Celebrating the Year of Health and Care Workers

Operation Smile Nicaragua's local medical volunteers perform surgery on a patient at the care centre in Managua. The safe resumption of in-person care offers a glimpse into how medical programmes will be conducted in the COVID-19 era, informing the organisation on how to approach treating patients as conditions improve from country to country. Operation Smile photo.

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.

Throughout 2020, our world fought against an obstacle that threatened the lives and safety of people worldwide.

Throughout these times of uncertainty and fear, one factor has remained constant: the diligence of healthcare professionals on the front lines of a crisis that challenged health systems around the world.

In recognition of their dedication to providing care amid the COVID-19 pandemic, the World Health Organization (WHO) designated 2021 as the International Year of Health and Care Workers.

As a global organisation comprised of more than 6,000 medical volunteers, we’re honoured to recognise them and their talents as instrumental to the success of delivering high-quality surgical and comprehensive care to people in need.

For nearly four decades, Operation Smile has relied on the unwavering devotion of healthcare professionals including surgeons, nurses, anaesthesiologists, speech therapists, dentists and more to carry on our life-changing work.

Volunteer operating room nurse Redeat Wondemu during screening at a 2017 medical mission in Puebla, Mexico. For Red, being a part of Operation Smile goes beyond surgery. It’s a resolution for children born with cleft in low-resource countries to live happy and dignified lives. Photo: Jasmin Shah.

“The most rewarding part is that at the end of the day, I can go to sleep knowing I was able to help someone,” said volunteer nurse Redeat Wondemu. “For Operation Smile, it’s not just about making them comfortable. You’re completely changing their life, the way they grow up, and the way they’re accepted in their community.

“Whatever the role is, we do it with our whole heart. And I think that’s beautiful.”

Since March 2020, we’ve depended on them more than ever before.

Without the commitment of volunteers like Redeat to improve the health and dignity of children born with cleft conditions, we wouldn’t be where we are today.

Through these efforts, we’re proud to join the WHO in celebrating the world’s hardworking and passionate medical professionals.

Just as frontline doctors, nurses, technicians and other professionals continue to care for those in their communities, we will continue to reach and care for our patients despite the challenges presented by COVID-19.

In February 2021, Operation Smile Nicaragua carried out its first first local mission of the year, which delivered surgery to 10 patients who've been waiting for their new smiles. Operation Smile photo.

We’re continuing to work with local health leaders around the world to resume care safely at our centres and through medical missions.

After the successful completion of several missions conducted by teams of local medical volunteers in 2020, we’ve outlined a schedule of medical programmes planned to take place through June 2021.

Dr. Ruben Ayala, Operation Smile's chief medical officer, monitors a patient during a 2014 medical mission in Hanoi, Vietnam. Photo: Zute Lightfoot.

“We have watched dismayed, how the number of children needing treatment has increased during the pandemic,” said Dr. Ruben Ayala, Operation Smile’s chief medical officer. “Understanding the enormity of the challenge, we have pulled together our knowledge, people and resources. Our leaders around the world have laid out country-specific plans for adapting, evolving and creating environments where care can still be delivered safely.

“Cautiously, but optimistically, we carry on the work where possible, sending a clear message to our patients that, in spite of the pandemic, we have not abandoned them, and we never will.”

Regardless of how the pandemic slowed our care delivery on missions, our local teams continue to serve a role in the fight against the pandemic, displaying their commitment to changing the lives of patients in their home countries who still need them.

Marijose Kapunan and her husband, Rodney, have volunteered on more than 25 Operation Smile medical missions and are just two of thousands of our volunteers who are serving their communities during the pandemic. Photo courtesy of Rodney Kapunan.

Marijose Kapunan and her husband, Rodney, have volunteered on more than 25 Operation Smile medical missions and are just two of thousands of our volunteers who are serving their communities during the pandemic.

“We nurses are in the front, centre and back in the fight against this global pandemic,” said Marijose, an Operation Smile volunteer nurse and frontline healthcare worker in Jacksonville, Florida. “Nurses are valuable assets in formulating plans and processes to better manage the disease and prevent future outbreaks.”

Although medical missions were temporarily suspended in 2020, Operation Smile staff and volunteers around the world refused to stand aside in the face of adversity, devoting time and energy to providing care in any way they could.

We were forced to reevaluate our normal practices of delivering care in order to push forward and seek out new and innovative opportunities to reach the patients who need us.

A patient from Nicaragua receives a virtual follow-up speech therapy care consultation from Operation Smile volunteer speech therapist. Operation Smile photo.

