Going the extra Miles for Smiles: Madagascar nutrition programme

Held by his mother, Patricia, 14-month-old Icardi sips formula from a bottle. Photo: Henitsoa Rafalia.

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

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

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

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

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

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

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

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

Photo: Henitsoa Rafalia.

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

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

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

Photo: Henitsoa Rafalia.

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

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

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

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

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

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

Photo: Henitsoa Rafalia.

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

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

Operation Smile Madagascar patient Coordinator Jose Augustin shares a smile with a patient. Photo: Henitsoa Rafalia.

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

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

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

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

Smile Photo: Henitsoa Rafalia.

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

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

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

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

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

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

After 35 years, Tereza is finally free

Tereza, 35 years old. Photo: Margherita Mirabella.

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.

After surgery, Tereza embraces her newfound happiness, but the pain of living 35 years with an unrepaired cleft condition isn’t something she’ll forget.  

As a child, Tereza faced torment because of how she looked. As she grew to adulthood, the bullying only intensified.

Some people from her community told her that she was only “half a person” and that she had nothing to contribute to village life.

Despite her dream of one day being accepted by those around her, the harassment caused Tereza to abandon her schooling and forced her to become completely ostracised from her village.

Although there were three people also born with cleft conditions in her community, Tereza’s decision to distance herself from her village also meant separating herself from the only three people who could understand the pain she was facing.

During a seemingly normal day, one of the people living with a cleft lip left to attend an Operation Smile medical mission in 2014.

Without enough money to afford the bus fare that would take her to Lilongwe, Tereza was forced to watch as the bus drove away.

But upon seeing them return with a new smile, Tereza was motivated. And she refused to let anything get in her way of attending the next mission.

Her opportunity came after she contacted Operation Smile Malawi, which arranged free transportation to the upcoming mission, eliminating the obstacle that stood in her way a year before.

Her perseverance paid off, and Tereza was taking the first step in her journey toward ending the painful harassment that had become all too familiar.

Although there were others in her community living with cleft conditions, Tereza believed that they were the only ones.

But after arriving at the mission site, Tereza was shocked to see so many others who looked like her.

For the first time in her life, Tereza felt like she was no longer alone.

Potential patients gather during a 2015 Operation Smile medical mission in Lilongwe, Malawi. This was the day Tereza learned that she was placed on the surgical schedule to receive her free cleft surgery. Photo: Margherita Mirabella.

It’s estimated that, worldwide, a child is born every three minutes with a cleft, which is about one in every 500 to 750 births.

We’re working to discover the causes of cleft through research and putting our evidence into action to prevent cleft conditions before they develop in the womb.

Tereza was amazed by the compassionate volunteers who were donating their time and expertise to patients and their families affected by cleft conditions – a sharp contrast to how she was treated in her community.

Globally, Operation Smile has improved the health and dignity of more than 300,000 patients living with cleft conditions, helping them to breathe, eat, speak and live a better quality of life with greater confidence.

In Malawi, our team is working to address the backlog of people like Tereza who have been unable to access the surgery they need.

For the first time in 35 years, Tereza was among people who would accept her for who she was, and she didn’t have to worry about what they’d say when they saw her cleft lip.

She found peace in the hectic environment of health assessments and pre-surgical appointments and was comforted by the fact that she was surrounded by kind people who understood what she was going through.

Tereza was overcome with happiness and relief when medical volunteers placed her on the schedule to receive her free surgery.

“When I have my surgery, it will be like I’m born again,” Tereza said. “I will be a new person.”

Tereza, after surgery. Photo: Margherita Mirabella.

While looking at her photo taken before surgery, Tereza admitted that she wasn’t happy. Living with an unrepaired cleft had taken a toll on her self-esteem and confidence.

Now, her life is very different.

“I am living a free life,” Tereza happily explained.

Since her successful surgery, Tereza has returned home and become part of her community again.

She loves engaging with others because she no longer fears being ridiculed.

Tereza feels excited to have had the opportunity to receive her life-changing surgery and plans to educate her community about cleft and Operation Smile’s life-changing work with hopes of preventing anyone else from experiencing the pain and loneliness she endured.

Photo: Margherita Mirabella.

