A Letter From Our Co-Founders
As we reflect on the past year, we are humbled by the love and leadership demonstrated by our local teams and medical volunteers around the world. Despite the COVID-19 pandemic restricting travel and straining health care systems, our teams across more than 30 countries responded with innovative solutions to reach the patients who need us most.
Around the world, we established virtual speech therapy programs for patients awaiting surgery, donated medical equipment to hospitals combating oxygen shortages, shipped life-saving ready-to-use therapeutic food (RUTF) to families fighting food insecurities, and we provided critical supplies and trainings for infection protection control, all with the ultimate goal of enhancing safe surgery protocols.
The skill and passion of our global network of more than 6,000 medical professionals ensures we offer each child the same quality care we would expect for our own children. Over the years, our relentless focus on the quality of a child’s care has given us a window into the greater need.
In the countries where we work, we estimate that there are 5 million people living with untreated cleft conditions, most of whom live beyond the reach of existing hospital care. Therefore, we are called to increase access to and strengthen standards of surgical care. Through our expertise in treating cleft conditions, we are able to increase access to a comprehensive care model that meets the full range of a patient’s needs including speech therapy, nutrition, dentistry, orthodontics, psychosocial support and more.
As we leveraged Operation Smile’s strengths through the uncertainties of a global health challenge, we realized that 40 years of experience led us to co-create solutions with local medical leaders for the successful delivery of safe, quality surgery and cleft care.
Operation Smile’s investments in our local volunteers have equipped them with the skills and resources to withstand the challenges we are facing today. It set us up to launch our next decade of commitment.
Marking our 40th anniversary year, Operation Smile has announced a 10-year commitment to increase access to care for 1 million patients who need cleft care and other essential surgeries.
We will reach our goal by working alongside our local partners including ministries of health, donors, hospitals, corporations and academic institutions to scale up our investments to increase access to more and safer care. This means expanding opportunities for women in medicine, research, investing in the education of health workers, and empowering the next generation of global health leaders.
Since the day we started Operation Smile, the face of a child has always been our guide. Children born with cleft conditions took us back to their communities to show us the need and get us to pay attention to their health-system infrastructure. Through excellence in cleft surgery, we can now open the door to impact community health systems as we build on 40 years of trust. Our commitment to children born with cleft conditions is unwavering. Now, more than ever, we are called to expand innovative solutions that will lead us into the next decade of love and leadership.
Keeping Our Promise
While our 2021 fiscal year* proved to be another challenging year for our patients, their families and our teams around the world, it was also a year that showcased Operation Smile’s commitment, resilience and adaptiveness.
The enduring COVID-19 pandemic presented our global community with adversity in myriad ways from lockdowns to food insecurity to health systems stretched beyond their limits.
Time and again, thanks to the unwavering compassion and generosity of our supporters and volunteers, our teams continued to provide patients with life-changing cleft surgery and comprehensive care amid daunting, ever-changing and complex circumstances.
*Operation Smile’s 2021 fiscal year was July 1, 2020 through June 30, 2021
2021 Program Highlights
Resuming Surgical Programs
When communities around the world were hit hard by the virus, thousands of patients in need of cleft care were left waiting.
Our global teams of volunteers were mobilized into action as they sought out new ways of safely resuming surgery and care. On a global scale, Operation Smile implemented additional stringent safety protocols during surgical programs, including temperature screening, mask-wearing, COVID-19 testing, socially distanced screening areas, increased sanitation measures and more.
The health of our volunteers, patients and their families has always remained at the forefront of our mission. But in order to reach patients like Lilia amid fear and uncertainty, we needed to go beyond our typical approach.
Valeria’s eight-month ultrasound revealed that her daughter, Lilia, would be born with a cleft lip and cleft palate. She had already lost her job as a kindergarten teacher due to pandemic lockdowns, and, tragically, her husband passed away just before Lilia was born. Grief, fear, loneliness and doubt filled Valeria’s thoughts. Still, she persevered.
While it seemed as though her dreams for her daughter would remain out of reach, Valeria connected with Operation Smile Mexico. Hope replaced her fear, support replaced loneliness, and care replaced doubt.
