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

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.

Today’s training, tomorrow’s solutions

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.

Rwanda faces dire challenges when it comes to the number and skill of its healthcare professionals: Only two reconstructive plastic surgeons and 18 anaesthesiologists serve the country of nearly 12 million people.

And the need extends far beyond cleft conditions. In Rwanda, much of the surgical demand results from trauma and burn wounds. The lack of adequately trained surgeons forces some patients to wait for years before they’re able to receive treatment, which worsens their conditions and further burdens the health system.

However, Operation Smile is helping to alleviate this needless suffering by empowering local healthcare workers with training and education.

Starting in 2015, Operation Smile has partnered with the University of Rwanda, Partners In Health and the Rwandan Ministry of Health to host twice-annual surgical training rotations. Now the organisation’s primary focus in the country, the rotations became formalised after a series of international medical missions conducted from 2010 through 2015.

Since then, more than 25 Rwandan general surgery residents have received hands-on training and education through the rotations.

Dr. Faustin Ntirenganya, the head of the surgery department at the University of Rwanda. Photo: Margherita Mirabella.

Dr. Faustin Ntirenganya, head of the surgery department at the University of Rwanda and one of the country’s two plastic surgeons, said: “Don’t fish for us, teach us how to fish — I like that approach. I used to be involved in cleft surgeries and missions with people coming from abroad. The old way of doing business was to come, operate and go. Then I heard Operation Smile was looking at something more sustainable, which meant coming to train residents.”

Dr. Steve Naum, an Operation Smile volunteer surgeon who’s helped spearhead the development of the rotations, said: “We have witnessed some of the graduated residents going out into the district hospitals and continuing to do reconstructive procedures for wounds and burn patients. This is evidence that their experience with Dr. Faustin and with us has given them the training, confidence and interest to continue practicing reconstructive procedures as general surgeons in the community.”

Dr. Steve Naum, Operation Smile volunteer surgeon educator. Photo: Margherita Mirabella.

The rotations have also strengthened the skills of residents in anaesthesiology, another area of massive need in Rwanda, with five graduates completing the programme since its inception.

According to Dr. Paulin Banguti, director of the postgraduate anaesthesia programme at the University of Rwanda, that number represents the initial surge of a new wave of future Rwandan anaesthesiologists. He hopes to have 60 active anaesthesiologists practicing in the country by 2024.

“We have 30 residents in the (University of Rwanda) programme now with a commitment to recruit between 10 to 15 new residents per year,” Paulin said. “Starting in August 2019, we will be producing an average of eight to 10 anaesthesiologists per year. This brings us very close to our goal.”

Dr. Paulin Banguti, director of the postgraduate anaesthesia programme at the University of Rwanda. Photo: Margherita Mirabella.

The future of reconstructive plastic surgery in Rwanda is looking brighter than ever.

Through a grant secured by Operation Smile Sweden through the Swedish Postcode Lottery, Operation Smile will help establish the country’s first-ever postgraduate reconstructive plastic surgery certification programme in partnership with the University of Rwanda and Rwanda’s ministries of education and health.

The programme began in September 2019 with its first graduates expected to receive their certifications in 2022.

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

Photo: Margherita Mirabella.

With surgery, a weight was lifted

Zafilahy, 32 years old, before surgery. Photo: Rohanna Mertens.

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

While routine in much of the world, surgery for many people living in low-income countries has misconceptions surrounding it, which can cause some to be fearful when it comes to receiving treatment.

That’s why when Virginie saw her husband, Zafilahy, for the first time after he returned home from his cleft lip operation, she had to be reassured that the doctors hadn’t stolen a part of his body during the procedure.

Instead, what the Operation Smile Madagascar volunteers had given him was a new smile.

Before his surgery, Zafilahy believed that he and the two other people from his community born with cleft conditions would be forced to live with an unrepaired cleft lip for the rest of their lives. None of them learned that a solution existed.

Throughout his life, Zafilahy was often called “Telo Moloha,” which translates to “three lips.”

But he never let the harassment prevent him from living a life of happiness.

During the 32 years he lived with an unrepaired cleft lip, he became a farmer, married the love of his life and had six children. But amid his joy, Zafilahy felt as though something was holding him back.

That was until Fidelis, a patient advocate with Operation Smile Madagascar, arrived in Zafilahy’s village spreading awareness about the non-profit’s work throughout the country.

Fidelis explained that all expenses from the surgery to repair Zafilahy’s cleft lip would be covered by Operation Smile. He felt immense relief because he knew it was a cost he wouldn’t be able to afford otherwise.

