Picturing Her New Beginning

Picturing Her New Beginning

Growing up, Akosua always felt different from the other children in her community. That feeling didn’t go away for more than 50 years. “I was never a happy woman,” Akosua said. “I never wanted my photo taken.”

Akosua lived 52 years of her life with a cleft lip. She never knew what her condition was called, but that didn't stop people from wrongly mistreating her. Photo: Margherita Mirabella.

Despite not knowing the name of her condition, Akosua knew that the mistreatment and judgment she endured were because she didn’t have the same smile as everyone else.

It wasn’t until she was 52 years old that she learned more about her condition. For Akosua and many people in her local community, the terms cleft lip and cleft palate were unfamiliar. The idea of cleft surgery was even more unknown.

Akosua’s family accepted and loved her, but some people refused to look past her cleft condition. The bullying became so severe that she stopped attending school at Primary School age. However, leaving school didn’t stop the hurtful name-calling from continuing into her adult life.

She never let the pain or hopelessness prevent her from creating happy memories. Akosua got married and had three children who supported her through the seemingly endless cycle of abuse. But making a living for herself and her family proved to be an unexpected obstacle.

As a vegetable seller, she encountered many people at the marketplace who refused to buy produce from her because of their misguided fear of her cleft lip. With the deeply rooted stigma and misconceptions surrounding cleft conditions in Ghana, some people believed her cleft lip was a negative reflection of the quality of her vegetables. In an effort to save her business, Akosua began covering her face.

After more than 50 years fighting to be accepted and treated with decency, Akosua found out that she’d never again need to hide from those around her.

In March 2015, Akosua learned that the reason her smile was different was because she was born with a cleft lip. In that moment, she not only discovered that the cause of her sadness and mistreatment was something completely outside her control, but also that there was an organisation dedicated to providing free, life-changing cleft repair surgeries for people like herself.

Cleft conditions are more common than Akosua ever realized. It is estimated that, worldwide, a child is born every three minutes with a cleft condition, making up about one in every 500 to 750 births.

Unable to afford living apart, Akosua and 20 of her family members share one home. Even with a proper diagnosis of her lifelong condition, Akosua knew that with her family’s meager income, surgery would remain out of reach. But the more she learned about Operation Smile Ghana’s free cleft care, the more relief and happiness she felt.

There was a chance to have the life she always wished for herself and her family. Accompanied by her brother, Charles, Akosua made the 10-hour journey by bus to a surgical program in Ho. Charles expressed his sadness toward the suffering his sister experienced throughout her life, but he was overjoyed to witness her get an opportunity for a new beginning. Following her comprehensive health evaluation, medical volunteers placed Akosua on the surgical schedule.

Akosua couldn’t believe that it was her own smile she saw as she glanced at her reflection in a mirror after surgery. “Now, I am confident, always happy and love having my photo taken,” she said.

Those who once treated her badly were surprised to see the change in Akosua when she returned home. Today, she hopes her vegetable sales increase so that she can help provide a better quality of life for her children and family.  The goals she has for herself go beyond the marketplace. Having left school early in life, Akosua intends to continue her education.

But her determination to help people involves more than just her own life. “I tell people about Operation Smile,” Akosua said. “I already found a new patient with a cleft, and I will make sure they are registered with Operation Smile Ghana and come to the next surgical programme.”

Akosua’s experience with Operation Smile Ghana instilled in her a passion to help others discover the surgical solutions offered by the organization. Seeking out people living with cleft conditions, Akosua gives them hope and helps them access the life-changing care earlier in life. Photo: Margherita Mirabella.

Help Operation Smile find more patients like Akosua

With your support we can avoid the suffering of a lifetime by treating cleft on patients sooner.

Our promise of improving health and dignity during the COVID-19 pandemic endures. Once again, we’re providing surgery and in-person care while taking stringent measures to keep our patients, their families and our volunteers safe. Hope is on the horizon. And we remain focused on what cleft care makes possible for children, helping them to better breathe, eat, speak and live with confidence.

Timely Cleft Surgery, Brighter Futures

Timely Cleft Surgery, Brighter Futures

Checking his phone every chance he could while at work, Felipe anxiously waited for his partner, America, to text him with news about their son, Jack.

Six-month-old Jack with his mom, America, during a 2018 Operation Smile Bolivia surgical program in Santa Cruz. Photo: Margherita Mirabella.

The anticipation of this moment after having waited months for the opportunity of surgery was almost too much for him to endure. But whether the news was good or bad, Felipe knew that, together, their family was strong enough to persevere. Finally, a text appeared. Jack was scheduled for free cleft surgery with Operation Smile Bolivia.

With tears of joy and shaking hands, America, who was at the surgical program in Santa Cruz when she texted Felipe, reassured him that their search for a solution had come to an end. At 6 months old, Jack would begin his cleft care journey. But it had been a difficult year.

Discovering their son’s cleft condition during a fifth-month ultrasound, the family’s joy of expecting their first child quickly turned to worry and fear.  Arriving home from that appointment, Felipe and América turned their devastation into determination as they began educating themselves about cleft conditions and researching their options for help. As working college students, they both knew that no amount of love they already had for their son would help them afford the cost of future surgery.

Amid their concern, hope appeared on their computer screen when they learned that Operation Smile Bolivia existed and was created to help families like theirs. As they called the phone number on the website, América and Felipe were moments away from discovering that life-changing cleft care would be free.

Unlike many parents of children with cleft lip and cleft palate, América and Felipe not only learned of their child’s condition but also found a solution before Jack was born. This is rare for families living in low-income countries.

