Therapeutic play alleviates fears for patients and their families

Therapeutic play alleviates fears for patients and their families

Child life specialist Cathy Cheonga, shares her experiences of volunteering for Operation Smile in Malawi and explains the importance of psychosocial care for patients.

Operation Smile's child life specialist, Cathy Cheonga, comforts Gertrude, before her cleft surgery

Medical volunteers like Cathy Cheonga in Malawi, play a vital role in the comprehensive care that helps our patients to thrive. Cathy is a child-life specialist and uses therapeutic play and activities to help our patients feel calm and relaxed before cleft surgery. This psychosocial care has a huge impact on our patients, many of whom have never been into hospital and are understandably anxious.

Cathy has been an Operation Smile volunteer for five years and has volunteered on six surgical programmes, she tells us more about her role and what inspires her.  

Q: Tell us about your role – what do you do on a surgical programme?

A: “I support patients and caregivers from their first moments when they arrive on the screening day and that’s the most important time to interact with the caregivers, as well as the patients. Because for most of them, it’s their very first time and they may have never been to the city or wherever we’re holding the surgical programme. So, everything is new to them. That’s the best part whereby you become so vulnerable, so that they trust you. Then I help them and walk with them on the journey.

“Many are also scared because they’re being told stories about cleft. For example, I met a mother whose child had a cleft palate and, in that village, that child has never been seen, because people will tell them mean things, like that the child is not going to make it and these sorts of things. So this is the best part of the mission, because I love to work with the caregivers as well as the patients, just to reassure them and to tell them that there is hope, there is a smile at the end of the journey.”

Q: What do you like most about working with Operation Smile?

A: “There are so many professionals, medical and non-medical coming together, just giving it their all to create something special for the patients. I love the interaction and integrations, I’m also learning lots of new things through working together. For example, I’m learning a lot of medical terms – sometimes I’m like ‘Oh, so this is what it is’ about some specific terms, I had just maybe heard when I visit my doctor, but now I’m able to understand even more. So, yes, I’m learning a lot of things – that’s good! ”

Q: What is your favourite patient story?

A: “Ah, there’s so many but I still remember this one lady. She grew up in a village and in that community she was the only one with cleft, both lip and palate. The stigma was really severe. However, her mother was determined to not give up on her – she used to say, ‘I’m gonna keep this child!’ and she cared for that child, until she grew up into a young lady.

“Then another man asked to marry her, despite whatever the parents of this man were saying about her cleft lip. His family was worried about the kind of children they would have. When he decided to marry her, they asked him to leave their community and leave them alone because they didn’t want to have anything to do with a woman with a cleft.

“They got married and they had two children together. One day, a friend of the husband told them that there were people providing care for people just like his wife. They said, ‘Why don’t you give it a try?’ They were excited but they also concerned about how they could afford it, as they thought it would require a lot of money.

“Their friend told them that care was free and that they just had to register. They didn’t know how to register, until one day he went to the city – as he is a businessman – and he saw a poster. He then got in touch with the patient coordinator and they managed to get to the next surgical programme.

“This is when I met them and she was very worried that the outcome of the operation could be bad. I spent time with her, chatting and encouraging her as much as I could. Then she felt much better when the surgeon came to take her to the operating room.

“After surgery she called me and she said that she wanted to thank me for encouraging her. She told her husband that she wanted to go to home very late, so that they would arrive in the middle of the night so she could surprise all the ladies of the village the following morning. She said, ‘I knew they would be there watching and doing all the errands and they would be staring at me, genuinely surprised.’

“I don’t think I’ll ever forget this story. You know? How she couldn’t believe that it was her when she looked at herself in the mirror? She thought it was a video! So I told her to go and look at her new smile on another mirror!”

Q: What are your hopes for Operation Smile in Malawi?

A: “So my wish is to see that when the children are born with cleft palates, they’re attended to immediately if the mother wishes. At that same time how, I think what they’re doing bringing in different sectors – I know these young people we’re bringing in, most of them have the passion and if they helped or were mentored so that they see what is lacking in our nation, so that they help, that would be great. ”

Q: What do you think was the impact of COVID-19?

