When All Seemed Lost, Hope for Janat Was Found

Baby girl with a cleft lip and palate
We first met Janat when she was 1 month old during an Operation Smile Morocco surgical programme in March 2020. Due to her cleft lip and palate, she had become severely malnourished and unable to breastfeed. Photo: Jasmin Shah.

As Janat entered the world, no one could’ve predicted the physical and emotional challenges that laid ahead for her and her family.

Remembering back to the day when she saw her daughter’s smile for the first time, Fatima recalled the shock and fear that filled her heart.

“I was scared,” Fatima said. “I was scared of her. It was the first time I had seen something like that.”

But as she held her newborn baby in her arms, Fatima knew that there wasn’t anything in this world she wouldn’t do to protect and care for Janat.

However, due to factors outside of her control, keeping that promise became increasingly more difficult as Janat’s health declined rapidly.

For children born with cleft conditions, especially a cleft palate like Janat’s, they often encounter major hurdles with feeding and struggle to receive proper nourishment during the most critical time in a baby’s development.

Janat and Fatima confronted these obstacles every day.

“I was afraid that I was going to lose her,” Fatima said. “She was suffocating, and the milk would come out of her nose. It was very painful for me seeing her like that. I was scared and didn’t know where to go or who to ask.”

Fearing for her daughter’s health, Fatima helplessly watched as Janat steadily became smaller and sicker during her first weeks of life.

“I had no hope that she would live,” Youssef said. “Every day, we thought she was going to die. She couldn’t breastfeed or bottle feed. Every day, we thought that she wasn’t going to live.”

Despite the consistent failed attempts at feeding Janat and the fear of watching her become more malnourished each day, Fatima persevered, determined to keep the promise she made.

Then one day, their hopes were realised.

Mother feeding her baby with a special feeding plate
Volunteer dentist Dr. Teresita Pannaci of Venezuela, left, observes as Janat is fed by her mum while testing out her new feeding plate. Before arriving to our programme in Oujda, Janat had lost nearly half of her birth weight. Photo: Jasmin Shah.

After a family member showed her an Operation Smile Morocco video, Fatima learned that the organisation not only provides free surgical care for children like Janat, but that an upcoming surgical programme was taking place in a little over a week in Oujda, a neighbouring city three hours away.

Overjoyed to learn there were skilled people devoted to caring for children with cleft conditions, Fatima and her husband prepared to make the journey, hoping that it wasn’t too late for 1-month-old Janat, who’d already lost nearly half of her birth weight.

Alongside hundreds of families seeking out care from Operation Smile highly trained medical professionals, Janat and her parents arrived in Oujda for screening day fully prepared to do whatever they could to save her life.

“I used to cry for my daughter to see her like that,” Fatima said. “But when I saw those kids, I told myself that I’m not alone and that my daughter was born like them. I saw some kids who’ve received surgery. I was relieved when I saw them. It gave me hope.”

It was a long and gruelling day for the family as volunteer paediatricians, anaesthesiologists, nurses and other specialties assessed Janat’s health throughout the screening process.

It quickly became clear to the volunteer team that Janat wouldn’t pass her comprehensive health evaluation.

At 1 month old, Janat was too young to receive surgery. Even if she were old enough, she was in a state of severe malnutrition that would have made it impossible to undergo anesthesia.

Just as Fatima started to think that they’d return home without a solution, the team of volunteer dentists on-site sprang into action.

Volunteers holding dental simulation dolls
Volunteer dentists Drs. Vilma Arteaga of Guatemala, left, Teresita Pannaci of Venezuela, centre, and Soukaina Dahou of Morocco each hold a dental simulation doll. These realistic dolls are used to teach dental students how to make impression molds of cleft palates to create feeding plates and obturators, which help patients like Janat feed, breathe and drink with ease. Photo: Jasmin Shah.

Joining forces with Operation Smile Morocco staff, Drs. Carmen Kamas-Weiting of the U.S. and Teresita Pannaci of Venezuela stepped in, quickly transporting Janat and her family to the local care centre.

“I was so happy,” Fatima said while surrounded by the dental team preparing to fit Janat with a feeding plate. “I’m happy that, finally, she will receive help.”

With a cleft palate – a gap in the roof the mouth – patients struggle to eat or drink because milk oftentimes spills out of their nose or causes them to choke, making it almost impossible to obtain the necessary amount of nutrition needed to thrive and gain weight.

Having a cleft palate also makes patients vulnerable to illness, as they are more susceptible to infection, disease and even death.

