Jackie’s story

Jackie Matthews, works as Clinical Nurse Specialist for South Thames Cleft Service at Guy’s and St Thomas’ Hospital, based at Queen Victoria Hospital at East Grinstead. She specialises in the care of infants and young children born with cleft conditions but she is also an Operation Smile volunteer and UK Medical Subcommittee member.

She has been on missions to Mexico, twice to the Dominican Republic and to Ghana.

Can you tell us more about your medical missions with Operation Smile?

I went on my very first medical mission as a volunteer in 2011 to Guadalajara, Mexico. My role was to help children in recovery just after they had received surgery.

On my second medical mission, and as the only British nurse on the mission, I joined other professionals from the USA, Sweden, Russia and Estonia, flying to Santo Domingo in the Dominican Republic.

There we screened more than 120 babies, children and adults, and had four operating rooms running consecutively, performing facial repairs for cleft lips, palates and other deformities. In total, we performed surgery on 79 patients, the youngest being just six months old – a little boy named Joshua.

I was lucky enough to follow little Joshua through the patient journey, accompanying him at screening, pre-operative assessment and on the morning of his surgery when I recovered him after his procedure and he woke to a familiar face. I was able to answer his mum’s questions and formed a relationship that really helped allay her fears. It was an amazing experience.

What are the main challenges you and the other medical volunteers have to face during a medical mission?

When an Operation Smile team arrives in a new country for a 10 day mission we take much of our own equipment to follow as closely as we can the theatre environment and standards we enjoy at home. Even then on my last mission to Ghana, we had to contend with heat, electrical storms and power failures!

During each mission we have to adapt to the new theatres and hospital environment and its very grounding work, with a team you’ve never met before. We hit the ground running, and have to be confident in our job so that we can meet any emergency and know what to do and who to go to.

Are there any similarities between your job in the UK and the one you do with Operation Smile?

My job is the same wherever I am, of course the conditions vary from country to country, but people are more like each other than we can imagine. When a father at my hospital in the UK hands his child over to me, the worry in his eyes is just the same as in the eyes of a mother in the Dominican Republic when she hands over her teenage daughter. There are many tearful moments when you see a child’s beautiful smile and their parents’ reactions when they see their child after their operation. It is so rewarding to know we’ve played a part in this transformation.

It really breaks my heart every time I meet a child who does everything to hide his or her smile.

Why are you so passionate about Operation Smile?

I consider myself lucky because I can see for myself the difference we can make together – to so many children and their families. My work doesn’t end with a mission – it continues and multiplies as I can tell other people what I have seen. I also love talking about my experiences and showing my photographs to local groups and schools.


None of our missions can happen without the ongoing help of our generous supporters. To help to support Jackie and the other hardworking UK volunteers in their life-transforming work, please click here.

Skilled at Heart

Editor’s Note: In Ethiopia, Operation Smile is helping to strengthen the country’s health system through specialised training and education programmes while continuing to provide patients with world-class levels of surgical care. This story is the second of a four-part series.

Operation Smile’s Global Standards of Care requires that all nursing volunteers are certified in Basic Life Support (BLS), a course which teaches the fundamentals of cardiopulmonary resuscitation (CPR).

That standard exists for good reason – cardiovascular disease is the leading cause of death worldwide, killing more than 17 million people every year. According to the American Heart Association (AHA), for every minute CPR is delayed to a victim of cardiac arrest, his or her chances of survival decreases by 10 percent.

In many low-and-middle-income countries, including Ethiopia, knowledge of these life-saving skills is not widespread – even among medical professionals. In response to this dire educational need, Operation Smile is committed to offering AHA training programmes in the countries where it works. These life-saving certifications not only improve patient safety at our medical mission sites, but also strengthen health systems in the trainees’ communities for the long term.

The impact of these programmes is immense. Of students surveyed who completed Operation Smile AHA courses, 84.4 percent of respondents said that principles taught in their courses changed policies or procedures in their home countries or hospitals. An even greater majority of respondents, 96.5 percent, said that the courses changed how they reacted to an emergency situation.

More than 84 percent said they have already used skills learned in the courses to save a life.

We recently caught up with long-time Operation Smile nursing volunteer Florence Mangula of Kenya about her experiences both as a student and instructor of BLS and Paediatric Advanced Life Support (PALS) courses. Affectionately called “Mama Africa” by the Operation Smile medical volunteer community, the intensive care unit nurse has become a fixture in spreading this life-saving knowledge throughout Sub-Saharan Africa.

What inspired you to become a nurse?

As a young girl, I used to get recurrent tonsillitis. I was afraid of injections, so my mother would have to force me to go to the nearest health centre for treatment. Every time I went, I saw a nurse in a clean white uniform, shoes, cap and dress. I was fascinated by her elegant walk, confidence and the passion she had for her work. She would greet me with a smile and say, “My sweet pie, sorry you are back!” As I grew older, I kept telling myself that I want to be like that nurse – compassionate with a caring attitude and empathy for human beings. She would always say, “I’m sorry, but want you to be well.” To this day, I walk with my head up, with confidence, and treat my clients with care and compassion. I love this! Thanks to her for being a role model of good nursing, for I think I have also inspired many others to become nurses.

