Children, parents and family have travelled – some for hours or days – by car, by bus or by foot to be here, at an Operation Smile medical mission. They’re hopeful. They’re anxious. Tragedy is almost certain without surgery. And for some, this day couldn’t have come sooner.

Part One

An Uncertain Future

Twenty years. Twenty-five years. Fifty-four years. That’s 99 years of needless suffering experienced by three of our patients: Virgilio, Enok and Marco.

As Senaida sat next to her son, Virgilio, she couldn’t help but smile widely when she looked at him. For Virgilio, each smile he shares with a new friend is a small victory over the 20 years of despair in which he lived.
Man showing friend his phone
Enok remembers being jeered, chased by packs of children and having people recoil in disgust at his cleft lip. While his memories echo the stories of thousands of Operation Smile patients – most young children – Enok already endured a lifetime of torment when he received surgery at 25 years old.

As soon as a child is born with a cleft lip or cleft palate, there are daunting odds stacked against them.

In many areas of the world lacking critically needed resources, people can’t get the surgical care they need from their local health systems, when they need it. Even if care is present, poverty prevents all too many people from getting surgery. Time and time again, this proves deadly for children born with cleft conditions.

“As many as 93 percent of children with untreated cleft conditions could die before their 20th birthdays.”

 

—Mossey PA, Modell B. Epidemiology of oral clefts 2012: an international perspective. Frontiers of Oral Biology. 2012; 16: 1-18.

And if these children survive into adulthood, like Marco, who lived with a cleft condition for more than five decades, their lives are often marked by loneliness and painful bullying.

Parents who bring their children to Operation Smile hope for surgery that can change all of that.

Healing After 54 Years

The Surgery He Always Deserved

Part Two

Safety on Centre Stage

But first, paediatricians need to perform comprehensive health exams to ensure that patients can safely undergo surgery.

A paediatrician’s findings are shared and discussed with the medical mission’s clinical coordinatorpaediatric intensivists and anaesthesiologists to determine if it’s safe for the patient to be put under anaesthesia – the aspect of surgery that presents the most risk in any environment, including the world’s most advanced hospitals.

Paediatrician Dr. Emmanuella “Ella” Amoako of Ghana uses play so she may listen to a young patient’s heartbeat and breath and ask questions about his medical history as part of the comprehensive medical evaluation process.

Part Three

A Burden No One Should Bear

Sometimes offering up their stethoscope to curious patients, paediatricians can seem light-hearted while taking their role seriously.

While play serves its purpose among medical volunteers to help build trust with patients, this initial evaluation is critical to the patient’s safety ‒ like that of 4-year-old Ramata in Ghana. Though cleft surgery is ideal at the youngest possible age, Ramata experienced chronic health complications and surgery was too risky.

It was heartbreaking for the medical team to give the news to her mother, who travelled hours on rough roads with Ramata to the mission site with the hopes that her daughter could receive surgery.

Ramata’s Smile

Five Times Denied

Five times, Ramata’s mother travelled to get surgery for her daughter. Five times, the trip home was made rockier by heartbreak.

While Ghana offers some of Africa’s most beautiful landscapes, it also suffers from a critical lack of adequate infrastructure, health care services and economic opportunities, resulting in some of the world’s most significant barriers to safe surgical care for its citizens. Our vision of improving patients’ health and dignity through safe surgery is backed by the idea that no one deserves to live with the burden of a cleft condition.

Each of Operation Smile’s medical volunteers wish that no family or patient would have to experience the disappointment of being turned away from surgery, but a patient’s safety is always the first priority.

Paediatrician Elodi Priranja of Madagascar leads a workshop on breastfeeding techniques for parents whose babies are too small to receive safe surgery during Operation Smile's 2017 medical mission to Antsirabe. Photo: Zute Lightfoot.

Part Four

Treating the Whole Patient

When a patient is healthy and approved for their life-changing procedure, feelings of joy can turn into anxiety as surgery day approaches.

