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Everyone Deserves Safe Surgery

Margherita Mirabella

Children, parents and family have traveled – some for hours or days – by car, by bus or by foot to be here, at an Operation Smile medical mission. They’re hopeful. They’re anxious. Tragedy is almost certain without surgery. And for some, this day couldn’t have come sooner.

Part One

An Uncertain Future

Twenty years. Twenty-five years. Fifty-four years. That’s 99 years of needless suffering experienced by three of our patients: Virgilio, Enok and Marco.

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As Senaida sat next to her son, Virgilio, she couldn’t help but smile widely when she looked at him. For Virgilio, each smile he shares with a new friend is a small victory over the 20 years of despair in which he lived.
Photo: Jasmin Shah
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Enok remembers being jeered, chased by packs of children and having people recoil in disgust at his cleft lip. While his memories echo the stories of thousands of Operation Smile patients – most young children – Enok already endured a lifetime of torment when he received surgery at 25 years old.
Photo: Margherita Mirabella
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1.
As Senaida sat next to her son, Virgilio, she couldn’t help but smile widely when she looked at him. For Virgilio, each smile he shares with a new friend is a small victory over the 20 years of despair in which he lived.
Photo: Jasmin Shah
2.
Enok remembers being jeered, chased by packs of children and having people recoil in disgust at his cleft lip. While his memories echo the stories of thousands of Operation Smile patients – most young children – Enok already endured a lifetime of torment when he received surgery at 25 years old.
Photo: Margherita Mirabella
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As soon as a child is born with a cleft lip or cleft palate, there are daunting odds stacked against them.

In many areas of the world lacking critically needed resources, people can’t get the surgical care they need from their local health systems, when they need it. Even if care is present, poverty prevents all too many people from getting surgery. Time and time again, this proves deadly for children born with cleft conditions.

And if these children survive into adulthood, like Marco, who lived with a cleft condition for more than five decades, their lives are often marked by loneliness and painful bullying.

Parents who bring their children to Operation Smile hope for surgery that can change all of that.

Part Two

Safety on Center Stage

But first, pediatricians need to perform comprehensive health exams to ensure that patients can safely undergo surgery.

A pediatrician’s findings are shared and discussed with the medical mission’s clinical coordinator, pediatric intensivists and anesthesiologists to determine if it’s safe for the patient to be put under anesthesia – the aspect of surgery that presents the most risk in any environment, including the world’s most advanced hospitals.

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Pediatrician Dr. Emmanuella “Ella” Amoako of Ghana uses play so she may listen to a young patient’s heartbeat and breath and ask questions about his medical history as part of the comprehensive medical evaluation process.
Photo: Zute Lightfoot
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Anesthesiologist Dr. Amaia Arana of the United Kingdom and Ella provide a patient with a comprehensive medical evaluation. Pediatricians and anesthesiologists work together to check patients’ airways and breathing to ensure they can safely receive anesthesia.
Photo: Zute Lightfoot
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Ella provides treatment for a young patient during an Operation Smile medical mission to Ho, Ghana. Even after a child is deemed healthy enough for surgery, an additional evaluation is performed on the day of the procedure to provide the most current and complete picture of the child’s health.
Photo: Margherita Mirabella
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Pediatrician Dr. Emmanuella “Ella” Amoako of Ghana uses play so she may listen to a young patient’s heartbeat and breath and ask questions about his medical history as part of the comprehensive medical evaluation process.
Photo: Zute Lightfoot
2.
Anesthesiologist Dr. Amaia Arana of the United Kingdom and Ella provide a patient with a comprehensive medical evaluation. Pediatricians and anesthesiologists work together to check patients’ airways and breathing to ensure they can safely receive anesthesia.
Photo: Zute Lightfoot
3.
Ella provides treatment for a young patient during an Operation Smile medical mission to Ho, Ghana. Even after a child is deemed healthy enough for surgery, an additional evaluation is performed on the day of the procedure to provide the most current and complete picture of the child’s health.
Photo: Margherita Mirabella
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Part Three

A Burden No One Should Bear

Sometimes offering up their stethoscope to curious patients, pediatricians can seem lighthearted while taking their role seriously.

While play serves its purpose among medical volunteers to help build trust with patients, this initial evaluation is critical to the patient’s safety ‒ like that of 4-year-old Ramata in Ghana. Though cleft surgery is ideal at the youngest possible age, Ramata experienced chronic health complications and surgery was too risky.

It was heartbreaking for the medical team to give that news to her mother, who traveled hours on rough roads with Ramata to the mission site with the hopes that her daughter could receive surgery.

