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.

Going Far Together: A Future for Women in Healthcare Around the World

By Dr. Naikhoba Munabi, plastic surgery resident at the University of Southern California and former Global Surgery Fellow at Operation Smile.

Dr. Naikhoba Munabi, left, stands beside Fouzia Mahmoudi, Operation Smile Morocco Co-Founder and Vice President, centre, and Operation Smile Co-Founder and President, Kathy Magee, during the 2020 March all women's mission in Oujda, Morocco. 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 asked how I’ve been able to climb the ladder of success to where I am today, my answer is always simple: I didn’t do it alone.

I come from a family of physicians, including women such as my mother and grandmother. On the occasions that people have said my race or gender would limit my ability to succeed in my chosen career, I looked to my family to confirm that these opinions were wrong.

My inspiration and support came from outside of my family, too. Female teachers, coaches, lab directors and classmates mentored and helped me believe in my capabilities. Even when I entered the arena of surgery where few women exist, I always had sources of encouragement to continue pushing forward in pursuit of my dreams.

Cleft surgeon Dr. Luca Autelitano of Italy, left, examines a patient with Dr. Naikhoba Munabi. Photo: Lorenzo Monacelli.

Unfortunately, not all women in the world are so lucky.

Almost 1 billion women globally do not have formal employment because they lack access to education, encouragement to continue persevering in a career of their choice, or do not know what a woman can achieve. But 18 million more healthcare workers are needed in the world. It is vital that women enter and continue in medical careers to help address the needs of some of the poorest and most disenfranchised individuals worldwide.

Better mentorship can help get more women into healthcare. Earlier this year during Operation Smile’s inaugural Women in Medicine: Inspiring a Generation medical programme in Oujda, Morocco, 25% of female volunteers said they struggled to find mentorship and guidance in their career despite wanting it.

Team photo of the female medical and nonmedical volunteers during the Women in Medicine: Inspiring a Generation medical mission. Photo: Jasmin Shah.

In male-dominated careers, such as medicine, societal norms are not always encouraging of women. The presence of a mentor can be the difference between a woman entering and staying in healthcare or turning away from adversity.

25% of female volunteers said they struggled to find mentorship and guidance in their career despite wanting it.

Bringing 95 female medical professionals from 23 countries together in Oujda helped establish those critical mentorship contacts. During the programme:

  • 73% of women who weren’t able to find a mentor in their home countries were able to identify one during the mission.
  • 100% wanted to maintain those professional relationships in the future.
  • 97% of women were more confident in their ability to perform their jobs.
  • 100% felt inspired to mentor women in their home countries.
Graph showing how mentorship during the mission had a trickle-down effect for participant home countries. 100% of participants established professional contacts to maintain in the future and 100% felt empowered to mentor working women at home. Graph courtesy of Naikhoba Munabi.

The Women in Medicine medical programme also inspired women to become leaders. Despite only 29% of volunteers having leadership experience with Operation Smile, 93% felt inspired to become a leader in the organisation and 97% felt inspired to become leaders in their home country. Through this desire to lead, 99% of women felt they would also advance professionally and 97% hoped their careers would involve working with other women in the future.

Simply put, creating a collaborative environment for female healthcare professionals encouraged women from all around the world to continue advancing and forging the path for more women to follow.

One of the best parts of being a global surgery fellow has been finding commonality with so many people of diverse origins around the world. The world is brimming with talent, including exceptional female talent. Operation Smile’s female volunteers are role models to other young aspiring and ambitious women in their communities. The women I have met worldwide have been an inspiration to me. The Women in Medicine medical programme was an ode to those female volunteers, their capabilities, their perseverance and their will to care for others.

Help us to continue doing everything we can for patients impacted by the COVID-19 pandemic. When it’s safe to resume surgeries, the support you give today will not only provide more children with the life-changing care they need but enable the next generation of healthcare workers to deliver care where it’s needed most.

Dr. Naikhoba Munabi pictured with volunteers from the all women's mission after completing the cleft surgery simulation workshop. Photo courtesy of Naikhoba Munabi.

