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.

His Story, His Words

Guibson poses for a photo before his surgery. Photo courtesy of Carla Formanek.
Guibson poses for a photo before his surgery. Photo courtesy of Carla Formanek.

Within Guibson is incredible strength that pushes him to pursue his dreams – strength that his mother, Iva, instilled in him.

After giving birth to her son at a hospital in Pará, Brazil, Iva’s life turned upside down. When she saw his cleft lip for the first time, a feeling of helplessness struck.

No previous ultrasound had revealed Guibson’s condition. She was devastated and had no idea how to help her baby.

But becoming a mother filled Iva with something even more powerful: love.

With an unwavering determination to find a solution for her son, nothing could have stopped her from giving Guibson a chance at a happy life after she learned about the possibility of surgery from a nurse soon after his birth.

Many people told Iva that she was foolish for letting doctors operate on her 6-month-old son. The confidence she had in the medical team (unaffiliated with Operation Smile) allowed her to ignore those judgmental comments and fight for her child’s life.

When the procedure was over, Iva felt an immense sense of relief. The operation appeared to be a success, and Iva believed that Guibson would heal without any complications.

But as he grew older, Guibson’s inner strength was tested when the results from his operation slowly reversed. The need for corrective surgery became crucial as the hardships he faced intensified.

Many of his peers ruthlessly teased him and excluded him from activities when he started school. Iva remembered that he would often return home crying because of this cruelty.

Photo courtesy of Guibson.
Photo courtesy of Guibson.

“I was heartbroken to see my boy suffering,” Iva recalled. “As a mother, I gave support, tried to help him … but inside, it hurt in me as much as in him.”

This horrible treatment was almost too much for Guibson to handle. He often considered quitting school, putting his dream of attending a university and studying agronomy, zootechnics or veterinary medicine at risk.

But even at a young age, Guibson was tough, and the abuse that he faced every day wasn’t enough to steer him away from the goals that he’d made for himself. That ambition helped him persevere and finish high school.

Being surrounded by a loving family, Guibson experienced many happy moments. But the pain that he coped with over the years took an emotional toll.

“They see your smile, but they don’t imagine what’s going on inside you,” Guibson said. “I was born like this, full of joy, but it’s not all the time that the smile reflects what you are feeling inside.”

For 22 years, he did his best to hide the pain that living with a cleft condition caused him – until the day when his life changed in an instant.

While watching TV one afternoon, Guibson saw a commercial for an upcoming Operation Smile medical mission in Santarém. He didn’t hesitate to buy a bus ticket for the 12-hour journey.

He and his mother arrived at 3 a.m. and were the third family in line for patient screenings. An hour later, the line had wrapped around the block with more families hoping that their child would receive a free, life-saving surgery from Operation Smile.

Later that day, medical volunteers performed Guibson’s comprehensive health evaluation and delivered the news that he had been waiting his entire life to hear.

He had been selected for surgery.

“Here in Operation Smile, you guys say, ‘One smile at a time.’ It’s my smile’s turn now!” Guibson said on the day of his surgery.

Almost an hour after hugging and kissing his mother for good luck, Guibson awoke from anaesthesia and saw his new smile for the first time.

Guibson's mother, Iva, embraces her son after seeing his new smile. Photo courtesy of Carla Formanek.

Apart from repairing his cleft lip, surgery had accomplished something much greater. It gave Guibson an opportunity to feel completely happy for the first time in his life.

Operation Smile reconnected with Guibson after he returned to Santarém for his 6-month post-operative consultation. His surgical result was outstanding, having healed beautifully, and the medical volunteers were thrilled to learn that he’s been dating someone for two months.

When asked how Guibson would describe his life today, he offered one word: gratitude.

“Gratitude for everything that has happened in my life in the recent months. Gratitude to God for having put Operation Smile angels in my life,” Guibson said.

He shared his appreciation with the Operation Smile medical team by writing an original poem titled “Dreams.” He hopes that when someone reads his poem, they gain the will to never stop striving for what they want in life.

