Devoted to Their Daughter

When Elisa was born in Madagascar, her parents’ joy lasted only for a fleeting moment before they saw her cleft lip and cleft palate.

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In an instant, their hopeful excitement gave way to overwhelming sadness.

Jean consoled his wife, Sidonie, encouraging her to be strong and that they would do everything they could to help Elisa. Though the parents were heartbroken, they held fast to their faith. They believed that their daughter’s condition was an obstacle sent by God for them to overcome.Indeed, their faith would be tested.

The midwife who helped deliver Elisa told her parents that surgery could repair their daughter’s cleft lip and palate, but the procedure would be too expensive for them. 

Undeterred, Elisa’s parents began seeking out surgical care for their daughter.

Sidonie and Jean were referred to a local doctor to see if he could help. When Elisa was 6 weeks old, the family travelled to the capital city of Antananarivo to see a plastic surgeon, who then explained that Elisa was too young to receive surgery and asked them to return in about five months for another evaluation.

Meanwhile, Elisa’s cleft lip and palate made it difficult for her to breastfeed and she soon became underweight. Desperate for her daughter to gain weight, Sidonie spoon-fed milk to Elisa, but it wasn’t enough for her to thrive. By the time the family returned to the surgeon when she was 6 months old, he delivered more bad news. Elisa had become malnourished and was not healthy enough to receive surgery.

Devastated by the diagnosis, Sidonie and Jean returned to their village uncertain about their daughter’s future. Still, they remained hopeful that she would one day receive surgery. Fortunately for Elisa, spoon feeding ensured that she would survive until she could begin eating solid foods, which helped her return to better health.

Though Elisa was too young to realise it, Jean and Sidonie dealt with cruel treatment from some members of their community. Some even seemed to take pleasure in the family’s suffering and blamed Sidonie for Elisa’s condition. Turning to superstition, certain neighbours said that Elisa’s cleft was caused by Sidonie using a shovel or wearing a key as jewellery during pregnancy.

All the while, the family continued to pray that Elisa would get the surgery she desperately needed as the odds for her future continued to worsen.

In the most resource-poor, poverty-stricken places like rural Madagascar, as many as 93 percent of children with an unrepaired cleft condition die before their 20th birthday.

Elisa at 2 years old waiting for the surgery to correct her cleft palate and cleft lip

Elisa at 2 years old, with other patients waiting in the pre op ward to be called for surgery with patient

When Elisa’s parents finally learned that Operation Smile provides free, safe cleft surgeries and would be conducting a medical mission in Tamatave, their prayers were answered.

Unlike Sidonie and Jean’s previous attempts at providing cleft surgery for their daughter, this time Elisa would not be turned away.

A comprehensive health evaluation determined that Elisa was healthy enough to receive surgery to repair her cleft lip. Her parents were overjoyed to learn that her life would soon be forever changed.

Sidonie and Jean waited nervously as the Operation Smile medical team performed Elisa’s surgery. After her successful procedure was completed and Elisa awoke from anaesthesia, the family poured out emotions when they were reunited in the post-operative room. After so much hardship, Elisa’s smile was finally whole.

When the family returned home, their neighbours were shocked by the difference in Elisa’s appearance. Children who once kept their distance from Elisa now became her playmates. Now Elisa is a happy and cheerful girl, living a fulfilling life.

Elisa with her mum, Sidonie, and dad Jean looking at their healthy daugther.

It all starts with nutrition

Malnutrition is one of the biggest barriers to children receiving the cleft surgery that could change their lives.

Breastfeeding is usually impossible because babies can’t latch on properly, and the specially designed bottles that babies with a cleft condition need often aren’t accessible to parents.

Children then become malnourished, which – as well as the immediate threat to their life – means they won’t be strong enough for the surgery that means they could eat normally: it’s a torturous circle.

But Operation Smile never just turns a child away.

If they don’t pass their comprehensive health evaluation, children are supported by Operation Smile’s nutrition programmes which provide ready-to-use-therapeutic food (a type of peanut paste), formula milk and cereals to families, along with education sessions and monthly assessments.

“We train families to use what they have to create nutritious food for their children,” says Dede Kwadjo, Operation Smile volunteer nutritionist. “We ask what they have available: fish, beans, banana. Then we work with them on solutions.”

“It’s so hard to tell parents that their child is too unwell for surgery,” says Dede. “We always promise to return. And thanks to our nutrition programmes, we can then give children the smile they deserve.”

Elisa standing happy fater her cleft lip surgery

Elisa standing proud

Elisa after cleft lip surgery, walking happily with with Mother Sidonie and Farther Jean Chrisostome

The family no longer has to hide their beautiful and healthy daugther

What is Operation Smile?

Every three minutes a child is born with a cleft, and this statistic doesn’t change even during a global pandemic. This means that 1 in 700 babies are born with a cleft lip or cleft palate, a gap in the lip and or mouth that didn’t close during early pregnancy.

In the developing world this isn’t always an option: the surgery can cost up to a year’s salary and often there are no local medical professionals qualified to carry out the procedure. This condemns children to a life of stigma and difficulties with breathing, eating and speaking. Many will never go to school.

Since Operation Smile was founded in 1982, Operation Smile’s medical volunteers have provided hundreds of thousands of free, safe surgeries to children in more than 30 countries.

Children can’t wait any longer for the care they need

No parent should have to choose between keeping a roof over a child’s head or giving them the medical care that they need to be healthy.

45 minutes is all it can take to perform the surgery that saves and changes lives and it costs as little as €180 This is possible thanks to the generous contributions of medical professionals who volunteer their time, as well as corporate partners that donate critical supplies and equipment necessary for safe surgery.

A grandmother’s everlasting love

Baby girl with cleft being held by her grandmother
Eight-month-old Heydi with her grandmother, Claudina. 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.

Claudina knew that her 16-year-old daughter, Wara, had a high-risk pregnancy. But she never imagined the series of challenges that would ultimately unfold after Wara went into labour.