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While Ghana offers some of Africa’s most beautiful landscapes, it also suffers from a critical lack of adequate infrastructure, health care services and economic opportunities, resulting in some of the world’s most significant barriers to safe surgical care for its citizens. Our vision of improving patients’ health and dignity through safe surgery is backed by the idea that no one deserves to live with the burden of a cleft condition.
Photo: Margherita Mirabella
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While Ghana offers some of Africa’s most beautiful landscapes, it also suffers from a critical lack of adequate infrastructure, health care services and economic opportunities, resulting in some of the world’s most significant barriers to safe surgical care for its citizens. Our vision of improving patients’ health and dignity through safe surgery is backed by the idea that no one deserves to live with the burden of a cleft condition.
Photo: Margherita Mirabella
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Each of Operation Smile’s medical volunteers wish that no family or patient would have to experience the disappointment of being turned away from surgery, but a patient’s safety is always the first priority.

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Pediatrician Elodi Priranja of Madagascar leads a workshop on breastfeeding techniques for parents whose babies are too small to receive surgery safely during a medical mission in Antsirabe.
Photo: Zute Lightfoot
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Pediatrician Elodi Priranja of Madagascar leads a workshop on breastfeeding techniques for parents whose babies are too small to receive surgery safely during a medical mission in Antsirabe.
Photo: Zute Lightfoot
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Part Four

Treating the Whole Patient

When a patient is healthy and approved for their life-changing procedure, feelings of joy can turn into anxiety as surgery day approaches.

Surgery often strikes fear in patients and their families, some of whom have never stepped foot inside a clinic or hospital. Medical environments can be sterile and uninviting, but child life specialists help ease patients’ tension by using therapeutic play to create an environment that is welcoming and friendly.

Using equipment like anesthesia masks during these sessions is a method that child life specialists use to help children understand and become more comfortable with the medical setting, calming their nerves prior to being admitted into the operating room.

When patients are under anesthesia – especially as soon as it has been administered and before the patient returns to consciousness – pediatric intensivists are at-the-ready to recognize and react to any medical complications with cardiopulmonary resuscitation, medication and other live-saving treatments.

The vast majority of Operation Smile patients are children. While their roles differ greatly both at their respective workplaces and whether at an Operation Smile medical mission or at one of our care centers, open communication between pediatricians and pediatric intensivists is crucial to our ability to deliver the best possible surgical results for our young patients.

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Pediatric Intensivist Marcos Polar of Perú attends to a child in post-op at a medical mission in Arequipa, Perú. Operation Smile’s volunteer pediatricians and pediatric intensivists are paramount to providing medical evaluations and treatments.
Photo: Margherita Mirabella
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Pediatric Intensivist Marcos Polar of Perú attends to a child in post-op at a medical mission in Arequipa, Perú. Operation Smile’s volunteer pediatricians and pediatric intensivists are paramount to providing medical evaluations and treatments.
Photo: Margherita Mirabella
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Part Five

A Global Standard of Care

Reinforced by more than three decades of leadership in performing safe surgery in resource-limited environments, we know that a single surgical procedure is a small part of a larger, multi-tiered process that’s focused on the entire well-being of the patient.

Our compassion for those we serve is put into action well before the surgeon makes the first incision and long after the final suture is closed. This commitment to the completeness of patient care doesn’t only ensure the best possible outcomes; it’s the right thing to do.

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We want to reach patients as early as possible. At the hospital where Luciana was born, a doctor told her father, Daniel, about Operation Smile – an organization that offers expertise in treating cleft conditions at no cost to its patients or their families.
Photo: Rohanna Mertens
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We partner with patient advocates like Don Alex and Don Rudis in Honduras to find the hardest-to-reach people living with cleft – whether they’re babies like Manuelito or men like Marco – and make comprehensive cleft care accessible to them.
Photo: Rohanna Mertens
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There are many specialized skills that aid in the healing process. Olga Sarmientos is a speech therapist at the center in Bogotá who used to see Oscar when he was a patient there. “... to see him so satisfied and happy with himself, makes me extremely happy,” she said.
Photo: Rohanna Mertens
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1.
We want to reach patients as early as possible. At the hospital where Luciana was born, a doctor told her father, Daniel, about Operation Smile – an organization that offers expertise in treating cleft conditions at no cost to its patients or their families.
Photo: Rohanna Mertens
2.
We partner with patient advocates like Don Alex and Don Rudis in Honduras to find the hardest-to-reach people living with cleft – whether they’re babies like Manuelito or men like Marco – and make comprehensive cleft care accessible to them.
Photo: Rohanna Mertens
3.
There are many specialized skills that aid in the healing process. Olga Sarmientos is a speech therapist at the center in Bogotá who used to see Oscar when he was a patient there. “... to see him so satisfied and happy with himself, makes me extremely happy,” she said.
Photo: Rohanna Mertens
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Guided by our Global Standards of Care*, our incredible nurses and plastic surgeons – together with our pediatricians, child life specialists, pediatric intensivists, anesthesiologists, among other critical medical specialties – deliver surgical results consistent with the world’s finest hospitals.

“In the settings we go into, we know that patients may not have access to the full complement of these specialties,” said Operation Smile Co-Founder and CEO Dr. Bill Magee. “So we’ve always set the stage for excellence – never modeling mediocrity.”

Why go to these lengths? The answer is simple: our patients deserve it.

*Global Standards of Care © 2006, 2015 Operation Smile, Inc. All Rights Reserved.