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2019 Annual Report

2019 Annual Report

A Letter From Our Co-Founders

Dear friends and supporters, 

We recognize that the work we accomplished last year simply wouldn’t have been possible without your unwavering commitment and passion to help us make our world a more caring and compassionate place for all. 

For 37 years, we’ve provided access to the highest quality of surgical care for patients and families living in resource-poor communities. And it’s through the persistent loyalty and ambition of our volunteers, partners, staff and supporters that we’ve been able to continue restoring the dignity of patients affected by cleft lip and cleft palate with safe surgery, while simultaneously evolving to strengthen health systems where we work through building trust and fostering relationships. 

Children possess an extraordinary power. Unifying people, cultures, families and governments, children inspired an alliance between two countries at a time when trust and friendship were effectively nonexistent between them. In 1989, Operation Smile became the first U.S. nonprofit organization welcomed back into Vietnam following the destructive and divisive conflict that ended decades before. 

It was through a chance encounter at my 25th high school reunion that we reconnected with the late John Connor, a Vietnam veteran who became involved with some of the first acts of goodwill between the U.S. and Vietnam. John knew that Operation Smile’s life-changing work could serve as a conduit for healing years of strain and distrust.  

We took a chance and soon learned that he was absolutely right. 

At our first medical mission in Hanoi, there was no room for hatred nor dwelling on the past. Our team worked side by side with Vietnamese medical professionals to change the lives of more than 100 children. We haven’t looked back since. Within four months of that first mission, the missing in action began their return to the United States.  

We also brought our son Todd, the third of our five children, to the mission so that he could witness these transcendental moments between volunteers, parents and their children. Twenty years later, Todd and his incredible wife, Charlotte, adopted their beautiful daughter, Olivia, from Vietnam. This experience and many others over the years have made an indelible impact on every member of our family, all of whom keep Operation Smile’s mission close to their hearts. 

In April 2019, after nearly 30 years of collaboration to improve the level of care patients and families receive in Vietnam, Operation Smile and Vietnam’s Ministry of Health proudly announced the co-creation and implementation of eight new guidelines for patient safety. We can’t think of a more fitting way to honor the memory and legacy of John and his vision of healing.  

We understand that achieving these kinds of milestones requires the effort of more than one organization or individual. Changing lives on a global scale requires collaboration, persevering over unforeseen obstacles, joining forces with unlikely allies and taking risks in order to do what’s right.  

More than anything else, Operation Smile is about people. And as we look back on the past year, we acknowledge that our work in Vietnam and around the world is driven by the generosity and love that our global family – volunteers, donors, partners and staff alike – have for our patients and their families.   

And while love has fueled our ability to expand as an organization in more ways than we could’ve ever imagined when we started Operation Smile 37 years ago, there’s still much work to be done.    

Thank you for remaining by our side. We invite you and your family to join our Operation Smile family as we continue on this incredible journey. 

Extending Our Reach, Expanding Our Impact

As we work toward our vision of a future where the health and dignity of all are improved through safe surgery, we’re utilizing our 37 years of expertise in treating cleft lip and cleft palate to create solutions that deliver safe and comprehensive care to people where it’s needed most. 

Addressing some of the world’s most pressing problems demands that we work in some of the world’s most impoverished and challenging environments. 

Mozambique is one of those places. 

In places like Mozambique, our patients and families face seemingly insurmountable barriers to accessing and receiving surgical care. It’s one of the world’s poorest and most impoverished countries with more than 46 percent of its 27 million people living in poverty. For nearly all of them, the cost of cleft surgery is impossible to afford. Compounding the economic barriers are the physical, with more than 63 percent of the population living in rural and remote areas far away from hospitals where surgery can be performed.  

While Operation Smile medical missions aim to increase access to cleft surgery for Mozambicans who need it, there’s also a need for potential patients and their families to learn that surgery is available through these programs. Many may not know that surgery can repair a cleft condition at all.  

