A future where no patient’s left behind

Q&A with Wone Banda

She’s volunteered for Operation Smile since 2017 and works at the Kamazu Central Hospital in Lilongwe, Malawi. Wone tells us more about her work, her hopes for Malawi and the ongoing hospital partnership with Operation Smile.

Q. What motivates you to volunteer for Operation Smile?
A. “I’m very passionate about cleft in general and I enjoy building a relationship with the parents and guardians, because it’s mostly the mothers or guardians that bring their children to the hospital. They come in anxious and with all sorts of horrible stories from their background. Stories of stigma and people just not understanding cleft conditions in their communities.

“They come in with this hope that I could improve the lifestyle of their child, so that when they go back to their communities, they’re able to integrate in a better way. They come in with all these high hopes and put us under this pressure to deliver, of course, because then you do the surgery for them and you see the results immediately. Once they see their child post-op, there’s always this overwhelming joy and they share that. They’re very expressive about that.

“It’s really great to know – that usually within 45 minutes for a cleft lip repair – you’ve completely transformed somebody’s whole life, and not just the patient, but also the relatives of that patient. It’s a really good feeling!”

Q. What made you choose a career in medicine?
A. “I chose a career in medicine because in my country, Malawi, we don’t have enough doctors to go around. The patient-to-doctor ratio is just ridiculous. We need more and more people in the service. I wanted to contribute, I wanted to do something that had a meaningful impact for my country. There are different ways to do it, but I thought helping people get better and feel better is the way that I wanted to pay back to my country and contribute.”

Q. How has volunteering with Operation Smile impacted you – both professionally and personally?
A. “Because of these regular surgeries and cleft work that I’ve been doing, I have really gotten better at it. I have also had opportunities to network with other people in the same field.

“For instance, at the recent Cleft Conference, I’ve met so many brilliant minds and attended so many presentations. I have gained a lot of knowledge, and when I came back, I was able to apply some of that knowledge into my practice. Professionally, I have really grown just by working with Operation Smile.

“Also, on a personal note, I feel happy because I feel like I’m helping so many people. Without Operation Smile, I probably wouldn’t be helping as many of those patients with cleft conditions as I am, because I probably wouldn’t know where to even begin to find them to begin with.”

Q: Can you tell us about Operation Smile’s partnership with the hospital in Lilongwe?
A: “There’s two types of frameworks that are currently ongoing in Malawi with Operation Smile. One of the ways that we collaborate is through what we call patient sequencing. Patients come into the hospital on a weekly basis for screening and then once they’re screened and are fit for surgery, we have an operating day where they get their surgery. Then we have follow-up clinics for them and they’re basically in the system.

“The other way is through the regular surgical programmes that we have. This year we’ve had two surgical programmes, one of them was what was called a long-term placement – we had a whole month of operations and screenings, and we can perform a lot of surgeries for that month. We had two weeks with a visiting plastic surgeon, and then the following two weeks was with a different visiting surgeon as well, which was great because then I had a chance to meet these two different, very experienced cleft surgeons. I learned quite a few things from them as well just by talking to them. Although we were both running separate operating tables, so it was not like I was working full-time with them, but we could discuss and exchange ideas and plan for the surgeries. It was a great experience.”

Q: What do you think that are the biggest barriers to care for our patients? 
A: “I think the biggest barrier is poverty, because people are really struggling to just make ends meet. For them to come to the central hospital (I’m in Lilongwe, which is at the centre of Malawi, but my patients come from all over the country), it’s not very cheap for them to get there. Operation Smile funds their transportation, but if they haven’t yet gotten in touch with Operation Smile, it’s really difficult, and it’s not just patients with cleft, it’s also patients with any surgical need. It’s difficult for the people that are struggling to come to our hospital. They’ll probably go to their nearest health facilities who have no clue about what to do with them if they need surgical care. We’re trying to give them that information out there, but there’s still people that are not aware that they can get help for this.

“There is also a language barrier, because we have so many languages in Malawi and people get anxious to say, ‘If I go there and I can’t speak their language, how would I communicate?’

“Then another barrier to seeking help is also fear because people associate surgery with scary, scary stuff. It’s like, ‘Okay, I have a child who was born with this problem, but at least they’re alive. If they undergo surgery, I might actually lose them, so why should I even bother? I’d rather just keep them that way’ Often in the villages there are myths about treatments and there is lack of trust in hospital care. Then also then there’s just not knowing that there’s help out there.”

Q: What are your hopes for Malawi in the future?

A: “I would really love to see Malawi having no children or adults living with untreated cleft conditions. I would like to be working on newborns only, not seeing patients left behind. We have patients that are living with cleft, some of them don’t even know that they can be treated or how to access care.  

“Operation Smile has a really good patient recruitment system, where they visit rural communities to pick out all those people that usually don’t know that they can get help for their condition. I think those are the people that I’m really looking forward to treat, so that at some point we will reach a scenario where there will not be people left out there experiencing all this stigma and not knowing that they can actually get help. I would really like to see more surgical capacity in Malawi so that there’s more of us providing cleft surgeries. The more surgeons and medical teams there are, the more help we can give to the people, and we’re not going to have patients with untreated cleft anymore, and we’re going to help many people as possible.”

Cleft care in Malawi since 2012