Local volunteers provided Lilia with ongoing comprehensive care until it was safe to resume surgeries. In addition to receiving a cleft palate feeding plate that made it easier for her to eat, Lilia participated in virtual speech therapies that helped her emotional and speech development. Finally, at surgical programs conducted by teams of Operation Smile Mexico volunteers, Lilia received cleft lip surgery in March 2021 followed by her cleft palate surgery in September 2021.
“This has changed my life because I know there is always a hope,” Valeria said. “I know that I’m not alone; I know that my daughter counts on people, special angels who support her, that love her. I thank Operation Smile for how wonderful you are.”
Ensuring Health That Lasts
As the pandemic impacts families and communities around the world, Operation Smile remains dedicated to providing comprehensive cleft care that helps our patients better breathe, eat, speak and live lives of greater quality and confidence. In addition to cleft surgery, our teams pioneered new ways enhancing our ability to deliver essential treatments including speech therapy, dentistry, psychosocial care, nutritional support and more.
While most of this ongoing comprehensive care was performed with patients at our care centers, the sudden impact of the pandemic hitting countries worldwide made providing this care in person impossible.
Driven to overcome these hardships, volunteer speech therapists and psychosocial care providers working in care centers across Latin America and the Caribbean established “HablemOS,” a virtual and telephone-based therapy program designed to reach patients affected by lockdowns or who live in remote areas.
The HablemOS team have delivered speech consultations to more than 3,200 patients with the potential of reaching even more by replicating similar programs in the other countries we serve.
“I want to give thanks to those who made this opportunity possible,” said volunteer speech pathologist Milagros Rojas. “COVID was not a limitation, because anything is possible when things are done with humanity and infinite love.”
Learn more at operationsmile.org/hablemos
RESPONDING TO INDIA'S DELTA SURGE
At the onset of the pandemic, Operation Smile mobilized to distribute millions of pieces of personal protective equipment to ministries of health, medical volunteers and partner hospitals around the world.
So, when the Delta coronavirus variant emerged and rapidly spread throughout India, our team in the country immediately took action. To combat the massive shortage of oxygen in the country, Operation Smile donated 100 oxygen concentrators to hospitals in Durgapur, Raipur, Vijayawada, Mumbai and Srinagar.
We caught up with Abhishek Singupta, the executive director of Operation Smile India, who provided an update on the status of his country and how our local efforts continue to impact the lives of patients and families today.
“These 100 oxygen concentrators are being used in COVID-19 wards in seven different hospitals … and have been instrumental in saving lives,” Abhishek said.
Learn more at operationsmile.org/india-oxygen
LIFE-SAVING NUTRITION CARE
The care that patients who are born with cleft conditions receive before surgery is equally – if not more – important than the ongoing comprehensive treatment they receive after leaving the operating room. Years ago, while aiding patient recruitment efforts for Operation Smile surgical programs in Madagascar, our director of nutrition Charlotte Steppling came to a startling realization.
“We were turning away patients suffering from malnutrition,” she said. “I was waiting to see these kids show up at the next mission, but they just weren’t coming back. They were dying, and it broke my heart.”
Children living with untreated cleft conditions often face major challenges with feeding and receiving proper nourishment during the critical months after they’re born. These factors can lead to malnutrition, delays in growth and development and sometimes even death.
Operation Smile knew that in order to uphold its promise of delivering high-quality, safe surgical care to as many patients as possible, nutrition needed to become a priority. Specialized nutrition programs have been established in 24 countries including Madagascar, India, Ghana and Guatemala, where more patients’ lives are being saved through timely intervention and dietary education.
“We need to reach these patients as early as possible,” Charlotte said. “Whenever a patient is born with cleft, they should know that Operation Smile exists.”
Learn more at operationsmile.org/nutrition-qa
WHEN ALL SEEMED LOST, HOPE FOR JANAT WAS FOUND
The diligence and passion of people like Charlotte helped 1-month-old Janat access the pre-surgical care that saved her life.
“I had no hope that she would live,” said Youssef, Janat’s dad. “Every day, we thought she was going to die. She couldn’t breastfeed or bottle feed. Every day, we thought that she wasn’t going to live.”
Despite her family learning about Operation Smile Morocco soon after she was born, Janat had already lost nearly half of her birth weight due to the severity of her cleft condition.