With a need for additional medical support, Wara was sent to a hospital in La Paz, Bolivia, where a medical team could provide her the care she required.

But there was one major obstacle standing in their way: The hospital was five hours away from their home.

Determined to overcome any obstacle for her family, and with no other options, Claudina and Wara ordered a taxi and set out on their way.

However, during the drive, it became apparent that Wara wouldn’t make it to the hospital before giving birth.

Thinking fast, Claudina instructed the taxi driver to pull over, and quickly stepped up to deliver her newest granddaughter Heydi.

But seeing Heydi’s cleft condition for the first time in the back seat of the taxi, Claudina and Wara soon grasped that their troubles were far from over.

Baby with a cleft lip
Photo: Margherita Mirabella.

After the ambulance arrived, they were rushed to a nearby community health centre before being transferred to the La Paz hospital where Wara and Heydi spent the next 36 hours recovering.

During this time, Claudina began to focus her attention on the next obstacle that the family would face – finding a way to get Heydi surgery to repair her cleft lip.

Although there was no indication that Heydi would be born with a cleft condition, that didn’t stop other family members and people in their community from making harmful remarks in passing and placing all blame on Wara.

This took an emotional toll on Wara. Despite the immense love she had for her daughter, Wara felt in her heart that making Claudina Heydi’s principal caregiver was the best decision for her family.

More than anything, Wara wanted Heydi to live a happy life without worry or fear of the stigma that’s often associated with having a cleft condition.

Heydi’s grandfather, Florencio, inquired about care from a private hospital that he knew provided surgery. But as farmers who made a meagre income selling potatoes and beans, Claudina and Florencio feared that without surgery, their granddaughter would live her entire life with an unrepaired cleft lip.

But they continued their search, never once giving up hope.

Then one day, a family member told them about Operation Smile Bolivia and the team of medical professionals who provide free reconstructive cleft surgery to children like Heydi around the world.

Smiling woman fills out medical evaluation with patient's grandmother
Volunteer paediatric anaesthesiologist Dr. Karin Strand of Sweden and volunteer post-anaesthesia care unit physician Dr. Ben Hu of the U.S. provide Heydi's comprehensive health evaluation to determine if she's healthy enough to receive cleft surgery during a 2018 surgical programme in Santa Cruz. Photo: Margherita Mirabella.

Claudina’s hope deepened when she received a call informing her that a surgical mission would be taking place soon.

One week before the programme, Heydi was seen by Operation Smile medical volunteers in La Paz and given a comprehensive medical evaluation to ensure she was a candidate for safe surgery. As a healthy 8-month-old, she passed and was cleared to attend the mission 18 hours away in Santa Cruz.

Claudina, Heydi and many other families of children born with cleft who were looking forward to receiving surgery boarded the bus for the long journey ahead.

On the day of Heydi’s surgery, Claudina waited anxiously, remembering the hardships it had taken their family to get to this point.

But seeing Heydi smile for the first time after surgery made every unexpected hurdle they endured throughout the past year worth it.

Anaesthesiologist carrying baby after successful cleft surgery
Volunteer cleft surgeon Dr. Carlos Hugo Dorado of Bolivia, left, and paediatric anaesthesiologist Dr. Karin Strand of Sweden, centre, carry Heydi out of the operating room toward the waiting arms of her grandmother, Claudina. Photo: Margherita Mirabella.

There was no doubt that Claudina loved Heydi from the moment she was born, regardless of her cleft condition.

But now, she knew Heydi wouldn’t have to worry about the opinions of others or the stigma surrounding cleft.

She would grow up feeling loved and cherished by everyone.

girl with repaired cleft reaching for a photo of herself before surgery held by her grandmother
Photo: Margherita Mirabella.
girl in pink jacket smiling
Heydi, today. Photo: Margherita Mirabella.

Explore more stories from Bolivia:

Lighting the way

young woman holding baby with cleft lip and palate
Pamela and Luz in 2004. Photo by Marc Ascher.

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 the heartbreaking miscarriage of her first child, Pamela was overjoyed to reach full-term with her second, Luz, a name meaning “light.”

But the happiness she felt after giving birth to her baby girl was replaced with the darkness of fear and confusion when the doctor took her away.

Pamela was only given a glimpse of Luz before she was ushered into a separate room.

When the doctor came back, Pamela saw her daughter’s cleft lip and palate for the first time. Shock and blame overwhelmed her, but she loved her daughter and wanted answers.

“At first, I thought that it was because I had had a previous miscarriage as a result of a fall,” Pamela said.

Her doctor assured her that this was not the reason for her daughter’s cleft lip and palate (while it’s difficult to determine the exact cause of an individual cleft case like Luz’s, Operation Smile is leading the way in cleft research with its partners in the International Family Study).

He told her that surgery was possible, but mentioned nothing about Operation Smile and the cleft lip and cleft palate surgeries that it provides at no cost to Bolivian patients and their families.

Going home led to more obstacles and more fear. Her daughter’s cleft condition made it almost impossible for her to breastfeed properly, and Luz began to lose weight. Becoming desperate, Pamela resorted to feeding her milk with a spoon, but Luz continued to cry out in hunger.

Baby with cleft being examined by doctor
Photo by Marc Ascher.

Fortunately, a friend of Pamela, whose baby had also been born with a cleft lip, arrived at their home with a special feeding bottle that had saved her child’s life. Feeding from this bottle, Luz soon began gaining weight and growing strong.

For several months, Pamela and her mother searched for any piece of information on cleft lip and cleft palate surgeries. And for several months, they were left without answers.

In 2004, after almost a year of living with an untreated cleft condition, Luz was given a chance at a brighter future when a street vendor informed her grandmother about having seen an announcement from Operation Smile on television.

Pamela and her mother called a volunteer from the Operation Smile team and learned that there was a medical mission taking place in Santa Cruz, Bolivia.

