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From the Field Global

Celebrating National Nutrition Month: Q&A with Operation Smile's Nutrition Council

For many babies, their cleft condition makes it nearly impossible to breastfeed properly. This causes some mothers to resort to alternative methods of feeding their baby. Volunteer pediatrician Elodi Priranja of Madagascar helps 3-moth-old Alain's mom practice a cup feeding technique during an Operation Smile Madagascar patient feeding program. Photo: Zute Lightfoot.

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Operation Smile's director of nutrition, Charlotte Steppling. Photo: Rohanna Mertens.
Hear from our director of nutrition, Charlotte Steppling, about why including nutritional support on our programs is saving patients' lives around the world.
Eleven-month-old Moses being fed by his mother, Aba, while waiting for patient announcement during an Operation Smile Ghana medical mission. Photo: Zute Lightfoot.
Ghanaian volunteer nutritionist Dede Kwadjo creates practical and effective solutions so patients suffering from malnutrition can receive surgery.
Hear from our director of nutrition, Charlotte Steppling, about why including nutritional support on our programs is saving patients' lives around the world.
Ghanaian volunteer nutritionist Dede Kwadjo creates practical and effective solutions so patients suffering from malnutrition can receive surgery.

Our promise of improving health and dignity during the COVID-19 pandemic endures. Once again, we’re providing surgery and in-person care while taking stringent measures to keep families safe. Hope is on the horizon. And we remain focused on what cleft care makes possible for children, helping them to better breathe, eat, speak and live with confidence.

It's heartbreaking to witness hopeful families arrive to our surgical missions only to leave disappointed after learning their child is too malnourished to receive cleft surgery. 

This is happening to far too many families, in far too many countries where access to breastfeeding education and early nutrition intervention is limited. Our Nutrition Council, unified by people with an unrelenting commitment to save lives, aims to knockdown the barriers that stand between our patients and surgery.  

Throughout this Q&A, you'll hear from key voices on our Nutrition Council, including Adriana Olivera, nutritionist and Operation Smile Paraguay Program Coordinator; Dede Kwadjo, nutritionist and registered dietician for Operation Smile Ghana; Elsa Nel, dietician from the United Arab Emirates; and Helen Kinigopoulos, credentialed speech language pathologist from the U.S.

“I wanted to be part of the larger vision of Operation Smile's mission,” Dede said. “The Nutrition Council provides a valuable platform where I can use my expertise as a dietitian, along with other dedicated colleagues, to ensure that no child is left behind because of poor nutrition.”

In honor of March being National Nutrition Month, this group addresses the connection between breastfeeding, nutrition and speech development and how they are all key components of Operation Smile's mission to deliver the highest quality of care to those who need it most. 

We recently connected with Adriana, Dede, Elsa and Helen to learn why prioritizing nutrition is vital to better surgical outcomes and how serving on the council gives them a direct path to creating positive change. 

Speech language pathologist Helen Kinigopoulos from the U.S. speaks to a mom in the feeding program during a 2018 Operation Smile mission in Antsirabe, Madagascar. Patients who aren't chosen for surgery because they're underweight or malnourished are invited to join the three-day feeding program that provides educational workshops for families about hygiene, health and nutrition including culinary demonstrations, one-on-one consultations and food distribution. Photo: Rohanna Mertens.

Q: In your own words, why is nutrition an important part of comprehensive care for our patients?  

Adriana: “Nutrition is the base for good health. Good health gives you quality of life. Without good health, the body isn't suitable to receive surgery, the body doesn't recover from injuries, and a person can't go through post-op without a good nutrition.” 

Dede: “Nutrition is a vital connection between a healthy child and a successful surgical outcome. Good nutrition not only ensures that the child is healthy enough to be selected for corrective surgery, but also provides a basis for a good surgical outcome in terms of post-surgery healing.” 

Elsa: “Babies and children with cleft lip and cleft palate face challenging nutrition issues from failure to take nutrition to malnutrition and failure to thrive and failure to recover after surgery. Nutrition therapy should be part of standard care for all Operation Smile patients. Early resolution of feeding problems will contribute to the vision of Operation Smile to bring hope, joy and smiles to all.” 

Helen: “Without adequate nutrition, surgery is denied or delayed, surgical outcomes may be compromised, development of dentition impacted, infections become more likely, cognitive development compromised, the likelihood of a successful life imperiled.”

Q: Operation Smile will begin credentialing nutritionists for the first time in the coming year. From your experience, how do you think this will impact teams’ abilities to provide nutrition care and guidance?  

Adriana: “It would definitely be a motivation for receive more volunteers in the nutrition area. It will help highlight the nutritionist’s work and will help others see that nutrition isn't just about giving diets or performing assessments. It has a lot of fields of action: for health improvement, the preparation of a patient for surgery, recovery and food education for a healthy life.”

Dede: “This would provide uniformity in nutritional care provided across teams and countries. It would also serve as a key factor in ensuring high standards of patient care and professional outputs across board. Thirdly, nutritional intervention is a key factor in providing care for children affected by cleft, and this would ensure it gets the attention it deserves.” 

Elsa: “My first reaction is to congratulate Operation Smile for expanding the team to be more multidisciplinary and adding nutrition as an integral part of patient care by professionals with the correct training and experience.” 

Helen: “Including credentialed nutritionists on Operation Smile teams is long overdue. The importance of adequate and appropriate nutrition for overall development and for improving safety and successful outcomes of surgery has been undervalued by those who haven't experienced the consequences of malnutrition.”   

