From loneliness to acceptance

Justin, 53 years old. Photo: Rohanna Mertens

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 he returned home, Justin was met with kindness and acceptance from members of his community for the first time in his life.

This was a sharp contrast to how many people in his village treated him before he received surgery from Operation Smile Madagascar to repair his cleft lip.

At 53 years old, Justin had spent his life feeling abandoned and alone because of his appearance.

His only son didn’t want to be seen with his father, and his wife left him due to the stigma associated with his unrepaired cleft lip.

The years of being called names like “sima,” a derogatory term meaning cleft lip, had caused Justin to become shy.

Then one day, Justin saw a poster for Operation Smile Madagascar in his village hall with pictures of patients before and after surgery.

That was the first time Justin had seen another person who looked like him, and the first time he saw someone whose cleft lip had been repaired.

While the thought of having his smile repaired was exciting, Justin also knew he would have to take a chance and travel somewhere far from his home.

But after speaking with a local health worker, Justin mustered up the courage to attend an upcoming Operation Smile medical mission.

He made the long 24-hour journey with his niece, Rasoa, and a large group of other families from the Ifanadiana area. None of them knew for certain if they would receive surgery once arriving in Antsirabe, but they felt hopeful for the possibility of a new beginning.

Patients from across Madagascar arrive for screening during a medical mission in Antsirabe. Photo: Rohanna Mertens.

Arriving at the mission site, Justin was shocked after witnessing the scene before him: There were hundreds of people who looked like him.

Rasoa carefully documented Justin’s entire cleft care process.

Taking photos every step of the way, Rasoa, without even realising it, was creating a record of events that would one day have the potential to change the lives of more people like her uncle.

After undergoing his comprehensive health evaluation, Operation Smile medical volunteers deemed that Justin was healthy enough to receive surgery.

He shared with volunteers that he wasn’t nervous going into the operating room. He simply felt anticipation to see the change in his appearance after the procedure.

Rasoa was thrilled to call her mother, Justin’s sister, and tell her the surgery was a success.

When Justin saw his new smile for the first time, he was delighted with the result.

“Thank you for caring for me,” he said to the Operation Smile team.

After surgery, Justin smiles wide beside his niece, Rasoa, who remained by his side throughout his journey. Photo: Rohanna Mertens.

Returning home, he no longer felt the need to cover his mouth when talking to people or hide from interactions with others.

Even those who’d abandoned him in the past were willing to reconcile and join him in celebration of his life-changing surgery.

His once estranged 26-year-old son reunited with him.

Even his ex-wife, who left him because of his cleft condition, wanted to reconcile and try again at their marriage, but he declined. Justin said that he would rather start a relationship with someone new.

Today, Justin hopes to help more people like him.

With the photos Rasoa took during the medical mission, he can do just that.

“We want to help Operation Smile Madagascar find more patients,” Rasoa said. “We have photos, so we can explain what happens at the mission.”

Justin now happily lives his life as a subsistence farmer and refuses to let his cleft condition define him any longer.

Help us to continue keeping our promise to patients like Justin 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.

Justin, after surgery. Photo: Rohanna Mertens.

It’s never too late for a new beginning

Photo: Margherita Mirabella.

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

Yohana spent most of her life without the acceptance of her community. 

As an adult living with a cleft condition, she’d endured decades of people calling her hurtful names.

In addition to the torment she experienced, Yohana became even more isolated with the passing of her husband. Losing someone who’d loved and cared for her despite her cleft condition was almost too much pain for her to bear.

But Yohana refused to give up.

With a sister who was also born with a cleft condition, Yohana knew she wasn’t alone. But growing up wasn’t easy for her.

Having never learned about the actual causes of cleft, which can be hereditary or environmental, members of their village believed that God put a spell on Yohana’s mother, causing the sisters to be born with cleft conditions.

With beliefs and misconceptions like these deeply rooted in the minds of people living in communities around the world, harmful stigma leads to people like Yohana and her sister experiencing severe emotional pain and social isolation.

Just like Yohana, millions of people living in low- and middle-income countries are still enduring needless suffering because they’re unable to receive surgery early in their lives.

Not only are families unable to afford to travel to the nearest hospital, let alone the cost of an operation, they are also facing the barrier of local communities not having enough skilled surgeons and nurses to meet the medical demands.

Photo: Margherita Mirabella.

Having witnessed her sister receive cleft lip surgery from another organisation years before, Yohana felt relieved to know that a solution existed, but she feared she’d never be able to afford the cost of surgery.

