Roman waited 19 years for his new life to start

Photo: Rohanna Mertens.

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.

While his story begins the same as many people born with cleft conditions, Roman was met with many hardships along his journey toward life-changing safe surgery.

The oldest of the five children in his family, Roman grew up never knowing that cleft surgery was possible.

However, even if Roman had known a solution was available, his family had no way of affording the cost of surgery as subsistence farmers, who cultivate only enough food and livestock to meet their own needs.

So, for 19 years, Roman lived with the burden of his unrepaired cleft lip.

He endured torment throughout his life because of his cleft condition, often being called names like “sima,” a derogatory term for cleft lip.

Growing up, he told people in his community that God had given him his lip, but that didn’t stop the hurtful bullying he experienced.

But everything changed for Roman when a local health worker came to his community and told him about an upcoming Operation Smile Madagascar medical mission in Antsirabe.

In the months after learning about his chance to receive surgery, Roman courageously made the bus trip to Antsirabe: It was farther than he had ever travelled away from his home.

Patients arriving at Operation Smile Madagascar's 2016 medical mission to Antsirabe. Photo: Zute Lightfoot.

Roman journeyed three and a half hours to reach our local team in Ifanadiana. They then transported him and other families the six hours to Antsirabe.

In some of the most remote areas of the world, many people like Roman lack access to critically needed resources and timely surgical care.

Operation Smile and its global community of volunteers strive to help patients and families overcome those barriers by bringing safe surgeries and comprehensive healthcare to where it’s needed most.

Upon his arrival to where Operation Smile provides accommodations for patients and their families, Roman was very surprised to see so many others who looked like him.

After passing his comprehensive health evaluation, Roman was deemed healthy enough to receive safe surgery.

On the day of his surgery, Roman admitted that he was scared but excited for his brighter future and ready to see his new smile.

And after receiving a surgery that lasted only around an hour, Roman’s life has permanently changed.

Photo: Rohanna Mertens.

After Roman made the long journey home to his excited community and family, many were surprised that his lip was completely repaired.

Today, Roman lives a happier life and is less shy.

With a new smile and a newfound confidence, Roman has experienced many aspects of life that he had never imagined, including getting a girlfriend.

His life has changed in many ways in the short time since his surgery, and he is looking forward to living a life of dignity, without fear of being teased or laughed at by members of his community.

While most of Operation Smile’s patients are children, there are many like Roman who are unable to receive safe surgical care until later in life.

Through nearly four decades of experience treating cleft, Operation Smile knows that cleft surgery offers optimism and hope – at any age.

“Thank you for taking care of me,” Roman expressed.

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

Roman, after surgery. Photo: Rohanna Mertens.

After 35 years, Tereza is finally free

Tereza, 35 years old. 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. If you can, when you can, help us keep our promise to care for children and create hope for tomorrow.

After surgery, Tereza embraces her newfound happiness, but the pain of living 35 years with an unrepaired cleft condition isn’t something she’ll forget.  

As a child, Tereza faced torment because of how she looked. As she grew to adulthood, the bullying only intensified.

Some people from her community told her that she was only “half a person” and that she had nothing to contribute to village life.

Despite her dream of one day being accepted by those around her, the harassment caused Tereza to abandon her schooling and forced her to become completely ostracised from her village.

Although there were three people also born with cleft conditions in her community, Tereza’s decision to distance herself from her village also meant separating herself from the only three people who could understand the pain she was facing.

During a seemingly normal day, one of the people living with a cleft lip left to attend an Operation Smile medical mission in 2014.

Without enough money to afford the bus fare that would take her to Lilongwe, Tereza was forced to watch as the bus drove away.

But upon seeing them return with a new smile, Tereza was motivated. And she refused to let anything get in her way of attending the next mission.

Her opportunity came after she contacted Operation Smile Malawi, which arranged free transportation to the upcoming mission, eliminating the obstacle that stood in her way a year before.

Her perseverance paid off, and Tereza was taking the first step in her journey toward ending the painful harassment that had become all too familiar.

Although there were others in her community living with cleft conditions, Tereza believed that they were the only ones.

But after arriving at the mission site, Tereza was shocked to see so many others who looked like her.

For the first time in her life, Tereza felt like she was no longer alone.

Potential patients gather during a 2015 Operation Smile medical mission in Lilongwe, Malawi. This was the day Tereza learned that she was placed on the surgical schedule to receive her free cleft surgery. Photo: Margherita Mirabella.

It’s estimated that, worldwide, a child is born every three minutes with a cleft, which is about one in every 500 to 750 births.

