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.

A Frontline Hero: Remembering Nurse Carlos Armas

Volunteer nurse Carlos Armas screens a patient during a 2015 Operation Smile medical mission in the Dominican Republic. Photo: Marc Ascher.
Volunteer nurse Carlos Armas screens a patient during a 2015 Operation Smile medical mission in the Dominican Republic. Photo: Marc Ascher.

Serving as one of Operation Smile Peru’s most beloved and admired volunteer nurses, Carlos Armas leaves behind a powerful legacy etched in the hearts and minds of those who knew him.

It is with great sadness that, on June 29, we learned Carlos lost his battle with COVID-19 after bravely fighting on the front lines of the pandemic. He was 63.

His commitment to patients was deeply ingrained in his spirit of wanting to care for people in need.

“Carlitos will always teach us about passion and selfless devotion to others in need.”

Silvana Espinoza, Volunteer Patient Imaging Technician for Operation Smile Peru

Despite knowing the risks, Carlos proudly led a team of selfless medical professionals and delivered much-needed care to people impacted by the coronavirus in his country.

“I still remember my last conversation with Carlitos,” said Anyela Quintanilla, Programs and Student Clubs Manager for Operation Smile Peru. “He said that they told him he could take leave because he was part of the high-risk group, but he refused to stay home. He decided to work at his hospital’s COVID area, passionately and lovingly caring for his patients.”

Motivated to help others at a young age, Carlos began his career as a nurse technician when he was 20 years old. But deep down, he always aspired to do more in his field.

Years later, after incredible determination and effort, Carlos graduated from Universidad Ricardo Palma at the age of 50 with a degree in nursing.

With pride, he would say, “I am Licentiate Carlos Armas,” a term meaning “graduate.”

Carlos with a patient during a 2018 medical mission in Lima, Peru. Photo: Margherita Mirabella.

After becoming a pre- and post-operative nurse for Operation Smile Peru in 2008, Carlos constantly demonstrated how much he loved being a volunteer and how helping people was his greatest passion.

When the pandemic first impacted his country and his people, Carlos was fiercely determined to care for patients – even if that meant sacrificing his own health and safety.

“I’m a nurse who has started from the bottom,” Carlos said to people who asked him why he accepted the position on the COVID-19 response team. “I’m not afraid.”

Carlos wasn’t the kind of person to stand by and watch as people suffered. His selflessness shined, not only with Operation Smile Peru, but wherever he felt that he could make a difference.

“This is a great loss to Operation Smile Peru’s family. You worked with us until the end. You could have stayed home. Yet you decided to stay and continue working. You wanted to be a part of this fight.”

– Maribel Obeso, Volunteer pre- and post-operative nurse for Operation Smile Peru

In addition to the COVID-19 pandemic, Carlos provided his services to care for families affected by the 1991 cholera outbreak and devastating earthquake that hit Pisco, Peru, in 2007.

Even in the face of adversity during his time on the front lines, Carlos refused to lose hope.

“Our patients are going back home walking now,” Carlos had shared with his team. “Things are getting better.”

On a medical mission in Lima, Peru, Carlos performs a comprehensive health evaluation on 3-month-old Gael during screening day. Photo: Margherita Mirabella.

People were drawn to Carlos’ optimism and kindness, not only on the front lines but during every Operation Smile medical mission.

“They say that friends are those who stick with you through the ups and downs. And under these circumstances, you’ve become part of our family. My dad will always be in our memories.”

– Karla Armas Moreno, Carlos Armas’ daughter

While Carlos is no longer with us to help create new smiles, his impact lives on through his friends, family and patients who were touched by his commitment and enthusiasm to do what was right.

Carlos and volunteer Nidia Ruiz during a 2015 Operation Smile medical mission in Puebla, Mexico. Photo: Marc Ascher.

EMEA Recruitment podcast with Dr Phil McDonald

We are thrilled to launch our new partnership with EMEA Recruitment. Starting with a special podcast episode featuring Co-Founder of Operation Smile UK and UK Medical Volunteer Dr Phil McDonald hosted by CEO of EMEA Recruitment Paul Toms. In this episode we will learn more about Dr Phil’s commitment and also about Paul’s personal connection with cleft and the reason he chose to collaborate with us.

Transcript

Paul Toms: Morning Phil, great to see you today. How are you?

Phil McDonald: Very well thanks, very well. Down in sunny Chichester.

Paul: I was going to say, what part of the world do we find you in? I guess with the current situation [COVID-19 pandemic], the travel has been a bit reduced recently, hasn’t it?

Phil: Yeah, so I’m spending most of my time in Chichester – there can be a lot of worse places to be, so we’re very happy here actually.

Paul: I really appreciate you spending the time with us today, because I know how busy you are, and I think it’s a great opportunity to take the time to speak with you.

As I mentioned in the introduction, clearly the work that Operation Smile does is very close to my heart, so it’s great to have you on the podcast today, and it’s hopefully an inspirational piece for me and for the listeners.

Obviously, in terms of the background, I know you’re the Co-Founder of Operation Smile UK, and it’s a charity that’s been running for 18 years now. So I thought as a general summary to start off with, if you’d be able to tell us a bit more about how the charity was founded and your role within the organisation, that could be a good starting point to kickstart off.

Phil: Well I first started volunteering with Operation Smile back in 1995, which is 25 years ago now, and there were very few volunteers in the UK.

In 1999, I was called totally out of the blue by a journalist from The Guardian called Tim Radford. He was writing an article about Operation Smile in The Guardian and he asked me a couple of questions, I gave a couple of quotes, and in this article – a lovely half-page article – it basically said, ‘Dr. Phil McDonald, Consultant Anaesthetist from Chichester, said…’ and there was some quote from me.