As a subsistence farmer, she cultivates only enough food and livestock to meet her needs.

After living 51 years with an unrepaired cleft condition, Yohana never imagined she’d ever receive the surgery she deserved.

Then one day, everything changed.

Just days after Yohana heard a radio announcement promoting Operation Smile Ghana, a medical non-profit that provides free surgeries for people living with cleft conditions, a patient coordinator from the organisation arrived in her village.

For the first time in her life, Yohana had hope, and she happily registered for the upcoming medical mission.

Two months after learning about the possibility of free and safe surgery to repair her cleft lip, Yohana and other potential patients boarded a bus that took them to the mission site in Ho.

The following day, medical volunteers performed her comprehensive health care assessment to determine if she was healthy enough to undergo anaesthesia.

With patient safety as our greatest priority, all people seeking care during a mission must pass a comprehensive health evaluation, which screens for any potential health issues that could impact their procedure and ensures that each patient receives the highest quality medical care.

Yohana marveled at the love shown to her by everyone at Operation Smile.

Their kindness made her feel comfortable and helped to quell her anxiety about surgery.

Hearing that she was placed on the surgical schedule, Yohana couldn’t wait to embrace her brighter future. Instead of feeling alone and being called hateful names, she would finally be known as Yohana to everyone.

Before surgery, Yohana was relaxed and confident that her lifelong struggles with her image would soon change. What she looked forward to the most was for the people who once mocked her to see her new smile.

Yohana, one year after surgery. Photo: Margherita Mirabella.

Yohana’s only son accompanied her to the mission and was eager to call the whole family to tell them about the successful surgery.

After Yohana returned home, the community that once shunned her celebrated her transformation.

“I used to be laughed at, but now, nobody laughs at me,” Yohana said. “Thank you, Operation Smile, for changing my life.”

Help us to continue keeping our promise to patients like Yohana 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.

After 35 years, Tereza is finally free

Tereza, 35 years old. Photo: Margherita Mirabella.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Tereza, after surgery. Photo: Margherita Mirabella.

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

Now, her life is very different.

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

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

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

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

Photo: Margherita Mirabella.

From patient to programme coordinator

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

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

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

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

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

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

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

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

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

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

Photo courtesy of Lam Tran.

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

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

Photo courtesy of Lam Tran.

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

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

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

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

Photo courtesy of Lam Tran.

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

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

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

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

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

Photo courtesy of Lam Tran.

Enok’s path

Margherita Mirabella, Operation Smile.

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

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

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

Margherita Mirabella, Operation Smile.

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

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

Margherita Mirabella, Operation Smile.

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

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

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

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

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

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

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

Margherita Mirabella, Operation Smile.

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

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

Margherita Mirabella, Operation Smile.

Two Thumbs-Up

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

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

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

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

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

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

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

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

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

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

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

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

This time, Bipul wasn’t afraid.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Pre-surgical dental care saved Janat’s life

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

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

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

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

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

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

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

Janat and Fatima confronted these obstacles every day.

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

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

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

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

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

Then one day, Fatima’s hopes were realised.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Meet Our Patients: Mossoró, Brazil

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

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

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

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

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

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

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

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

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

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

Overcoming Nutritional Barriers to Surgery in Ghana

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Photo: Zute Lightfoot.
Photo: Zute Lightfoot.

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

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

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

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

“We train our mothers to use what they have to create nutritious food for their children. We ask what they have available: fish, beans, banana. Then, we work with them to create a practical solution, teaching them how to help their child,” Dede said.

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

Another one of Dede’s patients is Moses.

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

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

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

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

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

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

The Road to Ramata’s Smile

Editor’s note: We teamed up with the storytelling group Cliff Co. to create Love Always Prevails, the hybrid documentary film about Ramata’s and Mariana’s Operation Smile journey, featured above. Click here for a behind-the-scenes look at the production of the film with videographer Jacob Watson of Cliff Co.

While Ghana offers some of Africa’s most beautiful landscapes, it also suffers from a lack of adequate infrastructure, health care services and economic opportunities, resulting in some of the world’s most significant barriers to safe surgical care for its citizens.

It also means rough roads lead from the rural community of Assin Praso to the historic city of Cape Coast.

Though the physical condition of the highways is the same for all who travel between the two cities, the round trips made by Mariana and her daughter, Ramata, were among the most challenging.

Ramata was born with a cleft lip and a cleft palate. Mariana was determined to access safe surgical care to repair her 4-year-old daughter’s condition.

