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.

Building the Capacity to Heal

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

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

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

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

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

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

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

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

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

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

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

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

Child life specialists are an integral part of that community.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Exchange for Smiles

Maria smiles wide with her new dentures that she received during Operation Smile Nicaragua's first combined dental and surgical medical mission in March 2019. Photo courtesy of Ryan Cody.
Maria smiles wide with her new dentures that she received during Operation Smile Nicaragua's first combined dental and surgical medical mission in March 2019. Photo courtesy of Ryan Cody.

For 42 years, the only food that Maria could eat was what her two teeth could grind down, and all she could say were the few sounds that she could form with a gap in the roof of her mouth.

Countless meals left on the plate. Countless thoughts left unsaid. For far too long.

Maria was willing to do whatever it took to access the care that she needed. Even a 10-hour journey from her village to the clinic in Managua, Nicaragua, couldn’t deter her.

When she arrived, Operation Smile Nicaragua and the Exchange for Smiles team were ready and eager to help.

During its first-ever combined dental and surgical medical mission in March 2019, Operation Smile Nicaragua teamed up with a cadre of second- and third-year students from the University of North Carolina at Chapel Hill Adams School of Dentistry.

The team not only provides the highest quality of care to their patients, but also mentors the next generation of dentists.

“Our programme employs a direct exchange: one UNC student paired with one Nicaraguan dentist,” said Ryan Cody, a fourth-year UNC dental student and founder of Exchange for Smiles. “At the end of the day, it’s the exchange of knowledge and resources for the gift of a smile.”

Maria’s care exemplifies the special dedication and devotion of this partnership.

By rallying together, the teams treated Maria’s two teeth, which had become infected over the years, and created dentures that would allow her to chew easier, eat better and smile bigger.

“We worked endlessly, Monday through Friday, fabricating dentures. We were nervous that we wouldn’t finish, as the denture fabrication process in the U.S. can take months,” Ryan said. “However, with teamwork, close communication and incredible laboratory support, the moment we were waiting for arrived.”

Photo courtesy of Ryan Cody.

For the first time in many years, Maria got to enjoy her meal – a meat dish with rice – thanks to the dentures that the team had crafted for her.

Ryan said that by the end of the March mission, they had educated and treated 250 more patients just like Maria.

This included a combined 732 dental consultations and procedures on top of the 230 dental patients that the partnership treated during its first Exchange for Smiles mission in March 2018.

Ryan’s Exchange for Smiles journey started when the long-time Operation Smile student volunteer pitched the idea to his mentor Dr. Bill Magee III, the son of Operation Smile Co-Founders Bill Magee and Kathy Magee.

Using the guidance and encouragement he received from the Magee family, Ryan boarded a plane to Nicaragua and presented his proposal to the executive director of Operation Smile Nicaragua. Ryan’s proposal earned him the support of both Operation Smile Nicaragua and UNC.

After fundraising to cover dental equipment, Ryan headed back to the country to purchase equipment as a contribution to the centre and an investment in the programme.

Empowering two teams of students and mentors to treat Maria and more than 500 patients like her was the dream.

The guidance and mentorship of Teresita Pannaci, Operation Smile volunteer dentist from Venezuela who took part in both Exchange for Smiles missions, also served essential roles in the programme’s educational effort.

As a functional orthopaedic maxillary trainer, Teresita teaches fellow volunteers in multiple countries around the world. Her creation of a doll named DAM simulates the experience of a newborn living with cleft palate and helps students practice taking intraoral impressions.

“Exchange Smiles is a wonderful programme with a powerful title,” said Teresita, who’s been a volunteer with Operation Smile since 1993. “In the end, the results exceeded my expectations. The excellent students of UNC, their participation, talent and commitment have favoured the community of Nicaragua.”

Photo courtesy of Ryan Cody.

The cornerstone of the Exchange for Smiles programme is education. The dental school students learn from their mentors, but most importantly, the dental school students are given the opportunity to use what they have learned to teach oral health and hygiene skills to patients and their families.

For second-year UNC dental student and vice president of Exchange for Smiles Celeste Kendrick, the importance of oral hygiene instruction was one of the biggest lessons she took home from the experience.

