A Historic Shipment is Saving Lives in Colombia

Man in white Operation Smile t-shirt holding an RUTF pouch talking to a mother and child
An Operation Smile Colombia volunteer explains the benefits of ready-to-use therapeutic food (RUTF) to a family living in the remote region of La Guajira, Colombia. A nutritive peanut paste, RUTF saves lives by providing crucial nutrition that helps children grow healthy enough to undergo surgery. Photo: Camilo Zapata.

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.

As the Covid-19 pandemic persists and the Delta variant of the coronavirus spreads, it’s estimated that 270 million people will grapple with life-threatening food shortages in 2021, according to the United Nations’ World Food Program.

This tragic figure represents a 55% increase of people facing food insecurity, up from an already staggering 150 million prior to the pandemic. And according to the U.N., many people living in several of the countries that Operation Smile serves are on the brink of famine.

This includes the La Guajira region of Colombia, one of the country’s most impoverished areas.

With resources already stretched by the mass displacement of Venezuelans due to socio-political crises that have lasted for years, La Guajira, which borders Venezuela, has also been hard hit by the effects of the pandemic and climate change. Indigenous and displaced communities are now being disproportionately affected by food shortages.

“Many indigenous people that live in this region produce crafts by hand, and the only income they used to make was selling these beautiful mochilas,” which are intricate woven handbags and packs, said Paula Franco, a now-former programme coordinator of Operation Smile Colombia. “But they’ve been unable to sell them because everything was closed for many months.”

For families affected by cleft conditions in this region, this reality is further compounded by the health risks posed by untreated cleft lip and cleft palate, which can cause difficulties with breastfeeding, bottle-feeding and eating solid food. This increases the risk of malnutrition and other severe health consequences, even death, if children don’t receive enough nutrition to qualify for life-saving surgery.

Volunteer nutritionist talking to father holding his son with a cleft
Operation Smile Colombia volunteer nutritionist Cindy Getial consults with a father about the nutritional status of his son, Enoc, during an August 2021 programme in which ready-to-use therapeutic food was distributed to families living in La Guajira, Colombia, a remote region where food insecurity threatens the lives of patients living with untreated cleft conditions. Photo: Camilo Zapata.

With a decades-long presence in La Guajira, the Operation Smile Colombia team has been working closely with local health authorities and partner non-profits in the region to monitor the needs of patients and their families throughout the pandemic. According to Paula, it became clear in late 2020 that these families were in urgent need of nutritional support.

In November, at Operation Smile Colombia’s first locally led surgical programme since pandemic lockdowns, a heart-wrenching number of children arrived for their health evaluations either malnourished or undernourished.

A proven solution that Operation Smile has employed in countries where malnourishment threatens the lives of young patients is ready-to-use therapeutic food (RUTF).

A nutritive peanut paste, RUTF saves lives by providing crucial nutrition that helps children grow healthy enough to undergo surgery.

Mother and son holding RUTF pouches
Patricia and her son, Wilmar, stand in their kitchen in La Guajira holding a package of ready-to-use therapeutic food. Photo: Camilo Zapata.

“When we learned about the possibility of using RUTF for patients suffering from malnutrition in Colombia, it seemed like an easy thing to solve – we have this RUTF product, so let’s send it to them so we can save lives,” said Melissa DiBona, Operation Smile’s associate vice president of legacy projects who spearheaded the organisation’s RUTF programme. “But then you learn that it’s not so easy.”

The import of medical supplies and equipment from the United States to Colombia is a complex and highly regulated bureaucratic process that can be painstakingly slow. And with adequate supplies and equipment available in-country, Operation Smile hasn’t shipped from the U.S. to Colombia since 2007.

Until now.

Group of people standing by shipment of RUTF pouches
Members of the Operation Smile logistics team pose for a photo with the historic shipment of RUTF before its forwarding to Colombia in May 2021. Pictured are, from left: Joe Sanchez, pharmacy specialist; Chris Brewington, warehouse assistant; Jesse Hines, chief of logistics and facilities; Yolanda Weaver, logistics quality assurance coordinator; Candace Streit, director of logistics; Edd Basilio, warehouse specialist; and Jojo Ocampo, warehouse team lead. Operation Smile photo.

