Overcoming Her Obstacles

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.

At 4 years old, Nazifa hadn’t spent much time outside of the clay and straw hut where she lived.

Her family shared the house with their livestock — a cow and some sheep — and they had no electricity or running water. The stamped clay floor was cold and dusty. A fire on a stone stove on the floor lit up the hut as her mother roasted corn in a pan.

Here, Nazifa spent her time while her siblings and the other children were out playing in the village on a hill in southwestern Ethiopia.

Nazifa was born with a cleft lip, and no one in the village had ever seen anything like it before. They were scared and thought it could be the work of an evil spirit. Some people in the village thought it could even be contagious.

“Not even Nazifa’s siblings want to use the same cup as her. When they are out playing, there is a game where you throw stones into a hole in the ground. They say they can use the hole in her lip instead,” said Sherab, Nazifa’s father. “She is not the only one who suffers. My wife and I cry when we hear what they say to her.”

Four-year-old Nazifa, before. Photo: Margherita Mirabella.

However, a local health clinic informed the family about Operation Smile, which forever altered the course of their lives.

Soon after, Nazifa and her father were among the hundreds of children and parents who travelled to the capital city of Addis Ababa with the hopes of receiving free cleft surgeries performed at an Operation Smile medical mission.

Taking his daughter to the distant hospital was a huge challenge and commitment for Sherab. Being a subsistence farmer, living off what they could harvest from the fields, he had never been outside of his region before nor had he visited a big city. The family had to borrow money from their neighbours to afford bus fare, so only Sherab and Nazifa could make the trip while his wife stayed home with Nazifa’s siblings and their newborn baby.

When they reached Addis Ababa, Nazifa caught a cold in the cool, high-altitude air. She coughed as medical volunteers performed her comprehensive health care assessment, an important step in determining if patients are healthy enough to receive surgery.

Sherab was not only anxious about his daughter’s health, but also because her cold could potentially postpone surgery and they would have to make the resource-draining trip again.

Photo: Margherita Mirabella.

Finally, after some days of medication, Nazifa’s cold subsided and she was cleared for surgery.

“I think everything went well. Nazifa is doing fine even though there were some problems to start with. Everything has turned out really well. Her muscle is fine and everything is working. The lip will be perfect,” said Dr. Malin Hakelius, a volunteer plastic surgeon from Sweden.

In the recovery room, Sherab cried when his daughter finally woke up after surgery. He had been so worried, but now he could relax.

At home, his family and neighbours were waiting to celebrate Nazifa’s surgery with a big homecoming meal.

The day after surgery, Nazifa looked in a mirror for the first time in her life. Never having seen her reflection before, she tried to see if there was someone behind the mirror.

Sherab just smiled and shook the hands of as many team members as he could. “Thank you,” he said in English, bowing respectfully as is customary in Ethiopia. “Thank you!”

On the last day of the medical mission, Nazifa and her father prepared to leave the hospital and take the long bus ride home. Nazifa was playing with some new friends, forming her lips to a perfect round shape to blow soap bubbles, laughing and enjoying herself.

That day, the Operation Smile team left the hospital after five days of surgery and final post-operation check-ups.

All the equipment had been packed and stowed, and the team-members were on the way to the airport, when they got a message: Nazifa had fallen from a stone wall, and the stitches on her lip had ripped open.

Nazifa's stitches from her first surgery from Operation Smile reopened after falling while playing with friends. Photo: Margherita Mirabella.
Nazifa's stitches from her first surgery from Operation Smile reopened after falling while playing with friends. Photo: Margherita Mirabella.

Sherab was devastated.

Operation Smile Ethiopia volunteer Ruth Emmanuel helped Sherab get Nazifa first aid care for the wound at the hospital and found them a place to stay for the night.

Although the volunteer medical team was still in the country, Malin said that an immediate repair on the wound wouldn’t be possible due to the trauma caused by the fall. Their best treatment plan was to clean the wound, let it heal and repair it during the next medical mission to Ethiopia.

After four years of hoping for a better life for his daughter, Sherab left the mission with Nazifa wondering if there would be a second chance for her to get surgery again.

Six months later, Operation Smile returned to Jimma, which was even closer to Nazifa’s home in southwestern Ethiopia.

Sherab travelled with Nazifa to the mission site, holding her hand tightly and not letting go of her, even for a second.

This time, everything went smoothly for Nazifa. Passing her comprehensive health evaluation once again, she underwent her reparative surgery and not only left the mission with her father but a brighter future and a life free from bullying and social isolation.

Today, Nazifa spends most of her time playing with friends from her community. The bullying and teasing she once endured has come to an end, and she’s enrolled in school, learning how to read and write for the first time.

Photo: Jörgen Hildebrandt.

“I like to learn things,” Nazifa said.

Nazifa must cross a river every day to go to school — a minor obstacle compared to the social barriers her surgery has helped her overcome.

Photo: Jörgen Hildebrandt.

Now 12 years old, Nazifa hopes to one day become a doctor so she can care for others like the medical volunteers who cared for her.

Her parents are thankful that surgery through Operation Smile has opened the door for Nazifa to pursue her dreams.

“She can read and write now, something we never learned ourselves,” Sherab said. “When it is time to go, she stops with everything she’s doing and runs to school. She runs because education is the foundation of life.”

‘I Was Afraid I Was Going to Lose Her’

Becoming a new mother is challenging at the best of times, but Fatima, mother to one-month-old Janat, feared her daughter was about to die. Janat was born with a cleft lip and palate and Fatima not knowing where to turn was overcome with worry.

Janat was losing weight. Every time Fatima tried to feed her, she spluttered and choked on the milk. The hungry cries of her starving daughter broke Fatima’s heart. Janat could only slowly drink three ounces of feed over the course of a day, no-where near enough for a growing child. Each attempt to feed her brought more heartache.

