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.

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.

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.

Ensuring Healthier Lives Through Nutrition: Q&A with Charlotte Steppling

Operation Smile's nutrition programme manager Charlotte Steppling. Photo: Rohanna Mertens.

As our nutrition programme manager, Charlotte Steppling has seen first-hand how lacking proper knowledge and guidance on nutrition can have a devastating impact.  

Years ago, while aiding patient recruitment efforts for Operation Smile medical missions, Charlotte came to a startling realisation.

“We were turning away patients suffering from malnutrition,” she said. “I was waiting to see these kids show up at the next mission, but they just weren’t coming back. They were dying, and it broke my heart.”

Children born with cleft conditions often face major challenges with feeding and receiving proper nourishment during the critical months after they’re born. These factors can lead to malnutrition, delays in growth and development and sometimes even death.

“What if we had come in contact with them earlier or what if we had a strong programme through Operation Smile Madagascar a year prior?” Charlotte often asked herself.

Operation Smile knew that in order to uphold its promise of delivering high-quality, safe surgical care to as many patients as possible, nutrition needed to become a priority.

Due to the compassionate individuals like Charlotte who’re devoted to helping bring nutritional support to the forefront, specialised programmes have been established in 24 countries including Madagascar, India, Ghana and Guatemala, where more patients’ lives are being saved through timely intervention and dietary education.

“We need to reach these patients as early as possible,” she said. “Whenever a patient is born with cleft, they should know that Operation Smile exists.”

We recently spoke with Charlotte to learn more about the future of Operation Smile nutrition programmes as well as why it’s crucial for children living with cleft to be well-nourished before they can receive surgery.

Charlotte speaks to participants in the feeding programme at the patient shelter during a 2018 Operation Smile medical mission in Antsirabe. Patients who aren't chosen for surgery because they're underweight or malnourished are invited to join the feeding programme. For three days, parents and children attend educational workshops about hygiene, health and nutrition. Photo: Rohanna Mertens.

Q: Charlotte, can you tell us a little bit more about how you found yourself in this role as Operation Smile’s nutrition programme manager?

A: “I arrived in Madagascar in 2013 to serve as a Peace Corps volunteer. In the village where I lived, I came across numerous children and adults living with untreated cleft lip and cleft palate. I realised there were numerous barriers to care including the lack of knowledge of and access to medical care. They were unaware of the opportunity to receive care and the potential to be evaluated by a medical team with the hopes of receiving free surgery. The idea was unfathomable to them: ‘Free surgery? Free care?’ As I explained to the potential patients, I spoke about Operation Smile and gained their trust, we travelled to the capital city, Antananarivo, and met the Operation Smile team.

“After three years of service with the Peace Corps and throughout three years spent recruiting more than 70 patients from a remote village in Madagascar, the local foundation offered me an opportunity to join their team. I was based in Antsirabe, a central highlands city and worked at the local hospital Operation Smile had partnered with.

“Here in Madagascar, there’s less than one physician – 0.18 actually – for every 1,000 people, which makes access to healthcare challenging. Nutritionists are a rarity. Antsirabe is located in a region that has a stunning rate of malnutrition at 65%, the highest rate in Madagascar. Interestingly, this region is also a prominent agriculture hub and the main producer of vegetables and cattle.

“It’s hard to make a child gain weight, and it’s really challenging when you are dealing with a ton of different variables. I believe increasing knowledge around nutrition, around the first 1,000 days of life, around healthy habits and adopting a hygienic environment, is essential.”

Children playing outside of the nutrition centre (unaffiliated with Operation Smile) Charlotte established to help patients and families overcome barriers to care. Photo: Zute Lightfoot.

“This motivation to make change, to make a difference in the lives of the most vulnerable, propelled me to open a non-profit to fundraise a nutrition centre in Antsirabe. We opened this nutrition centre (unaffiliated with Operation Smile) in 2017 and offered care to patients living with cleft conditions and those living without them. I could not stand to not make a difference. I could not sit back and not act.

“At Operation Smile in Madagascar, we decided to build a nutrition programme to cater to patients suffering from malnutrition. The programme paralleled the medical mission timeline, and we asked patients who were assessed as malnourished to stay at the patient village for a couple days.

“We built a programme based on education around breastfeeding, the promotion of healthy foods and nutrition, and the importance of water, sanitation and hygiene. We used in action activities to teach and empower families on how to adopt healthy behaviours that could make a lasting change in the lives of their children. We provided our patients and their families with donations of ready-to-use-therapeutic food (RUTF) and breast milk substitutes.

“Through follow ups, we noticed weight gain. Through interviews, we identified changes in the behaviour of caregivers. We were thrilled to see patients that were following the nutrition programmes were coming back for medical screening and cleared for surgery. I fully believe that, currently seeing the status of the world, we have the due diligence and the need to intervene on a nutritional level as an organisation.”