“I wish that people can believe in their dreams and believe that someday they will come true just like mine did,” he said. “And that they never think of giving up their dreams because we only achieve our goals by dreaming.”

Guibson with programme coordinator Ambra Marengo after receiving surgery to repair his cleft lip. Photo courtesy of Carla Formanek.

Here is Guibson’s poem, translated from Portuguese to English:

Fighting for your dreams is seeing life differently,
Realising that everything is within your reach.
Something strong that is born inside you,
Something everyone can reach.

Until someone comes and says:
Stop! Enough! It’s over!
And you get discouraged,
Ending what barely started.

These things make us give up,
and even stop smiling.
Letting a dream be just a memory
And losing any hope you had about it.
Until someone arrives and says:
Come on! You can do it! You can achieve it!

You stand up and pursue
Something that’s very good to feel.
And then, when you do it,
You realise,
That you’re smiling again.

Shifting Gears Toward Healing

Salah Eddine racing during a cycling competition. Photo courtesy of Salah Eddine.
Salah Eddine racing during a cycling competition. Photo courtesy of Salah Eddine.

Each time that 26-year-old cyclist Salah Eddine races toward the finish line, he proudly wears the Operation Smile logo – a reminder of who helped him get to where he is today.

Before working his way to becoming a championship-calibre professional cyclist, Salah Eddine was a young child, living each day with a cleft lip and palate.

But unlike so many children around the world living with cleft conditions, Salah Eddine didn’t endure years of social isolation or ridicule due to the stigma surrounding cleft.

Thinking back to his early childhood years, Salah Eddine remembers being happy and treated with kindness. He wasn’t abused by his peers or abandoned by his family.

Salah Eddine was loved, and because of that, he grew up smiling.

For three years, his family surrounded him with love and support, hoping to give him the best life possible. Still, without treatment, Salah Eddine’s cleft condition put his future at risk.

That was until the Operation Smile Morocco medical team stepped in with the safe and essential care that he needed to live a healthy life and pursue his dreams.

With its commitment to providing comprehensive care at no cost to its patients, Operation Smile Morocco provided Salah Eddine with every aspect of care that he needed, including multiple cleft surgeries, orthodontia treatments and orthognathic surgery.

Today, 23 years after connecting with the organisation, Salah Eddine uses his second chance to do what he loves most: cycling.

But over the course of that journey together, Operation Smile Morocco and Salah Eddine created a bond that spanned far beyond his treatments.

“I have complete trust and confidence in Operation Smile Morocco,” Salah Eddine said. “I feel among my own family who care about my quality of life and my wellbeing.”

Since 1998, Operation Smile Morocco has provided the highest quality of care possible to their patients.

As the foundation became more attuned to the needs of its patients, the medical teams began offering more comprehensive services including speech therapy, orthodontics, dental care, psychosocial support and surgical revisions.

The team also strengthened its patient outreach efforts to find and heal more people living with cleft conditions in Morocco.

But with successful, long-term patient results at the forefront of their mission, Operation Smile Morocco team members became concerned when patients like Salah Eddine – who’d received surgery nearly a decade earlier – began arriving at missions complaining of jaw pain, speech problems and insomnia.

Salah Eddine before receiving his orthognathic surgery from Operation Smile Morocco. Photo courtesy of Salah Eddine.
Salah Eddine before receiving his orthognathic surgery from Operation Smile Morocco. Photo courtesy of Salah Eddine.

It’s not uncommon for patients born with cleft conditions to undergo multiple corrective surgeries during their lives. But with every procedure, the risk of needing corrective jaw surgery, also known as orthognathic surgery, increases due to post-operative tissue fibrosis, which is an excessive amount of tissue around the surgical site.

Not only can the build-up of tissue fibres affect a patient’s ability to chew, but it can also impact their speech, breathing, alignment of the jaw and, ultimately, their quality of life.

It’s estimated that as many as 25 to 30 percent of patients who receive surgery for a cleft condition are candidates for orthognathic surgery.

