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On a single day in 2009, in the impoverished island nation of Madagascar, Dr. Ken Wilson of Halifax reached a professional pinnacle—a personal record he literally beams about when discussing. “I did 10 [surgeries] in one day—the most I have ever done. I couldn’t have done more. I was done.”

Please reread the doctor’s quote. Let it sink in awhile. However productive most people’s best work day may have been, it has probably not involved performing 10 life-changing surgeries, one after another, for no pay.

Operation Smile

Dr. Wilson is the highly respected head of the division of plastic surgery at the IWK Health Centre in Halifax; he began performing medical missions with a group called Operation Smile in 1995.

Operation Smile is an international children’s medical charity started in 1982 and headquartered in Norfolk, VA, that brings together medical professionals to provide safe, effective reconstructive surgery for children born with facial deformities such as cleft lip and cleft palate.

In his 18-year tenure with “Op Smile,” Dr. Wilson has travelled to more than 16 countries, including Senegal, Kenya, Ethiopia, Congo, Madagascar, Honduras, Guatemala, Mexico, Ecuador, Peru, Paraguay, Bolivia, Vietnam, Cambodia, China and India—many of those destinations multiple times.

He has completed, to date, 39 missions, performing cleft lip, cleft palate and other facial surgeries on a staggering 1,000 children, teenagers and adult patients, for no fee whatsoever.

Thirty years of service

In 1982, Dr. William (Bill) Magee and his wife, Kathy, first travelled from the US to the Philippines with a group of medical volunteers to perform cleft lip and cleft palate surgeries. There, hundreds more patients than they expected showed up at the medical site. They helped as many patients as they could on that trip but were forced to turn away many more.

Dr. Magee says the reality of that trip was devastating for everyone involved; Operation Smile grew out of the desire to help. “I think that’s why Operation Smile has attracted guys like Ken Wilson and more than 5,000 other medical volunteers,” says Dr. Magee. “It’s simply that you know how to do something. It’s not magic, you have the right people around you and you can do it well. We turned away 250 kids [in 1982] and we knew there was nobody coming back for them. That was very difficult.”

Dr. Magee recalls another story. “There was a lady with a basket of bananas who came up to us. She had her daughter, who was maybe eight years old, at her side. She said, ‘I’d like to give you these bananas as a gift for trying to take care of my daughter’—even though we had turned her daughter away. She ended up with tears in her eyes and we ended up with tears running down our cheeks.

“At the going away party that night, the lady who was the head of the hospital there said, ‘Please come back five years from now, 10 years from now, because these kids will still be here—they’ll just be five to 10 years older.’ It just didn’t seem fair that those kids would have to live like that. Kath and I said, ‘Why don’t we get together with a group of our friends and go back? We’ll take care of those kids.’”

Personal satisfaction

Every three minutes, a child is born with a cleft. One in 10 of these children will die before his or her first birthday. These children often cannot eat or speak properly and are shunned by their communities. “We see kids with scarves that cover their faces. Some never go to school,” says Dr. Wilson. “We had one kid in 2000, in Peru, called ‘Scarf Boy.’ He was about 10 years old, and he was very hesitant to take the scarf off so we could even get a look at him. He had apparently never been out of the house. He had a very bad cleft. We fixed him and he was up on the hospital ward (recovering) with no scarf. It was awesome!”

Dr. Wilson says he gets a lot of satisfaction from his work with Op Smile. “You have a group of people working toward one goal. You really feel like you’ve done something useful with your talents.” He says that every six months or so, he feels like he has to go. “It renews you. You come back and say, ‘Okay, this is why I do medicine.’”

Another story from his milestone 2009 mission in Madagascar still resonates with Dr. Wilson. “This man had two sons. They had walked for four days to get to us. He had sold his house and a cow to get the money to travel with these two kids, without knowing whether he was going to get the surgery for them; it was for opportunity only.

“[One son had] quite a severe cleft lip and the other was less severe, but certainly a noticeable cleft. We decided we’d do them on the same day, so they could recover and get back home. The father was wearing a New York Mets baseball hat—hard to believe in Madagascar. He had sold everything, and this was clearly a treasured possession, but he offered it to one of our group as a thank-you. They turned it down.”

That, he says, was a spectacular week. “It was magic. It was one of those times when everything is going right. We had a great bunch of cases and a South African team who were terrific; they are fun and they work hard.”

Team of experts

Operation Smile’s key objective is to create self-sufficiency in developing countries so that in-country medical professionals are empowered to treat their local populations. Medical education and training are provided for local doctors and in-country offices are established to recruit local medical volunteers, raise funds and coordinate local medical missions. Last year, 66 per cent of Operation Smile’s surgeries were performed by highly skilled in-country medical volunteers.

The team for an Operation Smile medical mission is often comprised of 40 medical professionals and supporting staff, depending upon the number of patients expected. That team includes six surgeons and six anaesthetists who work in pairs, sharing operating rooms (ORs). They operate on patients side by side. “There are two anaesthetist set-ups, two OR tables with lights. It’s like two ORs combined,” explains Dr. Wilson. “The surgeries are happening simultaneously. You try and maximize the amount of work you can get done. It’s great, because if there is an issue of any kind, there are other people right there who you can ask for an opinion.”

The surgical teams are aided by four or five operating room nurses, who, Dr. Wilson says, also manage all the equipment and help set up. Operation Smile has stringent guidelines and its volunteers only use medical gear and supplies that are state-of-the-art and meet the organization’s “Global Standards of Care.” Each cleft lip surgery takes about 45 to 90 minutes. Dr. Wilson estimates that cleft palate surgeries take roughly two hours.

The team also draws on the expertise of at least one dentist, who is usually an orthodontist, and one or two speech and hearing pathologists. The team is often accompanied by a couple of high school students from somewhere in the US who have been involved in Operation Smile’s student programs and who are accompanied by a chaperone.

There are also child-life specialists, who help families and patients prepare emotionally for surgery. Rounding out the team are support staff who catalogue and manage the voluminous medical records and who painstakingly photograph every patient, for quality assurance, before and after surgery.

A primary focus of Operation Smile is to educate youth and the community, while also providing specialized training for the international medical residents who often accompany the surgeons, and for the local doctors and medical staff on the ground in each country.

Triage approach

Although its focus began with children, Operation Smile has expanded to also include the medical treatment of adults. Dr. Wilson explains the triage approach which is used to help determine who is chosen for surgery and in what order.

“There are five priority levels. First: cleft lip, any age. Second: cleft palate under six years old; you get better speech and feeding results if the patients are younger. Third: cleft palate over six years old. Fourth: secondary surgery; these are kids who’ve already had a surgery but may have a bad scar, a deformed nose, or other similar concerns. Fifth: burns, scar removal et cetera. So you look at [all these factors], but you also consider: Where have they come from? What is the chance, if they don’t get the surgery this time, that it will ever happen? How far did they come?”

This balanced approach is mixed with compassion and concern. In Madagascar, where Dr. Wilson had his record-breaking day, he says 500 people showed up for screening. The team treated 211 of them, or 42 per cent. More than half could not be operated on, even with the gruelling work hours the team clocked. “That was just heartbreaking for everybody. We felt sorry for both the families and the team, who wanted to do everything they could. But we knew Op Smile had another visit planned.”

In fact, Dr. Wilson is now planning his 40th Operation Smile medical mission; this year he will head to Jiaozuo, China.

Says Dr. Magee: “Ken is kind of like the poster child for what every physician should be like. He’s calm, he’s reassuring and he’s got that gentle smile on his face. He’s always there for you, no matter what.”

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