Led by Kathy Magee, Operation Smile’s co-founder and president, members of the RUTF and Colombia teams reached out to the office of the ambassador of Colombia to the U.S. in January to express the urgent need of this shipment – 99 cases of RUTF – to get to those patients as soon as possible.

Promptly, now-former ambassador Francisco Santos Calderón met with the Operation Smile team to discuss expediting the shipment of RUTF into the country. According to Melissa, Santos agreed that the needs of children suffering from cleft conditions and malnourishment are a dire emergency, and he promised to work with his colleagues across various government agencies to help Operation Smile get RUTF to the families and children in need.

While the process was still lengthy in comparison to other countries’, the shipment was prioritised, expedited and cleared Colombian customs within four months of meeting with Santos.

After further regulatory processing and product registration, the RUTF was finally distributed to families in the department of La Guajira in early August 2021.

Family holding RUTF pouches
Patricia is pictured with her six children Wilmar, Yolimar, Karen, Alejandra, Yoiner and Frainer. Photo: Camilo Zapata.

According to Candace Streit, Operation Smile’s director of logistics, the shipment ranks as one of the top accomplishments of her team of experts in the nuanced and complex world of international medical logistics and customs.

“No corners were cut, but it was helpful to have the support of the ambassador, which definitely sped up the process,” Candace said. “The collaboration between several departments, several teams and Operation Smile Colombia is what made it successful.”

Operation Smile Colombia’s nutritionist, Cindy Getial, joined the organisation in May 2021 and delved into supporting the needs of families affected by cleft conditions and food scarcity in La Guajira. This also included packages of food that have been distributed throughout the pandemic.

“It became evident that they don’t have the tools needed (to ensure food security),” Cindy said. “By tools, I mean food and nutrition education. Families are unaware of healthy habits and physical tools both in their homes and in the region to be able to guarantee nourishment.”

Cindy added that while conditions in the area are tough, educating families about easily accessible, locally produced food makes nutritional improvements possible.

“I think the most important thing is the strategy we have to leave knowledge with the families for them to be their own managers in their effort to overcome the food insecurity situations they are going through,” she said.

While this life-saving shipment will help many children become healthy enough for their next chance at surgery, Melissa, Candace and Paula shared that they hope this achievement sets the stage for many more essential shipments of RUTF to reach patients and families as the need for improved food security mounts in Colombia.

“This was a perfect match for the need in this region, and it arrived at the perfect moment,” Paula said. “It’s so nice to see how after we opened a door that there are many opportunities – after we didn’t give up – and that this will really help the children.”

Help us to continue keeping our promise to patients 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.

Woman in a red dress holding her baby
Photo: Camilo Zapata.

Scenes of hope and healing: Surgical training rotations in Rwanda

Photo: Zute Lightfoot.

Nearly 12 million people live in Rwanda, one of Africa’s most densely populated nations. But with only two certified reconstructive plastic surgeons serving the entire population, the country lacks the surgical capacity to keep up with patient demands, forcing many people to wait months or even years to receive the care they need.

After witnessing this gap in the country’s healthcare system during a 2010 medical mission, Operation Smile volunteer surgeons Drs. Steve Naum and Bruce Ferris of the United States refused to stand by and watch as people suffered without proper care. Thanks to the initiative and commitment of Steve, Bruce, Rwandan plastic surgeon Dr. Faustin Ntirenganya and Rwandan anaesthesiologist Dr. Paulin Banguti, Operation Smile and the University of Rwanda now conduct three-week surgical training rotations twice a year at Rwinkwavu Hospital.

Throughout the three-week sessions, Rwandan general surgery and anaesthesia residents learn skills, gain knowledge and practice techniques they will use to perform safe and effective reconstructive plastic surgery procedures. Ready and willing to serve their country, these surgical residents will become part of the solution addressing the country’s massive surgical backlog.

Photo: Zute Lightfoot.

At Rwinkwavu Hospital, potential patients wait to receive their comprehensive health evaluations during the second week of Operation Smile’s April 2019 surgical training rotations in Rwinkwavu, Rwanda. At these medical programmes, it’s not unusual for more than 200 – or even 300 – people to arrive at the hospital hoping to have the surgery that they’ve been waiting years to receive. Through the empowerment and education of local surgeons, anaesthesiologists and other healthcare professionals, sustainable solutions are being built so more patients can receive timely surgical care closer to home.

Photo: Zute Lightfoot.