To keep their promise of providing patients with the care they need to thrive, Operation Smile Morocco activated new multi-disciplinary teams who had the skills and training to perform orthognathic surgery at medical missions.

It all began with Operation Smile Morocco Co-Founder and Vice President Fouzia Mahmoudi’s observations at the organisation’s care centre in Casablanca. Recognising the need to enhance its surgical capacity, Fouzia presented surgeons with multiple orthognathic cases that were similar to Salah Eddine’s.

“I was absolutely convinced that I had to do something for these kids,” Fouzia said. “And together, with a board that I have selected from many different fields and specialties, I have managed to co-found this great foundation in Morocco.”

Since making the decision to provide this type of surgery, Operation Smile Morocco has successfully completed four orthognathic programmes, changing the lives of patients who, without that added level of care, would continue coping with constant pain and discomfort.

With a commitment to providing long-term, quality care, medical teams have no plans of slowing down. And their success since 2015 has not only elevated the level of comprehensive care that their patients receive, but it’s also inspired other Operation Smile foundations in the process.

Currently, teams in Nicaragua, Guatemala and Italy are striving to deliver the same advanced care on an ongoing basis.

Madison Ebel, a programme manager for Operation Smile, has confidence that this milestone of providing orthognathic care represents the continued fulfilment of Operation Smile Morocco’s potential.

“Operation Smile Morocco is constantly driving for better. Even from these programmes, the focus hasn’t solely been on surgery,” Madison said. “Through their passion for education and growth, they’re continuously bringing in international volunteers for their mentorship and skills. I see them expanding into more comprehensive care as they always do.”

According to Fouzia, seeing Salah Eddine – someone who she describes as “one of my son’s from the mission” – thriving after surgery is incredibly gratifying. Patient stories like his are a reason why she and so many other members of Operation Smile are passionate about providing this final step.

“To see Salah Eddine realising his dream while pursuing his follow-ups in Operation Smile Morocco’s centre since he was an infant is very touching, very special,” Fouzia said. “It makes us proud of these fantastic outcomes.”

Operation Smile Morocco is a 20-year organisation that constantly aims to improve. And it’s through its commitment to comprehensive care that the organisation continues reaching new heights.

“Being a patient and going through the pain of all the surgeries enabled me to go through all of the obstacles in my career,” Salah Eddine said. “This is a lesson that I have been able to get – proudly – from Operation Smile Morocco’s family.”

Photo courtesy of Salah Eddine.
Photo courtesy of Salah Eddine.

Lighting the Way

Pamela and Luz in 2004. Photo by Marc Ascher.
Pamela and Luz in 2004. Photo by Marc Ascher.

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.

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 comforts Luz after her cleft lip surgery from Operation Smile at the 2004 medical mission in Santa Cruz, Bolivia. Photo: Marc Ascher.

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 stigmatisation many face when living with an untreated cleft lip or cleft palate.

Luz and Pamela in 2012. Photo: Marc Ascher.

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

Today, Luz is a junior in high 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.

Luz in 2018 at 15 years old. Photo: Margherita Mirabella.

She adores her dog, Beethoven, and enjoys listening to her favourite 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.

Photo: Margherita Mirabella.

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.”

Luz and Pamela in 2018. Photo: Margherita Mirabella.

Overcoming Her Obstacles

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.

At 4 years old, Nazifa hadn’t spent much time outside of the clay and straw hut where she lived.

Her family shared the house with their livestock — a cow and some sheep — and they had no electricity or running water. The stamped clay floor was cold and dusty. A fire on a stone stove on the floor lit up the hut as her mother roasted corn in a pan.

Here, Nazifa spent her time while her siblings and the other children were out playing in the village on a hill in southwestern Ethiopia.

Nazifa was born with a cleft lip, and no one in the village had ever seen anything like it before. They were scared and thought it could be the work of an evil spirit. Some people in the village thought it could even be contagious.