About the author: Dr. Naikhoba Munabi is a resident physician in plastic and reconstructive surgery at the University of Southern California. She took two years away from clinical training to work with Operation Smile as a Global Surgery Fellow. During her time with Operation Smile she worked with teams in multiple countries with a focus on sub-Saharan Africa. Dr. Munabi’s public health interests include education, health systems strengthening, and women’s empowerment. Clinically, she plans to continue training to be a craniofacial surgeon.

Assuring the Highest Quality of Care

Volunteer nurse and clinical coordinator Mamta Shah with a patient during a 2017 Operation Smile medical mission. Photo: Anja Ligtenberg.

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 it comes to our work of delivering exceptional cleft care to people around the world, the safety of our patients has been, and will always be, our greatest priority.

As an organisation comprised of compassionate and selfless medical professionals who go above and beyond by donating their time, energy and expertise to our mission, it wasn’t a surprise when some of those volunteers expressed interest in doing more with their volunteerism.

As many volunteers voiced a desire to serve on more medical missions, Operation Smile’s medical quality team created an innovative solution: The team established a position that not only presents volunteers with more opportunities to learn and care for patients, but further strengthens and enhances our safety protocols.

Bryan Zimmerman, Operation Smile Assistant Vice President of Quality Assurance, said that the inspiration behind creating a volunteer quality assurance (QA) officer position was to continue improving upon two of the organisation’s top priorities, the safety of our patients and the quality of their surgical results. QA officers’ evaluations are designed to bolster the knowledge, practices and abilities of our medical volunteers around the world.

“The only way to effectively create a culture of safety and quality is by showing that you care,” Bryan said.

Operation Smile Assistant Vice President of Quality Assurance, Bryan Zimmerman, centre, speaks to a mother and patient during a 2019 medical mission in Antsirabe, Madagascar. Photo: Lorenzo Monacelli.

After creating the curriculum for the QA training programme, Bryan and his team received applications from more than 35 volunteers from countries including Italy, Mexico, the U.K., Australia, Norway, South Africa and the U.S.

Of that total, 11 volunteers participated in and passed the five-day tactical training and education course that took place at Operation Smile Headquarters in November and December of 2019.

Volunteer clinical coordinator Mamta Shah checks the vitals of a patient after surgery. Photo: Anja Lightenberg.
Volunteer clinical coordinator Mamta Shah checks the vitals of a patient after surgery. Photo: Anja Lightenberg.

“Simulation stations were set up that provided opportunities to touch and feel what different parts of the mission are like,” said Mamta Shah, a volunteer nurse, clinical coordinator and QA officer. “The final was a walk through, an actual chart audit and mission audit twice. This was an incredibly valuable experience for volunteers.”

Posing as staff and volunteers, actors intentionally made mistakes and missteps during the mission simulation that the QA officers would be tested to identify. They were assessed during each of the mission phases: screening, pre-operative, anaesthesia, surgery, recovery and post-operative.

For Rodney Kapunan, a volunteer pre- and post-operative nurse with years of mission experience, the QA training instilled in him a new appreciation and respect for all roles and specialties.

“Training was an eye-opener for every one of us, because even though we are seasoned volunteers with more than 10 missions and experienced in our fields, we are now tasked to oversee the processes of the whole mission,” Rodney said.

Photo courtesy of Rodney Kapunan.

“Operation Smile is distinguished for being an association that follows the quality standards established,” said Rosa Sanchez, a volunteer nurse, clinical coordinator and quality assurance officer for Operation Smile Mexico. “We guarantee that patients receive good attention and give the family full security that their kids are in good hands.”

Slated to attend medical missions throughout 2020, the certified QA officers like Rodney and Rosa were ready to step into their new role and empower volunteer teams to continue delivering the highest quality of care possible.

But those plans were upended when the coronavirus pandemic began. Only two officers were able to attend their scheduled missions before Operation Smile’s decision to postpone all international travel.

As one of those two volunteers, Rodney witnessed the medical quality team’s vision come to life.

“There were a lot of great ideas that were brought forward by some volunteers during my last missions in Egypt,” Rodney said. “I reminded them that this organisation is always improving, and I love to hear their suggestions on process improvement and patient safety.”

Adapting to the pandemic, Bryan and his team now deliver online refresher courses that make sure the officers are prepared to reach their highest potential whenever it becomes safe to travel again.

But those courses weren’t the only component to transition online: Two additional QA officers received training and became credentialed through virtual training.

