Voices From the Frontline: Q&A with Nurse Doreenlove Serwah

Clinical coordinators Doreenlove Serwah, right, and Sally Herman during screening on the first day of an Operation Smile Ghana local mission in 2018. Photo: Zute Lightfoot.

The impact of the coronavirus varies from country to country, but the heroism that nurses like Doreenlove Serwah have while delivering care in their communities is universal.

Prior to the COVID-19 pandemic, Doreenlove safeguarded the success of Operation Smile medical missions in Ghana as a volunteer clinical coordinator. Today, she’s serving another vital role as the nursing lead at a local hospital, providing life-saving care to patients as well as educating her team of health workers on the necessary safety protocols that equip them with the skills and knowledge to handle the demands brought on by the virus.

“A lot of our nursing knowledge is now being channelled towards education,” Doreenlove said. “With education comes correcting misconceptions, alleviating anxiety and giving reassurance and general psychosocial counselling.”

As a Ghanaian nurse, Doreenlove relies on the courage and collaboration of her team in addition to her experience with Operation Smile to diligently fight this crisis head-on.

“My country, like many others globally, is facing the COVID-19 pandemic with the necessary urgency required,” Doreenlove said. “It’s a stressful time for everyone, especially healthcare workers, but we’re all doing the best that we can.”

We recently sat down with Doreenlove to hear more about the demands of being a nurse in a resource-limited country like Ghana and what inspires her to continue searching for hope despite the limitations she and her fellow medical professionals are facing.

Photo: Zute Lightfoot.

Q: With the impact of the COVID-19 pandemic, what is the current environment like in Ghana? In what ways have you seen the coronavirus affect families living in your country? 

A: “The current environment is quite tense. Closely watching havoc being created in even better resourced environments and gradually watching our in-country cases rising. Public education on prevention measures have, however, gained grounds, and treatment centres are slowly taking shape in anticipation of surges. I daresay we are cautiously optimistic for the future.

“With the implementation of social distancing protocols nationwide and limited lockdown in some major urban centres, life as we knew it has come to a standstill. Schools are not in session, and a lot of economic income-generating activities have been suspended. In a way, I believe this has caused nuclear families to possibly bond better despite the challenges as they spend more time together, too.”

Q: What has been your role in response to this challenging time? 

A: “As a nurse leader in my unit, I’ve been educating the nurses and other health workers on the need to adhere to the precautionary measures put in place by the World Health Organization to help combat the COVID-19 pandemic. Core topics include infection prevention and control practices such as hand and personal hygiene, proper ways of putting on and taking off personal protective equipment, proper cleaning and decontamination protocols as well as education on social distancing.

“In the managerial aspect, now more than before, is proper stock taking and procurement which is essential in the face of wide spread shortages to eliminate all waste while still ensuring adequate supply at all times. Apart from these, I’ve had to make changes in ward routines as well as prepare the ward in general should we have a COVID-19 suspected case since I work in paediatric emergency and its direct entry for patients without them having to go through all the usual processes.”

Q: What limitations have you and your other medical professionals faced? 

A: “Major limitations we have faced are having fairly little knowledge on the COVID-19 virus, widespread misconceptions, exaggerated fear and panic gripping both general population and health workers alike, and limited resources, especially with regards to personal protective equipment.

“In my country, there are limited testing centres. This means waiting a little longer than usual to receive results on the status of patients. Also, staff strength is sometimes diminished when a staff member has to self-isolate while waiting for results.”

Q: What have you learned from being involved with Operation Smile that’s helped prepare you for responding to COVID-19? 

A: “Involvement with Operation Smile has given me confidence in my leadership abilities, as I have clinically coordinated missions. I believe it has made me a more effective team player.

“The numerous educational sessions I’ve conducted for my nurses before, during and after missions have also given me insight to their general strengths and weaknesses, how to deliver information better, mentor efficiently, motivate adequately and manage better.”

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

A: “The pandemic and arising issues make it very apparent the role nurses play. We constitute a large workforce; dare I say the largest proportion in the health sector. We tend to have more interaction time with our patients, and this enables them to gain our trust and communicate more openly with us, allowing for us to counsel, educate and care for them. Our enhanced contact time and skills also allow us to make valuable observations and contributions to their health care planning.”

Q: It’s a very stressful time in your country and around the world right now. How are you doing, personally, with the impact this virus has placed on you?

A: “As a nurse, wife to a doctor and mother of two kids, I’ve had to place the care of my kids in the hands of my mother since my husband and I have to spend extra hours to help in providing services during this crisis. Also, in order not to take chances with the possibility of a cross infection from us to our kids, it has become prudent that they stay away from us for this period. We miss them and the normal family bonding we used to have.”

Q: What motivates you to continue working to provide care during this difficult time in Ghana? 

A: “Just the fact that I’m well prepared by my training and prior experiences, and the fact that society is looking up to me to lead in this difficult time keeps me continuing what I do.

“The population has a lot of respect and expectations of me, and that alone challenges me to deliver.”

Photo: Zute Lightfoot.

A Hands-On Approach to Care

Medical volunteers from Operation Smiles Future of Smiles mission in Durgapur, India, with their names written in Bengali on their arms. The mission featured volunteers from 12 different countries all working together to provide safe surgical care. Photo: Nicholas Nottage.

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 West Bengal, India, a young boy and his family travelled to a strange place in hopes of receiving a surgery that would change his life.  

Waiting in line for his name to be called, Astik noticed his grandmother, Rutipa, had a nervous expression on her face — and he mirrored it. When he looked ahead, he heard unfamiliar people speaking a language he didn’t understand.

Before he knew it, nurses with stark-white gloved hands were examining his cleft lip.

For Astik and many more patients like him around the world, receiving treatment at an Operation Smile medical mission marks the first time they’ve received care from doctors and nurses.

To make this new experience as comfortable as possible, the medical volunteer team at the site in Durgapur, India, took a hands-on approach: playing with gloves.

And thanks to the support from Ansell, a global healthcare company, there are always plenty in supply at Operation Smile medical missions. With one of its global headquarters in Melbourne, Australia, Ansell is a world leader in providing superior health and safety protection solutions that enhance human wellbeing. The company has partnered with Operation Smile since 2016 and routinely provides protective gloves for medical missions in India and around the world.

Operation Smile volunteer nurse Lora Edwards said this approach is similar to the way child life specialists calm children before surgery by slow exposure to operating equipment through play.

“Before I start working with a patient, I’ll blow up a glove and decorate it,” Lora said. “I turn the gloves into fish, let the child paint the nails or draw faces on the gloves.”

Lora said she does this before she begins touching a patient’s face to help them become more comfortable with the feel of the glove and grow more at ease with the medical process.

Through partnering with Operation Smile, Ansell help create a safer and more protected world by routinely providing gloves for medical missions in India and around the world.

Additionally, Ansell donates gloves to Operation Smile’s cleft centre in Durgapur, where they are stored in the warehouse. The donated gloves are either used at the cleft centre or are distributed to various mission sites across the country. Any gloves leftover from missions are returned to the cleft centre to ensure that they never go to waste.

Boxes of Ansell gloves waiting to be shipped to an upcoming medical mission in India. Photo: Nicholas Nottage.

According to Operation Smile India’s executive director, Abhishek Sengupta, these gloves are a hot commodity among the volunteers.

“They (Ansell gloves) are the only gloves the surgeons and nurses request,” Abhishek said.

The quarterly shipments of gloves are frequently marked on the volunteers’ calendars, he said, so they know when to expect them.

Dr. Alexis Rothermel, a surgical resident, said, “The gloves definitely allowed me to feel very comfortable while providing care to the patients but did not impede my dexterity while operating.”

Dr. Alexis Rothermel performing surgery with the help and supervision of cleft surgeon from India Dr. Gaurav Deshpandey. Photo: Nicholas Nottage.

Wearing gloves is critical for the safety of both the patients and medical professionals.