Most mothers don’t find out about their baby’s cleft condition until they are holding them in their arms for the first time. Many fathers don’t find Operation Smile for years due to lack of awareness of where to go or available resources in their country. And some families endure years – even decades – of watching their children grow up to experience the painful bullying and isolation associated with living with an untreated cleft condition.

But even with their early exposure to the reassurance and support of Operation Smile Bolivia’s local medical team, nothing could prepare the new parents for the impact of seeing Jack’s smile for the first time.

Loved by his entire family and friends and neighbours in Santa Cruz, Jack was surrounded by people who were prepared to do whatever was necessary to ensure a better future. And when he was first brought to an Operation Smile Bolivia programme, he was once again surrounded by people devoted to changing his life.

At 1 month old, Jack was too young to safely receive surgery, but volunteers fitted him with a feeding plate, which is a dental device that covers a patient’s cleft palate to help them feed with ease and remain strong and healthy enough during the months leading up surgery.

Although América felt saddened that Jack couldn’t receive surgery yet, she left the programme feeling confident in the local volunteer team and comforted by the fact that she was not alone. After several months of waiting, the day Felipe and América had been hoping for finally arrived.

Back in the care of Operation Smile volunteers, Jack passed his comprehensive health evaluation and was deemed healthy enough to undergo anaesthesia. For Felipe and América, despite the trust they’d placed in the volunteers, they couldn’t prevent the anxiety and worry from sinking in as they waited to see Jack’s new smile on surgery day.

Fear gave way to joy and relief when the family was reunited once again. On that day, one surgery changed the lives of three people.

Jack now feeds without difficulty and no longer requires a feeding plate. Their community was thrilled with his new smile and loves watching Jack laugh freely and continue to grow.

The transformation from a cleft repair surgery is seen immediately, but it wasn’t the end of Jack’s cleft care journey with Operation Smile Bolivia. A few months later, he was scheduled to receive his second surgery to repair his cleft palate.

In 2020, the pandemic interrupted Jack’s kindergarten classes, but Operation Smile Bolivia remained committed to providing patients like him with health that lasts. Staying in contact with the local volunteer team, Jack, Felipe and America embraced his ongoing care through virtual therapy sessions that worked to improve his speech.

A healthier and brighter future awaits for this loving family.  “We will be forever grateful,” América said.

Change a life today

Jack and his family received the vital support to help him thrive and grow strong to have his cleft surgery. You can help more families like Jack’s.

Our promise of improving health and dignity during the COVID-19 pandemic endures. Once again, we’re providing surgery and in-person care while taking stringent measures to keep our patients, their families and our volunteers safe. Hope is on the horizon. And we remain focused on what cleft care makes possible for children, helping them to better breathe, eat, speak and live with confidence.

A Reflection of Hope – Ziyalesi’s story

A Reflection of Hope

As they grow up, some children become curious about what their smiles would look like if they weren’t born with a cleft condition.

Ziyalesi didn’t have to wonder. All she needed to do was look at her twin sister, Rutia.

Rutia not only represented what Ziyalesi’s smile could be, but also the potential of how differently people in her community might treat her.

But unfortunately, her reality was more painful. With the cost of surgery beyond her family’s means, a new smile seemed to be an impossibility, and Ziyalesi endured the harmful stigma and isolation that can come with living with an untreated cleft condition.

She was oftentimes tormented by people on the streets whenever she left the safety of her home. Even the bullying she endured from her classmates sometimes went beyond verbal insults – Ziyalesi was also occasionally physically abused.

Seeing her daughter come home from school in tears was heartbreaking for Angela, Ziyalesi’s mom. To a certain extent, she understood her daughter’s pain, as she and her husband, Samuel, were also on the receiving end of their community’s torment and oppression.

When Ziyalesi was born with a cleft condition, Samuel and Angela believed they were being punished. Rather than providing the family with support or solace, their community mocked and taunted them. Lacking access to knowledge of the causes and treatment of cleft conditions, Angela believed that her daughter’s cleft condition would eventually heal on its own.

But, of course, it never did.

When Samuel and Angela were informed that surgery was available to help Ziyalesi, they were thrilled.

But their excitement was soon lost when they learned how much it would cost the family to pay for surgery. Yet, amidst the seemingly unending uncertainty and pain, Ziyalesi could always turn to the support and compassion of her sister. One day, Rutia and Ziyalesi hoped that they would look just alike.

Everything changed when Angela saw a poster for Operation Smile Malawi. Filled with relief, Angela read about how the organisation had teams of medical volunteers capable of providing free life-changing surgery.

Operation Smile made travel arrangements for Ziyalesi and her mother to reach Lilongwe, where the surgical programme would take place. Following their long journey, Angela felt reassured as she glanced around and saw other children who looked like Ziyalesi. For the first time, they felt like they weren’t alone.

Ziyalesi and Angela met with the compassionate volunteers at the programme site who conducted a comprehensive medical evaluation and determined that she was a candidate for surgery. After a cleft lip surgery, a procedure that can take as few as 45 minutes, the course of Ziyalesi’s life was changed forever.

“I am so happy because they won’t tease her anymore,” Angela said.

As she looked into the mirror after receiving surgery, Ziyalesi saw the new and beautiful smile she would have for the rest of her life. She smiled and said, “Now I look like my sister, Rutia.”  

Today, Ziyalesi lives a happier life, free of the burdens associated with cleft conditions, and is no longer bullied by those who misunderstood her condition. Following the family’s return home, many members of their community never expected to see such a drastic change to Ziyalesi’s smile. Some shared how they felt ashamed by the things they said and how they had treated the family.

One of the many people who was most excited to see Ziyalesi was Rutia, who said, “We have a new Ziyalesi now.”

Change lives today

Surgery is only one part of the comprehensive care we provide to our patients. We support children, like Ziyalesi that without your donation, wouldn’t have a chance to repair her cleft lip.