“Not even Nazifa’s siblings want to use the same cup as her. When they are out playing, there is a game where you throw stones into a hole in the ground. They say they can use the hole in her lip instead,” said Sherab, Nazifa’s father. “She is not the only one who suffers. My wife and I cry when we hear what they say to her.”

Four-year-old Nazifa, before. Photo: Margherita Mirabella.

However, a local health clinic informed the family about Operation Smile, which forever altered the course of their lives.

Soon after, Nazifa and her father were among the hundreds of children and parents who travelled to the capital city of Addis Ababa with the hopes of receiving free cleft surgeries performed at an Operation Smile medical mission.

Taking his daughter to the distant hospital was a huge challenge and commitment for Sherab. Being a subsistence farmer, living off what they could harvest from the fields, he had never been outside of his region before nor had he visited a big city. The family had to borrow money from their neighbours to afford bus fare, so only Sherab and Nazifa could make the trip while his wife stayed home with Nazifa’s siblings and their newborn baby.

When they reached Addis Ababa, Nazifa caught a cold in the cool, high-altitude air. She coughed as medical volunteers performed her comprehensive health care assessment, an important step in determining if patients are healthy enough to receive surgery.

Sherab was not only anxious about his daughter’s health, but also because her cold could potentially postpone surgery and they would have to make the resource-draining trip again.

Photo: Margherita Mirabella.

Finally, after some days of medication, Nazifa’s cold subsided and she was cleared for surgery.

“I think everything went well. Nazifa is doing fine even though there were some problems to start with. Everything has turned out really well. Her muscle is fine and everything is working. The lip will be perfect,” said Dr. Malin Hakelius, a volunteer plastic surgeon from Sweden.

In the recovery room, Sherab cried when his daughter finally woke up after surgery. He had been so worried, but now he could relax.

At home, his family and neighbours were waiting to celebrate Nazifa’s surgery with a big homecoming meal.

The day after surgery, Nazifa looked in a mirror for the first time in her life. Never having seen her reflection before, she tried to see if there was someone behind the mirror.

Sherab just smiled and shook the hands of as many team members as he could. “Thank you,” he said in English, bowing respectfully as is customary in Ethiopia. “Thank you!”

On the last day of the medical mission, Nazifa and her father prepared to leave the hospital and take the long bus ride home. Nazifa was playing with some new friends, forming her lips to a perfect round shape to blow soap bubbles, laughing and enjoying herself.

That day, the Operation Smile team left the hospital after five days of surgery and final post-operation check-ups.

All the equipment had been packed and stowed, and the team-members were on the way to the airport, when they got a message: Nazifa had fallen from a stone wall, and the stitches on her lip had ripped open.

Nazifa's stitches from her first surgery from Operation Smile reopened after falling while playing with friends. Photo: Margherita Mirabella.
Nazifa's stitches from her first surgery from Operation Smile reopened after falling while playing with friends. Photo: Margherita Mirabella.

Sherab was devastated.

Operation Smile Ethiopia volunteer Ruth Emmanuel helped Sherab get Nazifa first aid care for the wound at the hospital and found them a place to stay for the night.

Although the volunteer medical team was still in the country, Malin said that an immediate repair on the wound wouldn’t be possible due to the trauma caused by the fall. Their best treatment plan was to clean the wound, let it heal and repair it during the next medical mission to Ethiopia.

After four years of hoping for a better life for his daughter, Sherab left the mission with Nazifa wondering if there would be a second chance for her to get surgery again.

Six months later, Operation Smile returned to Jimma, which was even closer to Nazifa’s home in southwestern Ethiopia.

Sherab travelled with Nazifa to the mission site, holding her hand tightly and not letting go of her, even for a second.

This time, everything went smoothly for Nazifa. Passing her comprehensive health evaluation once again, she underwent her reparative surgery and not only left the mission with her father but a brighter future and a life free from bullying and social isolation.

Today, Nazifa spends most of her time playing with friends from her community. The bullying and teasing she once endured has come to an end, and she’s enrolled in school, learning how to read and write for the first time.

Photo: Jörgen Hildebrandt.

