THE LIFE-CHANGING work carried out by Irish surgeons in Ethiopia is the focus of a new documentary which will be aired on RTÉ One tonight.
Behind a Smile takes a look at the work of plastic surgeon Dr David Orr – of Our Lady’s Crumlin and St James’s Hospitals in Dublin – as he works to improve the lives of children born with a cleft lip or palate in Jimma, Ethiopia.
The surgery takes place for free thanks to Operation Smile.
“There are 2 billion people in the world who lack access to surgical care,” said Dr Orr.
In addition, only 4% of an estimated 234 million surgical procedures performed each year go to the poorest third of the global population. It is out of these shocking statistics that Operation Smile and surgical missions such as these came about.
Norah McGettigan’s documentary follows Hawa (10) as she undergoes surgery in Jimma.
Passing on skills
Orr initially got involved with Operation Smile after an experience as a student on a visit to Malawi in 1984.
“I remember being in a rural hospital that was staffed by very hard-working and very well-meaning but essential generalist doctors who didn’t have specialist knowledge.”
A retired English orthopaedic surgeon visited the hospital, and did “a phenomenal amount of work in two days”.
“It struck me how much value you could get in a developing country from a fully-trained specialist,” said Orr. Once he was fully trained as a specialist in plastic surgery, he got involved in Operation Smile, so he could offer his skills.
Operation Smile Ireland
He started Operation Smile Ireland in 2002/3 and undertook a number of large international missions where they sent out big teams with surgeons and anaesthetists to Kenya, Jordan and Addis Ababa.
One area they visited was Jimma in Ethopia, which is a large rural market town with its own university and medical school.
They needed far more than just two surgeons, and after working there the Operation Smile team spoke to the doctors about passing their skills on.
They said that’s definitely what we want. ‘We don’t want you go come here and do work for us, we want to do work ourselves’.
Operation Smile Ireland supported a training programme, and arranged overseas secondment to Taiwan where Jimma surgeons would learn about microsurgery.
They are now developing their own specialist departments in Jimma.
“We wouldn’t claim we have done all of that. We planted the seed for the idea,” said Orr.
They were supported by a number of partners, and Irish Aid, in doing the work.
Dr Orr also said he admires the fact training local surgeons are able to stay in their home country, and develop the service there. ”It’s incredibly admirable,” he said.
The best moment for me was to have reached the point where I was so confident in the guy that I had been training that I could stand back and fold my arms and give him the responsibility of training his junior colleague.
Facial deformities
The common narrative around children being born with facial deformities and cleft palates in the developing world is that they are ostracised or cast out of their local community.
Dr Orr said that in his experience, this is far from the case. “One of the things I’m anxious not to say is that people with facial deformities are not ostracised or put to one side. In some situations in any country people have odd beliefs around it, and sometimes you do hear stories that people see it as punishment.
But in my experience, these children are loved and cherished but people are very over-protective of them. The whole community is very worried they will be teased and they are not allowed out of the house. They are clearly loved and cared for.
The children are often brought to Dr Orr and his clinics from hundreds of miles away, with their trip often paid for by locals.
The whole village has supported them.
If you have something like a cleft lip and cleft palate, you won’t learn to speak properly. People misunderstand and think there is something wrong mentally, when there isn’t.
Orr describes his role as “a huge privilege”.
“It’s a constant struggle so you can get very dispirited working in our system,” he says of Ireland. “You sometimes lose sight of it – it’s just a daily grind getting in there and getting your job done.”
But he says that getting to go to a developing country and see “people’s appetite for just getting stuck in and getting it to happen” is worth it. He also knows that he’ll get to see the patients and their progress for the rest of their lives.
If I see a baby with a cleft, I know I’ll continue seeing them into their 20s. When I see a new baby here it’s the start of a long journey and our whole team will be involved.
Behind a Smile will air on RTÉ 1 tonight at 11.30pm.
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