Our promise of improving health and dignity during the COVID-19 pandemic endures. Once again, we’re providing surgery and in-person care while taking stringent measures to keep our patients, their families and our volunteers safe. Hope is on the horizon. And we remain focused on what cleft care makes possible for children, helping them to better breathe, eat, speak and live with confidence.

Care for Brighter Futures: Iris’ Story

Care for Brighter Futures: Iris’ Story

As soon as Iris gets off the bus and, together with her mother, moves through the crowds of people at a bus station in Managua, Nicaragua, she hides.

Walking behind her mother, she holds one hand on her mother’s shoulder and the other covers her mouth. Her eyes are locked on her mother’s back, as if she doesn’t want to meet the eyes of any of the strangers staring at her.

Iris is 11 years old and was born with a cleft lip and cleft palate.

In a certain way, she’s lucky. Her mother loves her no matter what. She thinks she is beautiful – the best thing that happened to her.

So many other children born with cleft conditions experience the opposite; their mothers and fathers feel shame and fear instead of happiness and love when they see their children for the first time. Iris has felt love from the very beginning.

But what Iris shares with nearly every child affected by cleft is the feeling of being different, not fitting in and not feeling equal to her peers. Though Iris goes to school with her friends, she always hides her face whenever she is among strangers. She’s used to living life in the shadows of her friends and family.

Iris and her mother, Sandra, have taken the bus for five hours from their hometown of Matagalpa to the capital city of Managua, where an Operation Smile cleft care center is located. They’re coming so Iris can finally receive surgery after so many years without treatment. Sandra has tried before to have her daughter treated at a regional hospital. The first time, Iris got sick. The next time, they just couldn’t afford the trip.

“My husband works in the fields as a farmer for anyone who can offer him some work. I am a housewife,” Sandra explains. “We are a poor.”

But this time they were fortunate. A woman who happened to see Iris decided to help the family by giving them information about Operation Smile and money for the bus trip. Now, they’ve arrived at the Operation Smile care center in Managua – eager, full of expectations but also nervous.

“What makes me very proud about this center is that we not only offer surgery to fix a cleft lip and cleft palate, but that we see the patient not as a surgical case, but as a family member,” says Indiana Siu, Operation Smile Nicaragua’s executive director. “They come here normally as babies and stay under our care until they are 16 or 17 when they are fully treated. It is not enough to just give them surgery, but to also help them integrate in to society so they can talk and communicate with other people.”

Operation Smile has a 25-year history in Nicaragua. With the support of the Nicaraguan Ministry of Health, it all started in 1993 with brigadas – “brigades” – of international medical volunteers coming in to perform surgeries at state-owned hospitals.

“At that time, we had no idea of the need. There were no mobile phones; announcements were made through radio,” says Eliza Maria McGregor Montealegre, Operation Smile Nicaragua’s co-founder and vice president of its board. “Soon, we discovered this was just the beginning of trying to solve a huge problem. Many other organizations came from abroad, but they all left after a while and we stayed.”

Indiana adds: “We have grown exceptionally in all aspects. When I started in 2010, we did 100 to 200 surgical procedures per year. Now, we are up to 500 per year. We have almost 14,000 visitors per year (at the care center). And by cooperating with the Ministry of Health, we can reach out to the population of the whole country and offer them safe surgery.”

In 2016, Operation Smile Nicaragua opened its new care center in Managua.

Named after the founding MacGregor family, it has brightly-colored walls, big windows and a welcoming atmosphere. A playground in a small outdoor square is full of children waiting for their appointments with the medical specialists. Here, Operation Smile offers consultations with anesthesiologists, pediatricians, orthodontists, speech therapists, psychologists and nutritionists. Surgeries are performed at Hospital Alemán Nicaragüense, a state-owned hospital nearby.

Now, it’s Iris’ turn to meet psychologist Dr. Maria José Chevéz. She shows Iris drawings of a child who’s about to have surgery – how the anesthesia mask is placed over the face. Then, Maria brings out a real mask and Iris tries it on for herself. She breathes as instructed.

“I try to explain to Iris and her mother what the steps are during the process. She feels nervous – it is her first time to be so far away from home for so long,” Maria says. “Many parents have questions, specifically about the anesthesia, if there are side effects. There are so many myths that it might have effects long term, so we try to explain and answer all the questions.

“If the mother feels calm during the process, the patient is very likely to feel calm as well,” she adds.

Iris and her mother spend nearly the whole day at the center and consult with all the necessary specialists. Tomorrow is her big day – Iris will finally receive the surgery that she’s always deserved. And here, with all the other children affected by cleft playing around her, she no longer hides her face.

Early in the morning, Operation Smile Nicaragua’s volunteer medical team arrives at Hospital Alemán Nicaragüense to prepare for the two surgeries to be performed that day.

Iris is one of those patients. In a bed in the pre-operative ward, Iris is lying face down, not wanting to talk to anybody.

“She is nervous and afraid because it is the first time she is at a hospital, undergoing surgery,” says Sandra, Iris’ mother, as she sits on the bed next to her daughter. “I am praying to God that everything will go well and that she feels better after.

“She is beautiful as she is, but I think she will be a happier person when this is over,” Sandra says as she strokes Iris’ hair carefully.

It’s almost time for Iris’ cleft lip surgery and Dr. Maria José Chevéz, the psychologist who she met yesterday at the center, is there to keep her calm. They walk towards the operating room and sit on a bench for a while, playing and talking.

But now it’s time to go. He takes Iris’ hand and they together walk into the operating room, leaving Sandra outside to pray and wait. “I have been waiting for this since she was a little baby,” Sandra says. “Ever since I got in touch with Operation Smile in January, we have been treated well. Everybody has been so nice and accommodating. Now I feel so happy that this moment is here”.