Alongside his brother and a large group of families, Zafilahy made the 13-hour bus trip to Antsirabe for the upcoming surgical programme.

It was the first time in 32 years that he’d left the comfort and familiarity of his village.

But Zafilahy wasn’t fearful of the long journey ahead. Instead, he felt eager because he knew something special awaited him at the destination.

Once they arrived, medical volunteers performed a comprehensive healthcare assessment to confirm Zafilahy was healthy enough to undergo anaesthesia.

For Operation Smile, patient safety is the greatest priority. To ensure that they receive the highest quality of medical care, each patient is screened for potential health issues that could impact their procedure or put them at risk.

When he was finally scheduled for surgery, Zafilahy was ecstatic.

A surgery that often lasts as little as 45 minutes changed Zafilahy’s life forever.

Zafilahy, after surgery. Photo: Rohanna Mertens.

Today with his new smile, Zafilahy is very happy and feels as though a weight has been lifted. He couldn’t wait to return home to his family and live a life free from the stigma of a cleft condition.

“Thank you, Operation Smile,” he stated. “Now, I do not worry about my health. I will be a happy man with no more worries.”

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

Photo: Rohanna Mertens.

A link in the chain: Q&A with dentist Dr. Guillermo Cifuentes

Volunteer dentist Dr. Guillermo Cifuentes of Guatemala during screening day at a 2021 Operation Smile medical mission in Guatemala City. Photo: Carlos Rueda.

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 volunteer paediatric dentist, Dr. Guillermo Cifuentes understands the vital role in-person care serves when building trust between himself, his patients and their families.

Though the COVID-19 pandemic temporarily halted Guillermo’s ability to deliver dental care face-to-face, providing virtual services gave him and his fellow volunteers a greater regard of the harsh reality that many patients face when trying to access care in resource-limited communities.

“We can do so much more when being in direct contact with the patients, but remote consultations allowed us to gain a deeper perspective into our patients’ lives,” Guillermo said. “I got to see their humble houses and rooms. Their wooden walls and tin roofs made me more aware of their reality, of the poverty in which they live, and it’s encouraged me to help even more.”

According to Guillermo, not everyone has what it takes to donate their time and expertise as a volunteer for Operation Smile.

“The important thing about volunteering is that it must come from the heart. You can’t force someone to do it,” he said. “What I like the most about volunteering is interacting with the patients and their parents, witnessing their happiness.”

We caught up with Guillermo to learn more about where his passion to volunteer began as well as how adjusting to virtual consultations reinforced why many patients and families depend on the care Operation Smile provides around the world.

One-year-old Lizandro waits to receive his comprehensive health evaluation during an April Operation Smile medical mission that Dr. Guillermo Cifuentes attended in Guatemala. Photo: Carlos Rueda.

Q: Why did you decide to become a volunteer for Operation Smile?

A: “I’ve always liked helping others. It’s something I had as a family. We always carried out some type of social service to help those who needed it the most. When I became a dentist and found out about Operation Smile, I managed to apply my knowledge to help my team and the children who have cleft conditions.

“What I like the most about volunteering is interacting with the patients and their parents, witnessing their happiness and how they change throughout the process that we help them through. And then, after the surgery, seeing the happiness on the parent’s face when their child can smile properly.”

Q: Why is it so important that parents trust the treatment you’re delivering to their children?

A: “It’s of great help when the parents trust the treatments we choose, especially in pre-surgical orthopaedics. It’s very helpful for us when the parents know the procedure and that they know that the pre-surgical orthopaedics helps their child feed better, the development of the arches and the conformation of the nose.

“Babies can feel their parents’ mood. If the mum, mainly, is in doubt, nervous or apprehensive, it will be difficult for the baby to accept the obturator. It’ll take more time. We must notice when this happens to give the mother positive reinforcement and show her she has strength and security to transmit that to the baby.”

Q: How do you feel knowing that you are changing your patients’ lives for the better?

A: “You won’t believe me, but the truth is I don’t think much about the fact that I’m an instrument of change in the lives of these children. It’s not something that I think about often. I just like to come to examine my patients. Of course, deep down, I know I’m contributing, that I’m a link in a chain by doing my job.”

Screening day during an April 2021 medical mission in Guatemala City. Photo: Carlos Rueda.

Q: The COVID-19 pandemic has been very difficult for all of us. You had to start working in a virtual clinic, which is new for you. What has the pandemic taught you about yourself and Operation Smile Guatemala?

A: “The pandemic has taught me how to take care of patients even with the restrictions. It can be frustrating to have remote consultations because we lack that close contact with our patients, which is very much needed. We can do so much more when being in direct contact with the patients, but remote consultations have allowed us to gain a deeper perspective into our patients’ lives and homes.