Karen Allen, an Operation Smile volunteer nurse on her second medical mission, fully grasps the importance and value of working with high-quality gloves.

“Everyone deserves to be healthy and safe in their workplace, and having reliable gloves available — despite working in countries that may not have the same resources — is crucial to making the medical volunteers feel comfortable and relaxed. I have used Ansell gloves before and always appreciate my chances to use them.”

Volunteer nurse Karen Allen teaches one of the patients how to blow bubbles during screening day. Photo: Nicholas Nottage.

While she spoke, Karen grabbed the glove on her hand by the bottom and pulled on the end, mimicking how she first slid them on.

“If I had done that with the gloves I use back home, my fingers would have come through the end and the bottom would have ripped,” she said.

Since her job requires her to wear gloves often, she admires how the Ansell gloves never leave her hands sore after a long day’s work.

“These gloves always meet my expectations when I have the opportunity to use them,” Karen said.

The site in Durgapur is shared with a medical college, and several of the nurses in training assisted during the medical mission process. Karen’s proper use of the gloves “sets a good example to the student nurses as well.”

Gloves are an integral part of every step of the medical mission process. Fortunately, with Ansell’s generous support, Operation Smile can ensure patient safety throughout its medical missions — and continue to bring them some comfort, too, in the form of a glove-shaped fish.

Karen posing with some of the student nurses who assisted during the Future of Smiles mission at the Durgapur care centre. Photo: Akash Samanta.

The Road to Ramata’s Smile

Editor’s note: We teamed up with the storytelling group Cliff Co. to create Love Always Prevails, the hybrid documentary film about Ramata’s and Mariana’s Operation Smile journey, featured above. Click here for a behind-the-scenes look at the production of the film with videographer Jacob Watson of Cliff Co.

While Ghana offers some of Africa’s most beautiful landscapes, it also suffers from a 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.

It also means rough roads lead from the rural community of Assin Praso to the historic city of Cape Coast.

Though the physical condition of the highways is the same for all who travel between the two cities, the round trips made by Mariana and her daughter, Ramata, were among the most challenging.

Ramata was born with a cleft lip and a cleft palate. Mariana was determined to access safe surgical care to repair her 4-year-old daughter’s condition.

Five times, Mariana raised enough money for bus fare and took Ramata to Cape Coast in search of a free surgical option. Five times, the return trip was made all the rockier by heartbreak.

Each time doctors assessed Ramata’s health, she was either anaemic or too underweight to receive safe surgery. Even if she would have been deemed healthy enough for surgery, she had no way of being able to afford its cost.

Ramata with her mother, Mariana. Photo: Margherita Mirabella.

Disappointed but undeterred, Mariana remained vigilant about finding care for Ramata despite her limited resources — she earns a meagre living carrying water containers and gathering firewood for her neighbours. When Mariana met a non-medical volunteer from Operation Smile Ghana who was conducting an awareness campaign in Assin Praso, the lives of the family would change forever.

At first, Mariana didn’t believe that the surgeries Ramata needed would be free when she called Clement Ofosuhemeng, the patient coordinator for Operation Smile Ghana, to learn more about the organisation and its work. He assured Mariana that there would be no cost for any procedures needed to repair Ramata’s cleft condition and that Operation Smile would provide a bus to take patients from the Assin Praso area to the next medical mission in Cape Coast.

After Mariana and Ramata made the three-hour trek back to Cape Coast for the Operation Smile medical mission, yet another roadblock diverted Ramata away from care for a staggering sixth time. Ramata had passed her comprehensive health assessment and was approved for cleft lip surgery when she contracted malaria — a major health scare for the young patient in its own right.

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. Photo: Margherita Mirabella

Fortunately, Ramata survived her bout with malaria and returned to good health as she and her mother looked forward to the next Operation Smile medical mission in the eastern city of Ho. It would be here that she would receive the life-changing procedure which had proved to be so elusive.

In the months leading up to the Ho medical mission, Ramata started attending kindergarten and immediately developed an affinity for school and learning. She also experienced bullying from some of her classmates while others would stare at her cleft lip and shun her. The teasing and isolation drove Ramata to tears.

Photo: Margherita Mirabella.

Mariana also suffered social hardships after Ramata was born. As her family offered little, if any, emotional support, she became the target of insults and blame from some of her neighbours for having birthed a child with a cleft condition. While these words infuriated Mariana, they also hardened her resolve to find a surgical solution for her daughter — to give her the chance to pursue an education without it being derailed by cruel treatment from her peers.

Again, Ramata and Mariana boarded the Operation Smile bus and made the 10-hour trip from Assin Praso to Ho. Again, she was cleared for surgery after her patient health assessment, but this time made it to the operating room without further complications and received surgery to repair her cleft lip.

Photo: Margherita Mirabella.

When Mariana saw Ramata for the first time after surgery, she was overjoyed by the fact that her daughter would look like all the other children in their community.

Mariana marvelled at the care and attention Ramata received during the missions and was amazed by the love and care the volunteers showed the patients and their families. She said that she is happy to share Ramata’s story with everyone she meets and would tell other mothers in her community who give birth to children with cleft conditions about Operation Smile’s work in Ghana so they can avoid the anguish and frustration that she experienced in searching exhaustively for safe surgical care for her daughter.

Finally, Ramata truly began her journey toward healing. She returned to Ho twice over the following year to receive procedures at Operation Smile medical missions to repair her cleft palate.

Four-year-old Ramata. Photo: Margherita Mirabella.

In 2019, Operation Smile returned to Ramata’s home in Assin Praso to see how life has improved for her and Mariana.

Since receiving her final cleft palate surgery in 2016, Ramata has developed into an outgoing young girl who is full of energy and enjoys playing with her newfound group of friends from the neighbourhood.

Eight-year-old Ramata poses for a photo with friends from her village. Photo: Zute Lightfoot.

No longer subject to the harmful bullying and teasing from some of her classmates, Ramata thrives in school and in life.

Today, she’s a confident and competitive student who loves to learn and is oftentimes the first student to raise her hand during class when the teacher asks a question.

Photo: Zute Lightfoot.

While the journey to finding care for Ramata was challenging and full of unforeseen obstacles, the love Mariana has for her daughter never allowed her to lose hope.

And today, that love only continues to deepen as Mariana watches Ramata grow into an enthusiastic, hard-working and joyful young girl with a beautiful heart and a beautiful smile.

Photo: Zute Lightfoot.

COVID-19 Conversation: Putting our Expertise to Work

Now, more than ever it’s our charge to safeguard the health and well-being of individuals around the world. We’re building upon our expertise in delivering cleft surgery and care in resource-limited settings as well as our history of improving the health and dignity of those we serve.

That’s why we’re finding the most meaningful ways that we can support people and their health needs in the communities where we work, even when medical missions are postponed, care centres are closed, and the future feels uncertain. It’s in this uncertainty that our swift action is required, and we’re doing everything that we can to help patients, families, and countries as this affects them.

This “COVID-19 Conversation” featured a live question-and-answer session with Ernest Gaie, our Senior Advisor of Global Business Operations, and Stuart Myers, our Senior Vice President of Global Operations and Programmes. The session was hosted by Laura Gonzalez, our Digital Content Manager, and John Streit, our Managing Editor and Writer, moderated the audience’s chat and questions.

Ernest brings 20 years of field-based experience working with nonprofit organisations primarily in sub-Saharan Africa and is a proud recipient of the Clinton Global Health Initiative for his outstanding leadership and management of Africare’s response to the Ebola epidemic in Liberia between 2014 and 2015.

Stuart has 15 years of experience of working within 30 countries on operations and programme management and has served in key roles at Project HOPE and the People to People Foundation.

Event Transcript

Laura: All right. So we’re going to go ahead and get started. I just want to say a quick thank you to all of you guys on the line for joining tonight. We’re so excited to announce Operation Smile’s first “COVID-19 Conversation” and the topic of this conversation is going to be “Putting Our Expertise to Work.”

