Operation Smile: changing lives, one smile at a time

Omran Amer Mohamed is five years old. Since both parents are unemployed, the family had not been able to afford the surgery he needed. Omran is very shy because of his deformity. He did not like to talk to people, was afraid to leave his house and he has no friends. On the day of his surgery he was very excited, he kept pointing at his lip and said:“Let’s go, let’s go!” His parents are very happy with the result of the surgery and say that they can already tell he is becoming more outgoing.

Operation Smile is aptly named. The international children’s charity helps children born with facial deformities, such as cleft lips and cleft palates. It works with volunteers, from medical professionals to those providing logistical and technical support, who donate their time and expertise to help change the lives of thousands of children and adults all over the world.

In many countries, children born with a cleft lip and/or palate are shunned by society. Often parents lack the means or knowledge to treat their children. This is where Operation Smile comes in. During surgical missions, complete surgical teams, doctors, nurses, speech therapists and dentists, are flown in to perform tens of surgeries per day, literally putting a smile on the face of those children and their parents. In the past two weeks an Operation Smile mission took place in the pediatric hospital of Assiut University. Members of the team spoke exclusively to Daily News Egypt.

The Organisation

Genny Adel is the regional programs director for the Middle East for Operation Smile. For a little over two years she has been the link between the headquarters in the United States, and Egypt and Jordan.

“It is the first time we have organised a mission that focuses mainly on education,” Adel said. “Normally we work with the Ministry of Health and use one of their hospitals during our surgical missions, but since this is mainly an educational mission we felt it made sense to partner with the pediatric hospital of the University of Assiut.”

Changing the focus of this mission from purely surgical to education is done with a long-term goal in mind. “We want to create partnerships that are sustainable and surgical centres that can function as centres of excellence according to Operation Smile protocols. Egypt already has several surgeons, anesthesiologists, and dentists who are accredited by Operation Smile. As soon as a local medical team is complete we can use our resources to reach those patients who have no access to our care, instead of using it to fly in the medical teams from abroad.”

Russell Papineau was Operation Smile project coordinator for the Assiut mission. “Planning a mission is done by both the country manager, Genny Adel in this case, and a project coordinator from our headquarters. Together we make sure all the logistics are in place so the medical teams can do their work smoothly and we can help as many patients as possible,” he said.

Papineau has a degree in business administration and finance, but after his parents volunteered on an Operation Smile mission, hearing their stories changed his life. “I am a practical person and sceptical by nature, but Operation Smile met all my expectations. Their goal is honourable, their methods are transparent and the job satisfaction is next to none. As a coordinator I get to help facilitate others changing lives for the better and many medical professionals return to their normal jobs with increased enthusiasm; they remember again why it is they chose the job that they do. That is an amazing feeling.”

Papineau was quick to underline everyone works hard during the missions and that his job involves a lot of grunt work, “but the results make it all worth it. Our first priority is our patients and their safety, but a close second is our volunteers. Without them none of this would be possible,” he said.

The Doctors

Dr Assem Kamel is the head of the plastic surgery department of the university hospital and has volunteered with Operation Smile for ten years, in Egypt and internationally.

“In this mission we focused mainly on furthering the education of our nurses, those on the wards and those in the operation room,” he said. “Our hospital has no Pediatric Intensivists or nurses trained in recovery room care, but we are changing that this week. It is the first time we are using our recovery room!”

Dr Kamel welcomes Operation Smile for several reasons, “the protocols they have developed are very good and I would like us to start using them in our hospital. Furthermore you meet doctors from different nationalities on these missions and the communication and sharing of experiences is invaluable.”

He was very optimistic about the results of this first educational mission. “The communication between the doctors and the nurses has improved a lot in this time. Especially for the residents in my program it was important to learn these two disciplines need to work together for the good of our patients.”

Dr Mohamed Makboul is a lecturer in the plastic surgery department of Assiut University and also an old hand with Operation Smile. He said “the way they work makes teams out of people, what normally can take months is achieved in just hours. The care and safety of the kids is central to everything they do and they are very well organised.”

Dr Fatma Ahmed Abdelaal is head of the pediatric anesthesiology department and has worked with Operation Smile at home and abroad. She oversaw the Basic Life Support training of the staff during this mission and also mentions teamwork as a valuable contribution of Operation Smile. “The connection between the doctors and the patients is important and within the structure it is very easy to work as a team. The humanity of all participants is beautiful, the whole team comes together to serve the child.”

Dr Gabriel Larrea was the pediatric intensivist on this mission. He does usually three missions per year in his native Ecuador and this was his eight international mission. When asked why he volunteers for Operation Smile he said “I try to see every patient as a son of God, and being able to help them gives meaning to my life.”

Dr Larrea ran the recovery room and gave training to the anesthesia and plastic surgery residents in the hope that after the mission they will be able to keep the recovery room open. “We focused on the management of children in the recovery room and on pain and shock management. We had a wonderful group of people, it is one of the perks of volunteering that you get to make friends and travel all over the world while doing something worthwhile. It does not get any better than that!”

The Nurses

The upbeat local nurses from Assiut welcomed the arrival of the Operation Smile team. “We are happy this opportunity is available for the children and the work Operation Smile do is excellent. There is the language barrier, of course, but eventually you find a way to communicate or one of the volunteers can help with the translation,” said Nadia, one of the nurses.

Another nurse, Sanaa, said she was surprised at the similarities between Operation Smile’s system when it comes to nursing and the existing one at the Assiut University hospital, “they do not operate so differently from us, which is a relief, but one key difference is that they stress the recovery period which is a critical period starting when the patient wakes up to when they are stable and are labelled as post-op. We simply do not have enough people to have a nurse watch the patient constantly as they do.”