Five times, Mariana raised enough money for bus fare and took Ramata to Cape Coast in search of a free surgical option. Five times, the return trip was made all the rockier by heartbreak.

Each time doctors assessed Ramata’s health, she was either anaemic or too underweight to receive safe surgery. Even if she would have been deemed healthy enough for surgery, she had no way of being able to afford its cost.

Ramata with her mother, Mariana. Photo: Margherita Mirabella.

Disappointed but undeterred, Mariana remained vigilant about finding care for Ramata despite her limited resources — she earns a meagre living carrying water containers and gathering firewood for her neighbours. When Mariana met a non-medical volunteer from Operation Smile Ghana who was conducting an awareness campaign in Assin Praso, the lives of the family would change forever.

At first, Mariana didn’t believe that the surgeries Ramata needed would be free when she called Clement Ofosuhemeng, the patient coordinator for Operation Smile Ghana, to learn more about the organisation and its work. He assured Mariana that there would be no cost for any procedures needed to repair Ramata’s cleft condition and that Operation Smile would provide a bus to take patients from the Assin Praso area to the next medical mission in Cape Coast.

After Mariana and Ramata made the three-hour trek back to Cape Coast for the Operation Smile medical mission, yet another roadblock diverted Ramata away from care for a staggering sixth time. Ramata had passed her comprehensive health assessment and was approved for cleft lip surgery when she contracted malaria — a major health scare for the young patient in its own right.

While Ghana offers some of Africa’s most beautiful landscapes, it also suffers from a critical lack of adequate infrastructure, health care services and economic opportunities, resulting in some of the world’s most significant barriers to safe surgical care for its citizens. Our vision of improving patients’ health and dignity through safe surgery is backed by the idea that no one deserves to live with the burden of a cleft condition. Photo: Margherita Mirabella

Fortunately, Ramata survived her bout with malaria and returned to good health as she and her mother looked forward to the next Operation Smile medical mission in the eastern city of Ho. It would be here that she would receive the life-changing procedure which had proved to be so elusive.

In the months leading up to the Ho medical mission, Ramata started attending kindergarten and immediately developed an affinity for school and learning. She also experienced bullying from some of her classmates while others would stare at her cleft lip and shun her. The teasing and isolation drove Ramata to tears.

Photo: Margherita Mirabella.

Mariana also suffered social hardships after Ramata was born. As her family offered little, if any, emotional support, she became the target of insults and blame from some of her neighbours for having birthed a child with a cleft condition. While these words infuriated Mariana, they also hardened her resolve to find a surgical solution for her daughter — to give her the chance to pursue an education without it being derailed by cruel treatment from her peers.

Again, Ramata and Mariana boarded the Operation Smile bus and made the 10-hour trip from Assin Praso to Ho. Again, she was cleared for surgery after her patient health assessment, but this time made it to the operating room without further complications and received surgery to repair her cleft lip.

Photo: Margherita Mirabella.

When Mariana saw Ramata for the first time after surgery, she was overjoyed by the fact that her daughter would look like all the other children in their community.

Mariana marvelled at the care and attention Ramata received during the missions and was amazed by the love and care the volunteers showed the patients and their families. She said that she is happy to share Ramata’s story with everyone she meets and would tell other mothers in her community who give birth to children with cleft conditions about Operation Smile’s work in Ghana so they can avoid the anguish and frustration that she experienced in searching exhaustively for safe surgical care for her daughter.

Finally, Ramata truly began her journey toward healing. She returned to Ho twice over the following year to receive procedures at Operation Smile medical missions to repair her cleft palate.

Four-year-old Ramata. Photo: Margherita Mirabella.

In 2019, Operation Smile returned to Ramata’s home in Assin Praso to see how life has improved for her and Mariana.

Since receiving her final cleft palate surgery in 2016, Ramata has developed into an outgoing young girl who is full of energy and enjoys playing with her newfound group of friends from the neighbourhood.

Eight-year-old Ramata poses for a photo with friends from her village. Photo: Zute Lightfoot.

No longer subject to the harmful bullying and teasing from some of her classmates, Ramata thrives in school and in life.

Today, she’s a confident and competitive student who loves to learn and is oftentimes the first student to raise her hand during class when the teacher asks a question.

Photo: Zute Lightfoot.

While the journey to finding care for Ramata was challenging and full of unforeseen obstacles, the love Mariana has for her daughter never allowed her to lose hope.

And today, that love only continues to deepen as Mariana watches Ramata grow into an enthusiastic, hard-working and joyful young girl with a beautiful heart and a beautiful smile.

Photo: Zute Lightfoot.