I’m Laura Gonzalez; I’m Operation Smile’s Digital Content Manager, and a lot of my work focuses heavily around our storytelling. I work really closely with my colleague, John, and I’ll let him introduce himself and then go over some of our rules for the chat.

John: Hi, I’m John Streit, the Managing Editor and Writer for Operation Smile, and alongside Laura, we’ve been keeping really close tabs on all of the stories that we’re going to be talking about tonight. And you know, we’ve been in this unprecedented the time, but we’re excited to share our initial response and how we’re putting our expertise to work with you guys.

I’ll be moderating the chat area of the webcast tonight. So, if you have any questions or want to engage in conversation with me during the webinar when Ernest or Stuart are speaking, just to enter it into the chat area, and I’ll be engaging in there. And then also, if you have any questions, I’ll be gathering those and, time permitted, will ask Stuart and Earnest some questions at the end of our event.

Laura: Thank you so much, John. And now I’m really excited to introduce you guys to two of our panelists. We feel really appreciative to have their time today and to hear what they have to say about Operation Smile’s response to the COVID-19 pandemic.

So, our panelists are Ernest Gaie; he’s our senior advisor of global business operations. Ernest brings decades of field basic experience working with nonprofit organisations in sub-Saharan Africa and was honoured by the Clinton Global Health Initiative for his outstanding leadership and management of Africa’s response to the Ebola epidemic between 2014 and 2015.

And Stuart Myers is our senior vice president of global operations and programmes. Stuart has served in key roles at Project Hope and People to People Foundation. He has worked in 30 countries over 15 years and has expertise in operations and project management.

Stuart, Ernest, thank you so much for joining today’s conversation.

Stuart: Thank you for having us. I appreciate the opportunity to share some of the things that have been going on.

Ernest: Thanks for having us, Laura and John, for sure.

Laura: Yeah, so we’re going to hop right into some questions, and then as John mentioned, at the end we might have an opportunity for audience participation.

So, Ernest, the current pandemic isn’t your first experience responding to an outbreak of infectious disease. How did your leadership and management of Africare’s response to the 2014 and ‘15 Ebola epidemic in Liberia prepare you for your current response with Operation Smile in regards to COVID-19?

Ernest: Yeah, sure, thanks Laura.

You know, after the Ebola in Liberia, I said to myself that I hope I never have an opportunity to get involved in another epidemic and, wow, five to six years down the road here I am again. I guess it’s a true call to our humanity and our profession and what we are passionate about, so, really glad to be here and to be a part of this noble institution.

I want to say that infectious disease outbreaks, such as the Ebola virus disease and now COVID-19, do have significant impact on health systems when you have such a scale and magnitude as we’ve had with COVID-19 that was declared a pandemic.

And when we talk about the health system it’s everything inclusive – health care workers, the health infrastructure, the testing and just the whole clinical aspect of it – the testing and diagnosis capability, the clinical solutions and just the surveillance aspect of it as well. So these things are largely impacted, and it is even more impactful when it comes to low and middle income countries. The reason is simple, we just struggle with weaker health systems and competing priorities and therefore, the level of investment that is required for the health system is also compromised by those competing priorities. And that was the case with Liberia where I worked with Aftercare as a country director. We served as a partner to the Ministry of Health just basically trying to help rebuild the health system in Liberia and show that essential health services were rebuilt and provided to folks.

And so, in 2014, we had this epidemic, the Ebola virus epidemic, and one of the reasons why it was it was critical for us to engage as an organisation was we realised that quickly, because the system was so overwhelmed, critical and essential health care was also compromised. At the time, Liberia was recording some of the worst maternal and child health indicators in the world. And therefore, the fact that the health facilities were also overwhelmed, they were unable to continue to provide essential maternal and child health care services. People realised that people were dying from basic simple sicknesses like malaria.

So as an organisation, one of the things that I did was to quickly bring back our programme team and say, “Look, listen, as a major partner to the Ministry of Health, this is a health emergency.” We cannot just sit and say, “We are implementing a development programme. And therefore, we’ll deal with the emergency; we’ll come back and deal with the post-recovery and development initiative.” So we reprogrammed; we repurposed some of the resources that we had for the response to, one, ensure that health care workers and the facilities had the requisite support to respond to any cases of Ebola that did show up at those facilities, but, two, to ensure that other essential services were provided.

I think this is the intersect. This is the experience and the skill set that I bring to this. I’m really pleased with the level of flexibility that has been demonstrated by Operation Smile and it’s leadership. I just really want to recognise the senior leadership and our Chief Medical Officer (Dr. Ruben Ayala) for stepping up and not just stepping out but demonstrating and putting forth it’s extensive network of medical expertise and other resources. I think this is just a phenomenal initiative that has happened so quickly. I was asked to lead and was able to mobilise the team that we’re currently working with.

One of the things that we did was to get out to our regional directors to get out to the respective foundations and programme countries that we work with and really try to gauge what the situation was in their respective countries and to understand from them, first-hand, where the critical needs and gaps were, and how we, as an organisation, can engage in the response as a partner, like a true partner, to them in good times, but in challenging times. I’m pleased to say that, out of that process, we now have a global COVID-19 response plan and implementation framework that we’ll be talking about later on this call. But really it has been a phenomenal experience – really incredible people we are working with and I’m so delighted that my experience from Ebola is really contributing towards our overall global response to support our foundations.

Laura: It’s wonderful to have that expertise that you bring, and when you speak about implementation of programmes like this, I think, Stuart, you kind of jumped in feet first when you joined the organisation. How have you been able to balance delving into the organisation, getting to know Operation Smile while also having to deal with such a dramatic disruption in the way that we run our programmes typically?

Stuart: I have to start by saying it’s coming up on the 90-day mark, and I have to say, it’s probably the most interesting 90 days I have ever had. I started I think the day the global conference started (early February 2020) and was an attendee there and attendee at the regional directors’ conference after. So, I got a very, very good overview of what Operation Smile was and started to just barely get an idea of how the pieces all fit together.

And then the COVID-19 pandemic began. What that allowed me to do was to see what I think is some of the best of Operation Smile. The easy thing for Operation Smile to have done would have been to say, “You know, it’s a pandemic. We’re not a relief organisation; we’ll just wait at home.” But from top to bottom of the organisation, the exact opposite response took place.

I think it was a good demonstration of the culture of Operation Smile, the compassion that it has for the people, patients and foundations and partners that we work with. It was also a time to experience firsthand the expertise that is available in the organisation: People like Ernest, people like Ruben, the Chief Medical Officer, (Operation Smile Co-Founder and CEO Dr. Bill Magee) and all of the regional directors, country directors and partners to see all of those people pull together in a response to what became a very, very serious problem for not just any one of our countries but all of them together. To see all come together in a very short timeframe and a very professional manner was very heartening for me. It’s really instructional, but also very heartening.

Laura: Yeah and you both speak about the leadership and the way that you guys, as members of that leadership group, came together. Can you take us a little bit behind the scenes after the pandemic was officially declared and governments around the world began implementing the various mandates that resulted in our medical programmes being postponed and international travel being postponed? What were the conversations like when leadership convened and decided that we did need to adapt the way that we’re working?

Stuart: The conversations immediately turned to focus upon, “What was the impact going to be upon our patients?” and furthermore, “What was the impact going to be on our volunteers?” At the time that the pandemic really rose to the surface as a serious global issue, we still had a number of missions that were planned in anticipation of being able to treat patients. We had international volunteers and local volunteers all geared up and ready to go.

But what really came to the forefront was making sure that the patients were safe and that our volunteers would be safe. That led to a number of discussions around both of those issues and also discussions with some other NGOs about how they were responding to the virus and the impact on their programmes, now looking for possibilities of where, even though our mission schedule may have been disrupted, how do we participate and help at the local level with the responses that were taking place.