Luckily, Fatima was seen by an Operation Smile dental team who arranged for her and Janat to be transported to our care centre in the city of Oudja. By this time Janat had lost nearly half of her birth weight and medical volunteers immediately identified Janat as at risk of dying.

Experts from the team were able to feed Janat with a special feeding plate. Rather than choking, with milk spilling from her nose, Janat hungrily drank three ounces with ease. ‘I was so happy. I was so relieved,’ said Fatima, ‘…I’ve never seen kind hearts like you before.’ Words that travel through our volunteers to you, as without you Janat would very likely have died.

Operation Smile will continue to support Fatima and Janat. Able to get the milk she needs to survive, Fatima will now be able to build up Janat’s strength for surgery to correct her cleft conditions. Although their journey is not over yet, we look forward to Janat growing into a happy and healthy child.

Overcoming Nutritional Barriers to Surgery in Ghana

Two-year-old Jocelyn during Operations Smile's 2017 medical mission in Koforidua, Ghana. Photo: Zute Lightfoot.
Two-year-old Jocelyn during Operations Smile's 2017 medical mission in Koforidua, Ghana. Photo: Zute Lightfoot.

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

For patients like Jocelyn, widespread poverty affecting areas across Ghana presents challenges and a host of barriers that stand between them and a brighter future after surgery. Some of these barriers can also be the difference between life and death.

Malnutrition remains one of the most significant obstacles to receiving care, affecting children with cleft conditions, especially babies with cleft palate, in the early developmental stages of their lives.

Without timely medical intervention, patients confront challenges with breastfeeding, struggle to receive proper nourishment when it’s most critical and become more susceptible to infections and diseases.

“Challenges people in Ghana are facing: no access to nutritious foods, foods are too expensive,” said volunteer nutritionist Dede Kwadjo.

Volunteer nutritionist Dede Kwadjo poses for a photo at the patient shelter where she has been consulting with mothers of babies born with cleft conditions. Photo: Zute Lightfoot.

Due to the rate of Ghanaian children experiencing growth delays and being moderately to severely undernourished standing at a staggering 19 percent, improving access to nutrition and educating families is crucial.

With an increased risk and probability of complications during surgery, many hopeful families who arrive with their children to Operation Smile medical missions leave disappointed and upset after medical volunteers deemed their baby too unhealthy to receive surgical care.

And in Ghana, a country known for having widespread and deeply rooted social stigma surrounding cleft, many children endure lives filled with pain, living in a world of isolation and being fearful of harassment from peers, members of their communities and, sometimes, even their own families.

This is what Cynthia hoped to protect Jocelyn from when she made the choice to help her future adoptive daughter.

She never expected that her decision to pause at a bus stop and speak with the father of a child living with an unrepaired cleft lip would save a life let alone take her on a journey toward motherhood.

Jocelyn pictured with adoptive mother, Cynthia. Photo: Zute Lightfoot.

Hoping to help him find a solution for his 2-year-old daughter, Jocelyn, Cynthia told the father about Operation Smile Ghana and the surgical care it provides at no cost to families.

Cynthia soon learned that Jocelyn’s mother had abandoned the family, leaving Jocelyn in the care of her dad. Over time, she also began to notice that he didn’t seem to make his daughter’s needs a priority, and Cynthia became more troubled and suspicious.

To make sure that he followed through for the care of his daughter, Cynthia travelled with the family to the 2017 local medical mission in Koforidua. But after performing a comprehensive health evaluation, medical volunteers determined that it wasn’t safe for Jocelyn to receive surgery: She was too underweight and showed signs of malnutrition.

“With nutrition, I always say, ‘If someone isn’t well nourished, a lot of things don’t go well,’” Dede said. “Making sure that someone is nutritionally adequate is a basis for good living.”

After Jocelyn was admitted for a five-day stay in the paediatric ward during the mission, Cynthia refused to leave her side.

Cynthia was thrilled to learn that Jocelyn had been enrolled into Operation Smile Ghana’s nutrition programme. But her excitement was short lived once she was told that Jocelyn had missed the first – and second – month of the programme.

Repeatedly, the Operation Smile Ghana team called Jocelyn’s home, using every resource they had to reach the family and make sure Jocelyn received the care she desperately needed.

Cynthia knew the kind of life Jocelyn could have if she received surgery. But she also suspected what her future held if her health didn’t improve and she wasn’t cleared for surgery.

Following numerous failed attempts at trying to convince Jocelyn’s father to bring her to the site of nutrition programme, Cynthia’s initial worries and fears about Jocelyn’s health and well-being were realised, and it became clear that she needed to step in.

Assured that Jocelyn wouldn’t go back into the care of her birth mother, the father agreed that Cynthia could have sole custody and become the person in charge of taking over Jocelyn’s care.

It was only after Cynthia offered to become Jocelyn’s primary guardian that her journey back to health – and to receiving free surgery on her cleft lip – truly began.

Photo: Zute Lightfoot.
Photo: Zute Lightfoot.

To help the overwhelming number of children suffering in the country, Operation Smile Ghana’s nutrition programme is conducted year-round in five regions across the country. The programme offers ongoing educational support and monthly intervention assessments to track patients’ development.

Ready-to-use therapeutic food (RUTF), a nutritive peanut paste; formula, and cereal mixes are given to patients whose nutritional deficiencies prevented them from passing their comprehensive health evaluation. Since 2015, Operation Smile has provided RUTF to malnourished patients living in the country. And today, during the COVID-19 pandemic, this support is critically needed. While surgeries are postponed, our team in Ghana is distributing RUTF to patients who need it so they can continue growing strong and healthy.

Dede Kwadjo speaks with Aba, mother of 11-month-old Moses, during screening for Operation Smile Ghana's first local mission in Koforidua. Photo: Zute Lightfoot.

For Dede, the individual education and empowerment consultations she offers to families are just as important as the care she delivers to the children.

