Read Ngan’s story inside

2012 Smile ReportHighlights of 15,496 smiles in 2011-12

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You’ve helped make a world of difference15,496 children born with cleft deformities are smiling today. All because of you and other Operation Smile supporters around the world. Thank you.

In countries all over the world, children healed by Operation Smile are discovering the joys of smiling. They are no longer outcasts suffering teasing and taunts, and they have stopped hiding their mouths behind their hands or scarves.

None of this would be possible without you – our supporters. During 2012, your generosity and commitment has changed the world for thousands of children with clefts.

I’ve seen a fantastic change

Dr. Ruben Ayala, Senior Vice President of International Programs and Medical Affairs.

‘I first volunteered for Operation Smile as a teenager in my hometown of David, Panama. I was 17 and I had never seen a child with a cleft. Watching the surgeons was amazing and the reason I went into medicine’.

‘Not so long ago, most of the surgeons treating clefts were from overseas. Today most of the surgeons are Panamanian. The skills our doctors have gained from working alongside doctors from the UK or America mean we can now heal our own children.’

Six-year old Samuel was one of 110 children who went home with a smile after our first Operation Smile project in Accra, Ghana.

Samuel

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Dreaming of becoming a teacher

Ngan’s broken smile made her an outcast in her small village in Vietnam. Her parents never dreamt she would grow up to be a happy, vibrant girl, but now look at her! 10 years later, Ngan dreams of becoming a teacher: she wants to inspire children to enjoy school as much as she does.

Bismita’s happy birthdayWhen Bismita first came to the Guwahati Cleft Care Centre she was so malnourished everyone feared she would die.

A programme of careful feeding helped her gain weight and by February, Bismita was well enough for her cleft lip repair. A few months later, Bismita celebrated both her first birthday and her cleft palate repair.

A first for KathmanduPushba and Rachana were two of the young patients to receive cleft surgery on Operation Smile’s first project in Kathmandu, Nepal.

Countries where Operation Smile work

Comprehensive Care, Dental and Training Centres

Supporters from the UK sent lots of birthday cards to Bismita in the hospital.

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Smile stories of the year

AnisaWhen Anisa was born, neighbours told her mother that she had caused the cleft by using a sharp knife to cut food during pregnancy. For years, sushila believed that she was totally to blame for the gaping hole in Anisa’s face. There was no treatment available at the local hospital and private treatment was completely unaffordable. Anisa seemed destined for a life of sickness and unhappiness.

Then a miracle happened. A neighbour told them operation smile was coming to Guwahati. Borrowing money from family and friends, Anisa’s family travelled 10 hours by bus to reach our medical project. since her surgery, Anisa is healthy and happy at school - she is no longer teased.

‘We would like to thank operation smile for making all this happen’, said her parents.

shortly after the birth of her son, mukagatare carried him on her back through the neighbourhood. people laughed at him and shouts rang in her ears. ‘What is his problem, why is he like that?’ ‘maybe it’s the mother’s fault. maybe she transmitted this disease to her baby!’

mukagatare could not breastfeed and she had to feed him cow’s milk with a spoon. he has suffered from malnutrition ever since. Then habimana’s father died suddenly this past December leaving his mother to care for five children and work in gardens to earn money for food.

When he arrived for cleft surgery aged seven, habimana was the size of a five-year-old. But he couldn’t have been happier. When his name was called he was running and laughing, hugging and high-fiving everyone.

his mother said ‘please tell everyone at operation smile, thank you and God bless you.’

habimana

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When Guo’s parents first saw their son had been born with a bilateral cleft lip and cleft palate, it was ‘very hard to accept.’ Nobody else in their family had been born with a facial deformity and they knew they would never be able to afford surgery for him. They worried that their son would be destined to a life of rejection.

When Guo was less than a year old, they brought him to operation smile. But Guo was underweight and too small to undergo surgery until later that year when he had his cleft lip repaired. A few months later, he had his cleft palate repaired too.

At the age of three, Guo and his parents made one last trip on their motorbike to operation smile in lincang where he received a third surgery, a lip revision, to make sure he would be set for the rest of his life.

‘our hearts are now comforted,’ said Guo’s parents, knowing their son has a chance to lead a normal life. ‘i hope to go to school, carry a backpack, and one day go to university’ said Guo.

Guo

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Ethiopia and the hospitals within it are a world away from the UK. Forget neat six bed wards with sinks, tiled floors and televisions. Forget the plethora of waiting rooms, consulting rooms, gleaming white bathrooms and corridors. Ethiopia has nothing like that. The hospitals I work in are rundown and ramshackle. Even running water can be a luxury. On my first visit to Addis 7 years ago, we washed our hands in barrels of water and avoided the toilets for as long as humanly possible.

Healthcare is a problem throughout the continent. But Ethiopia is making slow but steady improvements. Where once there were only three medical schools, now there are

fourteen. New doctors and other health professionals are starting to practice, but without more teaching and professional development there’s little chance that Ethiopia will ever catch up on the increasing number of children, adults and even entire families with clefts.

Huge cleft backlogEthiopia has the same number of babies born with clefts as the UK, about 1,000 a year. In the UK, surgery is carried out before one year of age, so adults with the condition are never seen. But in Ethiopia there is a huge backlog of about 30,000 children and adults living with cleft deformities, who have never been operated on.