Because we recognised very early that there was going to be a tremendous strain on the local health systems, and in order to make sure that they were able to respond appropriately, we took action to authorise our foundations, for example, to release buys and potentially equipment that we had in hand could be useful in responding to do the pandemic. So a lot of discussions around safety and volunteers, but then very quickly also discussions around, “How could we best respond?”

Laura: And so we’ve seen around the world that our staff and our volunteers have been innovating to serve the needs of the local communities where we’re working. Could you tell us a little bit more about some of those innovations, maybe the ones that are most impressive to you or the most out-of-the-box?

Stuart: Ernest, I’ll let you take this one.

Ernest: Thank you, Stuart. So on the COVID response side of things, as I said earlier, the leadership decided that it will reprogramme and repurpose to really support some of the initiatives that the foundations have stepped up to it as part of their own national response as well. So, we were able to release some funding to the different foundations, and the funding has been used to support some of the initiatives. In India for example there are regions where we have a comprehensive care centre – our regional director and executive director Abhishek (Sengupta) has worked with his team to address the immediate need of some of the most vulnerable populations.

They were able to provide food and non-food hygiene kits to go along with families. This is typical and we’re going to continue to see this as long as this pandemic continues, that more vulnerable populations will be faced with multiple challenges.

Not just with the epidemic itself but challenges around how do they meet their basic needs and how will they be able to even access health care if they need basic health care. So, that’s something that is happening. Other foundations have stepped up as Stuart mentioned to donate their supplies to the response, to their partner hospital partners or to the ministries of health.

We have also provided some trainings as well, and we have webinars that we have set up just to show that health care workers, front-line health care workers, have the basic training and skill set to respond to this pandemic. So those are some of the kind of initiatives that are happening.

In some other instances, we’ve been able to provide the foundations with the ability to provide equipment. In Malawi, for example, our team, staying engaged with some of the patients and their families, have also provided income-generating training so families are being taught to produce soap. We thought that was really fascinating and very great on their part, to ensure that they are able to have one of the critical supplies that they need to continue to protect themselves. I mean, like everybody is saying, “Wash your hands; sanitise your hands.”

Well if you don’t have the materials or the supplies to do that, how can you do that in an effective way? And so, you know, that’s just one of the ways. I’ll turn it over to Stuart to talk about what we’re doing from a technological standpoint to continue to stay engage with some of our patients.

Stuart: Sure, thank you. One of the things that started roughly at the same time that the pandemic started is that we began, in Nicaragua, to use a digital platform to reach out to patients, for example, who needed services related to speech pathology and potentially psychosocial support. That is a new initiative for us. We are looking at ways that we can, for example, roll that platform out across Latin America.

Also, a number of the local foundations have been doing things with text messaging and SMS messaging, where we’ve had access to cell phone numbers. We’ve been able to send a message just to check and make sure that our patients are doing okay and are doing well. So there are a number of ways that we’re trying to utilise technology that exists to be able to stay in touch with our patients and also help to respond to the COVID pandemic itself.

One of our speech pathologists uses the platform to communicate with patients. I think there’s a lot of potential in that type of initiative. If you have the platform, there are a number of things you can do across the continuum of comprehensive care, and that could reach back to your first initial contacts with the patient and getting them screened, getting them into the queue for treatment, all the way through the surgery process and then even beyond that to additional services that they might need.

So, we’re very excited about that. We think that’s a something that’s got great potential for us in the future.

Laura: Right, and speaking of the future, we’re getting some great questions in the chat about what returning to normal looks like once were given the all-clear that it’s safe to resume operations as usual. What are we doing right now to ensure that that transition is smooth?

Stuart: One of the things I think to keep in mind about something like an epidemic, it’s a different kind of event than, say, an earthquake or a hurricane, where the event is very concentrated and then you can immediately move into a relief and recovery. The pandemic, as we’ve all seen, has sort of been a rolling event. Country after country seems to get affected. Our assumption is that countries will come out of the pandemic in roughly the same kind of manner.

There will be a rolling recovery and restart. We’re working with our regional directors and the local foundations to try to get a handle on what that will look like both in terms of what it looks like in terms of timing of reopening countries and what kind of recovery period, for example, is the local health system going to need when they’ve been stretched so far to resolve the pandemic. They’re likely to have needs of their own in terms of just being able to do simple things like restocking supplies and making sure that they have staff available that’s well, rested and able to participate.

We’re looking for, essentially, at what we think will be a rolling kind of reopening and restarting. It will be driven by how quickly the countries are able to respond to COVID, but then also how quickly, for example, can they get back to where they can do the types of surgeries that we do in the local health system. Ernest, is there something you want to add to that?

Ernest: Yeah, sure, thanks. Laura, I’m glad that you asked this question, because I think it’s a critical question for us, and we need to be able to let people know what we’re doing so far. That will kind of pivot us into implementing our core programmes.

Just a couple of things: one, I think it’s important for us to realise that one of the things that such epidemics or pandemics when it comes to health systems is that if you roll the confidence and trust of people in the system – and when I say people, I’m talking about both service providers and those who were seeking the service.

So, health care workers, they want to be sure that they have the appropriate infrastructure that will protect them while they are providing the services and care. They want to make sure that they have personal protective equipment that can also help to protect them. They want to make sure that they do have the testing capabilities within their respective health facilities to ensure that they’re providing. And on the fourth side is that they need to be sure that when a patient walks in they have the clinical supplies, whether it’s vaccines or whatever kind of medical supplies that are needed to provide care. That has to be there to assure them.

On the other side, patients need to be assured that when they walk into a facility showing symptoms, or they feel that they have some kind of illness, they may not know that that facility is equipped to diagnose and to be able to treat and care for them.

Thankfully, as an organisation, to our federated model, our foundations are really stepping up to do that. We’re really grateful to have this extensive network of volunteers across the globe that have quickly adapted and adjusted themselves and put themselves to the front line.

So in terms of that assurance, we are already there. And you know patients are coming in to our senior volunteers … our staff and they show them that yes, “When things quiet down, it will be easier. We can trust these facilities and these health care workers to provide care for us.” More than that, through our foundation and leadership and with the trust and confidence of our donors and our partners, we reallocated the funding to support the national response.

As I speak to you, we have acquired almost 170 oxygen concentrators. We have acquired over 200 pulse oximeters and we have acquired a little over 500,000 assorted personal protective supplies that are all going right now to sub-Saharan Africa and to two countries in North Africa.

These, in our view, are just part of us reassuring the service providers and those who are seeking the services that, “Look, listen, we have the capability; we have the support network; we’re here as a key strategic partner to you as minister of health; we want to help you through this process. We will be standing and walking with you as we transition back to normal programming.”

So, I think that trust is critical, and I’m really, really very pleased that even those who are our individual (donors) are aware of what we’re doing, and they trust Operation Smile. And I can tell you, clearly, for sure that from our Co-Founders, Bill and Kathy (Magee), to our Chief Operating Officer Jim Siti, to our Chief Development Officer Kendra (Davenport) to (Senior Vice President of Global Philanthropy) Kristie (Porcaro), everybody is working around the clock to really stay engaged with all the different stakeholders, informing them of what we’re doing and reassuring them that during this critical period, we are repurposing and we’re providing much-needed support.

Here at home, we were able to provide basic needs to Sentara medical hospital here in in Virginia Beach. More than that, through our Student Programs, you can see that from the East Coast, Mid-America, Midwest, and West Coast, Kathy and Bridget (Clifford) and Jennifer (McKendree) are working tirelessly with their teams and students to provide hot meals to front-line health care workers. I mean, it is incredible teamwork here, and trust, in my opinion, is what is fueling this but the passion and the drive that we have are additional support to this.

I mentioned Ruben, our Chief Medical Officer, who is constantly engaging his colleagues in the medical field and our regional medical officers, so I can safely say that with the support and what is already going on in our respective foundations and programme countries and through our regional directors who can see a seamless transition back into all programmes.