Donatille lovingly holds her 4-year-old son, David, in her arms as she waits for medical volunteers to examine him before surgery. A typical Operation Smile medical mission aims to provide the highest-quality of surgical care to patients living with unrepaired cleft conditions. But during surgical training rotations, patients arrive at the programme site with various surgical needs – wounds, burns, cleft conditions and other congenital conditions – that require reconstructive plastic surgery.

David was born with a bilateral hand syndactyly, a surgically treatable condition where the toes or fingers of a newborn are fused together. Back home, David has friends, but many of his peers tease him about his hands, often calling him “ibimane,” which means “fused.” After an exhausting 9-hour journey – six hours by bus, two hours by foot and one hour by bike – Donatille arrived at Rwinkwavu with David. But every step they took together was worth it when Operation Smile medical volunteers told Donatille that her son was healthy enough to receive surgery.

“My child will be happy now that his fingers will be like all other children’s hands. He won’t want to hide his hand anymore,” Donatille said. “He will want to show everyone his new hand. If my son is happy, then I am happy.”

Photo: Zute Lightfoot.

Seventeen-month-old Sandrine and her mother, Angelique, arrived at the surgical training mission in Rwanda hoping to hear the answer for which they had been searching for more than a year. When Angelique saw her baby’s cleft lip for the first time, she was devastated, but she never stopped loving her daughter. Sadly, Sandrine’s father, Vincent, didn’t share his wife’s devotion after Sandrine was born. Unable to cope with the stigma associated with Sandrine’s cleft, Vincent refused to accept her as his daughter and forced both Sandrine and Angelique to leave their family home.

With time, Vincent eventually saw past that stigma, and the family agreed to reunite. But many unforeseen challenges would soon follow. In April 2018, Angelique and Sandrine travelled to Rwinkwavu Hospital for screening during an Operation Smile surgical training rotation. However, at just 3 months old, Sandrine was too young for surgery. During another rotation in October later that year, the family was met with heartbreak again when Sandrine’s comprehensive health evaluation determined that she was too malnourished. The pain and disappointment of enduring yet another unsuccessful medical evaluation was too much for Vincent to bear, and he convinced himself that surgery would never happen for his daughter. Once again, he chose to abandon his family.

Photo: Zute Lightfoot.

Operation Smile volunteer surgeon Dr. Steve Naum, centre, and plastic surgery resident Yves Nezerwa of Rwanda, left, sit with 14-year-old Solange as they detail their surgical process. Solange arrived at the rotation with a severe wrist contracture; a condition in which the wrist is pulled forward toward the palm or backwards toward the forearm due to the shortening of tendons or muscles.

While the condition is painless, a contracture can lead to restricted movement and sometimes results in complete immobility of the hand. But thanks to Operation Smile’s surgical training rotations, patients like Solange are receiving the reconstructive surgery that they need to live a more full and happy life.

Photo: Zute Lightfoot.

During these training rotations, reconstructive surgery is provided to patients living with a variety of surgically treatable conditions, free of charge. For many people living in Rwanda, paying for surgical care often means that an overwhelming financial burden will fall on an entire family. But thanks to the collaborative work of Operation Smile and the University of Rwanda, parents no longer need to choose between feeding their family and giving their child a better life.

Photo: Zute Lightfoot.

Operation Smile volunteer surgeon Dr. Bruce Ferris demonstrates different surgical techniques to general surgery residents during an operation. Through his experience with the programme, Bruce recognises how the rotations are drastically impacting the lives of people living in Rwanda.

“When I first started investigating doing rotations, it became very obvious to me that there were patients who needed surgical care that just weren’t getting it — languishing in hospitals for a very long time when they could have been cared for,” Bruce said. “It made sense that if we could develop the rotations, many of these patients would be taken care of and not have to be hospitalised for the long term.”

Photo: Zute Lightfoot.

Rwandan surgical residents observe Dr. Steve Naum perform surgery on a patient. Since 1998, Steve has volunteered with Operation Smile to help improve the health and dignity of patients living in Rwanda and around the world. But through his work with the organisation, Steve knew that ensuring the longevity of healthcare in Rwanda meant building sustainable solutions that could last long after a medical mission ended.

“It is easy for us to come to a place, do a number of cases, feel good about it and leave; but we don’t leave anything necessarily behind if we have not exchanged information or built some sort of knowledge or skill base for local surgeons to continue,” Steve said.

