In the middle of the night when everything was calm, Mario and I had a few minutes to look around Hospital Infantil Manuel De Jesus Rivera located in Managua, Nicaragua. Mario was a Nicaraguan physician who participated with the in-country Operation Smile missions and had volunteered to spend his night translating for me in the Post-Op Unit. We wandered out to the hospital lobby, and what I saw before me simply stopped me in my tracks. There were approximately twenty people sleeping on the ground right outside the locked doors to the front entrance. Mario explained that many of them are people who live in very remote areas and travel far to bring their children here. Since only one family member is allowed in a Post-Op room at night with their child, any other family member often sleeps outside.

Meanwhile, inside our Post-Op Unit, for every child sleeping in a bed or crib, there was a person attempting to sleep in a chair next to that bed or crib. Yet, despite this discomfort and other conditions that we would find difficult to bear, the parent remains patient with their child as he/she squirms or cries, sweating in the warm room, possibly febrile, and desperately seeking sleep in the strange, new environment.

As the sun was rising several hours later and we rounded from room to room, the same exhausted family members graciously accepted our repeated suggestions to push fluids for their child and smiled in return as we wished them the best.

-Amy Braun, Post Operative Nurse, Operation Smile Managua
November, 10-17, 2007

The children who needed an operation but weren’t quite ready for surgery are the ones I remember and think of. “X” was one of the last to be seen in screening, brought by her mother after we had begun to clean up for the day. She was one and a half years old and brighter than one might expect. She had a facial cleft, either Tessier 3 or 4 with additional clefting of her ear and lateral eyelid. She had cleft hands and an unusual skin condition with patches of firm, hypopigmented spots throughout her body. Although they looked like scars, her mother said that she was born with them. She had a head of thin, sparse hair and her skin was dry. We suspected that she had the ectrodacytly-ectodermal-dysplasia-cleft palate syndrome, also known as EEC. Her mother suspected that this was all due to moon rays from an eclipse that occurred the night she gave birth.

In addition to her hands, face, and skin abnormalities, “X” had a non-seeing eye and strabismus. The eye looked empty with no iris and just a bright white reflection. Her ear was thin and knobbly in appearance. She had anteriorly projecting teeth from her malpositioned, clefted alveolus. In spite of her appearance, there was a bright, feisty girl inside.

“X” came back the next day for bloodwork, but the overall sense from the team was that she was too small and undernourished to undergo a surgical procedure.

What will happen to her? How will she eventually look? Who will she eventually be? She will see a local ophthalmologist and will return to the next international mission screening in less than a year. Her mother is caring and attentive. She is a bright little girl. Who will she grow up to be?

Raymond Tse, MD, FRCSC, Plastic Surgeon, Canada
Team Nicaragua, Operation Smile World Journey of Smiles 2007

Saturday, 8AM – the day that all of the children will find out if their lives will be changed. Hundreds of people anxiously gathered around the hospital, awaiting for the lists to be posted.

Finally…the lists went up.

I recognized one of the mothers, whose daughter I screened for cleft lip surgery. I distinctly remembered her story – 14 hours of travel just to get to Managua, in the hopes of obtaining cleft lip surgery for her daughter. Hours and hours by foot, boat, and bus – and now they finally made it.

She walked away from the wall – crying. I didn’t know what to say. Did her child not make it on the schedule? Was her daughter too malnourished? Was she denied surgery for health issues?

Then, I felt a tap on my shoulder. It was her – with her daughter. As I spoke to her in the small amount of Spanish that I knew, I did understand her say, “Thank you”. Through a translator, she told me that today was the first day that she saw her daughter smile – she said that she didn’t know that her daughter could smile with a cleft lip, as she never saw her do it in the past year. Monday, her daughter would have cleft lip surgery.

I then realized that those were tears of joy.

-Albert Andres

I looked after one boy who was about 14 and mentally disabled. That day I was the only non-Nicaraguan in the OR and the only person who didn’t speak Spanish. As the Nurse, it was my job to help Anesthesia get the boy off to sleep. Unfortunately, because of his age and size, he needed an IV before he could off to sleep. The girls had tried in pre-op but he became very agitated and somewhat aggressive. The Nicaraguan Anesthesiologist elected to bring him back to have the IV started in the OR and warned me that me might have a fight on our hands. The boy was terrified and at first was very agitated but the Anesthesiologist and myself calmed him down and eventually got him to lie down. He grabbed my hand and I held his hand and re-assured him in what must of been the most horrible Spanish he had ever heard. He just looked at me and smiled. He had his IV started without so much as a flinch and went off to sleep without incident and the surgeon repaired his cleft lip. It showed me that caring for another person crosses all language and cultural barriers. My trip to Nicaragua with Operation Smile has been the highlight of my Nursing career.
Thank you