Neither the distance to the mission nor her small income were going to stop Pamela from raising enough money to pay for the journey – a journey that could alter her daughter’s life forever.

The trip for Luz, her mother and her grandmother proved to be challenging. During the trip, they faced a collapsed bridge that prevented the bus from crossing safely. All of the passengers were forced to walk until they could reach another bus, making an 18-hour trip even longer.

After many hours of walking, waiting and riding, they made it to Santa Cruz.

As she approached the medical mission site with Luz and her mother, Pamela felt uncertain and anxious. She didn’t know what to expect nor what the medical volunteers would say about her daughter’s cleft lip and palate.

But her hope returned when she saw other children with not only the same cleft condition as Luz but, in some situations, even more severe. In that moment, she knew that they weren’t alone.

Operation Smile medical volunteers completed a comprehensive health evaluation and determined that Luz was healthy enough to receive safe surgery and was placed on the first day of the mission’s schedule. Pamela was thrilled to hear that Operation Smile was going to give her daughter a chance at a more dignified and happy life.

Young mother holding her baby post cleft surgery
Pamela comforts Luz after her cleft lip surgery from Operation Smile at the 2004 medical mission in Santa Cruz, Bolivia. Photo: Marc Ascher.

Luz was fortunate enough to have found Operation Smile at an early age, as she was able to avoid the dangerous infections that can occur, as well as the damaging ridicule and stigmatisation many face when living with an untreated cleft lip or cleft palate.

Smiling child with mother after successful cleft surgery
Luz and Pamela in 2012. Photo: Marc Ascher.

“Thanks be to God that Luz has never had any problems,” Pamela said. “She never felt different.”

Today, Luz is a junior in high school with plans to make a difference – to shed light on the world by continuing her education.

“I don’t know what I want to study yet, but I do want to do something that will help people,” Luz said.

Teenage girl smiling with a repaired cleft
Luz in 2018 at 15 years old. Photo: Margherita Mirabella.

She adores her dog, Beethoven, and enjoys listening to her favourite singer, Justin Bieber. Luz also loves playing soccer and volleyball with her two best friends, Judith and Mariana.

Luz is scheduled to return to a mission to receive a rhinoplasty and to reconnect with the Operation Smile medical team who helped give her the smile she always deserved.

Teenage girl with repaired cleft holding a mug
Photo: Margherita Mirabella.

Pamela had this message for Operation Smile supporters and its medical volunteers: “Thank you very much for the help and support you have given me at the missions. I really feel that when I go to the missions, you are my family.”

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

Teenage girl with a repaired cleft smiling next to her mother
Luz and Pamela in 2018. Photo: Margherita Mirabella.

Building the capacity to heal

surgeon and girl with cleft smiling at each other
Volunteer surgeon Dr. Tilinde Chokotho speaks with 12-year-old Belita before her surgery during Operation Smile's 2019 mission to Lilongwe, Malawi. Photo: Zute Lightfoot.

Through the actions of dedicated and loyal volunteers who strive to make an impact, Operation Smile Malawi’s goal of increasing local surgical capacity remains at the core of its mission.

Volunteer surgeon Dr. Tilinde Chokotho was first introduced to Operation Smile Malawi during his residency in South Africa. And even after years of collaborating with volunteer medical teams from countries all around the world, Tilinde remains just as passionate about missions in Malawi being driven forward by local volunteers.

And that’s exactly what he witnessed during a 2018 medical mission held in Blantyre, Malawi.

“It is very important and quite significant to have such a strong representation,” Tilinde said. “It means that in the future, we could be pretty much self-sufficient. We could still have a few overseas volunteers to support, but, basically, it should be Malawians treating Malawians.”

Operation Smile invests in increasing the surgical capacity of low- and middle-income countries like Malawi so that it can serve and treat more people living with cleft conditions. As a local foundation, Operation Smile Malawi has worked to encourage and educate local surgeons, doctors and nurses with nearly 50 percent of Malawian volunteers.

Operating room nurse Seleman Badrlie has only been volunteering with Operation Smile since 2016, but he has already transformed many lives through attending 11 medical missions.

After finishing a mission in neighbouring Mozambique, Seleman joined the medical team in Blantyre to help create even more smiles. Back-to-back missions can be exhausting experiences, but for Seleman, it’s the right thing to do for the patients who are waiting.

“I felt like my help and my dedication to the team would be very important. Whatever I have to give to Operation Smile in order to bring smiles to people is OK with me,” Seleman said.

While Seleman is committed to the idea of Malawians driving the Malawi missions, he hopes to continue working with volunteers from around the world.

“It’s important to work on Malawian missions because it helps me gain skills,” he said. “I am always involved in working with the international volunteers, which is so helpful and allows me to learn valuable skills.”

As an organisation with a multidisciplinary approach to care, Operation Smile values its extensive community of volunteers who contribute a wide array of skill sets and professions that are vital to improving the health and dignity of people around the world.

Child life specialists are an integral part of that community.

Elderly woman with cleft shaking hands with practitioner
Operation Smile volunteer psychosocial practitioner Cathy Cheonga, left, and volunteer surgeon Dr. Stefan Rawlins of South Africa meet with 79-year-old Flyness before her cleft surgery. Photo: Zute Lightfoot.

Cathy Cheonga works as a psychosocial practitioner in Malawi and volunteers her skills to assist with the child life team. It was through an awareness campaign that she first heard about Operation Smile and how it strives to deliver exceptional surgery to people where it’s needed most.

As paediatric healthcare professionals, child life specialists help patients and their families understand and cope with the hospital experience. Through therapeutic play and activities, child life specialists ease patients’ fears and anxieties during the mission, helping comfort and soothe them during their time with Operation Smile.

But the event that cemented Cathy’s interest in the organisation’s mission was when the Operation Smile Malawi team visited her office.

“They came to our offices to find out if we had any volunteers who could offer their services. I attended my first mission last year, and the programme was successful, which was why they invited me back this year,” Cathy said.