At the patient shelter, participants in the feeding program listen as Charlotte talks about the importance to food diversification, nutrition and breastfeeding techniques. Photo: Rohanna Mertens.

Q: Tell us why adequate nutrition is so critical for children who are born with cleft conditions?  

A: “To receive surgery, you need to be at a healthy nutritional status. At Operation Smile, we have very high standards around who is cleared for surgery. All of our patients are candidates but being cleared for surgery is a very different topic. You have a lot of parents who are feeding them whatever they can, whether that’s watered-down rice water, condensed milk mixed with water or some type of porridge or stew.

“Then you have babies who’re having challenges latching or mothers who are having challenges breastfeeding. That’s where Operation Smile is focusing on prioritising mother’s milk as the first intervention. Mother’s milk is free and full of nutrients, so if we can somehow get mother’s milk to the baby, then that is the best option.

“Then you have babies who are essentially dealing with malnutrition because, a lot of times, the parents aren’t aware of nutritional diversification and food diversification. So, we teach them about food that’s accessible, available and affordable to the patient’s family.

“We work with communities through our local teams to figure out what is available, then think about innovative ways to include high-protein density foods and provide a balanced diet so that patients are well-fed and well-nourished. The patients’ caregivers are also well-educated and feel empowered that they can provide for their children.”

Charlotte watches as 12-year-old Frederic sees his mother, Celestine, for the first time after surgery. Photo: Zute Lightfoot.

Q: Is there a moment or a specific patient who really illustrates why you’re passionate about this?

A: “There was a patient with a bilateral cleft lip and cleft palate. He was maybe 4 months old when he first came to our medical mission. I had met his mother, and she was doing everything she could for her little boy. She was having challenges breastfeeding him because she was no longer producing milk and during the early months didn’t have the opportunity to receive counselling on relactation techniques. The baby was very hungry.

“At that time, I had opened up the nutrition centre, and she was one of its first members. Her son was part of the programme, and he was receiving RUTF through Operation Smile and breast milk substitutes as well. His mum also received meals, because it was apparent that she was having difficulties feeding herself.

“Then one day, he wasn’t feeling good. We brought him to the hospital in Antsirabe, and he was put in the paediatric ward, monitored over two days. His system just let go, and he didn’t make it.

“I often keep him and his mum in my thoughts when I design programmes. What if we had come in contact with them earlier? What if we had a strong programme a year prior to him being born? He could have come into the programme, and we could have intervened earlier and made a difference in his life. I never want another mum to feel that way or deal with the death of a child due to malnutrition when that’s something we can help with.”

Q: What’s happening right now with regard to nutrition programming that you’re most excited about?

A: “It’s an exciting time for nutrition and Operation Smile’s comprehensive care programmes. Currently, our team is working on building a resource library for our programme countries to feel more supported when it comes to building and designing nutrition programmes. We’re also creating a curriculum for training, having a credentialing pathway for nutrition volunteers and building training sessions for community health workers and caregivers. Working closely with our local teams, we’re striving to ensure that the information is country- and culture-specific based on what food groups are available and what recommendations they would like to make about nutrition and feeding.

“We’re also finalising a comprehensive nutritional assessment that will assess the nutritional status of a patient suffering from malnutrition and building a platform to track their progress. This assessment will allow the nutritionist in country or nutrition volunteer to properly provide the necessary prescription of care for the patient.”

Photo: Zute Lightfoot.

Q: Could you tell us a little bit more about your vision for the future? What are the main challenges in light of the pandemic? What’s the potential that we can see through these programmes?

A: “With the current pandemic, we are looking into innovative ways to run our programmes virtually. In countries where our patients live in extremely remote locations with no access to electricity, we are finding solutions on how to reach patients as early as possible. In Madagascar, we use patient advocates. We train community members to deliver messages around nutrition and feeding, water, sanitation and hygiene to get as close as we can to the patient in a trusted manner.

“When I look at a long-term vision for nutrition programmes for Operation Smile, I believe nutrition interventions and activities are going to take a forefront for a lot of our countries. COVID-19 has had a significant impact on childhood malnutrition and nutrition-related mortality. It’s had a detrimental impact on the general population, but the effect it’s having on people affected by cleft, who already have challenges feeding, is even more substantial.

“We need to act now. This is our time as an organisation to step in and make a change in the lives of our patients, in some ways saving their lives, providing them hope, and supporting them in these extremely difficult times.”

Photo: Rohanna Mertens.

Going the extra Miles for Smiles: Madagascar nutrition programme

Held by his mother, Patricia, 14-month-old Icardi sips formula from a bottle. Photo: Henitsoa Rafalia.