We’re working to discover the causes of cleft through research and putting our evidence into action to prevent cleft conditions before they develop in the womb.

Tereza was amazed by the compassionate volunteers who were donating their time and expertise to patients and their families affected by cleft conditions – a sharp contrast to how she was treated in her community.

Globally, Operation Smile has improved the health and dignity of more than 300,000 patients living with cleft conditions, helping them to breathe, eat, speak and live a better quality of life with greater confidence.

In Malawi, our team is working to address the backlog of people like Tereza who have been unable to access the surgery they need.

For the first time in 35 years, Tereza was among people who would accept her for who she was, and she didn’t have to worry about what they’d say when they saw her cleft lip.

She found peace in the hectic environment of health assessments and pre-surgical appointments and was comforted by the fact that she was surrounded by kind people who understood what she was going through.

Tereza was overcome with happiness and relief when medical volunteers placed her on the schedule to receive her free surgery.

“When I have my surgery, it will be like I’m born again,” Tereza said. “I will be a new person.”

Tereza, after surgery. Photo: Margherita Mirabella.

While looking at her photo taken before surgery, Tereza admitted that she wasn’t happy. Living with an unrepaired cleft had taken a toll on her self-esteem and confidence.

Now, her life is very different.

“I am living a free life,” Tereza happily explained.

Since her successful surgery, Tereza has returned home and become part of her community again.

She loves engaging with others because she no longer fears being ridiculed.

Tereza feels excited to have had the opportunity to receive her life-changing surgery and plans to educate her community about cleft and Operation Smile’s life-changing work with hopes of preventing anyone else from experiencing the pain and loneliness she endured.

Photo: Margherita Mirabella.

From patient to patient advocate

Weston Bello, an Operation Smile student volunteer from Malawi, right, poses with former patient John, who became a patient advocate after receiving surgery at the 2017 medical mission in Zomba, Malawi. Operation Smile photo.

Editor’s note: This story was written by Weston Bello, a student at the University of Malawi, Chancellor College, where he studies philosophy and psychology. As an Operation Smile student volunteer for two years, he’s taken part in two medical missions.

There is a part in the depths of our hearts that drives us to think of other people and seek to help in any way that we can. After John got his surgery from Operation Smile at the 2017 medical mission in Zomba, Malawi, that side of him came to life.

I met John before he got his surgery while he was staying at the patient village that Operation Smile provides at no cost. From what I noticed, he was very troubled by his situation. As he told me his story and the atrocities he had faced because of his cleft, I felt a deep need to help him in any way that I could.

From then onward, we became friends.

John first heard about Operation Smile from a volunteer who came to visit him at his workplace in 2017. When he learned about this opportunity to receive a surgery to care for his cleft lip, he was afraid that perhaps something would go wrong during the surgery. But thanks to the support and encouragement of the volunteers, John rallied the courage and went to the mission site in Zomba.

There, he received the gift of a transformed smile – and soon he would find a way to give back.

“After noticing how other people were suffering from cleft lip and cleft palate, I couldn’t just stand there and watch. I wanted them to get the same help that I got.”

– John, Operation Smile patient advocate in Malawi

At age 52 and close to retirement, John lives with his wife. His sister, who accompanied him to the Zomba mission, lives nearby and would check on him from time to time. A few weeks after the surgery, I visited John at his house to check on him, too.

I believe the day I visited him was the day that he became a volunteer for Operation Smile.

Before I left his house that day, he took me to visit a family that had a relative with cleft lip. I sat there listening to John talk to the family about Operation Smile and how it had changed his life, and I was very impressed.

From then onward, John went out and started looking for other people born with cleft lip and cleft palate so that they could receive the same gift that he did.

At the 2018 medical mission to Blantyre, John returned not as a patient, but as a volunteer. He helped out with patient coordination at the patient village.

Today, he continues to find other people born with cleft lip and cleft palate and shows them pictures of him before surgery. When people see the pictures, then see his new smile, they become motivated to receive care from Operation Smile.

He said that his life changed after getting his surgery; he is a happy person now. Once he retires, John said that he will continue reaching out to people and hopes that many people will also get free and safe surgeries and be happy as well.

“After noticing how other people were suffering from cleft lip and cleft palate, I couldn’t just stand there and watch,” John said. “I wanted them to get the same help that I got.”

Pre-surgical dental care saved Janat’s life

Janat, 1-month-old. 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 Janat entered the world in her small Moroccan village, no one could’ve predicted the physical and emotional challenges that laid ahead for her and her family.

