Operation Smile brings hope to millions amid the Covid-19 pandemic

‘EVERY three minutes, a child is born with a cleft lip or cleft palate,’ the global medical charity, Operation Smile, says on its website. The charity estimates that there are millions of children waiting for reconstructive surgery in the 34 countries – including the 10 in sub-Saharan Africa – where it works.

‘The majority of these children are unable to receive the medical care they need because it is too costly, far away, or specialised. Because of this, being born with a cleft condition can be fatal. If a child survives, they may face bullying and social isolation,’ the website states.

Operation Smile began operations in sub-Saharan Africa in 1987, via Kenya.  Since then it has held more than 258 medical programmes, providing surgery to more than 23,453 people, 51 percent of whom are children under five years old, as of December 2019.

The current Covid-19 pandemic has, however, brought the organisation’s missions to a halt. And understandably so: ‘Our first and foremost concern is for the safety our staff and volunteers all over the world. We have offices in more than 30 countries and our concern is for them,’ Kendra E. Davenport, Operation Smile’s Chief Development Officer, told Africa Briefing in an interview.

She says Operation Smile, having paid close attention to what the WHO [the World Health Organisation] and the CDC [Centre for Disease Control] have said about coronavirus and how it has impacted different parts of the world, has been compelled to temporarily pause its missions.

‘Our initial reaction a month ago was to be cautiously optimistic that it wasn’t going to impact our operations in our missions. But as the coronavirus has taken the entire world in its grip, we have to take steps to reduce contact [social distancing] and to protect our staff, volunteers and the people we serve. So we had to cancel virtually all our international missions as well as local missions. The difference between our international and local missions isn’t necessarily a location, but rather a local mission is supported entirely by people who are local to that area. So initially, we cancelled our international travel, meaning we weren’t flying volunteers into a given country to help support a mission. That was our first step.

‘Secondly, we cancelled local missions that were supported exclusively by people from that given country. And that was largely due to steps being taken abroad. So it really has impacted the way we operate. We are currently looking for new ways to provide support to the countries we are operating in. But it’s tricky, it’s definitely challenging us.’

4-year-old  Deborah Fogor after a successful cleft lip surgery performed by Operation Smile volunteers in Ghana  (Operation Smile Photo- Margherita Mirabella)

Ernest Gaie, Operation Smile’s Senior Advisor for Global Business Operations adds, ‘We operate as a federated model; that means we have Foundations across the globe that have also been affected by Covid-19 and together with them, from our leadership in here Virginia Beach [in the US], we’ve been able to move some of the medical supplies that we have in those Foundations to the ministries of health in the countries we operate in as part of our immediate response to the pandemic. The leadership is currently mobilising materials and financial resources to support those Foundations.’

Although the current situation is challenging, it is not dampening spirits but rather strengthening Operation Smile’s staff and volunteers’ resolve to redouble their efforts to provide more care when this is all over.

‘Post-coronavirus, we look to the future and we’re optimistic that collectively we will get through this,’ says Davenport. ‘We will get through this, we’ll weather this storm. We will learn from it. I think globally, we are learning how we are going to be able to navigate future shocks like this and how we are going to be able to operate around the world and ensure the safety of people.’


Operation Smile’s commitment to providing comprehensive care to individuals born with cleft conditions in Africa cannot be understated. ‘If you had asked me a month-and-a-half ago how does our mission look for the continent of Africa I would have said, “absolutely robust”,’ Davenport told Africa Briefing. ‘We know there’s a great need for cleft lip and cleft palate surgery on the continent, especially for sub-Saharan Africa. Right now I am reviewing concept notes that really focus on the expansion of our mission in different African countries. We’ve been on the continent for quite a while, but we know that our footprints can, and should grow to provide more cleft lip and cleft palate surgeries and comprehensive cleft care to more children, adolescents and adults in need throughout the continent.

‘So while right now we are all taking a pause in the work we are doing in Africa and around the world, as soon as we get the green light to start to ramp up again, to begin our missions again, and to really start to focus on the provision of cleft lip and cleft palate surgeries around the world, we will be back with a vengeance, and an appetite for really helping people and doing what we do best, which is to provide comprehensive care to those in need and create sustainable solutions related to safe surgery, utilising the corps of more than 6,000 volunteers, more than 300 global staff and a host of implementing partners.’

Anaesthesiologist Henry Lizi, Malawi. Day two of surgery. Operation Smile’s 2019 mission to Kazumu Central Hospital, Lilongwe. Malawi. 4th – 13th April. Photo:  Operation Smile – Zute Lightfoot

Currently, Operation Smile is active in Malawi, Madagascar, Democratic Republic of Congo (DRC), Ghana, Kenya, Rwanda, Ethiopia, South Africa and Mozambique, with plans to expand operations to do more surgeries and develop more partnerships with hospitals in order to help more people in need of surgery and build local capacity for quality surgical care.