Two things that we are working on right now to ensure that that is also included: one, we do realise that the infrastructure, particularly when it comes to our comprehensive care centres, we are now working with medical directors in those foundations where we have care centres, the (executive directors) and regional directors to ensure that the infrastructure is properly equipped to triage patients as they come in, so that in the future if we ever, God forbid, do have a similar situation that staff and other patients are not at risk when they walk in.

We’re doing trainings right now, we are partnering with other organisations to continue to ensure that front-line health care workers have the appropriate knowledge and skill set to really provide care in a safe manner.

Laura: Yeah, I’m hearing a lot of this trust and compassion which I feel are our core values of our organisation. We are out of time, but Stuart, did you have any kind of closing words you’d like to add?

Stuart: Just that, you know, the event has been unprecedented, and all organisations are trying to figure out how to how to respond in the immediate sense and how to position and come out of this pandemic. I think Operation Smile will not be an exception to that.

We are actively reviewing how we do, for example, our mission activities and what that will look like in a post-COVID world, where there may be restrictions on the size of groups that you can get together, how long they can stay together. So they’re going to be some adjustments along those lines that we will need to add, and we’re working our way through those very well. I’m very optimistic about and positive about the progress we’ve made and what the future looks like for us moving forward.

The organisation is a great organisation. It’s got a very critical role to play. We’re sure that we play the role in the current situation but also that we continue to play that important role as we move forward. I just appreciate everybody’s effort and support.

Laura: Thank you, both Steward and Ernest, so much for joining and for sharing your expertise with our audience. I know they appreciate it.

Audience Q&A

Zak: What did the rebuilding of the (Liberian) health system look like post epidemic?

Ernest: It was challenging, considering that the system was already impacted by the 14-year civil conflict. However, there was commitment from international development partners like USAID, Irish-Aid, DFID, World Bank and others that continued to fund the rebuilding process. So, we continued training healthcare workers, strengthening supply chains with delivery of essential medical supplies including pharmaceuticals, and improving health infrastructure. The focus was really building local health systems’ capacity at primary health care level to deliver essential health care in the areas of extended programme of immunisation/EPI, reproductive, maternal, neonatal and child health.

Linda: What criteria will Operation Smile use to determine that it is safe to resume international missions?

Ernest: Our Medical Advisory Council is currently working on this. However, we certainly operate within the global framework and will continue to observe global and national advisory, especially those based on scientific evidence as well as from recognised global health organisations.

Stuart: This will require a loosening of travel restrictions on both ends of the trip, i.e., the departure and arrival ends. While it’s not certain at this time what, if any, COVID-related documentation might be required in addition to normal travel documents, we are assuming that some form of testing or vaccine will need to be in place before we can ramp up international missions again.

Janine: Are the centres being used for the COVID-19 patients as an outreach to support area hospitals?

Ernest: Not at the moment due to the respective national governments’ stay-at-home mandates. However, as mentioned during the live event, our teams are using digital platforms to continue to provide consultations to patients where possible like in Nicaragua. Our plan is to further develop and expand this capability within our programme delivery.

Diana: Will Operation Smile be COVID testing (patients) before surgeries?

Ernest: We will continue to strengthen the capacity of our partner hospitals to include COVID-19 along with other pre-surgery testing that are part of our regiment. This will include providing testing equipment and supplies and training lab technicians on additional infectious disease diagnostics. We will also include this process for our volunteer team composition to ensure total safety for all including volunteers and patients.

Stuart: The current thinking is that we mostly likely will. Our standards of care are currently under review to take into account the implications of COVID-19 on our delivery of care.

Janine: Will there be more opportunities to participate in brainstorming ways to help others or the sharing of information?

Laura: Yes! “COVID-19 Conversation” will be an ongoing series, so please continue to tune in and keep asking great questions. We are passing all of the great ideas discussed in this forum throughout the organisation, so keep them coming! You can also visit https://operationsmile.ie/get-involved/fundraise/ to check out more great ways to support our work.

Lynn: Is there anything we could do as nurse or doctor volunteers in our homes, in addition to donating money right now?

John: While monetary donations are critically needed and will provide us with the ability and agility to respond to COVID-19 and ensure that we can resume providing surgeries when it’s safe to do so, there are many ways you can support your communities during the pandemic. You could consider donating cash or food to your local food bank, as this is an area of massive need that’s been amplified by shutdowns. You could also start by researching community-level response initiatives and find the best fit for you! The need out there is great, but with the kindness and support of people like you, Lynn, we will get through this together!

FA: Where can I volunteer in regards to Operation Smile?

John: Thank you, FA. We appreciate your willingness to support Operation Smile’s response to the COVID-19 pandemic. To explore ways to become involved, please visit https://operationsmile.ie/get-involved/fundraise/ to learn more about the many ways that you can make an impact!

After a Rigorous Journey, This Venezuelan Family Finds Solace in Brazil

Three-month-old Elizabeth surrounded by her mother, Yelisbeth, her father, Yoel, and her siblings. Photo: Carla Formanek.

Venezuela’s economic and political chaos has not only deterred tourists from visiting the region, but has led to more than 4.5 million residents seeking refuge in neighbouring nations as of February 2020.

From Venezuela to Iquitos, Peru

Yoel, his wife, Yelisbeth, and their four daughters are one of the families who left their home, friends and jobs behind in search of a better life.

While Yelisbeth and Yoel’s decision to leave Venezuela was promoted by their desire to find a safe place to raise their children, they were also looking for something they struggled to find in their home country – surgery for their 3-month-old daughter, Elizabeth.

Elizabeth was born with a cleft condition and a limb difference affecting her left hand.

It was only after arriving in Iquitos, Peru, that the family connected with a man who informed them about Operation Smile and the free surgeries it provides for children like Elizabeth.

Grasping on to the opportunity to help his daughter, Yoel contacted the organisation’s team based in Peru, only to learn that the solution would remain out of reach: The next medical mission was scheduled to take place in Lima, which was very far from where his family had settled.

In an attempt to prevent his family from enduring the harsh travel distance, Yoel reached out to Operation Smile Brazil.

After being informed that the family was Venezuelan, the organisation encouraged them to seek safe surgery from the foundation in his native country. But with such tumultuous times impacting the country and foundation, there weren’t missions scheduled for any upcoming dates.

Despite the continuous challenges preventing him and his family from settling peacefully in the new country, Yoel found strength to persevere for the people he loves and cherishes most in this world.

Photo: Carla Formanek.

While unsure of what the outcome would be, Yoel reached out to Operation Smile Brazil once again. He ended the call feeling more hopeful than ever.

The team told Yoel that, in a month and a half, a medical mission was taking place in Porto Velho, which was more than 650 miles away.

Over the radio, Yoel broadcasted Elizabeth’s story and his plans to travel to Brazil in order to find her the care she needs.

Moved by the family’s story and resilience, an owner of a boat company offered them tickets to board his boat and travel down the Amazon River to Santa Rosa de Yavarí, the last city before the Brazilian border.

This initiated the first step of the long and challenging journey that stood between Elizabeth and the care that could change her life forever.

From Iquitos to Tabatinga, Brazil 

It took the family nearly three days to reach Brazil.

Traveling to Tabatinga, an Amazonian city located on the other side of the border, the family was once again surprised and touched by the compassion shown to them along the way.

“We had the help of a lot of people,” Yoel recalled. “People we had never seen gave us food and lodging.”

From Tabatinga to Manaus, Brazil 

Landing in Tabatinga, the family crossed paths with a woman named Cristiana, who generously offered them lodging and food.

Yelisbeth and Yoel depended on the meagre income they made from selling chocolates and some of their last possessions they still had with them.

More than 550 miles away from the medical mission, the family estimated that the next stretch of their trip would cost almost three times the amount of money they had at the time.

Photo: Carla Formanek.

But knowing that their dream of finding Elizabeth surgery was continuously moving closer within their reach, the entire family once again made incredible sacrifices to earn money: They left the dog that had accompanied them at Cristiana’s house, sold their fridge and deserted one of their tuk tuks, a motorised tricycle, leaving the six of them to share one together.

