Kids come up smiling

Tebatso Magoro (4) and Ennie Junior (5) collectively travelled 414km to get to Operation Smile in Nelspruit.

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Tebatso, from Polokwane, and Ennie Junior, from Swaziland, were born with severe cleft lips and palates — the world’s fourth most frequent birth defect.

Children like them often find it difficult to talk, eat and breathe, while constant teasing by other children often leads to low self-esteem.

With 48 other patients, Tebatso and Ennie, accompanied by their mothers, are waiting to be screened by Operation Smile doctors at the Rob Ferreira Hospital in Nelspruit. The operation’s medical volunteers repair cleft lips, palates and other facial deformities for free.

The screening helps to prioritise patients. Volunteers spend only six days in the area, so they cannot operate on everyone.

According to one of the volunteer plastic surgeons, Piet Coetzee, of the University of Pretoria, they usually select priority one and two patients. Priority one is cleft lips that everyone can see, while priority two cases have both cleft lips and palates. Patients with cranial abnormalities require complicated operations that are normally not done on short missions.

Coetzee says one of the hardest parts of his job is ‘choosing who to help and who not to help … it’s an ethical dilemma of medicine”.

Before Tebatso is assessed by two plastic surgeons his picture is taken to help them ‘measure” the likely result of the operation.

It is agreed that Tebatso is a priority one case and should be operated on. He is one of the 30 patients scheduled for surgery.

Zipporah Ngumi, anaesthetist and dean of the University of Nairobi’s medical school, is one of the volunteers. She has been working for Operation Smile since 1987, when it first visited Kenya, and has convinced her daughter, a final-year medical student, to join some of the missions.

‘I volunteer at least once a year in Kenya and I’ve done missions in the Philippines, India, Ethiopia, South Africa and Swaziland.”

For her, the joy is ‘to see children change their lives”.

Now it’s Ennie’s turn. Nkuna says her daughter’s condition sometimes saddens her, ‘but when I see the other children today I see that I’m not alone”.

The surgeons agree that she’s a priority two case. Anil Madaree, head of the plastic and reconstructive surgery department at the University of KwaZulu-Natal, says surgery will include making the child’s lip look balanced and repairing the muscle, so that she can whistle and drink through a straw.

Ennie moves on to the anaesthetists, but the doctors say her heart murmur could be a problem.

After further questioning they conclude that her case is too complicated for such a short mission.
Nkuna and Ennie can’t hide their tears. But the doctors are adamant: Ennie Junior can’t be helped — at least not now.

Programme coordinator Tamlin Grier says that on a previous mission to Madagascar, medical volunteers were heartbroken because of their inability to operate more often.

But Grier says those not chosen for surgery will be referred to a cleft-palate centre ‘to make sure every patient eventually gets help”. Ennie is referred to Pretoria’s Steve Biko Academic Hospital.

Early the following morning the team sets up and it’s all systems go. Tebatso’s mom, who is clearly nervous, takes her son by the hand when his name is called. Madaree operates on the child for an hour, while his mother waits outside. The surgeon comes out of the theatre and announces that the operation was successful.

The little boy’s split lip has been sewn together. His face is heavily swollen, but doctors assure his ecstatic mother that he will heal within a week.

The child receives a get-well pack with a small mirror inside. Tebatso looks at himself and his face changes: ‘Ma look, I’m fixed!” he shouts. His mother lights up. ‘He’s finally going back to crèche,” she says, smiling.

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