With a new dynamic, Bryan and his team worked diligently to create a virtual QA education course that aligned with the same goals and experiences as the in-person training.

The curriculum included informative presentations, questionnaires addressing specific concerns and a virtual fact-find of a local hospital.

Operating room nurse Amanda Stahlhut during a patient's operation. Photo courtesy of Amanda Stahlhut.

“An opportunity for me to contribute to those great efforts is an honour,” said Amanda Stahlhut, an operating room nurse who underwent the virtual training. “I pledge to not lose momentum or motivation with the current pandemic delays, knowing that this QA programme will transform how quality and safety is viewed and actioned.”

Even some volunteers like Rodney say that they are using their QA officer training to be better prepared for working on the frontline of the COVID-19 pandemic.

“Especially when I’m putting on my personal protective equipment, I always have someone double check if I missed anything,” Rodney said. “I also practice good habits in my practice to better protect myself, my co-workers, patients, guests and family from contracting the virus, thus cultivating a culture of safety.”

The 13 officers, diversified by country as well as specialty, represent a multitude of positions including a surgeon, paediatrician, bio medical technician, two anaesthesiologists and various nursing specialties.

And as committed advocates for safety and care, the QA officers also embody Operation Smile’s unwavering drive to improve and evolve in order to meet the needs of every patient.

“We all make mistakes. We can evaluate our mistakes and see how we can improve on them,” Mamta said. “Increased efficiency and safety leads to better team morale and preparedness, which then leads to improved patient outcomes, improved patient satisfaction and better quality of care.”

Photo: Rohanna Mertens.

Overcoming Nutritional Barriers to Surgery in Ghana

Two-year-old Jocelyn during Operations Smile's 2017 medical mission in Koforidua, Ghana. Photo: Zute Lightfoot.
Two-year-old Jocelyn during Operations Smile's 2017 medical mission in Koforidua, Ghana. Photo: Zute Lightfoot.

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.

For patients like Jocelyn, widespread poverty affecting areas across Ghana presents challenges and a host of barriers that stand between them and a brighter future after surgery. Some of these barriers can also be the difference between life and death.

Malnutrition remains one of the most significant obstacles to receiving care, affecting children with cleft conditions, especially babies with cleft palate, in the early developmental stages of their lives.

Without timely medical intervention, patients confront challenges with breastfeeding, struggle to receive proper nourishment when it’s most critical and become more susceptible to infections and diseases.

“Challenges people in Ghana are facing: no access to nutritious foods, foods are too expensive,” said volunteer nutritionist Dede Kwadjo.

Volunteer nutritionist Dede Kwadjo poses for a photo at the patient shelter where she has been consulting with mothers of babies born with cleft conditions. Photo: Zute Lightfoot.

Due to the rate of Ghanaian children experiencing growth delays and being moderately to severely undernourished standing at a staggering 19 percent, improving access to nutrition and educating families is crucial.

With an increased risk and probability of complications during surgery, many hopeful families who arrive with their children to Operation Smile medical missions leave disappointed and upset after medical volunteers deemed their baby too unhealthy to receive surgical care.

And in Ghana, a country known for having widespread and deeply rooted social stigma surrounding cleft, many children endure lives filled with pain, living in a world of isolation and being fearful of harassment from peers, members of their communities and, sometimes, even their own families.

This is what Cynthia hoped to protect Jocelyn from when she made the choice to help her future adoptive daughter.

She never expected that her decision to pause at a bus stop and speak with the father of a child living with an unrepaired cleft lip would save a life let alone take her on a journey toward motherhood.

Jocelyn pictured with adoptive mother, Cynthia. Photo: Zute Lightfoot.

Hoping to help him find a solution for his 2-year-old daughter, Jocelyn, Cynthia told the father about Operation Smile Ghana and the surgical care it provides at no cost to families.

Cynthia soon learned that Jocelyn’s mother had abandoned the family, leaving Jocelyn in the care of her dad. Over time, she also began to notice that he didn’t seem to make his daughter’s needs a priority, and Cynthia became more troubled and suspicious.

To make sure that he followed through for the care of his daughter, Cynthia travelled with the family to the 2017 local medical mission in Koforidua. But after performing a comprehensive health evaluation, medical volunteers determined that it wasn’t safe for Jocelyn to receive surgery: She was too underweight and showed signs of malnutrition.