Part of the ramp-up to the July 2018 Quelimane mission were the patient recruitment efforts of then-volunteer Carlos Mahalambe. Inspired by a poster promoting a medical mission back in 2014, Carlos was moved to help. He helped patients and families access care at both of Operation Smile’s 2014 missions in Mozambique and enthusiastically volunteered to support the July 2018 Quelimane mission. Carlos brought 18 patients to that mission before joining our staff full-time as a patient coordinator. At the following mission in Nampula in August 2019, he recruited 89 potential patients to Operation Smile’s care.  

Operation Smile Mission to Quelimane, Moazambique

We’ve known for years that the need for cleft care in Mozambique is immense. It’s estimated that more than 13,000 children and adolescents are living with untreated cleft conditions in the country. We began working in Mozambique in 2013 and conducted two medical missions before making the tough decision to exit due to the escalating political unrest that was unfolding at that time. 

By 2017, tensions had eased, and the time was right to renew our commitment to Mozambican patients. After reengaging the ministry of health, we co-created plans for training and education to be the foundation of our work in the country going forward. 

In July 2018, we hosted our first international medical mission in Mozambique in five years in Quelimane, the culmination of eight months of collaboration. Our medical volunteers delivered 110 procedures to 75 patients and provided educational opportunities to more than 20 Mozambican health workers.  

Today, we continue to build upon this foundation of trust so that patients and families affected by cleft receive the surgery they deserve. 

We conducted 176 medical programs across 103 sites in 32 countries. Of that total, 112 missions were conducted by a majority of local medical volunteers.
Medical programs extended to 19 new sites in 13 countries, including Brazil, China, Egypt, Ghana, India, Jordan, Malawi, Morocco, Mozambique, Nicaragua, Philippines, Russia and Thailand.
We provided 19,718 patients with surgery and dental care at medical programs and care centers in 32 countries last year. Since 1982, we’ve helped more than 300,000 people receive life-changing surgical and dental care.
We’re proud that 83 percent of the medical volunteer positions filled on our missions in fiscal year 2019 were held by health care professionals from low- and middle-income countries; a majority of whom received training and education from Operation Smile.
In fiscal year 2019, 7,723 medical volunteer positions were filled by skilled and passionate professionals, donating 414,762 hours valued at $32,354,790.

Since the earliest days of Operation Smile – even before our co-founders, Dr. Bill Magee and Kathy Magee, gave it a name or organized its first medical mission – the stories of our patients have fueled our passion and our purpose. 

While hundreds of thousands of stories span four decades, all of our patients’ and their families’ experiences and perspectives shed light on the need for safe, effective and timely surgical cleft care that is as dire today as it was 37 years ago


Braving the World Together

For 10 years, Noemia lived with a cleft lip until her mother learned that surgery was possible through Operation Smile at the Quelimane mission.

The Pursuit of Smiles

Operation Smile’s commitment to patient recruitment and advocacy has helped thousands of patients access cleft care and fuels the growth of successful medical programs around the world. From the dedication of volunteers like Don Alex Guerrero in Honduras to Operation Smile Ghana patient coordinator Clement Ofosuhemeng, we’re building networks of like-minded people who understand the value of having their boots on the ground and engaging in face-to-face conversations and growing relationships that help ease fears and lead to healing.

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Through Clement’s patient recruitment efforts, we met Faustina. For 17 years, she lived with the burden of her unrepaired cleft lip. It’s places in Ghana like her community where the deeply rooted stigma of cleft is the most severe.  She told us, “I can’t go anywhere because of my cleft. I can’t attend school. I just spend my days helping my mother at home. I have my family, my siblings and parents, but I have no friends and I feel sad. I know that if I have the surgery, I will make friends.” 

Mohammed said that he’s always accepted Faustina’s condition as God’s will. When his daughter was born, doctors told him that surgery could fix her lip. However, the procedure couldn’t be performed at their district hospital, and it would be too expensive for him to afford. He tried in vain to find a free surgery for Faustina throughout her life, but it wasn’t until he connected with Clement that hope finally returned to the family.  

It was at an Operation Smile Ghana mission in January 2018 that Faustina finally received the surgery that she always deserved.  

