We are thrilled to launch our new partnership with EMEA Recruitment. Starting with a special podcast episode featuring Co-Founder of Operation Smile UK and UK Medical Volunteer Dr Phil McDonald hosted by CEO of EMEA Recruitment Paul Toms. In this episode we will learn more about Dr Phil’s commitment and also about Paul’s personal connection with cleft and the reason he chose to collaborate with us.

Operation Smile Medical Director Phil McDonald
Photo: Margherita Mirabella.


Paul Toms: Morning Phil, great to see you today. How are you?

Phil McDonald: Very well thanks, very well. Down in sunny Chichester.

Paul: I was going to say, what part of the world do we find you in? I guess with the current situation [COVID-19 pandemic], the travel has been a bit reduced recently, hasn’t it?

Phil: Yeah, so I’m spending most of my time in Chichester – there can be a lot of worse places to be, so we’re very happy here actually.

Paul: I really appreciate you spending the time with us today, because I know how busy you are, and I think it’s a great opportunity to take the time to speak with you.

As I mentioned in the introduction, clearly the work that Operation Smile does is very close to my heart, so it’s great to have you on the podcast today, and it’s hopefully an inspirational piece for me and for the listeners.

Obviously, in terms of the background, I know you’re the Co-Founder of Operation Smile UK, and it’s a charity that’s been running for 18 years now. So I thought as a general summary to start off with, if you’d be able to tell us a bit more about how the charity was founded and your role within the organisation, that could be a good starting point to kickstart off.

Phil: Well I first started volunteering with Operation Smile back in 1995, which is 25 years ago now, and there were very few volunteers in the UK.

In 1999, I was called totally out of the blue by a journalist from The Guardian called Tim Radford. He was writing an article about Operation Smile in The Guardian and he asked me a couple of questions, I gave a couple of quotes, and in this article – a lovely half-page article – it basically said, ‘Dr. Phil McDonald, Consultant Anaesthetist from Chichester, said…’ and there was some quote from me.

The day the article went out, I was contacted by quite a significant number of companies – film companies – wanting to do documentaries. There I was, I was a simple doctor in Chichester, and all these companies wanted to suddenly do a documentary. Fortunately, we ended up going with the BBC, and did this documentary called The Facemakers, which was filming a mission and following some patients in Davao in the Philippines. It was a lovely, 50-minute documentary, which went out prime time on BBC One in 2000.

Now, because of that, it obviously generated a lot of interest in this country about Operation Smile, and so we thought, well we need to set up a charity in this country so that we can raise funds and get more volunteers. So I was introduced to a few financial entrepreneurs and we had our first meeting in London – I remember it to this day – in the Royal Ocean Racing Club, where I met all these financial entrepreneurs, people in a totally different business to me, and we decided to set up the charity and eventually it became registered in 2002.

And, since 2002 till now – that’s 18 years – we’ve raised over £35m, which is quite incredible really, because, back in 2002, we had an office, which was leant to us by Netdecisions, we had one employee. Now we have 19 employees and an office in London. As I say, I’m very proud, as a Trustee for 18 years and also Medical Director for 18 years, we’ve raised all that money over that time.

Paul: It’s a huge achievement, as you say, it’s something you must be very proud of. In terms of the reasons why you did it in the first place, was there something that was close to your heart, as to why you wanted to do this right at the beginning? Was there something really driving you on to do that, because I suppose there’s a number of ways you could have taken your skills and a number of causes you could have helped, so is there a specific reason why it was the Operation Smile route that you went down?

Phil: It did all start as a bit of an accident, because when I started working with Operation Smile, I was working in Adelaide in the Children’s Hospital in 1995, and it literally was a total accident. There I was as a senior anaesthetic trainee in the coffee room, and one of my colleagues, a consultant, came in and said, ‘I’m meant to be going away with Operation Smile in two weeks’ time, but for family reasons I can’t go, can anyone else go?’ and I thought, put my hand up, two weeks in Bogota seemed like a good idea and I went.

And I suppose from that moment of seeing the difference that we made on a two-week medical mission with Operation Smile, all the children’s lives we changed – we operated on about 200 children that  medical mission – it just seemed such a valuable type of organisation. Obviously, there’s a great need around the world, and it’s so valuable that it’s very infectious; once you’ve been on one mission, you can’t stop going on them really.

