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.

After a Rigorous Journey, This Venezuelan Family Finds Solace in Brazil

Three-month-old Elizabeth surrounded by her mother, Yelisbeth, her father, Yoel, and her siblings. Photo: Carla Formanek.

Venezuela’s economic and political chaos has not only deterred tourists from visiting the region, but has led to more than 4.5 million residents seeking refuge in neighbouring nations as of February 2020.

From Venezuela to Iquitos, Peru

Yoel, his wife, Yelisbeth, and their four daughters are one of the families who left their home, friends and jobs behind in search of a better life.

While Yelisbeth and Yoel’s decision to leave Venezuela was promoted by their desire to find a safe place to raise their children, they were also looking for something they struggled to find in their home country – surgery for their 3-month-old daughter, Elizabeth.

Elizabeth was born with a cleft condition and a limb difference affecting her left hand.

It was only after arriving in Iquitos, Peru, that the family connected with a man who informed them about Operation Smile and the free surgeries it provides for children like Elizabeth.

Grasping on to the opportunity to help his daughter, Yoel contacted the organisation’s team based in Peru, only to learn that the solution would remain out of reach: The next medical mission was scheduled to take place in Lima, which was very far from where his family had settled.

In an attempt to prevent his family from enduring the harsh travel distance, Yoel reached out to Operation Smile Brazil.

After being informed that the family was Venezuelan, the organisation encouraged them to seek safe surgery from the foundation in his native country. But with such tumultuous times impacting the country and foundation, there weren’t missions scheduled for any upcoming dates.

Despite the continuous challenges preventing him and his family from settling peacefully in the new country, Yoel found strength to persevere for the people he loves and cherishes most in this world.

Photo: Carla Formanek.

While unsure of what the outcome would be, Yoel reached out to Operation Smile Brazil once again. He ended the call feeling more hopeful than ever.

The team told Yoel that, in a month and a half, a medical mission was taking place in Porto Velho, which was more than 650 miles away.

Over the radio, Yoel broadcasted Elizabeth’s story and his plans to travel to Brazil in order to find her the care she needs.

Moved by the family’s story and resilience, an owner of a boat company offered them tickets to board his boat and travel down the Amazon River to Santa Rosa de Yavarí, the last city before the Brazilian border.

This initiated the first step of the long and challenging journey that stood between Elizabeth and the care that could change her life forever.

From Iquitos to Tabatinga, Brazil 

It took the family nearly three days to reach Brazil.

Traveling to Tabatinga, an Amazonian city located on the other side of the border, the family was once again surprised and touched by the compassion shown to them along the way.

“We had the help of a lot of people,” Yoel recalled. “People we had never seen gave us food and lodging.”

From Tabatinga to Manaus, Brazil 

Landing in Tabatinga, the family crossed paths with a woman named Cristiana, who generously offered them lodging and food.

Yelisbeth and Yoel depended on the meagre income they made from selling chocolates and some of their last possessions they still had with them.

More than 550 miles away from the medical mission, the family estimated that the next stretch of their trip would cost almost three times the amount of money they had at the time.

Photo: Carla Formanek.

But knowing that their dream of finding Elizabeth surgery was continuously moving closer within their reach, the entire family once again made incredible sacrifices to earn money: They left the dog that had accompanied them at Cristiana’s house, sold their fridge and deserted one of their tuk tuks, a motorised tricycle, leaving the six of them to share one together.

After almost four days of travel, everyone arrived safely in the Amazonian capital.

It was after talking to truckers and learning more about road conditions that Yoel set their departure date.

“We said, ‘Let’s go tomorrow!’ We set the alarm for three in the morning and left,” he said.

From Manaus to Porto Velho, Brazil 

Over the course of the day, the smooth paved road that the family had become accustomed to gave way to dirt and loose gravel.

“It was an infinite line to the horizon. And on the side of the road, we only saw forest,” Yoel said. “We traveled for miles without going through any communities.”

But soon, the seemingly endless dusty roads transitioned into water after they arrived at the Igapó-Açu River located in northwestern Brazil.

While receiving passage across the river on a ferry brought temporary relief to the family, Yoel knew that they still had a long way to go before reaching the mission site in Porto Velho, which was nearly 350 miles away.

After departing from the ferry, Yelisbeth, Yoel and their children were met with more sun, heat and dust as they continued on their journey.

With exhaustion weighing on the entire family, they stopped and took a break on the side of the road. They were once again met with kindness. Witnessing Yoel signal from the road, a truck driver slowed to a halt and offered to take the family to Porto Velho in exchange for small price.

