Scenes of hope and healing: Tamatave surgical programme

Hope after the pandemic

There, we met Honoré, a very talkative and social six-year-old boy who lives nearby. Honoré’s mother, Eclaire, brought him to an Operation Smile surgical programme in 2019, but during his comprehensive health evaluation, medical volunteers determined that he was malnourished and, as a result, unable to receive surgery at that time. Honoré was then enrolled into Operation Smile Madagascar’s nutrition program, and the family was hopeful that he would receive surgery soon. But then, the COVID-19 pandemic struck.

Like many of the families we’ve met, Honoré’s mother and father struggled, as they both lost their jobs. Eclaire began selling bread and other goods in her community to make ends meet. Fortunately, the Operation Smile team in Madagascar remained in touch with the family and provided them with a food package of rice, beans, milk and oil; it was support that helped the family during a difficult time. After a long wait, the uncertainty and fear caused by the virus was replaced by hope for a brighter future as Honoré met our medical team to be screened for surgery. 

125 lives changed

Dr. Anna Strömberg, an anaesthesiologist from Sweden, served as the surgical programme’s clinical coordinator, a key volunteer role that ensures that the requirements for safe and efficient operating rooms and surgical schedules are met. Anna also served as the team leader for the nursing volunteers.

This international programme brought together more than 100 medical volunteers from Madagascar, Canada, France, Ghana, Honduras, Italy, Mexico, South Africa and the United States. The team provided 250 patients with comprehensive health evaluations. Of those patients, approximately 125 were placed on the weeklong surgical schedule.

During screening day, Honoré and some of his new friends enjoyed playing games as they awaited their comprehensive health evaluations. Unlike his first visit to an Operation Smile surgical programme, medical volunteers determined that Honoré was no longer malnourished and would be able to receive surgery during this programme thanks to the nutrition support that he received from the Malagasy team throughout the pandemic. 

Comprehensive cleft care includes the family

Nina Alexia Rabeson is a psychosocial care volunteer with a deep connection to Operation Smile’s work in Madagascar: Her daughter, Joyce, received surgery from Operation Smile in 2015. Now, Nina draws from her experience as a parent who has gone through the same process as those attending this programme.

Operation Smile’s psychosocial care providers create a welcoming and positive experience for children at our surgical programmes and care centres, many of whom may have had little or no previous experience in a medical setting, by engaging them in therapeutic play. Nina also consoles and informs parents or caregivers whose children were not able to receive surgery, providing them with advice, encouragement and resources so that they can continue their care journeys with Operation Smile. During this programme, Nina brought her 16-year-old son, Daniel, to volunteer. A member of the local Operation Smile Student Programmes club, Daniel and his fellow student volunteers assist families with their needs and spread smiles to young patients.

Screening and selection days can be an exhausting and emotionally trying time for parents and caregivers, so the atmosphere of joy and play that student volunteers and psychosocial care providers create for children is a key component of a successful and compassionate surgical programme. 

Comprehensive cleft care includes nutrition

Leásy, a seven-week-old baby boy born cleft palate made breastfeeding impossible, and the cost of formula is beyond the means of the family. As a result, Leásy is severely malnourished, as his primary source of nutrition had been condensed milk diluted with water that was fed to him with a spoon. With his birth weight of 3.5 kilograms having dropped to 2.4 kilograms, he was immediately enrolled into Operation Smile Madagascar’s nutrition programme and referred to a local nutrition clinic for an intensive treatment program.

The attention and care Leásy received from Operation Smile’s nutrition programme yielded immediate results, as he gained 100 grams in just two days. Jeanette said that she noticed a big difference in her grandson; he is more awake and alert, and his complexion looks healthier.

Leásy was then transferred to the local nutrition clinic, where he will receive treatment for the following month. Jeanette also received a special cleft palate nursing bottle and formula that will help Leásy continue to gain nourishment and weight. Malnutrition is a dire crisis in Madagascar with more than 44% of its people being undernourished and nearly 55% of children under five experiencing stunted growth. Now active in more than 20 countries, the organization’s global nutrition programme is led by Operation Smile’s director of nutrition Charlotte Steppling, whose experience working with children with cleft conditions who are malnourished in Madagascar led to its creation.

The wait is finally over

Honoré receives his long-awaited cleft lip surgery from Malagasy volunteer surgeon Dr. Romain Raherison with the assistance of volunteer nurse Guillaume Totoriaka, who is also from Madagascar. Romain is a graduate of Operation Smile’s Cleft Surgeon Training Programme and one of the few reconstructive plastic surgeons serving Madagascar today. The organisation aims to keep building surgical capacity through training more health workers like Romain and improving the infrastructure of local hospitals so that more Malagasy people can receive the care they need and deserve.

Dr. Joëlle Horace is a Malagasy general surgeon at Soavinandriana Military Hospital in Antananarivo. She is now training in cleft surgery techniques and working toward being accredited as an Operation Smile cleft surgeon. Under close supervision, she performed her very first cleft lip surgery during this surgical program.

“It was just as stressful as exciting,” she said with a big smile.

Joëlle’s first surgical programme was in 2019 when she took part as an observer. After that, she observed another surgical programme before participating in this one. She said she now needs a few more surgical programs and more cleft surgery experience before she can be accredited. Joëlle also said that it’s important to be a part of the programme, as there are many Malagasy children who are in need of surgery.

“It all begins with a smile,” she said. “As far as I’m concerned, every single child deserves the best care and the best surgery they can get. This is my heart speaking.”

A brighter, healthier future

Honoré and his mother, Eclaire, return to their community following his cleft lip surgery. His family and neighbours beamed with joy as he showed off his new smile. Eclaire said she thinks he looks beautiful after surgery and that he will look even more beautiful when he’s healed. She is certain that the surgery will have a positive impact on her son’s future; he will be able to speak more clearly and people will treat him with kindness.

“He will make friends, and nobody will say things about him,” she said.

The Operation Smile team in Madagascar will remain in touch with Honoré’s family so he can continue to receive the support he needs ahead of his cleft palate surgery.

Cleft care in Madagascar since 2007