A: “COVID caused a lot of impact, whereby maybe some of our patients lost hop. Especially those that maybe have just come to realise that surgery was possible or the ones born more recently, between 2019 and now. And who knows how many maybe we lost due to COVID or malnutrition, that could have had a great new smile? ”

Q: What are the biggest problems that you see in our patients’ lives?

A: “Stigma is the biggest enemy. Because of that stigma most of those patients that we are seeing are not going to school. Only a few are going far with education. Just a handful, but the rest, they go to class one, class two, in primary school, and then they’re being bullied! When they are a bit older and they realise what is happening to them, they just opt to drop out from school. So yeah, stigma is a big challenge.”

Q: What can we do to help more children, especially from this psychosocial perspective?

A: “What I feel would help is to have mentors, psychosocial counsellors being brought up in different communities where Operation Smile is, so they can be considered like support groups, helping out the patients and families wherever they are coming from. This can actually have a great impact!

“Who knows, maybe one day, the government will actually help out in having open education to kids in their own homes, just as they do in in some countries, whereby when a child has been hospitalized, he or she doesn’t use classes, their teachers can help them in their home or hospital.

“We are losing a lot of children from education, because they shy away from going back to school, and those parents cannot afford private tutors to be teaching those students at home. So these mentors can actually help them out and maybe making the parents understand that the children can still go back to school with a cleft condition.”

Cleft care goes beyond surgery

Our volunteers provide patients with comprehensive cleft care like emotional support. With your help, we can continue to care for children who desperately need our help.

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

Nourishing Her Country: Q&A with Nutritionist Monica Arredondo

Nourishing Her Country: Q&A with Nutritionist Monica Arredondo

In Guatemala, where one in every two children suffers from chronic malnutrition, Monica Arredondo’s lifelong passion is not only saving lives but helping alleviate a need in the country she loves.

Volunteer nutritionist Monica Arredondo during a surgical program in Guatemala.

“I chose nutrition because it’s a very important issue,” she said. “I wanted to contribute to Guatemala, my country, to be able to contribute my grain of sand to the children and achieve a better nutritional state for them.”

Living in impoverished areas around the world, the threat of malnutrition is severe for many families who are facing food insecurities and lacking easy access to resources they need. These risks become even more dire for children born with cleft lip and cleft palate because living with an untreated cleft condition can sometimes make it impossible for children to breastfeed, bottle-feed or eat solid foods.

And when children don’t receive proper nourishment or timely nutritional support, they can’t qualify for cleft surgery and continue to face life-threatening health consequences – even sometimes death.

Seeing her patients arrive to a surgical programme after having received ongoing nutritional care, Monica feels in her heart that she’s made a difference in their life and her own.

“To these patients who are here … it’s very exciting,” Monica said. “Everything we do with nutrition, everything is for them to be able to qualify for their surgery, and this definitely changes their lives in all aspects.”

We recently caught up with Monica to hear more about her dedication to serving the needs of her country and how Operation Smile Guatemala is confronting the impact of malnutrition head on.

Q: Can you go into more detail about the nutritional care Operation Smile Guatemala provides to patients and their families?

A: “First, children are evaluated to identify their weight and their size. To evaluate them, to identify whether they have chronic malnutrition or acute malnutrition, and also determine if they have a growth delay. Depending on the diagnosis that’s given, we can then choose the children who have malnutrition and enter them into the nutrition program. This is a program that Operation Smile Guatemala has to support families and provide them with baby formulas and other products to improve the nutritional state of their children.”

Q: Why is this specific discipline of comprehensive care vital to patients?

A: “It’s very important because, as I said, there are many children who have chronic malnutrition. This is also related to several factors, among them being the economic situation of the families, so this greatly influences the nutritional state of the children and as a country. Nutrition is very important because chronic malnutrition is a pretty big problem here in Guatemala and also for our patients with cleft lip and cleft palate.

“It’s important that patients have the right weight and size so that they can qualify for surgery. For parents or guardians, because sometimes it’s also other people who take care of the children, it’s very important to them. They are very grateful to Operation Smile Guatemala because we support them through ongoing consultations. Parents have many questions about what food they can give to their children. So for them, the first appointment is very important, but also the follow-up that’s given by Operation Smile Guatemala in terms of how they can be supported by nutrition.”