After almost four days of travel, everyone arrived safely in the Amazonian capital.

It was after talking to truckers and learning more about road conditions that Yoel set their departure date.

“We said, ‘Let’s go tomorrow!’ We set the alarm for three in the morning and left,” he said.

From Manaus to Porto Velho, Brazil 

Over the course of the day, the smooth paved road that the family had become accustomed to gave way to dirt and loose gravel.

“It was an infinite line to the horizon. And on the side of the road, we only saw forest,” Yoel said. “We traveled for miles without going through any communities.”

But soon, the seemingly endless dusty roads transitioned into water after they arrived at the Igapó-Açu River located in northwestern Brazil.

While receiving passage across the river on a ferry brought temporary relief to the family, Yoel knew that they still had a long way to go before reaching the mission site in Porto Velho, which was nearly 350 miles away.

After departing from the ferry, Yelisbeth, Yoel and their children were met with more sun, heat and dust as they continued on their journey.

With exhaustion weighing on the entire family, they stopped and took a break on the side of the road. They were once again met with kindness. Witnessing Yoel signal from the road, a truck driver slowed to a halt and offered to take the family to Porto Velho in exchange for small price.

Yelisbeth said that she still remembers the heady smell of petrol from the cart. And at night, when the driver would stop to rest after long hours of traveling, the family was reminded that they weren’t out of danger with being in such proximity of the Amazon Rainforest.

“We heard loud noises from the woods, and, suddenly, I saw pairs of bright eyes come out of the plants. They were jaguars,” Yoel said. “I could only think about the girls. They were my only concern.”

Conjuring up the last remaining strength they had, the family prevailed and traveled the final distance to the hospital, arriving the day before the mission was scheduled to start.

Elizabeth in the care of Operation Smile Brazil medical volunteers. Photo: Carla Formanek.

Elizabeth and her family were met with compassion from the Operation Smile Brazil medical team. And after Elizabeth passed her comprehensive health evaluation, the volunteers and staff struggled to hold back tears of joy when they informed Yoel and Yelisbeth that she was selected for surgery.

“It was a lot of sacrifice, but when we arrived here, we didn’t imagine that we would be received with such affection and love,” Yoel said.

He even said that the family hopes to make Brazil their forever home after the treatment they received from the people dedicated to the organisation.

Seeing Elizabeth’s beautiful new smile, Yelisbeth and Yoel knew that every sacrifice they made and every mile they traveled to get to this moment had been worth it.

Yelisbeth gazes in amazement at Elizabeth's new smile after surgery. Photo: Carla Formanek.
Yelisbeth gazes in amazement at Elizabeth's new smile after surgery. Photo: Carla Formanek.

This Aunt’s Love for Her Nephew Prevails

Felicia and her adoptive son, Kelvin, her biological nephew. Photo: Laura Gonzalez.

Editor’s note: This is the story of Kelvin, a 1-year-old boy from Ghana who received cleft lip surgery from Operation Smile in November 2019 – the month before his first birthday. Kelvin is the baby who portrays Ramata in the hybrid documentary film “Love Always Prevails,” which tells the story of Ramata’s mother, Mariana, and how she persevered through incredible hardships to ensure that her daughter received the surgery she deserved. Hybrid documentary films are created in a unique way, as a true story is scripted and filmed in direct collaboration with the people who lived the reality. We believe that this style of storytelling creates an emotional and intimate opportunity for the viewer to connect directly with our patients’ stories. We also worked in close collaboration with Felicia, Kelvin’s adoptive mother, who enthusiastically agreed to have her child play this role, so that Operation Smile can reach and treat more patients like Kelvin all around the world. We are very grateful and humbled to work with these families and appreciate their determination and compassion wholeheartedly.

Ramata, left, and Mariana spend time with Kelvin and Felicia during the filming of "Love Always Prevails." Photo: Zute Lightfoot.

A precious gift to her parents, Kelvin was born on Christmas Eve 2018.

But in Ghana, where he was born, the stigma surrounding cleft conditions is severe and deeply rooted; many people believe that babies born with cleft aren’t worthy of love.

This included Kelvin’s biological parents.

“My younger sister said she didn’t want a baby with a cleft, so she just ran away,” said Felicia, Kelvin’s aunt.

After her sister abandoned Kelvin, Felicia decided to adopt her nephew. She’s been raising him as her own son ever since.

“There was no one to take care of him, and I couldn’t leave him to die,” she said.

Felicia had never seen anyone with a cleft condition before. And although she didn’t know if a solution was out there, Felicia refused to walk away like her sister did.

While Felicia loves Kelvin, her life became very difficult after she made the decision to adopt him. She used to make a living as a trader, selling containers of water in the market.

“Now that I have this baby, I can no longer go to the market,” Felicia said. “I have to strap him to my back, and as soon as people see what he looks like, they don’t want to buy anything from me anymore. I have to beg people for money so I can feed him.”

Felicia felt relief and happiness when she learned that Operation Smile Ghana provides safe surgical care for patients like Kelvin. She saw an interview of patient coordinator Clement Ofosuhemeng on a national news broadcast and immediately called him to begin Kelvin’s care journey.

They traveled to Ho in April 2019 with the hopes that he would receive surgery from an Operation Smile medical mission. But after performing a comprehensive health evaluation, medical volunteers determined that Kelvin couldn’t be scheduled for surgery because he exhibited signs of malnourishment in addition to having contracted a cold.

“I don’t like to take him outside because when I do, he gets sick. He’s always sick,” Felicia said. “I don’t have money, so when I run out of food for Kelvin, I have to go out and ask people for it. I need someone to help me take care of him.”

Ramata holds Kelvin as he portrays Ramata as a baby during the filming of "Love Always Prevails" while Felicia watches in the background. Photo: Zute Lightfoot.

Through increasing education and promoting good health, Operation Smile Ghana aims to reduce malnutrition and illness as barriers preventing children from receiving safe surgery.

Before Felicia and Kelvin left the patient shelter to return home, volunteer dietitian Dede Kwadjo, who runs the nutrition programme for Operation Smile Ghana, evaluated Kelvin and gave Felicia helpful advice about the types of food that Kelvin needs to eat in order for him to become healthy enough for safe surgery.

“We train our mothers to use what they have to create nutritious food for their children. We ask what they have available: fish, beans, banana. Then, we work with them to create a practical solution, teaching them how to help their child,” Dede said.

“I will feed him well so he can gain weight and grow stronger,” Felicia said.

Felicia hasn’t heard from her sister since she left Kelvin shortly after his birth. She has no idea where she is. But after learning that Kelvin couldn’t receive surgery yet, Felicia refused to give up hope.

In August 2019, Felicia and Kelvin attended a mission in Cape Coast that was conducted entirely of Ghanaian medical volunteers, but again, they left heartbroken: Kelvin developed a cough before his medical evaluation, so he was unable to receive surgery.

Finally, in November 2019, Felicia and Kelvin traveled to Koforidua in another attempt at getting him the surgery that he needs and deserves. This time, Kelvin was deemed healthy and received cleft lip surgery.

Kelvin’s surgery came within the first year of his life, which is the best time for a baby to receive a cleft lip surgery.

Felicia said that she hopes to spread the word about the work that Operation Smile Ghana is accomplishing in the country.

“If I see someone else with a cleft, I will advise them and encourage them and ensure them that they should come and be seen by the doctors at Operation Smile.”

Meet Our Patients: Puebla, Mexico

Photo: Rodrigo Avina.

When both of her twin daughters, Daniela and Denise, were born with cleft conditions, Angélica relied heavily on the love and support of her family. 

As a single mother working tirelessly as a part-time maid to provide for her family, Angélica knew that paying for surgery for both of her twins was far beyond her means.

But that never stopped her from seeking out a solution. And while she was left without answers for more than a year, Angélica refused to stop searching because she knew that her daughters were depending on her.

“I am devoted to my children,” Angélica said.

