Since 2007, Operation Smile conducted 16 missions in Madagascar, providing free consultations to more than 6300 patients and free surgery to 2883 of them. We are aiming to conduct 3 surgical missions per year.
Operation Smile is known to provide free reconstructive surgeries for patients with facial deformities, especially with cleft lips and palates. But cleft care is not just surgery. It involves a lot of components from finding the patients, making sure they survive the first months of their life and are fit for surgery, ensuring they safely arrive at the mission site and live the life-changing and often scaring experience the best way possible, and providing follow up care. Operation Smile team in Madagascar is making the patient experience a top priority and the program a patient-centered care.
2 programs that we would like to highlight here are: the Feeding Program and the Patient Advocacy Program. We are also working on strengthening the Speech and the Dental Programs for a more comprehensive care.
Babies born with cleft struggle to feed correctly and usually fall underweight, often with life-threatening malnutrition. Obviously, surgery is not possible for these babies, which is a huge despair to already desperate parents. Without surgery, the baby won’t eat properly, without being fed properly, the baby won’t get surgery. They are trapped in a vicious cycle without finding an exit door.
Since 2017, Operation Smile in Madagascar conducted a pilot feeding program, rapidly supported by RUTF-Mana, which is a nutrition supplement for malnourished children.
All underweight babies who do not qualify for surgery stayed for a 2 days camp at the Patient Village. They attend various workshops on nutrition, healthy food, culinary demonstration, breastfeeding, cup feeding…all in partnership with local organizations like ORN (Office of Regional Nutrition), ONG Asa Soa or Red Cross.
Patient Advocacy Program
In 2016, we noticed a gentleman who came with 50 patients from his region. That is not common. The next mission he came with 80. We were amazed to learn that Mr Lala is walking, biking to the surrounding villages to let people know that cleft surgery is possible and it can be free. People trusted him because he is one of them and moreover because his child got a safe surgery.
Two other parents followed his path and Operation Smile team in Madagascar decided to support these amazing parents by giving them tools to work: cell phone, office supplies, posters, flyers…
These Patient Advocates, not only inform patients that surgery is possible, they also support our Patient Coordinator in finding transport for the patients to the mission site and accompany them so that they are not afraid and be more relax in a new environment. They play a crucial role helping organizing patients’ daily life at the Village: distribution of food, supplies, reminding them of basic rules, organizing tasks and cleaning, and most important constantly informing them what is happening and reassuring them throughout the process: screening, selection, surgery, post-op…
They are particularly involved during Patient Announcement along with the Child Life Specialist and other volunteers, at what we call the “Compassion booth” to support parents and patients who are not selected for surgery. These Patient Advocates have been through this difficult moment and have the right words for the parents and patients, and encourage them not to lose hope.
Increasing Surgical Capacity
The health infrastructure in Madagascar is not currently equipped to meet the overwhelming surgical need, and the country is facing a critical shortage of trained health care professionals. Madagascar’s estimated 0.6 surgeons, anesthesiologists, and obstetricians (SAOs) per 100,000 people sits below the minimum target of 20 SAOs per 100,000 people as recommended per the World Health Organization.
Operation Smile is addressing the immediate surgical needs in Madagascar through increased surgical programming and collaboration with local hospitals, government and non-governmental organizations. To address long-term challenges in the country’s surgical infrastructure, Operation Smile has partnered with the Ministry of Public Health to develop a pilot program for increasing surgical capacity that seeks to provide year-round cleft surgeries, increase surgical education, and innovate around challenges to infrastructure and the availability of resources.