Yelisbeth said that she still remembers the heady smell of petrol from the cart. And at night, when the driver would stop to rest after long hours of traveling, the family was reminded that they weren’t out of danger with being in such proximity of the Amazon Rainforest.

“We heard loud noises from the woods, and, suddenly, I saw pairs of bright eyes come out of the plants. They were jaguars,” Yoel said. “I could only think about the girls. They were my only concern.”

Conjuring up the last remaining strength they had, the family prevailed and traveled the final distance to the hospital, arriving the day before the mission was scheduled to start.

Elizabeth in the care of Operation Smile Brazil medical volunteers. Photo: Carla Formanek.

Elizabeth and her family were met with compassion from the Operation Smile Brazil medical team. And after Elizabeth passed her comprehensive health evaluation, the volunteers and staff struggled to hold back tears of joy when they informed Yoel and Yelisbeth that she was selected for surgery.

“It was a lot of sacrifice, but when we arrived here, we didn’t imagine that we would be received with such affection and love,” Yoel said.

He even said that the family hopes to make Brazil their forever home after the treatment they received from the people dedicated to the organisation.

Seeing Elizabeth’s beautiful new smile, Yelisbeth and Yoel knew that every sacrifice they made and every mile they traveled to get to this moment had been worth it.

Yelisbeth gazes in amazement at Elizabeth's new smile after surgery. Photo: Carla Formanek.
Yelisbeth gazes in amazement at Elizabeth's new smile after surgery. Photo: Carla Formanek.

This Aunt’s Love for Her Nephew Prevails

Felicia and her adoptive son, Kelvin, her biological nephew. Photo: Laura Gonzalez.

Editor’s note: This is the story of Kelvin, a 1-year-old boy from Ghana who received cleft lip surgery from Operation Smile in November 2019 – the month before his first birthday. Kelvin is the baby who portrays Ramata in the hybrid documentary film “Love Always Prevails,” which tells the story of Ramata’s mother, Mariana, and how she persevered through incredible hardships to ensure that her daughter received the surgery she deserved. Hybrid documentary films are created in a unique way, as a true story is scripted and filmed in direct collaboration with the people who lived the reality. We believe that this style of storytelling creates an emotional and intimate opportunity for the viewer to connect directly with our patients’ stories. We also worked in close collaboration with Felicia, Kelvin’s adoptive mother, who enthusiastically agreed to have her child play this role, so that Operation Smile can reach and treat more patients like Kelvin all around the world. We are very grateful and humbled to work with these families and appreciate their determination and compassion wholeheartedly.

Ramata, left, and Mariana spend time with Kelvin and Felicia during the filming of "Love Always Prevails." Photo: Zute Lightfoot.

A precious gift to her parents, Kelvin was born on Christmas Eve 2018.

But in Ghana, where he was born, the stigma surrounding cleft conditions is severe and deeply rooted; many people believe that babies born with cleft aren’t worthy of love.

This included Kelvin’s biological parents.

“My younger sister said she didn’t want a baby with a cleft, so she just ran away,” said Felicia, Kelvin’s aunt.

After her sister abandoned Kelvin, Felicia decided to adopt her nephew. She’s been raising him as her own son ever since.

“There was no one to take care of him, and I couldn’t leave him to die,” she said.

Felicia had never seen anyone with a cleft condition before. And although she didn’t know if a solution was out there, Felicia refused to walk away like her sister did.

While Felicia loves Kelvin, her life became very difficult after she made the decision to adopt him. She used to make a living as a trader, selling containers of water in the market.

“Now that I have this baby, I can no longer go to the market,” Felicia said. “I have to strap him to my back, and as soon as people see what he looks like, they don’t want to buy anything from me anymore. I have to beg people for money so I can feed him.”

Felicia felt relief and happiness when she learned that Operation Smile Ghana provides safe surgical care for patients like Kelvin. She saw an interview of patient coordinator Clement Ofosuhemeng on a national news broadcast and immediately called him to begin Kelvin’s care journey.

They traveled to Ho in April 2019 with the hopes that he would receive surgery from an Operation Smile medical mission. But after performing a comprehensive health evaluation, medical volunteers determined that Kelvin couldn’t be scheduled for surgery because he exhibited signs of malnourishment in addition to having contracted a cold.

“I don’t like to take him outside because when I do, he gets sick. He’s always sick,” Felicia said. “I don’t have money, so when I run out of food for Kelvin, I have to go out and ask people for it. I need someone to help me take care of him.”