What kind of experience did you have with BLS/PALS before receiving training from Operation Smile?

I’m an ICU nurse and I thought all nurses were trained in emergency life-saving techniques and CPR. When I received training from Operation Smile, I realised many nurses in my region didn’t have those skills – many feared to tend to emergencies and feared to take the course, which I found disappointing. I’m thankful that Operation Smile offers training in both BLS and PALS, as anyone who completes these trainings can save lives in their communities.

As a student, what did it mean to you to learn these skills?

I learned these skills to improve my performance and become more competent in CPR. In fact, the PALS training was of great help. It stimulated my critical thinking and made me evaluate the care I gave to my patients, as it involves equipment, drug administration and team dynamics.

How does Operation Smile select its AHA course instructors?

Operation Smile’s Global Standards of Care requires students to pass their exams with a score above 84 percent to become certified. Those who score over 92 percent are eligible to become instructors. Also, the student must pass in the skill station, where one is examined on competence. Then, the students must complete “training of trainers” course to become certified as an instructor.

What does it mean to you to teach these skills to fellow health care professionals?

I feel obliged and challenged to teach other health care providers. Because the classes are made up of both nurses and doctors, we must meet the needs of all as we work together as a team for the best results. Upon completion of training, each individual will use the skills obtained to save lived and reduce the mortality rate in the clinical areas by performing effective CPR.

How does it feel to be a part of the strengthening of health systems where you teach these programmes?

I must say, I’m very privileged and honoured to be among the team on this movement. I’ve seen nurses who lacked self-confidence step up to become effective team members. In Ethiopia, I’ve seen a nurse change careers to become a doctor, and another nurse enrol for a master’s degree in nursing due to exposure to the programme. I feel proud. My appeal is that we can one day reach countries that have not yet been reached.

Sisters’ Lives Transformed Through Safe Cleft Surgery

Sisters’ Lives Transformed Through Safe Cleft Surgery

Jheleen and Andrea before surgery

One of the most memorable moments for any parent is hearing your child say, ‘Mama’ for the first time. Such a simple word, but with it, a flurry of emotions and a love felt beyond words.

But not for Laila, mother of sisters Jheleen, aged four, and Andrea, aged three. Laila never heard this word spoken properly by her daughters. Each baby girl was born with a cleft condition. This made feeding very difficult for them, let alone speaking – and with their condition came a young life full of ridicule and shame for this family from the Philippines.

Laila and her husband Ronald doted on their two beautiful daughters, but they lived in constant worry as to how they would be able to heal their daughters’ broken mouths. Ronald’s meagre income barely allowed them to feed and clothe their family – they couldn’t imagine how they could ever afford the surgery that would change Jheleen and Andrea’s lives. When they did approach a doctor locally about what to do for their daughters, they were told that surgery could not be performed until the girls were seven years old. This explanation could not be further from the truth. In fact, cleft surgeries are recommended for healthy children before the age of two to yield the best healing results – something they had no way of knowing.

When they received a neighbourhood flyer that told them surgery was both possible for their young girls and free, they immediately pre-registered for the Operation Smile mission to the Philippines in November 2012.

Doctors and nurses evaluated the girls and found they were fit for surgery – this brought unmeasurable joy to Laila and Ronald who felt a deep trust and admiration for the Operation Smile medical teams who met the girls at the hospital.

After surgery, the girls were each given a mirror so they could see their new smiles. It took Andrea three days before she accepted that she was the little girl looking back at herself.

For their mother Laila, hearing Jheleen & Andrea pronounce ‘Mama’ properly for the first time brought her tears of complete happiness.

The girls are no longer stared at, teased and called names. They love to go to school and play with other children.

Jheleen & Andrea’s surgery has changed the lives of the whole family and they now look to their future with optimism and hope.

Operation Smile continues to visit the Philippines, as well as an average of 28 other countries annually, performing safe surgeries, as well as training local medical professionals and building a lasting solution in communities. This investment will mean a better future for children like Jheleen and Andrea – who will now have access to safe, effective and timely surgery when it’s needed most.

Andrea and Jheleen after surgery

Rikta’s Purpose

Photo: Jasmin Shah.

When one looks at this beautiful young woman, it’s hard to believe that earlier in her life, people refused to come near her.

Rikta was born with a cleft lip and palate, but today she’s a happy 20-year-old with dreams of getting into nursing school so that she can provide care for children like herself.

With the confidence and drive to pursue her goals, Rikta’s life is full of possibilities.

Before her parents connected with Operation Smile, it appeared that her future wouldn’t be this bright.