For Cathy, dedicating her time to attending missions and seeing the lasting impact that she has been able to make for children and their families motivates her to keep going.

“I have enjoyed my experience very much. I actually want to help the parents, as well as the children, to take away their fears: to say to them that this is part of life and everything is going to be OK and then help them transition from fear to hope and peace.”

When it comes to the question of enhancing skills, increasing capacity and building the local foundation, Cathy makes it clear that it’s a pressing concern.

“It’s actually really important because the mindset of many people is that other people have to come to help us, and yet, we are the very people who live with our fellow Malawians here,” Cathy said.

Cathy said that being local allows for a special understanding of the country’s beliefs and cultures, which can be useful in a mission context. She hopes to encourage the youth of Malawi to get involved and volunteer with Operation Smile Malawi so that they, too, can make a life-changing impact.

Through their partnership, Operation Smile U.K. and Operation Smile Malawi work collaboratively to reach a goal of clearing the backlog of patients who need cleft lip and cleft palate surgery in Malawi.

For Tilinde, the goal is possible. And he feels that a key element in achieving it is through increasing local capacity.

“It’s not just about doing the cleft repairs; comprehensive care is the ultimate goal,” he said. “We need training, not just for surgeons, nurses and anaesthesiologists, but other specialties like speech therapy.”

Smiling boy with cleft surrounded by medical volunteers
Anaesthesiologists Drs. Paul Phiri of Malawi, top left; Godfrey Phiri of Malawi, top centre; surgeon Dr. Mark Solomon of Kenya, top right; clinical coordinator trainee Courtney Allen of Australia, bottom left; and child life specialist Nicole Zina of the U.K., bottom right, pose with a patient before surgery during Operation Smile's 2018 medical mission in Blantyre, Malawi. Photo: Jasmin Shah.

Walk alongside Shijun

boy with cleft lip and palate looking at camera
Thirteen-year-old Shijun, before surgery. 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.

As a fifth grader, the one thing Shijun wanted most was to study his favourite subjects of literature and maths.

But being born with a cleft lip and palate in the Guangdong Province of China, he struggled to enjoy his time at school with the bullying he faced on a regular basis.

Although the harassment he received made him angry, Shijun chose to walk away instead of fighting with those who treated him badly.

It pained Shijun’s parents to witness their son endure the hurtful comments and isolation. But there was something that always gave them hope: They knew surgery to repair Shijun’s cleft condition was possible.

Paidong, Shijun’s dad, had a cousin who received surgery to repair his cleft condition and now lives a happier life.

This knowledge of a solution motivated Paidong to search tirelessly for the care his son needed.

But for years, Paidong was left disappointed after each attempt: The cost of surgery was beyond his means and impossible for his family to pay despite his yearly salary as a construction worker.

During one of his attempts, Paidong travelled to Guiyang to see a doctor who he hoped could help. The transportation to the city cost approximately 10% of Paidong’s annual income. And even after the immense cost, Shijun couldn’t receive surgery, and the family once again returned home with no results.

Operation Smile believes that parents should never have to choose between keeping a roof over their family’s head or the care that their child needs to stay healthy.

boy with a cleft walking with his father
Shijun and his dad, Paidong, walk side by side to the hospital. Photo: Zute Lightfoot.

This cycle of frustration and heartbreak came to an end when Shijun’s uncle discovered new information while visiting a friend at a local hospital in Bijie City.

After mentioning to the nurse that his nephew had a cleft lip, they immediately told him about Operation Smile China.

Learning that the organisation had a surgical programme scheduled in Dafang in the coming weeks, Shijun’s uncle rushed home to tell his family the exciting news.

Just like every other attempt at getting his son surgery, Paidong felt both hopeful and anxious in the weeks leading up to the Operation Smile China surgical programme. But he was filled with relief knowing that his family wouldn’t be responsible for the cost of transportation to the mission site and the surgical care Shijun would hopefully receive.

Soon, it was time for Shijun and his uncle to travel to the mission. Paidong made plans to return to Dafang County to meet them at the mission site – there was no way he would miss this opportunity.

boy with his father and uncle
Paidong, left, registers Shijun for screening during a 2016 Operation Smile China surgical mission in Dafang. Photo: Zute Lightfoot.

After a comprehensive health evaluation, Shijun was cleared for surgery by our volunteer medical team and scheduled for his operation to repair his cleft lip.

When it comes to our work of delivering exceptional cleft care to people around the world, the safety of our patients has been, and will always be, our greatest priority.

Throughout the screening process, medical volunteers take patients’ blood pressure, temperature and other vitals to ensure that there are no underlying health concerns that would risk the patient’s safety during surgery.

boy being escorted by medical team for cleft surgery
Shijun bravely walks into the operating room with anaesthesiologist Dr. Daniel Kim of Brazil. Photo: Zute Lightfoot.
surgery team performing cleft surgery
Volunteer plastic surgeon Dr. Shu Maoguo of China, centre, and plastic surgeon observer Dr. Brad Gandolfi of the U.S., left, perform surgery on 13-year-old Shijun. Photo: Zute Lightfoot.

On the morning of his scheduled surgery, Shijun was excited and couldn’t wait to see his new smile for the first time. He began to think of everything he wanted to do after surgery including play basketball with his friends without fear of being teased.

When he looked in the mirror and saw his smile for the first time, he said, “Thank you, thank you I feel good.”

boy looking at himself in a mirror after cleft surgery
Shijun stares at his new smile in the mirror the morning after his cleft surgery. Photo: Zute Lightfoot.

A few days following his surgery, Shijun returned to his grandparents’ home where family and neighbours were thrilled to see how much of a difference one surgery can make.

There were weeks filled with happiness among his family and friends. But a tragic accident halted all celebrations when Shijun fell and broke his leg, delaying his cleft palate surgery.

Paidong shared with us that he works hard to earn enough money to pay for the surgeries Shijun needs to recover from the compound fracture.