“With nutrition, I always say, ‘If someone isn’t well nourished, a lot of things don’t go well,’” Dede said. “Making sure that someone is nutritionally adequate is a basis for good living.”

After Jocelyn was admitted for a five-day stay in the paediatric ward during the mission, Cynthia refused to leave her side.

Cynthia was thrilled to learn that Jocelyn had been enrolled into Operation Smile Ghana’s nutrition programme. But her excitement was short lived once she was told that Jocelyn had missed the first – and second – month of the programme.

Repeatedly, the Operation Smile Ghana team called Jocelyn’s home, using every resource they had to reach the family and make sure Jocelyn received the care she desperately needed.

Cynthia knew the kind of life Jocelyn could have if she received surgery. But she also suspected what her future held if her health didn’t improve and she wasn’t cleared for surgery.

Following numerous failed attempts at trying to convince Jocelyn’s father to bring her to the site of nutrition programme, Cynthia’s initial worries and fears about Jocelyn’s health and well-being were realised, and it became clear that she needed to step in.

Assured that Jocelyn wouldn’t go back into the care of her birth mother, the father agreed that Cynthia could have sole custody and become the person in charge of taking over Jocelyn’s care.

It was only after Cynthia offered to become Jocelyn’s primary guardian that her journey back to health – and to receiving free surgery on her cleft lip – truly began.

Photo: Zute Lightfoot.
Photo: Zute Lightfoot.

To help the overwhelming number of children suffering in the country, Operation Smile Ghana’s nutrition programme is conducted year-round in five regions across the country. The programme offers ongoing educational support and monthly intervention assessments to track patients’ development.

Ready-to-use therapeutic food (RUTF), a nutritive peanut paste; formula, and cereal mixes are given to patients whose nutritional deficiencies prevented them from passing their comprehensive health evaluation. Since 2015, Operation Smile has provided RUTF to malnourished patients living in the country. And today, during the COVID-19 pandemic, this support is critically needed. While surgeries are postponed, our team in Ghana is distributing RUTF to patients who need it so they can continue growing strong and healthy.

Dede Kwadjo speaks with Aba, mother of 11-month-old Moses, during screening for Operation Smile Ghana's first local mission in Koforidua. Photo: Zute Lightfoot.

For Dede, the individual education and empowerment consultations she offers to families are just as important as the care she delivers to the children.

“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.

Eleven-month-old Moses being fed by his mother, Aba, while waiting for patient announcement during an Operation Smile Ghana medical mission. Photo: Zute Lightfoot.
Eleven-month-old Moses being fed by his mother, Aba, while waiting for patient announcement during an Operation Smile Ghana medical mission. Photo: Zute Lightfoot.

Another one of Dede’s patients is Moses.

At the same 2017 local mission conducted by all Ghanaian volunteers, the 9-month-old arrived in dire need of nutritional intervention.

For Aba, Moses’ mother, the personalised counselling and support she received from Dede throughout the nutrition programme constantly motivated her to never give up.

Despite her son’s recurring respiratory infections and low weight, Aba remained committed to the programme and became more hopeful as she began to see positive changes in Moses’ health. It was her perseverance and empowerment from Dede that led to Moses passing his comprehensive health evaluation and receiving cleft lip surgery.

While malnutrition continues to prevent babies and children from undergoing surgery at the ideal time, support from mothers like Aba, education from volunteers like Dede and unrelenting commitment from loving people like Cynthia are forces that can change the course of a child’s future.

“If you can empower somebody with right choices to prevent the person lacking something as basic as getting the right food and the right proportion at the right time, that will go a long way actually help the person to have a better quality of life,” Dede said. “I’m so passionate about it.”

Moses and Aba after his cleft lip surgery. Photo: Zute Lightfoot.

Clement’s “Why”

It’s nearing the end of a long day – the first day of surgeries during a recent Operation Smile medical mission in Koforidua, Ghana.

After 15 hours of nonstop work, Clement Ofosuhemeng remains deep in the process of putting his entire being into his role as Operation Smile Ghana’s patient coordinator.