Remembering back to the day when she saw her daughter’s smile for the first time, Fatima recalled the shock and fear that filled her heart.

But as she held her newborn baby in her arms, Fatima knew that there wasn’t anything in this world she wouldn’t do to protect and care for Janat.

However, due to factors outside of her control, keeping that promise became increasingly more difficult as Janat’s health rapidly began to decline.

For children born with cleft conditions, especially a cleft palate like Janat’s, they often encounter major hurdles with feeding and struggle to receive proper nourishment during the most critical time in a baby’s development.

Janat and Fatima confronted these obstacles every day.

“I was afraid that I was going to lose her,” Fatima said. “She was suffocating and the milk would come out of her nose. She can’t finish a bottle.”

Fearing for her daughter’s health, Fatima helplessly watched as Janat steadily became smaller and sicker during her first weeks of life.

“I knew that surgery was possible,” she said. “But I was scared and didn’t know where to go or who to ask.”

This is the case for many families of children born with cleft conditions.

Despite the consistent failed attempts at feeding Janat and the fear of watching her become more malnourished each day, Fatima persevered, determined to keep the promise she made.

Then one day, Fatima’s hopes were realised.

Volunteer dentist Dr. Teresita Pannaci of Venezuela, left, observes as Janat is fed by her mom while testing out her new feeding plate. Photo: Jasmin Shah.

After seeing an Operation Smile Morocco commercial, Fatima learned that the organisation not only provides free surgical care, but that there was an upcoming medical mission taking place in a little over a week in Oujda, a neighbouring city.

Overjoyed to learn there were skilled people devoted to caring for children with cleft conditions, Fatima and her husband prepared to make the journey, hoping that it wasn’t too late for 1-month-old Janat, who’d already lost nearly half of her birth weight.

Alongside hundreds of families seeking out care from Operation Smile Morocco’s highly trained medical professionals, Janat and her parents arrived in Oujda for screening day fully prepared to do whatever they could to save her life.

It was a long and gruelling day for the family as volunteer paediatricians, anaesthesiologists, nurses and other specialties assessed Janat’s health throughout the screening process.

It quickly became clear to the volunteer team that Janat wouldn’t pass her comprehensive health evaluation.

Having been unable to eat properly for the first month of her life, Janat had become severely malnourished and wasn’t healthy enough for safe surgery.

Just as Fatima started to think that they’d return home without a solution, the team of volunteer dentists on-site sprang into action.

Joining forces with Operation Smile Morocco staff, Drs. Carmen Kamas-Weiting of the U.S. and Teresita Pannaci of Venezuela stepped in, quickly transporting Janat and her family to the local care centre.

“I was so happy,” Fatima said while surrounded by the dental team preparing to fit Janat with a feeding plate. “I’m happy that, finally, she will receive help.”

With a cleft palate – a gap in the roof the mouth – patients struggle to eat or drink because milk oftentimes spills out of their nose or causes them to choke, making it almost impossible to obtain the necessary amount of nutrition needed to thrive and gain weight.

Having a cleft palate also makes patients vulnerable to illness, as they are more susceptible to infection, disease and even death.

To protect patients like Janat from the dangers of malnourishment – dangers that can prevent them from receiving the timely cleft surgery they need – dentists like Teresita and Carmen rely on pre-surgical dental care like feeding plates.

The soft mold of Janat's cleft palate, which later became her feeding plate that would allow her to drink milk with ease. Photo: Jasmin Shah.

The plates serve as the first step toward surgery, leading patients away from starvation and guiding them toward a healthier life – toward surgery.

“A baby with a cleft palate can’t eat,” Teresita said. “That’s why it’s so important to rehabilitate the function of breathing, sucking and swallowing food so that the child is eating in the home environment. This is the real reason why treatment must be done from birth.”

Patiently waiting for the dentists to create the plate, Fatima shared with the team that Janat could only manage to consume around three ounces of milk throughout an entire day. This amount is dangerously lower than the recommended two to three ounces of milk newborns are expected to consume every few hours.

With the feeding plate, the process of eating for Janat was transformed.

After testing out her new plate for the first time, Janat drank two and a half ounces of milk in less than eight minutes.

“I started to feel calm; [the plate] was working,” Teresita said. “I looked at her mother, and that’s when I saw she had tears in her eyes. When I asked, ‘Why are you crying? What kind of tears are these?’ She said, ‘They are tears of happiness,’ because she knew that her daughter was safe.”