But he’s grateful to Operation Smile China and its devoted community of volunteers who took care of his son. Paidong knows that when it’s time, he will not have the financial burden of also paying for Shijun’s cleft palate surgery.

Looking at Shijun today, it’s difficult to tell that he once had a cleft lip.

Operation Smile is committed to providing patients with health that lasts – we look forward to providing Shijun with the additional surgery he needs for his cleft palate and any other essential treatments he needs to live a happier and healthier life.

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

boy smiling after cleft surgery
Shijun smiles wide one year after surgery. Photo: Zute Lightfoot.

A Second Chance at a New Smile

woman holding baby with a cleft lip
Seven-month-old Mohamed with his mum, Benjebi. 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.

Holding her 3-week-old child in her arms, Benjebi tried to process the news she’d just received: Her son, Mohamed, was too young to receive cleft surgery.

After travelling more than 370 miles to attend an Operation Smile Morocco surgical programme in Oujda, Benjebi felt devastated to learn that Mohamed would return home without a new smile.

As thoughts of what Mohamed’s future would be like began racing through her head, Benjebi received news that made her feel hopeful once again.

The volunteer medical team told her that an upcoming Operation Smile Morocco mission was scheduled to take place in Dakhla six months later.

Benjebi clung to her renewed hope on their long journey back home. In six months, Mohamed would be old enough for surgery.

Remembering back to the day she gave birth, Benjebi never imagined she would have a child with a cleft lip. Unaware that this condition affected so many people, Benjebi felt isolated seeing her baby for the first time.

baby with cleft lip
Mohamed, before surgery. Photo: Margherita Mirabella.

After Mohamed’s birth, Benjebi became anxious as she watched her husband, Hamid, intensely stare at their new baby boy. She worried he wouldn’t accept their son because of his cleft condition.

But that was not the case.

Hamid loved his son, but he was confused by his son’s condition. It was like nothing he had ever seen before. Calming his wife’s fears, Hamid reassured Benjebi that he loved Mohamed and would always love him despite his cleft lip.

Sadly, their families did not show the same support.

Lacking access to education on the potential causes of cleft conditions, which can be environmental, hereditary or a combination of both factors, Benjebi and Hamid’s families blamed Benjebi.

They believed that Mohamed’s cleft condition was caused by Benjebi looking at a bad spirit during her pregnancy.

Despite the hurtful comments from family members, Hamid and Benjebi knew that nothing anyone said could diminish the love they both had for Mohamed.

This unconditional devotion motivated Benjebi and Hamid to overcome any obstacle that threatened to stand in the way of Mohamed receiving the smile he deserved.

In the months that followed their first attempt at getting Mohamed surgery in Oujda, Benjebi worked tirelessly to ensure that he would be healthy enough for surgery when the mission in Dakhla arrived.

As she boarded the bus that Operation Smile Morocco provided to transport families on the 32-hour journey to Dakhla, Benjebi hoped that her commitment to Mohamed’s health had paid off.

Surrounded by hundreds of families who’d also travelled to the surgical mission with hopes of their child receiving a new smile, Benjebi felt connected to the other mothers of children born with cleft conditions.

It felt as though for the first time, she wasn’t alone.

dentist smiling at baby with cleft lip
During Operation Smile Morocco's 2015 surgical mission in Dakhla, volunteer dentist Dr. Lo Hanane of Morocco examines Mohamed during the screening process. Photo: Margherita Mirabella.

Each patient underwent a comprehensive medical evaluation to ensure that they were healthy enough to receive surgery.

After Mohamed was examined by our volunteer paediatricians, dentists, anaesthesiologists and other medical professionals, Benjebi cried tears of joy when the team told her the words she’d been waiting to hear since first learning about Operation Smile Morocco: Mohamed was healthy enough to receive surgery.

smiling boy with repaired cleft lip
Mohamed, one year after surgery. Photo: Margherita Mirabella.

The following day, upon laying eyes on her son for the first time after surgery, Benjebi said it was as if Mohamed had been reborn. She took photos of her son and sent them to Hamid, who could not believe his son’s transformation and was eager to see Mohamed in person.

“I would like to thank Operation Smile for everything,” Benjebi said. “I want to encourage all doctors to volunteer and help the mothers who need help.”

When they returned home, many people from their community came to see Mohamed and share in the family’s celebration.

With Mohamed potentially being too young to remember his life before surgery, Hamid and Benjebi hope he will grow up happy and have the confidence to chase after his dreams without fear of the harmful treatment they once endured.

smiling boy with repaired cleft lip
Mohamed, 5 years old. Photo: Lorenzo Monacelli.

We caught up with Mohamed and his family again three years later. He is now in school and enjoys singing and playing ball.

Today, Mohamed is living a life that’s no longer defined by his cleft condition.

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

smiling boy holding a photo of himself before cleft surgery
Photo: Lorenzo Monacelli.

A Chance Encounter Brings Tiyamjane a New Smile

woman with a cleft lip
Eighteen-year-old Tiyamjane, before surgery. 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.

Growing up with a cleft lip in a rural village in Malawi, Tiyamjane fought – and overcame – many struggles throughout her life.

Some of the unthinkable challenges she experienced, including the death of both her parents at a young age, drew sympathy and compassion from those closest to her. While other hardships, like the burden of living 18 years with an unrepaired cleft condition, resulted in painful stigma, unfair treatment and being shamed by people in her community.

Enduring torment, teasing and name-calling because of her cleft condition not only made Tiyamjane sad, but she also felt angry. She was angry that she was being bullied solely based on her appearance. Lacking awareness of organisations like Operation Smile Malawi, Tiyamjane believed that there was nothing she could do to change how she looked or how people treated her.

To avoid the harassment, Tiyamjane decided to leave school at 11 years old and settle into life living with one of her sisters and working on their farm.