Ramata holds Kelvin as he portrays Ramata as a baby during the filming of "Love Always Prevails" while Felicia watches in the background. Photo: Zute Lightfoot.

Through increasing education and promoting good health, Operation Smile Ghana aims to reduce malnutrition and illness as barriers preventing children from receiving safe surgery.

Before Felicia and Kelvin left the patient shelter to return home, volunteer dietitian Dede Kwadjo, who runs the nutrition programme for Operation Smile Ghana, evaluated Kelvin and gave Felicia helpful advice about the types of food that Kelvin needs to eat in order for him to become healthy enough for safe surgery.

“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.

“I will feed him well so he can gain weight and grow stronger,” Felicia said.

Felicia hasn’t heard from her sister since she left Kelvin shortly after his birth. She has no idea where she is. But after learning that Kelvin couldn’t receive surgery yet, Felicia refused to give up hope.

In August 2019, Felicia and Kelvin attended a mission in Cape Coast that was conducted entirely of Ghanaian medical volunteers, but again, they left heartbroken: Kelvin developed a cough before his medical evaluation, so he was unable to receive surgery.

Finally, in November 2019, Felicia and Kelvin traveled to Koforidua in another attempt at getting him the surgery that he needs and deserves. This time, Kelvin was deemed healthy and received cleft lip surgery.

Kelvin’s surgery came within the first year of his life, which is the best time for a baby to receive a cleft lip surgery.

Felicia said that she hopes to spread the word about the work that Operation Smile Ghana is accomplishing in the country.

“If I see someone else with a cleft, I will advise them and encourage them and ensure them that they should come and be seen by the doctors at Operation Smile.”

Meet Our Patients: Puebla, Mexico

Photo: Rodrigo Avina.

When both of her twin daughters, Daniela and Denise, were born with cleft conditions, Angélica relied heavily on the love and support of her family. 

As a single mother working tirelessly as a part-time maid to provide for her family, Angélica knew that paying for surgery for both of her twins was far beyond her means.

But that never stopped her from seeking out a solution. And while she was left without answers for more than a year, Angélica refused to stop searching because she knew that her daughters were depending on her.

“I am devoted to my children,” Angélica said.

The solution she searched for was suddenly in sight when a pastor from their community told them about Operation Smile Mexico and the life-changing surgeries it provides for children like Daniela and Denise.

Not only did the pastor tell them where the upcoming medical mission would be, but he helped Angélica, her sister and her daughters secure transportation to the mission site, which was four hours from their home.

After the twins both passed their comprehensive health evaluations, the time came for them to receive their free, safe surgeries.

Today, Daniela and Denise now have beautiful new smiles and brighter futures.

“I feel like this is the best thing that could’ve ever happened to us,” Angélica said. “The way that they (Operation Smile Mexico) treated us inspired, motivated and encouraged us to allow them to perform surgery on our children.”

Care for Brighter Futures: Luciana’s Story

Nury sits on a sofa in their home in Bogotá, Colombia, trying to recall the moment that her first-born child, Luciana, entered the world.

“She was born on a Friday morning, and the nurse immediately placed her high up on my chest so I couldn’t see her face,” she said.

She knew about Luciana’s cleft lip and cleft palate from an ultrasound she received seven months into her pregnancy, but she refused to acknowledge her daughter’s condition.

“I know now, through Operation Smile, that it is quite common. But then, I just didn’t believe that it would happen to my daughter,” Nury says, shaking her head.

Luciana has just enjoyed being bathed in a baby bath tub. She was constantly smiling at both of her parents as they played with her and splashed lukewarm water on her little body.

Now she is on her mother’s lap, dressed to go for a visit to Operation Smile Colombia’s care centre in the city. Tomorrow, she’s scheduled to receive surgery for her cleft lip – the first step in a long series of procedures and consultations that she will continue to have through her teenage years.

Photo: Rohanna Mertens.

The journey to this point has been tough and painful for Nury.

“The day after she was born, they brought her to me again to see if I could breastfeed her even though she had a cleft palate. I turned her towards me and she yawned and it made me very shocked. I started to cry and the nurse took her away from me,” Nury says, the memory filling her eyes with tears.

Later, when she tried to breastfeed Luciana again, it just didn’t work. She had to start feeding her baby with a spoon.

“It made me so sad to see her feed like that,” Nury says.

Unlike his wife, Daniel, Luciana’s father, didn’t feel anguish when his daughter was born.

“I was not surprised, or afraid or sad – I felt just pure happiness. I thanked our Lord when she was born,” Daniel says. “I know God has a meaning for our lives and if He wanted to send her to us like this, it is a pleasure above everything else.”