Rikta with her mother, Meera. Photo: Marc Ascher.

After giving birth to Rikta and seeing her baby’s cleft lip and palate for the first time, Rikta’s mother, Meera, felt like she had lost everything. She often cried through the first days of Rikta’s life, pleading to God for the reason why her daughter was born with a cleft condition. Her husband, Shyamapada, was too shocked to speak.

Although they were happy to learn that surgery could repair Rikta’s cleft lip shorty after her birth, their joy was fleeting. The cost of the operation exceeded their family’s means, and they left the hospital without a solution to help their child.

That pain only intensified after they arrived home.

Meera and Shyamapada were met with accusations and blame from some neighbours who insisted that Rikta’s cleft condition was caused by one of them having done something wrong on the day of an eclipse.

Rikta’s cleft lip and palate made it almost impossible for her to breastfeed properly. Desperate to help her daughter, Meera resorted to feeding her milk with a spoon.

But she knew that Rikta’s struggles were far from over. Having contracted polio when she was younger, Meera has difficulty walking. And she feared that her daughter would endure harmful ridicule.

Photo: Marc Ascher

Meera’s worries were realised when Rikta started school. Due to the social stigma surrounding cleft conditions in her community, Rikta was not accepted by her classmates. She also experienced difficulty speaking clearly, and few people outside of her family could understand her.

“Every day, Rikta comes home and cries,” Meera said. “She compares herself to her sisters and brother and asks me why she’s not like them.”

Despite her anxiety about Rikta’s future, Meera held onto hope that one day she would have the chance to live a full and happy life.

When Rikta was 6 years old, that day finally came.

A neighbour brought Meera and Shyamapada a brochure detailing an upcoming Operation Smile medical mission in Bolpur, West Bengal; a city that’s a few hours away from their home by train.

Rikta waits with her mother during screening day at the 2005 Bolpur mission. Photo: Marc Ascher.

Anaesthetist Dr. Rodelo Valera of the Philippines checks Rikta’s vital signs during her comprehensive health evaluation. Photo: Marc Ascher.

After arriving at the mission site, Meera and Rikta saw the immense number of families that also made the journey. After receiving an extensive and comprehensive health evaluation from the Operation Smile medical team, Meera and Rikta waited anxiously with more than 450 potential patients and their families to learn if Rikta would receive surgery.

Meera was so relieved when Rikta’s name was called. The day she feared would never come had finally arrived; her daughter would be given a chance at a better life.

Rikta, her mother and child life specialist Shannon Case of the United States embrace each other before her surgery. Photo: Marc Ascher.

Emotions ran high as Rikta prepared for the operation.

Seeing that Rikta had become nervous and scared while waiting for her procedure, child life specialist Shannon Case helped comfort and sooth her before she entered the operating room.

Pre- and post-operative nurse Carrie Britton of the United States cares for Rikta, along with her mom, after surgery. Photo: Marc Ascher.

Later that day, Meera couldn’t hold back her tears of joy when she held Rikta in her arms after the successful surgery.

“From the deep core of my heart, I offer my love, affection, well wishes and endless regards for all of you. I am so extremely happy,” said Meera after seeing her daughter’s new smile. “It’s a new life for her. My dream has come true today. Thank you.”

Rikta would go on to receive two more surgeries from Operation Smile: one at the age of 10 for her cleft palate and an additional cleft lip surgery when she was 15.

It was after her latest surgery that Rikta decided that her purpose is to “dedicate her life to helping humankind.”

But even before aspiring to become a nurse, Rikta touched the lives of many.

Photo: Marc Ascher.

Operation Smile India Executive Director Abhishek Sengupta met the then-6-year-old Rikta and her mother for the first time when he was a student volunteer at the Bolpur mission. He worked as a translator, helping the family communicate with the medical volunteers.

Abhishek had the opportunity to not only meet Rikta before her surgery but see the confident young woman she became afterwards.

“Rikta’s journey is truly inspiring – it has been such a pleasure to see her grow up into this fine, ambitious, beautiful soul that she is today,” Abhishek said. “It’s a privilege. Thank you, Rikta!”

When Rikta learned about Operation Smile’s August 2017 Durgapur mission – 12 years after receiving her first surgery – she was eager to show her love and appreciation for the organisation that changed her life.

“I rushed here to thank them,” Rikta said after making the two-hour journey from her home.

Throughout Rikta’s life, Operation Smile and its medical volunteers remained committed to every step of her care and recovery. That unwavering devotion not only strengthened Rikta’s desire to help children but also created a lasting bond.

Today, Rikta is an honours physiology student in college who’s pursing entry into nursing school.

“Without them, I could not be what I am now.”

Photo: Marc Ascher.

More Than Smiles

More Than Smiles

Editor’s Note: In Ethiopia, Operation Smile is helping to strengthen the country’s health system through specialised training and education programmes while continuing to provide patients with world-class levels of surgical care. This story is the first of a four-part series.

