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 non-profit 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.
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 panellists. 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 panellists are Ernest Gaie; he’s our senior advisor of global business operations. Ernest brings decades of field basic experience working with non-profit 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 fuelling 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.
Zak: What did the rebuilding of the (Liberian) health system look like post epidemic?
Ernest: It was challenging, considering that the system was already impacted by the 14-year civil conflict. However, there was commitment from international development partners like USAID, Irish-Aid, DFID, World Bank and others that continued to fund the rebuilding process. So, we continued training healthcare workers, strengthening supply chains with delivery of essential medical supplies including pharmaceuticals, and improving health infrastructure. The focus was really building local health systems’ capacity at primary health care level to deliver essential health care in the areas of extended programme of immunisation/EPI, reproductive, maternal, neonatal and child health.
Linda: What criteria will Operation Smile use to determine that it is safe to resume international missions?
Ernest: Our Medical Advisory Council is currently working on this. However, we certainly operate within the global framework and will continue to observe global and national advisory, especially those based on scientific evidence as well as from recognised global health organisations.
Stuart: This will require a loosening of travel restrictions on both ends of the trip, i.e., the departure and arrival ends. While it’s not certain at this time what, if any, COVID-related documentation might be required in addition to normal travel documents, we are assuming that some form of testing or vaccine will need to be in place before we can ramp up international missions again.
Janine: Are the centres being used for the COVID-19 patients as an outreach to support area hospitals?
Ernest: Not at the moment due to the respective national governments’ stay-at-home mandates. However, as mentioned during the live event, our teams are using digital platforms to continue to provide consultations to patients where possible like in Nicaragua. Our plan is to further develop and expand this capability within our programme delivery.
Diana: Will Operation Smile be COVID testing (patients) before surgeries?
Ernest: We will continue to strengthen the capacity of our partner hospitals to include COVID-19 along with other pre-surgery testing that are part of our regiment. This will include providing testing equipment and supplies and training lab technicians on additional infectious disease diagnostics. We will also include this process for our volunteer team composition to ensure total safety for all including volunteers and patients.
Stuart: The current thinking is that we mostly likely will. Our standards of care are currently under review to take into account the implications of COVID-19 on our delivery of care.
Janine: Will there be more opportunities to participate in brainstorming ways to help others or the sharing of information?
Laura: Yes! “COVID-19 Conversation” will be an ongoing series, so please continue to tune in and keep asking great questions. We are passing all of the great ideas discussed in this forum throughout the organisation, so keep them coming! You can also visit https://operationsmile.ie/get-involved/fundraise/ to check out more great ways to support our work.
Lynn: Is there anything we could do as nurse or doctor volunteers in our homes, in addition to donating money right now?
John: While monetary donations are critically needed and will provide us with the ability and agility to respond to COVID-19 and ensure that we can resume providing surgeries when it’s safe to do so, there are many ways you can support your communities during the pandemic. You could consider donating cash or food to your local food bank, as this is an area of massive need that’s been amplified by shutdowns. You could also start by researching community-level response initiatives and find the best fit for you! The need out there is great, but with the kindness and support of people like you, Lynn, we will get through this together!
FA: Where can I volunteer in regards to Operation Smile?
John: Thank you, FA. We appreciate your willingness to support Operation Smile’s response to the COVID-19 pandemic. To explore ways to become involved, please visit https://operationsmile.ie/get-involved/fundraise/ to learn more about the many ways that you can make an impact!