Reflection on Workplace – Lindsay


NHS practitioner Lindsay explains what it’s like working on a COVID ward and how her experience on Operation Smile missions has helped her dealing with the pandemic.

Whilst attending our shift handover in the operating theatre department tearoom, I felt a strong sense of Déjà vu.

It reminded me so much of the morning meetings on an Operation Smile mission. The ‘buzz’, anticipation and the many questions being asked. Some familiar faces and lots of new ones.

As the virus became more prevalent in our workplace our shift patterns changed and our teams as well. We have been placed in teams of about 23 practitioners, Team A (that’s me!), B, C, D, E. Our shifts have also changed to 8-9 (13 hours) day and night. I recently was able to reduce my hours to part-time and so returning to these long difficult shifts is a challenge.

Just like an Operation Smile mission, when days can be long, we all keep each other going, support those who are tired or sad, play music (when appropriate) teach each other new skills, have breaks when possible and get through the shift with humour and kindness.

Safety is paramount, always. There are many human factors to consider so I am grateful for my H/F faculty training and Operation Smile for allowing me the opportunity to experience surgery in developing countries which has prepared me for this pandemic.

Instead of going into work feeling confident, I feel anxious, not knowing where I will be allocated. I am finding myself working with staff from other areas and I don’t know their strengths or weaknesses, just as they do not know mine.

We also are expected to cover shifts in ITU where full PPE is worn all day (12 hours). I am completely out of my comfort zone in this intensive environment. I admire the staff who work there. Wearing PPE for so many hours is very uncomfortable, hot and difficult to communicate.

Lindsay PPE

To identify ourselves we use stickers or tape to write our name/role on and attach them to our gowns or visors, a practise close to my heart.

I bought this excellent idea back to my workplace after my very first mission to Vietnam in 2014, back in my own department this was met with varying degrees of acceptance. However, with Covid-19 and wearing PPE this has become the norm. I hope it continues! Knowing someone’s name and role can be vital in an emergency situation.

Operation Smile has taught me to ‘make things work’. To be practical and use my common sense, get creative and to use all of the expertise in the team whilst at all times being aware of the situation and keeping our practise safe. I feel that these skills have been honed in on during this pandemic.

I am finding my position at work very tough, it’s an unprecedented time. I feel emotional and often sad, but I am coping.

On the 12th of April, John my partner and I were to be married and I should be in the Maldives on our honeymoon now! Instead I am preparing for a night shift in emergency theatre.

If I can help to fight this virus I will. As a nurse there is no question about that.

I am so looking forward to an Operation Smile mission, I cannot tell you how much I miss it and my ‘OP Smile’ family.

I send love and best wishes to you all and take comfort in your support.


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.

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.

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.

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.

Building the Capacity to Heal

Volunteer surgeon Dr. Tilinde Chokotho speaks with 12-year-old Belita before her surgery during Operation Smile's 2019 mission to Lilongwe, Malawi. Photo: Zute Lightfoot.

Through the actions of dedicated and loyal volunteers who strive to make an impact, Operation Smile Malawi’s goal of increasing local surgical capacity remains at the core of its mission.

Volunteer surgeon Dr. Tilinde Chokotho was first introduced to Operation Smile Malawi during his residency in South Africa. And even after years of collaborating with volunteer medical teams from countries all around the world, Tilinde remains just as passionate about missions in Malawi being driven forward by local volunteers.

And that’s exactly what he witnessed during a 2018 medical mission held in Blantyre, Malawi.

“It is very important and quite significant to have such a strong representation,” Tilinde said. “It means that in the future, we could be pretty much self-sufficient. We could still have a few overseas volunteers to support, but, basically, it should be Malawians treating Malawians.”

Operation Smile invests in increasing the surgical capacity of low- and middle-income countries like Malawi so that it can serve and treat more people living with cleft conditions. As a local foundation, Operation Smile Malawi has worked to encourage and educate local surgeons, doctors and nurses with nearly 50 percent of Malawian volunteers.

Operating room nurse Seleman Badrlie has only been volunteering with Operation Smile since 2016, but he has already transformed many lives through attending 11 medical missions.

After finishing a mission in neighbouring Mozambique, Seleman joined the medical team in Blantyre to help create even more smiles. Back-to-back missions can be exhausting experiences, but for Seleman, it’s the right thing to do for the patients who are waiting.

“I felt like my help and my dedication to the team would be very important. Whatever I have to give to Operation Smile in order to bring smiles to people is OK with me,” Seleman said.