-Quinn Sharkey RN, CNOR

Blues from the green eyed baby

Green eyes stared at you from the tiny 5 month old tot. Her 16 year old sister was her sole companion on her visit. With the child in one arm and an old diaper bag in the other,
she came from afar with little money and lots of hope. The child was cute, chubby and smiled at you at every opportunity. She smiled at our giggles, bubbles, and perhaps even freckles. Her mother was with her other sister who had been admitted in a distant hospital with pneumonia. The 5 month old could not be cleared to undergo surgery as she had congestion and fever. We told her sister that we could not operate on her lip now but will definitely do it after 3 months when she is healthy again. Her hopes dashed in one quick moment, sorrow rolled as tears from her cheeks. The sister was uncontrollable for 10 minutes. Then she looked up, looked at the baby and smiled again.

Her journey will continue and her hopes have been renewed. Again will come another opportunity and she will be back. Her little sister will have her lips repaired hopefully in the next few months. The green eyed baby’s smile will be complete soon.

As Dr. Magee and hordes of volunteers travel on this world journey, not only are they accumulating countless miles ( frequent flier for some), they are also spending many more smiles throughout the world.

-Pradeep Padmanabhan, M.D, Pediatrician,
Operation smile – Nicaragua mission November 07

Upon landing in Miami I found myself standing in a long U.S.Customs line, dreading the long wait & the less-than-pleasant Customs agents ahead. As I proceeded through the line an agent motioned for me to place my bags on the bench between us. He seemed to have an especially gruff, all-business attitude. As he began inspecting my first bag he asked the usual questions: “Where have you been? How long were you there? What was the purpose of your visit?” When I responded to the last question & he heard the name Operation Smile he looked up at me & said “I’ve heard of that group - tell me about them”. An immediate change in his attitude was evident & he actually became warm & engaging in his manner.

For the next several minutes he wanted to know all about Operation Smile, asking a number of questions about how our team worked together, types of surgeries performed, follow-up care, mission sites, etc . His entire personality underwent a most positive transformation as he became even more involved in this discussion!

His last question, however, was the most telling - “How do you doctors get compensation for this work you do?”

I simply replied : “Smiles. Beautiful Smiles on the faces of these precious children & their families as we complete our work.”

He looked into my face with a look I shall never forget & this tough guy’s voice began to crack as he said “God bless you & God bless Operation Smile.”

- Dan H Shell III, MD, Operation Smile volunteer

The mere mention of “Australia” conjures up happy images of kangaroos hopping across the bush with little joeys peeking out of mysterious pouches. Curiosity led me to question a new Australian friend about this idyllic image at the beginning of the Operation Smile World Journey mission held in Managua, Nicaragua, where our team of international volunteers gathered for ten magical days to create miracles. This talented, young woman, Anita, of Brisbane, Australia, volunteered to provide speech screening and important language instruction for each patient. With big smiles, she happily answered questions about that fascinating creature, the infamous “Kangaroo”. Anita laughingly announced that she had even brought one with her. It was plastic, inflatable, four-feet tall with a big tail and, yes, had the requisite joey peeking from its pouch. The children were delighted upon its arrival, and even the adults broke out in smiles as the brightly-colored icon of “hip-hop” made its way to the warm and dimly-lit play area where children waited for their call to surgery.

As a “medical records assistant”, I soon learned that my job of creating hundreds of medical files was a piece of cake compared to positions that entailed entertaining hungry and thirsty children waiting long hours for their facial surgeries to begin. Hour after hour, efforts by team volunteers to create diversions and entertainment were rewarded with big smiles from the soon-to-be surgical recipients. Standing close by were weary parents who accompany their children through hours of selective screening and now wait patiently to gently place their precious babes in the arms of virtual strangers as they are whisked away for lip and palate reconstruction.

It was during one of these long days that Anita’s “Kangaroo” appeared and towered over the little ones as their bright eyes reflected the wonder of such a happy creature in the midst of all the chatter and challenging chaos. One little patient, Eduardo, was particularly intrigued with “Kangaroo’s” presence and quietly sat on his chair patting and squeezing his new friend when suddenly his name was called. Karen, an anesthesiologist-CRNA, appeared from behind swinging surgery doors to claim him for his life-changing surgery, an answer to the prayers of his family.