To protect patients like Janat from the dangers of malnourishment – dangers that can prevent them from receiving the timely cleft surgery they need – dentists like Teresita and Carmen rely on pre-surgical dental care like feeding plates.

The soft mold of Janat's cleft palate, which later became her feeding plate that would allow her to drink milk with ease. Photo: Jasmin Shah.

The plates serve as the first step toward surgery, leading patients away from starvation and guiding them toward a healthier life – toward surgery.

“A baby with a cleft palate can’t eat,” Teresita said. “That’s why it’s so important to rehabilitate the function of breathing, sucking and swallowing food so that the child is eating in the home environment. This is the real reason why treatment must be done from birth.”

Patiently waiting for the dentists to create the plate, Fatima shared with the team that Janat could only manage to consume around three ounces of milk throughout an entire day. This amount is dangerously lower than the recommended two to three ounces of milk newborns are expected to consume every few hours.

With the feeding plate, the process of eating for Janat was transformed.

Baby with a cleft lip and palate trying a feeding plate
During the March 2020 surgical mission in Oujda, Morocco, Janat tries out her new feeding plate for the first time. Photo: Jasmin Shah.

After testing out her new plate for the first time, Janat drank two and a half ounces of milk in less than eight minutes.

“I started to feel calm; [the plate] was working,” Teresita said. “I looked at her mother, and that’s when I saw she had tears in her eyes. When I asked, ‘Why are you crying? What kind of tears are these?’ She said, ‘They are tears of happiness,’ because she knew that her daughter was safe.”

Fatima, filled with relief, revealed that it was the first time she’d ever seen Janat drink without suffocating.

“I wasn’t expecting that – that they have this kind of solution for little kids,” Fatima said. “I was really happy that my daughter can drink milk, get full and be calm. I can’t describe my feelings. I was so relieved and so happy.”

Fatima, Youssef and Janat returned to the care centre once more during the mission before heading home. After receiving demonstrations and educational support on the feeding plate from Teresita, Fatima felt confident in her ability to feed Janat.

Adapting well to her new feeding plate, Janat slept comfortably in her mother’s arms with a belly full of milk for the second day in a row – perhaps for the first time in her life.

Mother feeding her baby after having a feeding plate fitted
For perhaps the first time, Fatima watches as Janat drinks milk without choking thanks to her daughter’s new feeding plate. Photo: Jasmin Shah.

Drinking a few ounces of milk may seem insignificant, but the plate also enables patients to reach even larger milestones: improving nutrition, achieving and maintaining weight for surgery, breathing easier for a better quality of life, lessening the severity of the cleft palate as well as improving jaw and nose development.

Although Janat didn’t receive surgery, Fatima and Youssef’s determination was stronger than ever before, and they planned to return to the centre on an ongoing basis to allow for volunteers to monitor Janat’s care and progress.

The first month of Janat’s life had been filled with fear, uncertainty and seemingly impossible obstacles. But after leaving the Oujda care centre with a newfound hope and the support of Operation Smile Morocco volunteers behind them, Youssef and Fatima were confident that Janat’s path toward recovery had finally begun.

“My hope grew since the day I went to Oujda,” Youssef said. “She started to drink properly. She started gaining more weight day after day.”

With possibly only days left to live prior to obtaining her feeding plate, Janat was one of the last patients who received life-saving dental care from Operation Smile Morocco.

Because less than a week later, Covid-19 was declared a global pandemic.

Babies awaiting cleft surgery
Eight-month-old Elmehdi, right, 11-month-old Ouissal, centre, and another young patient await their life-changing surgeries at Operation Smile’s Women in Medicine: Inspiring a Generation medical mission in Oujda, Morocco, in March 2020. These were among some of the last patients to receive surgery from Operation Smile before medical programmes were postponed due to the Covid-19 pandemic. Photo: Jasmin Shah.

Countries everywhere hastily began closing its borders, halting transportation services and shutting down businesses. Operation Smile Morocco, like all of our teams around the world, made the decision to postpone future missions and care delivery at care centres.

While the decision was made to ensure the safety of patients, families, volunteers and staff, the postponements left thousands of patients like Janat waiting.

As a child grows, feeding plates should be replaced regularly. But with the pandemic forcing the closure of the Oujda care centre doors, where Janat was expected to return, receiving a new feeding plate became impossible.

“All the hope that we had started to vanish when Covid-19 appeared,” Youssef said. “We were really impacted by this pandemic. We lost hope as everything started to close.”