The Operation Smile nurses focused on giving training to the local nurses. One training involved teaching the use of stethoscopes and a foreign nurse’s hospital donated ten stethoscopes at the end of the mission. The training was well received by the local nurses and was a learning opportunity for everyone in attendance. Post-surgical care and Basic Life Support (BLS) were the main topics of the training.

The nurses stressed the difficulties of being a nurse in Egypt, with no proper pay, not enough resources, and a general disregard for the occupation. This means doctors are responsible for doing most of the work, a system they said overburdens doctors and leaves nurses unable to help.

Lisa Friessen was on her 33^rd mission in Assiut. At home in Alaska she works as a nurse educator and this experience was invaluable during this mission. “I was pleasantly surprised to see the huge interest of the local nurses in our training and how willing they were to change the mindset of the medical profession here to make them an integral part of the team,” she said.

Friessen works with Operation Smile out of love for the children and their families. “A baby born with a cleft deformity is not aware yet of what that means, but the parents and siblings are. They face fear and ridicule their communities, so by helping get these kids the proper surgeries we get to change the lives of whole families, and I love that.”

Angela Morro, a nurse from Colombia, has been volunteering for Operation Smile for the past ten years. She recently finished a year-long placement in India where she trained nurses in pre- and post-operative care. She offered this training in Assiut. “During the first week I worked alongside the local nurses and offered different lectures and training. In the second week I am observing how these five nurses are applying our way of working during their work.”

Morro found the nurses very receptive and open to learning. She was happy with the progress they had made. “Nurses here do not feel important, so I had to find a way to show them that it is possible to work differently and that doctors are ready to work together with them.”

“Nothing compares to seeing one of our kids look in the mirror for the first time after a surgery,” Morro said. “I can do my job and change lives for the better at the same time and that changes my life as well.”

The Dentist

Ahmed Hassan is an Egyptian dentist who has been accredited by Operation Smile and trains other dentists during Egyptian missions. He has volunteered on international missions and has been involved since his student days. Originally he planned to become an orthodontist, but his experience with Operation Smile changed his mind. He hopes to be a maxillofacial surgeon in two years. “Being on a mission is awesome,” he said. “I feel lucky to be a part of it and to assist in changing lives with simple, 45 minute surgeries.”

The technician

A mission also includes non-medical staff and bio-medical engineer, Jason Hudson, is one of them. Hudson works full time for Operation Smile and makes sure that all equipment on missions works. He travels the world a lot and that is not always easy. But, as he sums it up, “if I would do this job in a hospital I would just show up for work and go home, here I feel I make a difference.”

The non-medical volunteers

Almost everything else non-medical is handled by volunteers, mostly younger people, students or recent grads. They facilitate everything on the ground for the Operation Smile team. From translating, dealing with patients, keeping records, and dealing with logistics, to food and  transportation. “The volunteers do everything that is non-medical, as the name implies, and that can be literally anything. The team is here to do something specific and it is the volunteers’ job, and mine, to make this as easy for them as possible.

There is a lot of on the ground planning in case things do not go as planned, but we have nine volunteers on this mission in Assiut and many have been doing this for years. I tell them to remember things so I can forget them,” said Mohamed Abu Fadl, who works full-time for Operation Smile.

Many volunteers said Operation Smile was an invaluable learning experience for them. “I started doing this when I was in school. I originally wanted to study engineering but my experience made me switch to dentistry,” said Omar Dorghamy, one of the volunteers. For Salma Khaled, Operation Smile is a part of life, “I have been doing it for four years and counting. I have a full-time job and I did not study medicine but I come whenever my work permits me to travel, or if the mission is in Cairo, I am there all the time.”

The volunteers have a difficult job requiring organisational skills when dealing with logistics, language skills when translating, inter-personal skills when dealing with the patients. Their job is absolutely essential in ensuring the mission goes without a hitch, especially since Operation Smile is famous for its specific system and protocols, ensuring maximum efficiency and safety for everyone involved.

The children and their parents

The focus of all of this hard work is, of course, the children themselves and none of the people involved, be they doctors, nurses or volunteers, lose sight of that. The children bring a sense of fun and joy to the hospital, which, unsurprisingly, could look otherwise somewhat sterile with machines and needles in abundance.

Almost all of the families present at the hospital had come a considerable way. Upon arrival they undergo the lengthy process of having their child diagnosed, and if all is well, prepped for action. Some of the children present could not undergo surgery because they were either too young, (Operation Smile insists on a minimum of 6 months and 1 year for lip and palate surgeries, respectively), or because they were not strong enough for the operation.

Anaemia prevented two year old Amira, quite possibly the happiest toddler on the planet, from being operated on this time around, but her giggling presence cheered everyone on as she was receiving treatment for her condition. Operation Smile entered her name into their records. They will keep up with these potential patients, to have their operations whenever possible.

One six year-old child, Sabrine, had an opening in the palate of her mouth, left over from a previous surgery, which prevented her from eating properly. “Whenever she eats, the food escapes to her nose,” said her mother, who was understandably nervous as her daughter was being prepped for surgery. The operation was a success and Sabrine should recover quickly and fully, according to the doctors.

The doctors and nurses had obvious experience in dealing with children who have been ostracised for looking different. With the exception of Amira, who was only two, older children were very shy and their parents were visibly protective, no doubt a reaction to the sheltered lives the children had had to lead. The kids’ delight at being treated normally was touching to see. The children played with all the toys which Operation Smile brings along, uninhibited.

Most parents had heard about the mission through local NGOs, word of mouth, or flyers passed out in their villages. Spreading the news Operation Smile is in town is one of the greatest challenges facing the organisation. Getting the word out can sometimes be a bigger obstacle than the operation itself.