Every day for 18 years, she carried the weight of believing her cleft lip – and the pain and anger that came with it – was permanent.

woman with cleft lip
Photo: Jasmin Shah.

For Tiyamjane, living with a cleft lip was isolating, and she often felt alone. But cleft conditions affect more people than she ever realised: Worldwide, it’s estimated that every three minutes a child is born with a cleft condition.

Believing that she was the only person born with a cleft condition, Tiyamjane’s mindset pivoted instantly after seeing the cleft lip of a close friend’s newborn baby. Unlike Tiyamjane’s parents, her friend learned about Operation Smile Malawi and the possibility of surgery shortly after giving birth. After living her entire life with a cleft condition, Tiyamjane was shocked to discover that the solution she never knew existed was suddenly within reach.

Once learning the details of an upcoming surgical programme in Blantyre, it wasn’t long before Tiyamjane, her sister, her friend and baby set off together to travel by bus to the mission site. As she made the journey, Tiyamjane was hopeful a brighter future lay ahead and that she could live the rest of her life free from the pain of her cleft condition.

Even after arriving at the mission site, the surprises continued to follow: Tiyamjane couldn’t believe the number of adults and children she saw during screening who also had a cleft condition. After passing her comprehensive health evaluation, Tiyamjane was deemed healthy enough for surgery by a team of medical volunteers. Though Tiyamjane was nervous on the day of her long-awaited surgery, she bravely walked through the doors of the operating room and toward a brighter future.

smiling woman after cleft surgery
Tiyamjane, after surgery. Photo: Jasmin Shah.

The moment that Tiyamjane saw her new smile, she knew in her heart that her life had permanently changed. This newfound feeling of happiness deepened further when she returned home and received a warm welcome from the community that once mistreated her.

“I am always happy now,” Tiyamjane explained when Operation Smile Malawi volunteers visited her village a few months after her surgery. “Thank you for everything you did for me. Please continue to help others like you helped me.”

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

woman smiling holding a photo of herself before cleft surgery
Photo: Jasmin Shah.

The Sounds of Small Victories: Q&A with Phonoaudiologist Olga Sarmiento

Operation Smile Colombia volunteer phonoaudiologist Olga Sarmiento. Photo: Jasmin Shah.

Through creating speech therapy programmes that are structured around each child’s individual communications needs, volunteer phonoaudiologist Olga Sarmiento ensures patients are given every opportunity to thrive in life long after leaving her care.  

After meeting and studying with a phonoaudiologist during college, Olga was introduced to the world of Operation Smile Colombia when she was invited to join the organisation in Duitama. While initially hesitant, Olga realised that by providing speech therapy, she could directly impact the lives of children who are living with cleft conditions in the country.

“I accompanied her to work as a volunteer and began doing hearing exams. After that, a position opened. I was available, my resume was accepted and they called me,” Olga said. “It’s been nine years, and I feel like it’s been a month.”

When patients are living with a cleft palate – and even after a palate repair – they can experience difficulties with speaking clearly. Working as a phonoaudiologist at Operation Smile Colombia’s care centre in Bogota, Olga specialises in identifying those challenges, understanding the stages of communication development and providing specific skills and techniques that her patients require.

Whether it’s hearing, comprehension or the pronunciation of words, Olga works to prevent disruptions in a patient’s progress while also improve their abilities during the early stages of growth.

For Olga, the small moments with her patients are what motivate her to continue working with Operation Smile Colombia.

“A simple ‘sss,’ or simply making a ‘p’ – I know that if the child can do that, they can use it for life,” she said.

We recently sat down with Olga to learn more about how her role serves as a vital part to comprehensive care and how reaching children at the ideal developmental stage makes a big difference.

Photo: Rohanna Mertens.

Q: What motivated you to become a volunteer?

A: “The expectations of what I would be able to do, not having a point of reference of what I would encounter. Because really what I have learned from the children, the closeness I have been able to have with them has been incredible and my work fascinates me.”

Q: In your own words, why it is so important for patients to receive all of the multidisciplinary services here, including speech therapy?

A: “Our goal is that the children live each stage the same as children without a cleft condition. If they come here (Operation Smile Colombia), they achieve that.”

Q: What is special and different about working with children with a cleft in comparison to working with children with other speech difficulties?

A: “It’s more difficult. You really don’t know what you’re up against. So, it’s difficult, but at the same time it’s lovely – the sounds. When you don’t know what you’re hearing and don’t know how much the patient is improving. For me, when I’m talking to fathers and mothers around the world, they think that once the palate is closed, the baby will speak perfectly well. That’s not true. Therapy is also necessary.”

Photo: Rohanna Mertens.

Q: What is the dynamic of working with all the other specialties in the foundation and working together for each individual child?

A: “I consider the key to making it work is the respect for the other areas. I know that you’re the expert in that area, and I respect your procedure and your process as you go along. Personally, I’m very involved, and I’m aware of why they do this in this specialty. I’m always informed of the protocol that each specialty follows to inform the parents of the different areas so they don’t feel like there are so many pieces, but see a sequential order.

“That allows us to work. Let’s say that each area has its focal point where it’s the protagonist and other areas where it’s another professional, but the dynamics are that. We haven’t had such complex cases where we’ve had to meet to determine what’s best, because all the little ones go along with their respective process within each area, and each one has its objectives. When one goal implies or affects or improves another, then we meet and talk in a very informal way like, ‘Hello, this patient, I think … what do you think?’ We agree, and that’s how it works.”

Q: For the parents who come in, do they respond well and follow the specific programmes you provide their children at home? Do you notice the difference when the child comes in?

A: “If they have a goal for what they hope for their children, and that goal is perfection, they work it. If they aren’t clear with which way they are going, they don’t work on it because they don’t see the results that they want. But those who have their eyes and ears open, they do see the small gains. They get excited and work diligently at home. The clarity about what they have to do, that also motivates them.”

Q: How do you feel when a child graduates from the programme?

