had. It makes me feel so happy that I found this other side of me that I didn’t know thanks to Operation Smile,” she said.

Photo: Laura Gonzalez.

Uriel rests the morning after his cleft lip surgery as his sister, Diana, prepares to receive surgery on her cleft palate later that same day. At a prior mission, Diana received care from Operation Smile for her cleft lip. Uriel plans to return in a few months for surgery on his cleft palate. They were two of the 109 patients who received safe surgery at our mission in Guadalajara, Mexico.

Photo courtesy of Rodrigo Avina.

Eight-year-old Norma shares her new smile. With help from government workers, she and her father – along with a group of Huichol people from their community – left the mission and made the 13-hour journey back home. Norma looked forward to getting back home so that she could show her mum her smile. We talked to Rafael after Norma’s surgery and asked him what he would do if he saw another child with a cleft condition. He said that he would tell them to come get surgery from Operation Smile Mexico because, “you fix things here.”

Scenes of Hope and Healing: Antsirabe Medical Mission

More than 300 potential patients and their families arrived for screening during Operation Smile’s April 2019 medical mission in Antsirabe, Madagascar. With so few doctors in the country who specialise in cleft and craniofacial surgery, the need for cleft care in Madagascar is great. Photo: Margherita Mirabella.

Adeline with her 2-year-old son, Rindra, left, and Rolland with his 5-year old daughter, Lanto, were one of the families who hoped that their children would receive a free surgery from Operation Smile. The 2019 mission was Rolland and Adeline’s third attempt at getting Rindra and Lanto the life-changing care that they needed.

In 2017, they missed the bus to the mission due to a miscommunication. In 2018, they weren’t aware that a mission was taking place. But Rolland and Adeline never stopped believing that they would have another opportunity. And when Rolland learned about the Antsirabe mission, he walked four hours to the nearest hospital to register both children.

After passing her comprehensive health evaluation, Lanto was placed on the surgical standby list and eventually received surgery to repair her cleft lip. Sadly, due to arriving at the mission underweight and with an upper respiratory infection, Rindra was not cleared for surgery. Hearing that their son couldn’t receive surgery was very devastating for Adeline and Rolland. But after attending the feeding programme that was held during the mission, Adeline’s hope for Rindra grew when she learned important lessons about well-balanced meals and hygiene care.

Rindra was one of 52 children registered in the programme during the mission. And by educating parents like Adeline, medical volunteers hope to see each child arrive at the next mission healthy, strong and ready for surgery. Photo: Margherita Mirabella.

Nine-year-old Marie Angeline, also known as Feno by her family, is one of four children. Her and her father, Daniel, arrived in Antsirabe after travelling 4 hours – by foot – to a bus that took them to the mission site. Feno’s mother, Marie Denise, and Daniel had never seen anyone with a cleft condition before. Both parents were incredibly shocked when Feno was born because none of their other children were born with a cleft. Photo: Margherita Mirabella.

Eleven-year-old Clara smiles widely as she stands among many potential patients. After receiving cleft lip surgery when she was 8 years old, Clara returned to Antsirabe with her father, Dede, for an additional surgery on her cleft palate. Clara had a lovely time meeting new friends and seeing old ones during the mission. Some of the medical volunteers who recognised Clara were thrilled to see how confident and outgoing she had become. Photo: Lorenzo Monacelli.

Feno and Daniel wait with hundreds of other families at the patient village. She was one of 343 potential patients who received a comprehensive health evaluation after travelling long distances by foot, boat and bus to reach the international medical mission.

Daniel told medical volunteers that the reason Feno hasn’t started school isn’t because of her cleft condition. It’s because the closest school is a two- to three-hour walk from their home, and he wants Feno to be a little older before making that long journey. But during the mission, Feno admitted that she’s scared to go to school and would often tell her father, “I don’t want to go to school because I have a cleft lip, and I am not normal.” Photo: Margherita Mirabella.

Anaesthesiologist Dr. Nicoletta Fioretti of Italy examines a young patient’s lungs as part of her comprehensive health evaluation. Photo: Margherita Mirabella.

Anaesthesiologist Dr. Maura Albicini of Italy poses with a young patient and his father during one of the two patient screening days. A total of 13 nationalities, representing the countries of Madagascar, Kenya, Ghana, Morocco, South Africa, Sweden, Finland, Italy, Australia, Colombia, Brazil, Canada and the U.S. came together to provide screening, surgery and post-operative care for patients. Photo: Margherita Mirabella.

Surgeons Drs. Billy Magee of the U.S., left, Valeria Battista of Italy and David Chong of Australia discuss surgical options for a young patient during the second day of comprehensive health evaluations. Photo: Margherita Mirabella.

Daniel and Feno are all smiles as they pose for a photo with plastic surgeon Dr. Luca Autelitano of Italy and anaesthesiologist Dr. Nicoletta Fioretti of Italy. Drs. Autelitano and Fioretti were part of the medical team who helped repair Feno’s smile. With a huge grin, Daniel said that he was “faly,” meaning very happy, with the care that his daughter received from Operation Smile’s medical and non-medical volunteers and staff. Photo: Margherita Mirabella.

Clara calmly sits on the operating room table as the Operation Smile medical team prepares her for additional cleft palate surgery. Patient imaging technician Eli Zakariasy of Madagascar, left, waits to take the facial medical photos that assist the surgeon in completing their work. Photo: Lorenzo Monacelli.

MDG_2019_Antsirabe_000_Marie Angeline Rafenonirina_FTF_Before_001_web (1)

After passing her comprehensive health evaluation, Feno plays in the child life area to learn more about what will happen after she enters the operating room. Through playing with medical props, young patients like Feno see what tools will be used during the surgical process so they won’t be surprised or frightened when they go into surgery.

Friends and neighbours often called Feno, “sima,” a derogatory term for cleft. While waiting for her operation, Feno shared what she was most excited about after her surgery: People will stop calling her “sima” and start calling her Feno. Photo: Margherita Mirabella.

Clara proudly shares her beautiful smile. After passing her comprehensive health evaluation, Clara became one of the 109 patients who received safe surgical care at Operation Smile’s medical mission in Antsirabe, Madagascar. This was Clara’s third surgery that she received, and Dede is incredibly proud of the person that his daughter has become during their journey with Operation Smile.

With dreams of becoming a doctor, Clara hopes to make a difference and help children like herself. Photo: Lorenzo Monacelli.