Photo: Zute Lightfoot.

Anaesthesiologist resident Bruce Nzobere of Rwanda carries Sandrine back to the recovery room where her mother, Angelique, anxiously waits to see her baby’s new smile. Soon after Sandrine was born, doctors at the local health centre explained to Angelique that cleft conditions are common and that surgery was possible to help her daughter. It comforted her to learn that she wasn’t the only mother experiencing something like this. She said that she no longer felt alone.

“My hope was that my child would get surgery,” Angelique said. And because of Operation Smile’s devoted medical volunteers, Angelique’s hopes were realised.

Photo: Zute Lightfoot.

Post-anaesthesia care unit and recovery room nurse Florence Wachira of Kenya, left, works with Rwinkwavu Hospital nurse Nikas of Rwanda, right, as Angelique holds Sandrine after her cleft lip surgery. Angelique experienced a mixture of emotions throughout the day of her daughter’s surgery: anxiousness, nervousness but, most importantly, happiness. After enduring the abandonment of her husband and the disappointment of being denied surgery twice, Angelique finally got Sandrine the care she needed for a brighter future.

“She’s going to grow up well. Her health is going to be good,” Angelique said. “All I can say is thank you. I can’t say any more than thank you.”

Updates from India – An interview with Abhishek Sengupta

In the past weeks we have all witnessed with concern how the second wave of Covid-19 was unfolding in India. Here’s an update about our programmes in the country from Operation Smile India Executive Director, Abhishek Sengupta.

How is the current situation in India?

The second wave of the pandemic have been brutal on India. In terms of absolute number of new infections per day and number of deaths per day, the second wave has been devastating, much more severe and sudden than the first wave. Health systems were on the verge of a collapse with a shortage of drugs and oxygen. The government of India scrambled all resources to plug the gap due to increased need for oxygen beds and ICU beds. At some places even military personal and doctors were deployed. Also several armed forces hospitals have been opened up for the general public to address the sudden increase in demand for hospital beds.

How has India’s second wave affected Operation Smile India’s medical missions and care centres?

After the first wave, we were able to restart our centres in November/December 2020. We had just gotten into the groove and the month of April was hugely successful month for us. We provided surgery to over 170 patients in April. However, unfortunately we had to completely shut down two of our centres from May 1. We have a total of four year-round care centres. Durgapur and Mumbai has been shut down till the end of June. The Bangalore and Srinagar centres continue to operate, but under reduced capacity. This decision was taken keeping in mind the surge in number of new infections per day and regional level lockdowns imposed by the government. Hospitals were instructed to increase their capacity to treat patients with Covid-19. Thus a lot of resources (especially manpower) from our cleft centres was diverted to meet this demand.

We are currently watching the situation very carefully. We hope to have all centres up and running from July, however a lot will depend on how things progress with Covid-19.

How have your teams been able to respond so far?

Throughout these tough times (for us as well as for our patients and volunteers) we have continued to stay in touch with our patients. In spite of the lockdown, our teams have been able to make home visits to deliver necessary food supplements and formulas to patients enrolled in our nutrition programmes. We have also been in touch with patients whose appointment for consultation (speech, orthodontics and dental services) had to be pushed. We have ensured that there isn’t any inconvenience to patients and the ones that are on a treatment pathway receive necessary advice and support virtually.

Given the massive shortage of oxygen in the country, Operation Smile has donated 100 oxygen concentrators to our partner hospitals in India. Purchasing oxygen concentrators in such a short time has been a challenge because of the sudden increase in demand and limited supply, but we were able to cut through a lot of the red tape and ensure there were purchased on time and delivered to partner hospitals. These 100 concentrators are being used in Covid-19 wards of 7 different hospitals today and have been instrumental in saving lives.

What is the current situation for children and adults with cleft conditions who were scheduled for surgery?

We have postponed all surgeries for now. We have been in touch with all such patients and are providing necessary guidance and advise virtually. These patients would be prioritised for surgery as soon as the centres reopen.

Do you have a personal message for Operation Smile donors?