An hour later, the moment has arrived for Sandra to see her daughter for the first time after surgery. As Iris is brought to the recovery room on a rolling bed, Sandra can’t hold her tears back. She cries openly, embraces her daughter and talks to her with so much love in her voice:

“Thanks to God everything went well, my darling. You can relax and just recover now. I am crying because I want to thank God and everyone who has been working with you.” 

With tears in her eyes, Maria is also there to witness this emotional moment.

“After this surgery, Iris will be able to come back to her village and feel and look like the rest of the children there,” Maria says. “She will be able to feel confident and overcome her shyness a little at a time so she won’t feel the need to cover her face anymore.”

Change lives today

Surgery is only one part of the comprehensive care we provide to our patients. We support children, like Iris, by providing excellent centres of care, with specialisms in anaesthesiologists, paediatricians, orthodontists, speech therapists, psychologists and nutritionists.

Iris after her cleft lip and cleft palate surgery smiling at the camera

Our promise of improving health and dignity during the COVID-19 pandemic endures. Once again, we’re providing surgery and in-person care while taking stringent measures to keep our patients, their families and our volunteers safe. Hope is on the horizon. And we remain focused on what cleft care makes possible for children, helping them to better breathe, eat, speak and live with confidence.

Timely Surgery Leads to Rania’s Brighter Future

Timely Surgery Leads to Rania’s Brighter Future

Before Rania’s birth, no one in her family had seen another person with a cleft condition.

Heartbroken, shocked and confused, her family didn’t know what had caused her to be born with a cleft lip. But despite the uncertainty of what laid ahead, they knew they had to remain strong.

Believing that Rania’s cleft condition was God’s will, her grandmother, Nour, was determined to find the best cleft care possible regardless of how long it took her. Thanks to information shared by the doctors at the hospital where she was born, Rania’s family didn’t need to search for long.

Less than a week later, Rania was in the care of Operation Smile Morocco medical volunteers.

Baby Rania in her grandmother sling before her cleft lip surgery

Six-month-old Rania, before cleft lip surgery. Photo – Margherita Mirabella.

As one of the most active charities in the country, Operation Smile Morocco seeks to reach patients and families affected by cleft conditions by delivering safe surgery and providing year-round multidisciplinary services including speech therapy, psychosocial support, dental care and more at its three care center locations in Casablanca, El Jadida and Oujda.

Arriving with her grandmother to the nearby Casablanca center, 1-week-old Rania was too young to receive cleft surgery, but local volunteers fitted her with a feeding plate, a device that allowed her to feed more easily.

Pre-surgical dental care such as feeding plates helps children like Rania avoid life-threatening malnutrition that some patients experience when their cleft condition makes breastfeeding challenging.

With her new plate and the ongoing support of the volunteer medical team, Rania only needed to get a little older and stronger before she was ready for her cleft lip surgery.

It took six months, but the family finally received a call from Operation Smile Morocco letting them know that an upcoming surgical programme was taking place. They boarded a bus provided by Operation Smile and made the 32-hour journey from Casablanca to Dakhla.

Nour learned that Rania was not alone in her condition after their arrival at the mission site,

Rania’s family felt peace knowing they were among other families seeking help for their children’s cleft conditions.

After performing a health evaluation to ensure she was strong and healthy enough to undergo anaesthesia, volunteer medical professionals shared the exciting news with Nour that Rania was cleared and scheduled for her life-changing surgery.

Nour was overcome with happiness when she saw Rania’s new smile. She couldn’t believe the change one surgery could make.

Even before volunteers repaired Rania’s cleft condition, Nour loved her deeply. But it wasn’t until after seeing her granddaughter’s transformation that she realised cleft surgery would allow others to see Rania as the beautiful person Nour always knew she was.

Upon returning home to Casablanca, Nour and Rania’s lives have changed drastically. It had been a very isolating time for Nour during the months before Rania’s surgery as they waited for Operation Smile Morocco to call. She tried to stay inside with Rania as much as she could to avoid the questions and judgmental looks from some members of their community. Today, Nour takes Rania everywhere.

Now, when people look at Rania, all they see is a joyous girl who loves to smile at her grandmother. Even some family members who didn’t meet Rania until after surgery are surprised to learn that she was born with a cleft lip.

With early surgical intervention, Rania avoided the health problems and painful stigma that some people experience when living with an untreated cleft condition. Instead, Rania gets to grow up being excited about going to school and making friends. With a passion for drawing and dancing, Rania has the life every child deserves.

At 5 years old, when Rania was asked what she would say to those who helped her when she was an infant, she said, “Thank you for everything.”

You can too change many lives

We work with local organisations to develop local resources to become self-sufficient in caring for cleft coditions

Two lives transformed by one new smile

Two Lives Transformed by One New Smile

From Sandra’s Madagascar village where she’s lived her entire life, the nearest hospital is a 5-hour walk away.

This is the reality for many families living in areas of the world where access to safe and timely medical care is not only limited but oftentimes nonexistent altogether.

Geographical and financial barriers, and sometimes a fear of the unknown, can prevent patients like Sandra from accessing the life-changing care they need early in their lives.

Sandra lived the first 12 years of her life with an unrepaired cleft lip. Her family knew that care was possible, but their limited income and a strong stigma that deepened their fear of doctors and hospitals made it seem like Sandra’s surgery would remain out of reach.

Girl with a cleft lip

Twelve-year-old Sandra before cleft surgery. Photo: Zute Lightfoot.

It wasn’t until her grandmother, Manuelle, learned about Operation Smile and its global community of trusted medical volunteers that everything began to change.

