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Enok’s path

Margherita Mirabella, Operation Smile.

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

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

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

Margherita Mirabella, Operation Smile.

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

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

Margherita Mirabella, Operation Smile.

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

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

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

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

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

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

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

Margherita Mirabella, Operation Smile.

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

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

Margherita Mirabella, Operation Smile.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Two Thumbs-Up

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

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

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

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

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

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

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

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

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

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

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

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

This time, Bipul wasn’t afraid.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Pre-surgical dental care saved Janat’s life

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

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

When Janat entered the world in her small Moroccan village, no one could’ve predicted the physical and emotional challenges that laid ahead for her and her family.

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

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

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

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

Janat and Fatima confronted these obstacles every day.

“I was afraid that I was going to lose her,” Fatima said. “She was suffocating and the milk would come out of her nose. She can’t finish a bottle.”

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

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

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

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

Then one day, Fatima’s hopes were realised.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Fatima and Janat returned to the care centre once more during the mission before heading home. Adapting well to her new feeding plate, Janat slept comfortably in her mother’s arms with a belly full of milk for the second day in a row.

For the first time, Fatima watches as Janat drinks milk with ease thanks to her daughter's new feeding plate. Photo: Jasmin Shah.

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

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

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

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

Shortly after the conclusion of the March mission in Oujda, Operation Smile Morocco, like all of our teams around the world, made the decision to postpone future missions and care delivery at care centres. While the decision was made to ensure the safety of patients, families, volunteers and staff, the postponements left people like Janat and Fatima waiting.

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

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

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

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

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

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

Meet Our Patients: Mossoró, Brazil

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

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

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

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

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

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

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

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

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

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

Hope on The Horizon: Safely Resuming Surgery and Care

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.