“I like to learn things,” Nazifa said.

Nazifa must cross a river every day to go to school — a minor obstacle compared to the social barriers her surgery has helped her overcome.

Photo: Jörgen Hildebrandt.

Now 12 years old, Nazifa hopes to one day become a doctor so she can care for others like the medical volunteers who cared for her.

Her parents are thankful that surgery through Operation Smile has opened the door for Nazifa to pursue her dreams.

“She can read and write now, something we never learned ourselves,” Sherab said. “When it is time to go, she stops with everything she’s doing and runs to school. She runs because education is the foundation of life.”

‘I Was Afraid I Was Going to Lose Her’

Becoming a new mother is challenging at the best of times, but Fatima, mother to one-month-old Janat, feared her daughter was about to die. Janat was born with a cleft lip and palate and Fatima not knowing where to turn was overcome with worry.

Janat was losing weight. Every time Fatima tried to feed her, she spluttered and choked on the milk. The hungry cries of her starving daughter broke Fatima’s heart. Janat could only slowly drink three ounces of feed over the course of a day, no-where near enough for a growing child. Each attempt to feed her brought more heartache.

Luckily, Fatima was seen by an Operation Smile dental team who arranged for her and Janat to be transported to our care centre in the city of Oudja. By this time Janat had lost nearly half of her birth weight and medical volunteers immediately identified Janat as at risk of dying.

Experts from the team were able to feed Janat with a special feeding plate. Rather than choking, with milk spilling from her nose, Janat hungrily drank three ounces with ease. ‘I was so happy. I was so relieved,’ said Fatima, ‘…I’ve never seen kind hearts like you before.’ Words that travel through our volunteers to you, as without you Janat would very likely have died.

Operation Smile will continue to support Fatima and Janat. Able to get the milk she needs to survive, Fatima will now be able to build up Janat’s strength for surgery to correct her cleft conditions. Although their journey is not over yet, we look forward to Janat growing into a happy and healthy child.

Overcoming Nutritional Barriers to Surgery in Ghana

Two-year-old Jocelyn during Operations Smile's 2017 medical mission in Koforidua, Ghana. Photo: Zute Lightfoot.
Two-year-old Jocelyn during Operations Smile's 2017 medical mission in Koforidua, Ghana. Photo: Zute Lightfoot.

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.

For patients like Jocelyn, widespread poverty affecting areas across Ghana presents challenges and a host of barriers that stand between them and a brighter future after surgery. Some of these barriers can also be the difference between life and death.

Malnutrition remains one of the most significant obstacles to receiving care, affecting children with cleft conditions, especially babies with cleft palate, in the early developmental stages of their lives.

Without timely medical intervention, patients confront challenges with breastfeeding, struggle to receive proper nourishment when it’s most critical and become more susceptible to infections and diseases.

“Challenges people in Ghana are facing: no access to nutritious foods, foods are too expensive,” said volunteer nutritionist Dede Kwadjo.

Volunteer nutritionist Dede Kwadjo poses for a photo at the patient shelter where she has been consulting with mothers of babies born with cleft conditions. Photo: Zute Lightfoot.

Due to the rate of Ghanaian children experiencing growth delays and being moderately to severely undernourished standing at a staggering 19 percent, improving access to nutrition and educating families is crucial.

With an increased risk and probability of complications during surgery, many hopeful families who arrive with their children to Operation Smile medical missions leave disappointed and upset after medical volunteers deemed their baby too unhealthy to receive surgical care.

And in Ghana, a country known for having widespread and deeply rooted social stigma surrounding cleft, many children endure lives filled with pain, living in a world of isolation and being fearful of harassment from peers, members of their communities and, sometimes, even their own families.

This is what Cynthia hoped to protect Jocelyn from when she made the choice to help her future adoptive daughter.

She never expected that her decision to pause at a bus stop and speak with the father of a child living with an unrepaired cleft lip would save a life let alone take her on a journey toward motherhood.

Jocelyn pictured with adoptive mother, Cynthia. Photo: Zute Lightfoot.

