Community: Meet International Nonprofit Operation Smile

Interviewer: Ashley Liang & Freya Gulamali; August 1, 2020

Interviewee: Julie Brumana, Western U.S Student Programs Associate @ Operation Smile

Operation Smile is active in around 30 countries and provides life-changing cleft surgeries to children and young adults (Operation Smile).

Could you introduce yourself, your role at Operation Smile, and how and why you got involved?

My name is Julie Brumana and I am the student programs associate for the Western US. Student Programs is a specific department within the organization, and its purpose is to engage students in what we are doing. There are student clubs run in the US and all over the world that do fundraisers, awareness campaigns, and educational events. There are four student program associates: I cover the Western US, others cover the North, the South, and our headquarters near Virginia Beach, VA.

I’ve been on staff for 4 years now. I came on board because I’d heard about the organization. I’d seen those infomercials that make you cry—but I’ve learned so much more about Operation Smile since I’ve been on staff! I have also had the opportunity to go on medical missions with students as part of the student team.

Could you tell us a little bit more about what missions are and what they do?

Yes, Operation Smile is active in around 30 countries at the moment where we provide life-changing cleft surgeries to children and young adults. To explain a bit more about them, there are children all over the world that are born with cleft lips and cleft palates—including in the US, but we thankfully have the infrastructure so that it is normally addressed very early on. That is either when the lip, on one side or both sides, does not close in the womb or when the soft palate in the roof of the mouth does not close. This issue affects their appearance, so these children are subject to all sorts of bullying and other social and psychological issues. Additionally, many other dental and health issues can stem from this. For example, those with a cleft cannot close their mouth properly and cannot suck. Therefore, they are not going to get the nutrients needed. So, they are often malnourished and have dental problems that all relate back to being born with the cleft lip/palate. At Operation Smile, our goal is to provide these free and safe surgeries all over the world so that the children can grow strong and live happy healthy lives.

Operation Smile's goal is the provide free and safe surgeries all over the world so that the children can grow strong and live happy healthy lives (Operation Smile).

Wow, that is truly incredible. Speaking of which, when I attended the webinar in June, I remember learning about how Operation Smile has had to cancel missions and surgeries. How has Operation Smile adapted during these unprecedented times to continue to provide for the communities it serves while balancing the safety of both patients and frontline workers?

Operation Smile has been able to adapt quickly to what's going on because we have such a long history; we've been operating for almost 40 years, and everything that we do is really done through partnerships. We have volunteers, medical professionals, and other really strong networks built up in all the countries where we work, so we were able to shift. As you correctly stated, it hasn't been safe to do surgery since March. However, we've been continuing to provide services to our patients in other ways. One of the first actions that we took was donating supplies such as personal protective equipment. Then we began addressing the service changes. Even though we cannot immediately address the surgical needs of the patients, we still want them to stay connected with us and provide services that they need. For example, in Nicaragua, we have a few of our care centers. So in addition to the surgical missions, care centers allow us to provide patient care all year round. After their surgery, patients normally would come to the care center to receive nutritional services, speech therapy, and psychosocial care. However, these services are no longer safe in person, so we have our volunteers providing virtual services to as many patients as possible.

"Even though we cannot immediately address the surgical needs of the patients, we still want them to stay connected with us and provide services that they need."

We also have provided meals and personal hygiene kits in certain places in Africa and India. In some of these areas, there are families that are under-resourced and families that, logistically, are not easy to get to. With our surgical missions, that has also always been a big part of our challenge: letting people know there's a surgical mission, getting them to trust us to bring their children in, and then figuring out, logistically, how they physically can and economically afford to travel to us. Now, in the same way, we want to help provide for their sustenance because they are on lockdown too, like we are. Some families are stuck at home with no access to personal hygiene, food, and other supplies, so we have over 700 families in Mumbai, Durgapur, and Madagascar that Operation Smile India provides supplies to. These three locations are a few of the places where there have been very active programs. Because of our relationships with them and networks we already had in place, we're able to gather up food and personal hygiene supplies and provide them to the patients while they are still waiting—and still needing—their life-saving surgeries. So, it is nice that we were able to support them in that way.

How will the changes you’ve made and services that you provide be affected by COVID-19 and how you will operate in the future?

