The charity Operation Smile, now in Ireland for ten years, is a mobilised force of medical professionals who provide safe, effective reconstructive surgery for children born with facial deformities such as cleft lip and cleft palate. Every three minutes, a child is born with a cleft — often unable to eat, speak, socialise or smile. In some places these children are shunned and rejected. And in too many cases, their parents can’t afford to give them the surgeries they need to live a normal life.
Before and after success stories in Ethiopia.
Operation Smile Ireland
As the charity Operation Smile evolves, and as they grow their operations in Ireland, they are finding new and more sophisticated ways to tackle overwhelming problems. The Irish branch is very involved in this journey into the Third World.
So picture yourself facing the orthodontist as they tighten your child’s flashy iridescent blue braces, wondering if the teeth in question will look like the brochure promised after all of this sadomasochistic intervention. Your child is giving you eyes that wail, “Why me…dear God why me?” But there is another way to look at this situation…one of ridiculous privilege.
Getting teeth straightened in any capacity in Ethiopia is beyond a fantastical luxury for many, especially when flat-out staying alive is the main focus of everyday life. In some parts of Ethiopia, it is a more pressing problem to solve life-threatening facial deformities. And not all get fixed.
Dahlak
Dahlak was born to impoverished parents in Ethiopia. Though it should have been a happy occasion, his mother, Mahder, was shocked to see that her new baby had a jagged tear in his upper lip. Too poor to afford surgery, she feared for Dahlak’s future. Then Operation Smile came to nearby Addis Ababa.
Mahder was determined to get her son to the mission site and on the list for surgery. But when she arrived, more than 430 other children and young adults were waiting for their chance as well. Fortunately, Dahlak was one of 184 who received free surgery in the ensuing week. Mahder no longer fears that he’ll be scorned and rejected. He now has a beautiful face.
Cleft Palate
When someone brings forth life in Ireland and the baby has a facial malady like a cleft lip or cleft palate or both, it is something that can be fixed within the first year of life, and it is in no way a threat to the baby’s survival. Babies don’t have to wait years – or even a lifetime – to see a plastic surgeon.
But picture this. In developing countries like Ethiopia, some types of facial deformities can cause death, especially in new babies. And worse, the chances of getting to a hospital are small. Once you get to a hospital there is no guarantee of getting an operation. And, third-world standards of after-care even if you can get an operation, can mean that your chances are further diminished.
In Ethiopia, if you have a facial deformity and you can find a plastic surgeon, the surgeon isn’t likely to be able to help you out. Most of their time is spent on basic survival tactics. That is, dressing wounds and helping to heal burns. Facial reconstruction is just a fantasy in places like this where so many have yet to find food for the next day.
Compare Ireland
In Ireland, children are treated for cleft lip or cleft palates early and safely, and probably by a surgeon who is a volunteer for Operation Smile. All three cleft surgeons in the Republic of Ireland are Operation Smile volunteers. One of these surgeons is Dr David Orr, a consultant pediatric plastic surgeon at our Lady’s Hospital in Dublin, and Chairman of Operation Smile.
According to Dr Orr, there is a huge backlog of patients in Africa needing surgery. As such, he is heavily involved in setting up the operation in Jimma, Ethiopia. According to Dr Orr, the greatest urgency is to help those kids born with a cleft palate. “A cleft palate in the third world causes feeding difficulties. Breastfeeding fails because the baby can’t latch on, leaving the babies to die. So in Ireland, we would see one-third of babies with a cleft palate, one-third with a cleft lip, and one-third with both a cleft lip and palate. However, in a place like Jimma, Ethiopia, we would see cleft lips but no cleft palate, because the babies haven’t survived.”
Cleft Palate
A cleft lip or a cleft palate is a type of congenital deformity, running in families. It is where a baby is born with the face or mouth not having fused properly, so there is a gap. But this problem arises in different ways in different children. Sometimes it doesn’t just affect the mouth; it can also affect several different parts of the face such as the eyes, ears, nose, cheeks, and forehead.
The work of Operation Smile however concentrates on the mouth – all of the functions of survival take place with this part of the human body. Broadly speaking in most human groups approximately 1 in 700 children born have a cleft lip and/or a cleft palate. However certain genetic groups have larger or smaller occurrences.
It is most commonly found in the Philippines, where around 1 in 300 babies are born with a cleft lip or palate or both. In fact, it is in the Philippines that Operation Smile was born, because of the high number of problems with facial deformities.
Asfew
Just 14 years old, Asfew was born with a cleft lip and cleft palate and has spent his life rejected by his own mother and father. He and his older brother Hasan travelled for two days to the Jimma University Hospital. “The people, they discriminate,” Hasan said, through a translator. “He doesn’t go to school. People laugh at him, assault him, he leaves school and doesn’t want to go back.”