“During the first calls that we made, I got to see their humble houses and rooms. Their wooden walls and tin roofs made me more aware of their reality, of the poverty in which they live, and it’s encouraged me to help even more. It’s encouraged me to go ahead with the remote consultations because even if I can’t touch them, it’s very valuable for them. They call me and say, ‘Doctor! Good to see you! Doctor, look at how much my baby grew!’

“They’re very happy. They have taught me so much. They lift my spirits and make me understand that those calls are very important, even if we only see each other through a screen.”

Q: You’ve been able to have that physical contact with them again and help your patients in person. How do you feel about being able to go back to the clinic?

A: “The night before going back to the clinic, it was like the day before an exam. I didn’t sleep well because of the excitement. I was expectant. I felt a bit nervous, but at the same time, I was happy. Being able to go to the hospital again was wonderful. It’s a part of me. It’s what I do. My second home. It completes me. I feel like myself again.

“Getting to see the patients, the team of volunteers, and being able to physically evaluate the patients, to see the mother’s eyes while I explain the treatment and its benefits, and how it’s the first step toward surgery.”

Q: Explain to us why it’s so important that children born with cleft conditions receive orthopaedic care?

A: “These kids need to use their obturators. But during the pandemic, those who were already receiving the treatment had to pause it. Those who were born during the pandemic and haven’t yet started the treatment have been losing a lot of weight because it’s difficult for the mums to learn how to feed them on their own. They get very frustrated when they can’t breastfeed their children, giving them formula instead. We must begin or continue the treatments so that we can make sure that the separated segments develop correctly and eventually allow the child to feed properly.

“It’s important that the babies who were already receiving treatment get to continue with the process because their mothers tried to make them use the insert for as long as possible until it didn’t fit anymore. We looked for alternatives. Resuming the treatment means straightening and correcting the position of the segments like we were trying to achieve earlier for some. And for others, it’s about achieving better diction, better pronunciation and learning to breathe through their nose, which is something that they must learn. That’s the important thing.”

Q: Lastly, is there anything you’d like to say to other doctors or members of your specialty about volunteering?

A: “The important thing about volunteering is that it must come from the heart. You can’t force someone to do it. I could tell someone, ‘Come on, help us,’ but if that person lacks the conviction and desire to do it, they won’t be a good volunteer.

“There are lots of people who volunteer and many others who wish to do so. Many professionals have the knowledge and time to dedicate to our young patients, in our case, with their cleft lip or cleft palate. I invite those doctors to volunteer. We would benefit greatly from their knowledge, and our patients would, too. I invite those doctors to come to us, to get more information about Operation Smile Guatemala. I invite them to come here to the hospital, where we can inform them better on how to use their knowledge to help others.”

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

His dream is within reach

Cosmas, 21 years old. Photo: Margherita Mirabella.

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

If any of Cosmas’ 12 brothers and sisters were in need of medical care growing up, the closest health clinic to their home was a 30-minutue walk. As for the closest hospital, that was a three-hour walk.

Not once during any of his regular check-ups to the clinic was Cosmas told that his cleft condition could be repaired with surgery.

Cosmas grew to accept that his cleft as God’s will but was still unhappy. He believed that he’d live with the burden of an unrepaired cleft lip forever. For 21 years, he did.

But on a day that Cosmas expected to be like any other, a friend in his community told him that he wouldn’t have to live the rest of his life with his cleft condition because Operation Smile Malawi had an upcoming medical mission.

Unfortunately, he learned about the upcoming mission too late. Even if he and his dad had the money to pay for travel, they never would’ve reached the mission site in time. But both men refused to give up.

Ganizan, Cosmas’ father, was a 70-year-old subsistence farmer. Cosmas earned a small salary as a farmer, but he also learned that neither he nor his father could pay for surgery through the local hospital.

Cosmas was hopeful that he would receive another opportunity to get safe surgery for free through Operation Smile Malawi.

When Cosmas was 21 years old, Ganizan was determined to find a way to get his son the surgery that he knew would change his life. Walking the three hours it took to reach the district hospital in Dedza, Ganizan sought out more information about the process of getting his son to the next Operation Smile Malawi mission.

He was told to arrive back at the district hospital in August where a bus provided by Operation Smile Malawi would be waiting to take them to Lilongwe at no cost.

After much waiting, the day finally arrived, and Cosmas and his father left their community to begin the long 7-hour trip to the mission site.