While Seleman is committed to the idea of Malawians driving the Malawi missions, he hopes to continue working with volunteers from around the world.

“It’s important to work on Malawian missions because it helps me gain skills,” he said. “I am always involved in working with the international volunteers, which is so helpful and allows me to learn valuable skills.”

As an organisation with a multidisciplinary approach to care, Operation Smile values its extensive community of volunteers who contribute a wide array of skill sets and professions that are vital to improving the health and dignity of people around the world.

Child life specialists are an integral part of that community.

Operation Smile volunteer psychosocial practitioner Cathy Cheonga, left, and volunteer surgeon Dr. Stefan Rawlins of South Africa meet with 79-year-old Flyness before her cleft surgery. Photo: Zute Lightfoot.

Cathy Cheonga works as a psychosocial practitioner in Malawi and volunteers her skills to assist with the child life team. It was through an awareness campaign that she first heard about Operation Smile and how it strives to deliver exceptional surgery to people where it’s needed most.

As paediatric healthcare professionals, child life specialists help patients and their families understand and cope with the hospital experience. Through therapeutic play and activities, child life specialists ease patients’ fears and anxieties during the mission, helping comfort and soothe them during their time with Operation Smile.

But the event that cemented Cathy’s interest in the organisation’s mission was when the Operation Smile Malawi team visited her office.

“They came to our offices to find out if we had any volunteers who could offer their services. I attended my first mission last year, and the programme was successful, which was why they invited me back this year,” Cathy said.

For Cathy, dedicating her time to attending missions and seeing the lasting impact that she has been able to make for children and their families motivates her to keep going.

“I have enjoyed my experience very much. I actually want to help the parents, as well as the children, to take away their fears: to say to them that this is part of life and everything is going to be OK and then help them transition from fear to hope and peace.”

When it comes to the question of enhancing skills, increasing capacity and building the local foundation, Cathy makes it clear that it’s a pressing concern.

“It’s actually really important because the mindset of many people is that other people have to come to help us, and yet, we are the very people who live with our fellow Malawians here,” Cathy said.

Cathy said that being local allows for a special understanding of the country’s beliefs and cultures, which can be useful in a mission context. She hopes to encourage the youth of Malawi to get involved and volunteer with Operation Smile Malawi so that they, too, can make a life-changing impact.

Through their partnership, Operation Smile U.K. and Operation Smile Malawi work collaboratively to reach a goal of clearing the backlog of patients who need cleft lip and cleft palate surgery in Malawi.

For Tilinde, the goal is possible. And he feels that a key element in achieving it is through increasing local capacity.

“It’s not just about doing the cleft repairs; comprehensive care is the ultimate goal,” he said. “We need training, not just for surgeons, nurses and anaesthesiologists, but other specialties like speech therapy.”

Anaesthesiologists Drs. Paul Phiri of Malawi, top left; Godfrey Phiri of Malawi, top centre; surgeon Dr. Mark Solomon of Kenya, top right; clinical coordinator trainee Courtney Allen of Australia, bottom left; and child life specialist Nicole Zina of the U.K., bottom right, pose with a patient before surgery during Operation Smile's 2018 medical mission in Blantyre, Malawi. Photo: Jasmin Shah.

Exchange for Smiles

Maria smiles wide with her new dentures that she received during Operation Smile Nicaragua's first combined dental and surgical medical mission in March 2019. Photo courtesy of Ryan Cody.
Maria smiles wide with her new dentures that she received during Operation Smile Nicaragua's first combined dental and surgical medical mission in March 2019. Photo courtesy of Ryan Cody.

For 42 years, the only food that Maria could eat was what her two teeth could grind down, and all she could say were the few sounds that she could form with a gap in the roof of her mouth.

Countless meals left on the plate. Countless thoughts left unsaid. For far too long.

Maria was willing to do whatever it took to access the care that she needed. Even a 10-hour journey from her village to the clinic in Managua, Nicaragua, couldn’t deter her.

When she arrived, Operation Smile Nicaragua and the Exchange for Smiles team were ready and eager to help.

During its first-ever combined dental and surgical medical mission in March 2019, Operation Smile Nicaragua teamed up with a cadre of second- and third-year students from the University of North Carolina at Chapel Hill Adams School of Dentistry.

The team not only provides the highest quality of care to their patients, but also mentors the next generation of dentists.