Fatima, filled with relief, revealed that it was the first time she’d ever seen Janat drink without suffocating.

“I was so happy. I was so relieved,” she said. “I’m very grateful for what you’ve done for my daughter. I’ve never seen kind hearts like yours before.”

Fatima and Janat returned to the care centre once more during the mission before heading home. Adapting well to her new feeding plate, Janat slept comfortably in her mother’s arms with a belly full of milk for the second day in a row.

For the first time, Fatima watches as Janat drinks milk with ease thanks to her daughter's new feeding plate. Photo: Jasmin Shah.

Drinking a few ounces of milk may seem insignificant, but the plate also enables patients to reach even larger milestones: improving nutrition, achieving and maintaining weight for surgery, breathing easier for a better quality of life, lessening the severity of the cleft palate as well as improving jaw and nose development.

While Janat didn’t receive surgery during the March Oujda mission, Fatima’s determination was stronger than ever before, and she planned to return to the centre on an ongoing basis to allow for volunteers to monitor Janat’s care and progress.

Janat’s journey so far has been filled with fear, uncertainty and seemingly impossible obstacles. But no matter what lies ahead, Fatima refuses to give up.

“Nothing is too hard when it comes to my daughter. I will do anything.”

Shortly after the conclusion of the March mission in Oujda, Operation Smile Morocco, like all of our teams around the world, made the decision to postpone future missions and care delivery at care centres. While the decision was made to ensure the safety of patients, families, volunteers and staff, the postponements left people like Janat and Fatima waiting.

Thankfully, through closely following all health ministry guidelines and protocols, including mask-wearing, social distancing, temperature screenings and more, the Moroccan team has successfully reopened its care centre doors, allowing for waiting patients like Janat to return and continue their ongoing care.

Today, Janat is 10 months old and her condition has dramatically improved.

Through her family’s commitment to improving her health and the success of her feeding plate, Janat’s weight has significantly increased and she continues to show incredible developmental progress. To this day, Fatima remains hopeful for Janat’s continued improvement.

“My daughter will be OK. I’m happy now,” she said. “Surgery will be life-changing. In the future, Janat will get an education.”

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

10-month-old Janat, today. With the help of her feeding plate, along with her family's dedication and love to care for her, Janat has become healthier and gained considerable weight. Photo courtesy of Janat's family.

When All Seems Lost, Hope Appears

Photo: Marc Ascher

Shocked and heartbroken when her baby Valeska was born with a cleft lip, Zorida received more discouraging news within the first moments of her daughter’s life.

No sooner than learning that surgery was possible to repair Valeska’s cleft lip, the young Nicaraguan mother was told by doctors that the procedure would be far too expensive for her and Valeska’s father to afford. The couple was informed that more affordable, possibly even free, surgical treatments could be found in Managua — a six-hour bus trip from their hometown.

Every six weeks after the birth of her bright-eyed daughter, Zorida travelled to Nicaragua’s capital only to return home dejected. Each time she sought help for her baby, she realised surgery cost much more than the family could afford. One round trip cost the family 1,800 córdobas (£45) — a massive drain on their average weekly income of 1,000 córdobas (£25) — making it so Valeska’s father couldn’t afford to accompany 17-year-old Zorida and his baby on their journeys.

“I was so sad,” Zorida said. “I felt that there was no solution for my baby.”

Back at home, Zorida experienced ridicule from neighbours who blamed her for her daughter’s condition. Drawing from deeply-rooted local superstition, they said that Valeska’s condition resulted from Zorida walking outside during an eclipse.

Photo: Marc Ascher

“People laugh at my baby,” Zorida said. “They taunt her and I hear others talking about her. They tell their children that she’s horrible and if they stare at her, they could look that way too.”

Zorida couldn’t help but to feel a sense of guilt that Valeska was born this way.

“I thought it was somehow my fault,” she said. “I thought that somehow this was God’s judgment on me.”

As hope and resources dwindled after 10 months of searching, a call from the local hospital provided relief for the young family. Operation Smile was conducting a medical mission in Estelí — three hours away — and that free surgery was possible for Valeska.

Again, Valeska’s father struggled to earn the money to pay for the bus fare. Like each of the previous trips to Managua, he was unable to embark on this life-changing trek.

Anaesthesia resident Anna Bengsston of Sweden comforts Valeska. Photo: Marc Ascher.

At the medical mission’s site, Hospital San Juan de Dios, Zorida waited nervously while holding Valeska. Naturally, she remembered her unsuccessful attempts to access safe surgical care for her daughter and the disappointment that inevitably followed. After a successful screening, Zorida beamed with pure elation when she learned Valeska was selected for surgery. Now, she could exhale knowing that the bus ride back home would be filled with joy instead of despair.