“Some patients told us they had never been taught that brushing their teeth would help prevent oral disease and pain,” said Celeste. “They thought it was a natural, unavoidable part of life.”

When looking ahead to the next steps of its own education, the Exchange for Smiles experience has helped to calibrate the compass for both Celeste and Ryan.

“After being on a mission with a dental lens, I left slightly overwhelmed, yet motivated, after seeing first-hand how much need there is for dentistry post-surgery,” Celeste said. “This trip helped renew my purpose as a dental student and allowed me to see how important my education truly is.

“There are patients who need help, and though it may not seem like we’re making a difference by studying, they rely on us to do our part and become the best providers we can be.”

Photo courtesy of Ryan Cody.

Open Heart, Open Hands

Patient coordinator Carlos Mahalambe, left, rejoices with the patients and families he accompanied to Operation Smile’s July 2018 Quelimane medical mission. Photo: Zeke du Plessis.

Without its global network of selfless, caring and generous volunteers and staff, Operation Smile simply wouldn’t exist.

The organisation’s free, life-changing cleft surgeries are only made possible by people who unite from all walks of life, devoting their time, energy and compassion to those who need it most.

Through his work as a patient coordinator, Carlos Mahalambe is one of those people.

Driven to help Mozambicans affected by cleft conditions, the 42-year-old then-volunteer was responsible for bringing 18 potential patients to Operation Smile’s July 2018 medical mission held in Quelimane. As a staff member of Operation Smile in Mozambique, his efforts continue to make an immense impact: Carlos successfully recruited 89 patients to attend the August 2019 mission in Nampula.

“I was notified about the (Quelimane) mission, so I got in touch with the team and began advocating for patients,” said Carlos, smiling as he described his work. “I brought four people from my region, and when I arrived, I made some phone calls and connections and found another 14 potential patients in this region.”

Taking a unique path to becoming involved with Operation Smile, Carlos first learned about the organisation and its work in 2013 when he saw a poster at his previous workplace promoting an upcoming medical mission. While he had seen people living with cleft lip and cleft palate before, he never knew that surgery could repair the conditions.

Immediately, he knew that he could help.

“I was working at a lodge in Inhambane when I saw a poster for children needing help, and so I started to volunteer,” said Carlos, who worked as a luxury lodge manager. “I looked for patients, contacted them and dealt with the community to spread the word about recruiting patients.”

At the Quelimane medical mission’s patient village, patient coordinator Carlos Mahalambe was constantly on the move, supporting patients in any way he could. Photo: Zeke du Plessis.

Carlos helped patients and their families receive care from Operation Smile at both of its 2014 medical missions in Mozambique, as well as assisting with the post-operative process.

Soon thereafter, Operation Smile made the tough decision to suspend operations in Mozambique due to political unrest unfolding at that time. By 2017, those tensions had eased, and Operation Smile reached a new agreement with the Mozambican Ministry of Health. Going forward, the partnership will focus on conducting medical missions and providing training and education opportunities for local health professionals.

Even after the three-plus year pause in activity, Carlos was ready to jump back in when Operation Smile came calling again in 2018.

Raising awareness on the community level that cleft conditions are surgically treatable, Carlos uses pamphlets and literature provided by Operation Smile to explain the organisation’s mission when he visits schools and clinics.

“I talk with the people and say, ‘If you know any people who look like this and who need help or can’t afford to go for local surgery, they can please contact me and so I leave my number,’” Carlos said. “When they contact me, I forward them to Operation Smile. They then contact me and send me the scheduled date for the missions. I then let the patients know and I bring them with me.”

At the Quelimane mission’s patient village, Carlos was constantly on the move, supporting patients in any way he could.

“I assist with translating, helping patients with screening, making sure they get food and accommodation,” Carlos said. “If they get sick, I get them to the nurses and also helping them with anything they need.”

To be able to volunteer as a patient advocate throughout the Quelimane mission, Carlos used all of his annual leave, effectively donating that paid time off to the service of patients and their families. Uninterested in receiving praise or recognition for his efforts, he simply told his employer and co-workers at the time that he would be on vacation.

His motivation is as pure as it is profound.

“I feel happy because it’s like I am changing the life of the patient and that makes me very proud,” Carlos said. “I also see people being changed and becoming equal with the rest of the community. That makes me very happy.