The day the article went out, I was contacted by quite a significant number of companies – film companies – wanting to do documentaries. There I was, I was a simple doctor in Chichester, and all these companies wanted to suddenly do a documentary. Fortunately, we ended up going with the BBC, and did this documentary called The Facemakers, which was filming a mission and following some patients in Davao in the Philippines. It was a lovely, 50-minute documentary, which went out prime time on BBC One in 2000.

Now, because of that, it obviously generated a lot of interest in this country about Operation Smile, and so we thought, well we need to set up a charity in this country so that we can raise funds and get more volunteers. So I was introduced to a few financial entrepreneurs and we had our first meeting in London – I remember it to this day – in the Royal Ocean Racing Club, where I met all these financial entrepreneurs, people in a totally different business to me, and we decided to set up the charity and eventually it became registered in 2002.

And, since 2002 till now – that’s 18 years – we’ve raised over £35m, which is quite incredible really, because, back in 2002, we had an office, which was leant to us by Netdecisions, we had one employee. Now we have 19 employees and an office in London. As I say, I’m very proud, as a Trustee for 18 years and also Medical Director for 18 years, we’ve raised all that money over that time.

Paul: It’s a huge achievement, as you say, it’s something you must be very proud of. In terms of the reasons why you did it in the first place, was there something that was close to your heart, as to why you wanted to do this right at the beginning? Was there something really driving you on to do that, because I suppose there’s a number of ways you could have taken your skills and a number of causes you could have helped, so is there a specific reason why it was the Operation Smile route that you went down?

Phil: It did all start as a bit of an accident, because when I started working with Operation Smile, I was working in Adelaide in the Children’s Hospital in 1995, and it literally was a total accident. There I was as a senior anaesthetic trainee in the coffee room, and one of my colleagues, a consultant, came in and said, ‘I’m meant to be going away with Operation Smile in two weeks’ time, but for family reasons I can’t go, can anyone else go?’ and I thought, put my hand up, two weeks in Bogota seemed like a good idea and I went.

And I suppose from that moment of seeing the difference that we made on a two-week medical mission with Operation Smile, all the children’s lives we changed – we operated on about 200 children that  medical mission – it just seemed such a valuable type of organisation. Obviously, there’s a great need around the world, and it’s so valuable that it’s very infectious; once you’ve been on one mission, you can’t stop going on them really.

When the opportunity came to actually being able to make it happen in this country, again, it was taking those opportunities, and I suppose that’s always been a bit of a mantra in my life is, if an opportunity comes along, it may only come along once, you take that opportunity, and it’s just grown from there.

Paul: I know you’ve talked about the great work you’ve done in terms of the setting up of the foundation and the fundraising behind it. In terms of your role, what else do you do? Because I also think that’s quite important, in terms of the more hands-on, day-to-day things you’re involved in. It’d be quite good to understand how that works from your point-of-view?

Phil: My normal workdays? I work as a Consultant Anaesthetist, which means I anaesthetise patients to have operations, so from an Operation Smile point-of-view, I anaesthetise the children for the surgeon to do the operation.

My full-time, normal day job is working at a local hospital, which I’m very fortunate is only about a mile away, so I normally cycle to work in the morning, which is lovely. Just take yesterday for example, I was doing children’s operating lists, where in fact we were doing investigations of MRI scans. Now, we’ve got little babies, they don’t lie still for half-an-hour to do the scans, so you have to anaesthetise them, but one of the main parts of that job is actually spending time talking with the parents, who are extremely anxious that the child’s going to have the scan, what they’re going to find, they worry about the anaesthetic, so a lot of my time is spent actually preparing the parents and the children for the operation.

Come the afternoon, I was anaesthetising patients for bariatric surgery, which is weight-reduction surgery, so in the morning I was anaesthetising the smallest people in the hospital, in the afternoon I was anaesthetising the largest people in the hospital! It’s a really varied job and that’s what I love about it. For me, going to work on a day-to-day basis just isn’t a chore. I just love my job really.

Paul: When I look back at the operations that I had as I was getting a bit older, I think the last operation I had on my cleft lip and palate was when I was 13. I can still remember the anaesthetist from that time, because obviously when you’re younger, you don’t really know what’s going on, but I think as you get a little bit older, you’re more conscious of what’s about to happen. That moment when you’re in the operating theatre, you’re just waiting and you know, in those days – showing my age a bit now – there used to be a huge mask that goes over your mouth; I’m not sure they still do that now or whether there are different ways of anaesthetising people. But it’s quite a scary thing to go through, counting down from one to ten, and I just remember the people that were doing that, the anaesthetists that worked with me then, really helped massively in that five-minute period before actually being under. It’s a huge job to do really, to put the patient at ease before the operation actually starts.

Phil: It is really particularly important – it’s important with everyone – but particularly children, like yourself, you would have had a number of operations over the years, so if the first operation you go to, you’re really scared of the anaesthetist, it’s a complete nightmare after that, because the patient is only scared about coming in, and therefore it’s so important we get it right and actually make the children feel very relaxed. And as you say, we sometimes use the mask, we sometimes use IV, but we put special cream on so that they don’t feel the needles going in. Sometimes I use a bit of sedation to settle them, but it’s quite interesting because sometimes it’s actually the parents who are more anxious and the children are an absolute dream.

We always bring the parents in, but it’s quite interesting because most parents hold it together until the moment the child goes off to sleep. And the moment the child goes off to sleep, you just see the parents suddenly burst into tears, all the stress goes out of them. And I always find – I’ve taken my own children to the operating theatre – and when you’re on the other side, it’s a different story altogether.