When 113 out of more than 500 patients who received a preoperative health evaluation during a mission in Madagascar were unable to receive surgery due to malnutrition, Operation Smile knew that nutrition needed to become a priority. In response, specialized 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. Photo: Peter Stuckings.

Q: Why is breastfeeding so important for the nutrition of our patients?  

Adriana: “Breastfeeding has so many benefits. Human milk is the most important food for babies during the first six months of life. It provides vital protection, decreases infections, gases, diarrhea, and strengthens the immune system. This food is so complete that it's recommended as the only source of nutrition for the baby for six months, and after the introduction of other foods, it's recommended the continuity for two years.” 

Dede: “Breast milk remains the gold standard in meeting the vital nutritional needs of our patients, especially children under 6 months. Its characteristics of being free, safe, hygienic, having the right nutrient composition for age are major determinants when it comes to the health of the vulnerable population of children born with cleft conditions. Breastfeeding, when done well, is a game changer in fighting malnutrition among our patients.” 

Elsa: “Nothing beats breastfeeding in infant nutrition!” 

Helen: “Given the evidence that the nutritional benefits of breastfeeding cannot be duplicated, as an organization whose main beneficiaries are infants and their families, Operation Smile can use its platform to educate, guide and mentor parents in discovering and using the best methods of providing breastmilk for their vulnerable infant.”

Volunteer nutritionist Dede Kwadjo poses for a photo at the patient shelter where she has been consulting with mothers of babies born with cleft conditions. Photo: Zute Lightfoot.

Q: What do you hope to accomplish by serving on the Operation Smile Nutrition Council? 

Adriana: “As a program coordinator and nutritionist, I know the importance of this specialty for patient's selection for surgery. After working with this organization for two and a half years, I believe my experience can help promote the nutrition in Operation Smile, and by this, help our patients to be healthy by the time they have to receive their surgery and ensure a proper recovery and a healthy life.” 

Dede: “I wanted to be part of the larger vision of Operation Smile's mission in ensuring that no child is left behind when it comes to providing safe and timely reconstructive cleft surgery through strategic planning and program development. The Nutrition Council provides a valuable platform where I can use my expertise as a dietitian, along with other dedicated colleagues, to ensure that no child is left behind because of poor nutrition.” 

Elsa: “To support the Operation Smile nutrition team with multiple projects to help teams, health workers and patients.” 

Helen: “I represent the speech language pathologists in offering support to the Nutrition Council regarding the safety and effectiveness of feeding techniques for individuals with cleft palate and other craniofacial differences, especially those infants who have not yet had surgery.

“Nearly three decades as an Operation Smile volunteer have offered me the opportunity to learn from experience, education and personal investigation the necessity of understanding the culture, economic and living conditions in order to overcome the problems associated with feeding and nutrition of the population we serve. I hope to expand the awareness to Operation Smile speech language pathologists and other professionals of the multiple factors affecting feeding and nutrition as they relate to successful outcomes for our patients and patients-to-be.”

After receiving nutritional support and counseling from Dede Kwadjo, a mother confidently feeds her 1-year-old son, Nana, during a 2018 Operation Smile Ghana local mission in Koforidua. Photo: Zute Lightfoot.

Q: The Nutrition Council supports Operation Smile's nutrition team through developing educational resources for in-country teams, community health workers, volunteers and patient caregivers. How do you hope to see these making a positive impact on our patients?  

Adriana: “This is the most necessary and important action our patients need. Many of the nutrition and health problems come from the lack of information. My hope is that every person who receives these educational resources shares with their family so everyone benefits.” 

Dede: “Firstly, these educational resources serve as great training materials for our nutrition teams as well as other health care professionals. This would eventually show up in the enhancement of care for our patients. Secondly, a key aspect of nutritional interventions is knowledge empowerment for the caregivers. This has been shown to increase caregiver cooperation as well as enhance care for the patients. The educational resources would serve as good knowledge empowerment tools for the caregivers.” 

Elsa: “This is a great step forward in providing correct and standardized training to Operation Smile teams, which will benefit our patient population because feeding often requires extra time, patience and individualized nutrition.” 

Helen: “By working with other Operation Smile volunteer professionals to solve nutrition and feeding issues, heightened awareness will help identify those who are in need of both nutritional and feeding support and interventions.”

Charlotte speaks to participants in the feeding program at the patient shelter during a 2018 Operation Smile medical mission in Antsirabe. Patients who aren't chosen for surgery because they're underweight or malnourished are invited to join the feeding program. For three days, parents and children attend educational workshops about hygiene, health and nutrition. Photo: Rohanna Mertens.

Please include any additional thoughts you'd like to share about your experience on the Nutrition Council or serving as an Operation Smile volunteer.

Adriana: “I love that we can share our experiences working with Operation Smile in our countries. It's very enriching and inspiring to share insights, knowledge and the same desire to help all of our patients to improve their quality of life, regardless of the specialty we have.” 

Dede: “It's been awesome working with the council and seeing how far the nutritional component of cleft care has come in the organization. I've enjoyed being part of development of protocols and modules. Working with other likeminded colleagues from other countries has been a great shared learning platform for me, and I'm thankful for the opportunity.” 

Photo: Anton Crone.


It takes as little as $240 and as few as 45 minutes to provide life-changing surgery and a bright, beautiful new smile to a waiting child.