A little girl is lying on a hospital bed in a ward corridor. Her mother is covering her face, trying to protect her from people’s curious gazes. The skin on her face, chest and arms is terribly burned and she can’t close her eyelids. She needs surgery as soon as possible to preserve her eyesight. But at the hospital, which serves more than 15 million people in southwestern Ethiopia, there are no plastic surgeons that can help her.

“She was playing with her friends at home where they had an open fire on the floor. By mistake, her friends pushed her, and she fell face down in the fire,” Dr. Yonas Metaferia says.

A general surgeon at Jimma University Specialized Hospital, Metaferia is participating in Operation Smile’s Surgical Training Rotations, which occur twice annually. Per Hall, a British plastic surgeon and Operation Smile volunteer, has been coming to Jimma regularly since 2012 to train general surgeons in reconstructive plastic surgery techniques and theory.

“Oh dear, this is a surgical emergency,” Hall says when he takes a look at the girl with the burn.

Unfortunately, the girl is too dehydrated to go through surgery immediately. The team decides to have her transferred to the plastic surgery unit at Addis Ababa to receive surgery as soon as possible to save her eyesight.

“It is actually very upsetting, isn’t it, that you have cases like this without instant access to plastic surgery,” Hall says.

“Originally the hospital thought they just wanted us to come and do cleft lip and cleft palate surgery, which is what Operation Smile was about originally. As we came back over the years, they’ve realised that plastic surgery isn’t just about smiles – it’s about reconstruction,” Hall says as he follows Metafaria in his rounds at the general ward.

“They realised there was so much more we could offer with various types of plastic surgery techniques. We could help them with reconstructive surgery after removing cancerous tumours, with reconstructive burn surgery, with injuries to the hands by machetes or knives and with all these people that are hit by cars or fall off trees and have nasty injuries in their legs or limbs, exposing bones. You need to cover the wounds with skin – and that is plastic surgery,” Hall adds.

One of the patients who needs reconstructive plastic surgery is Meheftehe, a 1-year-old girl born with a severe facial cleft that runs from the corner of her eye down through her cheek and into her mouth and plate.

“As we came back here over the years, they’ve realised that plastic surgery isn’t just about smiles – it’s about reconstruction” – Per Hall

Meheftehe’s mother brought her to the hospital when she was only 19 days old, covering her face completely and afraid to show her to strangers, believing they would judge her for her daughter’s deformity.

At that time, the baby was too small to receive a safe surgery. On a surgical mission to Addis Ababa a year later, Operation Smile’s team performed the initial surgery to save her eyesight.

Now, Meheftehe is back for her palate surgery. This time, her parents are not hiding their little girl. They’re happy to show her to the world and let her make new friends at the hospital waiting room.

“I am 100 percent satisfied. You cannot compare before and after her first surgery. For each month, there is an improvement,” says Genet, Meheftehe’s mother.

Meheftehe will need many more surgeries to fix her facial cleft, including a bone graft.

However, in a country of almost 100 million people, the lack of plastic surgeons makes reconstructive surgery impossible for most. Today, there are little more than a dozen plastic surgeons, and almost all of them are based in Addis Ababa, the capital city. In Jimma, the need for plastic surgeons is immense, as it is across Ethiopia.

In 2012, Operation Smile began funding surgical training programmes with the goal of establishing a plastic surgery unit at Jimma University Specialized Hospital. Two of the hospital’s general surgeons are now training at plastic surgery units in Taiwan to become plastic surgeons, as part of a three-year curriculum required by the government. They will later return to Jimma to start the plastic surgery unit at the hospital and continue training new plastic surgeons in their home country.

Meanwhile, Hall and his fellow Operation Smile volunteers return to Jimma twice a year to help Metaferia and his colleagues as much as possible.

The focus of the two-week Surgical Training Rotations are to teach best practices and techniques not only to surgeons, but to anaesthetists and nurses as well.

Metaferia, the next surgeon to take part in the three-year curriculum and will train abroad in South Africa, performs a cleft lip surgery under the supervision of Hall. The result is excellent, and Hall is very optimistic about the future.

“In three years time, this will be a very vibrant, exciting new service. They will have their own plastic surgery ward and their own plastic surgery theatres,” Hall says. “They are going to come back with new skills and new techniques which will be new for this part of Ethiopia, certainly. Some of their skills will actually be new for Ethiopia in general.”

Meet Dr Rebecca Wilde

Rebecca is a UK-based anaesthetist, who participated in the Operation Smile Regan Fellowship Programme. She volunteered on medical missions in Ghana and Malawi.

Rebecca with a patient in Malawi

What inspired you to first get involved with Operation Smile?