After passing his comprehensive health evaluation, Cosmas and his father learn that he's been placed on the surgical schedule during a 2015 Operation Smile Malawi medical mission in Lilongwe. Photo: Margherita Mirabella.

Following their journey, they arrived in Lilongwe, and Cosmas felt at peace seeing others like him. For the first time, he knew that he wasn’t the only one living with a cleft condition.

As many as nine in 10 people around the world can’t access basic, surgical care and can endure years of bullying, social isolation and severe health problems from an untreated cleft condition. For Cosmas, a lack of education and awareness about cleft conditions in his community proved to be a barrier that lasted two decades.

Although he was often teased, all Cosmas wanted growing up was to be treated like everyone else. He had friends and loved to watch soccer and his favourite player, Malawi’s own Fisher Kondowe.

On the verge of undergoing a surgery that he waited on for more than two decades, Cosmas was looking forward to enjoying the activities of his peers without being burdened by his cleft condition.

His experience at the Operation Smile medical mission was much different than life in his community. There was no worry about being harassed or teased. For once in his life, he was around people who accepted him.

“When I go home people will stop making fun of me,” Cosmas said.

He walked into the operating room with confidence, knowing that he’d come out with a completely new smile – he couldn’t wait for the opportunities his future would hold.

Cosmas, one year after his surgery. Photo: Margherita Mirabella.

Ganizan didn’t stop smiling when he saw his son for the first time after surgery.

He had spent 20 years watching his son struggle to come to terms with his cleft condition and now his life is renewed. Both Cosmas and his father gave a big thumbs up when asked if they were satisfied with the surgery.

When he saw his reflection for the first time, he could not believe the change he saw in the mirror.

Since returning home, Cosmas feels like he is now free.

Although he always had friends, he didn’t like to go out in public with them for fear of being teased. Now, he feels excited to go out with friends because nobody stares at him or calls him names.

Interacting with others is something that Cosmas now embraces. He is currently in his first year of high school, and his favourite subject is social studies with dreams of becoming a police officer.

“I am very happy and thankful to Operation Smile, and I hope they will keep helping others,” Cosmas said.

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

Photo: Margherita Mirabella.

Connection Through Storytelling: Q&A with Volunteer Alison Smyth

Alison during a post-op follow-up in 2013. She embraces Jheleen, right, and Andrea, left. Operation Smile photo.

While many people may not know Alison Smyth, her impact on Operation Smile’s mission can be felt in nearly every patient story seen on our social media and website.

Through her volunteer work as Operation Smile’s assistant production manager, Alison has attended a total of 109 international trips with Operation Smile: 74 medical missions, 32 follow-up trips and three film productions.

Her journey with Operation Smile began while she was living in Lima, Peru, in 1999, when Alison volunteered as a translator in support of a medical mission.

“Like so many Operation Smile volunteers, I was hooked from the very beginning,” Alison recalled.

Over the years, her position in the organisation has transitioned into an integral part of our storytelling.

Connecting with patients face to face to learn how surgery transformed their lives allows Alison to see first-hand the change Operation Smile brings to the lives of families around the world. While interviewing patients and families is one of her major responsibilities, the work she does has a much greater impact.

During a 2012 medical mission in the Philippines, Alison embraces the family of Jan, a young patient who received surgery. Photo: Marc Ascher.

Families welcome Alison into their homes and see her as a friend and someone who they can trust.

Visiting them can include 15-hour car trips, long walks through the countryside and trekking through rice paddies. But no matter how the long journey is, Alison shares that it’s worth every mile to see the joy on the faces of families whose lives we have touched.

“In my work, I have seen so many instances where a child, the siblings and family members are shunned, teased, and ostracised from the community,” Alison explained. “Mothers who, before surgery, do not take their child out into the community in order to avoid the questions, the blame, the teasing.

“After surgery, many mothers say the biggest change in their life is that they can go out with their child and their child is like all the other children.”

We’re grateful for Alison’s compassion and devotion because we’re witness to the stories she’s helped bring to life.

“Quite simply, I love my work,” Alison said. “And I’m fortunate that I’m able to volunteer full-time. What inspires me? Our families – telling their stories and raising awareness for Operation Smile.”

We sat down with Alison to learn more about her work with Operation Smile throughout the years as well as hear her favorite stories from her time in the field.

Seven-year-old Sarban with Alison as they walk hand in hand through his community during a 2012 home visit after his surgery. Photo: Jasmin Shah.

Q: What is your favorite aspect of your work with Operation Smile?