Driven to lead: Q&A with Abhishek Sengupta

Abhishek Sengupta, Operation Smile India’s executive director and regional director for India, Russia and Italy. Photo: Lorenzo Monacelli.

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

First beginning his journey as a translator during medical missions, Abhishek Sengupta has continuously climbed the ranks within Operation Smile, holding many roles including programme coordinator, programme manager and regional programme manager.

Today, he uses his knowledge and expertise of the organisation to execute the role of executive director for Operation Smile India and the regional director in India, Russia and Italy.

“I grew up in a very small town where, since you were a kid, you were told that you have to either be a doctor or an engineer or a lawyer,” Abhishek said. “What Operation Smile exposed me to is that you can help people, and that can be a career.”

Pausing all medical programmes in India was an incredibly difficult decision, especially after having just wrapped a successful mission in Durgapur, but Abhishek knew that he needed to do everything in his power to protect his team, his patients and his country.

“For us, the biggest point of discussion that we had at that point of time was, one, patient safety and, second, volunteer safety,” he said. “That is what we championed in Operation Smile, and that is something that we would never compromise.”

We recently connected with Abhishek to hear more about his journey with Operation Smile and how his team in India strives to overcome COVID-19 challenges in the communities where they work.

Abhishek Sengupta, then the lead programme coordinator for Operation Smile India, poses with the translating team in Nagaon during a 2010 medical mission. Photo: Kieran Harnett.

Q: When did your involvement with Operation Smile begin?

A: “I actually started with Operation Smile as a student volunteer way back in 2005. That’s when I was getting my bachelor’s degree in English literature. Operation Smile had been working in India for just one year before that. They were doing a mission, looking for translators because, as you know, on a mission, the international volunteers need translators to communicate with local staff as well as patients. We took a van because our Operation Smile team that had sent a van for all the translators, and there were around 25 of us. There were like more than thousand people there. We got out and then we realised these are our patients. That day, we screened more than 600 patients. We went at 7 a.m. and came back to our dorm rooms at around 10 at night. We were exhausted, but we loved it.

“I think that’s when it clicked. Since then, I volunteered for a few more missions. We were doing missions in Bolpur, we’re doing missions in Deesa. Whenever they would come back to Bolpur for a mission, I’d help with patient recruitment, I’d help with some of the logistics with the hotel, lunch, dinner, as well as some of the hospital relationships. I would handle all that. That’s how it started. Believe it or not, the reason I was getting a bachelor’s in English literature was because I wanted to be a journalist. But then Operation Smile happened. Since then, I’ve been working in the development sector. After my graduation, I was offered a job as a programme coordinator in India, which I readily took. I love doing what I do. It’s been an amazing journey.”

Q: What was it specifically that drew you in to working with Operation Smile India?

A: “I think what really inspired me was the idea of helping people. I grew up in a very small town where, since you were a kid, you were told that you have to either be a doctor or an engineer or a lawyer. When I decided to be a journalist, that was actually going off the track. What Operation Smile exposed me to is that you can help people, and that can be a career. This was something that I didn’t know. That was inspirational. In my job right when I was a programme coordinator, I used to travel to rural India, I used to travel to small villages, meet patients, meet their families. At the same time, the next day, I would be sitting in an office in Bombay and meeting a corporate donor.

“That’s the interesting part, you meet policymakers, you meet health ministers, you meet health secretaries. The entire spectrum of people and the job is very interesting, it’s very dynamic. Every day is different. I’ve done over 100 missions in my life, and I still learn from each and every mission because it’s not the same. I think one is the element of dynamism with the job. The second, you get all that while you’re making a difference in someone’s life. I think you really don’t need anything more than that to choose, I think it was an obvious choice.”

During Operation Smile India's February 2020 medical mission in Durgapur, 130 patients like Shahid received life-changing care. Photo: Lorenzo Monacelli.

Q: What shocked you the most about the need for cleft surgery in India?

A: “I think when I started with Operation Smile, we were pretty much the only charity in India doing providing free surgery to children with cleft lip and palate. I had never seen a child with a cleft in my life. Even today, when I walk on the streets, I don’t see a child with a cleft lip and palate. Now imagine, while this is the reality, you end up on a mission or you come to an Operation Smile centre and you see hundreds, sometimes thousands of kids with cleft lip and palate. What that means is that there is something wrong. Why do we not see these kids in regular life?