Paul: It’s good you’ve been on the other side of the theatre, so the fact you can empathise with what people are going through is important. You know how to put people’s minds at rest and make the situation more comfortable for everybody involved on that side. Obviously earlier on, you mentioned a bit about the great work you guys have been doing in the fundraising for Operation Smile, £35m raised to date, because obviously EMEA are going into partnership with Operation Smile, we’re going to be hopefully adding to that number over the years. I thought it might be good for you to explain to the listeners how the money is spent and where the money goes really.

Phil: Well we obviously try and direct as much of the money to the frontline as possible and we have different models, but our main model is running a mission model. We used to run a lot of international medical missions. If I just take you through the very basics of what our medical mission involves, and where the money is being spent and why people may realise it does cost money for these things to happen.

First of all I would say that all the medical practitioners and all the nurses, doctors, any healthcare assistant who goes with us on these missions, does it on a purely voluntary basis, so none of us are getting paid, none of the volunteers get any money out of it whatsoever. The money goes into the organisation of our programmes, so a typical medical mission is all about the team and it’s really exciting.

We have a team of about 40/45 people and we all fly to a centre where we’re going to be working. Sometimes we know a few people on the team – on the whole, quite often – we won’t know any of the other people on the team. We’re all high-skilled healthcare professionals who know our job, but it’s bringing a team together on a day. The following day we’re working straight off; we can’t waste any time. This isn’t a holiday.

So, I’ll give you an example of a medical mission we did to Addis, the first mission we did to Ethiopia, in fact. We arrived there, we got all the gear to the hotel, met all the people coming from all over the world, we met all the local people who were going to help us as well, and the next day we started screening.

Screening involves looking at all the patients who have been recruited to come for the operation, and so we go to the Black Lion Hospital and there we were faced with 600 children waiting. Now, 600 children, that’s all very well and good, but they’ve all got a parent, or two parents, or a brother or sister, so there was approaching 2,000 people lined up around the hospital in the middle of Ethiopia, in the middle of Addis, waiting to be seen by us. And what we do do is that, in the team, there will be surgeons, anaesthetists, nurses, speech therapists, dentists, ENT specialists sometimes, and paediatricians, so that every patient that comes to a mission site will get seen. It’s crucial that everyone gets seen. And they’ll get seen by everyone in the team. So, you can imagine the logistics of that in two days, we have to screen 600 patients.

And then we have to decide who we’re operating on. The really heart-breaking, devastating side of all this is that these aren’t just numbers, these are 600 real patients who need operations, and we know that in five days’ operating that we’re going to be doing, that we’ll only be able to operate on 200. And that’s really heart-breaking when you start off in that position. The idea is that, whenever we go to a site, that we keep going back time and again, and the idea is that we train the local people to do the operations, so we see all of the patients and, over these two days, this is where a lot of the really amazing stories come out.

We’ve travelled for days to get there and it’s so hard for us to decide who we’re going to operate on. We have a very set criteria to how we do it, and to give you an example of the stories we hear, just a very simple example of a 16-year-old boy, who was called Sam, who lives in Ghana, I remember sitting there in front of him a couple of years ago, and there was Sam, who’s wearing a Manchester United football top, he looked like my son, my son was the same age – maybe it’s one of the reasons these stories often resonate, very similar to yours – and this child, 16 years with a cleft lip, not being operated on, and I just said, ‘How’s it affected you over the years? How have you felt about it?’, he just said four words, ‘I have no friends’. And you just sit there, and it brings a tear to my eye now just even thinking about it, and I just think, if that had been my 15/16-year-old son going to school every day, and being in the playground in the corner, no one talking to him, it’s just devastating. And that week we changed that child’s life. His life was changed. He would actually be able to go and play football with other people.

So anyway, we see a lot of patients, we see a lot of really heart-breaking stories, and then of course we have to decide who we can operate on. And that day’s a very difficult day, because you have to talk to everyone and say, ‘Well I’m really sorry we can’t do it this time around, but you will come back’, we give them a piece of paper to say, we were here last year, will you come next year, we’ll be here again. As a parent, that isn’t very helpful, but we can only do what we do, and we’ve got to do it safely and we can only do so many patients.

Then we have a day when we tend to set up the operating theatres and do a bit of education for the people who are helping us while we’re there, and then we have five days of operating. And we normally run five or six tables. So, we’ve set off 5/6 o’ clock in the morning, operate until we’ve finished all the patients that we’ve planned to do for the day. Sometimes that may take us on until 8, 9, 10 o’ clock at night, but it’s absolutely crucial that we only do it in a safe manner and we do it to the same standard that we would do in our own countries.

And the thing that I always go back to is that I always look at every operation we do as being a training opportunity. We have the local surgeons, local anaesthetists, local nurses, so when we’re doing the operation, we’re also training them to do the operations, so that, ultimately, they’ll be able to take over that role for us.

Then post-operatively, the kids – it’s really sweet – in the evenings, the older ones who can appreciate it the most, obviously the babies can’t, you have a 6/7-year-old, you give them a mirror to look in at the operation and how their face has changed. And the change in the face, the glowing smile that comes out is just amazing really and it‘s incredibly rewarding for us to see that afterwards. You’re never too old to have the operation, I mean, another story of an Ethiopian that’s in the Addis mission that we did. This guy was about 70, and he’d been very fortunate, he’d had a cleft lip all his life, he had got married, he had children, and the first thing he said after he had the operation, he just stared into the mirror for ten minutes, he just said, ‘I can now kiss my granddaughter for the first time’. And when you hear stories like that, it just really hits you and I get emotional thinking about it. I’ve told that story about 1,000 times, but it doesn’t stop really having quite an impact.