“We train our mothers to use what they have to create nutritious food for their children. We ask what they have available: fish, beans, banana. Then, we work with them to create a practical solution, teaching them how to help their child,” Dede said.

Eleven-month-old Moses being fed by his mother, Aba, while waiting for patient announcement during an Operation Smile Ghana medical mission. Photo: Zute Lightfoot.
Eleven-month-old Moses being fed by his mother, Aba, while waiting for patient announcement during an Operation Smile Ghana medical mission. Photo: Zute Lightfoot.

Another one of Dede’s patients is Moses.

At the same 2017 local mission conducted by all Ghanaian volunteers, the 9-month-old arrived in dire need of nutritional intervention.

For Aba, Moses’ mother, the personalised counselling and support she received from Dede throughout the nutrition programme constantly motivated her to never give up.

Despite her son’s recurring respiratory infections and low weight, Aba remained committed to the programme and became more hopeful as she began to see positive changes in Moses’ health. It was her perseverance and empowerment from Dede that led to Moses passing his comprehensive health evaluation and receiving cleft lip surgery.

While malnutrition continues to prevent babies and children from undergoing surgery at the ideal time, support from mothers like Aba, education from volunteers like Dede and unrelenting commitment from loving people like Cynthia are forces that can change the course of a child’s future.

“If you can empower somebody with right choices to prevent the person lacking something as basic as getting the right food and the right proportion at the right time, that will go a long way actually help the person to have a better quality of life,” Dede said. “I’m so passionate about it.”

Moses and Aba after his cleft lip surgery. Photo: Zute Lightfoot.

A Born Fighter

Photo: Justin Weiler.

Energetic and talkative, Bui loved preschool.

As he bounced around the playground in his rural Vietnamese community, the 3-year-old paid no mind to his cleft lip while playing ball games and taking turns on the slide.

But whenever young tempers would inevitably flare, Bui’s classmates dealt him cruel reminders of his condition by calling him “sut,” a derogatory term describing someone born with a cleft lip. Bui would react angrily by fighting back, hitting his bullies until they stopped the name-calling.

Incredibly, young Bui never cried in the face of the taunting — a testament to the unconditional love and support of his family. When he was born; his mother, Ai, and father, Luyen, had never seen someone with a cleft lip. To them, it mattered little compared to the joy of welcoming their third child to the family. Ai’s midwife explained it was not unusual for a child to be born with a cleft lip and that surgery was possible to repair it.

While the local clinic provided support on how to feed Bui — he had no trouble breastfeeding, which can be difficult or impossible for many babies born with cleft lip and cleft palate — the family’s lack of financial resources made it impossible for them to afford surgery. Luyen and Ai are subsistence farmers, and the family lives off what they grow.

Photo: Zute Lightfoot.
Photo: Zute Lightfoot.

Their only option for Bui to access care was registering with the local government, which would inform them when a free surgical option became available.

The family was ecstatic when the government agency informed them that Operation Smile was conducting a medical mission in Hanoi — a 2 ½ hour bus ride from from their village. While Ai was unable to make the journey due to the recent birth of her fourth child; Luyen, his mother, My, and Bui’s uncle made the nerve-wracking trip to Hanoi with Bui — each person’s first time in a big city.

At the mission hospital, the family was surprised to see many other families with children like Bui and enjoyed sharing similar experiences in raising a child with a cleft condition. This hopeful atmosphere soon gave way to disappointment. Bui’s patient health screening — a critical step in ensuring safe surgical care for all Operation Smile patients — revealed Bui was running a fever. Considering Bui’s condition and the week’s surgery caseload, this health hazard meant surgery would not be possible until Operation Smile’s next medical mission returned to Hanoi in four months.

Ai, Luyen and Bui made the next trip together; completing the first leg on a motorbike before completing the 100-kilometre trip via bus. Now Ai experienced the anxiety of her first visit to Hanoi, compounded by the tension leading up to her son’s health screening.

Photo: Zute Lightfoot.
Photo: Zute Lightfoot.
Photo: Zute Lightfoot.
Photo: Zute Lightfoot.

This time, Bui was deemed healthy enough to undergo anaesthesia and received his life-changing surgery. His parents were unsure of how their family would react when they saw Bui’s new smile for the first time, but they were ecstatic as they made the journey home.

Photo: Margherita Mirabella.

Six months later, Ai said the family was overjoyed to witness Bui’s new smile, especially his two older sisters. She added that since his surgery, Bui’s overall health improved and that she can now understand him completely when he speaks.

After making a full recovery from his surgery, Bui returned to preschool, which he loves more than ever as a result of his new smile. While he and his friends may still get into the occasional scuffle as young children sometimes do, the bullying and teasing he once endured has come to an end.

As Ai reflected on Bui’s surgery, she said that she was so thankful to the Operation Smile medical volunteers and supporters who forever changed her son’s life.

Photo: Margherita Mirabella.

Drawing Smiles

Anas with an Operation Smile medical volunteer. Photo courtesy of Anas.

Anas grew up believing that the scar on his lip was the result of a fall he’d had as a child – after 14 years, he learned the truth.

When their son was born with a unilateral cleft lip, Anas’ parents were scared and shocked. Neither had ever seen anyone with a cleft before.

Hoping to repair their son’s cleft condition, Anas’ parents took him to a clinic (unaffiliated with Operation Smile) where he received his first operation at 2 months old.

Sadly, the results of the surgery didn’t heal properly, and Anas was left with bad scars and unevenness in his lips.

Fearing that Anas would think his cleft condition was a consequence of God punishing him, Anas’ parents told him that his scars were the result of him falling from the stairs as a child.

So as he grew up, Anas never knew that there were more people just like him, living every day with an untreated cleft condition.

Anas’ parents loved their son. And in their minds, protecting Anas meant sheltering him from the truth.