These are difficult times, not only for the organisation but also for each of us personally. Almost everyone on the Operation Smile India team has either had Covid-19 themselves or have had close family members who have suffered. Most people on the team have also lost loved ones in this pandemic. The last year and half has been tiring. However, as a team and as an organisation, we all remain committed. During the first wave we stood by our partners and patients by providing food to over 15,000 families, this time we are supporting partner hospitals, patients and their families. In the future we wish to ensure safe and prompt vaccination for our patients and their families. It’s important to understand that we would not be able to do any of this without the help and support of our amazing donors and sponsors. In difficult times, as these, its generally the poor and marginalised that suffer the most and we at Operation Smile India are committed to stand beside them, but to be able to do this we need the continued support of kind-hearted individuals and like-minded organisations.

We hope that these tough times are behind us soon and we can quickly reopen out centres and start providing clinical services. Patients are waiting.

Scenes of hope and healing: Guatemala City surgical programme

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.

Photo: Rohanna Mertens.

Alongside his mother, Carmelina, 10-month-old Juan Elias was examined by volunteer dentist Dr. Vilma Arteaga at screening during Operation Smile Guatemala’s May 2021 medical mission​ in Guatemala City. Juan Elias, who was later deemed healthy enough to undergo surgery, was one of 26 patients to receive comprehensive health evaluations.

Photo: Rohanna Mertens.

Three-year-old John Kenneth listens to anaesthesiologist Dr. Emilio Peralta’s heartbeat during his own health evaluation.

John Kenneth’s mom, Yesenia, left; paediatrician Dr. Samantha Wilts of the U.S., centre; anaesthesiology resident Dr. Ligia Atz of Guatemala and anaesthesia team leader Emilio join in on the fun and laughter.

Photo: Rohanna Mertens.

Yesenia and her husband felt many emotions when they learned their middle child, John Kenneth, was born with a cleft lip and palate. Looking at their son after his birth, John Kenneth’s mum and dad were scared, uncertain and sad.

But they also felt hopeful.

Unlike many of the parents we meet, Yesenia knew that surgery was possible for her son. Her mother’s cousin, who had also been born with a cleft condition, received surgery from another organisation.

While Yesenia connected with Operation Smile Guatemala’s volunteer team soon after giving birth, John Kenneth’s road to a new smile was long and full of unforeseen challenges.

Photo: Rohanna Mertens.

John Kenneth undergoes his cleft surgery and becomes one of 15 patients to receive life-changing care during the medical mission. Plastic surgeons Drs. Labib Samarrai of the U.S., right; Pablo Ramazzini of Guatemala, left; and operating room nurse Grecy Queche work together to ensure the highest quality of care possible.

Years before his surgery, when John Kenneth was just 15 days old, Yesenia took a four-hour bus ride to the Operation Smile Guatemala clinic, determined to get her son care she knew he needed. Driven by love and hope, she made that same journey every month until the local staff informed her of an upcoming mission in April 2020. It wasn’t until she learned that all medical missions had been cancelled due to the pandemic that Yesenia began to fear the worst.

“I was scared that they would never operate again and John Kenneth would have to live with his face like this for the rest of his life,” she said.

Happily, Yesenia’s hopes were realised and John Kenneth now has a new smile and brighter future.

Photo: Rohanna Mertens.

Christopher’s mom, Lesli, received five ultrasounds during her pregnancy, but she didn’t learn her son would be born with a cleft condition. It wasn’t until the day of his birth when the doctor hesitated to let her see him that Lesli knew something was wrong. Upon seeing Christopher’s smile for the first time, she was scared and shocked. With having relatives from both her mother and father’s side of the family receive surgery for their cleft conditions, Lesli knew surgery was possible. But she never imagined it would affect her child.

Christopher was born after the COVID-19 pandemic had began spreading across the country. When Lesli called Operation Smile Guatemala, the organisation had already postponed upcoming medical missions and was closed to in-person visits. But the local volunteer team never gave up on Lesli or Christopher. Over the phone, they explained to Lesli how to tape his lip, which would help with feeding and preparation for future surgery. From then on, she received calls from our team every two weeks.

Months later, when the Operation Smile Guatemala clinic reopened in March, Lesli began making the five-hour trip every 15 days to bring Christopher in for his appointments and evaluations. It was during one of these visits that she learned about this upcoming medical mission in Guatemala City. Following his comprehensive health evaluation during screening day, Christopher was scheduled for surgery.

Photo: Rohanna Mertens.

Training and education opportunities are vital components to increasing surgical capacity and building sustainable solutions that address the backlog in the countries we serve.