As he spoke about his reason for taking on the daunting task of finding and serving patients and families affected by cleft in his country, you can see – and feel – the emotions ebb and flow within this soft-spoken and fervently-determined man.

“I see it as the only way to say thank you to my mother and then to humanity,” Clement says. “And I love doing it, and I don’t mind going to any length to get the patients.”

He’s done just that with unprecedented success since he became involved with Operation Smile in 2015 – first as a volunteer before becoming a full-time member of Operation Smile Ghana’s staff.

Operation Smile Ghana’s patient coordinator Clement Ofosuhemeng conducts a cleft awareness and patient recruitment campaign in Twifo Praso, Ghana. Photo: Zute Lightfoot.

Clement’s “why” is as dramatic and powerful as it is ingrained in the young Ghanaian activist.

As told to him by his grandmother, when Clement’s mother became pregnant with him, his father began having an affair with another woman. The woman then attempted to kill Clement’s mother by poisoning her food when she was six months pregnant.

The poison caused his mother to bleed profusely and she was rushed to a hospital. While she was unconscious, doctors decided that the only way to save her life was to abort Clement, who they believed would suffer life-threatening consequences. When Clement’s mother learned of the plan, she ran away from the hospital to a remote location to live for the remainder of her pregnancy.

Three months later, when she went into labour at the house where she was staying, no one was around to help deliver the baby.

“According to my mother, she said I’m the only child that when she was giving birth, she didn’t suffer at all. It was a smooth delivery,” Clement says. “Later, people came around and they rushed us to the hospital. And here I am. I don’t have any deformities…

“So, when I was little, I was a stubborn child. There was one time that she sent me to go and fetch water for her, and I didn’t want to go.

“She told me: ‘Clement, do you know that I stood for you when you were in my womb? You need to stand for me, no matter what. I just need a glass of water and you don’t want to go.’ I was 10 years old by then and I asked her, ‘What do you mean by that?’ And she said that one day she would tell me.”

But tragedy struck before that day would come. Clement’s mother died while giving birth later that year. The reason: there was no doctor available to perform a life-saving caesarean section. Clement’s sibling died as well.

“So, when I grew up, the thing that she used to tell me, I realised that it’s indeed true,” Clement says, holding back tears. “I told myself that if my mother stood for me when I was in her womb – she stood for me against all odds – what can I do for humanity?”

Operation Smile Ghana’s patient coordinator Clement Ofosuhemeng leads a storytelling session at the patient shelter during the November 2017 medical mission to Koforidua, Ghana. Photo: Zute Lightfoot.

Clement’s opportunity came in 2015 while he was working on his postgraduate national service project in the accounting department at Korle Bu Teaching Hospital in Accra, Ghana.

Korle Bu is home to Ghana’s National Reconstructive Plastic Surgery and Burns Centre, which is headed by Operation Smile Ghana medical director Dr. Opoku Ampomah. A co-worker, biomedical technician and Operation Smile Ghana volunteer Emmanuel Kumahor, introduced Clement to the organisation, and he immediately became energised to volunteer.

Clement has helped to bring hundreds of potential patients to each medical mission in Ghana since he joined the organisation. Their patient recruitment push for the April 2015 mission to Cape Coast, Clement’s first, proved to be pivotal.

Prior to that mission, patient turnout numbers were dwindling in Ghana, putting Operation Smile’s work in the country at risk. Both Clement and Sabrina knew that the patients and families were out there, mostly scattered around the thousands of remote villages in the country. However, they were just not being reached nor convinced – nor able – to receive Operation Smile’s care.

“When I heard that, I was saddened and I said, ‘Well, why? Is it true that there are no patients left in the country, or is it that something is not being done right? That might be the reason.’” Clement says. “So, I said, ‘Okay, well, I have a very strong connection on the ground,’ and I put up a strategy that I thought would work.”

And it did.

Operation Smile Ghana’s patient coordinator Clement Ofosuhemeng meets Ama, a woman who’s lived with an unrepaired cleft lip for 80 years and tells her about Operation Smile Ghana and an upcoming medical mission at which she could finally receive surgery. Photo: Zute Lightfoot.