But even in their efforts to help Anas live the best life possible, his parents couldn’t stop him from enduring years of harmful bullying.

When children at school noticed his scars, Anas would say that he’d cut himself shaving in an attempt to lessen the pain he felt. And when the hurtful comments and ridicule continued, Anas’ response to the cruel treatment would be to make a joke, hoping that laughing with his peers would make the bullying stop.

No matter how hurtful the abuse became, Anas persevered and refused to let it faze him or prevent him from living the life that he wanted.

Anas later admitted that the bullying he endured helped build his character and mould him into the person he is today – someone with the strength and desire to help others.

Anas with long-time Operation Smile Morocco volunteer paediatrician Dr. Najib Jilali in 2013. Photo courtesy of Anas.

It wasn’t until Anas was 14 years old that he learned that his father had been secretly researching medical options.

During his pursuit of finding a solution for his son, Anas’ father discovered Operation Smile Morocco and learned about the safe, life-changing surgeries it provides patients living with cleft conditions.

After hearing about the organisation’s upcoming medical mission, Anas’ father decided that it was finally time to tell his son the truth.

It was in that moment that Anas first learned about his cleft condition.

While travelling to the medical mission with his father, Anas didn’t know what to expect. He understood that the damage from his previous surgery could be repaired at the mission. But what Anas didn’t anticipate was the scene he would witness once he got there.

Hundreds of people just like him had travelled from across the country, carrying with them the hope of receiving surgery from Operation Smile Morocco.

At the mission, Anas felt an immediate connection with many of the patients. But it saddened him to see them hiding their faces and looking down in embarrassment because of their cleft lips.

Determined to make an impact, Anas formed a community by bringing together both Operation Smile Morocco patients and volunteers.

After passing his comprehensive health evaluation and receiving surgery to repair his cleft lip, Anas became inspired to achieve even more for the organisation.

Anas today. Photo: Ambra Marengo.
Anas today. Photo: Ambra Marengo.

Since his final surgery in 2013, Anas has earned a degree in psychology and volunteered with many organisations, working especially with orphans and children with autism.

Today, he interns at a hospital in addition to working toward becoming a credentialed child life specialist for Operation Smile Morocco.

Putting his psychology studies into practice, Anas touches the lives of patients and their families by helping calm worried parents after their child enters the operating room.

He tells them, “Look at me. I was your son!”

Once they see that Anas’ surgery was successful, anxious parents often immediately relax and try to learn more about his own journey to healing.

Anas says that being on both sides of the mission experience makes him feel like the bridge between the volunteers and patients.

After receiving surgery from Operation Smile Morocco, Anas gained so much more than a new smile.

“Here in Morocco, Operation Smile has a real community who gives a real hope to others. It gives the gift of a new beginning. We all share our humanity, languages, experiences with one another and become like a family.

“For patients, it’s a new beginning. We are giving them confidence and new hope. It is a priceless gift. This is really life changing; it has been for me, and it is for all of Operation Smile’s patients. It’s amazing to have such an organisation in my country. I am happy that, for my part, with the power of words, I can also draw smiles.”

Anas poses for a photo with a young patient during an Operation Smile Morocco mission. Photo courtesy of Anas.

Meet Our Patients: Madaba, Jordan

Meet Rana

Photo: Rae Ceretto.
Photo: Rae Ceretto.

More than six years ago, Leena and her husband travelled for four days to Jordan, leaving her home and family behind in Syria for a chance at a better life.

Leena said that she had no choice but to abandon everything in order to survive the violence and conflict in her own backyard.

“My home was destroyed because of the war. I had nothing left,” she said.

After four days of travel, she reached a United Nations refugee camp and was provided a one-room tent for shelter.

Today, that tent is home to her three young daughters, her husband, his second wife and their five children. All 11 of them live together.

For the last six years, Leena and her children have lived like this. Her eldest daughter, Rana, is 4 years old, so the tent is the only home that her daughters have ever known.

“I cannot afford to rent a house. I work on a farm with my husband in the fields. I work all day long, and I only earn five dinar a day,” Leena said. “I miss my daughters greatly. I don’t get to spend time with them. This makes my life very hard.”

The family often faces many hardships.

“Every time it rains, the tent falls down, everything is washed away,” she said.

For Leena, living in the tent makes raising her daughters difficult and accomplishing daily tasks a challenge. Sadly, when Rana was 1 year old, life became even harder after a tragic cooking accident.

Rana was playing close by as her mother was cooking potatoes with hot oil for dinner. When Leena turned to check on her, her daughter was no longer in sight.

In a panic, Leena turned back around, but it was too late. In a matter of seconds, her daughter had fallen into the hot oil and burned her arm.

“When I picked her up and I saw that her flesh had melted off of her arm, I was so in shock,” Leena said. “I blamed myself. Other people also blamed me and often asked, ‘why did you let this happen to her?’

“I wish I had two tents, one for cooking and one for living. I can’t help but think this would have never happened if I was back home in Syria.”

Today, 4-year-old Rana still hasn’t received the reconstructive plastic surgery that she needs. She’s grown up covering her arm with long sleeves and hiding her hand behind her back to keep it from being seen.

Other children, including her own brothers and sisters, often tease her because she is different, because of her scars. She hasn’t been able to make many friends.

“She is such a shy girl. In the summer, she wants to wear T-shirts and dresses like the other children, but she is scared,” Leena said. “She always asks me to cover her arm. I want her to get surgery so she can wear a dress, be confident and be happy. All I want is for Rana to be happy.”

Leena knew that she would never be able to afford surgery for Rana, but she did not give up hope. She had faith that it would all work out.

Then one day, she read online about Operation Smile Jordan and learned how it provides free surgery for children in need of reconstructive surgery for cleft conditions and burn-related injuries.

After connecting with the medical team, Leena was told to come to Operation Smile’s screening site in Madaba.

