Children, parents and family have travelled – some for hours or days – by car, by bus or by foot to be here, at an Operation Smile medical mission. They’re hopeful. They’re anxious. Tragedy is almost certain without surgery. And for some, this day couldn’t have come sooner.
Part One
An Uncertain Future
Twenty years. Twenty-five years. Fifty-four years. That’s 99 years of needless suffering experienced by three of our patients: Virgilio, Enok and Marco.
As soon as a child is born with a cleft lip or cleft palate, there are daunting odds stacked against them.
In many areas of the world lacking critically needed resources, people can’t get the surgical care they need from their local health systems, when they need it. Even if care is present, poverty prevents all too many people from getting surgery. Time and time again, this proves deadly for children born with cleft conditions.

“As many as 93 percent of children with untreated cleft conditions could die before their 20th birthdays.”
—Mossey PA, Modell B. Epidemiology of oral clefts 2012: an international perspective. Frontiers of Oral Biology. 2012; 16: 1-18.
And if these children survive into adulthood, like Marco, who lived with a cleft condition for more than five decades, their lives are often marked by loneliness and painful bullying.
Parents who bring their children to Operation Smile hope for surgery that can change all of that.
Healing After 54 Years
The Surgery He Always Deserved
Part Two
Safety on Centre Stage
But first, paediatricians need to perform comprehensive health exams to ensure that patients can safely undergo surgery.
A paediatrician’s findings are shared and discussed with the medical mission’s clinical coordinator, paediatric intensivists and anaesthesiologists to determine if it’s safe for the patient to be put under anaesthesia – the aspect of surgery that presents the most risk in any environment, including the world’s most advanced hospitals.
Part Three
A Burden No One Should Bear
Sometimes offering up their stethoscope to curious patients, paediatricians can seem light-hearted while taking their role seriously.
While play serves its purpose among medical volunteers to help build trust with patients, this initial evaluation is critical to the patient’s safety ‒ like that of 4-year-old Ramata in Ghana. Though cleft surgery is ideal at the youngest possible age, Ramata experienced chronic health complications and surgery was too risky.
It was heartbreaking for the medical team to give the news to her mother, who travelled hours on rough roads with Ramata to the mission site with the hopes that her daughter could receive surgery.
Ramata’s Smile
Five Times Denied
Five times, Ramata’s mother travelled to get surgery for her daughter. Five times, the trip home was made rockier by heartbreak.

While Ghana offers some of Africa’s most beautiful landscapes, it also suffers from a critical lack of adequate infrastructure, health care services and economic opportunities, resulting in some of the world’s most significant barriers to safe surgical care for its citizens. Our vision of improving patients’ health and dignity through safe surgery is backed by the idea that no one deserves to live with the burden of a cleft condition.
Each of Operation Smile’s medical volunteers wish that no family or patient would have to experience the disappointment of being turned away from surgery, but a patient’s safety is always the first priority.

Part Four
Treating the Whole Patient
When a patient is healthy and approved for their life-changing procedure, feelings of joy can turn into anxiety as surgery day approaches.
Surgery often strikes fear in patients and their families, some of whom have never stepped foot inside a clinic or hospital. Medical environments can be sterile and uninviting, but child life specialists help ease patients’ tension by using therapeutic play to create an environment that is welcoming and friendly.
Using equipment like anaesthesia masks during these sessions is a method that child life specialists use to help children understand and become more comfortable with the medical setting, calming their nerves prior to being admitted into the operating room.
Easing Fear, Building Trust
Purposeful Play
Building trust between children, families and the medical mission or care centre team is another key function of child life specialists’ work.

When patients are under anaesthesia – especially as soon as it has been administered and before the patient returns to consciousness – paediatric intensivists are at-the-ready to recognise and react to any medical complications with cardiopulmonary resuscitation, medication and other live-saving treatments.
The vast majority of Operation Smile patients are children. While their roles differ greatly both at their respective workplaces and whether at an Operation Smile medical mission or at one of our care centres, open communication between paediatricians and paediatric intensivists is crucial to our ability to deliver the best possible surgical results for our young patients.

Part Five
A Global Standard of Care
Reinforced by more than three decades of leadership in performing safe surgery in resource-limited environments, we know that a single surgical procedure is a small part of a larger, multi-tiered process that’s focussed on the entire well-being of the patient.

“By investing in bringing in the full cadre of specialties, local health systems take notice and will aspire toward exceptional patient care. We believe that anything less than excellence is unacceptable.”
—Dr. Bill Magee, Co-Founder and CEO of Operation Smile
Our compassion for those we serve is put into action well before the surgeon makes the first incision and long after the final suture is closed. This commitment to the completeness of patient care doesn’t only ensure the best possible outcomes; it’s the right thing to do.
Guided by our Global Standards of Care*, our incredible nurses and plastic surgeons – together with our paediatricians, child life specialists, paediatric intensivists, anaesthesiologists, among other critical medical specialties – deliver surgical results consistent with the world’s finest hospitals.
“In the settings we go into, we know that patients may not have access to the full complement of these specialties,” said Operation Smile Co-Founder and CEO Dr. Bill Magee. “So we’ve always set the stage for excellence – never modelling mediocrity.”
Why go to these lengths? The answer is simple: our patients deserve it.
*Global Standards of Care © 2006, 2015 Operation Smile, Inc. All Rights Reserved.
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