Assuring the Highest Quality of Care

Volunteer nurse and clinical coordinator Mamta Shah with a patient during a 2017 Operation Smile medical mission. Photo: Anja Ligtenberg.

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

When 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.

As an organisation comprised of compassionate and selfless medical professionals who go above and beyond by donating their time, energy and expertise to our mission, it wasn’t a surprise when some of those volunteers expressed interest in doing more with their volunteerism.

As many volunteers voiced a desire to serve on more medical missions, Operation Smile’s medical quality team created an innovative solution: The team established a position that not only presents volunteers with more opportunities to learn and care for patients, but further strengthens and enhances our safety protocols.

Bryan Zimmerman, Operation Smile Assistant Vice President of Quality Assurance, said that the inspiration behind creating a volunteer quality assurance (QA) officer position was to continue improving upon two of the organisation’s top priorities, the safety of our patients and the quality of their surgical results. QA officers’ evaluations are designed to bolster the knowledge, practices and abilities of our medical volunteers around the world.

“The only way to effectively create a culture of safety and quality is by showing that you care,” Bryan said.

Operation Smile Assistant Vice President of Quality Assurance, Bryan Zimmerman, centre, speaks to a mother and patient during a 2019 medical mission in Antsirabe, Madagascar. Photo: Lorenzo Monacelli.

After creating the curriculum for the QA training programme, Bryan and his team received applications from more than 35 volunteers from countries including Italy, Mexico, the U.K., Australia, Norway, South Africa and the U.S.

Of that total, 11 volunteers participated in and passed the five-day tactical training and education course that took place at Operation Smile Headquarters in November and December of 2019.

Volunteer clinical coordinator Mamta Shah checks the vitals of a patient after surgery. Photo: Anja Lightenberg.
Volunteer clinical coordinator Mamta Shah checks the vitals of a patient after surgery. Photo: Anja Lightenberg.

“Simulation stations were set up that provided opportunities to touch and feel what different parts of the mission are like,” said Mamta Shah, a volunteer nurse, clinical coordinator and QA officer. “The final was a walk through, an actual chart audit and mission audit twice. This was an incredibly valuable experience for volunteers.”

Posing as staff and volunteers, actors intentionally made mistakes and missteps during the mission simulation that the QA officers would be tested to identify. They were assessed during each of the mission phases: screening, pre-operative, anaesthesia, surgery, recovery and post-operative.

For Rodney Kapunan, a volunteer pre- and post-operative nurse with years of mission experience, the QA training instilled in him a new appreciation and respect for all roles and specialties.

“Training was an eye-opener for every one of us, because even though we are seasoned volunteers with more than 10 missions and experienced in our fields, we are now tasked to oversee the processes of the whole mission,” Rodney said.

Photo courtesy of Rodney Kapunan.

“Operation Smile is distinguished for being an association that follows the quality standards established,” said Rosa Sanchez, a volunteer nurse, clinical coordinator and quality assurance officer for Operation Smile Mexico. “We guarantee that patients receive good attention and give the family full security that their kids are in good hands.”

Slated to attend medical missions throughout 2020, the certified QA officers like Rodney and Rosa were ready to step into their new role and empower volunteer teams to continue delivering the highest quality of care possible.

But those plans were upended when the coronavirus pandemic began. Only two officers were able to attend their scheduled missions before Operation Smile’s decision to postpone all international travel.

As one of those two volunteers, Rodney witnessed the medical quality team’s vision come to life.

“There were a lot of great ideas that were brought forward by some volunteers during my last missions in Egypt,” Rodney said. “I reminded them that this organisation is always improving, and I love to hear their suggestions on process improvement and patient safety.”

Adapting to the pandemic, Bryan and his team now deliver online refresher courses that make sure the officers are prepared to reach their highest potential whenever it becomes safe to travel again.

But those courses weren’t the only component to transition online: Two additional QA officers received training and became credentialed through virtual training.