“A baby with a cleft palate can’t eat [properly],” said volunteer dentist Dr. Teresita Pannaci. “That’s why it’s so important to rehabilitate the function of breathing, sucking and swallowing food so that the child is eating in the home environment. This is the real reason why treatment must be done from birth.”
Patiently waiting for the dentists to create a cleft palate feeding plate, Janat’s mom, Fatima, shared with the team that Janat could only manage to consume around three ounces of milk throughout an entire day. With the feeding plate, Janat drank 2 1/2 ounces of milk in less than eight minutes.
“I started to feel calm; [the plate] was working,” Teresita said. “I looked at her mother, and that’s when I saw she had tears in her eyes. When I asked, ‘Why are you crying? What kind of tears are these?’ She said, ‘They are tears of happiness,’ because she knew that her daughter was safe.”
Heading home after the conclusion of the surgical program, Youssef and Fatima were confident that Janat’s path toward recovery had finally begun.
Learn more at operationsmile.org/janat
OUR COMMITMENT TO BOLSTERING NUTRITIONAL SUPPORT DIDN'T STOP THERE
Made worse by the pandemic, food insecurity threatens the lives of our patients and their families living in areas where access to safe foods is often unavailable, unaffordable or inaccessible locally. Having seen firsthand the devastating impacts poor nutrition can have, our local teams in Colombia ramped up efforts to support patients and their families through a historic shipment of 99 cases of ready-to-use therapeutic food (RUTF).
While this life-saving shipment will help many children become healthy enough for their next chance at surgery, we hope this achievement sets the stage for many more essential shipments of RUTF to reach patients and families as the need for improved food security mounts in Colombia and other places around the world.
“This was a perfect match for the need in this region, and it arrived at the perfect moment,” said Paula Franco, a now-former program coordinator of Operation Smile Colombia. “It’s so nice to see how after we opened a door that there are many opportunities – after we didn’t give up – and that this will really help the children.”
Learn more at operationsmile.org/colombia-rutf
Increasing the Capacity for Care
A common gap in the ability of low resource environments to deliver more surgical care is the lack of surgeons, anesthesiologists and nurses.
Once such place is Rwanda, where there are only two reconstructive plastic surgeons serving a country of more than 13 million people. To address this dire need, Operation Smile is partnering with the University of Rwanda, Partners in Health and the Rwandan ministry of health to reduce barriers to accessing reconstructive plastic surgery. The collaborative has evolved from a service delivery-focused partnership that hosted surgical training rotations twice a year to a health system-focused partnership.
This has allowed more than 25 general surgery residents to receive high-quality education throughout the program so far.
Operation Smile’s capacity-building efforts in Rwanda continue to evolve, as it’s currently participating in a three-year training program for reconstructive plastic surgery residents alongside its partners at the University of Rwanda, the College of Surgeons of East, Central and Southern Africa (COSECSA) and the Rwandan Surgical Society.
When the first cohort of residents graduate from the program in 2022, the number of Rwandan reconstructive plastic surgeons will more than double from two to five. Rwanda serves as an example of the types of multifaceted programs we are building with partners in countries around the world.
Operation Smile’s global medical education efforts also persevered during the COVID-19 pandemic through its American Heart Association (AHA) life support trainings, which empowered health care professionals from places of need with life-saving skills that strengthened their respective health systems.
From July 2020 through June 2021, Operation Smile hosted 67 AHA training programs in which 1,157 health workers participated. This included training for 111 trainers, and 1,115 total certificates were earned.
In many of the places where we work, health workers lack access to life-saving cardiopulmonary resuscitation (CPR) training. Last year through our 48 American Heart Association training programs in 20 countries, health workers earned 1,400 basic and pediatric advanced life support provider and instructor certifications.
Working Toward a Healthier Future
While our teams around the world are meeting today’s challenges, Operation Smile continues to work toward a future where everyone has access to the safe, effective and timely care they need and deserve.
But doing so means that we need to help to solve some of the world’s most pressing problems in global surgery.
Led by Dr. Allyn Auslander, Associate Vice President of Research, we are currently conducting cutting-edge epidemiology and genetic research to understand risk factors for cleft conditions that are unique to our patient populations.
Based on nine years of data collected through Operation Smile’s International Family Study, we have published evidence that pregnant women who reported smoke exposure from cooking indoors during pregnancy were 49% more likely to give birth to a child with a cleft condition than those who did not in eight of our program countries.