Our organization began utilising technology to provide patients with virtual speech therapy and psychosocial consultations, essential aspects of a patient’s comprehensive cleft care.

It also provided virtual education and training opportunities for health workers in low- and middle-income countries so they could better fight the virus.

Volunteers and staff working in care centres throughout Latin America created an opportunity to come together and provide much-needed virtual care, ensuring that we kept our promise of caring for patients and their families amid lockdowns and country restrictions.

The lengths that our volunteers will go to serve patients underscores the calibre of people donating their skills and expertise to Operation Smile.

Longtime Operation Smile volunteer speech pathologist Milagros Rojas of Peru during a 2019 medical mission in Lima. She brings years of experience to our local Latin America teams. Photo: Margherita Mirabella.

“I want to give thanks to those who made this opportunity possible,” said volunteer speech pathologist Milagros Rojas. “COVID was not a limitation, because anything is possible when things are done with humanity and infinite love.”

Today, Operation Smile volunteers continue to risk their own safety to serve their communities as the pandemic persists.

We’re extremely proud to work with passionate, talented health and care workers who care deeply about the patients and families they serve, whether it’s halfway around the world or right there in their home communities.

Volunteer plastic surgeon Dr. David Orr, left, performs surgery as students observe during a 2014 surgical training rotation in Jimma, Ethiopia. Photo: Jorgen Hildebrandt.

We know that professionals in hospitals, care centres and clinics around the world will continue putting the health and safety of their patients first.

There couldn’t be a more fitting time to declare 2021 as the Year of Health and Care Workers.

“Operation Smile changed my life,” said volunteer Jackeline Nuñez del Prado. “I thank God for giving me the opportunity to be part of the foundation that I love with my life. I’ll always be grateful for being part of the magic of creating smiles in the lives of patients and in my life as well.”

Join us as we celebrate 2021 as the Year of Health and Care Workers. The compassion and commitment of our volunteers are what enable us to continue keeping our promise to patients amid the COVID-19 pandemic. Your support today means we can help children living with cleft conditions through these uncertain times and provide them with the care and surgery they deserve when it’s safe to resume our work.

Volunteer nurse Jackeline Nunez del Prado of Bolivia screening a patient during a March 2020 medical mission in Oujda, Morocco. Photo: Jasmin Shah.

Meet our patients: Nicaragua

Jimena, 11 months old, received her new smile during Operation Smile Nicaragua's first medical mission of 2021. Operation Smile photo.

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.

Marling arrived at Operation Smile Nicaragua’s first local medical mission of 2021 with her 11-month-old daughter, Jimena.

As Jimena went through the screening process, Marling was cautious but tried to remain hopeful.

This wasn’t the first Operation Smile mission Jimena and Marling had attended.

Even from the beginning, the journey toward a new smile for Jimena was long and often filled with heartache and disappointment.

None of Marling’s prenatal check-ups indicated that she should be concerned with the development of her baby.

It wasn’t until Jimena was born that everything changed for Marling.

“When my little girl was born, the doctors told me she had cleft lip,” said Marling, thinking back on the day. “This was unexpected. But they said there was a foundation that provided free surgeries for children with this type of condition.”

Marling’s doctors were talking about Operation Smile Nicaragua.

Two months after Jimena was born, Marling travelled to Operation Smile Nicaragua’s care centre. But at that time, the COVID-19 pandemic had already hit the country hard.

“I got to the centre, and I was told it was closed,” Marling said. “I only wanted information about my daughter’s condition.”

Despite the centre’s temporary closure, the local volunteer team knew there were patients like Jimena who still needed care.

The courageous volunteers and staff created opportunities to ensure that they could still reach patients and families even though they were physically apart.

“They offered me the option of virtual consults,” Marling said.

The medical volunteer team followed up with Jimena and her family digitally until the day when it was deemed safe to resume in-person consultations.

“I felt welcomed when I visited the centre,” Marling said. “The doctors gave great service and gave my daughter a small disk that helped her for feeding.”

With this additional care, Jimena’s health continued to improve while her mother’s hope grew stronger.

Following strict health guidelines and safety protocols, Operation Smile Nicaragua announced that it would host a small-scale local mission in October 2020.

After learning that Jimena was a candidate for receiving surgery during that mission, Marling didn’t hesitate to make the journey.

However, an unforeseen health issue arose on the day of Jimena’s surgery that prevented the volunteer medical team from going through with the operation.

But even after Jimena’s surgery was cancelled, Marling didn’t lose hope that her daughter’s smile would one day be healed.

In December 2020, it appeared that Jimena’s second chance was within her grasp.