With only two weeks before the surgical program was scheduled to start, Manuelle was determined to get her granddaughter the care that she deserved despite any fears she had.

When it finally came time for their journey to Antananarivo, the capital city of Madagascar, love and perseverance motivated Manuelle to walk the five hours to their nearest hospital where an Operation Smile bus was waiting to transport her, Sandra and many other families to the mission site. Ten hours later, they stepped off the bus feeling both eager and nervous.

After a day filled with comprehensive health evaluations from anaesthesiologists, pediatricians and more, Sandra was told news that would forever change her life. She was scheduled to receive free cleft surgery.

Upon arriving home to their village following the mission, they were greeted by family and friends who were anxiously awaiting to see Sandra’s new smile.

It was through this journey with her granddaughter that Manuelle learned just how impactful free cleft surgery can be, and she wanted to do more for the people of her community.

Manuelle once passed a child with a cleft condition from a neighboring community walking down the road. She felt in her heart that she had a responsibility to inform the child’s family of the opportunities that existed. She wanted more families and grandparents to see the same incredible changes in their children that she saw in her own granddaughter.

Before surgery, Sandra enjoyed school but constantly dealt with teasing by other children who would tell her that she had a broken lip.

Operation Smile visited Sandra at her home six months after surgery. They were greeted by a new Sandra, one who skipped happily around her village surrounded by friends and a beautiful smile on her face. With the burden of painful bullying seemingly lifted from her shoulders, Sandra now lives a happier and healthier life as an outgoing 12-year-old who loves to play and study her favorite subject Malagasy.

With every smile and sound of laughter from her granddaughter, Manuelle became more determined to share her Operation Smile experience with as many people as she could reach. From house to house, Manuelle reassured families by describing the process of a mission, helping quell any fears they might have and urge them to reach out to Operation Smile.

“I’m happy to recruit for Operation Smile, and I will work hard to find more patients because of the work that they do,” Manuelle said.  During one trip, she walked nearly five miles, crossed a river and hiked another mile to reach a boy named Gino and a girl named Nordine. Both children were recruited for a later Operation Smile surgical program in Madagascar.

When asked what motivates her to find more children, Manuelle said, “My grandchild once suffered from cleft lip. My grandchild Sandra was teased, dropped out of school, and was a shy girl. Now I can’t keep her in the house. She has many friends and is constantly smiling. She is beautiful.  I would like to give that gift, the gift of smiling to others like Sandra.” 

Give hope to child like Sandra

You can change lives of families like Sandra’s.

Our promise of improving health and dignity during the COVID-19 pandemic endures. Once again, we’re providing surgery and in-person care while taking stringent measures to keep our patients, their families and our volunteers safe. Hope is on the horizon. And we remain focused on what cleft care makes possible for children, helping them to better breathe, eat, speak and live with confidence.

A Mother’s Love Overcomes Unexpected Challenges in Guatemala

A Mother’s Love Overcomes Unexpected Challenges

When Dayrim and Ethan departed from their local hospital in Guatemala City, feelings of hopelessness emerged.

Four times she had traveled to the hospital feeling optimistic that her 11-month-old son, Ethan, would finally undergo his cleft lip surgery. Four times his surgery was postponed.

Determined to give her son the life she imagined for him, Dayrim often reflected on how much she and Ethan had overcome together. By that point in his short life, Ethan had spent much of his time in hospitals surrounded by doctors and medical equipment.

From the moment Ethan was born, Dayrim became well-versed in fearing for her son’s health. Her due date hadn’t yet arrived when Dayrim was suddenly rushed to the hospital.

Two months prior to when he was expected, Ethan entered the world. Worry for her premature baby filled Dayrim with anxiety and uncertainty, which only intensified when she saw his smile for the first time.

Baby boy smiling at camera before his cleft lip surgery

Ethan, 11 months old, smiles before surgery during a 2018 surgical programme in Guatemala City. Photo: Carlos Rueda.

Although it was never detected in any prenatal ultrasounds, Ethan was born with a cleft lip and would spend the next two months in the pediatric intensive care unit fighting for his life.

Over the course of those few months, Dayrim watched as Ethan began growing stronger and becoming healthier each day. Looking at Ethan, one would never have known that he’d previously needed help breathing due to his underdeveloped lungs.

Medical staff at the local hospital first told Dayrim that surgery to repair Ethan’s cleft lip would be possible when he was 3 months old. Leaving the hospital after a fourth unsuccessful attempt at surgery, Ethan was close to turning 1 year old, but Dayrim didn’t feel any closer to getting him the cleft care he needed.

Then one day, a neighbor shared a story that altered the course of Ethan and Dayrim’s lives. She was told that they also had a child with a cleft condition who received life-changing surgery through Operation Smile Guatemala at no cost to their family. Upon seeing her neighbor’s child, Dayrim’s outlook on her son’s future became brighter, and she recognized that she wasn’t alone.

Their journey toward care and a better life for Ethan finally had an end in sight.

Immediately, Dayrim contacted Operation Smile Guatemala and traveled to a local clinic where medical volunteers told her a surgical mission was taking place the following month. This time, nothing was standing in her way, and Dayrim’s fifth attempt at getting Ethan cleft surgery proved successful.

During the mission, Ethan underwent a comprehensive medical evaluation and was deemed healthy enough for surgery. With her son’s new smile, Dayrim felt ready to start focusing on Ethan’s promising and happier future.

You can too change many lives

We work with local organisations to develop local resources to become self-sufficient in caring for cleft coditions

Our promise of improving health and dignity during the COVID-19 pandemic endures. Once again, we’re providing surgery and in-person care while taking stringent measures to keep our patients, their families and our volunteers safe. Hope is on the horizon. And we remain focused on what cleft care makes possible for children, helping them to better breathe, eat, speak and live with confidence.