At the hospital where Luciana was born, a doctor told Daniel about Operation Smile – an organisation that offers expertise in treating cleft conditions at no cost to its patients or their families. The next day, Daniel called Operation Smile Colombia, which scheduled an appointment for Luciana within the following three weeks.

“The process was fast and I really liked the way they prioritised Luciana,” he says.

Photo: Rohanna Mertens.

Now it’s surgery day for Luciana, and Daniel and Nury arrive to the centre with their baby. The clinic is filled with children of different ages and their parents waiting for their consultations with various specialists.

“We are well-known by patients all over Colombia and also by referring specialists in their hospitals,” says Dr. Mauricio Herrera, a cleft surgeon and the medical director of Operation Smile Colombia. “We have become a specialist care centre for patients born with cleft, and hopefully we will continue developing in this direction and become a national reference centre for the whole country.”

At the centre, patients like Luciana will be able to receive care such as dental care, pre-operative care; ear, nose and throat treatments; nutrition advice; psychological therapy; and speech therapy. Parents can even take courses on how to best support their children.

Today, Operation Smile’s care centre in Bogotá provides treatment for half of the children born with cleft conditions in Colombia every year.

Mauricio explains why it’s so important to offer the whole family help and care: “When a child is born with a cleft, the whole family is affected and sometimes it can crush them if they start to accuse each other or themselves. It is easy to think that we treat only the children born with cleft, but actually it affects so many people around them, and that is why the work we do here on a daily basis is so important.”

Now, it’s Luciana’s turn to go inside the operating theatre. Mauricio and the surgical team takes care of her while Daniel and Nury patiently wait outside. Luciana will soon have her lip fixed and will return in the coming months for her palate surgery. Today is just the first of the many days she’ll spend at the centre. She will continue to see specialists here throughout her childhood.

Operation Smile Colombia medical director and cleft surgeon Dr. Mauricio Herrera, left, performs Luciana’s cleft lip surgery with support from plastic surgery resident Dr. Angela Rivera and instrumentation student Valeria Garcia. Photo: Rohanna Mertens.

“The plan for Luciana is for her to have a normal childhood,” Mauricio says while the nurses and anaesthesiologist carefully prepare her for surgery. “By the treatment we can offer her, she will have a chance to have a life just like any other child, without the stigma the cleft otherwise would have caused her.”

After a little less than an hour, Luciana’s surgery is complete and she’s brought into the recovery room to be reunited with her parents. Nury cries when she sees Luciana for the first time – but unlike when she was born, these are tears of relief and happiness.

Photo: Rohanna Mertens.

One year later, Luciana is a vibrant little girl who loves playing in the park. At Operation Smile Colombia’s care centre, she continues to receive comprehensive treatment from medical volunteers who provide the ongoing care that she needs to thrive and live a life filled with happiness.

“She looks perfect, just as I had dreamed of. If it hadn’t been for Operation Smile offering a solution for Luciana, it would have been just terrible,” Nury says. “For me, as a mother, I would have fallen into a depression because people’s prejudice also affects the parents of children born like this. So it would have been very frustrating for her, for me and for her father if there had been no solution like this.

“Moving forward, I want to give her all the best things. I think every mother wants that for her children: to give them a good education, a good learning process, growth, always being by her side. I want to be by her side during all those moments. She is my whole life.”

This Family’s Message of Thanks

Seven-month-old Yi Miang and his mom, Lu Gong’e, during Operation Smile China’s 2016 medical mission to Lincang. Photo: Zute Lightfoot.

No prenatal check-up or ultrasound Lu Gong’e received indicated that the lives of her and her husband, Tian Shun, would soon change forever.

With healthy 6-year-old twins at home, Lu Gong’e didn’t anticipate that her pregnancy would be any different with her son, Yi Miang.

But on the day that Lu Gong’e and Tian Shun believed would be one of the happiest of their lives, the couple was confronted with heartbreak and shock.

Yi Miang was born with a cleft lip and palate.

Doctors at the hospital didn’t explain the cause of Yi Miang’s cleft. They simply said that surgery was possible but not at that hospital.

In that moment, Lu Gong’e’s mind filled with seemingly unanswerable questions and thoughts of uncertainty as she held her baby boy in her arms.

“How is this possible?”

Photo: Zute Lightfoot.
Photo: Zute Lightfoot.

Looking at their son, Tian Shun and Lu Gong’e couldn’t understand how one child could be born with a cleft condition while their twin girls were born perfectly healthy.