‘As an organisation, we have reached more than 300,000 people globally, and in our nearly three and half decades in Africa, we’ve  provided care to a little over 23,000 people with more than  just surgical services. We go beyond just the surgeries that we provide. We’ve done ortho-dentistry, provided speech therapy, nutritional and psychosocial support and several other services that have been needed. When people are affected by cleft, there are other medical or health conditions that also impact them. Speech is one of those, so as an organisation, we’ve also invested in this area, summing up the comprehensive care that we provide, as part of the rehabilitation as well,’ Gaie told Africa Briefing.

Davenport added: ‘One of Operation Smile’s hallmarks in Africa is that in addition to life-changing surgeries, we are training physicians. Nowhere is that more needed than in Africa particularly sub-Saharan Africa, where surgeries are in such high demand and yet so few are available. You look at Mozambique, the surgical, obstetric and anaesthesia (SAO) density of 0.6 to every 100,000 people is way below the World Health Organisation’s recommended of 22 per 100,000. So we know that’s the need, and the need is great. And we know that there’s the desire to take advantage of that training.’

Gaie backs Davenport’s assertion, saying that the organisation recognises the ‘…dearth of specialty skills that are needed to support surgeries, so in the last four to five years we’ve established two plastic and reconstruction residency post-graduate programmes in both Rwanda in collaboration with the University of Rwanda and in Ethiopia, in collaboration with the Jimma University. So far, we have had six plastic surgery residents through the plastic surgery programme in both countries. We have also supported the training of over 90 residents in the general surgery and anaesthesia residency programmes in Kigali, Rwanda and Jimma, Ethiopia and these providers have graduated with increased knowledge and skills in cleft and plastic and reconstructive surgery.

Safe surgery

Another aspect of Operation Smile’s focus is access to safe surgery, making it available to more people, especially in sub-Saharan Africa. ‘Lack of access to safe surgery takes more lives than malaria, TB and Aids combined,’ says Davenport. ‘If a child breaks their arm and it isn’t set correctly, breaks the skin and it gets infected, they can die from that,’ she explains.  ‘And yet that is a simple surgery [that] we want to make available,’ she adds.

Operation Smile in collaboration with LifeBox supported the establishment of an anaesthesia training programme at the Jimma University Hospital in Ethiopia’s Oromia region, one of only three training programmes in the entire country. ‘Anaesthesia is one of the critical components of providing safe surgery,’ says Gaie. ‘And unfortunately, across Africa, a lot of hospitals don’t even have anaesthesiologists. So we are doing everything we can to ensure that surgical ecosystems are built to meet the growing surgical needs in the countries we work.’

Operation Smile Mission Mission, Ho, Ghana. November 20th –27th 2015. Volta Regional Hospital, Ho. (Operation Smile Photo- Margherita Mirabella)

The organisation wants to expand its focus to include the strengthening of healthcare systems. According to Davenport, hospitals are not well-equipped to handle average injuries and illnesses. Therefore ‘by working with them and health ministries, government agencies as well as private sector partners in Africa, we can make surgeries much safer and more accessible. So it’s a more holistic approach we are looking to take in the months and years ahead.’

Gaie says the charity is collaborating with the Madagascar health ministry to ‘expand the surgical ecosystem’ in two regional referral hospitals. This includes infrastructure modification and improvement and essential supplies. ‘We are doing this in collaboration with several international partners, including Lifebox, Medical Aid International and World Children’s Initiative as part of our commitment to the continent, and we are doing everything we can to expand our footprint across the region. When we go in, we don’t just go in and do our work and get out. We work with the local capacity to strengthen them to take charge of their healthcare system.

Reputable brand

Operation Smile is a well-known and reputable brand that is helping to address a critical health need in sub-Saharan Africa. According to Gaie, ‘governments trust us and have been very receptive and supportive’ to their missions. ‘We have very good relationships with the governments of the countries we work in.’

Such is the reputation of the ‘Smile’ brand; the organisation is indeed receiving more requests from other countries. ‘For instance in Malawi where we have the cleft-free programme, they heard about the work that we have done with the Malagasy government to develop their national surgical, obstetrics and anaesthesia policy, and invited us to assist with a similar programme. They also reached out to us to help them develop their national cleft-free protocol,’ Gaie told Africa Briefing.

‘In the DRC, despite their security and other challenges, we still have a team and continue to provide critical healthcare in that country. The President [Felix Tshisekedi] recently invited our CEO and co-founder to visit because they recognise the impact of our work in the DRC and neighbouring countries,’ Gaie added.

Cleft is not going away, and the leadership of Operation Smile is determined to redouble its efforts to provide more surgery for victims when the coronavirus pandemic is over. ‘We will endure and get through coronavirus and resume treating people who need cleft lip, cleft palate surgery as soon as we possibly can,’ declared Davenport.

‘That’s why our donors and new and prospective donors should stick with us and fund our operations so that we can resume and get back to do what we do best. Trust is a hallmark of Operation Smile and I think the reason why so many ministries of health and so many governments are eager to work with us is because they value the work we do, they trust us.

‘We are a highly ethical organisation, we do complex work. And the fact that we do it with volunteers and it’s free to people in need, I think it makes the work we do worthy of donations,’ she added.

To support Operation Smile’s work in Africa with a donation, visit their website:



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