Hoping to help him find a solution for his 2-year-old daughter, Jocelyn, Cynthia told the father about Operation Smile Ghana and the surgical care it provides at no cost to families.

Cynthia soon learned that Jocelyn’s mother had abandoned the family, leaving Jocelyn in the care of her dad. Over time, she also began to notice that he didn’t seem to make his daughter’s needs a priority, and Cynthia became more troubled and suspicious.

To make sure that he followed through for the care of his daughter, Cynthia travelled with the family to the 2017 local medical mission in Koforidua. But after performing a comprehensive health evaluation, medical volunteers determined that it wasn’t safe for Jocelyn to receive surgery: She was too underweight and showed signs of malnutrition.

“With nutrition, I always say, ‘If someone isn’t well nourished, a lot of things don’t go well,’” Dede said. “Making sure that someone is nutritionally adequate is a basis for good living.”

After Jocelyn was admitted for a five-day stay in the paediatric ward during the mission, Cynthia refused to leave her side.

Cynthia was thrilled to learn that Jocelyn had been enrolled into Operation Smile Ghana’s nutrition programme. But her excitement was short lived once she was told that Jocelyn had missed the first – and second – month of the programme.

Repeatedly, the Operation Smile Ghana team called Jocelyn’s home, using every resource they had to reach the family and make sure Jocelyn received the care she desperately needed.

Cynthia knew the kind of life Jocelyn could have if she received surgery. But she also suspected what her future held if her health didn’t improve and she wasn’t cleared for surgery.

Following numerous failed attempts at trying to convince Jocelyn’s father to bring her to the site of nutrition programme, Cynthia’s initial worries and fears about Jocelyn’s health and well-being were realised, and it became clear that she needed to step in.

Assured that Jocelyn wouldn’t go back into the care of her birth mother, the father agreed that Cynthia could have sole custody and become the person in charge of taking over Jocelyn’s care.

It was only after Cynthia offered to become Jocelyn’s primary guardian that her journey back to health – and to receiving free surgery on her cleft lip – truly began.

Photo: Zute Lightfoot.
Photo: Zute Lightfoot.

To help the overwhelming number of children suffering in the country, Operation Smile Ghana’s nutrition programme is conducted year-round in five regions across the country. The programme offers ongoing educational support and monthly intervention assessments to track patients’ development.

Ready-to-use therapeutic food (RUTF), a nutritive peanut paste; formula, and cereal mixes are given to patients whose nutritional deficiencies prevented them from passing their comprehensive health evaluation. Since 2015, Operation Smile has provided RUTF to malnourished patients living in the country. And today, during the COVID-19 pandemic, this support is critically needed. While surgeries are postponed, our team in Ghana is distributing RUTF to patients who need it so they can continue growing strong and healthy.

Dede Kwadjo speaks with Aba, mother of 11-month-old Moses, during screening for Operation Smile Ghana's first local mission in Koforidua. Photo: Zute Lightfoot.

For Dede, the individual education and empowerment consultations she offers to families are just as important as the care she delivers to the children.

“We train our mothers to use what they have to create nutritious food for their children. We ask what they have available: fish, beans, banana. Then, we work with them to create a practical solution, teaching them how to help their child,” Dede said.

Eleven-month-old Moses being fed by his mother, Aba, while waiting for patient announcement during an Operation Smile Ghana medical mission. Photo: Zute Lightfoot.
Eleven-month-old Moses being fed by his mother, Aba, while waiting for patient announcement during an Operation Smile Ghana medical mission. Photo: Zute Lightfoot.

Another one of Dede’s patients is Moses.

At the same 2017 local mission conducted by all Ghanaian volunteers, the 9-month-old arrived in dire need of nutritional intervention.

For Aba, Moses’ mother, the personalised counselling and support she received from Dede throughout the nutrition programme constantly motivated her to never give up.