Last year, we made the journey to Faustina’s community in a remote corner of Ghana’s Central Region to learn how life has changed for her.  

Today, Faustina is a sewing apprentice, and she carries herself with confidence. Her fellow apprentices are her best friends, and she’s embracing opportunities from which she had always been isolated.  

She is the tailor of her future. 

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Closing the Gap

Faustina realizes a brighter future that she ever thought was possible, her 17 years of suffering reminds us of the debilitating effects of living with an untreated cleft condition. We believe that access to safe, effective and timely surgery is not a privilege, it’s a fundamental human right. We also know that providing surgery through mission and care center activity is only part of the solution.  

It’s stories like Faustina’s that compel us to create sustainable solutions with the goal of strengthening health systems so that patients can receive the surgery that they need, when they need it, close to home. 

In places around the world like Ghana, health systems are not able to meet the demand for cleft surgery and many more essential surgical conditions. Patients’ families’ financial means and physical distance from care are compounded by many hospitals’ lack of highly trained health workers that can deliver quality care, equipment, supplies and infrastructure.  

For decades, Operation Smile has invested in the training and education of health workers in low- and middle-income countries so that they can provide high-quality care both during our medical programs and every day at their home hospitals.

We conducted 95 American Heart Association life support training sessions in 23 countries and issued a total of 2,370 certifications.
We provided training for 836 multidisciplinary cleft care providers on 38 missions.
We provided opportunities for 278 health workers from low- and middle-income countries to participate in conferences and skills workshops.
We provided training and mentorship to 90 residents as we work to train the next generation of medical leaders.

Training Future Generations

In Rwanda, our commitment to strengthening the skills of local health workers continues through twice-annual surgical training rotations, which provide general surgery and anesthesia residents with hands-on training in reconstructive plastic surgery techniques.  

Rwanda faces dire challenges when it comes to the number and skill of its health care professionals: Only two reconstructive plastic surgeons and 18 anesthesiologists serve the country of nearly 12 million people. 

And the need extends far beyond cleft conditions. Much of the surgical demand in the country results from trauma and burn wounds. The lack of adequately trained surgeons forces some patients to wait for years before they’re able to receive treatment, which worsens their conditions and further burdens the health system. 

But through the rotations, more than 25 Rwandan general surgery residents have completed the training, bringing these life-changing and life-saving skills to communities across the country. The rotations have also strengthened the skills of residents in anesthesiology, another area of massive need in Rwanda, with five graduates completing the program since its inception. 

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By partnering with academic institutions like the University of Rwanda and corporate partners like Stryker, Operation Smile creates sustainable solutions and increases the surgical capacity available to people living in those countries.  

But it's through fostering relationships and collaborating with ministries of health and national governments that we can influence entire countries’ public health policies that directly impact our patients and their families. 

Vietnam Safe Surgery

After many years of working together to enhance the level of care hospitals offer patients, Operation Smile and Vietnam proudly announced the establishment of eight new guidelines for patient safety.  

Co-created by the organization and Vietnam’s Ministry of Health, these standards for safe surgery will impact the entire country.  

Available for adoption at 1,450 medical facilities and 63 provinces across Vietnam, the guidelines have the potential to affect up to three million surgeries every year. 

The announcement during a conference held in Hanoi on April 2, 2019, not only signified a major milestone for Operation Smile and the country but marked a vital step toward advancing the future of surgical care for families living in Vietnam.   

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Surgery for the People

As Operation Smile continues expanding its long-term impact into more countries, we’re forced to witness the devastating effects of hospitals operating with inadequate equipment and infrastructure.  

We believe that for our patients to live healthy and dignified lives, we must not only create solutions that eliminate gaps separating patients from care but ensure that the highest quality of surgical excellence is available to the people who arrive seeking help. 

In rural northeastern Nicaragua, these needed life-changing solutions are already providing people with care that wasn’t available to them a few years ago thanks to the pilot project called “Surgery for the People.” 

With the high-quality facilities, cutting-edge laparoscopic equipment and advanced training of the medical staff, patients are experiencing new methods of treatment and healing at the two primary hospitals in Siuna and Bonanza.  