This programme was volunteer plastic surgeon Dr. Labib Samarrai’s 30th medical mission with the organisation. Labib, left, mentors Dr. Pablo Ramazzini of Guatemala, right, during surgery as part of his credentialing process with Operation Smile. Empowering medical professionals like Pablo instils a confidence in them to practice their new skills and perform the techniques they’ve learned to deliver safe and effective cleft surgery in their local communities.

Photo: Rohanna Mertens.

Operation Smile Chief Development Officer Kendra Davenport shares a special moment with 15-month-old Gerson Eduardo in the recovery room after surgery.

“I feel like my team in Virginia Beach is tremendous and people have done a lot to educate me about what happens on a mission and what the obstacles and challenges are. But to see it up close is to really believe and understand,” Kendra said. “I think certainly the obstacles and challenges are huge, but the joy that the whole team feels when a child comes out of the operating room is palpable. For me, as a parent of a child who had to be operated on, it’s a tremendous leap of faith to hand over your child for that operation.”

Photo: Rohanna Mertens.

Justa, 11-month-old Luis Antonio’s mum, sees her son for the first time in the recovery room right after his surgery. It’s the determination and resilience of parents like Justa that enable and inspire us to overcome seemingly impossible challenges amid the pandemic.

Help us to continue keeping our promise to patients 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.

A centre of hope: Operation Smile Morocco

Operation Smile Morocco Co-Founder and Vice President, Fouzia Mahmoudi. Photo: Lorenzo Monacelli.

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

As an organisation forged from the passion of its volunteers and staff, Operation Smile Morocco revolutionises patient care with its work throughout the Middle East and North Africa region. 

But 20 years ago, the opportunity to establish a foundation in the country was nearly lost.

Before becoming Operation Smile Morocco’s compassionate and dedicated leader, Fouzia Mahmoudi was approached by Operation Smile Co-Founder and President Kathy Magee in 1998 with the idea to expand the global non-profit into Morocco.

The photos of children before and after receiving surgery brought Fouzia to tears.

“I told her, ‘I’m so motivated to work with you, but believe me, we don’t have those kids in Morocco. I have never seen them,’” said Fouzia, the current Co-Founder and Vice President of Operation Smile Morocco.

In that moment, after brushing the tears from Fouzia’s face, Kathy felt confident that Fouzia had the strength and heart to lead an Operation Smile foundation in the country.

Joining forces with a small team of volunteers, Kathy and Fouzia orchestrated a medical mission in the capital city of Rabat, determined to learn if there were children living in Morocco with unrepaired cleft conditions.

More than 700 people arrived during the first three days of the mission.

As hundreds of families came to Rabat seeking help for their children’s cleft conditions, Fouzia witnessed first-hand the devastating need in her country – a need she once believed didn’t exist.

“I went back to Kathy, and I told her, ‘There’s really a need for Operation Smile here, and I’m ready to do whatever I can to put a foundation here in Morocco,’” Fouzia said.

Collaborating with Kathy and other executive leaders of the organisation, Fouzia helped officially establish Operation Smile Morocco in 1999.

Launching into its 20th year, Operation Smile Morocco continues to be one of the most active and respected non-profits in the country through its work of delivering safe surgery to patients with a team of more than 400 volunteers.

“I’m so happy that, in such a short time, we’ve helped over 11,500 kids who I thought weren’t there just because they were hidden,” said Fouzia, her voice a mix of emotion and pride. “They were hidden in their own homes. They were prisoners. And we’ve been able to dig further, find them and help them.”

In the years following its inception, Operation Smile Morocco discovered that cleft surgery acts as only a single step along the path of a patient’s journey toward healing.

“Twenty years have shown us that cleft surgery is not only one short mission or one surgery. It’s a long process,” Fouzia said. “The centre is very, very important in the circle of Operation Smile.”

Operation Smile Morocco's care centre in Casablanca, Morocco. Photo: Lorenzo Monacelli.

Operation Smile Morocco established its first care centre in 2008 in Casablanca, which supplied the organisation with the infrastructure and innovative equipment needed to provide patients with year-round multidisciplinary care services including orthodontics, speech therapy, dentistry, psychosocial care, orthognathic evaluations and more.

Operation Smile Morocco volunteer plastic surgeon Dr. Wafaa Mradmi during a medical mission in Dakhla, Morocco. Photo: Margherita Mirabella.