The solution she searched for was suddenly in sight when a pastor from their community told them about Operation Smile Mexico and the life-changing surgeries it provides for children like Daniela and Denise.

Not only did the pastor tell them where the upcoming medical mission would be, but he helped Angélica, her sister and her daughters secure transportation to the mission site, which was four hours from their home.

After the twins both passed their comprehensive health evaluations, the time came for them to receive their free, safe surgeries.

Today, Daniela and Denise now have beautiful new smiles and brighter futures.

“I feel like this is the best thing that could’ve ever happened to us,” Angélica said. “The way that they (Operation Smile Mexico) treated us inspired, motivated and encouraged us to allow them to perform surgery on our children.”

Celebrating Year of the Nurse & Midwife: The Essential Roles of our Nurses

Editor’s Note: Alongside the World Health Organisation, Operation Smile is excited to celebrate 2020 as the International Year of the Nurse and Midwife. We recognise that a strong nursing and midwifery workforce is critical to the achievement of both universal health coverage and our vision of a future where health and dignity are improved through safe surgery. Currently, nurses and midwives account for nearly 50 percent of the global health workforce. However, there is a critical shortage of health workers globally, and nurses and midwives represent more than 50 percent of the current shortage. For all countries to reach U.N. Sustainable Development Goal 3 on health and well-being, the WHO estimates that the world will need an additional 9 million nurses and midwives by the year 2030. Through the platform of the International Year of the Nurse and Midwife campaign, Operation Smile seeks to inspire the future generation of nurses by highlighting the leadership, innovation and dedication to patient safety of our volunteer nurses, who have been and continue to be instrumental in the healing of hundreds of thousands of Operation Smile patients. By sharing their stories and celebrating their selflessness, creativity and compassion, we aim to contribute to the conversation on strengthening the profession so that we can work toward a healthier future for all.​

Post-anaesthesia care unit nurse Patricia Meireles tends to a young patient at an Operation Smile medical mission to Fortaleza, Brazil. Photo: Paulo Fabre.

One may not think that a medical mission site and an auto mechanic’s shop would have much – if anything at all – in common.

That is unless you’re Jeanne Kille, an Operation Smile volunteer operating room nurse.

“Growing up, my dad was an auto mechanic, so a ‘well-oiled machine’ was something our family could all relate to,” said Kille, who lives and works in Utah. “On my last medical mission, I was a Clinical Coordinator in China and I described my nurses as the grease that makes this machine of Operation Smile run – nurses are what makes this organisation run smoothly and efficiently.”

Out of the 51 volunteer positions on an Operation Smile international medical mission, 19 positions are filled by nurses. Currently, nurses represent 36% of our medical volunteers.

Operation Smile nurses are also the only medical volunteers who actively provide care for patients through every stage of the surgical process.

During patient screenings, nurses assist with comprehensive health evaluations, which determine if patients are healthy enough to receive anaesthesia and surgery. Operating room (OR) nurses manage the equipment needs of the surgeon and ensuring that sterility is never compromised. Post-anaesthesia care unit (PACU) nurses carefully monitor patients as they awake from anaesthesia before post-operative nurses tend to patients with wound care and educate their families about the healing process prior to being discharged.

Deidre Fenner, operating room nurse from Australia, at work during an Operation Smile medical mission to Cebu City, Philippines. Photo: Jörgen Hildebrandt.

Regardless of their subspecialty, Operation Smile nurses’ knowledge of paediatric principles and their diverse abilities ensure that every patient receives the exceptional care they deserve.

The pre-op and post-op nursing duties are combined into a single role, which requires physical stamina and sharp decision-making skills amid the bustling mission or care centre atmosphere.

“(Pre/post-op nurses) are adept at multi-tasking as they admit and assess new patients while monitoring those already on the ward,” said Ann Campbell, Operation Smile’s Senior Director of Medical Oversight. “They’re always using their critical thinking and assessment skills to recognise a change in the patient’s health status.”

PACU nurse Florence Mangula consults with a patient's father during an Operation Smile surgical training rotation in Ethiopia. Photo: Jörgen Hildebrandt.

In the pre-op role, nurses prepare and monitor our patients ensuring that they are physically ready for anaesthesia and surgery. They support the patient and family with information and emotional care while maintaining a time-sensitive workflow with the OR staff.

Next, OR nurses control the logistics and workflow of the operating room, often managing two surgical tables simultaneously.

“The role of an OR nurse is patient safety first,” said Bryn Frazier, a volunteer OR nurse. “We ensure that the correct procedure is to be performed on the correct patient prior to induction of anaesthesia… At the end of the case, we provide safe patient care with the anaesthesiologist as the patients wakes up from surgery.”

OR nurse Bryn Frazier (right) prepares a young patient for surgery during an Operation Smile medical mission to Tegucigalpa, Honduras. Photo: Jasmin Shah.

This is leads into the PACU, also known as the recovery room, where the patient is monitored as they return to consciousness after surgery. PACU nurses are responsible for monitoring the patient’s vital signs, assessing their airway and breathing, and must be ready in case the patient experiences any complications. They also make sure the patient is adequately hydrated and that their pain levels are controlled. As are all Operation Smile nurses, PACU nurses are trained in life support skills to respond to these potential emergency situations.

“PACU nurses play a very big role because they are the bridge between the OR staff and the paediatric (post-op) ward staff. In fact, they are the first people to see patients come into the ward before their parents see them,” said Florence Mangula, a PACU nurse from Kenya who has served on more than 30 Operation Smile missions. “The nurse then monitors the patient until they are fully awake… We also check for any bleeding or swelling from the operation site and report that to the (PACU physician).”

PACU nurse Chen Wei cares for a patient during an Operation Smile medical mission to Dafang, China. Photo: Zute Lightfoot.

Like all Operation Smile medical volunteers, our nurses are a diverse group which hails from around the world – a factor that presents communication challenges they do not face at work in their home countries.

“I have been in the OR with seven people and no one speaks the same language,” Frazier said. “Because of our commitment and knowledge, the cases run smoothly – we are all on the same page.”

Campbell added: “That’s what makes nurses great. We don’t stand around looking for someone to figure out the answer to a problem. We just link arms and jump in to get the job done.”

While the roles vary between subspecialty, the common thread between all Operation Smile nurses is their calling to serve those who need their attention and skill the most.

“We do missions in our home countries, we travel long distances to other countries, we learn new things from the other international volunteers or even the local hospital nurses and we teach new updated things to the other volunteers and local hospital nurses. It’s like a global knowledge exchange,” said Yazan AbuAlfa, a PACU nurse from Jordan. “We don’t change only the patients’ and their families’ lives, but our lives are changed too.”

PACU nurse Yazan AbuAlfa (center) consults with a patient alongside surgeon David Chong during an Operation Smile medical mission to Tegucigalpa, Honduras. Photo: Rohanna Mertens.

Skilled at Heart

Editor’s Note: In Ethiopia, Operation Smile is helping to strengthen the country’s health system through specialised training and education programmes while continuing to provide patients with world-class levels of surgical care. This story is the second of a four-part series.

Operation Smile’s Global Standards of Care requires that all nursing volunteers are certified in Basic Life Support (BLS), a course which teaches the fundamentals of cardiopulmonary resuscitation (CPR).

That standard exists for good reason – cardiovascular disease is the leading cause of death worldwide, killing more than 17 million people every year. According to the American Heart Association (AHA), for every minute CPR is delayed to a victim of cardiac arrest, his or her chances of survival decreases by 10 percent.

In many low-and-middle-income countries, including Ethiopia, knowledge of these life-saving skills is not widespread – even among medical professionals. In response to this dire educational need, Operation Smile is committed to offering AHA training programmes in the countries where it works. These life-saving certifications not only improve patient safety at our medical mission sites, but also strengthen health systems in the trainees’ communities for the long term.