A: “I feel satisfaction immediately. During the consultation, with each sound that I know would never have happened in the child’s life, thanks to my help, they were able to achieve that. So, the child isn’t talking well but has now made a new sound, that fulfils me.

“With that, I’m happy because I know that from session to session, the child will be demonstrating this. And some day, not too far ahead, we will be getting to the graduation. I make a big deal for the child and their parents. I get so excited, and it’s not even my child.”

Operation Smile Colombia volunteer phonoaudiologist Olga Sarmiento works with a young patient at the Operation Smile Colombia care centre in Bogotá, Colombia. Photo: Jasmin Shah.

Persevering through uncertainty, tragedy and the unexpected

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.

Throughout the COVID-19 pandemic, health systems in developed countries were pushed to their limits while the healthcare inequities in low- and middle-income countries became further exposed. 

The communities that were already vulnerable were hit hardest by the virus. Access to help was limited, personal protective equipment was scarce, and the already-restricted capacity of healthcare systems were overwhelmed with patients.

But, throughout these times of uncertainty and fear arose stories of people around the world who, despite all odds, found a way to persevere in the face of so much adversity.

Lilia and her mom, Valeria, moments after receiving their COVID-19 test during Operation Smile Mexico's 2021 surgical programme in Puebla. Photo: Henry Cuicas.

As a 27-year-old nursery school teacher, Valeria’s entire world was turned upside down when the pandemic forced the closure of schools across Mexico.

Expecting the birth of her first child, Valeria suddenly found herself without a job and without financial means to help support her family.

While still attempting to navigate through those challenges, Valeria was once again faced with the unexpected.

“When I was eight months pregnant, they told me,” Valeria explained. “It was clear that she had a cleft lip on the right side.”

Photo: Henry Cuicas.

Though consumed with a mixture of shock and guilt, Valeria and her husband, Daniel, refused to give up and soon began preparing for their daughter Lilia’s birth.

Sadly, Daniel would never get the chance to meet his daughter. He tragically passed away just before Lilia was born.

“If my husband were here, I would tell him that we will come out of this together, that we stand by my daughter, that we need to be strong,” Valeria said. “When I had her in my belly, he used to say that she is daddy’s princess.”

It took all of Valeria’s strength to persevere through the seemingly endless list of hardships that she faced, but she was determined to overcome any obstacle for Lilia, who would be born soon.

“I had to give it all for my daughter,” Valeria said.

The local hospital’s COVID-19 restrictions prevented visitors from being in the delivery room.

So, when it was time to deliver her baby, Valeria was alone.

Although Valeria knew that her daughter would be born with a cleft condition, she was still in shock when she saw Lilia’s smile for the first time.

Initially, Valeria blamed herself for Lilia’s cleft condition. Questions and doubt swarmed her thoughts. Had she not taken proper care of herself? Maybe it was something she ate.  

Valeria knew that Lilia would need surgery to repair her cleft condition, but since she was born in the peak of the pandemic in June 2020, many medical procedures, including cleft surgeries, were on hold in Mexico for the foreseeable future.

What Valeria wanted most was to give Lilia a happy life; however, with the challenges of the pandemic, her dream for her daughter seemed out of reach.

Photo: Henry Cuicas.

But soon, with the help of her sister, Valeria discovered Operation Smile Mexico.

It was after connecting with the organisation that Valeria not only learned she wasn’t at fault for her daughter’s cleft lip, but that the local volunteer team would provide Lilia with ongoing comprehensive care until it was safe to resume surgeries.

Due to Lilia being born with a cleft lip and palate, feeding was an exceptionally difficult task during her first month of life.

Dr. Daniel Zunzunegui, a volunteer dentist for Operation Smile Mexico, fit Lilia with a feeding plate. Molded to the roof of a baby’s mouth, the plates serve as a first step toward surgery, leading patients like Lilia away from starvation and malnutrition.

Learning that Lilia wouldn’t have to live with her cleft condition motivated Valeria. From her first appointment with Operation Smile Mexico, Valeria knew this organisation would support her and her daughter.

After months of Valeria feeling alone and discouraged, the Operation Smile Mexico team offered safety, hope and stability in her pursuit of surgery for Lilia.

While the pandemic made it temporarily unsafe to provide surgery, the local team in Mexico worked tirelessly to provide care, including speech therapy, throughout the pandemic and began seeing patients on a limited scale toward the end of 2020.

“Virtual speech therapies are a tool we had to develop due to the pandemic to reach the patients who need these therapies,” said Elidé Romero, Operation Smile Mexico volunteer speech therapist.

Lilia with Operation Smile Mexico volunteer speech therapist Elidé Romero during screening day. Photo: Henry Cuicas.

For patients like Lilia who are born with a cleft lip and palate, speech therapy before and after surgery is a vital component of comprehensive care. Even before they begin to form words.

Speech therapists provide children like Lilia with palate-strengthening exercises and techniques to help improve the surgical outcome.

But the work before surgery is just as important as receiving continuous care afterward. Their ongoing speech therapy care helps patients speak more clearly as they grow.

“(Lilia’s) main improvements include, one, reducing the risk of having a development gap,” Elidé said. “On the other hand, we teach mums how to interact with their babies in a way that’s enriching for the babies’ speech and complete development.”

Valeria made sure that Lilia never missed an appointment or therapy session.

“The speech therapy support is very impressive. My daughter has progressed well,” Valeria said. “I have seen a change in my daughter during the therapies. She does many little things like babbling, moving around, screaming, playing. Things she almost didn’t do at all before.

“She no longer has the sadness she felt at the beginning.”

Photo: Henry Cuicas.

As the world began to adjust to the new reality posed by COVID-19, Operation Smile Mexico began to resume surgical programmes.

When it became safe to do so, volunteers resumed delivering surgery to families like Valeria’s who hadn’t been able to access the timely surgical care they needed and deserved.

With strict COVID-19 protocols in place to ensure the safety of all volunteers, staff and patients, Operation Smile Mexico hosted a surgical mission in Puebla in March 2021.