Q: What challenges did the COVID-19 pandemic create for you and your team?

A: “In relation to the pandemic, it was a hard situation for Operation Smile Guatemala because it’s very important for us to have in-person consultations to evaluate weight, size and how the children are feeding. When it was done virtually, it was a problem because many of the families didn’t have this ability. So not having in-person consultations really affected us. It was hard because we didn’t have the opportunity to see the patients, so it was really difficult for us to have a follow-up with them.

“However, virtual consultations were carried out. It was about calling all patients who had scheduled appointments so that our team could collect the weight and size information. Nutritional education was greatly strengthened by these virtual calls for parents to also feel the help of how to continue to support their children.”

Q: There was a recent Operation Smile Guatemala surgical programme in Petén. How did it make you feel to see patients arrive to the programme healthy enough to receive surgery after having battled malnutrition?

A: “To these patients who are here, the truth is that it’s very exciting because it’s something that families expect. It’s very exciting for both the families and for us who are following the growth of all these children so that they could be here. Everything we do with nutrition, everything is for them to be able to qualify for their surgery, and this definitely changes their lives in all aspects.”

Providing nutrition care where it’s needed the most

Your support enables Operation Smile’s continue to provide nutrition programmes in countries such a Guatemala.

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

A Woman Who Inspires: Q&A with Surgeon Dr. Gladys Amaya

A Woman Who Inspires: Q&A with Surgeon Dr. Gladys Amaya

Like so many of the men and women who donate their life’s passion to Operation Smile, Dr. Gladys Amaya feels that the transformation she creates in the lives of people born with cleft conditions doesn’t compare to the impact they have made on her in return.

Gladys Amaya assists during surgery at the Operation Smile Cleft Lip and Cleft Palate Integral Care Clinic in Tegucigalpa, Honduras. Photo: Rohanna Mertens

Learning about Operation Smile Honduras during her medical residency, Gladys never looked back after witnessing the need for high-quality cleft care from medical professionals and surgeons like herself.

“I did not imagine the magnitude of the health problem we had in Honduras,” she said. Gladys hopes to inspire future surgeons just as her family encouraged her to never let anything stand in the way of going after her ambitions and goals.

“My dad was a man who stood up for women. They told him not to send me to the capital city to study,” Gladys said. “Today, Honduras has a woman president. I am currently the president of the Honduran Association of Plastic Surgeons. I think I am the third female plastic surgeon in Honduras.”

We recently caught up with Gladys where she spoke about the pride she feels serving as a female medical professional in her home country and how learning from her fellow volunteers shaped her into a better surgeon.

Q: How did you feel attending your first surgical program with Operation Smile Honduras?

A: “The first time, I was a resident, and I felt like I was a foreigner in my own country. They all knew each other and yet I was very well received. The good thing is that, as a resident, you work with doctors who already had 25 years repairing cleft conditions. One thinks that they know everything, but standing before a teacher, you realize that much remains to be learned. I was lucky as I worked with good people who guided me, explaining things to me step by step. All in a very loving way. I felt that it was a family. It was very impressive.

“I had the opportunity in that first program to work in the pre-operative ward. Around 300 patients came. At the end of the day, I was so tired. I didn’t imagine the magnitude of the health problem that we had in Honduras.”

Q: Do you think that volunteering for Operation Smile Honduras programs helped make you a better surgeon? 

A: “Completely. But it’s not just about surgical skill. Everyone becomes more sensitive. I love it because I have contact with surgeons from different cities and we meet and share. Every program is different. Even if you are the lead surgeon, a little tip from a colleague can make all the difference. Someone may think that it is something repetitive to operate on a cleft lip or cleft palate, but no, it’s about the patients.

“When I started in Operation Smile, I already had a son, and this generated an enormous empathy for children with cleft lip and cleft palate. Someone told me, ‘Charity starts at home,’ and I learned to have a little balance between the programs and my home.”

Q: How does it feel to be part of a team with other volunteers? Do they acquire knowledge that they later transfer to their communities? 

A: “In Operation Smile, we operate with an instrumentalist only. So you learn to work with both hands. The instrumentalist already knows everything they have to do and they already knows my rhythms during surgery.