‘I was inspired to get involved with Operation Smile by a colleague who was an amazing advocate for the charity. He then mentored me as a Regan Fellow in 2016, which was a fabulous experience that allowed me to witness the work Operation Smile does in the field. I committed to being a volunteer once I met the founders Bill & Kathy Magee and heard them speak about their 35 years of involvement since starting the organisation – it was very inspiring!’

Is there one patient whose story will always stay with you?

‘On medical mission in Malawi, I volunteered as a paediatric anaesthetist. During screening, I met a little baby girl not yet six weeks old with a unilateral cleft lip and significant cleft palate. This baby’s mother, who was only 19 years old, had travelled 200km to arrive at the medical mission site and was planning on travelling straight back after the screening. She was very worried about her baby and was struggling to breastfeed. As a result the baby was malnourished, very small (approx 2.5kg) and weak. With the help of a local medical volunteer translator, we talked with the mum about the baby’s health and how she might work with our wider team to feed the baby expressed milk and formula in a way the baby could take it more easily. We managed to reassure her and to convince her to meet with the nutrition support team that could provide the help they needed.

While this baby was too young and not fit at the time to undergo surgery, we felt incredibly moved by the journey this mother was going through and extremely hopeful that with Operation Smile’s support this baby would now have a great chance at survival and may be ready to undergo her first surgery on one of the upcoming medical missions.’

Describe the biggest challenges you see for patients where you have worked.

‘Working with Operation Smile in Ghana and Malawi has allowed me to see the need for safe surgery, but also for trained medical staff. Staff for basic healthcare and for work like cleft surgery, are in extremely short supply. Often these countries rely on training specialists through support of international trainers in and out of the home country.

As an anaesthetist, I was fascinated to discover that Malawi has just four doctors in training as anaesthetists, two of whom I met in Blantyre and two out of country training in South Africa.’

Jackie’s Story

Jackie Matthews, works as Clinical Nurse Specialist for South Thames Cleft Service at Guy’s and St Thomas’ Hospital, based at Queen Victoria Hospital at East Grinstead. She specialises in the care of infants and young children born with cleft conditions but she is also an Operation Smile volunteer and UK Medical Subcommittee member.

She has been on missions to Mexico, twice to the Dominican Republic and to Ghana.

Can you tell us more about your medical missions with Operation Smile?

I went on my very first medical mission as a volunteer in 2011 to Guadalajara, Mexico. My role was to help children in recovery just after they had received surgery.

On my second medical mission, and as the only British nurse on the mission, I joined other professionals from the USA, Sweden, Russia and Estonia, flying to Santo Domingo in the Dominican Republic.

There we screened more than 120 babies, children and adults, and had four operating rooms running consecutively, performing facial repairs for cleft lips, palates and other deformities. In total, we performed surgery on 79 patients, the youngest being just six months old – a little boy named Joshua.

I was lucky enough to follow little Joshua through the patient journey, accompanying him at screening, pre-operative assessment and on the morning of his surgery when I recovered him after his procedure and he woke to a familiar face. I was able to answer his mum’s questions and formed a relationship that really helped allay her fears. It was an amazing experience.

What are the main challenges you and the other medical volunteers have to face during a medical mission?

When an Operation Smile team arrives in a new country for a 10 day mission we take much of our own equipment to follow as closely as we can the theatre environment and standards we enjoy at home. Even then on my last mission to Ghana, we had to contend with heat, electrical storms and power failures!

During each mission we have to adapt to the new theatres and hospital environment and its very grounding work, with a team you’ve never met before. We hit the ground running, and have to be confident in our job so that we can meet any emergency and know what to do and who to go to.

Are there any similarities between your job in the UK and the one you do with Operation Smile?

My job is the same wherever I am, of course the conditions vary from country to country, but people are more like each other than we can imagine. When a father at my hospital in the UK hands his child over to me, the worry in his eyes is just the same as in the eyes of a mother in the Dominican Republic when she hands over her teenage daughter. There are many tearful moments when you see a child’s beautiful smile and their parents’ reactions when they see their child after their operation. It is so rewarding to know we’ve played a part in this transformation.

It really breaks my heart every time I meet a child who does everything to hide his or her smile.

Why are you so passionate about Operation Smile?

I consider myself lucky because I can see for myself the difference we can make together – to so many children and their families. My work doesn’t end with a mission – it continues and multiplies as I can tell other people what I have seen. I also love talking about my experiences and showing my photographs to local groups and schools.

None of our missions can happen without the ongoing help of our generous supporters. To help to support Jackie and the other hardworking UK volunteers in their life-transforming work, please click here.

Introducing Dr Annemieke

Annemieke is a paediatric intensivist and a member of the Operation Smile UK medical subcommittee. Annemieke has volunteered for many medical missions, travelling to India, Cambodia, Kenya, Ethiopia, Namibia, South Africa, Jordan, China, Honduras, Paraguay, Malawi, Vietnam and Madagascar.

Annemieke with a patient

What inspired you to first get involved with Operation Smile?