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.

Vololona leads a team of volunteers through a crowded neighbourhood, passing worn houses before stopping to knock on a metal door.

After a moment’s pause, Patricia appears holding her son, Icardi, who’s feeding from a bottle.

With relief in her voice, she says to the volunteers, “We’re so glad to see you. This is one of the last bottles we can prepare with the baby’s formula left.”

Amid the lockdowns and restrictions, Patricia and Vololona, Icardi’s grandmother, have tried to support their family.

Vololona sells small supplies to schools and churches while Patricia makes deliveries of steels rods in the community.

But with orders not coming in, and schools and churches closed, they’ve struggled to make ends meet.

“Baby formula is expensive, but we’ve somehow always managed to buy it, since Icardi needs it to grow,” Vololona explains. “But since the lockdown, we’ve not been able to put money aside to buy formula.”

Photo: Henitsoa Rafalia.

Throughout the COVID-19 pandemic, this has become the reality for many patients and their families around the world as they attempt to provide for their loved ones amid country-wide lockdowns and restrictions.

With the inception of the Extra S’Miles nutrition programme, our local teams in Madagascar are quite literally going the extra mile for families with hopes of minimising the hardships caused by the pandemic.

“Shortly after the state of health emergency was declared and lockdown measures were put in place, our patients became extremely vulnerable,” said Dr. Howard Niarison, Extra S’Miles Programme Coordinator. “We had to take action, even if that meant braving the virus and the miles that separate them from us.”

Photo: Henitsoa Rafalia.

The programme not only helps patients continue their nutrition treatment prescribed by medical volunteers prior to the pandemic, but also assist families living in regions where lockdown measures have made it nearly impossible to meet basic nutritional needs.

Malnutrition remains one of the most significant obstacles to receiving care due to an increased risk of complications during surgery. Without timely medical intervention, patients like Icardi can face major health issues as they are more vulnerable to illness, malnutrition and even death.

The Extra S’Miles team spanned nearly two thousand miles, travelling across the country of Madagascar to deliver nutritional packs to patients living in the regions hit hardest by the virus.

Within the packs provided to families are necessary supplies and hygiene products including food, soap, washable masks, hand sanitiser, ready-to-use therapeutic food (RUTF) and more.

Member of the Operation Smile Madagascar's Extra S'Miles nutrition programme team giving ready-to-use therapeutic food (RUTF) to a patient. Photo: Henitsoa Rafalia.

In addition to the nutritional packs, the Extra S’Miles programme enabled the team to check-in on the health of patients, reassure families that Operation Smile remained devoted to their well-being despite the cancellations of medical missions and provide counsel advice on how to remain healthy until the resumption of care.

Photo: Henitsoa Rafalia.

“It’s during difficult times that you know who your real friends are,” said José Augustin, patient coordinator for Operation Smile in Madagascar. “This health crisis is certainly a difficult time for our patients. Because we care for them, we’ll reach out to them since they can’t come to us.”

More than 530 families received the Extra S’Miles nutritional packs thanks to the dedicated team members who refused to let the pandemic prevent them from seeing smiles on the faces of patients in need.

Operation Smile Madagascar patient Coordinator Jose Augustin shares a smile with a patient. Photo: Henitsoa Rafalia.

With tears in her eyes, Patricia happily accepts the nutritional pack and the six cans of baby formula the Extra S’Miles team offers her.

Raising Icardi has been a long and difficult journey for Patricia and Vololona.

Despite their unconditional love for both Icardi and his older sister, they’ve faced seemingly insurmountable barriers in their attempts to care for a child living with a cleft condition.

Icardi’s father left shortly after his premature birth, unable to handle the stress of a baby born with cleft lip.

Smile Photo: Henitsoa Rafalia.

Many families like Icardi’s joined Operation Smile Madagascar’s nutrition programme with the hope of a new beginning.

The programme provides patients and families with educational support, ongoing health assessments and RUTF, a nutritive peanut paste that helps malnourished children gain enough weight to become healthy enough for safe surgery.

“Icardi is a survivor,” Vololona said. “That’s in part thanks to all the counsel and help we’ve received from Operation Smile. With this health crisis, Operation Smile has not forgotten him, nor us. We’re extremely grateful.”

Today, the Operation Smile Madagascar team remains steadfast in their commitment to the health and wellbeing of patients.

Through their continuous efforts to provide nutritional support, 62 patients were enrolled in the organisation’s nutrition programme as of October 2020. Of that total, 47 children reached an optimal weight with 13 more making significant progress along their journey to becoming healthy enough to receive safe surgery.