And then of course, at the end of the two-week medical mission, we usually have a big celebration, everyone lets their hair down, and then we all go back home, changed people.

Paul: Some of the stories you’ve mentioned there, I know some of the stories are online on the website as well, and personally it was one of the reasons why I picked up the phone to reach out to you guys, because I just realised how lucky I was going through this situation in the UK and it was almost expected that it was going to be sorted. Whereas in these types of countries you’re helping in, there’s a lot of people who have to wait a long time, as you’ve mentioned.

The waves of emotion you must go through in that two-week period, you go from one side where you’ve got to sit down with the child and the family and say, ‘Well you can’t have the operation this time around’, and then the other side when the operation is done, looking back at the photos and so on, emotionally it must be really draining for you to be in that situation. Because, even talking about it, that’s got to be really tough – rewarding, but a really tough few weeks. Is there a way you try to deal with it yourself, I guess emotionally, it’s very tough?

Phil: It is emotionally very tough. For me, the thing which is really fantastic about it is that you have a group of 40/50 people coming together and there’s only one answer, and it’s yes. And it’s a real can-do attitude. It’s a team of people, there’s no blockers there, it’s only solutions. And I think this is what I take home back with me, that actually if someone says, ‘I can’t do this because of this’, well let’s find the solution, we’ll find a way of doing it. I think that’s what I’ve really learnt from the whole Operation Smile projects I’ve been on, is this real can-do attitude. You take it back to the NHS, to your own workplace.

And your overriding emotions are that, when I talk to people who are raising money for us, I say, ‘Our part’s the easy part, the hard part is for you guys, who are raising money for us’. Because we go there and we’re the tip of that iceberg, and we’re actually doing the work and seeing the results and getting instantaneous rewards for it, whereas you guys in the background, without you guys raising the funds and supporting us, we wouldn’t be able to do the work. Our part, in a funny sort of way, working on the frontline, is the easy part.

Paul: You’ve mentioned about when you’re on the missions, it’s helping to educate the people to do the work locally as well. Is that the ultimate aim for Operation Smile, where the skills are available locally so that people can have these operations on a local scale?

Phil: Absolutely, Paul. This is the most incredibly important part of the programmes. I’ll give you a few examples. Firstly, I go back to when I went on my first medical mission to Bogota in 1995. The whole team was from outside of Colombia, so we have 45 healthcare professionals going in and they were all non-Colombian. Now, we did that mission, we operated on 200 children. We have the local nurses and doctors coming in and helping us during that time. And we started doing education programmes and teaching.

They have their own cleft centres, they even raise their own money, they have Colombian surgeons operating on Colombian children, being anaesthetised by Colombian anaesthetists, being looked after by Colombian nurses. And that is job done. It means, going forward, they are looking after their own people, and we’re not having to go in and do the extra stuff.

And that, if I were to encapsulate what we’re trying to achieve, that’s what we’re trying to achieve. And every country is a little different in how developed they are, and obviously it takes shorter or longer periods of times in different countries, and often there are huge backlogs, but that’s our aim, that we’re no longer needed. It’s beautiful to see that in somewhere like Colombia, where I went on my first mission.

We don’t only do education in our programmes – I’ve got to go there for a few other schemes as well, and just looking at Ethiopia, for example. In Ethiopia, back in 2005, when I first went, virtually all anaesthetics were given by anaesthetic nurses, so there were only 23 doctors who gave anaesthetics at the time in the whole of Ethiopia. I met one of those, Yumani, in Jimma, where I spent an awful lot of time.

Over the last 15 years, he’s become a very good friend, a very dedicated doctor, who’s an anaesthetist there, and his dream was to train more doctors to become anaesthetists and have a whole residency programme, so that all the anaesthetics in his hospital were being given by doctors. So we got together and we were trying to work out a way of doing this, and I suggested that – I give a lot of talks at home to my trainees all around the country, and they come to me and say, ‘I’d really like to help’, they get really excited about it, and they can’t go on normal Operation Smile medical  missions, because they’re not fully trained – we put together this scheme, a five-year programme, where my senior trainees would volunteer to go to Jimma for three to six months, and would help to encourage and train the doctors in Jimma to become anaesthetists, and help set up a residency programme.

So, over that period of five years, I had nine of my senior trainees go out there, and every single one of them has said it’s the most rewarding thing they’ve ever done. They’ve all gone back and helped out later on, as well. And now, in Ethiopia, we have a residency programme where there are 30 doctors training to be anaesthetists over a three-year programme. And every year, there’s another ten doctors signing up to train to be an anaesthetist.

We consider that, 15 years ago, there were only 23 doctors in the whole of Ethiopia who were anaesthetists, now we’ve got 30 training to be anaesthetists in Jimma alone. And it was very touching, I was very humbled, when Yumani asked me to go over and help do the examinations of the first cohort coming through, and it was just lovely after three years of seeing these people come through to be able to examine them, and they all passed with flying colours, and now Yumani has a residency programme. He has colleagues and he has a sustainable programme going forward, which is going to make a huge difference.

We’ve done it as well, we’ve tried to do it with surgeons, in the same kind of way, and that education is so important. Me going there for two weeks is going to have an impact, but to train someone who’s going to be there forever, is going to have a much bigger impact.

