An Operation Smile First: Surgical Training Rotation in Madagascar

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Throughout a week spanning late July and early August 2017, Operation Smile in Madagascar hosted its first-ever surgical training rotation at Centre Hospitalier de Référence Régionale (CHRR) in Antsirabe. Building on Operation Smile’s commitment to strengthening health systems where it works, an international team of medical volunteers united to provide training to Malagasy health care professionals by providing safe surgery for children suffering from cleft conditions. On screening day, the team provided comprehensive health evaluations for 29 patients to determine if they were healthy enough to go under anaesthesia to receive surgery during the rotation. Pictured here, operating room nurse trainer Joseph Mwangi of Kenya bonds with a young patient during the screenings. Photo: Charlotte Steppling.

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A patient and father pose for a photo during screening day for the surgical training rotation. For many Malagasy children, a comprehensive health evaluation from Operation Smile is the first medical exam they’ve ever received. Photo: Charlotte Steppling.

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Malnutrition is a serious problem for children in Madagascar, especially those who have a difficult time eating because of their cleft conditions. When children are underweight or malnourished – as so many in this country are – surgery can be very dangerous. In response to this dire need, Operation Smile in Madagascar launched a feeding programme in May to provide families of patients with nutritional counselling, healthy cooking demonstrations and feeding technique support. As part of the surgical training rotation, our team in Madagascar brought in 11 feeding programme patients and their parents for a feeding workshop. Patients were weighed to ensure they were gaining weight and parents received a consultation from a nutritionist. Thanks to a partnership with Birdsong Peanuts, Operation Smile in Madagascar was able to provide these families with a supply of RUTF MANA (Ready-to-Use Therapeutic Food/Mother Administered Nutritive Aid) – an easy-to-eat and nutritious peanut paste that helps children gain weight. An assistant nutritionist at CHRR said, “I have seen children grow and conquer malnutrition by using products like RUTF MANA. This is a blessing for these children. Thank you.” Photo: Charlotte Steppling.

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All 11 patients and their parents of the surgical training rotation’s feeding workshop pose for a photo to express their thanks to RUTF MANA and Birdsong Peanuts. At the workshop, each patient received a six-week supply of the nutritious peanut paste designed to help underweight or malnourished children gain weight. Operation Smile in Madagascar provided parents with nutritional counseling and training on how to use the paste and scheduled follow-up support to track patients’ weight gain as they grow toward becoming healthy enough to receive cleft surgery. One of the mothers said, “I had never heard of anything like this before, but I appreciate that RUTF MANA will make my baby grow stronger and healthier.” Photo: Charlotte Steppling.

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Operation Smile Programme Coordinator Kim Harrell, right, introduces an anaesthesia mask to young surgical training rotation patients and their parents to help ease their anxieties about receiving surgery. She discussed the various steps and rooms the patient would be brought through and parents were given the chance to ask questions about the surgical process. Photo: Charlotte Steppling.

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Avotriniaina is one of the many young patients who received cleft surgery through the surgical training rotation in Madagascar. After learning more about the procedure from Operation Smile medical volunteers, Avotriniaina’s father did everything he could to ease his daughter’s fears by playing with her, explaining what to expect before her surgery, and even showing her the medical equipment. “This is a mask. There will be air that makes you sleep, it’s not scary. Here you try, put it on your face. See it does not hurt,” her father said. “This is the hat the surgeon and nice people will be wearing. It’s blue, it’s not scary.” Because her father took such great care to walk her through every step of the procedure, Avotriniaina was calm and comfortable before receiving her life-changing surgery. Photo: Charlotte Steppling.

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 Surgical training rotation patient Hasitiana and his mother play with a surgeon’s cap. Photo: Charlotte Steppling.

 Patient imaging technician trainer Tahiana teaches Sarbiody, president of the Antsirabe Operation Smile student club, how to identify the next case based on the surgical schedule chart. Photo: Charlotte Steppling.

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Patients and families of the first surgical training rotation hosted by Operation Smile in Madagascar pose for a photo with Dr. El Hassan Boukind, one of Morocco’s leading reconstructive plastic surgeons and surgeon trainer for this rotation. During the week long rotation, 22 patients received life-changing cleft surgeries, 11 feeding programme families received critical nutritional support and Malagasy medical professionals strengthened their skills under the instruction of Operation Smile medical volunteers. And this was just the beginning; Operation Smile in Madagascar will be hosting five more week long surgical training rotations through December 2017. “The week went by so fast. It has been such an honour to work with such an amazing, diverse team,” said Ysma, a pre- and post-operative nurse from Madagascar. Charlotte Steppling, project manager for Operation Smile in Madagascar, added that the team at CHRR was critical to the success of the rotation. “Their patience, devotion to our mission, and consistent strong collaboration has made this week yet again a great show of how two entities come together to form a team,” Charlotte said. “It was a pleasure to work side by side with such a phenomenal team of medical professionals and such a great hospital.” Photo: Charlotte Steppling.

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“Every child that has a facial deformity is our responsibility. If we don’t take care of that child, there’s no guarantee that anyone else will.”

- Kathy Magee, Operation Smile Co-founder and President