But, frequently, the separation of child and parent is quite traumatic as medical personnel gather up a new patient who then begins to protest and reach back toward the safe arms of family. I watched as Karen instantly recognized the attachment Eduardo had made with his large, plastic friend and quickly reached out to place one puffy paw in Eduardo’s little hand. She then took hold of “Kangaroo’s” other paw and beckoned. Eduardo happily hopped off his chair still tightly grasping the paw; and, together, the happy trio rounded the corner to begin their journey down the long hallway. It was a sight to behold by surgeons and nurses alike as the smiling threesome made their way toward the surgery table. But “Kangaroo” wasn’t done with his mission. He was given “patient status” and happily succumbed to an oxygen mask along with his brave friend, Eduardo. Operation Smile was the recipient of a new ambassador that day.

As volunteers come to know, all language barriers and fears between parents and volunteers alike are absolved once the “magic begins”. I quietly stashed away this memorable, magical moment and returned to my ever-growing stack of medical records knowing that a picture in my mind of “kangaroo” and a little Nicaraguan boy’s walk to life-altering surgery would linger with me long after I disappeared into regular life.

- Connie Engel, Operation Smile Volunteer, Medical Records

As part of the 25th Anniversary Celebration of Operation Smile, and the World Journey of Smiles, Dr. Daniel Pyo MD, a plastic surgery volunteer from Morristown, NJ participated in a mission in Kisumu, Kenya. This was not his first surgical mission, but it was his first mission with Operation Smile. This mission was unlike any of his others because of the participation of his son, Christopher Pyo. Christopher is a 9 year old boy, who was fortunate enough to accompany his parents earlier in the summer to Beijing, China on a mission. The trip provided an incredible experience for Christopher, one that would change his life forever. The trip included a visit to a Chinese orphanage which truly affected young Christopher. Seeing the conditions that these children lived in, the things that they did not have, and the things that we took for granted in the states really changed young Christopher’s view about the world. Once we arrived back in the US, Christopher decided that for his upcoming birthday, he would write a letter asking his friends not to give him presents, but instead help him to sponsor a child for Operation Smile. He had recently seen a commercial for operation smile on TV, where they said that the cost to help one child was $240. He knew that his father was going to Kenya for the World Journey of Smiles in November. Christopher sent out the letter to his friends at school and at church, and he had 2 parties that raised a total of nearly $4000. Not knowing where to send this money, his father contacted Operation Smile who informed him that the NJ Gala for Operation Smile was going to be held shortly, and that Christopher would be invited as a special donor to present the donation directly to Bill and Kathy Magee. It was a magical evening that neither Christopher nor his parents will ever forget. Christopher made his presentation like a pro, and was the center of attention the rest of the evening. No two parents could be prouder of a son.
As the Kisumu mission was drawing closer, the family was getting excited. There were donations of stuffed animals, and other items that continued to arrive. Packing and trying to avoid an overweight bag were becoming a bit of a concern. In the preparation for this mission, Dr. Pyo felt a special sense of purpose, a responsibility to his son to bring back the experience for him. He decided to take as many photos as possible, to provide a photo-journal of the mission.

Mission Notes
The mission to Kisumu, Kenya was an incredibly successful mission. The number of successful results was astounding. Dr. Pyo was able to keep in touch with his family and Christopher via phone and internet.

“There were many significant and memorable moments. The first truly memorable moment was the initial visit through the city from the airport, to the hospital in Kisumu, Nyanza regional hospital. We were definitely in Kenya. The mass of humanity was staggering, and the sheer poverty was overwhelming. These people had very, very little, and it seemed that there would be a lot of work to be done. The screening days were long, and exhausting, but with the entire team pulling together, and working hard it was done. It was an amazing team, from the Physicians to Nurses, PIT staff, therapists, etc., to the local volunteers. The next memorable moment was the posting of the surgical list. Postings are always quite emotional, but this one was a little different. There were just so many people who came hoping for the chance to have their child’s life changed. The hope and anticipation in their eyes was striking. There was a father who brought 3 older children all with bilateral cleft lips and palates. He was reluctant to come initially because he felt that the children were cursed. His children were chosen. There were so many small stories that are too numerous to go into, but the final list was chosen, and it was time to set up for surgery. I was proud of each operation that I performed, because I knew that I was not alone. I thought of Christopher, and how his support for these children was a real blessing. The conditions during surgery were difficult. The OR’s were very hot, and humid. There was no AC, and there was no ventilation. We had fans running all the time, and despite that, the heat was oppressive. The first two days were very long, and difficult for everyone on the team. The flow was slow to start, but it was amazing to see how everyone, and everything came together, and the flow was smoother and smoother. The OR staff was incredible, and deserve much praise. The pre-op, and post-op areas were humming, and without the help of the staff in these locations it would have been impossible to have the results that we did. A special note of appreciation has to be sent out to the floor staff – Our Pediatrician, Dr. Mary Wilson, and our nurses Courtney Fratto, Kathy Hayes, Fanuel Mukhove, Jane Karanja, and Appele Ojola. This team had to endure the most difficult conditions, but they made it look easy. The last significant memory was the final wrap-up party in Kisumu. It was Friday evening, after we had finished our last surgery, and had packed everything up. Our hosts provided a wonderful party for us at a different hotel. I was asked to speak on behalf of the team and was proud to do so. After thanking everyone for their support and hard work, it came back to Christopher. I told everyone about his work and his humanity, and I was a very proud father. We had finished a very successful mission, and I was going back home to tell Christopher about all the children that he had helped. I will show him photos of all the children that we took care of, and show him the results of the operations. I will show him the love in their eyes, and the gratefulness in the hearts of the parents. I will bring back home all the smiles that he helped to create. “