When I give talks, if I were going to put one slide up, it would be a picture of this operating table in the Jimma operating theatre. At the end of the table, there’s this young trainee surgeon, Yohana, and she’s just started training to be a surgeon, and she’s operating on a child for a cleft lip. Standing next to her is Yonas, who is a trained surgeon, who we’d trained to do cleft lips on the previous year, and he’s standing there training his trainee to do the operation. Then, looking after the patient, a one-year-old child, we have Miliyon, who is an anaesthetist, who I met virtually on his first day of anaesthetic training – we’ve trained through the years – and he’s there giving the anaesthetic to this one-year-old. He’s a highly trained paediatric anaesthetist. So, you’ve got an Ethiopian anaesthetist, anaesthetising a child to be operated by an Ethiopian trainee, being trained by an Ethiopian surgeon. And that is the picture I put up at the end of all my talks and it’s what we’re trying to achieve. It’s just lovely to manage to do that.

Paul: You’ve touched on so many amazing things that yourself and the team have achieved. What is next for you? Is there a specific mission that will be lined up when you can get out or is there anything specific that you have in the pipeline for Operation Smile?

Phil: As you well know, we’re in very difficult times at the moment [due to the COVID-19 pandemic]. For example, last year (2019), we had programmes in 32 countries across the world. We ran 172 medical missions. We operated and changed the lives of over 16,000 children with cleft conditions. Obviously since March this year, we haven’t been able to do any of that. And that’s been quite devastating for us really.

I quite like my maths, and when you consider that there’s one child born every three minutes with a cleft lip or palate, that means that, every year, there are 175,000 children born with a cleft condition. Of those, one in ten will die before the age of one, which is frightening when you think about it, they don’t need to die. If they were living in the UK or the US, that wouldn’t happen. And the other really awful thing is 70% of those children won’t get an operation at all.

So, in these five to six months, there’s been approximately 80,000 children being born with a cleft lip or palate, of which 56,000 will never have an operation. Now, we would do some of those operations and we would be training people to do those operations, but not only did we have the backlog previously, we now have another 56,000 people who won’t get any operations. This is very heart-breaking for us, so what we’re doing in the interim, what we’ve been doing over the last six months, is that, because we have warehouses and offices in all these countries we work in, with a lot of medical equipment, we’ve redistributed all our equipment, we’ve given it all away to local hospitals, so that they can use it in this fight against COVID, so at least we’ve managed to do something there.

We’ve also managed to keep a register of as many new children who are born with cleft, and so that when we can start going away and we can start helping the local people do the operations, at least we have a register of our patients. And one of the key things is, if you’re born with a cleft lip or palate, you’re going to have difficulty with nutrition, so we’ve been having nutrition programmes for each country, where we’ve been helping to provide these families with nutrition, so the children are fed well enough so that when we get around to actually being able to operate again, at least they won’t be malnourished and they’ll be fit enough to have the operations.

We’re hoping that, come January next year [2021], we’ll be able to hopefully start sending international medical volunteers to these countries again; it’s going to vary from country-to-country and we’re hoping that we’ll be able to start doing that.

We’re also supporting, in a similar way to this, Zoom education and things like that. Surgeons, like Ethiopian surgeons and Colombian surgeons, giving them support and encouraging them to be able to do the operations while we’re not there. So, moving the charity forward, at the moment, we’re dealing with what we’re having to deal with due to COVID.

Long-term, what I’d really like to see is partnerships between non-NGOs around the world to all work together. I’m very keen that we don’t reinvent the wheel, so that different charities work together to not only provide cleft surgery, so for every anaesthetist that I train, they might anaesthetise 1,000 children with cleft, but they’ll also be anaesthetising 10,000, 100,000 people in their own careers for other operations, and provide safe anaesthesia and safe surgery for everyone going forward. And it’s bringing organisations together to make surgery safe throughout all these countries that, at the moment, are having great difficulties.

Paul: Is it too simplistic to say that the only thing that holds Operation Smile back is the funding? If you had more funding, it’d obviously be easier for you to reach out to more countries, to educate more people and to get to where you want to be sooner. Or is that too simplistic to put it that way?

Phil: Funding is hugely important. Across the world, we have about 5,000 Operation Smile volunteers. The more funding we have, the more missions we can do, and the more people we can send out to help educate the local people. There are other issues that are involved with that as well, because you need healthcare professionals to train in the countries we go to and, therefore, we need to also work alongside countries, encouraging them to support training of their own healthcare professionals, so that we can help train their professionals.

So funding is massive, it’s absolutely massive, and obviously, the more we get, the more we can do. It’s absolutely crucial. But we also need more volunteers, and we need governments to be able to encourage and help us move forward in their healthcare systems.

Paul: I’ve found it amazing to speak to you, because clearly, as I mentioned right at the start, it’s something that I’ve got a personal connection with, and I think the work that you and the team do is amazing. There aren’t many other words I can use to describe it. The help that you’re giving to these people is unbelievable. Those stories you told today and the ones you can see online, the difference in before and after the operation is huge, and the impact it makes on people’s lives is inspiring, and I think it’s amazing work that you guys are doing.

For us to be partnering with you on this is great, and we’re obviously going to do as much as we can to keep raising awareness of it and helping to raise funds towards the cause as well. Obviously, anything we can do to help, we’ll be on the case with that, as well.

Phil: Thank you very much, Paul. It has been a pleasure talking to you and I think you very much have a very personal attachment to this organisation, having gone through it yourself. I think, as you said earlier on, the fact that you had all the support in this country and you had the operations at the right time, a fantastic outcome, you’ve been able to have a fantastic, successful career. Without us doing this work, without you supporting us, there’s people who will be like you in other countries, who would never have that opportunity, and I think it’s absolutely crucial that we give that support to as many of those children as absolutely possible.

Paul: If any of the listeners want to reach out to you directly, Phil, what’s the easiest way they can do that?