Today, less people are being turned away without care, more lives are being saved and patients are returning home to their families and loved ones just days after surgery.   

A Center of Healing in Morocco

Over the years, we’ve recognized that upholding our promise of treating the whole patient means we must go beyond surgery and beyond the medical mission.  

Even after receiving cleft surgery and leaving the mission site, many patients still require additional treatment to fulfill their physical and emotional needs. 

By increasing the availability of ongoing, comprehensive services like speech therapy, dentistry, orthodontics, psychosocial care and nutrition at our year-round care centers, Operation Smile and its community of devoted volunteers deliver a level of complete care that every human deserves. 

Our commitment to ensuring that our patients thrive in life is evident in the work we’re achieving in Morocco


With successful, long-term patient outcomes at the forefront of its mission, the Operation Smile Morocco team became concerned when former patients began arriving at missions complaining of jaw pain, speech problems and insomnia.  

Undergoing multiple corrective surgeries, many patients are at an increased risk of requiring jaw surgery, also known as orthognathic surgery, due to an excessive amount of tissue around the surgical site. Not only can the buildup of tissue affect a patient’s ability to chew, but it can impact their speech, breathing and, ultimately, their quality of life.  

An estimated 25 to 30 percent of patients become candidates for orthognathic surgery. Adapting to this newly discovered need, Operation Smile Morocco activated new multidisciplinary teams with the skills and training to treat provide patients with specified treatment at its three care centers in Casablanca, El Jadida and Oujda.  

Through realizing the unmistakable demand for orthognathic care, countries including Nicaragua, Guatemala and Italy are also striving to implement and deliver the same advanced care on an ongoing basis. 

Creating a Lasting Impact

Improving a patient’s ability to communicate clearly to friends and family members makes speech therapy one of the most essential and prominent disciplines of comprehensive care provided by Operation Smile.  

Thanks to volunteer speech language therapists like Salmah Kola of South Africa, patients receive opportunities to thrive in every aspect of life.  

Q: Can you describe the value that speech language therapists bring to Operation Smile’s patients? 

A: “Speech therapists play a vital role in many areas within the mission context, namely feeding, speech development and correction, and language development across all ages. People with a cleft palate often present speech problems, making their speech difficult to understand and resulting in bullying or being shunned by the community. Although a cleft palate surgery fixes the palate, these patients often require follow-up speech therapy. This can be a long-term need, and all patients are encouraged to return to follow-up missions to assist with their speech.” 

Q: Have you been involved in training and education for Operation Smile? What is the value of providing those educational opportunities for medical professionals? 

A: “Collaboration is a recurring theme here, and a by-product of collaboration for me is capacity-building and upskilling. Every single mission that I have been on has included a training component. The training is as important as the surgeries that are performed. By equipping local volunteers with knowledge and skills, we ensure that the legacy of comprehensive care continues long after we have left.” 

Q: How do you feel that your service to Operation Smile has made you a better professional? 

A: “I have and will always maintain that although going on missions means that we give and share of ourselves and our expertise, we are also very much on the receiving end. The impact missions have had on me as a professional are great and valued, but these are not as important as the impact it has had on me as a human being. I have been humbled to be lucky enough to be a small part of this gigantic puzzle. I’m honored to work with people from all over the world who entrust me with something as valuable as their loved one’s feeding and communication. 

“The exciting thing about volunteering with Operation Smile is that the services we offer are constantly being monitored and improved upon. Working with the population affected by cleft is about more than just the aesthetic change. It’s about the changes we can make to our patients’ quality of life in the long term.” 

We provided 456,970 patient interactions, including patient health screenings, operations and post-operative care at medical missions; dental screenings and procedures; and operations and consultations at care locations.
Operation Smile operates 31 care centers in 16 countries, providing year-round medical services.

Creating a More Compassionate Tomorrow

Regardless of what challenges arise, Operation Smile strives to help its student volunteers overcome obstacles and evolve into advocates of change for children living with cleft conditions.  