In a single surgical procedure, Operation Smile volunteers repaired Valeska’s cleft lip, giving her a beautiful new smile in time for her first birthday.

Since Valeska’s surgery, Operation Smile Nicaragua opened the doors of its new cleft lip and cleft palate care centre in Managua in May 2016. The largest of its kind in the country, the centre serves as the administrative and educational headquarters for Operation Smile’s medical programmes as well as the treatment site for over 800 patients who regularly receive follow-up care. Its presence also helps eliminate resource-draining searches for families like Valeska’s.

Photo: Marc Ascher

Meet Our Patients: Mossoró, Brazil

In 2017, 67-year-old Dona Maria received surgery during an Operation Smile Brazil medical mission. Photo: Marcelo Braga.

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.

In the densely populated city of Mossoró, Brazil, Dona Maria spent her entire life living with an unrepaired cleft lip.

While she undoubtedly faced challenges and overcame obstacles because of her cleft, 67-year-old Dona Maria consistently dreamt of one thing.

Though seen by many as a simple pleasure, what she wished for most was to wear lipstick.

During a 2017 Operation Smile Brazil medical mission, Dona Maria passed her health evaluation and underwent her long-awaited surgery, feeling closer than ever to reaching that dream.

Dona Maria 2

Moments after waking from the operation, Dona Maria felt eager to see her new smile.

After 67 years of living with a cleft condition, she proudly showed the entire medical volunteer team who were thrilled to be a part of that special moment.

After allowing her lip to properly heal from surgery, Dona Maria could finally live out her dream of putting on red lipstick for the first time in her life.

Laine Paiva, a volunteer photographer for Operation Smile Brazil, was so moved by Dona Maria’s story that she arranged a photoshoot with her, capturing images of her dreams becoming reality.

Thriving thanks to timely surgery

Olga and her daughter, Lungile, before surgery. Photo: Zute Lightfoot.
Olga and her daughter, Lungile, before surgery. Photo: Zute Lightfoot.

When Olga gave birth to her daughter, Lungile, her joy lasted only for a fleeting moment before she was overwhelmed with shock.

Lungile was born with a cleft lip, a condition that Olga had never seen before.

Distraught and heartbroken, Olga and members of her family struggled to understand why Lungile was born with a cleft lip*. They also struggled with the uncertainty of whether or not she would be able to receive treatment.

“I was scared the first time I saw her,” said Lydia, Lungile’s grandmother. “I thought there would be no one to help her.”

But as the family’s initial feelings of shock faded, their unconditional love for Lungile only grew.

Olga said that while the doctors and nurses at the hospital assured her that surgery to repair Lungile’s lip was possible, they also explained that the waiting list was very long and that it may take years before she could receive an operation.

Photo: Zute Lightfoot.

It’s critical that babies born with cleft conditions receive surgery as soon as they are old enough and healthy enough to undergo anaesthesia. The longer Lungile’s wait for surgery, the longer her condition could put her health at risk. Her speech and dental development could become impaired. She could suffer from emotional hardships, such as bullying and social isolation, throughout those precious, formative years.

Soon after receiving this discouraging news, Olga met Dr. Vanessa Soares, an Operation Smile South Africa medical volunteer and dentist at the same hospital where Lungile was born. Vanessa told Olga that Operation Smile provides free surgeries for children born with cleft conditions, like Lungile, and provided her with the organisation’s phone number.

Immediately, Olga called Operation Smile South Africa and learned that a medical mission would be coming to the family’s home town of Mbombela just after Lungile’s first birthday – within the ideal time frame for cleft surgery.

Fortunately for Lungile, her cleft lip did not prevent her from feeding properly as it does for so many babies born with cleft conditions. Difficulty in feeding can lead to life-threatening malnutrition which also prevents potential patients from being healthy enough to undergo anaesthesia. To combat this barrier to surgical care, Operation Smile has established nutrition programmes in places where malnutrition is prevalent, such as Madagascar, Ghana and Malawi, to help children gain weight and become healthy enough for surgery.

When the medical mission arrived to Mbombela, Olga was surprised to see so many children with cleft conditions. The Operation Smile medical team conducted comprehensive health evaluations to determine which patients were healthy enough to receive surgery. Olga was elated to learn that Lungile was among those selected to get an operation during the medical mission.