Leaving Kisumu and Kenya was not as easy as Dr. Pyo had thought it would be. There is still so much work that needs to be done, but his family was also waiting for him at home. “Part of what makes these missions so special are the lifelong friendships that are made. The friends that are made in very difficult situations are always very special. I salute the entire team that served in Kisumu, Kenya. They will always remain in a very special place in my heart.”

- Daniel Pyo, Operation Smile volunteer

View Album

I knelt before her, arms extended to hold her and maybe to be held as well.

She uttered that these are tears of joy, not of sorrow, not of fear. And she gently smiled.

She shared that she had traveled from doctor to doctor, to different cities to find help for Ruth. Always told, this is her life, there is nothing we can do. She felt hope was fading, were there no answers? How could this be?

Rocking, swaying, pouring of emotions, she spoke of her story, of her struggle, her hard life; no husband, no partner, cleaning other peoples clothing to feed her children. Her life is hard, she felt alone, so alone. This became a momentary chant. Life is so very hard…

Then the chant began to transform to an expression of heartfelt thanks and tremendous gratitude. Thanks to all for giving her daughter the gift a new life…of possibility…of hope. For coming so far, for giving up and sharing a part of our lives. She poured out adoration for the team members of Operation Smile.

The room began to hum, voices coming together in song, the song of women waiting with their own children as they gave witness. Offering a hymn of union to support each other and to something greater than themselves, something divine.

Lifting us, holding us in our tears.

- Jennifer Kreimer, Chile Life Specialist

On the second day of screening an American nurse from a small village arrived with a Bolivian 15 month old baby boy with a cleft lip and palate. They had flown in from a remote area two hours away. The boy began the screening process but when the surgeons examined him, she asked that they correct only the boy’s palate and delay the lip surgery. When asked why, she explained that she was the adoptive mother and she was concerned that if the birth mother saw the baby’s repaired cleft lip, she would change her mind about giving up the baby for adoption, a process which would not be finalized until a few weeks later. She stated that the birth mother had refused an earlier opportunity to have the surgery performed on her son.

After speaking with the surgeons, she was not sure if she would consent to the baby’s surgery because the surgeons would not agree to operate on his palate first. She continued with the screening process. Eventually she arrived at my station where I was checking that the charts were complete. We started talking. She mentioned that her friend had met someone at the Santa Cruz airport and told him about OS. What a coincidence! I stated that I was the person she had heard about. She continued to tell me about her work in the village and that she was in the process of adopting this baby boy. She has three other boys of her own and that this baby was a blessing to her family.

The mother did agree to the surgery and the baby was the first cleft lip to be performed on my table during the first day of the surgery week. As the baby went to sleep he started to cry but soon drifted off to sleep. The surgery lasted 45 minutes and his repaired lip look fantastic. I visited the baby and his adoptive Mom in post-op to check on them and to give the baby a teddy bear. She told me that she would contact me at a later date and let me know how everything was going.

- Greg Samson, RN, Operation Smile volunteer

…to feel overwhelmed by their stories?
…to ache for the children who were turned away?
…to be brought to tears by the desperate yearning of mothers and fathers?
…to witness compassion that could heal the heart of humanity?
…to understand the power of collaboration that could unify nations from across the globe?
…to appreciate that by working together we could make a difference?

I may have imagined all of this and more…
…but I didn’t expect that we could change the world….until now.

Having worked for Operation Smile for the past year I believed I knew what the organization stood for, what it meant to be a part of it and how we were impacting the lives of many, one smile at a time. However, the full appreciation of what has come to be over the past 25 years revealed itself to me on my mission to Jordan. To be in the Middle East during this time of crisis and to witness the common bonds of compassion, understanding and acceptance, uniting people from all nations, is a testament to what can be accomplished when we join together to realize the essence of our humanity.

With much appreciation and thanks,

- Kyla Shawyer, Operation Smile