In addition to identifying actionable preventative measures, such as the use of safe cookstoves and education on the dangers of indoor open-flame cooking, the study also points to an urgent need for global representation in epidemiological and genetic research. The study currently has the largest and most diverse cleft genetic repository from low- and middle- income countries. This includes groups of people, such as patients with cleft conditions from Madagascar, who are rarely, if ever, included in peer-reviewed research.
“If the status quo in medical research and innovation holds, the same inequities that ensure world-class medical care for people living in high-income environments will mean that the majority of humanity – we’re talking billions of people – will continue to live without on an ever-increasing scale,” Allyn said. “… I believe the first step is representation in research and there is much work to be done.”
GLOBAL SURGERY FELLOWS RISING TO THE CHALLENGE
Allyn also leads Operation Smile’s Global Surgery Research Fellowship, a two-year program that gives young medical professionals long-term opportunities to expand and enhance their global health knowledge and expertise.
A marquee achievement for the team is their ongoing advancement through the Global Surgery Training Challenge. The competition, hosted by Appropedia, the Intuitive Foundation, MIT Solve, Nesta Challenges and the Royal College of Surgeons in Ireland, charges teams with creating novel, low-cost surgical training modules to help practitioners learn and assess new skills to improve the health of their communities.
The goal of the challenge is to provide a solution to address the dearth of trained surgical providers throughout sub-Saharan Africa. Our team of Global Surgery Fellows led by Drs. Priyanka Naidu of South Africa and Zach Collier of the U.S. joined forces with the U.K.-based medical education software company AmoDisc to create an open-source virtual training platform and simulator for local flap surgeries.
Local flap surgeries restore form, function and feeling for patients who have wounds due to burns, trauma, cancer, infections and congenital conditions including cleft lip and cleft palate. Yet in much of sub-Saharan Africa, the lack of surgeons trained in flaps creates needless suffering or death for patients in environments that already have so many factors preventing the provision of safe surgery. This project aims to eliminate surgical training as one of those factors.
Out of more than 100 teams, the “AmoSmile” team was one of 10 selected to advance to the Discovery Award stage of the contest, earning $200,000 to continue development of their module. Building on that success, the team is now one of four teams to advance to the final round, winning another $500,000 to continue research and development.
GLOBAL ESSENTIAL SURGERY PROJECT PROGRESS
Global Surgery Fellows also play a key role in Operation Smile’s ongoing Global Essential Surgery Project, which addresses the root causes that prevent hospitals from treating more people living with conditions that can be healed by surgery.
Financially supported by the UBS Optimus Foundation and in collaboration with ministries of health, NGO partners and local stakeholders, health workers, and hospitals, the project seeks to provide more training opportunities to improve the skills of health workers, revitalize critical infrastructure, and address barriers that prevent patients from seeking or reaching care.
At designated hospitals in Madagascar, Nicaragua and Vietnam, the project has trained more than 1,500 health workers, built new operating rooms, provided major renovations to hospitals, created safe surgery protocols and raised communities’ awareness of surgically treatable conditions that are now served at those hospitals.
At Vietnam-Cuba Friendship Hospital in Hanoi, Global Essential Surgery Project partner site and site of Operation Smile Vietnam’s ongoing cleft surgery programs, training provided during the project led the hospital to create permanent quality improvement teams. A group of nurses trained by Operation Smile in safe surgical practices and operating room-monitoring techniques has expanded into an OR safety monitoring team that is now a permanent part of the hospital’s surgical staff.
Biomedical technicians trained in equipment process management have created a new hospital-wide protocols for all clinical teams. The creation of these new teams and processes means that health workers across the country can observe, adapt, and adopt the hospital’s safe surgical practices and quality improvement measures for their own hospitals.
A Window to the World
With one gift, Anthony L. Burgess found a way for his love of his late wife, Hideko, and their passion for Operation Smile’s mission to live on for generations to come.
Anthony donated $1 million with a bequest at his passing to provide the means for Operation Smile to create the Anthony L. and Hideko S. Burgess Interactive Learning Center (ILC) at its global headquarters in Virginia Beach, Virginia.
With its immersive experience, the ILC will promote empathy and encourage cultural inclusivity by allowing students and visitors to walk alongside a patient in a replica of our surgical program process to help them understand the challenges and realities of our patients and their families’ lives, as well as learn more about global health care.