A: “Being out in the field and meeting and learning about the families’ lives, hopes and fears for their child. The time at the mission and going through surgery and recovery is filled with anxiety for the parents, and even though they are happy post-surgery, they still worry about how they will care for their child through the recovery process. Probably my most favorite aspect is when I return to the country six months to a year later and meet the families, babies, children, adults again and learn how the surgery has restored dignity to the family and learn of the hopes they now have for their child’s future.”

Q: You’ve been a volunteer with Operation Smile for more than 20 years. What inspires you to continue volunteering full time?

A: “Over the years, I have seen how our in-country foundations have, through their work and education, reduced the stigma of living with a cleft condition. To hear mothers say that they learned about Operation Smile at birth or, in some cases, during the pre-natal ultrasound is an enormous step forward. For a mother to know that there is a solution is life changing.

“Mothers that come to a centre with their baby say that the experience is very positive because, at the centre, they meet other mothers like them and are able to share experiences with them. A number say that the centre is like their second family. Knowing that in some small way I can be part of the team that is instrumental in making a difference is what motivates me to continue to travel many, many weeks a year (at least before COVID-19 and hopefully again in the not-too-distant future).”

One day after surgery, Alison holds 8-month-old Bismata at her home following a 2012 Operation Smile India medical mission. Photo: Jasmin Shah.

Q: Can you tell us something that people would be surprised to learn about the patients you’ve met during your travels?

A: “Not sure if this is surprising, but the trust the families put in the Operation Smile teams is humbling. They trust complete strangers with their child. The fact that they so rarely complain about the many hours they wait or the fact that they may not be scheduled for surgery this time.”

Q: Is there a patient or family story that stands out as most memorable in your time with Operation Smile? What was so powerful about that story?

A: “So many stories! The 56-year-old gentleman in Ghana who was 55 before he learned that surgery was possible. On learning that he was scheduled for surgery he called his wife to tell her to prepare two chickens and buy Fanta because they were going to hold a party when he got home. Two sisters in the Philippines: when I asked the mother what was the most special part of the girls’ surgery day – apart from the surgery itself – she answered hearing the girls say “Mama” properly for the first time. In so many cases the most powerful aspect is that a simple surgery can return dignity to a child, a patient, a family and in some cases a community.

“One of the most memorable answers I received was on asking 66-year-old Qi Xiu what she was looking forward to most after her surgery. Her response was, ‘I am looking forward to taking my grandchildren to school and no one will laugh at me.’

“When we met Qi Xiu a year later, she told us, ‘I love my smile, nobody laughs at me anymore.’”

Alison reconnects with 66-year-old Qi Xiu of China one year after receiving surgery during a 2016 medical mission. Photo: Zute Lightfoot.

Her name is Jane Rose

Jane Rose longed to be called by her name. Writing it repeatedly in her notebook, the spirited 7-year-old hoped that the dream she wrote on paper would eventually come true.

But in reality, she faced almost constant bullying because of her cleft condition from many children in her community who refused to call her anything besides “bungi,” a derogatory word for cleft.

Seven-year-old Jane Rose, before. Photo: Jörgen Hildebrandt.

“My heart breaks every time I hear them bully her. The only way to stop it is to get her cleft lip repaired. They will not stop otherwise,” said Eutigio, Jane Rose’s father.

Jane Rose loves going to school and is very intelligent. She refused to give in to her abusers.

With big dreams of one day becoming a teacher, she felt determined to attend school each day despite the constant bullying.

Jane Rose's father, Eutigio, watches as his daughter completes her homework. Photo: Jörgen Hildebrandt.

Her family lives in a house made of bamboo in Cebu City, Philippines. With no access to electricity or water in their home, Jane Rose and her family share the only nearby well with the many neighbours in the area.

Southeast Asia, including the Philippines, is a region where cleft conditions are more common than the rest of the world – around one in 500 children are born with a cleft condition. The global average is closer to one in 750 births.

Even though there are skilled plastic surgeons in the country – some who volunteer with Operation Smile – most families can’t afford the cost of surgery.

It broke Eutigio’s heart knowing that as a garbage collector, the cost of surgery for Jane Rose was beyond his means.

In the past, he’s tried twice to get his daughter this life-changing surgery for free through other organisations.

But both times, Jane Rose was denied because of health issues.

With each failed attempt, Eutigio’s anxiety and worry for his daughter deepened.

“My biggest fear is that she’ll grow up being bullied all her life,” he said.

Photo: Jörgen Hildebrandt.

It wasn’t until Eutigio learned about Operation Smile Philippines that he believed and hoped their third attempt at surgery would be different.

Upon arriving at the medical mission, Jane Rose and her father felt excited at the thought that this could be the opportunity for which they’ve been waiting.