Unforeseen Hope Arises in Malawi: Magret’s Story

Unforeseen Hope Arises in Malawi: Magret’s Story

Magret is no stranger to overcoming adversity.

While working as a subsistence farmer in Malawi striving to provide a good life for her four children, Magret also withstood the burden of living with an unrepaired cleft condition for 34 years.

When Magret was born, her parents received no explanation about her cleft condition or where to seek help.

Severe bullying and ostracisation by her community contributed to the loneliness Magret felt while growing up.

Instead of succumbing to her circumstances, Magret remained optimistic, radiating her positivity and hope to family and friends around her.

Living in a country where access and awareness of cleft care opportunities are extremely limited, Magret never knew treatment was possible. But even if she had been made aware of a surgical solution, affording the cost of an operation would have been out of her reach.

Magret before her cleft lip surgery

Photo caption:After living 34 years with an unrepaired cleft condition, Magret arrived at our 2018 surgical program in Blantyre, Malawi, feeling hopeful and unafraid. Photo: Jasmin Shah.

Her children were thrilled to see her new smile after Magret returned home.

Through her work on the farm, Magret cultivates only enough food to meet her family’s needs. Her husband, Laston, moved to South Africa with hopes of finding a job that could provide his family supplementary income.

Around the world, there are millions of people like Magret who endure years of needless suffering because of the barriers preventing them from accessing care earlier in their lives.

Unable to afford travel to the nearest hospital, let alone the cost of an operation, many people living in low-income countries like Malawi also face a lack of skilled surgeons required to meet patient demands. These obstacles motivate Operation Smile to find innovative ways to extend its impact and reach more patients.

After living three decades with a cleft lip, Magret encountered an opportunity that she always believed was impossible. A local community leader told her that Operation Smile Malawi mobilised teams of medical professionals capable of giving her a new smile through cleft surgery at no cost to her.

Joined by her sister, Magret immediately traveled to the upcoming surgical program taking place in Blantyre. Volunteers performed a comprehensive health evaluation and deemed Magret healthy enough to be placed on the surgical schedule.

Bravely waiting to receive her long-overdue surgery, Magret’s mind began to drift toward the parents she saw at the mission. As a mother, she sympathised with the mothers and fathers who’d watched their own children live with and endure the same pain and isolation she experienced.

She also felt overjoyed that those parents had found Operation Smile because their kids now had the chance to receive the cleft surgery that eluded Magret her entire life.

Filled with joy after surgery, Magret called her family to tell them about her transformation and sent a photo to Laston.

Her children were thrilled to see her new smile after Magret returned home. Together, they tore apart all of Magret’s pre-surgery photos.

“I am so happy now,” she said. “Thank you for what you did for me. Please continue to help others.”

With your help we can change more lives

Magret is one of the 1000’s patients we have helped in over 40 years. Can you support us to continue to provide cleft care to patients in the most deprived parts of the world?

Our promise of improving health and dignity during the COVID-19 pandemic endures. Once again, we’re providing surgery and in-person care while taking stringent measures to keep our patients, their families and our volunteers safe. Hope is on the horizon. And we remain focused on what cleft care makes possible for children, helping them to better breathe, eat, speak and live with confidence.

Lighting the Way In Bolivia

Lighting the Way In Bolivia

After the heartbreaking miscarriage of her first child, Pamela was overjoyed to reach full-term with her second, Luz, a name meaning “light.”

But the happiness she felt after giving birth to her baby girl was replaced with the darkness of fear and confusion when the doctor took her away. Pamela was only given a glimpse of Luz before she was ushered into a separate room.

When the doctor came back, Pamela saw her daughter’s cleft lip and palate for the first time. Shock and blame overwhelmed her, but she loved her daughter and wanted answers.
“At first, I thought that it was because I had had a previous miscarriage as a result of a fall,” Pamela said.

Her doctor assured her that this was not the reason for her daughter’s cleft lip and palate (while it’s difficult to determine the exact cause of an individual cleft case like Luz’s, Operation Smile is leading the way in cleft research with its partners in the International Family Study).

He told her that surgery was possible, but mentioned nothing about Operation Smile and the cleft lip and cleft palate surgeries that it provides at no cost to Bolivian patients and their families.

Going home led to more obstacles and more fear. Her daughter’s cleft condition made it almost impossible for her to breastfeed properly, and Luz began to lose weight. Becoming desperate, Pamela resorted to feeding her milk with a spoon, but Luz continued to cry out in hunger.

Mum holding baby girl with cleft lip and cleft palate

Pamela and Luz in 2004. Photo by Marc Ascher.

Fortunately, a friend of Pamela, whose baby had also been born with a cleft lip, arrived at their home with a special feeding bottle that had saved her child’s life. Feeding from this bottle, Luz soon began gaining weight and growing strong.

For several months, Pamela and her mother searched for any piece of information on cleft lip and cleft palate surgeries. And for several months, they were left without answers.

In 2004, after almost a year of living with an untreated cleft condition, Luz was given a chance at a brighter future when a street vendor informed her grandmother about having seen an announcement from Operation Smile on television. Pamela and her mother called a volunteer from the Operation Smile team and learned that there was a medical mission taking place in Santa Cruz, Bolivia.

Neither the distance to the mission nor her small income were going to stop Pamela from raising enough money to pay for the journey – a journey that could alter her daughter’s life forever. The trip for Luz, her mother and her grandmother proved to be challenging. During the trip, they faced a collapsed bridge that prevented the bus from crossing safely. All of the passengers were forced to walk until they could reach another bus, making an 18-hour trip even longer.