With a new dynamic, Bryan and his team worked diligently to create a virtual QA education course that aligned with the same goals and experiences as the in-person training.

The curriculum included informative presentations, questionnaires addressing specific concerns and a virtual fact-find of a local hospital.

Operating room nurse Amanda Stahlhut during a patient's operation. Photo courtesy of Amanda Stahlhut.

“An opportunity for me to contribute to those great efforts is an honour,” said Amanda Stahlhut, an operating room nurse who underwent the virtual training. “I pledge to not lose momentum or motivation with the current pandemic delays, knowing that this QA programme will transform how quality and safety is viewed and actioned.”

Even some volunteers like Rodney say that they are using their QA officer training to be better prepared for working on the frontline of the COVID-19 pandemic.

“Especially when I’m putting on my personal protective equipment, I always have someone double check if I missed anything,” Rodney said. “I also practice good habits in my practice to better protect myself, my co-workers, patients, guests and family from contracting the virus, thus cultivating a culture of safety.”

The 13 officers, diversified by country as well as specialty, represent a multitude of positions including a surgeon, paediatrician, bio medical technician, two anaesthesiologists and various nursing specialties.

And as committed advocates for safety and care, the QA officers also embody Operation Smile’s unwavering drive to improve and evolve in order to meet the needs of every patient.

“We all make mistakes. We can evaluate our mistakes and see how we can improve on them,” Mamta said. “Increased efficiency and safety leads to better team morale and preparedness, which then leads to improved patient outcomes, improved patient satisfaction and better quality of care.”

Photo: Rohanna Mertens.

Voices From the Frontline: Q&A with Nurse Doreenlove Serwah

Clinical coordinators Doreenlove Serwah, right, and Sally Herman during screening on the first day of an Operation Smile Ghana local mission in 2018. Photo: Zute Lightfoot.

The impact of the coronavirus varies from country to country, but the heroism that nurses like Doreenlove Serwah have while delivering care in their communities is universal.

Prior to the COVID-19 pandemic, Doreenlove safeguarded the success of Operation Smile medical missions in Ghana as a volunteer clinical coordinator. Today, she’s serving another vital role as the nursing lead at a local hospital, providing life-saving care to patients as well as educating her team of health workers on the necessary safety protocols that equip them with the skills and knowledge to handle the demands brought on by the virus.

“A lot of our nursing knowledge is now being channelled towards education,” Doreenlove said. “With education comes correcting misconceptions, alleviating anxiety and giving reassurance and general psychosocial counselling.”

As a Ghanaian nurse, Doreenlove relies on the courage and collaboration of her team in addition to her experience with Operation Smile to diligently fight this crisis head-on.

“My country, like many others globally, is facing the COVID-19 pandemic with the necessary urgency required,” Doreenlove said. “It’s a stressful time for everyone, especially healthcare workers, but we’re all doing the best that we can.”

We recently sat down with Doreenlove to hear more about the demands of being a nurse in a resource-limited country like Ghana and what inspires her to continue searching for hope despite the limitations she and her fellow medical professionals are facing.

Photo: Zute Lightfoot.

Q: With the impact of the COVID-19 pandemic, what is the current environment like in Ghana? In what ways have you seen the coronavirus affect families living in your country? 

A: “The current environment is quite tense. Closely watching havoc being created in even better resourced environments and gradually watching our in-country cases rising. Public education on prevention measures have, however, gained grounds, and treatment centres are slowly taking shape in anticipation of surges. I daresay we are cautiously optimistic for the future.

“With the implementation of social distancing protocols nationwide and limited lockdown in some major urban centres, life as we knew it has come to a standstill. Schools are not in session, and a lot of economic income-generating activities have been suspended. In a way, I believe this has caused nuclear families to possibly bond better despite the challenges as they spend more time together, too.”

Q: What has been your role in response to this challenging time? 