But surgery evaded Jimena once again.

After contracting a fever, she and Marling were informed by medical volunteers that undergoing surgery was too unsafe. Jimena’s family returned home disappointed but more determined than ever.

Jimena is ready to enter the operating room during Operation Smile Nicaragua's local 2021 medical mission in Managua. Operation Smile photo.

With her mother’s support and perseverance, Jimena arrived at Operation Smile Nicaragua’s first local mission of 2021.

After a comprehensive health evaluation, nothing stood in the way of Jimena and her brighter future.

She became one of 10 patients to undergo their long-awaited surgeries during the February mission.

“I feel happy because my daughter received her first surgery,” Marling said. “I thank those involved that made my daughter’s smile possible.”

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

In February 2021, Operation Smile Nicaragua carried out its first first local mission of the year, which delivered surgery to 10 patients who've been waiting for their new smiles. Operation Smile photo.

Speech therapy programme “HablemOS” helps thousands across Latin America

Operation Smile Nicaragua's care centre in Managua was the first centre to reopen its doors to patients amid the pandemic and began providing a mix of in-person and virtual consultations. Photo: Operation Smile Nicaragua.

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.

Despite the unprecedented challenges the COVID-19 pandemic brought to our medical programmes and care delivery, we’ve refused to stand aside in the face of this adversity.  

Volunteers and staff working in care centres throughout Latin America found an opportunity to come together to make sure that we kept our promise of caring for patients and their families amid lockdowns and country restrictions.

For patients born with cleft lip and cleft palate, speech therapy before and after surgery is an essential component of comprehensive cleft care.

Most of this ongoing work was done in person with patients at centers, but with the impact of the pandemic hitting countries worldwide, providing this care suddenly became impossible.

Operation Smile Regional Director Lizet Campos. Photo: Jasmin Shah.

Working closely with her fellow regional directors, Operation Smile Regional Director Lizet Campos created the concept of the programme called “HablemOS,” a play on words meaning “let’s talk” in Spanish with the capitalised “OS” at the end of the word symbolising Operation Smile.

Cleft conditions can make eating extremely difficult, so speech therapists oftentimes conduct consultations soon after a child is born, providing families with advice on how to properly feed their child.

Hundreds of patients have received speech consultations at care centres in Managua, Nicaragua; Asunción, Paraguay; Bogota, Colombia; and Caracas, Venezuela. Photo: Rohanna Mertens.

Speech therapists also provide patients with palate-strengthening exercises before surgery that help improve the procedure’s outcome. As a child grows and begins to speak, their ongoing care helps patients be able to speak more clearly.

In collaboration with our medical oversight team, speech council, programme manager Mauricio Rojas of Mexico and programme coordinator Maria Cristina Galindez of Venezuela, Lizet and her team implemented HablemOS in mid-August of this year.

With the support of Operation Smile Sweden and generosity of the Swedish Postcode Lottery, Lizet and her team have a fully funded programme that they hope will show patients and their families that Operation Smile remains committed to them despite the current global challenges.

“So far, the programme is proving to be a resounding success,” Lizet said. “To date, our teams in Latin America have delivered speech consultations to more than 3,200 patients. There’s also an in-person component, as 629 of the consultations were given at our care centres in Managua, Nicaragua; Asunción, Paraguay; Bogota, Colombia; and Caracas, Venezuela, though this continues to be conducted on a much more limited basis than the virtual therapy sessions.”

Volunteers and staff feel inspired by the deepening of the organisation’s investment in speech therapy, which is critical to helping our patients live dignified and fulfilling lives.

Longtime Operation Smile volunteer speech pathologist Milagros Rojas of Peru during a 2019 medical mission in Lima. She brings years of experience to our local Latin America teams. Photo: Margherita Mirabella.

The HablemOS team is honoured to lead the way in developing a programme that has the potential to be replicated and implemented everywhere that Operation Smile works.

“Just imagine, in these sessions, through songs and stories, we can make our little ones exercise their speech abilities and keep them from finding it tedious,” said volunteer speech pathologist Milagros Rojas. “Instead, these sessions turn into play sessions.”

Knowing that many patients’ families had access to either internet-connected smartphones or computers, speech therapists were contacting families and resuming or beginning virtual consultations within weeks for hundreds of patients while the doors of the centres remained closed to the public.

If families lacked internet access, therapies were delivered over the telephone as well.

With a lack of certified speech therapists like Milena Cleves in Latin America, the HablemOS program provides opportunities to increase the number of qualified therapists in the region. Photo: Marc Ascher.

