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.

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.’

To Heal and to Comfort

Editor’s Note: In August, we covered Operation Smile in Madagascar’s first-ever surgical training rotation at Centre Hospitalier de Référence Régionale in Antsirabe. Since then, we have conducted five out of the six rotations scheduled for 2017. Building on Operation Smile’s commitment to strengthening health systems where it works, international teams of medical volunteers provide training to Malagasy health care professionals by providing safe surgery for children suffering from cleft conditions. Throughout the rotations, we’ve been receiving informative and inspirational field updates from Charlotte Steppling, the project manager for Operation Smile in Madagascar. In this two-part “From the Field” series, Charlotte shares the compelling stories of two patients who received surgery during the fourth rotation, which took place Sept. 23 through Sept. 29. This is the second story.

Ten years ago, Mampionona was born in a small village 230 kilometers west of Antananarivo.

“When he was born, his mother did not know what to say – she had just seen her sister die from illness. She was very emotional when her baby was born,” said Tantely, Mampionona’s aunt. “We named the boy Mampionona, which in Malagasy means ‘to heal and to comfort.’ This baby became our healing and our family’s comfort.”

As a newborn, Mampionona had difficult eating because of his cleft lip. His mother tried hard to feed him milk with a cup. At 6 months old, he started eating solid foods and was able to gain a good amount of weight.

“This child was a gift – a gift from god. God knew that our family needed something special,” Tantely said. “We had just lived through a traumatic death in the family and this baby was here to comfort us. He gave us a child with a cleft because he knew we could take care of him.”

The family had heard that in a larger town nearby, there was a local doctor that could offer cleft surgery.

“But the surgery was so expensive,” Tantely said. “We tried saving up, but then ended up spending money on chickens, rice and household items. We never thought there would be a solution.”

In August, Tantely was invited to a wedding in another city. At the wedding, she met a young mother who was rocking her baby girl in her arms. Making pleasantries, Tantely asked her, “That is a beautiful baby, how old is she? Is she your only child?”

Tantely’s eyes widened as she glanced at the baby’s face.

“Does – does – did your baby have a cleft?” The words stumbled out of her mouth.

The mother of the baby nodded yes. She explained that not even two months prior she had gone to Antsirabe and received free surgery from Operation Smile.

Later that day, Tantely called Operation Smile in Madagascar’s hotline number. She spoke to Flex Manantsoa, the patient coordinator for Operation Smile in Madagascar and registered her nephew in the database.

One month later, Flex gave Mampionona’s family a call to inform them that he would have the chance to receive surgery at surgical training rotation being held in late September. The family was elated.

“I couldn’t believe it!” Tantely said. “I decided that I would accompany Mampionona to Antsirabe. His mother was pregnant and his grandma cannot travel long distances, so it was my duty to bring him.”

Before Mampionona arrived at the patient village on Friday afternoon, he had never seen another person with a cleft. He told his aunt, “Can you believe it? Look at this village – everyone looks like me! Everyone has a cleft. Even the small kids, even the babies, and even the adults – they all look like me!”

Mampionona went through screening and was selected for surgery. During the week, they met and talked with other families about their experiences.

“We all agree that it is such a relief to be here,” Tantely said. “To be taken care of by such nice people, and everything is free. From a place to sleep to soap to wash ourselves. We are so thankful.”

The following week, Mampionona returned to his village. It will be a big change for the villagers who have always known him for his unique cleft.

“They don’t believe we are really getting surgery – they think that to receive surgery I must give a piece of my thigh to put on Mampionona’s lip! Can you imagine? I mean, I would still give a piece of my thigh if I had too! People will be so shocked and surprised to see him. To see him smile. To see him look like everyone else,” Tantely said.

“I am going to tell everyone about this experience. I am going to find more people more children like Mampionona. I thank everyone on the Operation Smile team. Thank you for giving Mampionona the gift of smiling like all other children. Thank you!”

A Landmark Patient

A Landmark Patient

Photo: Charlotte Steppling.

Editor’s Note: In August, we covered Operation Smile in Madagascar’s first-ever surgical training rotation at Centre Hospitalier de Référence Régionale in Antsirabe. Since then, we have conducted five out of the six rotations scheduled for 2017. Building on Operation Smile’s commitment to strengthening health systems where it works, international teams of medical volunteers provide training to Malagasy health care professionals by providing safe surgery for children suffering from cleft conditions. Throughout the rotations, we’ve been receiving informative and inspirational field updates from Charlotte Steppling, the project manager for Operation Smile in Madagascar. In this two-part “From the Field” series, Charlotte shares the compelling stories of two patients who received surgery during the fourth rotation, which took place Sept. 23 through Sept. 29. This is the first story.