A: “As a nurse leader in my unit, I’ve been educating the nurses and other health workers on the need to adhere to the precautionary measures put in place by the World Health Organization to help combat the COVID-19 pandemic. Core topics include infection prevention and control practices such as hand and personal hygiene, proper ways of putting on and taking off personal protective equipment, proper cleaning and decontamination protocols as well as education on social distancing.

“In the managerial aspect, now more than before, is proper stock taking and procurement which is essential in the face of wide spread shortages to eliminate all waste while still ensuring adequate supply at all times. Apart from these, I’ve had to make changes in ward routines as well as prepare the ward in general should we have a COVID-19 suspected case since I work in paediatric emergency and its direct entry for patients without them having to go through all the usual processes.”

Q: What limitations have you and your other medical professionals faced? 

A: “Major limitations we have faced are having fairly little knowledge on the COVID-19 virus, widespread misconceptions, exaggerated fear and panic gripping both general population and health workers alike, and limited resources, especially with regards to personal protective equipment.

“In my country, there are limited testing centres. This means waiting a little longer than usual to receive results on the status of patients. Also, staff strength is sometimes diminished when a staff member has to self-isolate while waiting for results.”

Q: What have you learned from being involved with Operation Smile that’s helped prepare you for responding to COVID-19? 

A: “Involvement with Operation Smile has given me confidence in my leadership abilities, as I have clinically coordinated missions. I believe it has made me a more effective team player.

“The numerous educational sessions I’ve conducted for my nurses before, during and after missions have also given me insight to their general strengths and weaknesses, how to deliver information better, mentor efficiently, motivate adequately and manage better.”

Q: In light of this pandemic, why do you feel it’s so important to recognise nurses and the role they serve in the medical field? 

A: “The pandemic and arising issues make it very apparent the role nurses play. We constitute a large workforce; dare I say the largest proportion in the health sector. We tend to have more interaction time with our patients, and this enables them to gain our trust and communicate more openly with us, allowing for us to counsel, educate and care for them. Our enhanced contact time and skills also allow us to make valuable observations and contributions to their health care planning.”

Q: It’s a very stressful time in your country and around the world right now. How are you doing, personally, with the impact this virus has placed on you?

A: “As a nurse, wife to a doctor and mother of two kids, I’ve had to place the care of my kids in the hands of my mother since my husband and I have to spend extra hours to help in providing services during this crisis. Also, in order not to take chances with the possibility of a cross infection from us to our kids, it has become prudent that they stay away from us for this period. We miss them and the normal family bonding we used to have.”

Q: What motivates you to continue working to provide care during this difficult time in Ghana? 

A: “Just the fact that I’m well prepared by my training and prior experiences, and the fact that society is looking up to me to lead in this difficult time keeps me continuing what I do.

“The population has a lot of respect and expectations of me, and that alone challenges me to deliver.”

Photo: Zute Lightfoot.

A Hands-On Approach to Care

Medical volunteers from Operation Smiles Future of Smiles mission in Durgapur, India, with their names written in Bengali on their arms. The mission featured volunteers from 12 different countries all working together to provide safe surgical care. Photo: Nicholas Nottage.

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

In West Bengal, India, a young boy and his family travelled to a strange place in hopes of receiving a surgery that would change his life.  

Waiting in line for his name to be called, Astik noticed his grandmother, Rutipa, had a nervous expression on her face — and he mirrored it. When he looked ahead, he heard unfamiliar people speaking a language he didn’t understand.

Before he knew it, nurses with stark-white gloved hands were examining his cleft lip.

For Astik and many more patients like him around the world, receiving treatment at an Operation Smile medical mission marks the first time they’ve received care from doctors and nurses.

To make this new experience as comfortable as possible, the medical volunteer team at the site in Durgapur, India, took a hands-on approach: playing with gloves.