“There’s a lack of certified speech therapists throughout the Latin America region and in many other low- and middle-income countries,” Lizet said. “So we knew it would be critical to offer training and education opportunities to speech therapy providers so that more – and more qualified – therapists can deliver care to more patients.”

Working together with the Mexican speech and language therapy non-profit Hablarte E Integrate, the training and education portion of the programme has enrolled 61 speech therapists from 13 Latin American countries.

“Although we’re professionals, we can always grow in knowledge,” said Operation Smile Panama volunteer speech therapist Alina Navarro. “I’m delighted to be acquiring a new perspective. In terms of mentoring, it’s been useful to discuss the cases together with other professionals.”

The HablemOS programme team feels driven to keep delivering much-needed speech therapy care to patients as the world continues to cope with the effects of COVID-19.

“I want to give thanks to those who made this opportunity possible,” Milagros said. “COVID was not a limitation, because anything is possible when things are done with humanity and infinite love.”

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

HablemOS team member and programme manager Mauricio Rojas, left, shares a special moment with Jonathan during a 2019 medical mission in Mexico. Photo: Rohanna Mertens.

“Some Day” Finally Arrives for Seth

Seth, before surgery. Photo: Margherita Mirabella.

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

In Ghana, a country known for having deeply rooted and widespread social stigma surrounding cleft conditions, many people like Seth endure lives filled with pain.

Constantly living in isolation and being fearful of harassment from members of their communities, some people affected by cleft grow up feeling hopeless and unworthy of love or happiness.

Lacking awareness of the cause of cleft conditions, people in Seth’s community often insulted him. In school, he struggled to make friends and would often choose to skip break time with hopes of avoiding the harmful treatment from some of his classmates.

Throughout his childhood, Seth frequently asked his mother, “Why am I like this?”

Born with a cleft lip in rural Ghana, neither Seth nor his mother knew that there were organisations like Operation Smile devoted to helping people like Seth.

The years following his childhood were full of dark times for Seth.

Believing that being alone was his only escape from the insults and abuse, Seth isolated himself, which deepened his self-doubt and unhappiness.

Seth shared that the worst part of living with an unrepaired cleft condition was looking into a mirror because he said it reminded him that he was “not complete.”

To him, this meant he’d never have a fulfilling life.

Seth spent years battling depression, often asking God to forgive him for whatever it was that he believed he’d done wrong and to heal his smile.

There were even instances throughout his life that Seth considered suicide. But in those moments, he reminded himself of his mum, who continually reassured him that they’d one day meet someone who will help him.

Seth waited 34 years for that day to arrive.

The course of Seth’s life changed in March of 2015 when he saw a flyer for Operation Smile Ghana.

Patient coordinator Clement Ofosuhemeng carries Operation Smile Ghana posters as he travels throughout remote villages recruiting patients and raising awareness for the organisation. Photo: Zute Lightfoot.

Marvelling at the before and after pictures of others born with cleft conditions like him, he realised that a solution was possible, and it gave him a renewed hope that his “someday” may come soon.

There was an upcoming medical mission in Cape Coast. It was a long 10-hour journey from his home, but everything he experienced leading up to that moment made him determined to go.

After hours of travelling, he finally reached what he hoped was the beginning of his new life.

But there were hundreds of potential patients living with cleft conditions who attended the mission, all seeking life-changing surgery.

During a 2018 medical mission in Ghana, families of patients gather at the patient shelter on the second day of surgery. Photo: Zute Lightfoot.

Unfortunately, due to the high demand for cleft care in Ghana, Seth was not placed on the surgical schedule at that time. There were too many patients in need.

Seth was devastated, but he refused to give up.

While he knew it wasn’t his turn yet, Seth also knew he was getting closer to his day and said that he believed God would find him another opportunity to get the surgery he deserved.

A few months later, Seth received a phone call from Operation Smile Ghana telling him about another mission in Ho.

The mission site was a little more than two hours from his home. So, once again, he bravely travelled away from his community, hopeful of finally receiving his transformative surgery that he’d waited on for 34 years.

Once Operation Smile medical volunteers deemed him healthy enough for surgery following his comprehensive health evaluation, Seth nervously waited to hear his name announced.

That day, when Seth was told he’d be receiving his new smile, he felt in his heart that the hardships he endured were coming to an end. Finally, Seth could be truly happy.

“I’m not worried because I know everything will be okay,” Seth said. “I will be able to go everywhere with confidence.”

Seth smiles wide alongside his friend. Photo: Margherita Mirabella.