As soon as I qualified as a Paediatric Intensivist I started working with Operation Smile. Living in a Western country I think it’s easy to forget how privileged we are to have excellent healthcare that is safe, reliable and accessible to all.

What I like most about Operation Smile is that we involve local healthcare professionals and medical students, teaching and training them to be able to continue providing medical care after we have left the country.

You were recently part of a medical mission to India with Operation Smile. What did you do there?

I always go as Paediatric Intensivist, team doctor and one of the team leaders. Pre-operatively I’m part of the team screening patients that are eligible for surgery. We come across an array of diseases and disorders and also offer support and treatment for patients that aren’t surgical candidates.

After helping create the surgical schedule I spend most of my time in the recovery room, assessing post operative patients. Because the paediatric wards have no ability to monitor vital parameters and can be quite hectic, I need to guarantee patients have no risk of complications before they leave the recovery room. I always work closely with an excellent team of nurses, who allow me to be flexible in supporting the anaesthetic team, patient wards and continue screening newly arrived patients.

What is it like to be there at the medical mission site as families start to arrive?

Local Operation Smile staff will inform patients and their families several months before the mission starts, providing logistic details such as the location and the available transportation. When the international volunteers arrive most of the families and patients are already at the location being cared for (shelter and food).

We meet patients and families for the first time during the screening process, when we examine patients and review if they are eligible for surgery. On a screening day we usually see well over 100 patients. These days are long, the language barriers can be challenging and we rely heavily on our local volunteers, often medical students, who help us communicate with families and take away any cultural barriers.

I am always humbled by the enthusiasm and patience of the local teams and families. Despite sometimes having waited for several hours to be examined, people are always welcoming and kind. It’s the moments when you connect with a family or share a laugh that makes these days so special to me.

How has volunteering with Operation Smile impacted you professionally and personally?

Having worked in hospitals with extremely limited resources (no basic medications, electricity, fresh water) has reinforced how fortunate I am to have a safe home, access to medical care, clean water and food. I have never needed to question these things as a child, adult or as a medical professional working in the UK.

Working with medical professionals from different cultural, economical and religious backgrounds has made me a better and more compassionate doctor. I love working with an enthusiastic team of professionals that continuously supports and teaches each other.

Meeting patients and families has opened my eyes to the injustices in the world and has strengthened my determination to give back and make a difference in somebody’s life and I hope to continue my work with Operation Smile in the years to come.

In An Instant, Nicolle’s Time Arrived

Eleven-month-old Nicolle during Operation Smile’s 2011 medical mission in Guatemala City, Guatemala. Photo: Erin Lubin.

As police officers, Jessica and her husband, Maynor, are trained to shield people from harm – but after the birth of their daughter, Nicolle, they soon learned that there was nothing they could have done to protect the one person they loved most.

But regardless of the obstacles the first-time parents confronted, they faced them together as a family.

“From the moment we knew my wife was pregnant with our first child, we were filled with hope,” Maynor said.

Jessica and Maynor were joyful and excited on the day of Nicolle’s birth. But after receiving concerned glances from the doctors, their happiness soon gave way to feelings of fear and panic.

Nicolle was born with a cleft lip and palate.

“The doctors just looked at me but said nothing,” Jessica said. “Then, one approached me and asked if I knew my baby would be born with a problem. I became very scared.”

Learning that their baby will be born with a cleft condition can be heart-breaking for many parents to hear. However, becoming aware early on in the pregnancy often gives families something invaluable: time.

Time that can be used to discover available surgical solutions by researching hospitals and local medical organisations. It’s also time that parents can use to emotionally prepare themselves for the difficult journey ahead.

Sadly, time was something that Jessica and her husband didn’t have.

Not once during any of Jessica’s prenatal check-ups and ultrasounds was Nicolle’s cleft condition revealed.

“The doctor didn’t even want to tell me the sex of my baby,” Jessica said. “I didn’t know what the doctors were talking about when they told me my baby had been born with a cleft lip and cleft palate.”

Neither parent had ever seen someone with a cleft condition before.

Questions surrounding Nicolle’s cleft lip remained unanswered as Jessica and Maynor left the hospital – no one explained to them why their daughter had been born with a cleft.

Arriving home led to even more challenges and more uncertainty.

Nicolle’s cleft condition made breastfeeding difficult and Jessica admitted that one of the toughest aspects of having a child with a cleft lip was coping with the discrimination and rejection from members of their community.

“It was a very difficult time as we watched the other couples celebrating the birth of their babies, while we felt lost and were inconsolable,” Jessica said.

With the knowledge that surgery was possible, Maynor and Jessica researched organisations near their home for several months, hoping to find a way to repair Nicolle’s cleft lip and give her the life they knew she deserved.

For a long time, they were left without answers.

Nicolle smiles wide at her father, Maynor. Photo: Erin Lubin.

“We were constantly worried about how we could afford surgery on our police salaries,” Maynor said. “We wondered what her life would be like as she grew.”