“I started to engage with patients and patients’ families, hear their stories. Once you hear these stories, you just understand. How these kids are shunned away, and then you hear stories about the taboo and the superstitions that are associated with cleft. Something needs to be done about it. I think that’s what’s very critical, and that’s what I think people like us want to do and we have dedicated ourselves to doing and same with Operation Smile, I think that is what we champion, and that is what we want to continue doing.”

Photo: Lorenzo Monacelli.

Q: Although we’ve had to postpone many surgical missions due to COVID-19, could you speak a little bit about what your team has done to provide food and relief items to families and migrant workers in India?

A: “We are very proud of what we have done. Of course, we believe that it is our responsibility to stand beside communities even in times of hardship, especially in times of hardship. Once we shut down our programmes, we realised that this is going to stay and our teams were there and we wanted to help people. One way was to collaborate with hospitals and provide them with PPE, get our volunteers to help supporting as frontline workers in COVID wards and all of that, but then we realised that there were already people doing that. Plus, at that point of time, there was a huge shortage of PPE, so even for us to buy, it was difficult.

“Then we realised that because of the lockdown, there was another challenge. India has more than 4.5 million migrant workers. These are people who come from small villages to smaller towns or bigger cities in search of jobs. They would work at restaurants, pubs, bars, factories, small businesses. Most of them are daily wage earners. Depending on the number of hours they worked a day, they would get paid at the end of the day. That’s how they sustain. What happens is these factories, these restaurants, these businesses where they work, that’s where they stay. At night, they would sleep at the restaurant once it’s closed down. Because of the lockdown, suddenly all these businesses were shut. Suddenly, none of these people were being paid. They lost their jobs overnight. Most of them also didn’t have a place to stay because they were still living in the place where they work, or even if they were paying rent in a big city, once their daily income is gone, they were not able to pay that rent. There were no trains to go back home. There were no buses. You would see migrant workers walk for seven days, 12 days, 14 days on the highways trying to go back home because there were no transport.

“The other problem that happened is because these are people who pretty much live on a day-to-day basis, they don’t have any savings. Once they lost their jobs, there were a huge number of people who were living hungry. They didn’t have money to have two meals a day, leave aside three meals a day. We saw this as a problem, and we decided that that is a space we want to work in.

“We picked up two cities where we run centres. We started giving out food supplies. Overall, in about four weeks, we were able to support about 2,500 families, providing them food supplies. In each packet, there would be rice, potatoes, lentils or cooking oil, enough for about 20 days for each family. Then, of course, we also gave some hygiene kits, which is masks, sanitisers, soaps, buckets and mugs, because we felt that is important in these times. We hope that, socially, as we accept this as a new reality, I think people’s health-seeking behaviours are also influenced. Those are some challenges that, as a country, we can overcome.”

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

Photo: Lorenzo Monacelli.

From patient to programme coordinator

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.

This story was written by Brady Hishmeh, Operation Smile Student Programmes Media Intern.

As a senior in his university looking to kick-start his career right after graduation, Lam Tran devoted his time and focus to the job hunt. From checking postings to reading helpful guides and so much in between, it turns out Lam wouldn’t just find his career — he would find his calling. 

In a book titled “How Much Youth is Worth,” he discovered Operation Smile.

It was listed in a paragraph where the author shared the importance of Vietnam’s youth working for non-profit organisations to better their communities. Eager to land a job and taking the suggestion from the book, he didn’t think twice about Operation Smile and quickly filed applications to several organisations in Vietnam.

Operation Smile was the first to respond — and that’s when he realised this wasn’t his first interaction with the organisation. He read its name and stopped.

Lam Tran with Operation Smile Co-Founders Dr. Bill Magee and Kathy Magee. Photo courtesy Lam Tran.

“Oh wow,” Lam recalled thinking at the time. “I recognised the organisation that brought me free surgery in the past.”

And when Lam arrived for his interview with Operation Smile Vietnam, the location’s programme director Ms. Duc said, “Welcome back, Lam.”

With his important perspective and drive to help others, Lam’s story seems to have come full circle as he’s now helping Operation Smile’s patients receive the same kind of care he did, and from the same organization.