Naturally, Olga was anxious as her daughter was wheeled into the operating room. In less than an hour, she was reunited with Lungile in the recovery room as she woke from anaesthesia.

She couldn’t believe her eyes when she saw her daughter for the first time after surgery.

Olga and Lungile, after Lungile's cleft lip surgery. Photo: Zute Lightfoot.

Olga’s anxiety was replaced by joy and gratitude as she reflected on the compassion of the Operation Smile medical team and Vanessa.

“What she has done for me –” Olga said of Vanessa, pausing as her emotions welled up. “I love her.”

A year after her surgery, 2-year-old Lungile is thriving.

“Lungile loves to dance hip hop, listen to Rihanna and play her brothers’ musical instruments,” said Olga, who has become an advocate for Operation Smile South Africa in her community.

“I was out shopping with Lungile, and I met a lady who burst into tears because her daughter also had a cleft lip, and so I told her she would be OK,” said Olga, who accompanied the mother and her child to the next Operation Smile medical mission to Mbombela. “The baby, Ntando, and Lungile have become great friends.

“I will tell people in my community who have children born with cleft lip that their children can be fixed and they will look nice.”

Photo: Zute Lightfoot.

* Editor’s Note: While it’s difficult to determine the exact cause of an individual’s cleft condition, research from Operation Smile’s International Family Study shows that cleft conditions can be caused by genetics, environmental factors or a combination of both.

This Selfless Mother Finally Receives Lifesaving Surgery

Editor’s note: Since Operation Smile’s founding in 1982, delivering safe surgery to people living with cleft conditions in low-resource settings around the world has been – and will continue to be – its driving force.

But as the organisation expanded into more and more places of dire need, it has been met by the devastating effects of hospitals operating with inadequate infrastructure and equipment.

Fuelled by the foundational belief that everyone in need of surgery deserves exceptional care, Operation Smile is applying its expertise in treating cleft conditions to create sustainable solutions that will bring safe and essential surgery to people where it’s needed most.

In rural northeastern Nicaragua, this life-saving work is already underway through a pilot project called Cirugía para el Pueblo – “Surgery for the People.” For deeper context on the problems that this initiative is addressing, follow this link to watch the video and read more.

Surrounded by her family, Nicolasa is wheeled toward the operating room.

After passing through the door, she stands and takes a brave step toward living a life free of pain.

Enduring years of immense discomfort from a large kidney stone and its resulting complications caused Nicolasa to lose much of her strength. But listening to her talk about the dedication she has for her family proves that she is anything but weak.

Nicolasa poses with members of her family. Photo: Jörgen Hildebrandt.

“They told me that I won’t have any wounds, that it is done using a laser,” Nicolasa says about her impending surgery. “And that it will make my recovery faster so I can look after my son.”

She refused to give up after a tragic accident left her son paralysed from the neck down many years ago. Even as she dealt with the unbearable pain, she continued to make sacrifices in order to care for him.

Unfortunately, not being able to leave Suina to receive surgery was one of the sacrifices.

Leaving her son behind was never an option for Nicolasa, and surgery remained out of reach – until now.

Today, Nicolasa and so many other patients like her who suffer from treatable illnesses can access the care that they need and deserve. With support from the UBS Optimus Foundation, Operation Smile and Nicaragua’s Ministry of Health are working together on a pilot project at the two primary hospitals in Siuna and Bonanza called Cirugía para el Pueblo – “Surgery for the People.” By joining forces, Operation Smile and the Ministry of Health seek to improve the surgical infrastructure of the hospitals and to spread awareness about surgically treatable conditions to the people of the region.

Urological surgeon Dr. Augustin Mendoza. Photo: Jörgen Hildebrandt.

With a new laser technique, urological surgeon Dr. Augustin Mendoza operates using equipment that allows patients like Nicolasa to undergo surgery without invasive measures or painful recoveries. And because of its location, the project makes this care and technology accessible for more people who need it close to home.

“Surgery for the People improves access to healthcare to people who, for many years, didn’t have this access,” Dr. Mendoza said. “Surgery for the People is opening possibilities to people from the most remote areas, providing surgery that is safe and of high quality.”

Photo: Jörgen Hildebrandt.

As Nicolasa rests in the hospital’s recovery area, she grasps Dr. Mendoza’s hand.

“Thank you,” she says to him. “May God light your way.”

The day after her surgery, Nicolasa is ready to leave the hospital, return to her son and put 20 years of pain behind her.

Nicolasa and Dr. Mendoza after surgery. Photo: Jörgen Hildebrandt.

Realising an unexpected future

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.