“Let us open our hands, let us open our hearts and try to help those in need. It is very important for us to change the lives of others so they can become one with the rest of society.”

Patient coordinator Carlos Mahalambe speaks with Sean Robson of Operation Smile South Africa during the July 2018 Quelimane medical mission. Photo: Zeke du Plessis.

His Grain of Sand

Driving down his typical sales route, Victor Hernández, a Sabritas delivery driver in Chiapas, Mexico, saw something that shook him to his core.

After noticing a group of children playing together near the side of the road, Victor decided to pull his truck over and offer them a simple act of kindness – some bags of free potato chips.

When Victor approached the kids, he came face to face with Irma, a 5-year-old girl who was living with an untreated cleft lip and palate.

Immediately, he began making phone calls to his colleagues to find help for her.

“For me, it was important to act immediately because … the faster I acted, the chances of finding help would be better,” Victor said. “I would be able to get more support. It involves looking here, searching there, talking to this person, talking to that person, and maybe that way I was going to find support faster.”

Sabritas driver Victor Hernández stands in front of his delivery truck in Chiapas, Mexico. Photo: Rohanna Mertens.

It was then that Victor learned that Sabritas is a long-standing corporate partner of Operation Smile Mexico. Sabritas is a subsidiary of PepsiCo as is Lay’s, which partnered with Operation Smile for two successful U.S. campaigns, “Smile with Lay’s,” that raised $1 million in both 2018 and 2019.

And one of his colleagues told him that, at that very moment, Operation Smile was hosting a medical mission just 40 minutes away from Irma’s community.

Victor returned to explain to Irma’s parents that free and safe surgery was possible at the mission.

After Victor carefully explained what they could expect, Irma’s parents agreed to have him pick them up and take them to the mission site two days later.

This was the first time that Irma had ever left her community.

After receiving a comprehensive health evaluation from Operation Smile Mexico medical volunteers, Irma underwent surgery to repair her cleft condition, ensuring a brighter future full of smiles – a future that she always deserved.

“Seeing her finally smile, and with her face completely changed, despite the stitches she had, gave me a pleasant feeling,” Victor said. “It’s really indescribable because we knew then that this girl would have a completely different life.”

Photo: Rohanna Mertens.
Photo: Rohanna Mertens.

Today, Victor continues his advocacy for patients like Irma living with cleft conditions in the communities around his route.

“After little Irma’s operation, I tried to get more involved,” Victor said. “I felt the urge to put up posters in stores, talk to people and see if they knew anyone with the same condition, try to get them to approach me so that I could channel them into the right hands.

“As a human being, I felt so much tenderness and concern to see the needs of these children.”

Victor’s commitment to spreading awareness continued to strengthen, and more people began to see him as a reference for Operation Smile Mexico – as a person they could trust to help.

Eleven-month-old Carlos with his parents, Azucena and Juan Carlos, and Victor at their home in Pueblo Nuevo, Mexico. Photo: Rohanna Mertens.

It was then that Juan Carlos and Azucena approached Victor, hoping that he would help their 11-month-old son, Carlos, who was living with an unrepaired cleft. Victor immediately told them that Operation Smile Mexico was the solution.

Photo: Rohanna Mertens.

“Little Carlos’ parents are young and, like all parents, sometimes they worry a lot about their children,” Victor said. “But I see that they care for him, love him, and they’ve done the impossible by bringing him (to Operation Smile).”

Medical volunteers performed a comprehensive health evaluation on Carlos and determined that he was healthy enough to receive safe surgery and a new smile.

The day that Victor made the decision to help Irma, the course of his life changed forever. And connecting Carlos and his family to Operation Smile only inspired Victor to do more for the people living with cleft in Mexico.

“One’s life changes when one cares about the little people one helps,” Victor said. “I feel really good, and I would like to help more people. I know that, perhaps, what we do is a small thing, just a grain of sand, but with that grain of sand, a life can be changed. And if we just look around us, we can see more people in need.”

Victor with Azucena as she holds Carlos in her arms after surgery during Operation Smile's May 2019 medical mission in Mexico. Photo: Rohanna Mertens.

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.”