With only a few general surgeons and specialists able to provide the surgery, Ethiopia has little chance of healing every child born with a cleft let alone catch up with the backlog. Most adults die with the clefts they were born with. But, thanks to a longstanding relationship between Operation Smile and Ethiopia, the pace of change is about to accelerate. A small revolution is taking place.

Ethiopia is a huge country, four times the size of the UK. People have to travel vast distances to get anywhere. Roads are scarce, so people walk, ride donkeys or take clattering bus rides over potholed tracks to reach Operation Smile in Addis Ababa or Jimma.

The magic of Ethiopia with Dr Phil McDonald

The stark statistics UK EthiopiaDoctors per million people 3,000 50

Number of people served by hospital 250,000 15,000,000

Babies born with clefts every year 1,000 1,000

Number of children living with clefts 0 30,000

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Medical training and teaching – a transformative force

An Operation Smile medical team of two doctors, two anaesthetists and two nurses, work in Jimma five times a year for two weeks at a time. In total this provides 10 weeks of surgery for children, and some adults, with clefts. Every child coming into surgery is an opportunity to pass on surgical and anaesthetic skills to Ethiopian surgeons, doctors, nurses and medical students. These regular surgical rotations help both children with clefts and provides over 500 hours of intensive hands-on training and mentoring over a year.

During my last visit to Jimma we were able to help train five young doctors in the vital skills required to provide safe anaesthetics to children. We also delivered training in life support skills and updates in anaesthetic practice to 15 nurse anaesthetists who had received no education since they had qualified. They are desperate to learn about and to practice safer anaesthetics. The visiting surgeons were able to train 3 general surgeons how to repair a simple cleft lip – next time they will be moving onto more complex cases.

During those two weeks, 52 children’s lives were transformed. Which is great for them and their families. Better still, the Ethiopian teams gained new and specialist experience that will benefit everyone in their country.

The win-win results of training and teaching

Every surgeon trained in cleft surgery will go on to change the lives of local children. If a newly skilled surgeon does just five operations a week during a 25 year career, 5,000 children and adults will benefit from everything learnt during the Operation Smile project. If five surgeons do the same thing, 25,000 children will benefit. The numbers are encouragingly staggering.

It’s the same in anaesthetics. New skills apply to all surgical procedures, not just cleft repairs. So the training benefits double or even quadruple. In a country like Ethiopia, where surgical death rates are much higher than here at home, safer anaesthesia could save the lives of thousands of people.

Changing thousands of lives last year, this year and in years to come The magic of training, while performing surgery that changes children’s lives, is the promise it makes to every Ethiopian born with a cleft. With more doctors graduating from Ethiopian medical schools than ever before, the hands-on experience and teaching from Operation Smile volunteers is helping create a new generation of clinical specialists. Many are already practicing safer anaesthesia and cleft repair surgery. And as

more children are healed, more specialists will follow.

It’s wonderful to be part of forging a new future for the people of Ethiopia. I want to thank you for everything you have done to help change the lives of children living today and those still to be born.

Dr Phil McDonald FRCA, FFICM is Medical Director of Operation Smile UK and Consultant in Anaesthetics and Intensive Care at St Richard’s Hospital, Chichester.

Changing children’s lives, while changing a whole countryevery gift to operation smile changes the life of one child today and hundreds more in the future.

every time a child has their cleft repaired they leave with a smile.

every time a local surgeon, anaesthetist or nurse practices alongside an operation smile team, the skills they learn will benefit more children.

This is the beauty of supporting and volunteering for operation smile. You’re not just healing one child, you are healing thousands.

“ Fix a child’s cleft in a day and that child will be forever grateful. Teach a surgeon to fix a child’s cleft and that surgeon will spend a lifetime making children forever grateful.”

For years, Adbu wished his cleft would go away. After surgery from an operation smile team in ethoipia, his wish came true.

Adbu before

Adbu after

This year in numbers

370,520 Free heAlThcAre evAluATioNsincluding visits with paediatricians, anaesthesiologists, dentists, speech pathologists, child psychologists.

300,000 voluNTeer hoursFree care for our patients and training for other medical professionals.

15,496 pATieNTs receiveD surGerY WorlDWiDe72% of patients were treated during medical projects involving medical volunteers and 28% received treatment at comprehensive care centres in china, colombia, honduras, india, italy, morocco, philippines and vietnam.

21,114 posT-operATive evAluATioNsto ensure children are healing properly after surgeries and to evaluate whether further care is required.

5,200 meDicAl voluNTeersWorldwide; almost half living outside the us.

2,800 NeW meDicAl voluNTeerstrained in 32 countries, to reach even more children.

167 meDicAl missioNsconducted across 122 sites, in 36 countries.

30 NeW meDicAl siTesincluding expansion into Guatemala and Nepal.

£2.7m iN meDicAl suppliesshipped 396 pallets to 45 medical missions around the world.

www.operationsmile.org.uk 0844 581 1110

Changing Lives One Smile at a Time

This beautiful photograph captures the magic of operation smile. in less than 45 minutes Jackeline’s smile – and her life – was transformed. Thank you for all your support during 2012.