After returning home, Seth felt inspired by Operation Smile’s work in Ghana and wanted to be a part of it.

He hopes to become an advocate for the organisation and share his experience with others to help recruit more patients in need.

With his new smile, Seth gained confidence to chase after his dream.

“Before my surgery I never wanted to talk to people, now I am happy to talk to everyone,” he said. “I’m now in school to learn how to become a pastor. Before my surgery, I would never ever have considered becoming a pastor.”

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

Seth, after surgery. Photo: Margherita Mirabella.

Ensuring Healthier Lives Through Nutrition: Q&A with Charlotte Steppling

Operation Smile's nutrition programme manager Charlotte Steppling. Photo: Rohanna Mertens.

As our nutrition programme manager, Charlotte Steppling has seen first-hand how lacking proper knowledge and guidance on nutrition can have a devastating impact.  

Years ago, while aiding patient recruitment efforts for Operation Smile medical missions, Charlotte came to a startling realisation.

“We were turning away patients suffering from malnutrition,” she said. “I was waiting to see these kids show up at the next mission, but they just weren’t coming back. They were dying, and it broke my heart.”

Children born with cleft conditions often face major challenges with feeding and receiving proper nourishment during the critical months after they’re born. These factors can lead to malnutrition, delays in growth and development and sometimes even death.

“What if we had come in contact with them earlier or what if we had a strong programme through Operation Smile Madagascar a year prior?” Charlotte often asked herself.

Operation Smile knew that in order to uphold its promise of delivering high-quality, safe surgical care to as many patients as possible, nutrition needed to become a priority.

Due to the compassionate individuals like Charlotte who’re devoted to helping bring nutritional support to the forefront, specialised programmes have been established in 24 countries including Madagascar, India, Ghana and Guatemala, where more patients’ lives are being saved through timely intervention and dietary education.

“We need to reach these patients as early as possible,” she said. “Whenever a patient is born with cleft, they should know that Operation Smile exists.”

We recently spoke with Charlotte to learn more about the future of Operation Smile nutrition programmes as well as why it’s crucial for children living with cleft to be well-nourished before they can receive surgery.

Charlotte speaks to participants in the feeding programme at the patient shelter during a 2018 Operation Smile medical mission in Antsirabe. Patients who aren't chosen for surgery because they're underweight or malnourished are invited to join the feeding programme. For three days, parents and children attend educational workshops about hygiene, health and nutrition. Photo: Rohanna Mertens.

Q: Charlotte, can you tell us a little bit more about how you found yourself in this role as Operation Smile’s nutrition programme manager?

A: “I arrived in Madagascar in 2013 to serve as a Peace Corps volunteer. In the village where I lived, I came across numerous children and adults living with untreated cleft lip and cleft palate. I realised there were numerous barriers to care including the lack of knowledge of and access to medical care. They were unaware of the opportunity to receive care and the potential to be evaluated by a medical team with the hopes of receiving free surgery. The idea was unfathomable to them: ‘Free surgery? Free care?’ As I explained to the potential patients, I spoke about Operation Smile and gained their trust, we travelled to the capital city, Antananarivo, and met the Operation Smile team.

“After three years of service with the Peace Corps and throughout three years spent recruiting more than 70 patients from a remote village in Madagascar, the local foundation offered me an opportunity to join their team. I was based in Antsirabe, a central highlands city and worked at the local hospital Operation Smile had partnered with.

“Here in Madagascar, there’s less than one physician – 0.18 actually – for every 1,000 people, which makes access to healthcare challenging. Nutritionists are a rarity. Antsirabe is located in a region that has a stunning rate of malnutrition at 65%, the highest rate in Madagascar. Interestingly, this region is also a prominent agriculture hub and the main producer of vegetables and cattle.

“It’s hard to make a child gain weight, and it’s really challenging when you are dealing with a ton of different variables. I believe increasing knowledge around nutrition, around the first 1,000 days of life, around healthy habits and adopting a hygienic environment, is essential.”

Children playing outside of the nutrition centre (unaffiliated with Operation Smile) Charlotte established to help patients and families overcome barriers to care. Photo: Zute Lightfoot.

“This motivation to make change, to make a difference in the lives of the most vulnerable, propelled me to open a non-profit to fundraise a nutrition centre in Antsirabe. We opened this nutrition centre (unaffiliated with Operation Smile) in 2017 and offered care to patients living with cleft conditions and those living without them. I could not stand to not make a difference. I could not sit back and not act.

“At Operation Smile in Madagascar, we decided to build a nutrition programme to cater to patients suffering from malnutrition. The programme paralleled the medical mission timeline, and we asked patients who were assessed as malnourished to stay at the patient village for a couple days.

