More Than Smiles

Editor’s Note: In Ethiopia, Operation Smile is helping to strengthen the country’s health system through specialised training and education programmes while continuing to provide patients with world-class levels of surgical care. This story is the first of a four-part series.


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A little girl is lying on a hospital bed in a ward corridor. Her mother is covering her face, trying to protect her from people’s curious gazes. The skin on her face, chest and arms is terribly burned and she can’t close her eyelids. She needs surgery as soon as possible to preserve her eyesight. But at the hospital, which serves more than 15 million people in southwestern Ethiopia, there are no plastic surgeons that can help her.

“She was playing with her friends at home where they had an open fire on the floor. By mistake, her friends pushed her, and she fell face down in the fire,” Dr. Yonas Metaferia says.

A general surgeon at Jimma University Specialized Hospital, Metaferia is participating in Operation Smile’s Surgical Training Rotations, which occur twice annually. Per Hall, a British plastic surgeon and Operation Smile volunteer, has been coming to Jimma regularly since 2012 to train general surgeons in reconstructive plastic surgery techniques and theory.

“Oh dear, this is a surgical emergency,” Hall says when he takes a look at the girl with the burn.

Unfortunately, the girl is too dehydrated to go through surgery immediately. The team decides to have her transferred to the plastic surgery unit at Addis Ababa to receive surgery as soon as possible to save her eyesight.

“It is actually very upsetting, isn’t it, that you have cases like this without instant access to plastic surgery,” Hall says.

“Originally the hospital thought they just wanted us to come and do cleft lip and cleft palate surgery, which is what Operation Smile was about originally. As we came back over the years, they’ve realised that plastic surgery isn’t just about smiles – it’s about reconstruction,” Hall says as he follows Metafaria in his rounds at the general ward.

“They realised there was so much more we could offer with various types of plastic surgery techniques. We could help them with reconstructive surgery after removing cancerous tumours, with reconstructive burn surgery, with injuries to the hands by machetes or knives and with all these people that are hit by cars or fall off trees and have nasty injuries in their legs or limbs, exposing bones. You need to cover the wounds with skin – and that is plastic surgery,” Hall adds.

One of the patients who needs reconstructive plastic surgery is Meheftehe, a 1-year-old girl born with a severe facial cleft that runs from the corner of her eye down through her cheek and into her mouth and plate.

“As we came back here over the years, they’ve realised that plastic surgery isn’t just about smiles – it’s about reconstruction” – Per Hall

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Meheftehe’s mother brought her to the hospital when she was only 19 days old, covering her face completely and afraid to show her to strangers, believing they would judge her for her daughter’s deformity.

At that time, the baby was too small to receive a safe surgery. On a surgical mission to Addis Ababa a year later, Operation Smile’s team performed the initial surgery to save her eyesight.

Now, Meheftehe is back for his palate surgery. This time, her parents are not hiding their little girl. They’re happy to show her to the world and let her make new friends at the hospital waiting room.

“I am 100 percent satisfied. You cannot compare before and after her first surgery. For each month, there is an improvement,” says Genet, Meheftehe’s mother.

Meheftehe will need many more surgeries to fix her facial cleft, including a bone graft.

However, in a country of almost 100 million people, the lack of plastic surgeons makes reconstructive surgery impossible for most. Today, there are little more than a dozen plastic surgeons, and almost all of them are based in Addis Ababa, the capital city. In Jimma, the need for plastic surgeons is immense, as it is across Ethiopia.

In 2012, Operation Smile began funding surgical training programmes with the goal of establishing a plastic surgery unit at Jimma University Specialized Hospital. Two of the hospital’s general surgeons are now training at plastic surgery units in Taiwan to become plastic surgeons, as part of a three-year curriculum required by the government. They will later return to Jimma to start the plastic surgery unit at the hospital and continue training new plastic surgeons in their home country.

Meanwhile, Hall and his fellow Operation Smile volunteers return to Jimma twice a year to help Metaferia and his colleagues as much as possible.

The focus of the two-week Surgical Training Rotations are to teach best practices and techniques not only to surgeons, but to anaesthetists and nurses as well.

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Metaferia, the next surgeon to take part in the three-year curriculum and will train abroad in South Africa, performs a cleft lip surgery under the supervision of Hall. The result is excellent, and Hall is very optimistic about the future.

“In three years time, this will be a very vibrant, exciting new service. They will have their own plastic surgery ward and their own plastic surgery theatres,” Hall says. “They are going to come back with new skills and new techniques which will be new for this part of Ethiopia, certainly. Some of their skills will actually be new for Ethiopia in general.”

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“Every child that has a facial deformity is our responsibility. If we don’t take care of that child, there’s no guarantee that anyone else will.”

- Kathy Magee, Operation Smile Co-founder and President