“When I saw the other families with their babies with cleft conditions, I thought, ‘I’m not the only one. There are more families besides me.’”

After a comprehensive medical evaluation, Valeria was told that 9-month-old Lilia would be receiving surgery the next day.

“Honestly, I didn’t expect it,” Valeria said with tears in her eyes. “I thank God because I asked for it a lot. I have gone through a lot since my daughter was born.”

Valeria kisses Lilia once more before the medial team takes Lilia into the operating room where she will receive her free cleft surgery. Photo: Henry Cuicas.

Having a child with a cleft condition is often a scary experience – especially for a first-time parent.

This fear was compounded for Valeria because she was going through this experience in the midst of a global pandemic.

But, despite the obstacles, setbacks and tragedy of losing her husband, Valeria did everything possible to make sure her daughter would receive the cleft care that she deserved.

Lilia successfully received surgery to repair her cleft lip, but her cleft care journey is still ongoing.

Valeria reunites with Lilia moments after her successful surgery. Photo: Henry Cuicas.

She will need continued speech therapy and another surgery to repair her cleft palate.

Operation Smile Mexico is committed to providing Lilia and Valeria with health that lasts and can’t wait to see how Lilia progresses as she continues to grow.

Photo: Henry Cuicas.

The love Valeria has for her daughter gave her the strength to make incredible sacrifices. Due to her determination and perseverance, Lilia will have a happier and healthier life.

“I will always be there for her, and I will always fight for my daughter,” Valeria said. “No matter what I have to do for her, I will always be there for Lilia. She will always be my child.”

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

Lilia, after surgery. Photo: Henry Cuicas.

A family’s journey towards healing

Eight-month-old Annika with her mum, Justina. 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.

Rather than having feelings of joy and relief, the birth of her daughter led to some of the most frightening moments of Justina’s life. 

Seconds after being born, Annika needed immediate mouth-to-mouth resuscitation.

After watching her daughter spend two weeks being fed with a feeding tube in the hospital’s intensive care unit in La Paz, Bolivia, Justina no longer knew what to do or who to believe.

The weeks after Annika was born were filled with a whirlwind of emotions and inconsistent opinions from medical professionals.

One doctor told Justina that her baby would be a child with special needs. Another said that Annika was sick.

But the reality was that Annika was born with a cleft condition.

Photo: Margherita Mirabella.

For Justina, it seemed like a lifetime ago that she was enjoying the happy memories of finding out she was pregnant. She believed she was starting menopause at 37 years old when, much to her surprise, she was actually expecting her third child.

Those nine months waiting for Annika to arrive were filled with joy and anticipation for the entire family.

When that day finally came, Justina’s happiness and excitement were replaced with sadness.

Diagnosed with postnatal depression, Justina felt devastated at the thought of Annika not being able to live the life her daughter deserved because of the cleft condition. She often cried, wondering if it would’ve been better if Annika had died, and at times, she wanted to die herself.

But with the support of her husband, Asencio, two older daughters and the help of her therapist, Justina found the strength she needed to persevere for herself and for Annika.

More importantly, she realised that Annika was just like any other child beyond her cleft condition. With a resolve to do everything in her power to provide a good life for her family, Justina turned her all of her focus toward getting her daughter the care she needed to repair her cleft condition.

At the school of one of Justina’s older daughters, a teacher heard that Annika was born with a cleft condition and told Justina about Operation Smile Bolivia.

The teacher explained the organisation’s mission of providing free life-changing cleft repair surgeries to those who need it most. Initially, Justina thought the idea of free surgery was too good to be true, but she soon realised that this was the solution for which she’d been searching.

With a new sense of calm, Justina contacted Operation Smile Bolivia.

From that moment on, everything began to look different for Justina and her family. Finally, there was hope for Annika’s future.

The family attended a pre-mission screening the week before the medical programme was set to take place. Annika was seen by a surgeon and anaesthesiologist who gave her a comprehensive medical evaluation to ensure that she was healthy enough for surgery.

For the first time, Justina didn’t feel so alone.

Annika was approved for surgery in Santa Cruz – 18 hours away from their home in La Paz.

While she was thrilled that Annika was cleared for surgery, Justina began to worry about how she would afford the cost of transportation to the Santa Cruz mission site.

It was soon after that Operation Smile Bolivia informed her that all transportation fees came at no cost for patients and families.

With bus tickets and travel supplies in-hand, Justina, Annika and many more families boarded the bus for the long trip.

Justina, Annika and many other families wait with hopes that their child will receive life-changing surgery during a 2018 Operation Smile surgical programme in Bolivia. Photo: Margherita Mirabella.

Once in Santa Cruz, the families staying at the patient centre were taken to the zoo for a day of fun before surgeries began. For many, this was the first time leaving their communities. The fun activity hoped to ease the stress and anxiety of being in an unfamiliar environment.

“Everything is wonderful – the care, the shelter, the trip to the zoo,” Justina said. “Everyone is so warm and kind.”

Justina remembers the day of Annika’s surgery as one filled with many nerves. But she also can’t forget the joy of seeing her daughter for the first time in the recovery room.

Volunteer pre- and post-operative nurse Asa Ostberg of Sweden checks on how Annika is feeling after her surgery. Photo: Margherita Mirabella.

Justina and her family had endured so much since Annika’s birth. But the conflicting doctors’ diagnoses, hospital visits and feelings of uncertainty were all left in the past as Justina held her daughter in her arms.

Annika, after surgery. Photo: Margherita Mirabella.

After a few days of recovering, an overjoyed Justina and Annika boarded the bus for a long journey home.

With Annika’s cleft condition repaired and her health in good standing, her family could finally begin living their lives without fear, doubt and uncertainty.

“I’m never going to stop thanking Operation Smile and God,” Justina said.

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

Annika seven months after surgery. Photo: Margherita Mirabella.