After the family arrived back home, some members of their community blamed them, believing that they had done something to cause Yi Miang’s cleft clip. Lu Gong’e and Tian Shun faced stigmatisation and judgement from those who lacked proper knowledge on the causes of cleft conditions, which can be the result of environmental or hereditary factors.

Filled with love for Yi Miang, Lu Gong’e didn’t pay mind to the teasing or harmful comments.

Instead, Tian Shun and Lu Gong’e immediately sought out other hospitals in the area, tirelessly looking for a specialist with the skills and training to help Yi Miang. But even after months of searching, they remained without a solution.

Then one day, a representative from Operation Smile China visited their village and shared information that changed everything.

Tian Shun and Lu Gong’e learned that the organisation specialises in cleft lip and cleft palate repairs. They were also informed that an upcoming medical mission was taking place in Lincang, where Yi Miang could receive safe surgery at no cost to them.

Finally, the solution they’d searched for since Yi Miang’s birth was in sight.

“When I heard there was a mission, I was very excited,” Lu Gong’e said. “I travelled a whole day to the hospital, and my heart is full of happiness.”

Lu Gong’e and 7-month-old Yi Miang travelled 20 hours by bus to reach Lincang. While she was aware that cleft conditions existed, what Lu Gong’e saw upon arrival shocked her.

Hundreds of families with children affected by cleft conditions had travelled to the mission site just as her and Yi Miang had. Until then, she had no idea that one in 500-750 babies are born with cleft conditions.

Patient safety is at the forefront of every Operation Smile mission. To ensure that Yi Miang was healthy enough to undergo surgery, medical volunteers performed a comprehensive health evaluation, checking his blood pressure and other vitals before clearing him for surgery.

Volunteer pediatrician Dr. Elena Belonogova from Russia examines Yi Miang during screening day. Photo: Zute Lightfoot.

Lu Gong’e was thrilled when Operation Smile China volunteers placed Yi Miang on the surgical schedule. But at the same time, envisioning her son receiving surgery on his cleft lip scared her.

When Yi Miang entered the operating room, Lu Gong’e patiently sat in the waiting room, clutching his small jacket with tears falling down her cheeks.

A short time later, her worry turned into tears of happiness when Lu Gong’e reunited with Yi Miang and saw his beautiful new smile.

Photo: Zute Lightfoot.
Photo: Zute Lightfoot.

Tian Shun and Lu Gong’e were overcome with relief at their son’s transformation. Sitting by Yi Miang’s side as he rested after surgery, they knew that they would return to a future mission so Operation Smile China could repair their son’s cleft palate.

Before leaving the mission, Lu Gong’e and members of the volunteer medical team shared a beautiful moment when she told them that she couldn’t wait to show Yi Miang all of the pictures she’d taken during the mission. She wanted her son to see the faces of all the people who helped give him a brighter future.

Five months later, after traveling 10 hours to the 2017 medical mission in Dafang, Tian Shun, Lu Gong’e and Yi Miang reunited with the Operation Smile China team.

People at the mission described Yi Miang as a happy, outgoing 1-year-old who loves to laugh. Medical volunteers were delighted to announce that he was cleared to receive palate surgery.

“Before the first surgery, I was very nervous,” Lu Gong’e said. “But the surgery was so successful. I’m very confident about this surgery, and my heart is calm.”

Photo: Zute Lightfoot.

As Lu Gong’e and Tian Shun waited for Operation Smile China’s medical team to perform surgery on Yi Miang’s cleft palate, they wrote a letter thanking the doctors, nurses and volunteers who’d helped change their lives.

The letter has been translated from Mandarin below:

“First of all, I would like to convey my appreciation to this mission. And I want to thank all of the staff and volunteers from this mission.

Go team!

The welcome that everyone showed to my child before surgery really touched me, and I wish to show my appreciation to every single one of you for the concern and care you gave to my child.

Everyone here smiles so brightly. A smile can really relax people, and these smiles make me feel that there is nothing to worry about and to be calm and stress free.

Now, I’m outside of the operating room waiting for a perfect outcome.

My thoughts are that I wish that my baby will grow up to be a person like you and be able to convey your love to more people and society in general.

When Yi Miang grows up, I’ll tell him everything that happened at the mission. I’ll show him photos from the mission so that he will know what he received today.

This is not an easy task as so many people contributed to his health. I want him to be thankful to every single one of you.”

One-year-old Yi Miang poses for a photo with his parents, Lu Gong’e and Tian Shun, during Operation Smile China’s 2017 medical mission in Dafang. Photo: Zute Lightfoot.

A Father’s Promise Fulfilled

Antonia Samia, 19 years old, in October 2016. Photo: Marc Ascher.

