Helping people to smile after stigma

Helping people to smile after stigma Mohamed Zimar shows off his new smile. Photo: Operation Smile.
Legacy Supplement 2021 – A Future Full of Hope
Operation Smile continues to combat cleft lips, palates and stigma around the world, through Covid and beyond, hears Jason Osborne

Cleft lips and cleft palates aren’t too much a feature of day-to-day life in Ireland or the western world anymore, modern science and medicine allowing these conditions to be fixed mere months after birth in most cases.

However, it is not so abroad – speaking to The Irish Catholic, Operation Smile volunteer nurse, Niamh Ryan, tells of people’s ongoing struggles with cleft lips and palates, but also of their struggles with the attached stigma that continues to exist in many societies around the world today.

Mrs Ryan got involved with Operation Smile “decades ago when I was a young nurse” through her connections in the healthcare world. An anaesthetist she knew encouraged her to check out a charity that was getting off the ground in Ireland, and she leapt at the chance to take part in its volunteer work. Operation Smile “seemed to tick all the boxes” so she sent in her CV and got started then and there.

Asked about the nature of her work with the charity, she begins with some context, explaining that cleft lips and palates aren’t so prominent a problem in Ireland anymore.


“So basically, here in Ireland, if a baby is born with cleft lip or a cleft palate, they are seen nearly within three months of their birth and their journey of repairing it all starts then. Whereas in third world countries, it takes a little bit longer …I go on the medical missions, and  here in Ireland, I work in the operating theatre – and I do the same thing on our medical missions,” she tells this paper.

“I would be involved in what we call the screening, when the children and the families come to our mission centre, so I would do some of the screening there and then I would go into the OR with the other nurses and the local nurses and I would set up the OR, which is the operating room for our week of surgery, and prepare all of the instruments, get all of the equipment that we need and all that sort of thing. During the week of surgery, I’m involved with the surgeons and with the anaesthetists, the local nurses, the local doctors, all that sort of thing, so I would be there for example: I would go in in the morning and I’d get the theatre ready with the instruments and all the stuff that we would need for the day.

“Then we would start our list and I would be there to help the anaesthetists put the children to sleep. I would be making sure that the surgeon has all the equipment he needs, all the sutures he needs, all that sort of stuff.”


Mrs Ryan does far more than this, however, also helping to mentor the local nurses, as well as rehabilitating the patients as they wake up from surgery. The picture she paints is one of sustainability – not content with merely performing surgery, Operation Smile seeks to give the people on the ground the skills and information they need to fix cleft lips, palates and stigma.

The work takes place all over the world, too. While such conditions may not be an enormous problem in Ireland anymore, plenty of places around the world continue to subject people to decades of misery without access to proper care and attention. Mrs Ryan’s time with Operation Smile has taken her to Kenya, India, Swaziland, Madagascar, Ethiopia, the Congo and more multiple times, a reminder of the truly global scale of the work.


Asked about the social stigma people born with cleft lips and cleft palates often face in their various countries, Mrs Ryan shares her experience of it on the ground.

“You see the children, and adults as well, when they’re coming to their screening, they’ve got their hands over their mouths, they’re very shy, they don’t want to make eye-contact with you. They’re wearing a scarf, they’re not, in one way, used to being out in public, for want of a better word. They’re afraid that people will start looking at them and pointing at them.

“I remember in Kenya, one of my first missions, there was this 14-year old-boy who had a cleft lip. We did him… and I was there with him supporting him through his surgery. After his surgery I sat him up on the operating table and I got a mirror and I showed him his face, and he just looked and he says, ‘I can kiss girls now’. We all just looked at each other and we just winked and said, ‘Yeah’,” she laughs.

“Some of the younger children, like some of the babies, they wouldn’t be aware of the stigma because they’re too small – but this was a 14-year-old, girls were on his mind at that age, and he would have had the experience of the stigma.”

It’s not just young people the conditions affect, either. Some have to live with cleft lips, palates and the ensuing stigma for decades, which ensures that when they receive Operation Smile’s care, it’s gratefully received indeed.

Old man

“This 84 year old man [in the Congo] came into the theatre like that, with his daughter. He had travelled many, many miles and we did his surgery, again, under local anaesthetic. When we showed him his face, he put his two hands and raised his eyes to heaven, and gave thanks. We walked him around the operating room and everybody stopped what they were doing and they clapped him. He was like a film star,” Mrs Ryan says.

The pandemic impacted their work, as it impacted everybody’s, a waiting list forming as their medical missions were paused during the initial months of the Covid outbreak. However, they’ve already set to work tackling it, and Mrs Ryan says that legacy donations and all of the donations that they receive are essential in enabling them to do so.

“Without our donors, we wouldn’t be able to do what we do. Every penny adds up, every dollar adds up, every euro adds up. As I said, I’m blessed to be able to do it. I’m so delighted that I’m part of it, but I wouldn’t be able to do it without the support of our donors and the wider community, like our families. Every little bit helps, and it’s not for us, it’s for the people and countries that are a lot less well-off than us.”