Her hope of getting Rana the care she needed continued to grow.

In Jordan, Operation Smile has expanded the surgical programmes it provides in order to address the needs of the local community. Many individuals in this area suffer from cooking-, accident- and conflict-related burns just like Rana.

The goal of burn-related reconstructive surgery is to improve the cosmetic appearance of scars and increase the function and range of motion that may have been limited due to the damaged skin.

Around the world, Operation Smile strives to use the expertise of its volunteer medical teams in treating cleft to create solutions that deliver safe surgery where it’s needed most.

As of March 2019, the United Nations reports that 670,238 individuals have registered as refugees from Syria. Leena and her family are just a few of the Syrian refugees who are currently seeking asylum in Jordan. Many of them do not have access to surgical care.

In the countries where its medical teams work, Operation Smile is able to customise the safe surgical care it provides based on the local need.

In addition to providing cleft care, Operation Smile Jordan provides surgical burn care to children who need it.

As long as there are children like Rana in need, Operation Smile will continue working to make sure safe and essential surgical care is available because the organisation believes that access to surgery is a basic human right.

“I speak to my family in Syria almost daily, I miss them. They’re doing fine, and it’s more safe now, but I cannot go back because I left the country,” Leena said. “It is my only hope that I will see my family again. To go back home in Syria and to give my daughters a normal life.”

Meet Mirna

Mirna with her father, Zeyad. Photo: Laura Gonzalez.

Regardless of where 6-month-old Mirna needed to be during Operation Smile Jordan’s mission, her father, Zeyad, was always close by.

Zeyad and his wife, Tasneem, arrived at the screening site with hopes that their baby girl would receive safe surgery and be given the chance to live the life they knew she deserved.

Throughout the family’s time at the mission, Zeyad couldn’t contain his love for his daughter and was often seen bouncing Mirna on his knee and giving her many kisses.

Before the day of her five-month ultrasound, Tasneem had never known that a child could be born with a cleft condition. But after the doctor told her about her daughter’s cleft lip, she began to worry about Mirna’s future and how her cleft condition might cause her to face additional health issues throughout her life.

“When I learned how she would be born, I was in shock,” Tasneem said.

She returned home to her husband later that day in a panic but couldn’t find the words to tell Zeyad what the doctor had said.

“All she could do was pace around the house touching her lip,” Zeyad recalled.

Unlike his wife, Zeyad was not concerned when he finally heard the news about his daughter.

He immediately got to work on talking to different doctors and researching online information to learn more about cleft conditions and what potential treatments existed.

The doctor who delivered Mirna informed them that surgery would cost more than $10,000 – a cost that they would never have been able to afford.

When asked how they learned about Operation Smile, Tasneem replied with one word: “Facebook.”

After reaching out online to Operation Smile, Tasneem and Zeyad were given the information they needed by the local team to take the one-hour taxi ride to reach the screening site.

Unfortunately, after receiving her comprehensive health evaluation, Mirna revealed to be too underweight to receive safe surgery.

When Zeyad heard the news, his confident and happy demeanour changed to genuine concern, and he started fumbling with his daughter’s medical papers.

Tasneem told the medical team that the thing she was looking forward to for Mirna most of all was, “that she would be normal, that she would be beautiful.”

Members of the local medical team reassured the anxious parents that all hope was not lost. They explained that Mirna could still receive surgery once she gained a little weight.

A reason why Operation Smile returns to countries like Jordan is because patients like Mirna are still waiting for their chance at a brighter future.

Meet Amar

Photo: Rae Ceretto.
Photo: Rae Ceretto.

A seemingly normal day quickly turned into one that Amar would be forced to remember for the rest of her life.

When Amar was 6 years old, she was playing in the garden with her friends in their village just outside of Damascus, the capital of Syria.

Suddenly, the entire street where she grew up was destroyed by fire and shrapnel when a car that was parked near the garden exploded.

Amar was hit by the blast and severely burned by the fire. Now, she lives with a scar covering the right side of her face – a scar that serves as a reminder of the life she left behind in Syria.

“I had no time to think and process what happened, I just reacted,” Amar’s father, Mhammad, said. “I needed to get my family away from the danger. There was no time to waste if we wanted to survive the war.”

Two months later, they relocated to Jordan.

Today, Amar is 12 years old and lives with her family in the capital Amman. Since the explosion, she has received burn care from another medical organisation that successfully made the scar on her face slightly smaller. Her father hopes that one day the scar will go away completely.

“I hope the scar will grow smaller and smaller so she can forget what happened to her,” Mhammad said.

Amar is teased heavily by other children in her school because of the burn on her face.

“I don’t remember the explosion, but I’m always teased, and it bothers me a lot. I’m trying my best to cope with it,” Amar said.

Despite the teasing, Amar excels in school. She is in sixth grade, and her favourite subjects are English, Arabic and science. Her voice is soft and kind, and she beautifully blended English and Arabic as she shared her story.

“After school, I want to be a lawyer because I want to help children who went through the same things that I did. I sympathise with them so much,” she said.

Amar is incredibly inspiring. Her positivity and compassion for others shines through her beautiful brown eyes and her warm smile. She enjoys her life outside of school by running and drawing things like animals, people and nature.

“I want to continue my studies and build a new future for myself here. I want to leave what happened to me behind,” Amar said.

Meet Nebras

Photo: Rae Ceretto.
Photo: Rae Ceretto.

Nebras’ mother, Hanaan, remembers the accident.

“I was doing chores around the house. I put water on to boil in a kettle, and I forgot that I left it on,” Hanaan said. “Nebras was playing and accidentally pulled the kettle down, spilling the water.”

The scolding hot water left her with significant scarring on her face, chest, entire right arm and hand. Nebras was 1 year old when the incident happened, and the severity of the burns have required Nebras to receive emergency medical care and expensive, ongoing treatments ever since.