“Our programme employs a direct exchange: one UNC student paired with one Nicaraguan dentist,” said Ryan Cody, a fourth-year UNC dental student and founder of Exchange for Smiles. “At the end of the day, it’s the exchange of knowledge and resources for the gift of a smile.”

Maria’s care exemplifies the special dedication and devotion of this partnership.

By rallying together, the teams treated Maria’s two teeth, which had become infected over the years, and created dentures that would allow her to chew easier, eat better and smile bigger.

“We worked endlessly, Monday through Friday, fabricating dentures. We were nervous that we wouldn’t finish, as the denture fabrication process in the U.S. can take months,” Ryan said. “However, with teamwork, close communication and incredible laboratory support, the moment we were waiting for arrived.”

Photo courtesy of Ryan Cody.

For the first time in many years, Maria got to enjoy her meal – a meat dish with rice – thanks to the dentures that the team had crafted for her.

Ryan said that by the end of the March mission, they had educated and treated 250 more patients just like Maria.

This included a combined 732 dental consultations and procedures on top of the 230 dental patients that the partnership treated during its first Exchange for Smiles mission in March 2018.

Ryan’s Exchange for Smiles journey started when the long-time Operation Smile student volunteer pitched the idea to his mentor Dr. Bill Magee III, the son of Operation Smile Co-Founders Bill Magee and Kathy Magee.

Using the guidance and encouragement he received from the Magee family, Ryan boarded a plane to Nicaragua and presented his proposal to the executive director of Operation Smile Nicaragua. Ryan’s proposal earned him the support of both Operation Smile Nicaragua and UNC.

After fundraising to cover dental equipment, Ryan headed back to the country to purchase equipment as a contribution to the centre and an investment in the programme.

Empowering two teams of students and mentors to treat Maria and more than 500 patients like her was the dream.

The guidance and mentorship of Teresita Pannaci, Operation Smile volunteer dentist from Venezuela who took part in both Exchange for Smiles missions, also served essential roles in the programme’s educational effort.

As a functional orthopaedic maxillary trainer, Teresita teaches fellow volunteers in multiple countries around the world. Her creation of a doll named DAM simulates the experience of a newborn living with cleft palate and helps students practice taking intraoral impressions.

“Exchange Smiles is a wonderful programme with a powerful title,” said Teresita, who’s been a volunteer with Operation Smile since 1993. “In the end, the results exceeded my expectations. The excellent students of UNC, their participation, talent and commitment have favoured the community of Nicaragua.”

Photo courtesy of Ryan Cody.

The cornerstone of the Exchange for Smiles programme is education. The dental school students learn from their mentors, but most importantly, the dental school students are given the opportunity to use what they have learned to teach oral health and hygiene skills to patients and their families.

For second-year UNC dental student and vice president of Exchange for Smiles Celeste Kendrick, the importance of oral hygiene instruction was one of the biggest lessons she took home from the experience.

“Some patients told us they had never been taught that brushing their teeth would help prevent oral disease and pain,” said Celeste. “They thought it was a natural, unavoidable part of life.”

When looking ahead to the next steps of its own education, the Exchange for Smiles experience has helped to calibrate the compass for both Celeste and Ryan.

“After being on a mission with a dental lens, I left slightly overwhelmed, yet motivated, after seeing first-hand how much need there is for dentistry post-surgery,” Celeste said. “This trip helped renew my purpose as a dental student and allowed me to see how important my education truly is.

“There are patients who need help, and though it may not seem like we’re making a difference by studying, they rely on us to do our part and become the best providers we can be.”

Photo courtesy of Ryan Cody.

Open Heart, Open Hands

Patient coordinator Carlos Mahalambe, left, rejoices with the patients and families he accompanied to Operation Smile’s July 2018 Quelimane medical mission. Photo: Zeke du Plessis.

Without its global network of selfless, caring and generous volunteers and staff, Operation Smile simply wouldn’t exist.

The organisation’s free, life-changing cleft surgeries are only made possible by people who unite from all walks of life, devoting their time, energy and compassion to those who need it most.

Through his work as a patient coordinator, Carlos Mahalambe is one of those people.

Driven to help Mozambicans affected by cleft conditions, the 42-year-old then-volunteer was responsible for bringing 18 potential patients to Operation Smile’s July 2018 medical mission held in Quelimane. As a staff member of Operation Smile in Mozambique, his efforts continue to make an immense impact: Carlos successfully recruited 89 patients to attend the August 2019 mission in Nampula.