Past crumbling stone walls and houses constructed of clay and wood hardened together from years in the Moroccan sun, Siham enjoys the 20-minute walk she takes every day to school.  

While having transformed into a safe space where she laughs freely with her best friends and eagerly studies her favourite subjects, school was once a place where Siham felt like a stranger.

Siham was born with a cleft lip.

Photo: Margherita Mirabella.

But she was also born with an inner strength and courage that would guide her as she fought to overcome unforeseen obstacles along her cleft care journey.

Having never met another person with a cleft condition before, Siham’s parents, Samira and Youssef, felt devastated and scared after seeing their baby girl for the first time.

But their sadness could not outweigh the love they felt for their daughter. And when asked if she wanted to abandon Siham at a local orphanage, Samira refused to give the idea a second thought and said:

“I want her. She’s my baby, and I’m happy to have her.”

Supporting a family of six and living in a remote village near the coast – with the closest hospital hours away – Youssef and Samira feared that accessing affordable, high-quality medical care for Siham would forever remain out of their reach.

But regardless of what challenges they knew lied ahead, Samira and Youssef cherished Siham and vowed to do everything that they could to give her a happy and fulfilling life.

However, with every passing day, Youssef and Samira’s commitment was tested.

As Siham grew older, the intense social stigma surrounding cleft in the community caused her to endure painful bullying and mistreatment from people in her village. Children from school refused to let Siham sit next to them during class.

Her parents often witnessed her come home crying and angry.

Siham loves to learn, but the torment and name calling at school became too much for her to bear.

“Students used to see me as a stranger and say, ‘Look at that girl. Look at that girl’s mouth. She’s not like us,’” Siham said. “Then, I didn’t want to go to school at all.”

Deciding to not return to school, Siham rarely ventured outside the safety of her home.

“I always wondered why I was born like this and if anyone would ever come to save me,” she said. “I never thought there was a future for me.”

Photo: Margherita Mirabella.

Samira learned about Operation Smile Morocco and the free cleft care its team of medical volunteers provide after a friend informed her of another parent whose child received surgery from the organisation.

A few months after contacting the organisation’s office in Casablanca for more information, Samira and Siham departed from their home and made the 36-hour journey – by bus – to the upcoming medical mission site in Dakhla.

For the first 12 years of her life, Siham lived each day believing that she was the only person in the world who was born with a cleft condition.

But after arriving at screening day, Siham witnessed something she never imagined was possible.

“It was a strange feeling; I thought I was the only one to suffer from that problem,” she said. “But I saw others who were suffering like me, and that I wasn’t alone.

“I became one of them, and they were like my brothers and sisters.”

Twelve-year-old Siham plays with children also born with cleft conditions during Operation Smile Morocco's 2015 medical mission in Dakhla. Photo: Margherita Mirabella.

After receiving her comprehensive health evaluation, Siham was deemed healthy enough to receive safe surgery and placed on the surgical schedule of Dr. Wafaa Mradmi, Operation Smile Morocco volunteer plastic surgeon.

While waiting for her own surgery, Siham kept many of the younger patients relaxed in the child life area by passing them toys and helping them practice putting on anaesthesia masks.

When Siham’s name was called, she got up, said goodbye to her mum and walked confidently toward the operating room.

Siham walks with volunteer surgeon Dr. Wafaa Mradmi toward the operating room. Photo: Margherita Mirabella.

With her arms wrapped around her patient in a tight embrace, Wafaa walked beside Siham, who’s eyes pooled with tears of joy as she anticipated what her new smile would look like after her life-changing surgery.

Wafaa has made this walk many times before with hundreds of patients. But the weight of responsibility she feels in that moment is the same every time.

“These parents have confidence in us,” Wafaa said. “They have sometimes travelled for two days, three days, and come with blind faith and place what they cherish most in the world in our hands.

“We do not have the right to let them down.”

Longtime Operation Smile Morocco volunteer Dr. Wafaa Mradmi performs surgery on Siham during the Dakhla mission. Photo: Margherita Mirabella.

In the eyes of Samira, her daughter has always been beautiful. What she hoped for most after surgery was the return of education into Siham’s life.

After anxiously waiting for more than an hour, Samira entered the recovery room and saw Siham’s new smile for the first time.

“I was very happy because the smile came back to her,” Samira said. “Now, she goes outside of the house, and she didn’t do that before. She laughs now. She is happy.”

Siham's mom, Samira, holds her daughter in the recovery room after surgery. Photo: Margherita Mirabella.