“We built a programme based on education around breastfeeding, the promotion of healthy foods and nutrition, and the importance of water, sanitation and hygiene. We used in action activities to teach and empower families on how to adopt healthy behaviours that could make a lasting change in the lives of their children. We provided our patients and their families with donations of ready-to-use-therapeutic food (RUTF) and breast milk substitutes.

“Through follow ups, we noticed weight gain. Through interviews, we identified changes in the behaviour of caregivers. We were thrilled to see patients that were following the nutrition programmes were coming back for medical screening and cleared for surgery. I fully believe that, currently seeing the status of the world, we have the due diligence and the need to intervene on a nutritional level as an organisation.”

At the patient shelter, participants in the feeding program listen as Charlotte talks about the importance to food diversification, nutrition and breastfeeding techniques. Photo: Rohanna Mertens.

Q: Tell us why adequate nutrition is so critical for children who are born with cleft conditions?  

A: “To receive surgery, you need to be at a healthy nutritional status. At Operation Smile, we have very high standards around who is cleared for surgery. All of our patients are candidates but being cleared for surgery is a very different topic. You have a lot of parents who are feeding them whatever they can, whether that’s watered-down rice water, condensed milk mixed with water or some type of porridge or stew.

“Then you have babies who’re having challenges latching or mothers who are having challenges breastfeeding. That’s where Operation Smile is focusing on prioritising mother’s milk as the first intervention. Mother’s milk is free and full of nutrients, so if we can somehow get mother’s milk to the baby, then that is the best option.

“Then you have babies who are essentially dealing with malnutrition because, a lot of times, the parents aren’t aware of nutritional diversification and food diversification. So, we teach them about food that’s accessible, available and affordable to the patient’s family.

“We work with communities through our local teams to figure out what is available, then think about innovative ways to include high-protein density foods and provide a balanced diet so that patients are well-fed and well-nourished. The patients’ caregivers are also well-educated and feel empowered that they can provide for their children.”

Charlotte watches as 12-year-old Frederic sees his mother, Celestine, for the first time after surgery. Photo: Zute Lightfoot.

Q: Is there a moment or a specific patient who really illustrates why you’re passionate about this?

A: “There was a patient with a bilateral cleft lip and cleft palate. He was maybe 4 months old when he first came to our medical mission. I had met his mother, and she was doing everything she could for her little boy. She was having challenges breastfeeding him because she was no longer producing milk and during the early months didn’t have the opportunity to receive counselling on relactation techniques. The baby was very hungry.

“At that time, I had opened up the nutrition centre, and she was one of its first members. Her son was part of the programme, and he was receiving RUTF through Operation Smile and breast milk substitutes as well. His mum also received meals, because it was apparent that she was having difficulties feeding herself.

“Then one day, he wasn’t feeling good. We brought him to the hospital in Antsirabe, and he was put in the paediatric ward, monitored over two days. His system just let go, and he didn’t make it.

“I often keep him and his mum in my thoughts when I design programmes. What if we had come in contact with them earlier? What if we had a strong programme a year prior to him being born? He could have come into the programme, and we could have intervened earlier and made a difference in his life. I never want another mum to feel that way or deal with the death of a child due to malnutrition when that’s something we can help with.”

Q: What’s happening right now with regard to nutrition programming that you’re most excited about?

A: “It’s an exciting time for nutrition and Operation Smile’s comprehensive care programmes. Currently, our team is working on building a resource library for our programme countries to feel more supported when it comes to building and designing nutrition programmes. We’re also creating a curriculum for training, having a credentialing pathway for nutrition volunteers and building training sessions for community health workers and caregivers. Working closely with our local teams, we’re striving to ensure that the information is country- and culture-specific based on what food groups are available and what recommendations they would like to make about nutrition and feeding.

“We’re also finalising a comprehensive nutritional assessment that will assess the nutritional status of a patient suffering from malnutrition and building a platform to track their progress. This assessment will allow the nutritionist in country or nutrition volunteer to properly provide the necessary prescription of care for the patient.”

Photo: Zute Lightfoot.

Q: Could you tell us a little bit more about your vision for the future? What are the main challenges in light of the pandemic? What’s the potential that we can see through these programmes?

A: “With the current pandemic, we are looking into innovative ways to run our programmes virtually. In countries where our patients live in extremely remote locations with no access to electricity, we are finding solutions on how to reach patients as early as possible. In Madagascar, we use patient advocates. We train community members to deliver messages around nutrition and feeding, water, sanitation and hygiene to get as close as we can to the patient in a trusted manner.