Today, Nebras is 15 years old.

She has received treatment from Operation Smile three times in the past. And during a recent medical mission in Madaba, Jordan, Nebras came again in search of additional care.

“I don’t remember any pain from my injury or any of my previous surgeries because I was so young. But I’m nervous to see the doctor today,” Nebras said. “I know I’ve seen lots of doctors before. I don’t know why I feel this way. It’s just something inside of me.”

Nebras travelled to the mission site seeking a treatment to help ease the pain in her hand caused by the burn.

“It hurts me when I write too much,” she said.

Writing is important to Nebras. She’s an extremely intelligent girl and a model high school student whose favourite subjects are science and maths. When she grows up, she wants to be a doctor.

“It’s a dream of mine. I like working to achieve challenging things,” she said.

Even though she enjoys school, Nebras still faces hurtful treatment from a few of her classmates. She says that they are rude to her because of the way she looks.

They know that she was burned many years ago, but they still ask, “Why does your face look like that?” with hopes that she will react.

“I try not to react, but it depends on my mood. If I’m happy, I explain the accident to them. If I’m sad, I ignore them, but it affects me a lot more.”

Thanks to Nebras’ caring friends, her attempts to disregard the bullies painful comments are made a little easier. She says that she feels lucky to have an amazing group of friends who support her.

“I have many friends. We’re very close to each other, we do everything together. They’re like my soul sisters,” she said.

Hanaan was asked why she chose Operation Smile to care for her daughter’s burns. Her answer was beautiful.

“I have trust in Operation Smile, that’s why I chose to come here. I want the best for my daughter. I know she will make an impact on society. I want her to be someone who empowers and inspires others, like a world leader or a president.”

From Hurt to Healing: Efren’s Emotional Change

Editor’s Note: The Philippines holds a special place in the history – and future – of our organisation. It was there that Dr. Bill Magee, a plastic surgeon, and his wife Kathy, a nurse and clinical social worker, became inspired to create Operation Smile after witnessing first-hand the dire need for life-changing cleft surgeries while working an independent volunteer medical mission in 1982. Unable to provide surgery for so many children due to lack of resources, the Magees promised to return. We’ve been going back ever since. As we work into our 35th year, we’re highlighting the birthplace of Operation Smile with this four-story series. This is the second story.

At 9 years old, Efren’s schoolmates were his worst enemies. He lashed out against his bullies, who constantly targeted him with insults because of his cleft lip and cleft palate. He came home in tears almost daily, his father, Efren Sr., recalled.

After receiving life-changing surgery from Operation Smile in the Philippines, Efren now carries himself with a sense of dignity and his outlook on life has been fundamentally changed – he’s happier, more confident and now looks forward to going to school.

“Those who have bullied him have now become his friends,” Efren Sr. said. “When he goes to school now, he is never in a fight. Now, the other children are happy for his sake.”

Photo: Jörgen Hildebrandt.

In the years leading up to Operation Smile’s intervention, Efren and his family lived with so much hurt in their hearts. When he was born, Efren’s mother, Juditte, was stricken with overwhelming sadness when she saw first saw her baby’s deformity. Juditte struggled to understand how her baby could be born this way. She thought it could be related to a fall she took when she was nine months pregnant with Efren, or it was a result of Efren sucking his thumb as he developed in the womb.

“We didn’t have any relatives with cleft, so we wondered why this happened to us,” Juditte said. “We felt so sad about his situation, and I have cried a lot.”

Scientists do not believe that either possibility Juditte pondered causes cleft conditions. In an effort to understand all known causes of cleft, both genetic and environmental, Operation Smile and its partners are leading the International Family Study, which seeks to translate medical research findings into preventative measures to help families like Efren’s in the future.

When Efren was 6 years old, the family was hopeful that he could receive surgery at a medical mission led by another non-profit organization. During screening, the medical staff discovered that Efren had an irregular heartbeat and believed that surgery would be too risky to perform.

Living in extreme poverty severely limited the family’s options for a future surgical solution. It would be three years before the Philippines-based non-profit Abounding In Love would connect Efren’s family with Operation Smile in June 2014. During that time, the family’s home was destroyed by Typhoon Yolanda in 2013. A tent provided by the United Nations Refugee Agency served as temporary housing for the family as they waited for their new home to be built.

With Abounding In Love covering their transportation costs, Juditte’s sister and Efren arrived at the Operation Smile medical mission site in Cebu for another chance to heal Efren’s smile. His parents had to stay home on Bantayan Island as Juditte had to care for their six other children and Efren Sr. could not afford to miss work.

A comprehensive health evaluation performed by Operation Smile medical volunteers found that the irregularity of his heartbeat was so minor that surgery posed no threat to Efren. Finally, he was cleared for surgery to repair his cleft lip.

After Efren’s successful procedure was complete, his aunt could breathe a sigh of relief. She looked forward to also relieving Efren’s parents’ anxiety by returning to Bantayan Island with Efren and his new smile.

Photo: Jörgen Hildebrandt.

“I am so happy now – I can’t express in words how happy I am. It hurt so much every time I saw him come back from school crying before,” said Efren Sr., whose son’s speech abilities dramatically improved in the months following his cleft lip surgery.

Without the help of Operation Smile, Efren’s parents would not have been able to afford surgery for their son. Efren’s father is a fisherman and struggles to make enough to feed his family of nine. The older children work with their father, instead of going to school, to help supplement the family income. However, Efren Sr. envisions a brighter future for his son.

“I am hoping Efren will continue school up to a high level and go to college – I would like him to become a teacher,” Efren Sr. said. “He has big dreams, but couldn’t do it without surgery – without Operation Smile.”

Photo: Jörgen Hildebrandt.

“A Pillar of my Life”

Ángel and his daughter, Karla, waited anxiously.