“I was notified about the (Quelimane) mission, so I got in touch with the team and began advocating for patients,” said Carlos, smiling as he described his work. “I brought four people from my region, and when I arrived, I made some phone calls and connections and found another 14 potential patients in this region.”

Taking a unique path to becoming involved with Operation Smile, Carlos first learned about the organisation and its work in 2013 when he saw a poster at his previous workplace promoting an upcoming medical mission. While he had seen people living with cleft lip and cleft palate before, he never knew that surgery could repair the conditions.

Immediately, he knew that he could help.

“I was working at a lodge in Inhambane when I saw a poster for children needing help, and so I started to volunteer,” said Carlos, who worked as a luxury lodge manager. “I looked for patients, contacted them and dealt with the community to spread the word about recruiting patients.”

At the Quelimane medical mission’s patient village, patient coordinator Carlos Mahalambe was constantly on the move, supporting patients in any way he could. Photo: Zeke du Plessis.

Carlos helped patients and their families receive care from Operation Smile at both of its 2014 medical missions in Mozambique, as well as assisting with the post-operative process.

Soon thereafter, Operation Smile made the tough decision to suspend operations in Mozambique due to political unrest unfolding at that time. By 2017, those tensions had eased, and Operation Smile reached a new agreement with the Mozambican Ministry of Health. Going forward, the partnership will focus on conducting medical missions and providing training and education opportunities for local health professionals.

Even after the three-plus year pause in activity, Carlos was ready to jump back in when Operation Smile came calling again in 2018.

Raising awareness on the community level that cleft conditions are surgically treatable, Carlos uses pamphlets and literature provided by Operation Smile to explain the organisation’s mission when he visits schools and clinics.

“I talk with the people and say, ‘If you know any people who look like this and who need help or can’t afford to go for local surgery, they can please contact me and so I leave my number,’” Carlos said. “When they contact me, I forward them to Operation Smile. They then contact me and send me the scheduled date for the missions. I then let the patients know and I bring them with me.”

At the Quelimane mission’s patient village, Carlos was constantly on the move, supporting patients in any way he could.

“I assist with translating, helping patients with screening, making sure they get food and accommodation,” Carlos said. “If they get sick, I get them to the nurses and also helping them with anything they need.”

To be able to volunteer as a patient advocate throughout the Quelimane mission, Carlos used all of his annual leave, effectively donating that paid time off to the service of patients and their families. Uninterested in receiving praise or recognition for his efforts, he simply told his employer and co-workers at the time that he would be on vacation.

His motivation is as pure as it is profound.

“I feel happy because it’s like I am changing the life of the patient and that makes me very proud,” Carlos said. “I also see people being changed and becoming equal with the rest of the community. That makes me very happy.

“Let us open our hands, let us open our hearts and try to help those in need. It is very important for us to change the lives of others so they can become one with the rest of society.”

Patient coordinator Carlos Mahalambe speaks with Sean Robson of Operation Smile South Africa during the July 2018 Quelimane medical mission. Photo: Zeke du Plessis.

His Grain of Sand

Driving down his typical sales route, Victor Hernández, a Sabritas delivery driver in Chiapas, Mexico, saw something that shook him to his core.

After noticing a group of children playing together near the side of the road, Victor decided to pull his truck over and offer them a simple act of kindness – some bags of free potato chips.

When Victor approached the kids, he came face to face with Irma, a 5-year-old girl who was living with an untreated cleft lip and palate.

Immediately, he began making phone calls to his colleagues to find help for her.

“For me, it was important to act immediately because … the faster I acted, the chances of finding help would be better,” Victor said. “I would be able to get more support. It involves looking here, searching there, talking to this person, talking to that person, and maybe that way I was going to find support faster.”

Sabritas driver Victor Hernández stands in front of his delivery truck in Chiapas, Mexico. Photo: Rohanna Mertens.

It was then that Victor learned that Sabritas is a long-standing corporate partner of Operation Smile Mexico. Sabritas is a subsidiary of PepsiCo as is Lay’s, which partnered with Operation Smile for two successful U.S. campaigns, “Smile with Lay’s,” that raised $1 million in both 2018 and 2019.

And one of his colleagues told him that, at that very moment, Operation Smile was hosting a medical mission just 40 minutes away from Irma’s community.

Victor returned to explain to Irma’s parents that free and safe surgery was possible at the mission.

After Victor carefully explained what they could expect, Irma’s parents agreed to have him pick them up and take them to the mission site two days later.

This was the first time that Irma had ever left her community.

