The Last and Best Adventure, Operation Smile
“A smile is good medicine”
Each year thousands of children are born with facial deformities. For those born in underdeveloped countries these deformities can mean ridicule, the inability to speak, malnutrition or even an early death. Operation Smile tries to help as many of these kids as possible. Operation Smile sends doctors and nurses on missions or to medical centers around the world to fix children with cleft lips, cleft palates, and other facial deformities. For the last three years, I have been looking for an opportunity for our family to join one of the Operation Smile missions.
I met their founders a few years ago and was inspired by their leadership and the dedication throughout the organization. For 30 years, they have been changing lives and smiles all around the world. I wanted my family to volunteer on one of their trips and see it in action. I knew they would be inspired by the professionals. However, the timing has never worked out: trips were during school, during a busy time at work or Op Smile didn’t have a trip during our spring break or our summer vacation. As I put our 200 day trip together, I asked for a list of missions and looked for a place where we would cross paths with a mission. Initially, it did not look good. We were not trekking thru the Congo or Morocco; we weren’t going to Central America, the Caribbean, or Vietnam. I noticed there was one possibility at the end of our trip. In August, they were going to be in the Philippines and we were going to be somewhere in Asia.
It looked perfect. However, this mission was not a normal mission. It was a joint mission with Operation Smile and the US Navy and would be on the U.S.S. Mercy, an oil tanker turned hospital ship. On most Op Smile missions, there are a couple student volunteers or non-medical volunteers who assist the professionals, however, the Navy had dictated that only essential medical personnel would be on this mission. Once again, it looked as if we were thwarted from volunteering. However, after a couple months of back and forth and our family agreeing to obey some strict Navy rules, the Navy granted us permission to board the U.S.S. Mercy while it was docked in Subic Bay, Philippines.
Our mission began with a bus ride from Manila to Subic Bay. It was clear that many of the professionals had a camaraderie from previous missions and everyone appeared to know what was going on. We did not. But that night, we were briefed with what needed to happen the rest of the week. Our first day would be screening the children. We expected more than 150 kids to come through that morning. They would come to a basketball gym where each child and a parent would go through a gantlet of medical groups. In one short period of time they would be documented, vitals checked, blood drawn, pediatrician visited, anesthesiologists consulted, examined by plastic surgeons, screened by dentists, taught by speech therapists and health experts. The following days would be on the ship prepping and doing surgeries.
The first night each set of professionals coalesced into groups to plan their next day. We were left without a group. Lauren, our team leader, told us we could sit in on any one of the teams, but we felt out of place and decided to return to our hotel. Our role the next day at the screening would be to entertain some of the kids or their siblings who were waiting.
When we woke up the next morning it was already in the 90’s and every breath reminded us we were in the tropics. We had breakfast and headed to the screening. One of the doctors, Shelly, talked to us about screenings she had done in Vietnam where it was this hot, and the whole day took place outdoors. At least we were going to be in a gymnasium.
When we arrived, there were already about 50 kids lined up to be checked. The medical professionals ambled to their tables to prepare for the day. Asher and McKane began playing with the kids almost immediately. They had bags of crayons and pages ripped out of coloring books to hand to the kids. They also walked around blowing bubbles, and by the end of the day, they were flying paper airplanes and throwing boomerangs made out of tongue depressors. The latter was a trick they learned from Jason, who was appropriately one of the doctors from Australia.
I spent much of the day walking through the entire screening process with different kids. The patients ranged in age from 6 months to 25 years. Surgical preference was given to the younger kids. The younger the kid the better the chance of learning to speak normally. The younger kids are also at a greater risk for infection or malnutrition. However, some of the preteens and teens were the hardest to see go through the system. They were living stressful lives. Without a palate they found it hard to learn to speak, swallowing was not natural, and any child with a hole in his face, in any culture, is subject to ridicule or worse from his peers. They entered the process subdued and shy. By the time they completed being screened, they loosened up and played with the volunteers.
By the end of the day, the team had narrowed the candidates down from 160 to around a hundred. Children were rejected for a variety of reasons. If they had the flu or other illness, if they had a heart defect that would make surgery risky, or if they were too old or too young, they would have to wait until another mission. But there were many who made it through. One mom, who had a cleft lip herself, brought in her 2 and 4-year-old who both had cleft palets. After the screening, the team agreed to not only operate on the two kids, but also to fix the mom’s lip as well.