“When I look at a long-term vision for nutrition programmes for Operation Smile, I believe nutrition interventions and activities are going to take a forefront for a lot of our countries. COVID-19 has had a significant impact on childhood malnutrition and nutrition-related mortality. It’s had a detrimental impact on the general population, but the effect it’s having on people affected by cleft, who already have challenges feeding, is even more substantial.

“We need to act now. This is our time as an organisation to step in and make a change in the lives of our patients, in some ways saving their lives, providing them hope, and supporting them in these extremely difficult times.”

Photo: Rohanna Mertens.

From loneliness to acceptance

Justin, 53 years old. Photo: Rohanna Mertens

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

When he returned home, Justin was met with kindness and acceptance from members of his community for the first time in his life.

This was a sharp contrast to how many people in his village treated him before he received surgery from Operation Smile Madagascar to repair his cleft lip.

At 53 years old, Justin had spent his life feeling abandoned and alone because of his appearance.

His only son didn’t want to be seen with his father, and his wife left him due to the stigma associated with his unrepaired cleft lip.

The years of being called names like “sima,” a derogatory term meaning cleft lip, had caused Justin to become shy.

Then one day, Justin saw a poster for Operation Smile Madagascar in his village hall with pictures of patients before and after surgery.

That was the first time Justin had seen another person who looked like him, and the first time he saw someone whose cleft lip had been repaired.

While the thought of having his smile repaired was exciting, Justin also knew he would have to take a chance and travel somewhere far from his home.

But after speaking with a local health worker, Justin mustered up the courage to attend an upcoming Operation Smile medical mission.

He made the long 24-hour journey with his niece, Rasoa, and a large group of other families from the Ifanadiana area. None of them knew for certain if they would receive surgery once arriving in Antsirabe, but they felt hopeful for the possibility of a new beginning.

Patients from across Madagascar arrive for screening during a medical mission in Antsirabe. Photo: Rohanna Mertens.

Arriving at the mission site, Justin was shocked after witnessing the scene before him: There were hundreds of people who looked like him.

Rasoa carefully documented Justin’s entire cleft care process.

Taking photos every step of the way, Rasoa, without even realising it, was creating a record of events that would one day have the potential to change the lives of more people like her uncle.

After undergoing his comprehensive health evaluation, Operation Smile medical volunteers deemed that Justin was healthy enough to receive surgery.

He shared with volunteers that he wasn’t nervous going into the operating room. He simply felt anticipation to see the change in his appearance after the procedure.

Rasoa was thrilled to call her mother, Justin’s sister, and tell her the surgery was a success.

When Justin saw his new smile for the first time, he was delighted with the result.

“Thank you for caring for me,” he said to the Operation Smile team.

After surgery, Justin smiles wide beside his niece, Rasoa, who remained by his side throughout his journey. Photo: Rohanna Mertens.

Returning home, he no longer felt the need to cover his mouth when talking to people or hide from interactions with others.

Even those who’d abandoned him in the past were willing to reconcile and join him in celebration of his life-changing surgery.

His once estranged 26-year-old son reunited with him.

Even his ex-wife, who left him because of his cleft condition, wanted to reconcile and try again at their marriage, but he declined. Justin said that he would rather start a relationship with someone new.

Today, Justin hopes to help more people like him.

With the photos Rasoa took during the medical mission, he can do just that.

“We want to help Operation Smile Madagascar find more patients,” Rasoa said. “We have photos, so we can explain what happens at the mission.”

Justin now happily lives his life as a subsistence farmer and refuses to let his cleft condition define him any longer.

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

Justin, after surgery. Photo: Rohanna Mertens.

Going the extra Miles for Smiles: Madagascar nutrition programme

Held by his mother, Patricia, 14-month-old Icardi sips formula from a bottle. Photo: Henitsoa Rafalia.

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.

Vololona leads a team of volunteers through a crowded neighbourhood, passing worn houses before stopping to knock on a metal door.

After a moment’s pause, Patricia appears holding her son, Icardi, who’s feeding from a bottle.

With relief in her voice, she says to the volunteers, “We’re so glad to see you. This is one of the last bottles we can prepare with the baby’s formula left.”

Amid the lockdowns and restrictions, Patricia and Vololona, Icardi’s grandmother, have tried to support their family.

Vololona sells small supplies to schools and churches while Patricia makes deliveries of steels rods in the community.

But with orders not coming in, and schools and churches closed, they’ve struggled to make ends meet.