Along a dusty roadside in the state of Ceará in northern Brazil, Antonia Samia sips a cold drink on a hot day at the local coconut stand with her father and sister.

The area has been stricken by a drought spanning more than five years and the scorching wind whips around the dust, which covers everything and everyone in a fine layer.

Life is hard for many in this desolate, arid region of a nation better known for lush rainforests, the mighty Amazon River and the sprawling cityscapes of Rio de Janeiro and São Paulo. Like the other farmers in the area, Antonia’s father, Iranildo, has had to cope with the effects of the lengthy drought. In times like these, he can only grow enough food to feed his large family. Even when more favorable conditions prevailed, Iranildo earned a low and inconsistent income selling surplus corn, beans and cassava.

Photo: Marc Ascher.

On this day, the family trio laugh and enjoy the time with one another as they reminisce about the past. Antonia’s newlywed husband, Alan, works at the coconut stand and the upbeat 19-year-old beams with a wide, loving smile when their eyes meet. In precious moments like these, it’s nearly impossible to imagine a time when there wasn’t much that made Antonia smile.

Antonia, her father Iranildo and her sister, Samily. Photo: Marc Ascher.
Antonia, her father Iranildo and her sister, Samily. Photo: Marc Ascher.
Antonia and her husband, Alan. Photo: Marc Ascher.
Antonia and her husband, Alan. Photo: Marc Ascher.

That time was 11 years ago, before her cleft lip was repaired by Operation Smile Brazil.

Cleft conditions have long haunted Antonia’s family. She represents the fifth straight generation afflicted with the deformity. Iranildo and Antonia’s mother, also named Antonia, were devastated to see their fifth daughter born with a cleft lip, but that paled in comparison to the love they felt for their newborn baby. Unlike so many children born with cleft conditions, Antonia was also very fortunate to be able to breastfeed without difficulty.

However, with a family of nine to support, there was no way Iranildo could afford surgery for Antonia. Even when he caught word of Operation Smile Brazil’s inaugural mission to Fortaleza shortly after Antonia was born, Iranildo couldn’t afford the bus fare nor the time away from the farm. All he could do was offer Antonia a promise that he hoped he could one day fulfill: “I promise I will get it fixed.”

Antonia, 8 years old, in September 2006 at the Operation Smile Brazil medical mission to Fortaleza. Photo: Marc Ascher.

So while she was fortunate enough to grow up physically healthy, the emotional distress Antonia would experience was inevitable. Once in school, she was relentlessly bullied and tormented by her classmates because of her cleft lip. Often, Antonia would come home from school in tears, telling her mother that she no longer wanted to study. The terrible names she was called were just too painful and persistent to endure.

When Antonia was 8 years old, her aunt, Leidinha, intervened and finally persuaded Iranildo to take Antonia to Fortaleza for a chance to receive free surgery at an Operation Smile Brazil medical mission. To this day, Antonia calls Leidinha “an angel.”

Iranildo, Antonia and Leidinha made the more than 3-hour bus ride to arrive at the medical mission site. Antonia was frightened to travel without her mother, who had to stay behind to care for her young children.

At the hospital, Antonia remembers playing with the other children as she awaited her comprehensive medical evaluation, which determined that she was healthy enough to go under anaesthesia for her procedure. Finally, Iranildo could make good on the promise he made to his daughter.

Still too young to understand the life-changing effects of the surgery she would soon receive, Antonia cried as the doctors took her into the operating room despite the best efforts of the medical volunteers to calm her worries. She didn’t understand that her father couldn’t come with her. Iranildo soothed his daughter’s fears by explaining that he would be there waiting for her after her procedure.

Antonia, 12 years old, in August 2010 at the Operation Smile medical mission to Fortaleza. Photo: Marc Ascher.

After a successful surgery, Iranildo couldn’t believe his eyes when he saw his daughter for the first time.

“Antonia was the most beautiful child in the world,” Iranildo said. “The other children (who had surgery) were pretty, but she was the most beautiful.”

Antonia remembers waking up from anaesthesia – her face felt strangely different and her lip was sore. All she wanted was to return home to the loving embrace of her mother. Once reunited, Antonia’s mother cried tears of joy when she saw her daughter’s new smile.

Antonia’s parents decided to keep her away from school as her lip healed fully. Once it was time to return, her teacher gathered her classmates – her former tormentors – together and asked them: “Have you seen Antonia? Look at her now – she has had surgery and see how beautiful she is.”