In Winston-Salem, North Carolina, our International Student Leadership Conference united more than 350 high school students from 21 countries around the world at Wake Forest University to engage with each other, learn from motivational speakers and participate in collaborative leadership training.

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Creating a more compassionate world requires inspiring the next generation of advocacy-minded leaders into action. It also calls for the Student Programs team to provide students like Brady Hishmeh -- a high schooler from New Jersey who was born with a cleft condition -- with opportunities to be brave and be heard. 

For many students in attendance at the 2017 International Student Leadership Conference, the existence of cleft was often seen as a distant issue only found in resource-poor countries. When the reality was that all they needed to do was look to the person sitting next to them.  

Brady welcomed members of his community to the stage to form the first-ever ISLC cleft panel. By sharing their motivational stories of adversity and advocacy, the students on the panel empowered those in the audience to embrace each other’s differences and be proud of exactly who they are.  

To this day, the panel continues to inspire and change the hearts and minds of Operation Smile student volunteers.

Changing Lives Through Advocacy

At just 10 years old, Elizabeth Alberti was facing her seventh surgery to repair her cleft condition. While Elizabeth was initially nervous about undergoing another procedure, her anxiety soon evolved into advocacy.

“One afternoon, she had a sudden burst of perspective,” Elizabeth’s mom, Heather, recounted. “She said, ‘Mom, here I am pushing back about having another surgery, and I just realized that there are kids all over the world who would give anything to have just one.’” Empowered and inspired by her surgeon and Operation Smile volunteer Dr. Arun Gosain, Elizabeth decided to help children living with cleft conditions access the same quality of care that she received through launching the first “Team E” digital campaign.

After sharing her story, posting personal videos and speaking openly about the challenges of living with a cleft condition, it wasn’t long before Elizabeth raised $16,000 for the organization, successfully giving more than 60 children new smiles. 


Operation Smile believes that youth has the power to change the world.

But this isn’t where Elizabeth’s story ends. If anything, her “Team E” campaign was only the beginning.

Impactful Partnerships

For the second consecutive year in a row, Operation Smile was proud to extend our impact to more patients and families with the help of our incredible corporate partners.  

In 2019, we teamed up with Lay’s once again to spread smiles across the country with the #SmileWithLays campaign! Our specially designed “Smile Bags,” featuring some of our dedicated volunteers, were available across the U.S. Thanks to another successful campaign, Lay’s made a $1 million donation to Operation Smile! 

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Child with a cleft lip being kissed by guardian, smiling into camera
Family in Durgapur

Advancing Safe Surgery in India with Baxter

With a burgeoning population and less than 5 percent of gross domestic product expenditures directed toward public health care, the health system in India is ill-equipped to provide comprehensive care to those living with cleft lip and cleft palate throughout the country. Currently, the backlog of untreated cleft cases stands at an estimated 200,000. 

With a shared vision to address this dire need, the Baxter International Foundation has committed $2.2 million over three years to support a project that advances safe surgery in India. With this support, we are implementing a scalable solution for equitably increasing access to surgical and multidisciplinary cleft care for some of the world’s most marginalized patients.  

The funds support the ongoing maintenance of Operation Smile’s three year-round multidisciplinary and surgical care centers in Mumbai, Srinagar and Bangalore, operated in partnership with INGA Health Foundation. In addition, the funds helped Operation Smile launch a new center in Durgapur, West Bengal, at the IQ City Narayana Multispecialty Hospital on March 7, 2019. The Durgapur center serves as a hub for operations, supporting surgical service, multidisciplinary care, education and training, and ongoing medical programs in West Bengal and surrounding states.  

Over the coming three years, this project is expected to impact 300,000 patients, family members, community members and health workers.

A mother and her child wait patiently at the shelter during a 2018 Operation Smile India surgical program in Durgapur. Photo: Jasmin Shah.

By dedicating ourselves to the fundamental cause of improving the health and dignity of those who need it most through safe surgery, we know that we can transcend our differences and change the lives of patients, families, communities, countries and the world.