As I mentioned, we are just starting to get some local surgical capacity back in Vietnam and Italy locally. This means that in Vietnam, for example, the surgical staff and volunteers are all from Vietnam. This is unlike the missions where we bring everything, including the volunteers and equipment, into a country. For instance, in the medical mission that I was on, we had 12 countries represented in the medical staff coming to volunteer in Ghana, and we flew in the supplies and people. Meanwhile, we're also trying to build up the healthcare system in countries like Ghana so that they eventually can have the staff to do the full mission and surgeries themselves. To your question about how our current actions are going to change how we operate in the future, we—as quickly as possible and when our ministries of health tell us it's safe—want to get back to providing surgeries because that is our core mission. Our networks, which have allowed us to do these missions effectively, are only being strengthened by the pandemic because we are having to work together in new ways. We're challenging our corporate sponsors and challenging our volunteers to think and engage differently with us, so I think that will just strengthen our relationships and network in the future.

In terms of how we actually provide the surgical missions, I do not believe there will be a specific change in our surgery procedure—I hope not because we can provide so much more with our current procedure. We work very closely with the Ministries of Health in a lot of countries, and in all countries, cleft surgery is considered elective surgery, so we cannot provide surgery at this time. This means that we currently have a backlog of around 10,000 surgeries, which will just continue to build up as the pandemic continues. That said, we are working on helping to train local volunteers so that if we cannot send international volunteers in to do the surgeries, the people in the local areas still can. So moving forwards, there might be more local volunteers conducting our missions. This is great because that means that their health system is strengthening. That is really our goal: to strengthen their healthcare system to have similar benefits as the US healthcare system. So, when a child is born with a cleft palate, they are able to receive those surgeries immediately. In the times of COVID-19, it’s hard and it’s ever-changing. You never really know what’s going to happen in the next month or so with it, so that is why our teams are doing webinars and different trainings for volunteers all around the world. This way, when it is time to say that we can hold medical missions again, everyone is ready and able to go out into the field.

"...we currently have a backlog of around 10,000 surgeries, which will just continue to build up as the pandemic continues."

I think as an organization, we are doing a really good job of keeping folks connected to us, even during this time when they are not doing what they usually do, for instance, medical volunteers are not going out on missions. We’re still working with our individual donors, and people are still engaged and supporting us because they realize that we need to be ready to go when the time comes. We also do trainings all the time, because anywhere that we work, we have to make sure that the medical workers in that country are up to the credentialing and training standard that we would expect in the United States. So, just because you're working in a country that doesn't have as high of a standard for medical professionals, we must bring them up to our standard before they practice on one of our medical missions. For example, we do basic life support training and others done by nurses, doctors, and medical professionals that need it or need it to be renewed. We found a way to do this successfully virtually, so we're still doing what we can and seem to be doing pretty well.

Operation Smile trains local medical workers so that they are up to the credentialing and training standard expected in the United States (Operation Smile).

Wow, it seems like Operation Smile has adapted quite well in this pandemic!

Yes, Operation Smile does not sit still; it’s part of our culture! It really comes from our co-founders, who started the organization back in the early 80s, and they make sure we are getting things done. If we can't do something one way, we will do it another—and that's the personality of the organization

I love that you are using this pandemic as an opportunity to strengthen and empower the local services in the community itself. How does Operation Smile coordinate with international governments to strengthen the local system, especially during this time where your work is also adjusting?

I think it looks different in different countries. I know that in Vietnam, we were one of the first US organizations to come in to do medical work to be trusted by the government. There are many other countries like this around the world where this relationship building allows us access to the country and builds relationships with the country’s ministries of health. It is mostly conversations, relationships, and us providing medical standards. In the over 30 years that we have provided service in Vietnam, we have actually built a relationship with their Ministry of Health to the point that our surgical standards are now their surgical standards for their entire country. Also, I know Ruben Ayala, Operation Smile’s Chief Medical Officer, has worked with the World Health Organization (WHO). However, we are never doing anything subversively, and we are always working with international volunteers—as we’ve said, our ultimate goal is to strengthen the healthcare systems in those countries to that of the US standard, so that those medical workers can do work without our assistance.