“I am very happy to be here,” Eutigio said. “There are so many children here with the same problem. I thought it was only our family.”

After the screening process, medical volunteers were thrilled to tell Eutigio the good news.

Operation Smile medical volunteers check Jane Rose's vitals during screening to ensure that she's healthy enough to undergo anaesthesia for her surgery during a 2015 medical mission in Cebu. Photo: Jörgen Hildebrandt.

“I am so happy she passed all the health examinations since this is the third time we’ve tried. I am very happy and very thankful,” Eutigio said.

It was finally time for Jane Rose to receive the surgery she always deserved.

A surgery that can take 45 minutes changed her life forever.

The day after her cleft repair surgery, Jane Rose stared at her new smile in the mirror, not taking her eyes away from what she saw.

“I’m so happy that she looks so beautiful. Thank you!” said Eutigio.

Eutigio sees Jane Rose's new smile for the first time. Photo: Jörgen Hildebrandt.
Photo: Jörgen Hildebrandt.

Years have passed since Jane Rose’s surgery, and so many aspects of her life have changed during that time.

Today, Jane Rose continues to excel in her studies at school. According to her teacher, Jane Rose is very involved and intelligent. She even received a medal for the time she spent studying.

With her newfound confidence after surgery, Jane Rose participated in a school mini pageant and has gained many friends.

But the greatest and most noticeable change is how the children who once bullied her now call her by her real name. At last, she’s living out her dream that once occupied the lines of her notebook.

Jane Rose plays with friends at her home one year after receiving surgery from Operation Smile Philippines. Photo: Jorgen Hildebrandt.

Eutigio hopes that Jane Rose will now be able to follow her dreams, finish school, and become a teacher.

“She will have a better future now,” he said.

Today, nobody bullies or teases her – many have no idea that Jane Rose was born with a cleft lip.

“I am not a ‘bungi’ anymore, I am just beautiful,” Jane Rose said.

Jane Rose, today. Photo: Jörgen Hildebrandt.

Training surgeons: Q&A with Dr. Ravaka Rakotorahalahy

Cleft surgeon Dr. Ravaka Rakotorahalahy of Madagascar. Photo: Lorenzo Monacelli.

In cleft surgeon Dr. Ravaka Rakotorahalahy’s home country of Madagascar, there are many obstacles that prevent patients from getting the surgery they need and deserve.

Before the country was gripped by COVID-19 lockdowns, one of Ravaka’s last patients he served lived with an untreated cleft lip for 19 years.

In many communities, people may not know that surgery can treat cleft lip and cleft palate. While not an emergency condition, cleft surgery is time-sensitive, and often children suffer long-term speech, nutritional and aesthetic complications if they don’t receive surgery early in life. Many people can’t afford to pay for an operation or live very far away from a hospital and lack the means to get there.

Also, some of the most significant barriers to surgical care are the lack of healthcare workers, trained surgeons and physical infrastructure needed to meet the demands of Malagasy people living with cleft conditions.

That’s why Operation Smile is committed to helping patients and their health systems overcome these daunting challenges so that everyone who needs cleft surgery can receive effective treatment as soon in their lives as possible.

Established in 2017 and funded by Stryker, Operation Smile’s Cleft Surgeon Training Programme (CSTP) addresses the fundamental need for more – and more highly trained – surgeons to provide ongoing quality cleft care in their communities.

In addition to rapidly elevating the skills of cleft surgeons in resource-limited settings which lack specialised training opportunities, the programme creates a pathway for candidates to become credentialed Operation Smile medical volunteers.

CSTP candidates are paired with mentors – experienced Operation Smile volunteer surgeons – with whom they train during two to three surgical programmes per year in their home country.

Dr. Ravaka Rakotorahalahy with mentor Dr. Pernille Lindholm of Denmark during a 2019 Operation Smile medical mission in Madagascar. Photo: Rohanna Mertens.

“I quickly discovered that Ravaka had dexterous hands that were precise and steady. His brain was sharp, and he quickly picked up the art of cleft surgery with remarkable attention to detail that cannot be taught. You just have it. And Ravaka had it,” said Dr. David Chong, one of Ravaka’s mentors and chair of the CSTP. “Most of all, I noticed Ravaka’s heart. Filled with compassion and kindness, he was incredibly gentle with patients and families. He loved caring for his people. One of the great highlights of my work with Operation Smile has been to see the wonderful cleft surgeon that Ravaka has become and rejoice for what that means for the people of Madagascar.”