At an Operation Smile medical mission in Puebla, Mexico, screening day had already been long and exhausting before a medical volunteer would announce which patients had been put on the surgical schedule.

Questions were asked about Karla’s history with her cleft lip and palate, photos were taken for health records and medical volunteers conducted a comprehensive health evaluation to determine if she was healthy enough for safe surgery.

But for Karla and her father, their anticipation would soon become elation.

“When they called her name, I didn’t know whether to cry, laugh or sing,” Ángel said with tears in his eyes, as he reminisced on that special day.

Karla, age 2. Photo: Jasmin Shah.

More than two years before travelling to the mission, Ángel and his wife, Julieta, were thrilled to be three months into the pregnancy of Karla, their fifth child. But their excitement soon turned to heartbreak when an ultrasound showed that their baby would be born with a cleft condition.

“We felt badly,” Ángel said. “Pain, anger. That’s how I felt.”

But the pain he felt couldn’t compare to the love he felt for his daughter. Even when his neighbours blamed him for Karla’s condition, Ángel never stopped loving and fighting for her.

“My daughter Karla is a pillar of my life and the reason I value life,” he said.

Her cleft lip and palate caused eating to be difficult. For the first year of her life, Karla had to be fed with a syringe.

Ángel searched for a hospital or organisation that would provide affordable surgical care for his daughter, and for months, he was met with disappointment.

Feeling strained but determined, he continued his search until he found a local organisation that not only connected him with Operation Smile Mexico, but also provided him transportation to the medical mission.

After years of feeling helpless, hope finally returned to Ángel.

After the numerous obstacles Karla and her father faced together, Karla’s chance at a brighter future had arrived.

Karla enjoys singing and playing with local volunteers in the child life area. Through play, these young patients are able to remain calm and happy in this new, and often stressful, hospital environment. Photo: Jasmin Shah.
When it's Karla’s turn for surgery, her surgeon, Dr. Blas Dominguez of Mexico, and clinical coordinator Rosy Frias take Karla to the operating room. Photo: Jasmin Shah.

As he watched his daughter walk toward the operating room, Ángel became anxious but had faith in the Operation Smile medical team.

After his daughter’s cleft lip surgery, Ángel could not look away from his daughter’s new smile.

“The feelings I had when I saw her, with the surgery done, I cried inside. I was happy,”  he said. “I will make it my life’s mission to find and help families with clefts.”

Karla sees her new smile for the first time. Photo: Jasmin Shah.

And today, Ángel is doing just that.

At the most recent Oaxaca mission, he volunteered as a patient advocate, comforting nervous parents and letting them know what to expect just as someone did for his family two years before.

Double the Smiles

Manus, left, and Wanna hold their twin sons, Ou and Lak, centre, as they await their comprehensive health evaluations during an Operation Smile medical mission in Thailand. Photo: Peter Stuckings.

Thailand’s beauty is not only seen woven within its towering forests and cascading waterfalls, but also in the smiles of its people.  

In Thai culture, a smile can convey more than just happiness or pride. It can also express an apology or exhibit sorrow with the idea that obstacles in life are more easily overcome if confronted with a smile. Because of this belief, Thailand is aptly nicknamed “The Land of Smiles.”

And in rural north-eastern region of the country, Wanna and her husband, Manus, work hard to provide the best possible lives for each other and their three children.

Yet, the challenges the family faces every day couldn’t prepare them for the news that they received four months into Wanna’s second pregnancy with their twin sons, Lak and Ou.

An ultrasound revealed that Ou had a cleft lip and palate.

While Wanna was devastated by the news, Manus felt enormous guilt and believed that he was the sole cause of his son’s condition. He attributed it to bad karma because each time that he fished, he would tear the hook from the fish’s mouth, leaving an open gash in its lip.

His feeling of blame only intensified after the delivery of the other twin, Lak, who was born with a cleft lip and palate that wasn’t detected by the ultrasound.

Ou, left, and Lak. Photo: Peter Stuckings.

After the twins’ births, a doctor informed Wanna and Manus that surgery was possible – a huge relief because their cleft conditions caused Lak to struggle when drinking milk and Ou to choke when being fed.

While they were grateful that surgery was an option, the family couldn’t afford the cost.

While Wanna cares for the children at home, Manus farms rice and cassava on the nine acres of land that he leases. At the most, he makes a low and inconsistent income of around £1,200 a year. Half of this total is then paid to the land owner.

But the young parents were determined that both of their sons would receive surgery to fix their conditions and help them eat without difficulty. They also knew that their sons faced lives filled with ridicule and exclusion due to deep-rooted social stigma associated with cleft in their community.

Nothing would stop them from finding a solution and, thanks to Operation Smile Thailand, they did.

Soon after the twins were born, they learned about a medical mission taking place in nearby Ubon Ratchathani, Thailand, where a team of medical volunteers could perform surgery, free of charge.

Once Lak and Ou received comprehensive health evaluations, the 8-month-old boys were deemed healthy enough to receive surgery and placed on the mission schedule.

Wanna and Manus see their son Ou's smile for the first time after his cleft lip surgery. Their other twin son, Lak, also received cleft lip surgery during the same mission. Photo: Peter Stuckings.

Wanna was overjoyed with the results of her sons’ cleft lip surgeries. But she was still worried because both twins continued to struggle to eat and drink. The boys needed to grow bigger and stronger before they could receive cleft palate surgeries.

And one year later, Lak and Ou returned to a mission in Surin and got the operations that made eating and drinking effortless.

Ou, left, and Lak, one year after their cleft lip surgeries. Photo: Peter Stuckings.

Wanna diligently works with the twins to improve their speech by using the exercises from an Operation Smile Thailand speech training camp they attended two years after their palate surgeries.

As twins, Lak and Ou are very similar. They both love spicy food, mangos and riding bikes outside of their home. However, Lak, the elder of the two, has a hot temper and is closer to his mother, while Ou is very headstrong and always talks about how he is “dad’s son.”