After receiving a comprehensive health evaluation from Operation Smile Mexico medical volunteers, Irma underwent surgery to repair her cleft condition, ensuring a brighter future full of smiles – a future that she always deserved.

“Seeing her finally smile, and with her face completely changed, despite the stitches she had, gave me a pleasant feeling,” Victor said. “It’s really indescribable because we knew then that this girl would have a completely different life.”

Photo: Rohanna Mertens.
Photo: Rohanna Mertens.

Today, Victor continues his advocacy for patients like Irma living with cleft conditions in the communities around his route.

“After little Irma’s operation, I tried to get more involved,” Victor said. “I felt the urge to put up posters in stores, talk to people and see if they knew anyone with the same condition, try to get them to approach me so that I could channel them into the right hands.

“As a human being, I felt so much tenderness and concern to see the needs of these children.”

Victor’s commitment to spreading awareness continued to strengthen, and more people began to see him as a reference for Operation Smile Mexico – as a person they could trust to help.

Eleven-month-old Carlos with his parents, Azucena and Juan Carlos, and Victor at their home in Pueblo Nuevo, Mexico. Photo: Rohanna Mertens.

It was then that Juan Carlos and Azucena approached Victor, hoping that he would help their 11-month-old son, Carlos, who was living with an unrepaired cleft. Victor immediately told them that Operation Smile Mexico was the solution.

Photo: Rohanna Mertens.

“Little Carlos’ parents are young and, like all parents, sometimes they worry a lot about their children,” Victor said. “But I see that they care for him, love him, and they’ve done the impossible by bringing him (to Operation Smile).”

Medical volunteers performed a comprehensive health evaluation on Carlos and determined that he was healthy enough to receive safe surgery and a new smile.

The day that Victor made the decision to help Irma, the course of his life changed forever. And connecting Carlos and his family to Operation Smile only inspired Victor to do more for the people living with cleft in Mexico.

“One’s life changes when one cares about the little people one helps,” Victor said. “I feel really good, and I would like to help more people. I know that, perhaps, what we do is a small thing, just a grain of sand, but with that grain of sand, a life can be changed. And if we just look around us, we can see more people in need.”

Victor with Azucena as she holds Carlos in her arms after surgery during Operation Smile's May 2019 medical mission in Mexico. Photo: Rohanna Mertens.

Voices From the Frontline: Q&A with Nurse Dinah Leal

Dinah - Covid

Q: Could tell us a bit more about what’s the situation in your hospital and how you’ve been involved with the COVID-19 response?

A: “I work in one of the largest teaching hospitals in Europe and we’ve been involved in the frontline response to COVID-19 from the start, because we’re the primary hospital for COVID admissions for our region. As a member of the perioperative team, I was directly involved in the reassigning of our operating theatres, as ICU, overflow pods for patients requiring critical care. So we were responsible for the reconfiguration of the theatres and the staffing of the new area in supporting the critical care steps.”

Q: How has being involved with Operation Smile helped prepare you for responding to the COVID-19 pandemic?

A: “My involvement with Operation Smile helped in so many ways. In particular, it helped us with the building of the new clinical areas such as the operating theatres, all the skills were used in Operation Smile, preparing for the missions, that gave me the skills for the planning and reassigning of the new clinical areas. The skills developed in team working were invaluable in this situation, which helped with the reconfiguration of the critical care areas in a hurry.  And also the communication and the teamwork. Well, you have to be very clear about reassigning tasks and what you want to achieve and working in a logical and efficient manner to build a new area that works for the new purpose. It was a wonderful experience and I really enjoyed.”

Q: What kind of limitations have you and other members of your team faced?

DL: Well, we faced a lot of challenges and limitations. But first of all, we were particularly challenged by the time factor because we were expecting a surge in critical care needs to arrive very suddenly, possibly overwhelmingly. So we were really challenged to prepare very quickly.

Similarly to an Operation Smile situation where we have to really be ready in a couple of days. And sometimes we can be delayed by lack of cargo, or delays in cargo. But still, we have to be ready to start surgery on the Monday morning. Here in our situation, we needed to be ready to provide critical care very quickly.

The next serious challenge we faced was the equipment. We were very low. There was a nationwide shortage of equipment, especially ventilators and oxygen delivery equipment. But between the team and the biomedical team, we were able to work together and we quickly managed to overcome this and more than doubled our capacity for critical care in a few days. It was challenging but it was very exciting to be part of it and see how it worked.