Photo courtesy of Lam Tran.

“In Operation Smile, we have a very meaningful slogan: ‘Changing lives, one smile at a time,’” Lam said.

“That’s true for me. This mission at Vietnam Cuba (hospital) changed my lips, my nose and also my face. I understand (patients’) feelings, their inferiority, and I know the advance they get when they’re more confident. One surgery not only changes the smile but also changes someone’s life. So, as an Operation Smile coordinator, I always try my best to help people like myself.”

Photo courtesy of Lam Tran.

Born with a cleft condition in Thai Binh, Vietnam, a small province south of Hanoi, Lam said his greatest challenge growing up as a child living with cleft was his lack of confidence.

Having to deal with bullies is pretty universal, something that almost every child experiences. But for children with cleft conditions, it can serve as a constant reminder that there’s something separating yourself from your peers. It’s an easy target for jibes, jokes and painful stigma.

The amazing thing about a cleft condition is that it can be repaired. Lam’s had three surgeries, repairing his lip and nose.

“Since then, I’m more confident, more ‘normal,’ and I don’t see myself as a cleft boy anymore. I’m really able to be myself and do my own things,” Lam said.

Photo courtesy of Lam Tran.

Having returned to Operation Smile, though in a different role, Lam realised the importance of his work.

“Running a mission, doing coordinator work, helping the kids, everything seemed to tell me, ‘Lam, this is the mission of your life.’”

Lam is a living example of the impact surgery can have on an individual.

Focusing on his career as a programme coordinator allows Lam the ability to help lift children from the uncertainty of life with a cleft condition into the reality of confidence, strength and self-assuredness that surgery provides.

When asked what he believes is his greatest achievement in life has been so far, he responded: “I haven’t achieved my greatest goal so far, I’m still on my way there: Help as many kids as possible.”

Photo courtesy of Lam Tran.

Enok’s path

Margherita Mirabella, Operation Smile.

Enok remembers being jeered, mocked, chased by packs of children and having people recoil in disgust at his cleft lip. While his memories echo the stories of thousands of Operation Smile patients – most young children – Enok already endured a lifetime of torment when he received surgery at 25 years old.

Suffering from a severe bilateral cleft lip, Enok finally summoned the courage to seek help during an Operation Smile medical mission to Rwanda in 2013. Even then, Enok was reluctant to receive surgery. It was on a visit to his village that Operation Smile volunteers saw him persuaded.

“If they were not here to convince me, I wouldn’t be able to temper going into a bar and sitting with other people and sharing a cup,” Enok said. “But now I can enter into any place and people even come to share the cup with me.”

Margherita Mirabella, Operation Smile.

It’s been three years since Enok’s life was irrevocably changed by Operation Smile. Though his surgical scars are almost invisible to the naked eye, his emotional scars continue to heal as this soft-spoken man recalled the daily struggles he once faced.

“I walk to work from my home and before the surgery, I would take all sorts of detours and creep through people’s gardens and farms so that I could avoid being seen,” Enok explained as he walked through lush green vistas on his way home from the bakery at which he works. “Children would either run away if they saw me or run behind shouting horrible things.”

Margherita Mirabella, Operation Smile.

It’s hard to believe that Enok’s walks of shame ever occurred, as he is constantly stopping to greet yet another friend or pass along the latest news and gossip with a neighbour. People called his nickname throughout the walk; and when they yelled, “Bibi,” it wasn’t hard to detect notes of affection and pride in the tone.

“Before (the surgery), everyone was scared of me. I couldn’t stand and talk to a girl, but now I can easily find a girl on the roadside and stand for a while and talk to her,” Enok explained as he grinned. “Even young kids would get frightened when they saw me, but nowadays I am a normal person in the community. I meet people and they talk to me like they would someone who has been there the whole time.”

When Enok mentioned being “there the whole time,” he referred to being cruelly ostracised and made to feel as if he didn’t exist before the surgery. At home, his mother hovered in the background, ever-protective of her seventh child and confirmed this misery.