The teacher went on to explain that she had always been beautiful and that she had always been just like them – that any of them could have been born with a cleft and that Antonia never chose to be born with her condition.

From that moment on, the bullying ceased and Antonia made many friends and enjoyed social life as she continued her studies.

Antonia with Operation Smile Co-Founders Dr. Bill Magee and Kathy Magee in August 2010 at the Operation Smile medical mission to Fortaleza. Photo: Marc Ascher.

Meanwhile, her outstanding surgical result and photogenic nature grabbed the attention of a well-known toothpaste brand. Incredibly, the girl who was once so relentlessly tormented would become the face of a nationwide advertising campaign in Brazil.

Last October, Antonia visited the Operation Smile medical mission to Fortaleza. There, she helped nurture children and their parents by talking to them to ease their fears about surgery. She showed them a photo of her face before her procedure as she stood before them as living proof of Operation Smile’s life-changing work. Antonia said the experience brought back powerful memories and that helping the parents and children brought her so much joy.

Photo: Marc Ascher.

“If it was not for Operation Smile, I would not be here telling my story,” said Antonia, who hopes to become a doctor or nurse to one day help children like her. “Thank you for bringing back my happiness.”

Photo: Marc Ascher.

A new life for Moses

When Moses was born with a cleft lip and cleft palate in rural Ghana, his mother Aba was heartbroken. She didn’t know what to do and struggled even to feed Moses because of his condition.

Aba brought Moses to Operation Smile, hoping he would be treated, but at 3 months old and suffering from malnutrition, he was too young and frail.

We made a promise to Aba that Moses would get his chance to receive surgery. She was given nutritional advice to build his strength, so he would be ready for surgery at our next medical mission.

Aba never gave up. For his cleft lip alone, Moses missed two chances at surgery due to his low weight and fragile health. For one, Aba brought him on a 19-hour trip almost halfway across Ghana.

Finally, two years after she first came to Operation Smile, the trust Aba placed in us came to fruition when Moses received his cleft lip surgery. He is now almost out of the woods. He still needs surgery to fix his cleft palate, but Aba knows she can count on us for help.

Britany’s Care Centre Connection

Cintia didn’t understand what was wrong with her daughter, Britany, when she was born.

Her daughter was born with a cleft lip and cleft palate, conditions she had never seen or heard of before.

“I felt like my family didn’t show me any support,” Cintia said. “They were looking at this problem as if it was nothing. I felt very lonely.”

Cintia lives with her 3-year-old twin sons and Britany, 10, on the outskirts of Tegucigalpa, Honduras. Her husband works in another city and returns home once per month. She works as a street vendor selling cakes.

When Britany was 4 months old, she received surgery to repair her cleft lip at Hospital San Felipe in Tegucigalpa. However, the surgery was not performed by a plastic surgeon and the stitches broke open soon after, leaving her with an open wound.


Hope was not lost.

“I was told about Operation Smile Honduras and that they had a specialist team that could do this at their centre,” Cintia said. “I went there and they gave her a medical evaluation. When she was 10 months old, her lip was repaired again.”

Britany at 1 year old, after surgery. Photo: Marc Ascher.
Britany at 1 year old, after surgery. Photo: Marc Ascher.

The staff at Operation Smile Honduras’ year-round cleft care centre, which is only steps away from Hospital San Felipe, has since performed additional surgeries to correct Britany’s cleft palate. Since then, she has come to the centre regularly for the comprehensive care offered there.

“Our centre is really something extraordinary because we attend to patients in so many different areas; like psychology, dentistry, orthodontics, speech therapy as well as paediatrics, surgery and anaesthesiology,” said Jeanie Barjum, Executive Director at Operation Smile Honduras.

“Even though the appointments are booked in advance, we have new patients coming in almost every day.

“We see disheartened parents coming through the door of our centre, but they can meet immediately with our psychologist. You can see a complete change. They are filled with hope that their children will be able to smile.”

Britany at 9 years old, holding a photo of herself before her first Operation Smile surgery. Photo: Rohanna Mertens.
Britany at 9 years old, holding a photo of herself before her first Operation Smile surgery. Photo: Rohanna Mertens.

In 1997, Operation Smile extended its medical programs to six cities across Honduras, including San Pedro Sula, Santa Rosa de Copán and Tegucigalpa.

Opened in 2007, the care centre in Tegucigalpa offers free surgeries and post-operative care to cleft patients, who can also take advantage of long-term, comprehensive services including audiology and psychology consultations.

“Honduras is a small country with almost 9 million people, and we have given more than 4,500 smiles during the 20 years since we started working here,” Jeanie said. “Since the opening of the centre, we have had more than 25,000 appointments. This is a very high number if we consider that one in every 500 children born here has a cleft condition.”