Tsifoina was born with a cleft lip in 2016. On Tuesday, Sept. 26, the 9-month-old boy became the 2,500th patient to be operated on by Operation Smile in Madagascar.

“When I gave birth to Tsifoina, I was so surprised – shocked to see his cleft. The doctor and midwife took him to the neonatal ward and came back to comfort me,” said Tiavina, Tsifoina’s mother. “They explained to me that cleft can be repaired. Yet, I couldn’t hear anything they said – my mind was blank. I was so surprised and could only imagine, ‘How could this happen to us? What did I do? What did this child do to deserve this?”

Tsifoina’s parents had seen television advertisements and heard from word-of-mouth that there were options for surgery, among them Operation Smile. First, they searched the internet and found the Operation Smile Facebook page. They contacted Operation Smile through direct message and spoke with Mamy Ramamonjisoa, country manager for Operation Smile in Madagascar.

“Two weeks after Tsifoina’s birth, we received an appointment to meet with Mrs. Mamy,” said Tsitohaina, Tsifoina’s father. “She explained to us that there are many different possibilities and she shared the information about the next international medical mission in Antsirabe in May.”

When the mission arrived in Antsirabe, so did the family with the hope that their then-4-month-old son would receive surgery.

Photo: Charlotte Steppling.

Unfortunately, Tsifoina was not chosen for surgery at the mission. Due to the overwhelming patient turnout – more than 500 arrived for screening – older children were given priority over infants like Tsifoina, who could wait for a future program and still be within ideal age range for surgery.

“I still kept hope. I knew that one day Operation Smile would call our family and we would have our turn to receive surgery,” Tiavina said. “I was impressed when I saw all of the children, all of the mothers, waiting to be chosen. There were hundreds. I told my husband, ‘One day it will be our turn. We must believe.’”

“We were told that there will be another international mission in November, but we were very surprised that we were called to come in September because there would be a mini-mission in Antsirabe,” Tsitohaina said of the opportunity for his son to receive surgery at the fourth of the six surgical training rotations being conducted in 2017.

“I could barely sleep – the days couldn’t go by any slower! We could not wait until September to go to Antsirabe,” Tiavina said.

The rotation arrived and Tsifoina received surgery from surgeon educator Dr. Mwepu of the Democratic Republic of the Congo and his mentees Drs. Ravaka and Briand of Madagascar. His mother and father patiently waited for him to come out of the operating room.

Once reunited with their son, tears of joy spread across the parents’ cheeks.

“Since the beginning, we were confident that if he receives surgery from Operation Smile, the results would be extraordinary,” Tiavina said. “And we are also so pleased to hear that Tsifoina is the 2,500th patient operated on in Madagascar!”

“What an honor,” Tsitohaina said. “We are so grateful to Operation Smile for having offered smiles to 2,500 patients in Madagascar. Thank you!”

Photo: Charlotte Steppling.

After Surgery, the Teasing and Name Calling Stopped

Sidonie is a beautiful girl from Antananarivo, Madagascar, but lived with a cleft lip until she was 7 years old. When Sidonie was born, her parents were shocked when they saw her cleft lip. Her mother was so shocked that she cried for days. Sidonie’s paternal grandfather was also born with a cleft lip, but her parents never thought one of their kids would be born with this condition.

Sidonie’s mother, Harimino, is a house wife and a brick maker, and Sidonie’s father, Jean Patrick, is a construction worker. At Sidonie’s first doctor’s visit, Harimino learned that her daughter’s cleft lip could be repaired through surgery. However, Sidonie’s parents had no idea how they could afford to feed their family of six and save money for the surgery.

As a child, Sidonie was a healthy girl, but she was constantly teased by the other kids. The kids at school and in her neighborhood used to call her, “Sima” which means “Cleftie,” a name that she hated.

In 2011, Harimino heard on the radio that Operation Smile was coming to Antananarivo. She couldn’t believe that the surgery was free, so she decided this was going to be Sidonie’s chance to be like all the other little girls. Upon arriving at the hospital, Harimino and Sidonie were amazed to see so many other children like Sidonie who were born with cleft lip. After a comprehensive medical evaluation, both Sidonie and her mother were overjoyed when she was scheduled for surgery.

When Sidonie’s mother first saw her precious daughter after the surgery, she experienced mixed emotions. She was happy that Sidonie’s lip was finally repaired but sad that Sidonie’s new face looked so strange to her.

During vacations and breaks from school, Sidonie helps her mom at the brickmaking factory and loves to play with her sister and best friend, Safi. At the time of her surgery, Sidonie was on vacation from school and was completely recovered by the time she went back to school. Sidonie got to start a new year and a new life with no teasing or name calling. Today, Sidonie is in the fifth grade. She loves school, and her favorite subject is math.