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

Let’s Talk: Speech Therapy Programme “HablemOS” Helps Thousands Across Latin America

Operation Smile Nicaragua's care centre in Managua was the first centre to reopen its doors to patients amid the pandemic and began providing a mix of in-person and virtual consultations. Photo: Operation Smile Nicaragua.

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.

Despite the unprecedented challenges the COVID-19 pandemic brought to our medical programmes and care delivery, we’ve refused to stand aside in the face of this adversity.  

Volunteers and staff working in care centres throughout Latin America found an opportunity to come together to make sure that we kept our promise of caring for patients and their families amid lockdowns and country restrictions.

For patients born with cleft lip and cleft palate, speech therapy before and after surgery is an essential component of comprehensive cleft care.

Most of this ongoing work was done in person with patients at centers, but with the impact of the pandemic hitting countries worldwide, providing this care suddenly became impossible.

Operation Smile Regional Director Lizet Campos. Photo: Jasmin Shah.

Working closely with her fellow regional directors, Operation Smile Regional Director Lizet Campos created the concept of the programme called “HablemOS,” a play on words meaning “let’s talk” in Spanish with the capitalised “OS” at the end of the word symbolising Operation Smile.

Cleft conditions can make eating extremely difficult, so speech therapists oftentimes conduct consultations soon after a child is born, providing families with advice on how to properly feed their child.

Hundreds of patients have received speech consultations at care centres in Managua, Nicaragua; Asunción, Paraguay; Bogota, Colombia; and Caracas, Venezuela. Photo: Rohanna Mertens.

Speech therapists also provide patients with palate-strengthening exercises before surgery that help improve the procedure’s outcome. As a child grows and begins to speak, their ongoing care helps patients be able to speak more clearly.

In collaboration with our medical oversight team, speech council, programme manager Mauricio Rojas of Mexico and programme coordinator Maria Cristina Galindez of Venezuela, Lizet and her team implemented HablemOS in mid-August of this year.

With the support of Operation Smile Sweden and generosity of the Swedish Postcode Lottery, Lizet and her team have a fully funded programme that they hope will show patients and their families that Operation Smile remains committed to them despite the current global challenges.

“So far, the programme is proving to be a resounding success,” Lizet said. “To date, our teams in Latin America have delivered speech consultations to more than 3,200 patients. There’s also an in-person component, as 629 of the consultations were given at our care centres in Managua, Nicaragua; Asunción, Paraguay; Bogota, Colombia; and Caracas, Venezuela, though this continues to be conducted on a much more limited basis than the virtual therapy sessions.”

Volunteers and staff feel inspired by the deepening of the organisation’s investment in speech therapy, which is critical to helping our patients live dignified and fulfilling lives.

Longtime Operation Smile volunteer Milagros Rojas joined the HablemOS team, bringing with her years of experience as a speech pathologist. Photo: Margherita Mirabella.

The HablemOS team is honoured to lead the way in developing a programme that has the potential to be replicated and implemented everywhere that Operation Smile works.

“Just imagine, in these sessions, through songs and stories, we can make our little ones exercise their speech abilities and keep them from finding it tedious,” said volunteer speech pathologist Milagros Rojas. “Instead, these sessions turn into play sessions.”

Knowing that many patients’ families had access to either internet-connected smartphones or computers, speech therapists were contacting families and resuming or beginning virtual consultations within weeks for hundreds of patients while the doors of the centres remained closed to the public.

If families lacked internet access, therapies were delivered over the telephone as well.

With a lack of certified speech therapists like Milena Cleves in Latin America, the HablemOS program provides opportunities to increase the number of qualified therapists in the region. Photo: Marc Ascher.

“There’s a lack of certified speech therapists throughout the Latin America region and in many other low- and middle-income countries,” Lizet said. “So we knew it would be critical to offer training and education opportunities to speech therapy providers so that more – and more qualified – therapists can deliver care to more patients.”

Working together with the Mexican speech and language therapy non-profit Hablarte E Integrate, the training and education portion of the programme has enrolled 61 speech therapists from 13 Latin American countries.

“Although we’re professionals, we can always grow in knowledge,” said Operation Smile Panama volunteer speech therapist Alina Navarro. “I’m delighted to be acquiring a new perspective. In terms of mentoring, it’s been useful to discuss the cases together with other professionals.”

The HablemOS program team feels driven to keep delivering much-needed speech therapy care to patients as the world continues to cope with the effects of COVID-19.

“I want to give thanks to those who made this opportunity possible,” Milagros said. “COVID was not a limitation, because anything is possible when things are done with humanity and infinite love.”

Help us to continue keeping our promise 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.

HablemOS team member and programme manager Mauricio Rojas, left, shares a special moment with Jonathan during a 2019 medical mission in Mexico. Photo: Rohanna Mertens.

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.