"The bequest from Mr. Burgess is a full-circle love story," said Kathy Magee, Co-Founder and President of Operation Smile. "Mr. Burgess came into the organization as a monthly donor and, through our planned giving program, established a living legacy with the Interactive Learning Center. He made a generous decision to complete the project in honor of his wife and their 55-year marriage, knowing that the ILC will foster learning, education and cultural understanding for generations to come."
The ILC will honor Anthony, Hideko and their long-term devotion to the people we serve. Dan Burgess says his parents would be proud to have their names tied to something with the potential to inspire future generations to serve through empathy and love.
“There is no greater joy than the joy of giving,” Dan said. “There really isn’t, and maybe they will take that away from this and incorporate that in their lives.”
Learn more at operationsmile.org/ilc
Students Sending Hope
When Operation Smile Student Programs sees a need, it challenges its student volunteers to address it. And its young leaders answered the call through the “Sending Hope” initiative.
Knowing that proper nutrition and good health are key in ensuring that patients are healthy enough to receive surgery, Operation Smile’s student volunteers were determined to make sure that patients in Guatemala, Nicaragua, Panama and Paraguay received the support they needed amid the pandemic.
Students from nine countries banded together to provide meal kits and essential care items to help patients become healthy enough for surgery as soon as it was safe to do so. So far, the initiative has helped more than 800 Operation Smile patients, raised more than $80,000 and provided families with more than 9,000 health care items.
The Power of Partnerships
We simply wouldn’t have been able to provide our patients with world-class care, improve health systems nor respond to the many challenges posed by the pandemic without the support of the many partners that make our work possible.
Operation Smile is a global family, and we rely on the passion and dedication of our foundations in Australia, Canada, Ireland, Italy, Sweden and the United Kingdom that provide crucial funding for our programs around the world. These teams contributed $20,425,950, which accounted for 23% of our total revenue.
Last year, the Johnson & Johnson Baby Care campaign, “3 for Change,” was successfully launched in Colombia and Mexico, with co-branded products sold across more than 100 distribution points and a direct donation of $30,000 from the company. The campaign led to an 847% increase of individual donors during its first three months, with more than 527,000 people reaching Operation Smile Colombia’s Facebook page in less than two months. It included pediatric conferences, education initiatives and had a positive impact on the way we portray children born with cleft lip and cleft palate by presenting their stories in an uplifting manner.
Baxter International Foundation made a three-year commitment of 2 million dollars from 2021 to 2023 to invest in our four care centers in India with the objective to ensure many patients and their families receive free surgical and comprehensive treatments, including covering the cost of lodging, transportation and meals while in our care.
A partnership that started eight years ago, our partnership with Mölnlycke is a comprehensive collaboration. Mölnlycke donates surgical gloves to Operation Smile and supports it financially through employee-led fundraising events to raise money for the organization. Mölnlycke has its own project in Cebu, Philippines, and has extended its global partnership with many “Mölnlycke Champions” all over the world.
With Align Technology’s support, totaling nearly $1 million in cash to date, Operation Smile has been able to deliver the highest quality surgical care to people living in places in need as well as empowering youth globally. Our shared success is intrinsically linked to our strong alignment in values and founding principles.
Pigeon has supported the equivalent of 200 life-changing surgeries to children living with cleft lip and cleft palate through its “We Hear You Baby” campaign in 2022 by making a $50,000 donation to Operation Smile and providing the organization with total value over $60,000 of essential feeding equipment, nutritional supplements and oral care products to help babies grow strong and healthy both before and after surgery in China, Philippines, Mexico, Peru, Panama and Guatemala.
Longtime corporate partner Stryker has supported our efforts through global engagement of team members, product support and education grants to help take our education programs to the next level.
Since 2013, our supporters shopping on Amazon raised more than $500,000 for Operation Smile as their charity of choice through AmazonSmile.
Since 2014, Operation Smile has shared a mission of creating festive cheer with Balsam Hill, the leading retailer of stunningly realistic artificial Christmas trees and timeless holiday décor. Balsam Hill has supported our life-changing work by bringing new smiles to the faces of more than 1,500 children and young adults born with cleft conditions through their annual #celebritiesforsmiles ornament campaign.