The impact of these programmes is immense. Of students surveyed who completed Operation Smile AHA courses, 84.4 percent of respondents said that principles taught in their courses changed policies or procedures in their home countries or hospitals. An even greater majority of respondents, 96.5 percent, said that the courses changed how they reacted to an emergency situation.

More than 84 percent said they have already used skills learned in the courses to save a life.

We recently caught up with long-time Operation Smile nursing volunteer Florence Mangula of Kenya about her experiences both as a student and instructor of BLS and Paediatric Advanced Life Support (PALS) courses. Affectionately called “Mama Africa” by the Operation Smile medical volunteer community, the intensive care unit nurse has become a fixture in spreading this life-saving knowledge throughout Sub-Saharan Africa.

What inspired you to become a nurse?

As a young girl, I used to get recurrent tonsillitis. I was afraid of injections, so my mother would have to force me to go to the nearest health centre for treatment. Every time I went, I saw a nurse in a clean white uniform, shoes, cap and dress. I was fascinated by her elegant walk, confidence and the passion she had for her work. She would greet me with a smile and say, “My sweet pie, sorry you are back!” As I grew older, I kept telling myself that I want to be like that nurse – compassionate with a caring attitude and empathy for human beings. She would always say, “I’m sorry, but want you to be well.” To this day, I walk with my head up, with confidence, and treat my clients with care and compassion. I love this! Thanks to her for being a role model of good nursing, for I think I have also inspired many others to become nurses.

What kind of experience did you have with BLS/PALS before receiving training from Operation Smile?

I’m an ICU nurse and I thought all nurses were trained in emergency life-saving techniques and CPR. When I received training from Operation Smile, I realised many nurses in my region didn’t have those skills – many feared to tend to emergencies and feared to take the course, which I found disappointing. I’m thankful that Operation Smile offers training in both BLS and PALS, as anyone who completes these trainings can save lives in their communities.

As a student, what did it mean to you to learn these skills?

I learned these skills to improve my performance and become more competent in CPR. In fact, the PALS training was of great help. It stimulated my critical thinking and made me evaluate the care I gave to my patients, as it involves equipment, drug administration and team dynamics.

How does Operation Smile select its AHA course instructors?

Operation Smile’s Global Standards of Care requires students to pass their exams with a score above 84 percent to become certified. Those who score over 92 percent are eligible to become instructors. Also, the student must pass in the skill station, where one is examined on competence. Then, the students must complete “training of trainers” course to become certified as an instructor.

As a student, what did it mean to you to learn these skills?

I learned these skills to improve my performance and become more competent in CPR. In fact, the PALS training was of great help. It stimulated my critical thinking and made me evaluate the care I gave to my patients, as it involves equipment, drug administration and team dynamics.

How does Operation Smile select its AHA course instructors?

Operation Smile’s Global Standards of Care requires students to pass their exams with a score above 84 percent to become certified. Those who score over 92 percent are eligible to become instructors. Also, the student must pass in the skill station, where one is examined on competence. Then, the students must complete “training of trainers” course to become certified as an instructor.

Care for a Brighter Futures: Luciana’s Story

Nury sits on a sofa in their home in Bogotá, Colombia, trying to recall the moment that her first-born child, Luciana, entered the world.

“She was born on a Friday morning, and the nurse immediately placed her high up on my chest so I couldn’t see her face,” she said.

She knew about Luciana’s cleft lip and cleft palate from an ultrasound she received seven months into her pregnancy, but she refused to acknowledge her daughter’s condition.

“I know now, through Operation Smile, that it is quite common. But then, I just didn’t believe that it would happen to my daughter,” Nury says, shaking her head.

Luciana has just enjoyed being bathed in a baby bath tub. She was constantly smiling at both of her parents as they played with her and splashed lukewarm water on her little body.

Now she is on her mother’s lap, dressed to go for a visit to Operation Smile Colombia’s care center in the city. Tomorrow, she’s scheduled to receive surgery for her cleft lip – the first step in a long series of procedures and consultations that she will continue to have through her teenage years.

Photo: Rohanna Mertens.

The journey to this point has been tough and painful for Nury.

“The day after she was born, they brought her to me again to see if I could breastfeed her even though she had a cleft palate. I turned her towards me and she yawned and it made me very shocked. I started to cry and the nurse took her away from me,” Nury says, the memory filling her eyes with tears.

Later, when she tried to breastfeed Luciana again, it just didn’t work. She had to start feeding her baby with a spoon.

“It made me so sad to see her feed like that,” Nury says.

Unlike his wife, Daniel, Luciana’s father, didn’t feel anguish when his daughter was born.

“I was not surprised, or afraid or sad – I felt just pure happiness. I thanked our Lord when she was born,” Daniel says. “I know God has a meaning for our lives and if He wanted to send her to us like this, it is a pleasure above everything else.”

At the hospital where Luciana was born, a doctor told Daniel about Operation Smile – an organisation that offers expertise in treating cleft conditions at no cost to its patients or their families. The next day, Daniel called Operation Smile Colombia, which scheduled an appointment for Luciana within the following three weeks.

“The process was fast and I really liked the way they prioritised Luciana,” he says.

Photo: Rohanna Mertens.

Now it’s surgery day for Luciana, and Daniel and Nury arrive to the centre with their baby. The clinic is filled with children of different ages and their parents waiting for their consultations with various specialists.

“We are well-known by patients all over Colombia and also by referring specialists in their hospitals,” says Dr. Mauricio Herrera, a cleft surgeon and the medical director of Operation Smile Colombia. “We have become a specialist care centre for patients born with cleft, and hopefully we will continue developing in this direction and become a national reference centre for the whole country.”

At the centre, patients like Luciana will be able to receive care such as dental care, pre-operative care; ear, nose and throat treatments; nutrition advice; psychological therapy; and speech therapy. Parents can even take courses on how to best support their children.

Today, Operation Smile’s care centre in Bogotá provides treatment for half of the children born with cleft conditions in Colombia every year.

Mauricio explains why it’s so important to offer the whole family help and care: “When a child is born with a cleft, the whole family is affected and sometimes it can crush them if they start to accuse each other or themselves. It is easy to think that we treat only the children born with cleft, but actually it affects so many people around them, and that is why the work we do here on a daily basis is so important.”

Now, it’s Luciana’s turn to go inside the operating theatre. Mauricio and the surgical team takes care of her while Daniel and Nury patiently wait outside. Luciana will soon have her lip fixed and will return in the coming months for her palate surgery. Today is just the first of the many days she’ll spend at the centre. She will continue to see specialists here throughout her childhood.

Operation Smile Colombia medical director and cleft surgeon Dr. Mauricio Herrera, left, performs Luciana’s cleft lip surgery with support from plastic surgery resident Dr. Angela Rivera and instrumentation student Valeria Garcia. Photo: Rohanna Mertens.

“The plan for Luciana is for her to have a normal childhood,” Mauricio says while the nurses and anaesthesiologist carefully prepare her for surgery. “By the treatment we can offer her, she will have a chance to have a life just like any other child, without the stigma the cleft otherwise would have caused her.”

After a little less than an hour, Luciana’s surgery is complete and she’s brought into the recovery room to be reunited with her parents. Nury cries when she sees Luciana for the first time – but unlike when she was born, these are tears of relief and happiness.

Photo: Rohanna Mertens.

One year later, Luciana is a vibrant little girl who loves playing in the park. At Operation Smile Colombia’s care centre, she continues to receive comprehensive treatment from medical volunteers who provide the ongoing care that she needs to thrive and live a life filled with happiness.

“She looks perfect, just as I had dreamed of. If it hadn’t been for Operation Smile offering a solution for Luciana, it would have been just terrible,” Nury says. “For me, as a mother, I would have fallen into a depression because people’s prejudice also affects the parents of children born like this. So it would have been very frustrating for her, for me and for her father if there had been no solution like this.

“Moving forward, I want to give her all the best things. I think every mother wants that for her children: to give them a good education, a good learning process, growth, always being by her side. I want to be by her side during all those moments. She is my whole life.”