“These parents have confidence in us. These parents have put their hope in our hands, and we don’t have the right to let them down,” volunteer surgeon Dr. Wafaa Mradmi said. “From our point of view, we aren’t doing anything particularly special, but they look at us as if we have truly saved their lives.”

But volunteers like Wafaa noticed that many of the patients arriving in Casablanca seeking follow-up care had travelled hours – or even days – to reach the centre.

With this, the organisation recognised that in order to uphold its commitment of providing access to ongoing care at every step of recovery, it must expand its reach even farther.

Operation Smile Morocco's third care centre in Oujda, Morocco. Photo: Lorenzo Monacelli.

In 2014, Operation Smile Morocco opened its second centre in El Jadida, followed closely by the third in 2019 located in Oujda.

“Centres help a lot. People won’t have to go six or seven hours to be checked,” said Nour Mahmoudi, programme manager for the organisation. “They’ll have a centre here locally where they can come and have those treatments.”

Dr. Lahcen Oussehal, Operation Smile Morocco volunteer orthodontist, examines a patient at the care centre in Casablanca, Morocco. Photo: Lorenzo Monacelli.

“Orthodontic treatment is one of the most important treatments for patients after the first surgery,” volunteer orthodontist Dr. Lachen Oussehal said. “It’s very important for these patients because they have a lot of dental discrepancies.”

With 12 years of volunteer experience with Operation Smile Morocco, Lachen sees many of his patients grow up and achieve their dreams with a newfound confidence.

“It’s indescribable. I can say that those patients are happy with themselves, they are happy with their appearance. We give them a very good quality of life,” he said.

Along with orthodontics and dentistry, speech therapy remains one of the most essential and prominent disciplines of care provided by Operation Smile Morocco due to the lack of knowledge surrounding the impact of cleft conditions on a patient’s speech.

Volunteer speech therapist Othman El Hammouni during a therapy session with patient at the care centre in Casablanca. Photo: Lorenzo Monacelli.

Many patients, especially those born with cleft palate, experience problems with speaking clearly, which makes it difficult for their speech to be understood. This means that many patients continue to endure severe bullying or ostracisation even after returning home with a repaired cleft condition.

For volunteer speech therapist Othman El Hammouni, he measures success by what happens after his patients leave the centre.

“The goal for us is, when they go out, they can order whatever food they want or go to the grocery and be understood by colleagues, by other kids without being marginalised,” Othman said. “So, if we reach that level, my job is completed.”

Volunteer surgeons Drs. Handouf Abdellah, left, and Kharbouch Abdelhouahab, right. Photo: Lorenzo Monacelli.

As two of the first volunteer surgeons to join the organisation in 1999, Drs. Handouf Abdellah and Kharbouch Abdelhouahab witnessed its evolution and advancement throughout the last two decades.

“It’s an honour to serve for 20 years here in Morocco,” Handouf said. “What drives me to stay is my love of kids and my love of helping the ones in need.

“(Operation Smile Morocco) has changed a lot in growth, in all ways. Especially the community of education in all specialties. This allowed us to increase the healthcare in our hospitals.”

Kharbouch believes it’s the meaning behind being an Operation Smile Morocco volunteer that inspires him.

“Operation Smile Morocco isn’t only an organisation, it’s a family.”

Regardless of how long they’d been with the organisation, volunteers and staff of Operation Smile Morocco shared a united answer when asked what motivates them to continue changing lives for another 20 years.

“The smiles. The smiles of the babies, being able to see them and just imagining them going through life with the change,” Nour said. “You’re giving them a chance to live, a chance to grow, the power to study and go further and be something in society.

“We are giving them hope.”

Help us to continue keeping our promise to patients in Morocco 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.

Photo: Margherita Mirabella.

Driven to lead: Q&A with Abhishek Sengupta

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

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

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

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

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

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

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

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

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

Q: When did your involvement with Operation Smile begin?

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

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

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

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

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

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

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

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

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

Photo: Lorenzo Monacelli.

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

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

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

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

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

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

Photo: Lorenzo Monacelli.

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.

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.

COVID-19 Conversation: Putting our Expertise to Work

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

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

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

Ernest brings 20 years of field-based experience working with 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.

Event Transcript

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

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

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

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

Laura: Thank you so much, John. And now I’m really excited to introduce you guys to two of our 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.

Audience Q&A

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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