Janat’s family wasn’t sure if Janat would ever be able to return for the additional comprehensive cleft care she still needed. The Operation Smile Morocco team didn’t know if they’d see her again.

Six months later, Youssef and Fatima received a call that changed everything.

“When I saw [Operation Smile Morocco’s] phone number, I was so happy,” Youssef said. “Our hope was back.”

The Casablanca care centre’s doors had reopened.

Operation Smile Morocco's care centre in Casablanca
Operation Smile Morocco established its first care centre in 2008 in Casablanca, which supplied the organisation with the infrastructure and innovative equipment needed to provide patients with year-round multidisciplinary care services including orthodontics, speech therapy, dentistry, psychosocial care, orthognathic evaluations and more. Photo: Lorenzo Monacelli.

Unlike their journey to Oujda, which was a three-hour trip from their home, it would take Fatima and Youssef two days to reach Casablanca, a daunting journey for any family to make.

With the feeding plate, they had watched their daughter grow stronger each day, only for that hope to be ripped away by the pandemic.

But Youssef and Fatima had also witnessed something beautiful: families holding their children in their arms after life-changing surgery.

That reason alone is why they knew that no amount of distance would discourage them from seeking that same opportunity for Janat. They made the two-day trip to Casablanca five times.

“Nothing is too hard when it comes to my daughter,” Fatima said.

Sleeping baby with a cleft lip and palate
Due to difficulty feeding caused by her cleft palate, 1-month-old Janat arrived to our March 2020 programme in Oujda severely malnourished and on the verge of starvation. Photo: Jasmin Shah.
Smiling girl with a cleft lip and palate
Janat, now almost 2 years old, shares her biggest smile during screening at Operation Smile Morocco’s October 2021 surgical programme in Casablanca. Photo: Jasmin Shah.

Back in the care of medical volunteers, Janat received new feeding plates, pre-screening health evaluations and a date for Operation Smile Morocco’s October 2021 surgical mission. With each visit over the course of her many trips to the centre, improvements to Janat’s health and happiness were undeniable.

Dr. Soukaina Dahou, volunteer dentist for Operation Smile Morocco, was part of the team of dentists who created Janat’s first feeding plate. Reconnecting with Janat’s family and watching as she ate cookies and laughed with joy, Soukaina couldn’t believe she was seeing the same child she met more than a year prior who’d been close to starvation and unable to breastfeed.

“Seeing Janat again truly is one thing that proves that what we do is really important,” Soukaina said. “To see them healthy, to speak correctly, it makes me very happy. Seeing these results comforts me. It means that we help people in a good way.”

Janat and her family travelled for the sixth time to Casablanca hopeful that the team of medical volunteers would share the news that Janat could finally have her long-overdue cleft lip surgery.

Medical volunteer examines cleft patient
Volunteer anaesthesiologist Dr. Anne-Marie Banning from Sweden examines Janat during her comprehensive health evaluation. Photo: Jasmin Shah.

Overcoming her battle with malnutrition, months of delayed care amid the pandemic and countless miles travelled to and from her home, Janat passed her comprehensive health evaluation.

“My dream is coming true,” Youssef said. “Janat is the light of the house. I wanted to see my daughter as other girls, I wanted her to grow up and be a normal kid. She will be able to talk to people normally. I was so happy when they called me and told me that my daughter will receive the surgery.”

During a surgery that took a little more than an hour, Janat and her family’s lives were changed forever.

Smiling mother holds her daughter after cleft lip surgery
Fatima is filled with happiness and joy as she holds Janat after the surgery that repaired her daughter’s cleft lip. Photo: Jasmin Shah.

Fatima understands that while she’s relieved and filled with hope after seeing Janat’s new smile, this surgery is just one step along Janat’s cleft care journey.

Operation Smile Morocco plans to provide Janat with surgery to repair her cleft palate, the condition that nearly took her life more than a year ago.

Gazing at her transformed smile, Janat’s family feels prepared to make any sacrifice and travel any distance to ensure her future is bright.

“I didn’t expect her to be this perfect,” Fatima said. “I am ready [for her cleft palate surgery]. I will go anywhere, any place. She is my priority.”

Smiling father holds his daughter after cleft surgery
Janat’s dad, Youssef, can't contain his joy after seeing his daughter for the first time after her surgery. Photo: Jasmin Shah.
Father kisses his daughter as return home after cleft surgery
Alongside her mom, dad and grandfather, Janat prepares to make the journey home with her new smile. Photo: Jasmin Shah.

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 families 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.

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