Phil: If they want to reach me directly, I am on LinkedIn, which is where you got this connection from, they can go directly to the Operation Smile UK website, and there’s a direct link there. There’s a phone number, they can phone the office if they want to speak to someone in person, there’s always someone manning the phones, virtual or not. And I’m very happy for anyone to contact me, you have my email address, phone number. If anyone wants to chat about anything, feel free to contact me. I’m always available and, personally, I love the organisation and I love talking about it.

Paul: What we’ll do, when the podcast goes out, we’ll make sure your contact details align with the podcast and Operation Smile’s details on there, as well. So if people want to reach out to you, the organisation, or indeed myself, they definitely can do on that side. All that’s left for me to say is huge thanks today again, Phil, for doing this with us. Really appreciate your time and I look forward the partnership.

Phil: Thank you very much.

The Power of Passion: Operation Smile Nurses Marlene Do and Karina Olivo

Operation Smile volunteer nurse Marlene Do of Canada poses with a patient during a medical mission. Photo courtesy of Marlene Do.
Operation Smile volunteer nurse Marlene Do of Canada poses with a patient during a medical mission. Photo courtesy of Marlene Do.

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 it comes to caring for a child, there are many aspects of her work as a volunteer that Marlene Do enjoys.

According to Marlene, a devoted Operation Smile volunteer nurse from Canada, the children she meets on medical missions are what keep her coming back for more.

They remind her that, despite needing to be resilient during life’s most challenging times, there are opportunities to enjoy life and smile in the smaller moments.

The stickers and bubbles that she uses to play and bond with patients during screening aren’t just for them. They can be for her, too.

Photo courtesy of Marlene Do.

Donating her time and skills as a nurse on seven medical programmes, Marlene often witnesses just how much surgery can positively impact a child’s growth, development, speech and overall quality of life.

As a patient progresses, the organisation does as well.

Out of the 51 volunteer positions on an Operation Smile international medical mission, 19 positions are filled by nurses, representing 36 percent of all our medical volunteers.

Nurses like Marlene are the only medical volunteers who actively provide care for patients at every stage of the surgical cleft care process.

“Operation Smile [provides] their patient population with comprehensive cleft care,” Marlene said. “They are provided with access to so many specialists like child life specialists, speech language pathologists, dentists and orthodontists. [The organisation invests] in the future of the countries they work in by capacity building through teaching and mentorship.”

Operation Smile volunteer nurse Karina Olivo of Canada. Photo courtesy of Karina Olivo.
Operation Smile volunteer nurse Karina Olivo of Canada. Photo courtesy of Karina Olivo.

Regardless of their subspecialty, Operation Smile nurses like Marlene and Karina Olivo possess specific skillsets and knowledge that contribute to the promise of providing every patient with the exceptional care that they deserve.

“I became an Operation Smile volunteer 10 years ago, for the same reason I pursued nursing,” Karina said. “I wanted to help bring care to those who might otherwise never receive it due to lack of access. The collaboration, learning and flexibility that allow teams to work towards the same goal never ceases to amaze me.”

Early on in her career, during her first rotation in a children’s hospital, Karina recognised her desire to become an advocate for children and their families, allowing her the opportunity to become a paediatric nurse.

Karina then began testing out different areas of the nursing medical field — from a bedside nurse to education to management — that empowered and enriched her with every experience, as both a professional and a human being.

“Nurses are the glue that hold healthcare together,” Karina said. “For many people, [they are] the only healthcare professional they will have contact with.”

With 2020 being the International Year of the Nurse and Midwife, stories like Karina and Marlene’s are the ones we hope will inspire the next generation of nurses and celebrate the people who are instrumental in changing the lives of patients and their families around the world.

Help more nurses like Karina and Marlene continue to change the lives of patients living with cleft. Your support today means that we can keep our promise to our patients and provide them with the surgery and care they need when it’s safe to resume our work around the world.

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.

Assuring the Highest Quality of Care

Volunteer nurse and clinical coordinator Mamta Shah with a patient during a 2017 Operation Smile medical mission. Photo: Anja Ligtenberg.

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 it comes to our work of delivering exceptional cleft care to people around the world, the safety of our patients has been, and will always be, our greatest priority.

As an organisation comprised of compassionate and selfless medical professionals who go above and beyond by donating their time, energy and expertise to our mission, it wasn’t a surprise when some of those volunteers expressed interest in doing more with their volunteerism.

As many volunteers voiced a desire to serve on more medical missions, Operation Smile’s medical quality team created an innovative solution: The team established a position that not only presents volunteers with more opportunities to learn and care for patients, but further strengthens and enhances our safety protocols.

Bryan Zimmerman, Operation Smile Assistant Vice President of Quality Assurance, said that the inspiration behind creating a volunteer quality assurance (QA) officer position was to continue improving upon two of the organisation’s top priorities, the safety of our patients and the quality of their surgical results. QA officers’ evaluations are designed to bolster the knowledge, practices and abilities of our medical volunteers around the world.

“The only way to effectively create a culture of safety and quality is by showing that you care,” Bryan said.

Operation Smile Assistant Vice President of Quality Assurance, Bryan Zimmerman, centre, speaks to a mother and patient during a 2019 medical mission in Antsirabe, Madagascar. Photo: Lorenzo Monacelli.

After creating the curriculum for the QA training programme, Bryan and his team received applications from more than 35 volunteers from countries including Italy, Mexico, the U.K., Australia, Norway, South Africa and the U.S.

Of that total, 11 volunteers participated in and passed the five-day tactical training and education course that took place at Operation Smile Headquarters in November and December of 2019.

Volunteer clinical coordinator Mamta Shah checks the vitals of a patient after surgery. Photo: Anja Lightenberg.
Volunteer clinical coordinator Mamta Shah checks the vitals of a patient after surgery. Photo: Anja Lightenberg.