Jeanie Barjum, Executive Director at Operation Smile Honduras, with a patient and her father. Photo: Rohanna Mertens.
Jeanie Barjum, Executive Director at Operation Smile Honduras, with a patient and her father. Photo: Rohanna Mertens.

Operation Smile’s impact is something that Dr. Edwin Javíer Cruz, Executive Director of Hospital San Felipe, has witnessed firsthand.

“We have been working together with Operation Smile for the last 20 years, and it has been very successful because together we have given so many surgeries to people from the whole country,” Dr. Cruz said. “These types of surgeries are very expensive in the private sector and far too expensive for the majority of the people in our nation. Operation Smile is definitely an organisation that is changing the lives of people in whole communities.”

The hospital benefits from hosting Operation Smile’s international and Honduran teams for the brigadas or medical missions, according to Dr. Cruz. Hospital San Felipe doesn’t offer plastic surgery, but his staff’s exposure to the medical missions allows for cross-collaboration.

“The staff is getting a lot of experience since we only do these kind of surgeries when Operation Smile is here,” Dr. Cruz said. “My staff also gains experience and knowledge to bring with them if they go on to work outside of the hospital – for example, in private clinics.”

Stephany Martínez, Operation Smile Honduras Patient Coordinator, embraces Britany at one of her care centre visits. Photo: Rohanna Mertens.
Stephany Martínez, Operation Smile Honduras Patient Coordinator, embraces Britany at one of her care centre visits. Photo: Rohanna Mertens.

Next door at the care centre, a dosen patients and their parents waited for their appointments. Stephany Martínez is the patient coordinator and keeps track of the hundreds of patients on their list.

“Our patients are mostly very poor. They have to travel far to reach the centre or a hospital where we have medical missions, and they lack the knowledge about the possibilities and benefits of surgery,” Stephany said. “We hear many shocking stories. For example, we had a 58-year-old woman with a cleft lip who had never had surgery because people in her village told her a surgery would be life-threatening.”

Her colleague, dentist and odontologist Dr. Gisela López, shared: “Many people might know about us, but they don’t know that the service we offer is for free. Even if they have problems paying for transportation, Operation Smile will pay for their transportation to the centre, especially for those living outside the city.”

Dr. Gisela López, dentist and odontologist at Operation Smile Honduras. Photo: Rohanna Mertens.
Dr. Gisela López, dentist and odontologist at Operation Smile Honduras. Photo: Rohanna Mertens.

Gisela’s role – and the roles of all of the medical specialists working at the centre – involves more than just providing medical care.

“Many times, it is more than giving them medical care. You show them affection, you tell them how handsome they are or you just make sure that the child feels accepted,” Gisela said. “We see all our children at the centre as beautiful.”

Gloria Vilchez is the care centre’s audiologist and speech therapist. She knows the importance of having patients and their parents regularly visit the centre for ongoing treatment.

Audiologist and speech therapist Gloria Vilchez examines a young cleft patient. Photo: Rohanna Mertens.
Audiologist and speech therapist Gloria Vilchez examines a young cleft patient. Photo: Rohanna Mertens.

“The children here need a lot of stimulation. We live in a country with a low level of education and many parents don’t know that they need to stimulate their children from an early age to be able to help them in their speech development,” Gloria said. “And they need to practice at home, not only here. So the work we are doing here helps because we can give steady support to the parents that need it.”

Now in fifth grade, Britany and enjoys her studies and playing with her friends. She dreams of one day becoming a police officer so she can help people.

Britany wasn’t the only person in her family whose life was changed by Operation Smile Honduras. Inspired by Britany’s treatment at the care centre, her mother, Cintia, is currently studying to become a nurse.

Cintia said she wants to be able to give back to other what she has received from Operation Smile Honduras and that one day she hopes to become a medical volunteer for the organisation.

But above all, she is grateful that her daughter received her life-changing surgeries and continues to benefit from the ongoing care she deserves.

“I am so happy because she has been able to live a normal life – she doesn’t feel any shame, she has no problems and is just a happy girl,” Cintia said. “I imagine that if she didn’t have those surgeries, her life would have been very difficult, filled with bullying. Children who can’t speak properly are bullied at her school. She has good speech and she is in good health.

“I really want to thank God and Operation Smile. Without them, she wouldn’t be happy like this.”

Britany at 10 years old. Photo: Rohanna Mertens.
Britany at 10 years old. Photo: Rohanna Mertens.