Ou, left, and Lak, three years after their cleft lip surgeries. Photo: Peter Stuckings.

By providing access to free, safe surgical care, Operation Smile gave Lak and Ou more than just new smiles. It restored a vital aspect of their culture and ensured that the twins would grow up happier and healthier with the promise of brighter futures.

“I would like to thank Operation Smile who helped my sons get surgery,” Wanna said. “This project could help all Thai children with cleft have new smiles.”

Photo: Peter Stuckings.

The Tailor of Her Future

It’s been a jarring and crawling two-hour drive since the pavement of the nearest town gave way to a red clay road pocked with pools of muddy water that conceals vicious potholes and crevices.

The condition of the road stands in stark contrast to the lush natural beauty that surrounds it as you head deeper into jungle. Just as it narrows down to a car-wide path cut through the thick tropical underbrush, the road widens, and the vegetation clears.

A small green hut emerges a couple of hundred metres ahead.

Photo: Zute Lightfoot.

Now 18 years old, Faustina stands behind a manual sewing machine, focussing on a line of stitches that she’s running into a bolt of purple and white fabric. Under the shade of this green hut, under the watchful eye of Memunatu, the village’s head seamstress, Faustina and her classmates are studying to become masters of the craft.

The sounds of cheerful laughter and conversation fill the humid air, echoing into groves of green cocoa trees as the near-equatorial sun shines brilliantly.

Photo: Zute Lightfoot.

“To be honest, with my cleft, I could have never imagined this kind of a future for myself,” says Faustina with a cool confidence as 17 years of isolation and stigmatisation are sent into the past with a subtle giggle.

The change in Faustina’s demeanour is as dramatic as the physical transformation of her smile – both made possible by a surgery that lasted a little more than 45 minutes.

When we first met her at an Operation Smile Ghana medical mission, her eyes reflected a lifetime of pain and longing. She stuck close to her father, Mohammed, as she dreamed of what her life could be like after surgery.

Today, Faustina is the tailor of her future.

Faustina, her teacher, Memunatu, centre, and her fellow sewing apprentices. Photo: Zute Lightfoot.

“I wanted to be a hairdresser, but after the surgery, I gave it some thought and realised that I really wanted to be a seamstress,” Faustina says. “Learning to be a seamstress makes me happy, and I will be able to help my family by sewing for my siblings and my mother and father.”

Her teacher tells us more about how Faustina has transformed into the friendly, often outgoing, young woman that she is today.

“Before the surgery, she used to be a shy type, quiet type, that any time there is gathering you would definitely not find her among the people showing up,” Memunatu says. “After surgery, what I’ve seen is that she is now very friendly and she’s open. She has a lot of friends and you can see that now she feels free.”

Memunatu adds that Faustina been a quick study as a seamstress, and that she envisions a bright future for her in the craft.

Faustina says that she’s completely focussed on studying the craft of sewing and that her goals are both to get her own sewing machine and to master sewing so that she can open her own shop. She envisions a future where she meets a good man, gets married, starts a family and supports her parents as they grow older.

As we talk to Faustina, her selfless nature becomes more apparent. She tells us that the reason she pivoted from dreams of hairdressing to sewing was because sewing was something that she could do for the entire family, community and herself, whereas hairdressing limited her to a smaller group of people.

Faustina and her father, Mohammed. Photo: Zute Lightfoot.

“As a father, my wish is to see that my daughter achieves something in life, and it’s her greatest wish to learn something, and I realise that sewing is what she’s very passionate about,” Faustina’s father, Mohammed, says.

“I know that life has its trends. You pass through difficulties before you get to the promised land, before you make it. So for me, I see her life going through this process. Operation Smile gave her that surgery, and it’s making life easier for her to push for achieving her dreams.”

Mohammed says that every day when he prays, he prays for the continued success and deepening of the skills of everyone involved with Operation Smile.

Faustina and her stepmother harvest cocoa near their home. Photo: Zute Lightfoot.

Faustina’s home is located at the top of the tallest hill in the area. It’s surrounded by the cocoa trees that her family and other community members farm for the Ghana Cocoa Board, which buys the beans for commercial distribution. This is the community’s principal form of income. Subsistence crops are also grown, and livestock are raised to round out the lifestyle. The natural beauty surrounding the village is absolutely breathtaking.

Faustina and Mohammed lay out cocoa beans for drying. Photo: Zute Lightfoot.

Although Faustina’s community has rallied around her since her surgery, the spectre of the mistreatment that she endured for most of her life lies just under the surface.

As she sits proudly atop full bags of cocoa beans next to the village’s scale, we ask her a question that evoked deep emotions in everyone within earshot: “How have you been able to forgive and befriend the same people who once treated you so poorly?”

“I have forgiven them,” Faustina says. “But I’ve realised that they have this sort of guilt in them because of how they acted towards me before my surgery. And now that they have accepted me, deep in their minds, you realise that they have this sort of ill feeling of guilt in them. But for me, I don’t hold anything against them. I have accepted them as friends.”

Faustina poses with her family and members of her community. Photo: Zute Lightfoot.

She tells us that before surgery, when she dreamed, she would have her cleft lip and that those dreams would be sad. But after surgery, those dreams ceased and that she would be as she is today, singing in front of her church. Now that she can — and does — sing before the congregation, she says she feels like her dreams have come true.

“When I fetched water with a cup to drink, no one wanted to use the same cup as me. So life, as a whole, was not pleasant for me; I wasn’t a happy person,” Faustina says. “So, there was no way that it could cross my mind that the future would look bright.

“But now, looking at this change and the ability to mingle with people, to go everywhere that I want to go, everyone accepting me, I see a bright future. Now, when I take a cup and fetch water and drink, people use that same cup and drink.

“It means that I’m accepted by all.”

Photo: Zute Lightfoot.