Despite her son’s recurring respiratory infections and low weight, Aba remained committed to the programme and became more hopeful as she began to see positive changes in Moses’ health. It was her perseverance and empowerment from Dede that led to Moses passing his comprehensive health evaluation and receiving cleft lip surgery.

While malnutrition continues to prevent babies and children from undergoing surgery at the ideal time, support from mothers like Aba, education from volunteers like Dede and unrelenting commitment from loving people like Cynthia are forces that can change the course of a child’s future.

“If you can empower somebody with right choices to prevent the person lacking something as basic as getting the right food and the right proportion at the right time, that will go a long way actually help the person to have a better quality of life,” Dede said. “I’m so passionate about it.”

Moses and Aba after his cleft lip surgery. Photo: Zute Lightfoot.

A Born Fighter

Photo: Justin Weiler.

Energetic and talkative, Bui loved preschool.

As he bounced around the playground in his rural Vietnamese community, the 3-year-old paid no mind to his cleft lip while playing ball games and taking turns on the slide.

But whenever young tempers would inevitably flare, Bui’s classmates dealt him cruel reminders of his condition by calling him “sut,” a derogatory term describing someone born with a cleft lip. Bui would react angrily by fighting back, hitting his bullies until they stopped the name-calling.

Incredibly, young Bui never cried in the face of the taunting — a testament to the unconditional love and support of his family. When he was born; his mother, Ai, and father, Luyen, had never seen someone with a cleft lip. To them, it mattered little compared to the joy of welcoming their third child to the family. Ai’s midwife explained it was not unusual for a child to be born with a cleft lip and that surgery was possible to repair it.

While the local clinic provided support on how to feed Bui — he had no trouble breastfeeding, which can be difficult or impossible for many babies born with cleft lip and cleft palate — the family’s lack of financial resources made it impossible for them to afford surgery. Luyen and Ai are subsistence farmers, and the family lives off what they grow.

Photo: Zute Lightfoot.
Photo: Zute Lightfoot.

Their only option for Bui to access care was registering with the local government, which would inform them when a free surgical option became available.

The family was ecstatic when the government agency informed them that Operation Smile was conducting a medical mission in Hanoi — a 2 ½ hour bus ride from from their village. While Ai was unable to make the journey due to the recent birth of her fourth child; Luyen, his mother, My, and Bui’s uncle made the nerve-wracking trip to Hanoi with Bui — each person’s first time in a big city.

At the mission hospital, the family was surprised to see many other families with children like Bui and enjoyed sharing similar experiences in raising a child with a cleft condition. This hopeful atmosphere soon gave way to disappointment. Bui’s patient health screening — a critical step in ensuring safe surgical care for all Operation Smile patients — revealed Bui was running a fever. Considering Bui’s condition and the week’s surgery caseload, this health hazard meant surgery would not be possible until Operation Smile’s next medical mission returned to Hanoi in four months.

Ai, Luyen and Bui made the next trip together; completing the first leg on a motorbike before completing the 100-kilometre trip via bus. Now Ai experienced the anxiety of her first visit to Hanoi, compounded by the tension leading up to her son’s health screening.

Photo: Zute Lightfoot.
Photo: Zute Lightfoot.
Photo: Zute Lightfoot.
Photo: Zute Lightfoot.

This time, Bui was deemed healthy enough to undergo anaesthesia and received his life-changing surgery. His parents were unsure of how their family would react when they saw Bui’s new smile for the first time, but they were ecstatic as they made the journey home.

Photo: Margherita Mirabella.

Six months later, Ai said the family was overjoyed to witness Bui’s new smile, especially his two older sisters. She added that since his surgery, Bui’s overall health improved and that she can now understand him completely when he speaks.

After making a full recovery from his surgery, Bui returned to preschool, which he loves more than ever as a result of his new smile. While he and his friends may still get into the occasional scuffle as young children sometimes do, the bullying and teasing he once endured has come to an end.

As Ai reflected on Bui’s surgery, she said that she was so thankful to the Operation Smile medical volunteers and supporters who forever changed her son’s life.

Photo: Margherita Mirabella.