And thanks to the support from Ansell, a global healthcare company, there are always plenty in supply at Operation Smile medical missions. With one of its global headquarters in Melbourne, Australia, Ansell is a world leader in providing superior health and safety protection solutions that enhance human wellbeing. The company has partnered with Operation Smile since 2016 and routinely provides protective gloves for medical missions in India and around the world.

Operation Smile volunteer nurse Lora Edwards said this approach is similar to the way child life specialists calm children before surgery by slow exposure to operating equipment through play.

“Before I start working with a patient, I’ll blow up a glove and decorate it,” Lora said. “I turn the gloves into fish, let the child paint the nails or draw faces on the gloves.”

Lora said she does this before she begins touching a patient’s face to help them become more comfortable with the feel of the glove and grow more at ease with the medical process.

Through partnering with Operation Smile, Ansell help create a safer and more protected world by routinely providing gloves for medical missions in India and around the world.

Additionally, Ansell donates gloves to Operation Smile’s cleft centre in Durgapur, where they are stored in the warehouse. The donated gloves are either used at the cleft centre or are distributed to various mission sites across the country. Any gloves leftover from missions are returned to the cleft centre to ensure that they never go to waste.

Boxes of Ansell gloves waiting to be shipped to an upcoming medical mission in India. Photo: Nicholas Nottage.

According to Operation Smile India’s executive director, Abhishek Sengupta, these gloves are a hot commodity among the volunteers.

“They (Ansell gloves) are the only gloves the surgeons and nurses request,” Abhishek said.

The quarterly shipments of gloves are frequently marked on the volunteers’ calendars, he said, so they know when to expect them.

Dr. Alexis Rothermel, a surgical resident, said, “The gloves definitely allowed me to feel very comfortable while providing care to the patients but did not impede my dexterity while operating.”

Dr. Alexis Rothermel performing surgery with the help and supervision of cleft surgeon from India Dr. Gaurav Deshpandey. Photo: Nicholas Nottage.

Wearing gloves is critical for the safety of both the patients and medical professionals.

Karen Allen, an Operation Smile volunteer nurse on her second medical mission, fully grasps the importance and value of working with high-quality gloves.

“Everyone deserves to be healthy and safe in their workplace, and having reliable gloves available — despite working in countries that may not have the same resources — is crucial to making the medical volunteers feel comfortable and relaxed. I have used Ansell gloves before and always appreciate my chances to use them.”

Volunteer nurse Karen Allen teaches one of the patients how to blow bubbles during screening day. Photo: Nicholas Nottage.

While she spoke, Karen grabbed the glove on her hand by the bottom and pulled on the end, mimicking how she first slid them on.

“If I had done that with the gloves I use back home, my fingers would have come through the end and the bottom would have ripped,” she said.

Since her job requires her to wear gloves often, she admires how the Ansell gloves never leave her hands sore after a long day’s work.

“These gloves always meet my expectations when I have the opportunity to use them,” Karen said.

The site in Durgapur is shared with a medical college, and several of the nurses in training assisted during the medical mission process. Karen’s proper use of the gloves “sets a good example to the student nurses as well.”

Gloves are an integral part of every step of the medical mission process. Fortunately, with Ansell’s generous support, Operation Smile can ensure patient safety throughout its medical missions — and continue to bring them some comfort, too, in the form of a glove-shaped fish.

Karen posing with some of the student nurses who assisted during the Future of Smiles mission at the Durgapur care centre. Photo: Akash Samanta.