Jessica and Maynor’s concern for their daughter only intensified after learning that Jessica’s mother had previously given birth to two sons with cleft conditions – both of whom later died in infancy.

But despite their fear and uncertainty about the future, their love for Nicolle motivated them to continue fighting for her.

In an instant, the lives of the family changed forever when Nicolle’s grandmother saw an announcement for Operation Smile in the newspaper informing people about the cleft lip and cleft palate surgeries it provides at no cost to its patients.

Hoping that it was the solution they had been searching for, Maynor and Jessica called to schedule an appointment for Nicolle. They were asked to come to an upcoming medical mission in Guatemala City before the call finished.

“When we arrived for Nicolle’s medical evaluation, we were received with love and understanding,” Jessica said. “Everyone from the Operation Smile team took great care of us and made us feel comfortable and calm.”

After performing a comprehensive health evaluation on Nicolle, the Operation Smile volunteer medical team was pleased to inform Jessica and Maynor that their daughter was healthy enough for a free, safe surgery.

During the moments leading up to Nicolle’s surgery, Jessica and Nicolle’s grandmother began to cry and expressed their worries about Nicolle being too young to undergo the procedure.

“She and Jessica were very scared about the surgery,” Maynor said. “However, the doctors were very understanding and encouraged us to be calm and said that everything was going to be fine.”

Later that same day, the entire family watched as Nicolle bravely entered the operating room.

“The hope that she was going to be perfect kept us strong,” Maynor said.

Nicolle shows off her new smile six months after her cleft lip surgery. Photo: Erin Lubin.

After receiving a surgery that can take as little as 45 minutes, Nicolle now has a beautiful new smile that will last a lifetime.

She later underwent additional surgery on her cleft palate at a future Operation Smile medical mission.

Nicolle three years after surgery. Photo: Carlos Rueda.

Today, eight years after receiving her life-changing cleft lip surgery, Nicolle is a lively young girl who enjoys attending school and her dance classes on Saturdays.

“We wish to thank everyone. The team, donors and companies who support Operation Smile,” Jessica said. “Nicolle now has a normal life. She’s a happy little girl who loves to play and is always smiling. We’re very grateful to Operation Smile because they changed Nicolle’s life and ours as well.”

Nicolle today. Photo: Carlos Rueda.

Daniel’s Drive: Training Ethiopian Surgeons

Dr. Daniel Getachew, left, and Dr. Per Hall, right, evaluate a patient’s X-ray with Dr. Yonas Exchetu at Jimma University Specialized Hospital in March 2015. Photo: Jasmin Shah.

How did one surgeon’s sleepless night become another’s dream come true?

When the vision of the former, Dr. Per Hall of the United Kingdom, fuelled the relentless drive of the latter, Dr. Daniel Getachew of Ethiopia.

At Operation Smile’s 2018 NEXT Medical Conference, the reconstructive plastic surgeons shared their perspectives on the successes and challenges of the surgical training rotations hosted by Operation Smile at Ethiopia’s Jimma University Specialized Hospital (JUSH).

The commitment of Daniel and his staff cemented the establishment of a 28-bed reconstructive plastic surgery ward in JUSH’s newly constructed hospital. The unit officially opened on Jan. 1, 2018, just days after Daniel returned to Jimma after completing a three-year training program in Taiwan.

His graduation made him the first general surgeon to earn accreditation as a reconstructive plastic surgeon through an Operation Smile surgical training rotation.

“It’s just like a dream come true,” Daniel said. “I couldn’t wait for that day to come.”

While Daniel’s accreditation and his new ward are significant milestones for both JUSH and Operation Smile, there is still much work to be done for the unit to become self-sustaining.

Daniel and Per emphasized this in their presentation at NEXT, making impassioned appeals to the Operation Smile medical community gathered in Norfolk, Virginia, on May 10, 2018.

Daniel, left, and Per present an update on the Jimma, Ethiopia, surgical training rotations at the 2018 Operation Smile NEXT Medical Conference in Norfolk, Virgina, on May 10, 2018. Photo: Marc Ascher.

“This is actually just the beginning of a better future that I’m hoping to see,” Daniel said in front of a crowd of more than 250 of his fellow volunteers from around the world. “So anyone who is interested in coming to teach us and help the patients is very much welcome to come.”

Daniel didn’t know it at that time, but his unit would get another major boost of visibility later in the conference. The day after their presentation, Per was selected as the Operation Smile’s volunteer of the year in honour of his leadership of the Jimma rotations.

Today, as Daniel emerges as the leading plastic surgeon at JUSH, Operation Smile is working with key partners to develop the next layers of training to support the growth of the new plastics unit.