Siham’s cleft care journey didn’t end after one surgery.

Operation Smile Morocco has revolutionised cleft care throughout the Middle East and North Africa region after recognising a patient’s need for ongoing, comprehensive care after surgery.

The establishment of its first care centre in Casablanca in 2008 supplied the organisation with the infrastructure and innovative equipment needed to provide patients with year-round multi-disciplinary care services including orthodontics, speech therapy, dentistry, psychosocial care, orthognathic evaluations and more.

After receiving surgery in 2015, Siham received ongoing orthodontic treatment at Operation Smile Morocco’s Casablanca care centre.

“I was very happy – an unimaginable joy – when I knew that they would continue caring for her condition,” Samira said.

During the years that followed her surgery, orthodontist Dr. Abderrahman Harouga of Morocco performed Siham's ongoing dental care. Photo: Lorenzo Monacelli.
Operation Smile Morocco's care centre in Casablanca. Photo: Lorenzo Monacelli.

Siham, now 17 years old, walks to school free from fear.

When she arrives to class, Siham is met with big smiles and hugs from her closest friends who invite her to sit with them. She loves to draw and enjoys studying French.

For most of her life, Siham believed that looking forward to the future was something only possible for the other kids around her – children who weren’t born with a cleft lip.

But today, with a new smile and newfound confidence, Siham refuses to let anything or anyone stand in the way of her dreams.

Siham walking home from school with two of her closest friends. Photo: Lorenzo Monacelli.

“My life changed after the surgery,” Siham said. “I hope to become a teacher because the professor is the foundation in all science. The doctor would not have become a doctor if he had not studied. The teacher is key.”

“I want to say to the doctors, ‘Thanks so much. You saved my life.’” she said. “If I hadn’t have come to you then, I wouldn’t be living life like the rest of the people.”

Help us change the lives of more patients like Siham amid these challenging times. Your support today means that we can keep our promise to our patients and provide them with the surgery and comprehensive care they deserve when it’s safe to resume our work around the world.

Siham, today. Photo: Lorenzo Monacelli.

She Lived in Pain for More than 20 Years

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.

Immense pain dominated Nicolasa’s life for much of the past two decades.

The days of her feeling strong and happy working on a farm near Siuna, Nicaragua, have transformed into days filled with discomfort and sadness.

As a mother with a family to support, she tried to fight off the agony for as long as she could.

“By using home remedies, I could handle it. The pain went away,” she said.

“But one year ago, it got worse.”

After an ultrasound, Nicolasa learned that the pain was caused by a large kidney stone on her right side. And since she didn’t receive medical treatment for 20 years, she developed a severe infection that put her life at risk.

At the time of her diagnosis, doctors informed her that she needed surgery as soon as possible to save her life, but one major challenge stood in her way: safe surgical care wasn’t available in her hometown. People living in this area were forced to travel hours away from their homes, over rough and dangerous mountain roads, to the distant capital city of Managua when they needed treatment.

Photo: Jörgen Hildebrandt.

But leaving was never an option for Nicolasa, who dedicates much of her life to caring for her son, who became paralysed below his neck after suffering a tragic accident many years ago.

“One day, he went to swim in the river, and he hit his head on a stone and had a cervical fracture,” she said. “He can’t turn around; he can’t do anything. I look after him.”

The love that she had for her son allowed Nicolasa to put his needs above her own health and wellbeing.

“It is hard for me to do all the work at home. It is hard for me to be in charge of everything. Because I used to like working in the field with the machete, to milk the cows.” she said. “But now I feel weak and sad, without the strength I used to have.”

But today, parents like Nicolasa no longer have to choose between supporting their families and travelling to get essential surgical care. 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 this remote region.

Nicolasa poses for a photo with members of her family. Photo: Jörgen Hildebrandt.

This project has provided the staff at Siuna’s hospital with essential equipment and training so that patients can get the high-quality care they deserve without having to sacrifice the resources and time needed to travel to Managua, a round trip that would take an entire day or more to complete via bus trip.

On this day, Nicolasa received another ultrasound, but instead of leaving the hospital dejected and in pain, she looked forward to gaining back the strength and happiness she once enjoyed.

After 20 years of selflessly putting her family’s needs above her own, Nicolasa finally has the opportunity to live a life free of pain through a safe surgery that she’ll receive in her hometown.

Nicolasa’s story continues in This Selfless Mother Finally Receives Life-Saving Surgery.

Dr. Augustin Mendoza evaluates Nicolasa ahead of her surgery. Photo: Jörgen Hildebrandt.