RWA_2016_Enok_Enok Birimoyesu_Male, 25 Years Old, After, BCL, Original Chart Number 155, Original Mission Dates Sept 2013, Original Mission Location Ruhengeri (Musanze), Rwanda - Ruhengeri Hospital. Post-Op Dates May 2-3, 2014, Post-Op Location Ruhengeri (Musanze), Rwanda - Ruhengeri Hospital, Post op Chart 175. Follow up, Home Visit May 2016, Interviewer Sean Robson. (Operation Smile Photo- Margherita Mirabella)

“Whenever I was going somewhere with Enok, young kids would run away because they thought he would bite them,” she said. “I kept hoping and praying that God would help him. When it happened, I praised God for it because it was an answer to my dreams. It was done perfectly and he is really new as he says.”

Since receiving surgery, Enok has enjoyed a more fulfilling experience working at the bakery as well.

“I have regained respect from my community, including my boss and colleagues, because before I was less considered and working in a way isolated from the rest,” Enok explained.

Margherita Mirabella, Operation Smile.

There is a confidence around the baker and, together with his mother, he’s become an advocate for Operation Smile’s work in Rwanda. They’ve even gone so far as to track down a nearby resident and friend, Veronica, who has a cleft lip and encourage her to seek surgery.

“She is afraid for now, but we are trying to convince her,” Enok said. “As for the good things that have happened to me and changed me to a new person, if I meet someone with the same problem, I would advise him or her to go to see the doctor and find out if there is any opportunity for surgery.”

Margherita Mirabella, Operation Smile.

Let’s Talk: Speech Therapy Programme “HablemOS” Helps Thousands Across Latin America

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Longtime Operation Smile volunteer Milagros Rojas joined the HablemOS team, bringing with her years of experience as a speech pathologist. Photo: Margherita Mirabella.

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

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

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

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

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

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

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

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

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

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

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

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

Two Thumbs-Up

Nine-year-old Bipul during patient announcement day at Operation Smile’s 2018 medical mission in Durgapur, India. Photo: Jasmin Shah.

After loving and raising three daughters together, Nioti and her husband, Monbula, remained hopeful that they would finally welcome a son into their family.

When Nioti gave birth to their fourth child, Bipul, during the early hours of one winter night, she and Monbula were overjoyed to see that their prayers had been answered: Their first son was born.

But instead of feeling relief and excitement on the day of Bipul’s birth, the family was overcome with great pain when they looked at their only boy and saw that he was born with a cleft lip.

Lacking proper knowledge on the actual causes of cleft, which can be environmental or hereditary, Monbula and Nioti believed that Bipul’s cleft condition was a punishment from the gods due to the influence of a lunar eclipse during her pregnancy.

While some people believed Bipul to be “polluted” because of his cleft lip, Nioti had a love for her son that outweighed everything else.

“My fate was to have this baby,” Nioti said.

Monbula and Nioti learned about the possibility of surgery on the same day that Bipul was born. And while they didn’t know what Bipul’s future held, they were confident that their son would one day receive the care they knew he needed and deserved.

And when the family learned that free surgery was possible in the nearby town of Odisha, it seemed as though that day had arrived.

But for 3-year-old Bipul, the idea of leaving home frightened him. And so, his family decided not to go, resulting in Bipul having to continue living with an unrepaired cleft.

As Bipul grew older and started going to school, the teasing and name-calling he received from some of his peers became almost too much for him to bear. He would often come home crying due to the harmful abuse he endured throughout the day. In an attempt to comfort her son, Nioti would tell Bipul that he would one day receive surgery that would repair his cleft lip and change his life.

When Bipul was 9 years old, the surgery his mother always talked about didn’t feel too far away after Operation Smile hosted an awareness event in their village for an upcoming medical mission in Durgapur.

This time, Bipul wasn’t afraid.

He even said that, if he had to, he would travel on his own to reach the mission. As if all the fear that once held him back had vanished, Bipul bravely made the journey with his family toward a new smile.

Bipul with his mother, Nioti, as they wait for his surgery to repair his cleft lip. Photo: Jasmin Shah.

At every stage of the mission, whether it was receiving a health evaluation or waiting during patient announcement day, Bipul had a huge smile on his face as he gave two thumbs-up to anyone who passed by.

Bipul’s courage helped him not only face the unfamiliar environment of the mission, but also connect with other patients and volunteers at the hospital.