The majority of people in Ghana are of Christian faith, and Clement’s uncle is a professional theological lecturer. Clement knew about the widespread and severe social stigma associated with cleft in the country, so he partnered with his uncle to raise awareness about both Operation Smile Ghana’s work and the true nature of cleft conditions – that they are a surgically treatable conditions and not the result of supernatural curses – throughout his vast network of church leaders.

Clement also embarked on several awareness campaigns that brought this message of hope and healing to the most remote and impoverished communities throughout the country.

“There are places that when I go, cars don’t go there. So, if I have to walk, I will walk. If I have to crawl, I will crawl. If I have to swim to that place, I will swim,” Clement says with stern conviction. “My mission is to go as far as I can go to spread the message wide, so that we will be able to help patients with cleft lip and cleft palate.”

Clement adds that Operation Smile Ghana isn’t just saving lives within the medical context.

“In Ghana, there are some cases that when mothers give birth to babies with cleft, they kill them. I must be frank. It’s hard to say, but that is the Gospel truth,” Clement says. “When someone gives birth to a baby with cleft, society frowns on them. They are rejected and isolated. People share derogatory remarks about them and point fingers at them. They are seen as not fit to be accepted as human beings.

“And I’ve been through all the regions in Ghana, and I can say for sure that the stigma runs through all the regions. They see them to be from the rivers. They see them to be from the smaller gods. They see them to be animals.

“Of course, if the person is educated, then that person knows that it is possible for surgery to be done. And if the person is also around people that are well-enlightened about this particular deformity, then that person will get proper counsel.

“But what if that person happens to be in a community where they frown on such cases? That’s where the problem lies.”

Operation Smile Ghana’s patient coordinator Clement Ofosuhemeng and his network of volunteer patient advocates reach people affected by cleft in some of Ghana’s most remote communities. Photo: Zute Lightfoot.

Convincing naturally sceptical families and patients that they can trust Operation Smile is where Clement excels. Utilising his persistent yet kind-hearted nature, he explains that the organisation performs this work across Africa and around the world by showing them several Operation Smile foundations’ websites and before-and-after photos of past patients. He says that many conversations begin with patients and caregivers thinking it all sounds too good to be true, as the medical care is free, and Operation Smile Ghana covers the expenses of travel to and from the mission as well as lodging and food during it. But most of the time, he’s eventually able to break through.

“I try my best to establish a very good rapport with them, so that they feel comfortable coming to me, comfortable calling me. I always call them – numerous calls, numerous counselling sessions so they feel that we are here for them,” Clement says. “We are with them to go through the procedure before the surgery, during the surgery and after the surgery. So, it’s not only the surgery.”

Operation Smile Ghana’s patient coordinator Clement Ofosuhemeng, left, and volunteer Emmanuel Amass Amankwah listen as a patient’s mother shares her story during the November 2017 medical mission to Koforidua, Ghana. Photo: Zute Lightfoot.

Once patients and their caregivers arrive to the mission’s patient shelter, incredible transformations begin to take shape. Operation Smile Ghana takes special care to create a supportive community atmosphere among the families. They educate the attendees about cleft conditions and offer activities that have the potential to become income earning, such as tie-dying fabric and crafting beaded jewellery.

At the shelter during a recent mission, Clement called for a group of patients and their families to gather in a circle. He asked for each of them to share their stories. As the group listened, the emotions are nearly palpable.

Clement said that the sharing of these experiences resonates far beyond the patient shelter and into the communities from where they came.

“When they come to the shelter and then they see so many people with cleft, it strengthens them. They may have thought that they were the only one with a cleft, but now what are they seeing? People with various degrees of cleft. So, at the shelter, it’s like a family.

“Right from day one, I’m always with them. We crack jokes. I share my story with them. And sometimes, the stories they have are way more powerful than even mine…

“When they return to their villages, I see them to be potential ambassadors to help erase the stigma. Now that they have received education about cleft, they can spread the information, the good news and the truth so that it will remove the negative perception that people have about cleft. So, when I’m able to recruit more than 300 potential patients, I see them all as people that can help make the job work – to make information about Operational Smile go viral.”

Operation Smile Ghana’s patient coordinator Clement Ofosuhemeng and volunteer patient advocates Issac Arthur and Patrick Kwane Yalley conduct a cleft awareness and patient recruitment campaign in Mfantsiman, Ghana. Photo: Zute Lightfoot.

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 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 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.