Celebrating Year of the Nurse & Midwife: The Essential Roles of our Nurses

Editor’s Note: Alongside the World Health Organisation, Operation Smile is excited to celebrate 2020 as the International Year of the Nurse and Midwife. We recognise that a strong nursing and midwifery workforce is critical to the achievement of both universal health coverage and our vision of a future where health and dignity are improved through safe surgery. Currently, nurses and midwives account for nearly 50 percent of the global health workforce. However, there is a critical shortage of health workers globally, and nurses and midwives represent more than 50 percent of the current shortage. For all countries to reach U.N. Sustainable Development Goal 3 on health and well-being, the WHO estimates that the world will need an additional 9 million nurses and midwives by the year 2030. Through the platform of the International Year of the Nurse and Midwife campaign, Operation Smile seeks to inspire the future generation of nurses by highlighting the leadership, innovation and dedication to patient safety of our volunteer nurses, who have been and continue to be instrumental in the healing of hundreds of thousands of Operation Smile patients. By sharing their stories and celebrating their selflessness, creativity and compassion, we aim to contribute to the conversation on strengthening the profession so that we can work toward a healthier future for all.​

Post-anaesthesia care unit nurse Patricia Meireles tends to a young patient at an Operation Smile medical mission to Fortaleza, Brazil. Photo: Paulo Fabre.

One may not think that a medical mission site and an auto mechanic’s shop would have much – if anything at all – in common.

That is unless you’re Jeanne Kille, an Operation Smile volunteer operating room nurse.

“Growing up, my dad was an auto mechanic, so a ‘well-oiled machine’ was something our family could all relate to,” said Kille, who lives and works in Utah. “On my last medical mission, I was a Clinical Coordinator in China and I described my nurses as the grease that makes this machine of Operation Smile run – nurses are what makes this organisation run smoothly and efficiently.”

Out of the 51 volunteer positions on an Operation Smile international medical mission, 19 positions are filled by nurses. Currently, nurses represent 36% of our medical volunteers.

Operation Smile nurses are also the only medical volunteers who actively provide care for patients through every stage of the surgical process.

During patient screenings, nurses assist with comprehensive health evaluations, which determine if patients are healthy enough to receive anaesthesia and surgery. Operating room (OR) nurses manage the equipment needs of the surgeon and ensuring that sterility is never compromised. Post-anaesthesia care unit (PACU) nurses carefully monitor patients as they awake from anaesthesia before post-operative nurses tend to patients with wound care and educate their families about the healing process prior to being discharged.

Deidre Fenner, operating room nurse from Australia, at work during an Operation Smile medical mission to Cebu City, Philippines. Photo: Jörgen Hildebrandt.

Regardless of their subspecialty, Operation Smile nurses’ knowledge of paediatric principles and their diverse abilities ensure that every patient receives the exceptional care they deserve.

The pre-op and post-op nursing duties are combined into a single role, which requires physical stamina and sharp decision-making skills amid the bustling mission or care centre atmosphere.

“(Pre/post-op nurses) are adept at multi-tasking as they admit and assess new patients while monitoring those already on the ward,” said Ann Campbell, Operation Smile’s Senior Director of Medical Oversight. “They’re always using their critical thinking and assessment skills to recognise a change in the patient’s health status.”

PACU nurse Florence Mangula consults with a patient's father during an Operation Smile surgical training rotation in Ethiopia. Photo: Jörgen Hildebrandt.

In the pre-op role, nurses prepare and monitor our patients ensuring that they are physically ready for anaesthesia and surgery. They support the patient and family with information and emotional care while maintaining a time-sensitive workflow with the OR staff.

Next, OR nurses control the logistics and workflow of the operating room, often managing two surgical tables simultaneously.

“The role of an OR nurse is patient safety first,” said Bryn Frazier, a volunteer OR nurse. “We ensure that the correct procedure is to be performed on the correct patient prior to induction of anaesthesia… At the end of the case, we provide safe patient care with the anaesthesiologist as the patients wakes up from surgery.”

OR nurse Bryn Frazier (right) prepares a young patient for surgery during an Operation Smile medical mission to Tegucigalpa, Honduras. Photo: Jasmin Shah.

This is leads into the PACU, also known as the recovery room, where the patient is monitored as they return to consciousness after surgery. PACU nurses are responsible for monitoring the patient’s vital signs, assessing their airway and breathing, and must be ready in case the patient experiences any complications. They also make sure the patient is adequately hydrated and that their pain levels are controlled. As are all Operation Smile nurses, PACU nurses are trained in life support skills to respond to these potential emergency situations.