When Asfew was born, his family wanted to disown him. His mother and father did not take care of him, leaving Hasan, who was only 8 years old at the time, to take care of his younger brother himself. Hasan, now a school teacher in his village, said his parents are not educated. He blames their lack of education for denying Asfew the love and care he deserved as a baby. He thinks if his family knew that Asfew’s cleft lip was not a curse, they would have loved him and raised him as their son.
“I am an educator,” Hasan said through a translator, “I will go back and tell everyone this is not a disease, this is a birth defect that has a cure! And I will teach not only my family but the community about this condition. I will teach them not to discriminate.”
Hasan said he first heard of Operation Smile a few years ago and has been saving his money to pay for the transportation to bring his brother to get surgery. Every penny was worth it, he said. In the recovery room after surgery, Hasan looks at his brother’s repaired lip, smiling with tears in his eyes. Whispering to let his brother rest, he says: “This is your new life now.”
Operation Smile Ireland: Ethiopia
In Ethiopia, the occurrence is pretty much the same as everywhere else, but the problem is that anyone who suffers from this condition is unlikely to get help for it. Operation Smile is hoping to change this…and quickly. Operation Smile has had an interest in Ethiopia (and other places around the globe) for many years. The usual drill for Operation Smile is to send in a team of medical professionals for 2 weeks.
In this time, they set up a surgical environment that mimics a first-world country environment as best as they can. Then the team interviews hundreds of local people needing surgery, and chooses as many patients as they can to operate on before they fly out again. Accompanying the surgeons and other assisting volunteers is a huge pile of medical equipment, which is dispatched from their centre of operation in Virginia, USA. (To get all of the drugs and operating devices and other medical paraphernalia through customs on either side is a monumental task in itself, and it is conducted like a full-scale military operation).
Fly in, fly out
This method of “fly in, operate, fly out” is now evolving to the next stage in Ethiopia, along with other selection places across the globe. It is being conducted along the lines of the proverb about feeding a man a fish and he’ll eat for a day.
Operation Smile are now starting to teach local doctors how to fish so they eat for life. That is, they are flying in with equipment, and this time the equipment has a one-way ticket. It is set up permanently in a local hospital. The Operation Smile doctors then use it to teach local surgeons how to operate on cleft lips and palates. They are also teaching local doctors how to use anesthetics safely, which is particularly tricky when it comes to small children and babies.
Even here in Ireland, in a safe theatrical surgical environment; anesthesia is difficult on a baby so young. Says Dr Orr, “Babies here in Ireland are operated on at 3 months. However because conditions are so different in Ethiopian hospitals, operations are not conducted until the baby is a year or older. Plastic surgery is complex; even in a modern hospital with intensive care, it is hard enough! So the question is, what can you do safely in a third-world environment?” This is a question that needed to be asked when setting up the Operation Smile project in Jimma, Ethiopia, which is 300 kilometres South of the capital Addis Ababa.
Remote
Dr Orr explains that the hospital is not only remote, with some utterly terrible roads, but the hospital is very basic. And there is a lack of local qualified staff. “There is just three qualified surgeons to look after 5 to 7 million people. And that is for ALL surgeries, not just cleft lips and palates. It is a phenomenal unmet need. The people of Ethiopia want to get their medical system sorted out and the university town of Jimma want to continually improve medical care. But they can’t do this without outside help.”
So Operation Smile is now tackling this problem differently. “Instead of sending infrequent missions into the area, they are deploying more frequent missions with just two surgeons. The plan is to teach the local surgical residents how to do cleft palate and other facial surgeries while they are there.”
It is hoped that with this new system in place, other local doctors will learn how to conduct the operations and the knowledge will spread. Perhaps this will help to clear the backlog of patients desperately needing surgery for a normal life.
Operation Smile Ireland: Before and after success stories in the Philippines.
Operation Smile backstory
On our shores, Operation Smile Ireland is part of Operation Smile Global. As a charity has come a long way since its inception in 1982 when Dr Bill Magee and his wife Kathy – a nurse – flew into the Philippines for a cleft repair mission. They were so overwhelmed by the need for cleft lip and palate work that they immediately started Operation Smile.
So the great hope is that as the charity ages, the way it operates becomes more sophisticated. And this more sophisticated model of operation will get close to clearing the backlog of children who desperately need operations – so they can speak, eat and socialise normally. So next time your teenager has a whine attack about their disco-coloured braces, you can tell them about Operation Smile and their work in Ethiopia. That should quiet them down for at least three minutes.
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