After many hours of walking, waiting and riding, they made it to Santa Cruz. As she approached the medical mission site with Luz and her mother, Pamela felt uncertain and anxious. She didn’t know what to expect nor what the medical volunteers would say about her daughter’s cleft lip and palate.

But her hope returned when she saw other children with not only the same cleft condition as Luz but, in some situations, even more severe. In that moment, she knew that they weren’t alone.

Operation Smile medical volunteers completed a comprehensive health evaluation and determined that Luz was healthy enough to receive safe surgery and was placed on the first day of the mission’s schedule. Pamela was thrilled to hear that Operation Smile was going to give her daughter a chance at a more dignified and happy life.

Pamela’s hope returned when she saw other children with not only the same cleft condition as Luz but, in some situations, even more severe. In that moment, she knew that they weren’t alone.

Operation Smile medical volunteers completed a comprehensive health evaluation and determined that Luz was healthy enough to receive safe surgery and was placed on the first day of the mission’s schedule. Pamela was thrilled to hear that Operation Smile was going to give her daughter a chance at a more dignified and happy life.

Luz was fortunate enough to have found Operation Smile at an early age, as she was able to avoid the dangerous infections that can occur, as well as the damaging ridicule and stigmatization many face when living with an untreated cleft lip or cleft palate.

“Thanks be to God that Luz has never had any problems,” Pamela said. “She never felt different.”

Today, Luz is in secondary school with plans to make a difference – to shed light on the world by continuing her education.

“I don’t know what I want to study yet, but I do want to do something that will help people,” Luz said. She adores her dog, Beethoven, and enjoys listening to her favorite singer, Justin Bieber. Luz also loves playing soccer and volleyball with her two best friends, Judith and Mariana.

Luz is scheduled to return to a mission to receive a rhinoplasty and to reconnect with the Operation Smile medical team who helped give her the smile she always deserved.

Pamela had this message for Operation Smile supporters and its medical volunteers: “Thank you very much for the help and support you have given me at the missions. I really feel that when I go to the missions, you are my family.”

We offer comprehensive cleft care

Surgery is one part of what we do. There is much more to cleft care

Our promise of improving health and dignity during the COVID-19 pandemic endures. Once again, we’re providing surgery and in-person care while taking stringent measures to keep our patients, their families and our volunteers safe. Hope is on the horizon. And we remain focused on what cleft care makes possible for children, helping them to better breathe, eat, speak and live with confidence.

When All Seemed Lost, Hope for Janat Was Found

Baby girl with a cleft lip and palate
We first met Janat when she was 1 month old during an Operation Smile Morocco surgical programme in March 2020. Due to her cleft lip and palate, she had become severely malnourished and unable to breastfeed. Photo: Jasmin Shah.

As Janat entered the world, 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.

“I was scared,” Fatima said. “I was scared of her. It was the first time I had seen something like that.”

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 declined rapidly.

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. It was very painful for me seeing her like that. I was scared and didn’t know where to go or who to ask.”

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

“I had no hope that she would live,” Youssef said. “Every day, we thought she was going to die. She couldn’t breastfeed or bottle feed. Every day, we thought that she wasn’t going to live.”

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, their hopes were realised.

Mother feeding her baby with a special feeding plate
Volunteer dentist Dr. Teresita Pannaci of Venezuela, left, observes as Janat is fed by her mum while testing out her new feeding plate. Before arriving to our programme in Oujda, Janat had lost nearly half of her birth weight. Photo: Jasmin Shah.

After a family member showed her an Operation Smile Morocco video, Fatima learned that the organisation not only provides free surgical care for children like Janat, but that an upcoming surgical programme was taking place in a little over a week in Oujda, a neighbouring city three hours away.

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 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.

“I used to cry for my daughter to see her like that,” Fatima said. “But when I saw those kids, I told myself that I’m not alone and that my daughter was born like them. I saw some kids who’ve received surgery. I was relieved when I saw them. It gave me hope.”

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.

At 1 month old, Janat was too young to receive surgery. Even if she were old enough, she was in a state of severe malnutrition that would have made it impossible to undergo anaesthesia.

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

Volunteers holding dental simulation dolls
Volunteer dentists Drs. Vilma Arteaga of Guatemala, left, Teresita Pannaci of Venezuela, centre, and Soukaina Dahou of Morocco each hold a dental simulation doll. These realistic dolls are used to teach dental students how to make impression molds of cleft palates to create feeding plates and obturators, which help patients like Janat feed, breathe and drink with ease. Photo: Jasmin Shah.

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.

Baby with a cleft lip and palate trying a feeding plate
During the March 2020 surgical mission in Oujda, Morocco, Janat tries out her new feeding plate for the first time. Photo: Jasmin Shah.

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 wasn’t expecting that – that they have this kind of solution for little kids,” Fatima said. “I was really happy that my daughter can drink milk, get full and be calm. I can’t describe my feelings. I was so relieved and so happy.”

Fatima, Youssef and Janat returned to the care centre once more during the mission before heading home. After receiving demonstrations and educational support on the feeding plate from Teresita, Fatima felt confident in her ability to feed Janat.

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 – perhaps for the first time in her life.

Mother feeding her baby after having a feeding plate fitted
For perhaps the first time, Fatima watches as Janat drinks milk without choking 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.

Although Janat didn’t receive surgery, Fatima and Youssef’s determination was stronger than ever before, and they planned to return to the centre on an ongoing basis to allow for volunteers to monitor Janat’s care and progress.

The first month of Janat’s life had been filled with fear, uncertainty and seemingly impossible obstacles. But after leaving the Oujda care centre with a newfound hope and the support of Operation Smile Morocco volunteers behind them, Youssef and Fatima were confident that Janat’s path toward recovery had finally begun.

