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Patient Story Madagascar

Unconditional Love

Patient Story Madagascar

Unconditional Love

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Fear overwhelmed Clara’s mother as she laid eyes on her baby for the first time.

Clara was born with a severe cleft lip and cleft palate. Her mother didn’t dare to breastfeed her. She even refused to acknowledge Clara as her own child.

In their tiny village in the highlands of Madagascar, their neighbors would quietly gossip about Clara and her condition. Every time Clara’s mother caught word of that talk – the result of the social stigma associated with cleft in that community – it deepened her sense of shame.

After two years, the emotional burden became too much for Clara’s mother to bear. She decided to abandon her family, but wanted to leave the village with her younger son, who wasn’t born with a cleft.

Clara’s father, Dede, who accepted and loved Clara unconditionally, refused. And so Clara’s mother walked away from her family, and they haven’t heard from her since.

On that day, Dede decided he would do everything he could to find a solution for his daughter. He wanted her to feel the love of others, instead of being feared and isolated.

It would take him six years.

Clara with her father, Dede. Photo: Zute Lightfoot.

We first meet Clara, then 8 years old, and Dede at a local health clinic in a tiny village on a winding road that links the nearby town of Mandoto with the closest big city, Antsirabe.

To reach the clinic from their village, they have to walk barefoot for more than two hours over steep hills, across three rivers, through several rice paddies and down a red dirt road.

Clara and Dede would walk barefoot for more than two hours to reach the closest local clinic from their village. Their journey often included traversing over steep hills, crossing rivers, passing through several rice paddies and walking down a long red dirt road. Photo: Zute Lightfoot.

This is where they first saw the posters some time ago – a medical team from Operation Smile was coming to Antsirabe to provide children like Clara with free surgery. They saw the before and after photos and realized there was finally a solution within reach. 

A surgery would mean everything to Clara – but also to her father: “I would be the happiest father in the world,” he says, smiling.

As they walk through the village to the health clinic, children follow them and stare at the two large gaps in Clara’s lip. She’s become accustomed to this kind of treatment, but it still hurts her feelings. She lowers her head as if to hide from the curious glares.

“When Clara goes to school, she is mocked and bullied all the time,” Dede says, dejected. “The children tease her because she can’t make herself understood. They don’t understand what she is trying to say, so she avoids going outside and doesn’t attend school so often.”

Dede never once gave up on trying to find Clara the care she needed. Photo: Zute Lightfoot.

One week later, Clara and Dede board a bus, paid for by Operation Smile, that takes them to the surgical program site in Antsirabe. At the Operation Smile patient shelter, more than 300 patients and their caregivers have gathered to attend the next day’s health screenings, which determine who will be able to receive surgery during the program.

Clara and Dede embrace and share big smiles after reaching the surgical site of a 2016 Operation Smile Madagascar program. Photo: Zute Lightfoot.

The following day, Clara is carefully examined by Operation Smile medical volunteers and is deemed healthy enough to receive cleft lip surgery, joining the more than 160 children that would receive surgery that week.

Operation Smile volunteer anesthesiologist Dr. Jonas Wanbro of Sweden evaluates Clara's health to see if she's healthy enough to receive surgery. Photo: Zute Lightfoot.

The evening before her life-changing surgery, Clara checks in to the hospital’s pre-operative ward. For the first time in her life, she brushes her teeth with a toothbrush. She falls asleep, eager and full of curiosity for the day ahead.

Early the next morning, Clara and Dede wait in the child life area just outside of the operating room. Here, the children who are going to receive surgery learn what is going to happen through therapeutic play with certified child life specialists. Clara places an anesthesia mask on a doll’s face, and then on her own mouth, and breathes deeply.

Soon after, Dr. Jonas Wanbro of Sweden, an Operation Smile volunteer anesthesiologist, arrives. He takes Clara’s hand and greets her in Malagasy: “Salama.” Jonas then guides her down the corridor to the operating room. Clara sits on the table – seemingly fearless – and with some help places the anesthesia mask on her mouth, breathes and falls fast asleep.

Operation Smile volunteer cleft surgeon Dr. Petra Peterson of Sweden has carefully planned Clara’s procedure. Clara’s bilateral cleft lip is broad and also affects her nose. With a pen, Petra marks the skin with small dots. Then, the operation to carefully stitch her lip together, layer by layer, can begin. It’s like a puzzle – all the pieces are there, but they need to be fit together just right.

Operation Smile volunteer cleft surgeon Dr. Petra Peterson performs Clara's cleft lip surgery. Photo: Zute Lightfoot.

Dede has been patiently waiting outside of the operating room. After Clara wakes from anesthesia in the recovery room, he’s is now able to see his daughter’s new smile. Dede seems worried, but as soon as he sees Clara, his face glows with pure happiness. His daughter looks so different – so beautiful. Everyone in the recovery room is moved to tears by the emotional reunion.

Eight months later, we meet Clara again at the local health clinic. This time, 9-year-old carries herself with a newfound sense of confidence – she doesn’t look down or avoid eye contact. We then take the long walk with her to her school – over hills, rice paddies and rivers. When we arrive, she runs ahead of us, eager to show us to her friends.

After her cleft lip surgery, brighter days were ahead for both Clara and Dede. Photo: Zute Lightfoot.
Clara shares her new smiles after her life-changing cleft surgery. Photo: Zute Lightfoot.

At school, her classroom is full of children sitting on small wooden benches. There is no electric light, just the sunlight coming through the open door and windows. The teacher speaks to the class in French. Clara sits next to two other girls her age, smiling and beaming of joy. Only two thin scars on her lip reveal that she once suffered from a cleft lip. As soon as the lesson is over, the children run outside to play. Clara holds her friends’ hands, giggling and laughing.

With plans to return for her cleft palate surgery, both Clara and Dede’s lives were transformed. With her new smile, Clara made friends and soon began living the life she always deserved. Photo: Zute Lightfoot.

“When we came home from the hospital after surgery, everybody in our village was amazed to see her,” Dede says. “She looked so different, like another person. I explained to them that it was thanks to Operation Smile.”

They’re now preparing to go back to the hospital in Antsirabe for Clara’s palate surgery. Dede is so proud that his daughter wants to become a doctor so that she can help other children born with cleft conditions.

Dede is remarried and has new children with his second wife – one of them was born the same day that Clara received her first surgery.

“Can you imagine?” Dede says. “The day my oldest daughter receives a new smile; I am blessed with a new child.”

Clara, 11 years old. Photo: Lorenzo Monacelli.

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 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.