Seven-year-old Monu and Bipul pose for a photo during patient announcement day. Photo: Jasmin Shah.

Seven-year-old Monu – whose family also learned about the mission at the same awareness event – was one patient in particular who formed a strong bond with Bipul.

While living with a cleft condition can put a child’s life in jeopardy with an increased risk of illness and malnutrition, it can also lead to a life of loneliness and isolation due to the harmful stigmatisation.

For Monu and Bipul, they’d lived five minutes away from each other their entire lives – but never met each other until that day at the mission.

Monu’s parents, Santosh and Bina, knew that their son wasn’t the only child living with a cleft condition. But as they looked around the mission site, they were shocked to see the number of families who had arrived in Durgapur seeking out safe surgical care for their children.

Bipul and Monu play together as they wait to receive their cleft lip surgeries. Photo: Jasmin Shah.

After they passed their comprehensive health evaluations, Bipul and Monu stayed near each other throughout the mission, playing happily together in the child life area before their surgeries. Taking after his older companion, Monu also began giving a thumbs-up to the volunteers and staff members he met. Later during the mission, the Operation Smile medical team healed the smiles of the new friends, who remained close even after returning home.

With a safe surgery from Operation Smile, a patient’s future becomes brighter. Not only does a child get the opportunity to go to school and make friends without fear of bullying, but they also gain a newfound confidence to chase after a dream that they once feared would never come true.

Monu’s dream is to become a police officer. Bipul wants to continue receiving an education and eventually learn to speak English.

For Monu and Bipul, a condition that often prevents people from building relationships ended up uniting two unlikely friends.

Monu and Bipul one year after receiving surgery from Operation Smile. Photo: Jasmin Shah.

Pre-surgical dental care saved Janat’s life

Janat, 1-month-old. Photo: Jasmin Shah.

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

When Janat entered the world in her small Moroccan village, 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.

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 rapidly began to decline.

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. She can’t finish a bottle.”

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

“I knew that surgery was possible,” she said. “But I was scared and didn’t know where to go or who to ask.”

This is the case for many families of children born with cleft conditions.

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, Fatima’s hopes were realised.

Volunteer dentist Dr. Teresita Pannaci of Venezuela, left, observes as Janat is fed by her mom while testing out her new feeding plate. Photo: Jasmin Shah.

After seeing an Operation Smile Morocco commercial, Fatima learned that the organisation not only provides free surgical care, but that there was an upcoming medical mission taking place in a little over a week in Oujda, a neighbouring city.

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 Morocco’s 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.

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.

Having been unable to eat properly for the first month of her life, Janat had become severely malnourished and wasn’t healthy enough for safe surgery.

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

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.

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 was so happy. I was so relieved,” she said. “I’m very grateful for what you’ve done for my daughter. I’ve never seen kind hearts like yours before.”

Fatima and Janat returned to the care centre once more during the mission before heading home. 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.

For the first time, Fatima watches as Janat drinks milk with ease 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.

While Janat didn’t receive surgery during the March Oujda mission, Fatima’s determination was stronger than ever before, and she planned to return to the centre on an ongoing basis to allow for volunteers to monitor Janat’s care and progress.

Janat’s journey so far has been filled with fear, uncertainty and seemingly impossible obstacles. But no matter what lies ahead, Fatima refuses to give up.

“Nothing is too hard when it comes to my daughter. I will do anything.”

Shortly after the conclusion of the March mission in Oujda, 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 people like Janat and Fatima waiting.

Thankfully, through closely following all health ministry guidelines and protocols, including mask-wearing, social distancing, temperature screenings and more, the Moroccan team has successfully reopened its care centre doors, allowing for waiting patients like Janat to return and continue their ongoing care.

Today, Janat is 10 months old and her condition has dramatically improved.

Through her family’s commitment to improving her health and the success of her feeding plate, Janat’s weight has significantly increased and she continues to show incredible developmental progress. To this day, Fatima remains hopeful for Janat’s continued improvement.

“My daughter will be OK. I’m happy now,” she said. “Surgery will be life-changing. In the future, Janat will get an education.”

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

10-month-old Janat, today. With the help of her feeding plate, along with her family's dedication and love to care for her, Janat has become healthier and gained considerable weight. Photo courtesy of Janat's family.