Surgery often strikes fear in patients and their families, some of whom have never stepped foot inside a clinic or hospital. Medical environments can be sterile and uninviting, but child life specialists help ease patients’ tension by using therapeutic play to create an environment that is welcoming and friendly.

Using equipment like anaesthesia masks during these sessions is a method that child life specialists use to help children understand and become more comfortable with the medical setting, calming their nerves prior to being admitted into the operating room.

Easing Fear, Building Trust

Purposeful Play

Building trust between children, families and the medical mission or care centre team is another key function of child life specialists’ work.

When patients are under anaesthesia – especially as soon as it has been administered and before the patient returns to consciousness – paediatric intensivists are at-the-ready to recognise and react to any medical complications with cardiopulmonary resuscitation, medication and other live-saving treatments.

The vast majority of Operation Smile patients are children. While their roles differ greatly both at their respective workplaces and whether at an Operation Smile medical mission or at one of our care centres, open communication between paediatricians and paediatric intensivists is crucial to our ability to deliver the best possible surgical results for our young patients.

Paediatric Intensivist Marcos Polar of Perú attends to a child in post-op at a medical mission in Arequipa, Perú. Operation Smile’s volunteer paediatricians and paediatric intensivists are paramount to providing medical evaluations and treatments. Photo: Margherita Mirabella

Part Five

A Global Standard of Care

Reinforced by more than three decades of leadership in performing safe surgery in resource-limited environments, we know that a single surgical procedure is a small part of a larger, multi-tiered process that’s focussed on the entire well-being of the patient.

“By investing in bringing in the full cadre of specialties, local health systems take notice and will aspire toward exceptional patient care. We believe that anything less than excellence is unacceptable.”

 

—Dr. Bill Magee, Co-Founder and CEO of Operation Smile

Our compassion for those we serve is put into action well before the surgeon makes the first incision and long after the final suture is closed. This commitment to the completeness of patient care doesn’t only ensure the best possible outcomes; it’s the right thing to do.

We want to reach patients as early as possible. At the hospital where Luciana was born, a doctor told her father, Daniel, about Operation Smile – an organisation that offers expertise in treating cleft conditions at no cost to its patients or their families. Photo: Rohanna Mertens
We want to reach patients as early as possible. At the hospital where Luciana was born, a doctor told her father, Daniel, about Operation Smile – an organisation that offers expertise in treating cleft conditions at no cost to its patients or their families. Photo: Rohanna Mertens
We partner with patient advocates like Don Alex and Don Rudis in Honduras to find the hardest-to-reach people living with cleft – whether they’re babies like Manuelito or men like Marco – and make comprehensive cleft care accessible to them. Photo: Rohanna Mertens
We partner with patient advocates like Don Alex and Don Rudis in Honduras to find the hardest-to-reach people living with cleft – whether they’re babies like Manuelito or men like Marco – and make comprehensive cleft care accessible to them. Photo: Rohanna Mertens
Olga Sarmientos is a speech therapist at the centre in Bogotá who used to see Oscar when he was a patient there. “... to see him so satisfied and happy with himself, makes me extremely happy,” she said. Photo: Rohanna Mertens.
Olga Sarmientos is a speech therapist at the centre in Bogotá who used to see Oscar when he was a patient there. “... to see him so satisfied and happy with himself, makes me extremely happy,” she said. Photo: Rohanna Mertens.

Guided by our Global Standards of Care*, our incredible nurses and plastic surgeons – together with our paediatricians, child life specialists, paediatric intensivists, anaesthesiologists, among other critical medical specialties – deliver surgical results consistent with the world’s finest hospitals.

“In the settings we go into, we know that patients may not have access to the full complement of these specialties,” said Operation Smile Co-Founder and CEO Dr. Bill Magee. “So we’ve always set the stage for excellence – never modelling mediocrity.”

Why go to these lengths? The answer is simple: our patients deserve it.

*Global Standards of Care © 2006, 2015 Operation Smile, Inc. All Rights Reserved.

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