“Baby formula is expensive, but we’ve somehow always managed to buy it, since Icardi needs it to grow,” Vololona explains. “But since the lockdown, we’ve not been able to put money aside to buy formula.”

Photo: Henitsoa Rafalia.

Throughout the COVID-19 pandemic, this has become the reality for many patients and their families around the world as they attempt to provide for their loved ones amid country-wide lockdowns and restrictions.

With the inception of the Extra S’Miles nutrition programme, our local teams in Madagascar are quite literally going the extra mile for families with hopes of minimising the hardships caused by the pandemic.

“Shortly after the state of health emergency was declared and lockdown measures were put in place, our patients became extremely vulnerable,” said Dr. Howard Niarison, Extra S’Miles Programme Coordinator. “We had to take action, even if that meant braving the virus and the miles that separate them from us.”

Photo: Henitsoa Rafalia.

The programme not only helps patients continue their nutrition treatment prescribed by medical volunteers prior to the pandemic, but also assist families living in regions where lockdown measures have made it nearly impossible to meet basic nutritional needs.

Malnutrition remains one of the most significant obstacles to receiving care due to an increased risk of complications during surgery. Without timely medical intervention, patients like Icardi can face major health issues as they are more vulnerable to illness, malnutrition and even death.

The Extra S’Miles team spanned nearly two thousand miles, travelling across the country of Madagascar to deliver nutritional packs to patients living in the regions hit hardest by the virus.

Within the packs provided to families are necessary supplies and hygiene products including food, soap, washable masks, hand sanitiser, ready-to-use therapeutic food (RUTF) and more.

Member of the Operation Smile Madagascar's Extra S'Miles nutrition programme team giving ready-to-use therapeutic food (RUTF) to a patient. Photo: Henitsoa Rafalia.

In addition to the nutritional packs, the Extra S’Miles programme enabled the team to check-in on the health of patients, reassure families that Operation Smile remained devoted to their well-being despite the cancellations of medical missions and provide counsel advice on how to remain healthy until the resumption of care.

Photo: Henitsoa Rafalia.

“It’s during difficult times that you know who your real friends are,” said José Augustin, patient coordinator for Operation Smile in Madagascar. “This health crisis is certainly a difficult time for our patients. Because we care for them, we’ll reach out to them since they can’t come to us.”

More than 530 families received the Extra S’Miles nutritional packs thanks to the dedicated team members who refused to let the pandemic prevent them from seeing smiles on the faces of patients in need.

Operation Smile Madagascar patient Coordinator Jose Augustin shares a smile with a patient. Photo: Henitsoa Rafalia.

With tears in her eyes, Patricia happily accepts the nutritional pack and the six cans of baby formula the Extra S’Miles team offers her.

Raising Icardi has been a long and difficult journey for Patricia and Vololona.

Despite their unconditional love for both Icardi and his older sister, they’ve faced seemingly insurmountable barriers in their attempts to care for a child living with a cleft condition.

Icardi’s father left shortly after his premature birth, unable to handle the stress of a baby born with cleft lip.

Smile Photo: Henitsoa Rafalia.

Many families like Icardi’s joined Operation Smile Madagascar’s nutrition programme with the hope of a new beginning.

The programme provides patients and families with educational support, ongoing health assessments and RUTF, a nutritive peanut paste that helps malnourished children gain enough weight to become healthy enough for safe surgery.

“Icardi is a survivor,” Vololona said. “That’s in part thanks to all the counsel and help we’ve received from Operation Smile. With this health crisis, Operation Smile has not forgotten him, nor us. We’re extremely grateful.”

Today, the Operation Smile Madagascar team remains steadfast in their commitment to the health and wellbeing of patients.

Through their continuous efforts to provide nutritional support, 62 patients were enrolled in the organisation’s nutrition programme as of October 2020. Of that total, 47 children reached an optimal weight with 13 more making significant progress along their journey to becoming healthy enough to receive safe surgery.

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

Roman waited 19 years for his new life to start

Photo: Rohanna Mertens.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Photo: Rohanna Mertens.

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

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

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

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

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

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

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

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

Roman, after surgery. Photo: Rohanna Mertens.

After 35 years, Tereza is finally free

Tereza, 35 years old. Photo: Margherita Mirabella.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Tereza, after surgery. Photo: Margherita Mirabella.

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

Now, her life is very different.

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

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

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

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

Photo: Margherita Mirabella.

From patient to patient advocate

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

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

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

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

From then onward, we became friends.

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

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

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

– John, Operation Smile patient advocate in Malawi

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

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

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

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

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

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

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

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