“Teamwork is the best. The beauty of Operation Smile is that there is no competition. We just do it the best way we can, and in the end, we all achieve almost the same results. We create a standard.”

Q: You recently ran an all-female surgical program. What inspired you to do that?  

A: “Most of the volunteers and staff at Operation Smile Honduras are women. Operation Smile carried out a ‘Women in Medicine’ program in Morocco, and we had the idea of doing something similar to commemorate Honduran Women’s Day on January 25.

“We women felt empowered that we could do it. And it was possible because most of the team are women. One of the volunteers has to travel three to four hours to get to the program. She has a son born with a cleft palate. She said, ‘Operation Smile operated on my child, so I’m going to be a volunteer for Operation Smile.’ And she has reached out to more volunteers.”

Q: What is the difference that a program carried out only by women can make? 

A: “The benefit is because we know each other. We are a team. The women-only program went great, but it’s not about excluding men. For me, it was a coincidence that we were only women. The result does not depend on us being women. No matter the gender, every professional learns to do it one hundred percent.”

As stewards of Operation Smile’s mission to improve health and dignity through access to safe surgery, the women who served on this programme changed the lives and futures of 70 families.

As one of the 70 patients who received life-transforming care, 3-year-old Chaoui departed from the women’s mission with a brighter and healthier future ahead of her.
For many patients like Chaoui, surgery is the first milestone along their journey with Operation Smile Morocco. Additional orthognathic surgery, speech therapy, psychosocial care and more are a few of the ongoing comprehensive services the local team delivers at their multiple care centers across the country.

“I really try to do as much speech therapy and train the parents to do the therapy and encourage them so that their child can go to school or go back to school,” said volunteer speech therapist Candace Myers of Canada.

“I often tell the parents, ‘With quite a bit of work, they can improve their speech, and then they can be a doctor, a surgeon, a nurse, a teacher. Your child can do anything.’”

Strengthening local health care systems

Your support enable Operation Smile’s work with local health care professionals to build capacity and create long term sustainability for cleft care.

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

Women in Medicine: Clark Agno Gonzales

Women in Medicine: Clark Agno Gonzales

To celebrate International Women’s Day 2022, EMEA Recruitment welcomed Clark Agno Gonzales onto their podcast. Clark is a medical volunteer with Operation Smile.

Clark in a programme wearing an Operation Smile tshirt

“I’ve got this skill, I’ve got this talent, there’s really nothing that’s going to hold me from helping these kids.”

Clark is a nurse with the NHS in the UK. She also volunteers as a recovery room nurse on our medical programmes around the world. She explains to Paul Toms, our Founder, how many children she looks after on a typical mission and the countries that she’s visited with the charity.

Originally from the Philippines, a case that particularly stands out to Clark was in her home country. A grandfather brought one of his grandchildren for surgery, but had a bilateral cleft lip himself. When the Operation Smile team offered to operate on him, they saw an immediate transformation, which was emotional for all involved. Clark and her fellow volunteers connect after the day’s work over dinner to let their emotions out.

She was originally invited to join an Operation Smile medical programme by her university professor. Using her skills and talent, Clark sees an instant transformation in her patients.

There are up to 100 volunteers on a programme. Before the surgery day begins, they break into teams to plan, and even connect with each other before leaving for the mission. Local volunteers ensure that the Operation Smile team stays safe in each location.

Two years ago, Operation Smile organised a Women in Medicine short-term surgical programme, where 60% of volunteers were female. This teaching programme focused on empowering women to complete the surgeries on their own. Senior surgeons, nurses and dentists go along to share their knowledge with the younger generation, which aims to benefit patients and the health system in that country.

Clark reveals the challenges she faces before and during a medical mission. She also explains how she manages to fit these missions into her life, amongst a day job and new baby. It’s the “mission high” that brings joy and happiness to Clark, who even gives up her holiday time for Operation Smile.

We end the episode by finding out what Clark has learned about herself by visiting Operation Smile’s programme sites.