Meet Our Patients: Mossoró, Brazil

In 2017, 67-year-old Dona Maria received surgery during an Operation Smile Brazil medical mission. Photo: Marcelo Braga.

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 the densely populated city of Mossoró, Brazil, Dona Maria spent her entire life living with an unrepaired cleft lip.

While she undoubtedly faced challenges and overcame obstacles because of her cleft, 67-year-old Dona Maria consistently dreamt of one thing.

Though seen by many as a simple pleasure, what she wished for most was to wear lipstick.

During a 2017 Operation Smile Brazil medical mission, Dona Maria passed her health evaluation and underwent her long-awaited surgery, feeling closer than ever to reaching that dream.

Moments after waking from the operation, Dona Maria felt eager to see her new smile.

After 67 years of living with a cleft condition, she proudly showed the entire medical volunteer team who were thrilled to be a part of that special moment.

After allowing her lip to properly heal from surgery, Dona Maria could finally live out her dream of putting on red lipstick for the first time in her life.

Laine Paiva, a volunteer photographer for Operation Smile Brazil, was so moved by Dona Maria’s story that she arranged a photoshoot with her, capturing images of her dreams becoming reality.

Hope on The Horizon: Safely Resuming Surgery and Care

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.

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.

A hallmark of Operation Smile medical missions and care centres is undoubtedly their bustling atmosphere – full of energy and full of people gathered to ensure that our patients get the cleft surgery and care that they need and deserve.

Volunteer medical professionals work side-by-side, quite literally shoulder-to-shoulder, conducting comprehensive health evaluations for scores of patients during a screening day. Those patients and their families, often numbering in the hundreds on large-scale international missions, gather and share stories of perseverance and hope. Care centres’ waiting rooms are filled with the sounds of children playing as they await their consultations.

But the COVID-19 pandemic brought these familiar and vivacious sights and sounds to an abrupt, albeit temporary, end.

In March 2020, Operation Smile made the decision to suspend international travel for medical volunteers and postpone medical missions and care delivery at care centres.

While these decisions were made with the safety of patients, volunteers, staff, their families and communities as the top priority, the postponements have left waiting more than 10,000 patients scheduled to receive treatment.

The organisation quickly pivoted to address many of the pandemic’s novel challenges, such as providing hospitals around the world donations of personal protective equipment (PPE) and providing patients and their communities with food and hygiene supplies as lockdowns stifled livelihoods.

Yet, there is hope on the horizon. Though care delivery looks, sounds and feels much different than before, Operation Smile has resumed providing cleft surgeries in Vietnam, Italy and China. In Morocco and Nicaragua, care centres are once again offering patients in-person care like dentistry, speech therapy and psychosocial care.

The resumption of in-person care offers a glimpse into how medical programmes will be conducted in the COVID-19 era, informing the organisation on how to approach treating patients as conditions improve from country to country.

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

Dr. Ruben Ayala, Operation Smile’s chief medical officer, said that while he stands behind the decision to postpone activity, it’s important to consider the long-term consequences that untreated cleft conditions can cause.

“The choice to not provide care to people, either surgery or comprehensive care, is not a benign one. Children are still suffering because of it,” Ruben said. “The reality is that the longer we wait, the longer more children are going to have difficulty eating, speaking and there will be issues in their growth and development.

“You’re going to have to weigh the pros and cons. We need to step back from the all-or-nothing approach to one that is based on the knowledge that is constantly evolving and the awareness.”

In May 2020, the first Operation Smile country to resume providing surgery was Vietnam, a country that imposed strict lockdown measures at the onset of COVID-19’s spread in neighbouring China. As a result, the country avoided a major outbreak. When the decision was made to host a medical mission conducted entirely of Vietnamese volunteers, there were only around 300 confirmed COVID-19 cases and zero deaths.

Viet Nguyen, the chief representative for Operation Smile Vietnam, said that volunteers are closely following both Operation Smile and health ministry guidelines to reduce the risk of spreading the virus during missions, including mask-wearing, temperature screenings, socially distanced waiting areas and increased sanitation measures.