As the situation progressed, we were then challenged by the shortage of PPE, that was the next big challenge for the country and for us on the frontline, that meant that we had to be really careful about what we used. And we had to make sure that we didn’t use equipment that other staff would need more so than us. We had to be very careful and select the appropriate one to the task and be very mindful of waste and, you know, looking after our colleagues, because it was a very, very real possibility that we could run out at any time. We did get very low on a couple of occasions early on in the crisis but we were able to get by just by judicious use of it really.

Q: In light of this pandemic, why do you feel it’s so important to recognise nurses and the role they serve in the medical field?

A: Well, nurses have been rightly recognised as playing a critical role in the response to COVID-19. And I think their importance in the frontline was really recognised.

They are a vital part of the team response with their ability to support their medical colleagues and provide the caring and the hands-on skills which have been an intrinsic and essential part of patient recovery.

The role of nurses has been even more important because they had to play the role of the family, due to the infectious nature of the disease. In many cases, the enormous responsibility of supporting the patient at the end of life has become one of the most vital nursing roles, which normally the family would do alone.

So it’s been particularly poignant to see the role of nurses here, and some of the stories that have come from the ICU are very moving and very, very sad because so many patients have died without their family and it’s been terribly difficult to manage. So the role of nurses in that respect has been really important.

It brings to mind the importance of our role in Operation Smile missions, where the nurses are the ones who are entrusted with the safety and care of the children on behalf of their parents. That responsibility, and the honour and privilege we have playing that role when these parents hand their children over for surgeries, brings home how important this role is. It is not only a clinical role. It’s a real, real caring role.

Q: Did you feel prepared, like psychologically prepared or did you receive any support for that? Because I know that it can be very hard to process all of this.

A: Well, my exposure to the situation has been very limited because I work in the operating theatre. I know my colleagues have found it extremely difficult. The hospital has provided a lot of support, but it remains to be seen whether that’s been enough. As colleagues, we can provide support to each other and nurses are really good at doing that.

In the early days, I felt very strongly as one of the senior members of staff, that supporting the younger staff was really important, and really listening to them and being there for them. Another role was really important for us senior nurses, particularly, because in our hospital, they sent the younger staff down first, and the senior ones were kept away because we might get the virus. So our role is very supportive.

Q: I can imagine and as you said because of your experience with Operation Smile, you developed skills that are beyond your standard duties that can help.

A: In Operation Smile missions when you’re working in different countries, there’s a massive level of trust for those parents to hand the children over to us. It’s a different thing to caring for patients in the ICU, but it’s still a very personally challenging situation.

Q: What motivates you to continue fighting on the frontline?

A: Well, as a nurse, it’s a vocation to do whatever is necessary to ensure the safety and the best care of our patients, whatever the setting. On a personal level, the rewards of doing this kind of work can’t be put into words. It comes from the joy of seeing a patient recover after successful treatment. That’s our mission, whatever the setting.

Q: At Operation Smile we always have the happy ending, because of the type of activities that we do. I think that in this kind of situation it’s hard to see that sometimes you’re not able to provide a happy ending.

A: That’s right, but, in fact, you know, nursing isn’t always about happy endings. Sadly, it’s about many different sorts of endings. What’s fundamental for us is knowing that you’ve done your best to make the situation, however difficult it is, a little bit better for the patient and the family.

That’s the real joy of knowing you’ve done a good job.

Q: Can we talk about the Malawi programme because I know how much passion and experience you put into this programme. So can you just tell us if you feel like the training, the charity deed is helping local nurses to cope with Covid-19?

A: I’m sure it’s helping and I sincerely hope the planning and preparation skills we’ve taught them in setting up our clinical areas for Operation Smile, together with the techniques for delivering care, in particular, the aseptic techniques and techniques for the prevention of cross infection. These are vital skills for managing the effects of this pandemic and I hope that they’ve helped our nurses in Malawi. We planned to teach specialist skills in Malawi, but on top of a good basic foundation, basic techniques for prevention of infections. All those topics are all part of the training programme and they’re all techniques that can be used no matter what the subject is. So surgical or medical in the case of the pandemic, these skills are across the board and the aim of our programmes in Malawi is to teach the basic skills. I can’t wait to go back there. I was supposed to go for the long-term placement in April.

Operating room Nurse Dinah Leal, instructs at a scrub tech training programme. Operation Smile’s 2019 mission to Kazumu Central Hospital, Lilongwe. Malawi. Photo: Operation Smile - Zute Lightfoot.