So far, the eight graduates of the CSTP have provided more than 300 cleft surgeries in their communities outside of Operation Smile medical programmes.

Currently, Operation Smile is preparing for a second cohort of CSTP candidate surgeons to start the programme in July 2021. We’re working closely with our teams around the world to identify and designate local educators and partner with local hospitals to provide quality cleft surgery training despite challenges presented by the pandemic.

We recently caught up with Ravaka, a recent CSTP graduate, about his experience in this unique training programme and how its empowering him to deliver world-class cleft care in a place of dire need.

Cleft surgeons Drs. Irene Tangco of the Philippines, left, and Ravaka Rakotorahalahy of Madagascar repair the cleft lip of 14-year-old Irongany during a 2018 Operation Smile Madagascar medical mission in Antsirabe. Photo: Rohanna Mertens.

Q: What inspired you to pursue a career in cleft surgery?

A: “Since I was a student, I was a fan of surgery. In general surgery training, I realised that I am quite comfortable in soft surgery. Then, I had the opportunity to learn about Operation Smile when I was in Antsirabe. I participated and loved it so much.”

Q: Could you describe the need for more trained cleft surgeons in Madagascar? What are some of the challenges that young medical professionals can face as they pursue their specialty?

A: “In Madagascar, there are many cases of cleft lip and cleft palate, so it is really essential to have more well-trained surgeons in this specialty. There are fewer cleft surgeons in Madagascar because this specialty is not offered during residency. Here, paediatric surgeons and maxillofacial surgeons are trained for cleft lip and cleft palate surgery.”

Q: How did you learn about the opportunity to participate in the CSTP? What were your initial thoughts when you learned about the programme?

A: “When I was in Antsirabe as assistant surgeon in the surgery field, Operation Smile carried out a medical mission in our hospital. Then, Dr. Romain Raherison, a paediatric surgeon who already worked with Operation Smile, asked me if I was interested in joining the organisation. Without hesitation, I accepted … He introduced me to country manager Mamy Ramamonjisoa, and since then I was there as an observer. After two missions, I was asked to join the CSTP.

“When I was informed about this programme, I was really happy to be among the participants. There, I said to myself that I will develop my knowledge, my skills and experiences. Once I am able to operate, I will help my compatriots who suffer from cleft lip and cleft palate.”

Q: Has the CSTP provided you with training and education that you may have otherwise not received?

A: “Certainly, the CSTP provided me an exceptional training and education. Maybe I could access training like that in another country, but I would never have the financial capacity.”

Cleft surgeons Drs. Ravaka Rakotorahalahy of Madagascar, left, Luca Autelitano of Italy, centre, and speech pathologist Angela Rezzonico of Italy examine a patient during a 2019 Operation Smile Madagascar medical mission in Antsirabe. Photo: Margherita Mirabella.

Q: Who were your CSTP mentors? Could you tell us more about your relationship with them and how they worked with you?

A: “My mentors are Drs. El Hassan Boukind (Morocco), Christie Smit (South Africa), Beto Herrera Ruelas, Desi Mwepu (Democratic Republic of the Congo), Irene Tangco (Philippines), David Chong (Australia), and Pernille Lindholm (Denmark).

“With my mentors, we got along well. They shared with me their techniques, some tips and even the way of life for a plastic surgeon. Everyone has their own pedagogy, but it is not difficult to adapt. They have become both friends and family to me. I will never forget them.”

Q: What are the skills that you feel the programme helped you most improve?

A: “The CSTP helped me a lot in terms of precision and accuracy. My mentors taught me the principle of flaps and suturing techniques in plastic surgery and to have soft hands with each gesture. In short, the CSTP also helped me develop skills in general surgery because, currently, I practice them in every operation.”

Drs. Briand Michel Rakotomanga, left, and Ravaka Rakotorahalahy, third from the left, observe as cleft surgeon Dr. Lora Mae de Guzman of the Philippines operates and Hasina Ramiakajoto, right, translates as part of the Cleft Surgeon Training Programme. Photo: Rohanna Mertens.

Q: Could you share one of your most powerful or poignant experiences with a patient/family while training? After graduation?

A: “When I graduated, during the last mission before COVID-19 lockdowns in February 2020 in Antsirabe, I had a case of incomplete bilateral cleft lip in a 19-year-old girl from Mananjary in the southeast of Madagascar who had a lot of difficulty in her social life and in her studies. I operated on her cleft lip while she was under local anaesthesia (older patients can received cleft lip surgery with an anaesthetic injected at the surgical site, similar to how anaesthetics are used for dental procedures). She was very good during the operation; I always spoke to her throughout the operation.