“PACU nurses play a very big role because they are the bridge between the OR staff and the paediatric (post-op) ward staff. In fact, they are the first people to see patients come into the ward before their parents see them,” said Florence Mangula, a PACU nurse from Kenya who has served on more than 30 Operation Smile missions. “The nurse then monitors the patient until they are fully awake… We also check for any bleeding or swelling from the operation site and report that to the (PACU physician).”

PACU nurse Chen Wei cares for a patient during an Operation Smile medical mission to Dafang, China. Photo: Zute Lightfoot.

Like all Operation Smile medical volunteers, our nurses are a diverse group which hails from around the world – a factor that presents communication challenges they do not face at work in their home countries.

“I have been in the OR with seven people and no one speaks the same language,” Frazier said. “Because of our commitment and knowledge, the cases run smoothly – we are all on the same page.”

Campbell added: “That’s what makes nurses great. We don’t stand around looking for someone to figure out the answer to a problem. We just link arms and jump in to get the job done.”

While the roles vary between subspecialty, the common thread between all Operation Smile nurses is their calling to serve those who need their attention and skill the most.

“We do missions in our home countries, we travel long distances to other countries, we learn new things from the other international volunteers or even the local hospital nurses and we teach new updated things to the other volunteers and local hospital nurses. It’s like a global knowledge exchange,” said Yazan AbuAlfa, a PACU nurse from Jordan. “We don’t change only the patients’ and their families’ lives, but our lives are changed too.”

PACU nurse Yazan AbuAlfa (center) consults with a patient alongside surgeon David Chong during an Operation Smile medical mission to Tegucigalpa, Honduras. Photo: Rohanna Mertens.

Meet Edward, Volunteer Nurse from Ghana

Gentle and smiling Edward Sarpong hails from Agogo in the Ashanti region of Ghana. Qualified for 8 years, Edward has been a nurse volunteer since April 2017 supporting 4 medical missions in Ho and Koforidua in Ghana and one in China. His first mission to Ethiopia in March 2019 was during the Surgical Rotation led by Per Hall, UK volunteer surgeon.

When asked why he volunteered for Operation Smile, Edward said “I was working as a paediatric nurse and came across many cleft children in the ward. One teenage parent brought in a child with a cleft lip and palate who died on my shift and I was so upset that wanted to find a way to bring hope to these children and their mothers. My research led me to Operation Smile.”

After his BLS course and credentialing by Operation Smile, Edward feels that “the exposure to different nurses from different countries gives me an opportunity to keep learning from them. Operation Smile is really touching lives, not only of the patients but the healthcare systems too. Change is happening all over the world because of them. The knowledge we gain is being shared on our return home. As Africans, we are learning how to change the lives of our people and through our volunteering for Operation Smile, we can give back to our country, through service to our community.”

Ghana now leads its own local missions. For Edward, “its rewarding to be part of the Ghanaian team which manage surgical missions across the nation, as we find and treat children and adults with cleft, so in need.”

Like all our volunteers, Edward has many heart rendering stories to tell. On his first mission, he “went to the patient shelter and met a mother who had been told she had given birth to a lizard. This mother kept her child hidden for over a year, never taking her outside, afraid of reactions. She was accused of adultery and was told that her child was a curse from the gods. Her marriage broke down and she even thought of killing her child. But she did not and she loved her child despite everything”. Edward went on to say, “that through her tears, this mother said she could now rebuild her life and her child’s and that the cleft operation given by Operation Smile had changed their lives forever”.

These experiences have “made me want to volunteer with Operation Smile whenever they ask me, wherever they send me”.

Operation Smile depends on volunteer network from many nations. Like Edward, they are the ones that continually change lives across the globe and we remain grateful for all they do.