“Simulation stations were set up that provided opportunities to touch and feel what different parts of the mission are like,” said Mamta Shah, a volunteer nurse, clinical coordinator and QA officer. “The final was a walk through, an actual chart audit and mission audit twice. This was an incredibly valuable experience for volunteers.”

Posing as staff and volunteers, actors intentionally made mistakes and missteps during the mission simulation that the QA officers would be tested to identify. They were assessed during each of the mission phases: screening, pre-operative, anaesthesia, surgery, recovery and post-operative.

For Rodney Kapunan, a volunteer pre- and post-operative nurse with years of mission experience, the QA training instilled in him a new appreciation and respect for all roles and specialties.

“Training was an eye-opener for every one of us, because even though we are seasoned volunteers with more than 10 missions and experienced in our fields, we are now tasked to oversee the processes of the whole mission,” Rodney said.

Photo courtesy of Rodney Kapunan.
Photo courtesy of Rodney Kapunan.

“Operation Smile is distinguished for being an association that follows the quality standards established,” said Rosa Sanchez, a volunteer nurse, clinical coordinator and quality assurance officer for Operation Smile Mexico. “We guarantee that patients receive good attention and give the family full security that their kids are in good hands.”

Slated to attend medical missions throughout 2020, the certified QA officers like Rodney and Rosa were ready to step into their new role and empower volunteer teams to continue delivering the highest quality of care possible.

But those plans were upended when the coronavirus pandemic began. Only two officers were able to attend their scheduled missions before Operation Smile’s decision to postpone all international travel.

As one of those two volunteers, Rodney witnessed the medical quality team’s vision come to life.

“There were a lot of great ideas that were brought forward by some volunteers during my last missions in Egypt,” Rodney said. “I reminded them that this organisation is always improving, and I love to hear their suggestions on process improvement and patient safety.”

Adapting to the pandemic, Bryan and his team now deliver online refresher courses that make sure the officers are prepared to reach their highest potential whenever it becomes safe to travel again.

But those courses weren’t the only component to transition online: Two additional QA officers received training and became credentialed through virtual training.

With a new dynamic, Bryan and his team worked diligently to create a virtual QA education course that aligned with the same goals and experiences as the in-person training.

The curriculum included informative presentations, questionnaires addressing specific concerns and a virtual fact-find of a local hospital.

Operating room nurse Amanda Stahlhut during a patient's operation. Photo courtesy of Amanda Stahlhut.

“An opportunity for me to contribute to those great efforts is an honour,” said Amanda Stahlhut, an operating room nurse who underwent the virtual training. “I pledge to not lose momentum or motivation with the current pandemic delays, knowing that this QA programme will transform how quality and safety is viewed and actioned.”

Even some volunteers like Rodney say that they are using their QA officer training to be better prepared for working on the frontline of the COVID-19 pandemic.

“Especially when I’m putting on my personal protective equipment, I always have someone double check if I missed anything,” Rodney said. “I also practice good habits in my practice to better protect myself, my co-workers, patients, guests and family from contracting the virus, thus cultivating a culture of safety.”

The 13 officers, diversified by country as well as specialty, represent a multitude of positions including a surgeon, paediatrician, bio medical technician, two anaesthesiologists and various nursing specialties.

And as committed advocates for safety and care, the QA officers also embody Operation Smile’s unwavering drive to improve and evolve in order to meet the needs of every patient.

“We all make mistakes. We can evaluate our mistakes and see how we can improve on them,” Mamta said. “Increased efficiency and safety leads to better team morale and preparedness, which then leads to improved patient outcomes, improved patient satisfaction and better quality of care.”

Photo: Rohanna Mertens.

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.

Her Lasting Impact: Q&A with Salmah Kola

Speech language therapist Salmah Kola of South Africa, left, screens a young patient during an Operation Smile medical mission in Koforidua, Ghana. Photo: Zute Lightfoot.

The first time Salmah Kola was exposed to Operation Smile’s work, she didn’t foresee that one day she’d become a key member of the organisation.

She first learned about the organisation when the South African TV show “Free Spirit” showcased a medical mission in Madagascar. Looking back, Salmah remembered seeing the crowds of patients and families and being in awe of what was being accomplished across her beloved continent.

At the time, she was still a speech therapy student, but her now-late brother told Salmah that he could envision her doing similar work once she finished school.

And sure enough, after Salmah graduated, she was reintroduced to Operation Smile when a fellow colleague – an Operation Smile volunteer – returned from a medical mission in Rwanda. She shared stories with Salmah and talked about how it felt to be involved in something that was changing global healthcare.

“I signed up immediately! It was only after some time that I went on my first mission to the Democratic Republic of Congo, and I have not looked back since,” she said.

That decision changed the course of her life.

Travelling to Ghana, Malawi, the Democratic Republic of Congo, Madagascar and Paraguay as a speech language therapist, Salmah has spent eight years helping transform the lives and futures of children.

Providing speech therapy care to people in Africa and South America is only the beginning for Salmah. With no plans of slowing down, she aims to attend missions all over the world.

“I have been on nine missions so far, and I strongly hope that my mission career continues indefinitely,” Salmah said.

We recently sat down with Salmah to learn more about her work as a speech language therapist and hear what has driven her to dedicate her life to Operation Smile for nearly a decade.

Salmah speaks with a patient's family member during a medical mission in Ho, Ghana. Photo: Margherita Mirabella.

Q: What is your motivation to give so much of your time and effort to Operation Smile?