Read more for our financial statement and board information.

Financial Statement

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. Our stringent medical standards require the purchase of high-quality, and therefore high-cost, medical supplies, which are then shipped worldwide to our program sites. We send skilled medical and nonmedical volunteers to be beside patients who need them. By training and credentialing local medical professionals, we empower them to deliver world-class care in communities where they live. For patients and families facing financial hardship in order to attend our programs, we cover the costs of transportation, lodging and food. By partnering with national governments and other organizations, we’re working toward long-term health system improvements so that future generations can receive care in their communities. It’s our honor to participate on the world stage of surgical innovation and excellence to raise awareness about cleft conditions, safe surgery and the need for more equitable health services globally. 

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. 

*For the time period July 1, 2018 – June 30, 2019. The full financial statements, audited by KPMG LLP, are available via request by calling 1-888-OPSMILE and can be found on our financial stewardship page.

Board of Directors


  • Board Director
  • CEO, RoundhouseOne
  • San Francisco, Calif., U.S.


  • Board Director
  • Retired Plastic Surgeon
  • Quinton, Va., U.S.


  • Board Director and Officer
  • President and Co-Founder, Operation Smile
  • Virginia Beach, Va., U.S.


  • Board Director
  • Former Co-Owner,
  • American By-Products Recyclers and Planet Earth Biodiesel
  • Atlantic Highlands, N.J., U.S.


  • Board Director and Officer
  • CEO and Co-Founder, Operation Smile
  • Virginia Beach, Va., U.S.


  • Board Director and Officer
  • Managing Partner, Federal Capital Partners
  • Chevy Chase, Md., U.S.


  • Board Director and Officer
  • COO and Partner, J.R. Reingold & Associates
  • Alexandria, Va., U.S.


  • Board Director and Officer
  • CEO and Founder, Swift Transportation Company
  • Phoenix, Ariz., U.S.


  • Board Director and Officer
  • Partner,
  • Thorn Run Partners LLC
  • Washington, D.C., U.S.
  • Founder & CEO
  • Healthcare Lighthouse
  • Denver, Colo., U.S.

Senior Leadership


  • Officer
  • Chief Financial Officer, Operation Smile
  • Virginia Beach, Va., U.S.


  • Officer*
  • Chief Medical Officer, Operation Smile
  • Virginia Beach, Va., U.S.


  • General Counsel, Operation Smile
  • Virginia Beach, Va., U.S.


  • Officer*
  • Chief Development Officer, Operation Smile
  • Virginia Beach, Va., U.S.


  • Senior Vice President of Logistics and Facilities, Operation Smile
  • Virginia Beach, Va., U.S.


  • Officer*
  • Vice President of Global Media Strategy and Public Relations, Operation Smile
  • Virginia Beach, Va., U.S.


  • Senior Vice President of Global Philanthropy, Operation Smile
  • Virginia Beach, Va., U.S.


  • Officer
  • Chief Operating Officer, Operation Smile
  • Virginia Beach, Va., U.S.

*Appointed Officer of the Board for End of Fiscal Year 2019

Photo and Video Credits

We work with an incredible group of visual artists who connect global audiences to the heart of each story we tell.

Their approach to portraying the beauty and dignity of patients, the passion of volunteers and supporters, and the orchestration of our medical programs allows us to experience an indelible memory in the moment that the video or photo is captured, no matter where we are in the world.

Daniel Aldamiz, Marc Ascher, Oli Cohen, Bobby Cullipher, Martin Flink, Laura Gonzalez, Ashley Gutierrez, Jörgen Hildebrandt, Markus Jordö, Markus Junghard, Zute Lightfoot, Alejandra Mejías, Fran Mendez, Rohanna Mertens, Paul McReynolds, Kat Millar, Margherita Mirabella, Andrés Morantes, Chris Naum, Samuel Nilsson, Laura Portela, Kirby Repolido, Carlos Rueda, Jasmin Shah, Reinaldo Ortiz Toledo, Kristy Walker, Jacob Watson, Justin Weiler, Beny Zambrano and Epidemic Sound