Generous supporters like Leslys Vedder allow our teams around the world to remain responsive to patients’ needs during the pandemic, providing them with the cleft surgery and comprehensive care that they need and deserve. “Through my giving, I am grateful for the opportunity to honor my late husband, Jim, by investing in a cause that makes the world a better place,” Leslys said. “The idea that children and families should not suffer with cleft conditions isn’t just a value of Operation Smile. It’ s a human value – one that I’m proud to share with a global community of compassionate and like-minded people.”
The surgeries we perform around the world are made possible by donations of the inhalation anesthetic Ultane (sevoflurane) from AbbVie and endotracheal tubes and electrocautery pencils from Medtronic.
In 2021, we also welcomed new gift-in-kind partners, whose gifts help us reduce the overhead cost of items that are essential to our programs. We’d like to thank Accord, Apotex, American Regent, Sagent and Zydus for their support.
Esquel, one of the world's largest textile companies, manufactured and delivered 1 million high-quality reusable Determinant masks to Operation Smile Vietnam, a gift valued at $1.3m, to help protect staff, volunteers, patients, hospital partners and Ministry of Health agencies during the pandemic.
We hold ourselves accountable to the trust you place in our work to improve health and dignity through safe, effective and timely surgery.
Committed to being the best steward of your gifts, we direct funds to programs that bring the highest standards of care to people living with cleft and other facial and dental conditions.
Most importantly, we pride ourselves on following the highest standards of accountability, effectiveness and efficiency.
As one of the largest volunteer-driven surgical organizations, Operation Smile celebrates the hundreds of employees around the world who work tirelessly to ensure that the organization continues to extend its impact. Our heartfelt gratitude also goes out to the families of employees and volunteers whose sacrifices make our life-changing work possible.
We work with an incredible group of creative professionals, volunteers and supporting staff who help us connect global audiences to the heart of each story we tell.
Their approach to portraying the beauty and dignity of patients and the passion of volunteers brings us closer to their experiences as well as the benefit that Operation Smile provides to patients, their families and health care workers around the world. Thank you for your part in bringing these stories to life.
Aimee Berniard, Aina Andrian, Alaina Kovel, Alan Hall, Alexa Langford, Alexandra Olney, Alison Smyth, Amanda Lichtenstein, Andrea Jacoboski-Taylor, Beatriz Vidal, Beny Zambrano, Bret Perry, Bethany Bogacki, Beverly Driskill, Camilo Zapata, Carlos Rueda, Cheryl Pink, Chris Lane, Daniel Aldamiz, Derrick Lorah, Elliott Wilkerson, Eric Clark, Erin Chen, Flora Campollo, Gary Marshall, George Knowles, George Lozada, Greg Corsino, Henry Cuicas, Hentisoa Rafaliarifaly, Holisoa Razakandisa, Howard Niarson, Isabella Garzón, Jamie Walz, Jane Chong, Jasmin Shah, Jen Amaya, Jena Bright, Jenny Dougherty, Joanne Bowers, John Essick, John Streit, Jordan Moore, Jorge Saim, José Augustin, Josh Gold, Joy Knowles, Juan José Marin, Julie Dion, Karey Gardner, Kat Wallace Knowles, Katie Downtain Ward, Kellee Zimmerman, Kelly Pullin, Laura Gonzalez, Laurie Messenger, Leila Hemaidan, Lilly Deljoo, Lizzy Plumb, Lori Collins, Marc Ascher, Marc Serber, Marco Tulio Chajón, Matt Haskell, Matt Trygar, Mauricio Rojas, Michael Duley, Midori Hanayama, Miguel Pichardo, Nathan Looney, Nick Ciuffreda, Nicole Ige-Hutto, Nicole Incardone, Nicolette Tallmadge, Nik Miller, Paul McReynolds, Reynaldo Ortiz, Rob Abreu, Rodrigo Aviña,Rohanna Mertens, Rojoniaina Michael, Ryan Barlow, Sam Amsterdam, Scott Selsor, Sean Riordan, Sofia Machado Lemus, Sonia Rush, Stephanie Rakotomizao, Susanne Edmark, Thomas Lyford-Pike, Todd Bemis, Toky Andriamisaina, Tonatiuh Moreno, Tristan Benedict-Hall and Yvonne Mosley.
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