Patients and their families wait for their comprehensive medical evaluations in a physically distanced waiting area during Operation Smile Vietnam's medical mission in Ho Chi Minh City in May 2020. Operation Smile photo.

“In the past at missions, we would gather about 100 patients and their families; there would be a few hundred of them at the hospital. Right now, we’re only able to bring in about 10 to 20 patients to the hospital each day,” Viet said. “We have to do the screening process as usual. It takes more time, but actually that’s a very good way for us to ensure the safety of our patients, families and also our medical volunteers.”

From May to September 2020, more than 500 patients have received cleft surgery at six Operation Smile Vietnam local missions.

“It’s positive progress,” Viet said. “We feel safe. We strictly follow the guidelines, and we’re making appropriate decisions. We’re actually doing a great collaboration with our in-country partners and also with the headquarters of Operation Smile in the U.S., and we did it at the right time.”

Operation Smile Vietnam volunteer surgeons perform a procedure during the May 2020 medical mission in Ho Chi Minh City. Operation Smile photo.

In Italy, a country that was hard-hit by COVID-19, Operation Smile has also resumed providing surgery and cleft care services at its three Smile House locations in Rome, Milan and Vicenza.

Dr. Domenico Scopelliti, a long-time Operation Smile volunteer cleft surgeon and the director of Smile House Rome, explained that the Italian context differs greatly from that of Vietnam.

“The project here is how to face a journey before the time of a vaccine,” Domenico said. “I very often use terms of navigation, because when we describe our journey, imagine that we’re going from point A to point B and the COVID pandemic moved our boat to point C. The route is totally different – we need to project another route.”

Smile Houses are creating physical pathways that are designed to drastically reduce the risk of the virus entering their facilities, alongside bolstered PPE that includes ventilated surgical helmets.

Dr. Domenico Scopelliti, a long-time Operation Smile volunteer cleft surgeon and the director of Smile House Rome, wears a specialised surgical helmet to prevent the spread of COVID-19 during surgery. Operation Smile photo.

Anyone entering a Smile House must have tested negative for COVID-19 within 48 hours of their visit. They then change out of their clothes, place them into a seal bag, and into PPE garments provided by the centre. Entrances and exits are separated, and medical staff change their PPE and fully decontaminate the operating rooms between each patient. Only one parent can accompany a child into the facility, and mask-wearing and physical distancing are practised.

“Timely surgery is very important, because if you do the right job at the right time, you reduce the risk of a patient having functional consequences,” Domenico said. “It’s important to respect that time because if we promise to operate all the newborn kids in the first years of age, we have to maintain our promise.”

In August 2020, Operation Smile also hosted its first two local missions in China. Though the pandemic originated in Wuhan in the country’s east in late 2019, the mission sites of Meigu and Zhaotung are in China’s western region, which was spared the brunt of the disease due to strict lockdowns. Sixty-two patients received surgery at the missions, and four more missions are planned through the end of 2020.

As teams around the world are working within the guidelines of their ministries of health to continue serving patients through telehealth services and nutritional support, our care centres in Nicaragua and Morocco were cleared to reopen their doors to patients for non-surgical services in July 2020.

While the Moroccan team hopes to be able to resume cleft, bone graft and orthognathic surgeries before the end of 2020, it’s been able to provide most of the other services it offers to help patients live more fulfilling lives. Each of Morocco’s centres in Casablanca, Oujda and El Jadida are offering pre-surgical screenings, post-operative care, dental and orthodontic care, psychological and speech therapy workshops and nutrition support.

In the early stages of the pandemic, the Operation Smile Nicaragua team recognised the need to stay connected with its patients by offering them virtual consultations for speech therapy and psychological counselling. Today, they continue to offer virtual care alongside in-person services like speech therapy, psychology, plastic surgery, paediatrics, nutrition, periodontics, odontology and nursing, averaging about 130 consultations per week.

According to Ruben, though COVID-19 will continue to pose challenges for the foreseeable future, those obstacles are surmountable.

“There’s a whole world ahead of challenges, but if we focus on that commitment to children, we will unavoidably become really innovative in how we address the challenge,” Ruben said. “We look forward to partnering with other organisations, to partner with governments, to partner with private entities, civil society and especially with the communities and the families and, most importantly, the patients to see a way forward and an opportunity for all.”

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