“Carefully crafting programs to locally grow general surgeons and anaesthetists in cleft and plastic surgery skills is key to the success and long-term sustainability of the unit,” said Libby Durnwald, Operation Smile’s associate program officer of education. “It will take the effort, creativity and passion of dedicated volunteers alongside local providers to design a program that lasts for years to come. The next cohort of plastic surgery trainees will be fortunate to have Daniel as a role model, teacher and leader as they work to develop their skill sets.”

Spearheaded by Dr. David Orr of Ireland and Per, the rotations have been conducted twice per year since 2012.

The two-week training courses for Ethiopian surgeons, anaesthetists and nurses have revolutionised how patients receive surgical care at JUSH, the only hospital serving the 15 million-plus people living in Ethiopia’s southwestern region.

The focus of the rotations isn’t only on cleft surgery, but also teaching general surgeons a wide range of techniques to better heal burn, trauma and surgical wounds, which represent the bulk of the hospital’s need for plastic surgery.

“When you go somewhere like Jimma, where they have such a huge workload, cleft lip and palate are actually a really small (portion of the overall need),” Per said. “Every day, you have people with intestinal obstructions, machete injuries, people falling from trees, road traffic accidents, burns – they come in and they have to be dealt with immediately.”

When scheduled cases are delayed by emergencies, the backlog builds. This reveals the immense need for increased staff and training to handle both immediate and elective surgical care in Jimma.

Daniel performs surgery under the guidance of Dr. David Orr during the November 2014 Operation Smile surgical training rotation in Jimma, Ethiopia. Photo: Jörgen Hildebrandt.

The goal is to close this critical gap between the amount of reconstructive plastic surgeons and the people they serve, especially in the country’s more remote areas like those surrounding Jimma. In Ethiopia, there are little more than a dozen reconstructive plastic surgeons serving 105 million people, and most of them are cantered in and around Addis Ababa, the capital city.

Operation Smile Chief Medical Officer Dr. Ruben Ayala said: “I believe that the genius of individuals like David Orr and Per Hall – who believed in the power of training the local professionals way before Operation Smile looked beyond (medical missions) – is that they saw a need that was tangible; it was really in their faces and they couldn’t turn away from it.

“They also saw the opportunity in what Operation Smile could and should offer. They paved the way for us, as an organisation, to start thinking about the impact that we could have on the lives of children and on the lives of entire communities.”

So, back to Per’s sleepless night.

After years of serving on medical missions in Ethiopia, David and Per stepped into uncharted territory when they brought Operation Smile’s first surgical training rotation to JUSH in 2012. Per said that while he knew that the hospital’s general surgeons were skilled, he didn’t know what to expect from their initial attempts at performing cleft lip surgery.

At that time, Daniel was the hospital’s general surgery consultant, and two of his residents were the rotation’s surgical trainees, including Dr. Yonas Yilma Metaferia, who assisted Per on the first surgery of the day.

Per evaluates a patient in need of reconstructive plastic surgery with surgical training rotation student Dr. Yonas Yilma Metaferia in March 2016. Photo: Jörgen Hildebrandt.

“When the second patient was on the table, I asked Yonas if he would like to put the marks on the lip. He did, and I looked, and I thought, ‘Well that’s perfect,’” Per recalled. “I gave him the scalpel and asked him if he’d like to carry on. He then did 85 percent of the second cleft lip he had ever seen in his life.

“And that night I could not sleep. Because I just thought, ‘Wow, we’re starting at such a high level,’ and there was almost an arrogance that we didn’t realise that. These guys had enormous hours of surgery under their belts. By the time they are consultants or attendings, their flying hours are in the hundreds of thousands compared to U.K. and U.S. trainees, and they’re using very limited resources very ingeniously.”

After the first rotation, Per gathered the surgical results of his mentees to be analysed by Operation Smile’s medical oversight team. They affirmed what Per already knew: The results were fantastic and the need to invest in the training of these general surgeons was solidified.

“We can take general surgeons like Daniel and use (the rotations) as a test case to show that you can teach cleft lip surgery to very able people and get results that are comparable or better than some of the outcomes I have seen on other Operation Smile missions. That’s why I couldn’t sleep,” said Per, who acknowledged the further complexities of and training required to perform cleft palate surgery.

Per added: “It wouldn’t have worked without Daniel’s drive.”

“He is so motivated to make this happen, so we are very, very lucky in this project and we need to support him. We need Daniel to train his own surgeons internally and we need to support the supply chain, the consumables and equipment. There is such a lot of stuff that they need.”

Despite the challenges ahead, Daniel is optimistic that the future of his unit is bright.

“I have already established the plastic surgery unit, and a lot of people are getting help from it, so you can see how it’s going to exponentially change the service that we can deliver,” Daniel said. “We can sustain that for a much longer time and we can provide service for the rest of our region.”

Daniel, left, and Per present an update on the Jimma, Ethiopia, surgical training rotations at the 2018 Operation Smile NEXT Medical Conference in Norfolk, Virgina, on May 10, 2018. Photo: Marc Ascher.