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From the Field Madagascar

Scenes of Hope and Healing: Tamatave Surgical Program

Photos by Jörgen Hildebrandt

After more than two years of the pandemic preventing Operation Smile from providing cleft surgeries in Madagascar, an international team of medical volunteers were finally able to unite to provide patients with care in Tamatave during the last week of April 2022.

There, we met Honoré, a very talkative and social 6-year-old boy who lives nearby. Honoré’s mother, Eclaire, brought him to an Operation Smile surgical program in 2019, but during his comprehensive health evaluation, medical volunteers determined that he was malnourished and, as a result, unable to receive surgery at that time. Honoré was then enrolled into Operation Smile Madagascar’s nutrition program, and the family was hopeful that he would receive surgery soon. But then, the COVID-19 pandemic struck.

Like many of the families we’ve met, Honoré’s mother and father struggled, as they both lost their jobs. Eclaire began selling bread and other goods in her community to make ends meet. Fortunately, the Operation Smile team in Madagascar remained in touch with the family and provided them with a food package of rice, beans, milk and oil; it was support that helped the family during a difficult time. After a long wait, the uncertainty and fear caused by the virus was replaced by hope for a brighter future as Honoré met our medical team to be screened for surgery. 

Dr. Anna Strömberg, an anesthesiologist from Sweden, served as the surgical program’s clinical coordinator, a key volunteer role that ensures that the requirements for safe and efficient operating rooms and surgical schedules are met. Anna also served as the team leader for the nursing volunteers.

This international program brought together more than 100 medical volunteers from Madagascar, Canada, France, Ghana, Honduras, Italy, Mexico, South Africa and the United States. The team provided 250 patients with comprehensive health evaluations. Of those patients, approximately 125 were placed on the weeklong surgical schedule.

During screening day, Honoré and some of his new friends enjoyed playing games as they awaited their comprehensive health evaluations. Unlike his first visit to an Operation Smile surgical program, medical volunteers determined that Honoré was no longer malnourished and would be able to receive surgery during this program thanks to the nutrition support that he received from the Malagasy team throughout the pandemic. 

Nina Alexia Rabeson, center, is a psychosocial care volunteer with a deep connection to Operation Smile’s work in Madagascar: Her daughter, Joyce, received surgery from Operation Smile in 2015. Now, Nina draws from her experience as a parent who has gone through the same process as those attending this program.

Operation Smile’s psychosocial care providers create a welcoming and positive experience for children at our surgical programs and care centers, many of whom may have had little or no previous experience in a medical setting, by engaging them in therapeutic play. Nina also consoles and informs parents or caregivers whose children were not able to receive surgery, providing them with advice, encouragement and resources so that they can continue their care journeys with Operation Smile. During this program, Nina brought her 16-year-old son, Daniel, to volunteer. A member of the local Operation Smile Student Programs club, Daniel and his fellow student volunteers assist families with their needs and spread smiles to young patients.

Daniel, left, and Nina, center, blow bubbles to the excitement of some young patients. Screening and selection days can be an exhausting and emotionally trying time for parents and caregivers, so the atmosphere of joy and play that student volunteers and psychosocial care providers create for children is a key component of a successful and compassionate surgical program. 

Leásy, a 7-week-old baby boy born with a cleft lip and palate, rests in the arms of his grandmother, Jeanette. His cleft palate made breastfeeding impossible, and the cost of formula is beyond the means of the family. As a result, Leásy is severely malnourished, as his primary source of nutrition had been condensed milk diluted with water that was fed to him with a spoon. With his birth weight of 3.5 kilograms having dropped to 2.4 kilograms, he was immediately enrolled into Operation Smile Madagascar’s nutrition program and referred to a local nutrition clinic for an intensive treatment program.

The attention and care Leásy received from Operation Smile’s nutrition program yielded immediate results, as he gained 100 grams in just two days. Jeanette said that she noticed a big difference in her grandson; he is more awake and alert, and his complexion looks healthier.

“I’m so grateful and happy. Thank you, Operation Smile, thank you. Now, I know that he is in good hands,” Jeanette said. 

Leásy was then transferred to the local nutrition clinic, where he will receive treatment for the following month. Jeanette also received a special cleft palate nursing bottle and formula that will help Leásy continue to gain nourishment and weight. Malnutrition is a dire crisis in Madagascar with more than 44% of its people being undernourished and nearly 55% of children under 5 experiencing stunted growth. Now active in more than 20 countries, the organization’s global nutrition program is led by Operation Smile’s director of nutrition Charlotte Steppling, whose experience working with children with cleft conditions who are malnourished in Madagascar led to its creation.

Eager to receive surgery and a new smile, Honoré is all smiles as he enters the operating room with Dr. Jonas Wanbro, a volunteer anesthesiologist from Sweden. His mother, Eclaire, said that she was neither nervous or calm, but that emotions were running high nonetheless. 

Honoré receives his long-awaited cleft lip surgery from Malagasy surgeon Dr. Romain Raherison with the assistance of scrub nurse Guillaume Totoriaka, who is also of Madagascar. Romain is a graduate of Operation Smile’s Cleft Surgeon Training Program and one of the few reconstructive plastic surgeons serving Madagascar today. The organization aims to keep building surgical capacity through training more health workers like Romain and improving the infrastructure of local hospitals so that more Malagasy people can receive the care they need and deserve.

Dr. Joëlle Horace is a Malagasy general surgeon at Soavinandriana Military Hospital in Antananarivo. She is now training in cleft surgery techniques and working toward being accredited as an Operation Smile cleft surgeon. Under close supervision, she performed her very first cleft lip surgery during this surgical program.

“It was just as stressful as exciting,” she said with a big smile.

Joëlle’s first surgical program was in 2019 when she took part as an observer. After that, she observed another surgical program before participating in this one. She said she now needs a few more surgical programs and more cleft surgery experience before she can be accredited. Joëlle also said that it’s important to be a part of the program, as there are many Malagasy children who are in need of surgery.

“It all begins with a smile,” she said. “As far as I’m concerned, every single child deserves the best care and the best surgery they can get. This is my heart speaking.”

Honoré plays with nurse Andréa Berg of Sweden during his final check-up of the surgical program. Before patients and families depart a program, Operation Smile volunteers like Andréa carefully explain wound care routines and provide them with the medicine and supplies they need to ensure the best outcomes. Honoré said that he will always remember playing with the green frog puppet at the program as well as receiving his cleft lip surgery. 

Honoré and his mother, Eclaire, return to their community following his cleft lip surgery. His family and neighbors beamed with joy as he showed off his new smile. Eclaire said she thinks he looks beautiful after surgery and that he will look even more beautiful when he’s healed. She is certain that the surgery will have a positive impact on her son’s future; he will be able to speak more clearly and people will treat him with kindness.

“He will make friends, and nobody will say things about him,” she said.

The Operation Smile team in Madagascar will remain in touch with Honoré’s family so he can continue to receive the support he needs ahead of his cleft palate surgery.

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