A: “Collaboration, collaboration and more collaboration! I have never worked in a context where a group of strangers from all over the world can come together and make such a great impact in a short amount of time. The team element that is fostered in every mission is what makes missions so appealing to me. All team members are valued, and there is always room for sharing. Beyond that, there are always local volunteers who are involved, which makes the impact of the work we do more lasting. These factors, amongst others, result in comprehensive care, which is why I’m so committed to Operation Smile. Just the mere fact that speech therapists are included in missions means that each patient’s long-term success is a priority.”

Q: Can you describe the value that speech language therapists bring to Operation Smile’s patients?

A: “Speech therapists play a vital role in many areas within the mission context, namely feeding, speech development and correction, and language development across all ages. To elaborate on one area, feeding issues are common, particularly in a child’s first few months of life. This can be a very frightening and debilitating time for parents, and without the right information and support, it can have detrimental effects. Many of the patients we see on missions in Africa come from impoverished backgrounds, and special cleft bottles are not feasible due to the lack of running water, limited safe heating systems and poor literacy to aid them in using formula. In cases such as these, we offer feeding solutions that are better suited to the child’s needs and the context. Having in-country volunteers also means that these families receive follow-up care and very often return to missions stronger, healthier and ready for surgery.

“Furthermore, speech is another main area of concern. People with a cleft palate often present speech problems, making their speech difficult to understand and resulting in bullying or being shunned by the community. Although a cleft palate surgery fixes the palate, these patients often require follow-up speech therapy. This can be a long-term need, and all patients are encouraged to return to follow-up missions to assist with their speech. During missions, the family and caregivers are counselled on activities and exercises that can be used to correct speech. With the assistance of translators, letters to the school can also be written to advise and educate teachers on the speech problem and how it can be managed.

“Interestingly, in some of the countries where I have worked, speech therapy is an unheard of profession, so much so that translators use long-winded explanations to describe what we do since the vocabulary for the profession does not exist in the native language. This means that we play a vital role in advocating for the profession and have the opportunity to see patients who, had Operation Smile not been active in their country, may never have had the opportunity to receive our services. For the field of speech therapy, this is simply phenomenal!”

Q: How do you feel that your service to Operation Smile has made you a better professional?

A: “I have and will always maintain that although going on missions means that we give and share of ourselves and our expertise, we are also very much on the receiving end. I have become a better speech therapist by having had the opportunity to work with other speech therapists with more years of experience, more mission experience and different insights than what I have. Reflecting on all my mission experiences with my fellow speech therapists from Canada, the U.K., the U.S., Sweden and South Africa, I’m fortunate to say that I have truly fine-tuned my skills, shared my expertise and developed lifelong friendships. Beyond expanding my speech therapy skills, my organisational skills have improved. When screening 100-plus patients in a day and sifting through them to divide them into appropriate groups – for example, those needing feeding intervention and those needing speech therapy – the admin piles up fast. Thankfully, this is a skill that missions have helped me hone in on.

“The impact missions have had on me as a professional are great and valued, but these are not as important as the impact it has had on me as a human being. I have been humbled to be lucky enough to be a small part of this gigantic puzzle. I’m honoured to work with people from all over the world who entrust me with something as valuable as their loved one’s feeding and communication.”

Photo: Zute Lightfoot.

Q: Which patient or family story stands out as the most memorable in your time with Operation Smile? What was so powerful about that story?

A: “Since I have an added qualification in lactation consultancy and a keen interest in feeding intervention, my favourite patient stories are often the ones surrounding the young, malnourished babies. These families often need extensive counselling and support in order for them to support their baby’s growth. Something worth mentioning is that the mothers are often proactive in supporting each other through their difficulties. So often, mothers who arrive at the mission site with healthy and thriving babies are ready and willing to assist those who are struggling. You may see them sitting in on a feeding talk, offering a shoulder to cry on or assisting with physical care of a baby to allow a stressed mother time to relax and process. This is truly one of those moments that restore my faith in humanity. I also always tell the mothers that what we know is not as powerful as what we share.”

Q: Have you been involved in training and education for Operation Smile? What is the value of providing those educational opportunities for medical professionals?

A: “Collaboration is a recurring theme here, and a by-product of collaboration for me is capacity-building and upskilling. Every single mission that I have been on has included a training component. The training is as important as the surgeries that are performed. By equipping local volunteers with knowledge and skills, we ensure that the legacy of comprehensive care continues long after we have left.

“Training means that we value the work we do beyond our own needs and wants, meaning that sustainability is of greater importance. I would love to go on missions to the same site every year, but it’s more important for me to be able to share a skill and make sure that, in my absence, patients still receive the treatment they need. The reason initiatives like the speech and dental conference are so important is because they supply a platform for us to brainstorm ideas to make sustainability of speech therapy a reality. This is where we, as speech therapists, come together and really plan how we can make follow-up speech therapy a reality and, in so doing, effect greater change.”

Q: In November, you were a part of a global team of speech language pathologist leaders who gathered at Operation Smile Global Headquarters. Can you describe that experience and the importance of bringing that group together?

A: “November’s meeting was nothing short of insightful, educational and exhilarating. The speech and dental conference afforded us with the opportunity to meet and discuss pressing issues, which are sometimes difficult to address through email or telephone. We were able to share our experiences and expertise and make future plans to further our role and our impact on missions. Speech therapy needs after surgery can be extensive and long term, and ideas such as speech camps were discussed and explored. This is just one way that we are looking at ensuring that the patients we treat get the most holistic care. The exciting thing about volunteering with Operation Smile is that the services we offer are constantly being monitored and improved upon. Working with the population affected by cleft is about more than just the aesthetic change. It’s about the changes we can make to our patients’ quality of life in the long term.”

Salmah with a young patient and his father during a medical mission in Koforidua, Ghana. Photo: Zute Lightfoot.

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.