“My hope grew since the day I went to Oujda,” Youssef said. “She started to drink properly. She started gaining more weight day after day.”

With possibly only days left to live prior to obtaining her feeding plate, Janat was one of the last patients who received life-saving dental care from Operation Smile Morocco.

Because less than a week later, Covid-19 was declared a global pandemic.

Babies awaiting cleft surgery
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.

Countries everywhere hastily began closing its borders, halting transportation services and shutting down businesses. 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 thousands of patients like Janat waiting.

As a child grows, feeding plates should be replaced regularly. But with the pandemic forcing the closure of the Oujda care centre doors, where Janat was expected to return, receiving a new feeding plate became impossible.

“All the hope that we had started to vanish when Covid-19 appeared,” Youssef said. “We were really impacted by this pandemic. We lost hope as everything started to close.”

Janat’s family wasn’t sure if Janat would ever be able to return for the additional comprehensive cleft care she still needed. The Operation Smile Morocco team didn’t know if they’d see her again.

Six months later, Youssef and Fatima received a call that changed everything.

“When I saw [Operation Smile Morocco’s] phone number, I was so happy,” Youssef said. “Our hope was back.”

The Casablanca care centre’s doors had reopened.

Operation Smile Morocco's care centre in Casablanca
Operation Smile Morocco established its first care centre in 2008 in Casablanca, which supplied the organisation with the infrastructure and innovative equipment needed to provide patients with year-round multidisciplinary care services including orthodontics, speech therapy, dentistry, psychosocial care, orthognathic evaluations and more. Photo: Lorenzo Monacelli.

Unlike their journey to Oujda, which was a three-hour trip from their home, it would take Fatima and Youssef two days to reach Casablanca, a daunting journey for any family to make.

With the feeding plate, they had watched their daughter grow stronger each day, only for that hope to be ripped away by the pandemic.

But Youssef and Fatima had also witnessed something beautiful: families holding their children in their arms after life-changing surgery.

That reason alone is why they knew that no amount of distance would discourage them from seeking that same opportunity for Janat. They made the two-day trip to Casablanca five times.

“Nothing is too hard when it comes to my daughter,” Fatima said.

Sleeping baby with a cleft lip and palate
Due to difficulty feeding caused by her cleft palate, 1-month-old Janat arrived to our March 2020 programme in Oujda severely malnourished and on the verge of starvation. Photo: Jasmin Shah.
Smiling girl with a cleft lip and palate
Janat, now almost 2 years old, shares her biggest smile during screening at Operation Smile Morocco’s October 2021 surgical programme in Casablanca. Photo: Jasmin Shah.

Back in the care of medical volunteers, Janat received new feeding plates, pre-screening health evaluations and a date for Operation Smile Morocco’s October 2021 surgical mission. With each visit over the course of her many trips to the centre, improvements to Janat’s health and happiness were undeniable.

Dr. Soukaina Dahou, volunteer dentist for Operation Smile Morocco, was part of the team of dentists who created Janat’s first feeding plate. Reconnecting with Janat’s family and watching as she ate cookies and laughed with joy, Soukaina couldn’t believe she was seeing the same child she met more than a year prior who’d been close to starvation and unable to breastfeed.

“Seeing Janat again truly is one thing that proves that what we do is really important,” Soukaina said. “To see them healthy, to speak correctly, it makes me very happy. Seeing these results comforts me. It means that we help people in a good way.”

Janat and her family travelled for the sixth time to Casablanca hopeful that the team of medical volunteers would share the news that Janat could finally have her long-overdue cleft lip surgery.

Medical volunteer examines cleft patient
Volunteer anaesthesiologist Dr. Anne-Marie Banning from Sweden examines Janat during her comprehensive health evaluation. Photo: Jasmin Shah.

Overcoming her battle with malnutrition, months of delayed care amid the pandemic and countless miles travelled to and from her home, Janat passed her comprehensive health evaluation.

“My dream is coming true,” Youssef said. “Janat is the light of the house. I wanted to see my daughter as other girls, I wanted her to grow up and be a normal kid. She will be able to talk to people normally. I was so happy when they called me and told me that my daughter will receive the surgery.”

During a surgery that took a little more than an hour, Janat and her family’s lives were changed forever.

Smiling mother holds her daughter after cleft lip surgery
Fatima is filled with happiness and joy as she holds Janat after the surgery that repaired her daughter’s cleft lip. Photo: Jasmin Shah.

Fatima understands that while she’s relieved and filled with hope after seeing Janat’s new smile, this surgery is just one step along Janat’s cleft care journey.

Operation Smile Morocco plans to provide Janat with surgery to repair her cleft palate, the condition that nearly took her life more than a year ago.

Gazing at her transformed smile, Janat’s family feels prepared to make any sacrifice and travel any distance to ensure her future is bright.

“I didn’t expect her to be this perfect,” Fatima said. “I am ready [for her cleft palate surgery]. I will go anywhere, any place. She is my priority.”

Smiling father holds his daughter after cleft surgery
Janat’s dad, Youssef, can't contain his joy after seeing his daughter for the first time after her surgery. Photo: Jasmin Shah.
Father kisses his daughter as return home after cleft surgery
Alongside her mom, dad and grandfather, Janat prepares to make the journey home with her new smile. Photo: Jasmin Shah.

Our promise of improving health and dignity during the COVID-19 pandemic endures. Once again, we’re providing surgery and in-person care while taking stringent measures to keep our patients, their families and our volunteers safe. Hope is on the horizon. And we remain focused on what cleft care makes possible for children, helping them to better breathe, eat, speak and live with confidence.

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