“When we were done, she was really happy when I showed her a photo of her new smile. She couldn’t smile right away, but her tears flowed when seeing her photo. The next day, I saw her, she insisted on taking a picture with me. Six months after, Operation Smile decided to do mobile post-operative checks, and I was among the team going. I had the opportunity to meet my patient and her family in Mananjary, the result is impeccable. There, I asked her why she was really good during the operation and she replied that she just wanted to have a smile like the others and to be able to live without problems.”

Q: What would you say to another Malagasy surgeon who would be interested in joining the CSTP?

A: “To Malagasy surgeons who wish to join the CSTP, it is a very interesting programme in which we acquire a lot of skills not only in plastic surgery but in all types of surgical management. Good luck and work hard. The Malagasy people are waiting for us and need our support.”

Q: Why are you passionate about practising cleft surgery in Madagascar?

A: “Given the high number of cleft cases in Madagascar, I want to give hope and a smile to the lives of these people … I am very passionate about plastic surgery. God gave me all the assets to do it.”

Cleft surgeon Dr. Ravaka Rakotorahalahy of Madagascar. Photo: Margherita Mirabella.

A long-awaited transformation

Rong Zhen, 57. Photo: Zute Lightfoot.

Looking around, Rong Zhen stared in wonder at the children who surrounded her during a medical mission in Dafang, China.

Part of her felt sorry for them. Undergoing a medical procedure is scary, no matter what age, and many of the children she saw were just a few years old.

But at the same time, she was overjoyed that their families found Operation Smile. It meant that they wouldn’t be forced to grow up and endure the consequences of living with an unrepaired cleft condition, an experience that Rong Zhen was all too familiar with.

Worldwide, it’s estimated that every three minutes, a child is born with a cleft condition. Barriers to care cause many patients in developing countries with cleft conditions to go untreated – patients like Rong Zhen, who lived 57 years with a cleft lip.

Until just a few months before attending an Operation Smile China mission, Rong Zhen never knew that surgery to repair her cleft lip was even a possibility.

She lived every day believing that her cleft lip – and the harmful mistreatment she received from others – was permanent.

Rong Zhen was often laughed at and teased because of her appearance. Finding work was a constant struggle. She suspected that many employers refused to hire her because of her cleft condition.

Despite these challenges, Rong Zhen’s life was filled with family and love. As a mother of three adult children and a grandmother to three grandchildren, she feared that the people she loved most in the world would suffer from the same condition. Fortunately, none of Rong Zhen’s children or grandchildren were born with a cleft condition.

But living with the burden of an unrepaired cleft lip prevented her from being truly happy.

It wasn’t until a village leader told Rong Zhen about Operation Smile China that she learned surgery and a brighter future for herself were possible.

She was amazed at the fact that a global medical organisation was providing these life-changing surgeries for free.

This news changed Rong Zhen’s life. She had never imagined herself with a new smile.

Rong Zhen begins the health screening process during a 2016 Operation Smile China medical mission in Dafang. Photo: Zute Lightfoot.

The mission dates arrived in no time, and she and her husband, Cailong, set out on the two-hour bus ride to Dafang. Their children were overjoyed that soon their mother would have her cleft lip repaired.

When they arrived at the mission site, Rong Zhen and other patients underwent their comprehensive health screenings. This evaluation ensures that each patient is healthy enough to become a candidate for safe surgery – the highest priority for Operation Smile.

The Operation Smile China mission lasted only a few days, but during that time, hundreds of children and adults received surgery that changed their lives forever.

Rong Zhen was among them.

A huge grin appears on Rong Zhen's husband's face when he sees her new smile for the first time after surgery. Photo: Zute Lightfoot.

Rong Zhen’s cleft condition never prevented Cailong from finding his wife beautiful.

Looking at her after surgery, Cailong saw the same woman who he’d been happily married to for the last 34 years. She was still the same person who he loves and the same mother who helped raise their children. But now, there’s one significant difference.

Rong Zhen is finally, truly happy when she looks at her new smile.

Rong Zhen and her husband, Cailong, share a special moment the morning after her surgery. Photo: Zute Lightfoot.

People like Rong Zhen who don’t have access to basic surgical care can endure years of bullying, social isolation and health problems from an untreated cleft condition.

Fortunately, cleft surgery can bring immediate transformation to a patient’s life in as little as 45 minutes.

After a successful surgery, Rong Zhen could not have been happier.

“I love to smile now,” she said. “Thank you Operation Smile. I would never have been able to smile if Operation Smile had not come to Dafang.”

Rong Zhen, after. Photo: Zute Lightfoot.