Happy Faces
Volunteer organization that provides reconstructive surgery to children in developing countries gives its young patients a reason to smile

By Linda Childers
April 11, 2003

The 12-year-old girl sat somberly in the medical facility, anticipating the surgery that would transform both her appearance and her life. Born with a bilateral cleft lip, she had never known the joys of childhood that many take for granted. In her native India, children with deformities are ostracized and forbidden to attend school with their peers.

Her destiny changed the day she met medical volunteers from Operation Smile.

Cindi Raglin, RN, who works in the neonatal intensive care unit at Children's Hospital of The King's Daughters in Norfolk, Va., is one of many nurse volunteers who have traveled on medical missions with Operation Smile, a private, nonprofit volunteer medical services organization based in Norfolk, Va.

Through Operation Smile, nurses from across the world spend two weeks working as part of a medical team to provide free reconstructive surgery to children in India and other developing countries. Medical volunteers provide the surgery and supplies needed to repair cleft lips, cleft palates, burns, tumors and other birth defects.

During an international mission, Operation Smile volunteers can repair a cleft lip in as little as 45 minutes at a cost of $750. Surgeries are funded through individual and corporate donations and provided at no cost to families.

"It's remarkable to see the transformation after these children undergo surgery," Raglin said. "The girl in India who rarely smiled was beaming the day after her operation."

Raglin is one of Operation Smile's most ardent supporters. Not only has she traveled on nine missions with the organization, she also volunteers 30 hours a week at its headquarters, where she reviews volunteer applications and assigns nurses to medical teams.

"When you go on a mission with Operation Smile, it changes your life," Raglin said. "After my first mission, I fell in love with the organization."

William Magee, DDS, MD, and his wife, Kathleen, MSW, founded Operation Smile in 1982, after they traveled to the Philippines. They were overwhelmed to find hundreds of children who were ravaged by deformities and who had no access to medical care. The Magees returned the next year to help more than 200 children. With that mission, Operation Smile was born.

Last year, Operation Smile volunteers offered reconstructive surgery at 26 sites across the world, including Bolivia, Brazil, Cambodia, China, Russia, Thailand and Vietnam. In addition to providing free surgical services in developing countries, Operation Smile provides education and training around the world to physicians and other health care professionals to achieve long-term self-sufficiency.

"You meet the most incredible families on these missions," Raglin said. "One family in Colombia had just lost their home and everything they owned in a mudslide, but all they cared about was their child having the chance to have their cleft palate corrected."

Terri Klimek, MS, CRNA, of the University of Michigan Health System in Ann Arbor, clearly remembers the faces that greeted her when she first arrived in Morocco on an Operation Smile mission.

"There were hundreds of people waiting and hoping their children would be selected for surgery," Klimek said. "Many come from miles away by mule, by bus or on foot. When you have screened 300 to 600 patients and can operate on only 120 to 160, you understand the Magees' dedication to helping these children."
Medical volunteers work in conditions that are far different from the state-of-the-art medical centers in the United States.

"Some hospitals have equipment that is 30 to 50 years old and open electrical outlets next to the scrub sinks," Klimek said. "The biomedical technician spends several days wiring and rewiring equipment to make sure everything is not only functional but safe."

Safety is a No.1 priority with Operation Smile, and volunteers must be certified in ACLS and PALS.

Operation Smile provides its own cardiac monitors, ETCO2, pulse oximetry, vaporizers and emergency equipment for each mission. Many of the medical volunteers also bring and donate supplies.

Surgeries are performed during the course of a week, with volunteers often putting in 12-hour days. Each medical team consists of five to seven anesthesia providers (anesthesiologists and certified registered nurse anesthetists), five to seven surgeons and a host of other personnel-including nurses, medical records personnel, dentists and pediatricians. A typical team may consist of medical professionals from four to eight different countries.

Sandra Dietzel, RN, who works at Johns Hopkins Hospital Children's Center in Baltimore, has made 11 trips with Operation Smile. "I think the personal satisfaction I receive on each medical mission far outweighs what I give," Dietzel said. "It's amazing to work with a team to create a little miracle in another part of the world."

While few children born in the United States have deformities such as a cleft lip or cleft palates, it is common in developing countries that babies are born with these birth defects. Researchers attribute the large number of children born with birth defects to mothers not receiving adequate prenatal care and a lack of folic acid in their diets.

"In the United States, even the poorest families have access to medical care, but that's not the case in these counties," Dietzel said. "These families are so grateful for our efforts that they try to repay us with fruit, produce and other commodities."

Terri Klimek has received thank-you notes from patients' families she has worked with on past missions.

"One mother wrote that her 13-year-old son used to look in the mirror and ask for an operation that would fix his nose and mouth," Klimek said. "He told his mom he was ugly and that no one would fall in love with him. After the surgery, the boy said we had made his biggest dream come true."

After traveling overseas to serve on an Operation Smile medical mission, many nurses find themselves making return trips.

"People have asked me why I give up my vacation time to work 12-hour days in countries where I need a translator to help me," Kilmek said. "I tell them these missions are the most rewarding thing you will ever do in your career. The feeling you get when you see a child look in the mirror after surgery is priceless."

For more information on nursing opportunities with Operation Smile or how to support its programs, call its corporate offices at (757) 321-7645 or visit its Web site at www.operationsmile.org.

Contact Linda Childers at eastbaypr@aol.com