The next day we went on the boat for the first time. We were badged and given very strict rules about leaving and getting back on the boat. One of the Navy’s rules was you always needed to return to the boat with the same group with whom you left. And each group needed to have a sober buddy. For our group, which usually included some of the other volunteers, Asher was the sober buddy. After we announced her role, the officer checking us out would look at us quizzically, at which point we would act as if were deadly serious. After his second look at Asher, he would ask if she could carry me back on board. I assured him she could.
We used most of the first day on the boat to set up the operating, recovery and post-op rooms. The teams were set up to do 15-20 kids a day. The team of volunteers were made up of people from more than ten countries. Just the doctors came from Italy, Ecuador, Philippines, US, Ireland, Egypt and Australia. For some of the volunteers, this was their 20th mission, for some it was their first. For all of them it took a brief 24 hours before they were all bonding and working and playing as a team. That evening the local charity (DSFS) threw a party for the kids and the volunteers. It was very special to watch the doctors and nurses playing games with the kids. McKane and Asher were right in the front playing dancing games and Simon Says with the kids.
The next day was the first day of surgery. Anyone who has been part of successful sports, business or other team knows how special it is when everyone does their part and comes together. The whole enterprise is capable of doing things no individual ever could do on their own. That is what happened in the morning. Each member suited up, went to their station and the process started. The kids were prepped, knocked out, their palates were fixed, they were woken up and then sent to recovery. There were 4 or 5 operating rooms going at all times, it was like a big organic machine, and we got to be a part of it.
The team gave Asher a specific job. She had to take the kids to the O.R. and then take the moms to the recovery room when the kids were ready. It was a pretty amazing experience for her to get to watch all the kids reunited with their parents. Kieran’s job was to work the phone in the hospital ward. The two hospital wards were on a different level of the ship from the recovery room and the operating rooms, so each trip involved walking people to elevators and escorting them up or down. It took some coordination to have the right people in the right place at the right time. McKane continued to play with the kids. Each day a new set of 15-20 kids would come in and the previous day’s would leave. In each group, there were patients who had bonded with my kids on the screening day, and they were all so happy to see them. I tried to keep busy helping the kids as needed, taking out the trash, scrubbing the hospital wards between groups, or talking to the leaders of the ship.
As the patients came in, some were scared, others were nervous, and all the kids and parents were cold. They were not used to sleeping with air conditioning. One noteworthy group of people had to feel as if this entire process was part of an alien abduction.
One of the kids I took a special liking to was named Sammy. He and his dad were both about 4’6”. Sammy was 17 but looked 12, and he had lived his whole life in the jungle with a cleft palate. At the screening Sammy and his dad had big eyes and neither one of them cracked a smile the entire time.
When they showed up on the boat, they had that same scared look. The first thing we all had to do on the ship was get chest x-rays to prove we didn’t have TB. The day before, one of the native families wasn’t allowed on the ship because the mom did have TB. Sammy and his dad waited their turn and, thankfully, they both were TB negative. After the x-ray, they had about 24 hours to wait before his surgery the next day. I checked in on them a few times while they were waiting. Once Sammy was playing nerf basketball with some of the younger kids, but most of the time he was glued to a 55 inch TV outfitted with a Roku filled with cartoons. The cartoons were all in English, but he sat right in front of the TV and watched 3 or 4 movies without moving.
The next day it was Sammy’s turn. Asher took him and his dad upstairs, and Sammy was taken into the back. Within a couple hours, Asher took his dad up to recovery. Recovery is a bit of a shock; your loved one is drugged and full of stitches. Sammy’s dad nervously went up to his child and held his hand until he woke up.
That night was a quiet night. All the kids who had their surgery done that day were sleeping off their anesthesia. The following morning I was surprised to see how much better they all felt. By noon, when it was time to take them off the boat and put them in vans going to the convention center, the kids were still in pain and walked slowly but they were back to being themselves. As I walked Sammy and his dad toward the van, I was struck by how different his life will be with a functioning mouth. And as I looked at them, their stoic demeanor cracked and they both smiled at me for the first time.