Operation Smile Cambodia is preparing to mark 13 years of carrying out corrective surgery on cleft lips and palates in the Kingdom. Marissa Carruthers goes behind the scenes.

The collage of photographs plastered on the white wall reveals a startling difference. Half show babies, children, teens and adults baring facial deformities; sat next to each photo is another headshot of a stranger. Here the subjects of the portraits wear a twinkle in their eyes, and their smooth, almost flawless skin stretches into a broad grin.

On closer inspection, it’s apparent the adjoining photos are the same person – before and after shots of those born with cleft lips and palates having undergone free treatment provided by Operation Smile Cambodia (OSC).

“Seeing the first smile on patients’ faces after the operation is amazing,” says Dr Mok Theavy, OSC medical director, recounting the moment Cambodians who thought they were scarred for life first look in the mirror after the operation. “These children come in very shy, and then suddenly after the operation they gain all this confidence,” adds OSC board member and Emaxx CEO Sean Ngu. “That is incredible to witness.”

Dr Theavy was the country’s first trained plastic surgeon to start practising after the Khmer Rouge was ousted. Having been forced to work in rice paddies under the regime, Dr Theavy had always dreamed of a career where he could help his fellow people. In 1999, when international organisation Operation Smile mooted expanding into the Kingdom, he had already gained a reputation for his skilled and dedicated work to help his country back on its feet, and was one of the first that founders Bill and Kathy Magee contacted for help.

In April 2002, Operation Smile carried out its first international medical mission in Cambodiaat Phnom Penh’s Khmer-Soviet Friendship Hospital, with Dr Theavy and his expertise at the forefront. Since then, OSC has played an instrumental role in breaking down the barriers associated with cleft deformities as well as carrying out more than 3,600 successful free life-changing surgeries across the country.

As OSC gears up to celebrate its 13th year in the Kingdom next month, it is working towards a new mission – to create a cleft-free Cambodia. “We plan to be the first country in the world to eradicate cleft lip, which is unbelievable and thanks to the amazing work of all those involved, from the volunteers to the surgeons, donors and partners,” Ngu says.

With the organisation well on its way to achieving its target, its focus has shifted towards finding those hard-to-reach patients in outlying rural areas as well as engaging in education. Often, cleft children are born with a stigma ranging from having been bad in a previous life to being a curse on the family. As a result children are often bullied or hidden from the public by relatives. In extreme cases, children are  murdered. To date, OSC has rescued two newborns from being killed.

“Now it’s about patient awareness and patient recruitment,” says Jay McCord, OSC country manager, “It’s about making people aware that clefts can be treated and it’s nothing to be ashamed of. This is a global problem and abandonment is a big issue. If we let people know it’s a treatable issue, then they will come to us.”

Paving the way for the future, a year ago the OSC team opened a dedicated cleft care centre on the once-dilapidated third floor of the Khmer-Soviet Friendship Hospital, which they transformed into five clean and equipped wards for about 15 to 20 patients. It also includes nursing stations, an operating theatre and post-recovery ward. The country’s first dedicated speech therapy centre also runs from there.

And when it’s not being used for OSC patients, the floor is full of local patients seeking other surgery. “The idea is to not only treat cleft patients but also help improve the overall medical care in Cambodia,” McCord says, adding surgeons often carry out plastic surgery on other facial deformities apart from clefts.

Awareness is another continual challenge. “The biggest reasons for not being treated are ‘surgery is scary’, ‘we didn’t know it’s possible’ or ‘it’s too expensive’,” Dr Theavy says. “People also can’t afford to leave their jobs for a few days or afford the transport. We have to remove some of these barriers.” Financial and other means of support is therefore offered to families.

Another common problem is that cleft children are often under-nourished as they cannot suckle milk properly, meaning it is unsafe to carry out surgery. OSC teaches families how to feed and offers nutritional guidance with the aim of performing surgery as early as possible.

“Children use more energy eating than they actually get from it so often these children are underweight when they’re six-months-old, which is the best age to have lip surgery,” McCord adds. “The idea is if we help them early on then the baby can be as fit and healthy as possible to have surgery.”

For more information, visit cambodia.operationsmile.org.