Listen to the full episode via your podcatcher of choice or in the link

Changing Lives: Q&A with Operation Smile volunteer nurse Jackie Matthews

Changing Lives: Q&A with Operation Smile volunteer nurse Jackie Matthews

Jackie Matthews works as a Clinical Nurse Specialist in the UK. She specialises in the care of infants and young children born with cleft conditions. She is also an Operation Smile volunteer and UK Medical Sub-committee member.

Jackie has been on medical missions to Mexico, Malawi, the Dominican Republic and Ghana.

Can you tell us more about your medical missions with Operation Smile?

I went on my very first medical mission as a volunteer in 2011 to Guadalajara, Mexico. My role was to help children in the recovery room just after they had received surgery.

On my second medical mission, I joined other professionals from the USA, Sweden, Russia and Estonia, flying to Santo Domingo in the Dominican Republic.

There we screened more than 120 babies, children and adults, and had four operating rooms running consecutively, performing facial repairs for cleft lips, palates and other conditions. In total, we performed surgery on 79 patients, the youngest being just six months old – a little boy named Joshua.

I was lucky enough to follow little Joshua through the patient journey, accompanying him at screening, pre-operative assessment and on the morning of his surgery when I recovered him after his procedure and he woke to a familiar face. I was able to answer his mum’s questions and formed a relationship that really helped allay her fears. It was an amazing experience.

UK medical volunteer Jackie Matthews entertains a baby held by her mother

Jackie plays with a baby during a medical mission in Malawi

UK volunteer nurse Jackie Matthews comforts an emotional mother as she looks at her child after cleft surgery

Jackie comforts a mother as she sees her child for the first time after cleft surgery

What are the main challenges you and the other medical volunteers have to face during a medical mission?

When an Operation Smile team arrives in a new country for a 10 day surgical programme we take much of our own equipment. This is so that we can follow, as closely as we can, the theatre environment, and standards we enjoy at home. Even then, on my last mission to Ghana, we had to contend with heat, electrical storms, and power failures!

During each mission we have to adapt to the new theatres and hospital environment. It’s very grounding work, with a team you’ve never met before. We hit the ground running, and have to be confident in our job so that we can meet any emergency and know what to do and who to go to.

Are there any similarities between your job in the UK and the one you do with Operation Smile?

My job is the same wherever I am, of course the conditions vary from country to country, but people are more like each other than we can imagine.

When a father at my hospital in the UK hands his child over to me, the worry in his eyes is just the same as in the eyes of a mother in the Dominican Republic when she hands over her teenage daughter. There are many tearful moments when you see a child’s beautiful smile and their parents’ reactions when they see their child after their operation. It is so rewarding to know we’ve played a part in this transformation.

It really breaks my heart every time I meet a child who does everything to hide their smile.

Why are you so passionate about Operation Smile?

I consider myself lucky because I can see for myself the difference we can make together – to so many children and their families. My work doesn’t end when I come back to the UK – it continues and multiplies as I can tell other people what I have seen. I also love talking about my experiences and showing my photographs to local groups and schools.

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

Our medical missions wouldn't be possible without our amazing medical volunteers, who selflessly give up their free time to support us. Help us continue to provide life-changing cleft care by clicking the link below.

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Training surgeons: Q&A with Dr. Ravaka Rakotorahalahy

Cleft surgeon Dr. Ravaka Rakotorahalahy of Madagascar. Photo: Lorenzo Monacelli.

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

In cleft surgeon Dr. Ravaka Rakotorahalahy’s home country of Madagascar, there are many obstacles that prevent patients from getting the surgery they need and deserve.

Before the country was gripped by COVID-19 lockdowns, one of Ravaka’s last patients he served lived with an untreated cleft lip for 19 years.

In many communities, people may not know that surgery can treat cleft lip and cleft palate. While not an emergency condition, cleft surgery is time-sensitive, and often children suffer long-term speech, nutritional and aesthetic complications if they don’t receive surgery early in life. Many people can’t afford to pay for an operation or live very far away from a hospital and lack the means to get there.

Also, some of the most significant barriers to surgical care are the lack of healthcare workers, trained surgeons and physical infrastructure needed to meet the demands of Malagasy people living with cleft conditions.

That’s why Operation Smile is committed to helping patients and their health systems overcome these daunting challenges so that everyone who needs cleft surgery can receive effective treatment as soon in their lives as possible.

Established in 2017 and funded by Stryker, Operation Smile’s Cleft Surgeon Training Programme (CSTP) addresses the fundamental need for more – and more highly trained – surgeons to provide ongoing quality cleft care in their communities.

In addition to rapidly elevating the skills of cleft surgeons in resource-limited settings which lack specialised training opportunities, the programme creates a pathway for candidates to become credentialed Operation Smile medical volunteers.

CSTP candidates are paired with mentors – experienced Operation Smile volunteer surgeons – with whom they train during two to three surgical programmes per year in their home country.

Dr. Ravaka Rakotorahalahy with mentor Dr. Pernille Lindholm of Denmark during a 2019 Operation Smile medical mission in Madagascar. Photo: Rohanna Mertens.

“I quickly discovered that Ravaka had dexterous hands that were precise and steady. His brain was sharp, and he quickly picked up the art of cleft surgery with remarkable attention to detail that cannot be taught. You just have it. And Ravaka had it,” said Dr. David Chong, one of Ravaka’s mentors and chair of the CSTP. “Most of all, I noticed Ravaka’s heart. Filled with compassion and kindness, he was incredibly gentle with patients and families. He loved caring for his people. One of the great highlights of my work with Operation Smile has been to see the wonderful cleft surgeon that Ravaka has become and rejoice for what that means for the people of Madagascar.”

So far, the eight graduates of the CSTP have provided more than 300 cleft surgeries in their communities outside of Operation Smile medical programmes.

Currently, Operation Smile is preparing for a second cohort of CSTP candidate surgeons to start the programme in July 2021. We’re working closely with our teams around the world to identify and designate local educators and partner with local hospitals to provide quality cleft surgery training despite challenges presented by the pandemic.

We recently caught up with Ravaka, a recent CSTP graduate, about his experience in this unique training programme and how its empowering him to deliver world-class cleft care in a place of dire need.

Cleft surgeons Drs. Irene Tangco of the Philippines, left, and Ravaka Rakotorahalahy of Madagascar repair the cleft lip of 14-year-old Irongany during a 2018 Operation Smile Madagascar medical mission in Antsirabe. Photo: Rohanna Mertens.

Q: What inspired you to pursue a career in cleft surgery?

A: “Since I was a student, I was a fan of surgery. In general surgery training, I realised that I am quite comfortable in soft surgery. Then, I had the opportunity to learn about Operation Smile when I was in Antsirabe. I participated and loved it so much.”

Q: Could you describe the need for more trained cleft surgeons in Madagascar? What are some of the challenges that young medical professionals can face as they pursue their specialty?

A: “In Madagascar, there are many cases of cleft lip and cleft palate, so it is really essential to have more well-trained surgeons in this specialty. There are fewer cleft surgeons in Madagascar because this specialty is not offered during residency. Here, paediatric surgeons and maxillofacial surgeons are trained for cleft lip and cleft palate surgery.”

Q: How did you learn about the opportunity to participate in the CSTP? What were your initial thoughts when you learned about the programme?

A: “When I was in Antsirabe as assistant surgeon in the surgery field, Operation Smile carried out a medical mission in our hospital. Then, Dr. Romain Raherison, a paediatric surgeon who already worked with Operation Smile, asked me if I was interested in joining the organisation. Without hesitation, I accepted … He introduced me to country manager Mamy Ramamonjisoa, and since then I was there as an observer. After two missions, I was asked to join the CSTP.

“When I was informed about this programme, I was really happy to be among the participants. There, I said to myself that I will develop my knowledge, my skills and experiences. Once I am able to operate, I will help my compatriots who suffer from cleft lip and cleft palate.”

Q: Has the CSTP provided you with training and education that you may have otherwise not received?

A: “Certainly, the CSTP provided me an exceptional training and education. Maybe I could access training like that in another country, but I would never have the financial capacity.”

Cleft surgeons Drs. Ravaka Rakotorahalahy of Madagascar, left, Luca Autelitano of Italy, centre, and speech pathologist Angela Rezzonico of Italy examine a patient during a 2019 Operation Smile Madagascar medical mission in Antsirabe. Photo: Margherita Mirabella.

Q: Who were your CSTP mentors? Could you tell us more about your relationship with them and how they worked with you?

A: “My mentors are Drs. El Hassan Boukind (Morocco), Christie Smit (South Africa), Beto Herrera Ruelas, Desi Mwepu (Democratic Republic of the Congo), Irene Tangco (Philippines), David Chong (Australia), and Pernille Lindholm (Denmark).

“With my mentors, we got along well. They shared with me their techniques, some tips and even the way of life for a plastic surgeon. Everyone has their own pedagogy, but it is not difficult to adapt. They have become both friends and family to me. I will never forget them.”

Q: What are the skills that you feel the programme helped you most improve?

A: “The CSTP helped me a lot in terms of precision and accuracy. My mentors taught me the principle of flaps and suturing techniques in plastic surgery and to have soft hands with each gesture. In short, the CSTP also helped me develop skills in general surgery because, currently, I practice them in every operation.”

Drs. Briand Michel Rakotomanga, left, and Ravaka Rakotorahalahy, third from the left, observe as cleft surgeon Dr. Lora Mae de Guzman of the Philippines operates and Hasina Ramiakajoto, right, translates as part of the Cleft Surgeon Training Programme. Photo: Rohanna Mertens.

Q: Could you share one of your most powerful or poignant experiences with a patient/family while training? After graduation?

A: “When I graduated, during the last mission before COVID-19 lockdowns in February 2020 in Antsirabe, I had a case of incomplete bilateral cleft lip in a 19-year-old girl from Mananjary in the southeast of Madagascar who had a lot of difficulty in her social life and in her studies. I operated on her cleft lip while she was under local anaesthesia (older patients can received cleft lip surgery with an anaesthetic injected at the surgical site, similar to how anaesthetics are used for dental procedures). She was very good during the operation; I always spoke to her throughout the operation.

“When we were done, she was really happy when I showed her a photo of her new smile. She couldn’t smile right away, but her tears flowed when seeing her photo. The next day, I saw her, she insisted on taking a picture with me. Six months after, Operation Smile decided to do mobile post-operative checks, and I was among the team going. I had the opportunity to meet my patient and her family in Mananjary, the result is impeccable. There, I asked her why she was really good during the operation and she replied that she just wanted to have a smile like the others and to be able to live without problems.”

Q: What would you say to another Malagasy surgeon who would be interested in joining the CSTP?

A: “To Malagasy surgeons who wish to join the CSTP, it is a very interesting programme in which we acquire a lot of skills not only in plastic surgery but in all types of surgical management. Good luck and work hard. The Malagasy people are waiting for us and need our support.”

Q: Why are you passionate about practising cleft surgery in Madagascar?

A: “Given the high number of cleft cases in Madagascar, I want to give hope and a smile to the lives of these people … I am very passionate about plastic surgery. God gave me all the assets to do it.”

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

Cleft surgeon Dr. Ravaka Rakotorahalahy of Madagascar. Photo: Margherita Mirabella.

Celebrating the Year of Health and Care Workers

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Speech therapy programme “HablemOS” helps thousands across Latin America

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Photo: Zute Lightfoot.

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

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

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

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

Operation Smile staff member talking to carers about nutrition
Operation Smile's nutrition programme manager Charlotte Steppling greeting a child during a programme. Photo: Rohanna Mertens.

Going the extra Miles for Smiles: Madagascar nutrition programme

Mother holding baby with a cleft who's feeding from a bottle
Held by his mother, Patricia, 14-month-old Icardi sips formula from a bottle. Photo: Henitsoa Rafalia.

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

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

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

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

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

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

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

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

Photo: Henitsoa Rafalia.

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

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

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

Photo: Henitsoa Rafalia.

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

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

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

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

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

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

Photo: Henitsoa Rafalia.

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

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

Patient Coordinator, Jose Augustin holding baby boy with a cleft lip
Operation Smile Madagascar patient Coordinator Jose Augustin shares a smile with a patient. Photo: Henitsoa Rafalia.

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

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

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

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

Smile Photo: Henitsoa Rafalia.

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

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

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

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

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

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