When the opportunity came to actually being able to make it happen in this country, again, it was taking those opportunities, and I suppose that’s always been a bit of a mantra in my life is, if an opportunity comes along, it may only come along once, you take that opportunity, and it’s just grown from there.

Paul: I know you’ve talked about the great work you’ve done in terms of the setting up of the foundation and the fundraising behind it. In terms of your role, what else do you do? Because I also think that’s quite important, in terms of the more hands-on, day-to-day things you’re involved in. It’d be quite good to understand how that works from your point-of-view?

Phil: My normal workdays? I work as a Consultant Anaesthetist, which means I anaesthetise patients to have operations, so from an Operation Smile point-of-view, I anaesthetise the children for the surgeon to do the operation.

My full-time, normal day job is working at a local hospital, which I’m very fortunate is only about a mile away, so I normally cycle to work in the morning, which is lovely. Just take yesterday for example, I was doing children’s operating lists, where in fact we were doing investigations of MRI scans. Now, we’ve got little babies, they don’t lie still for half-an-hour to do the scans, so you have to anaesthetise them, but one of the main parts of that job is actually spending time talking with the parents, who are extremely anxious that the child’s going to have the scan, what they’re going to find, they worry about the anaesthetic, so a lot of my time is spent actually preparing the parents and the children for the operation.

Come the afternoon, I was anaesthetising patients for bariatric surgery, which is weight-reduction surgery, so in the morning I was anaesthetising the smallest people in the hospital, in the afternoon I was anaesthetising the largest people in the hospital! It’s a really varied job and that’s what I love about it. For me, going to work on a day-to-day basis just isn’t a chore. I just love my job really.

Paul: When I look back at the operations that I had as I was getting a bit older, I think the last operation I had on my cleft lip and palate was when I was 13. I can still remember the anaesthetist from that time, because obviously when you’re younger, you don’t really know what’s going on, but I think as you get a little bit older, you’re more conscious of what’s about to happen. That moment when you’re in the operating theatre, you’re just waiting and you know, in those days – showing my age a bit now – there used to be a huge mask that goes over your mouth; I’m not sure they still do that now or whether there are different ways of anaesthetising people. But it’s quite a scary thing to go through, counting down from one to ten, and I just remember the people that were doing that, the anaesthetists that worked with me then, really helped massively in that five-minute period before actually being under. It’s a huge job to do really, to put the patient at ease before the operation actually starts.

Phil: It is really particularly important – it’s important with everyone – but particularly children, like yourself, you would have had a number of operations over the years, so if the first operation you go to, you’re really scared of the anaesthetist, it’s a complete nightmare after that, because the patient is only scared about coming in, and therefore it’s so important we get it right and actually make the children feel very relaxed. And as you say, we sometimes use the mask, we sometimes use IV, but we put special cream on so that they don’t feel the needles going in. Sometimes I use a bit of sedation to settle them, but it’s quite interesting because sometimes it’s actually the parents who are more anxious and the children are an absolute dream.

We always bring the parents in, but it’s quite interesting because most parents hold it together until the moment the child goes off to sleep. And the moment the child goes off to sleep, you just see the parents suddenly burst into tears, all the stress goes out of them. And I always find – I’ve taken my own children to the operating theatre – and when you’re on the other side, it’s a different story altogether.

Paul: It’s good you’ve been on the other side of the theatre, so the fact you can empathise with what people are going through is important. You know how to put people’s minds at rest and make the situation more comfortable for everybody involved on that side. Obviously earlier on, you mentioned a bit about the great work you guys have been doing in the fundraising for Operation Smile, £35m raised to date, because obviously EMEA are going into partnership with Operation Smile, we’re going to be hopefully adding to that number over the years. I thought it might be good for you to explain to the listeners how the money is spent and where the money goes really.

Phil: Well we obviously try and direct as much of the money to the frontline as possible and we have different models, but our main model is running a mission model. We used to run a lot of international medical missions. If I just take you through the very basics of what our medical mission involves, and where the money is being spent and why people may realise it does cost money for these things to happen.

First of all I would say that all the medical practitioners and all the nurses, doctors, any healthcare assistant who goes with us on these missions, does it on a purely voluntary basis, so none of us are getting paid, none of the volunteers get any money out of it whatsoever. The money goes into the organisation of our programmes, so a typical medical mission is all about the team and it’s really exciting.

We have a team of about 40/45 people and we all fly to a centre where we’re going to be working. Sometimes we know a few people on the team – on the whole, quite often – we won’t know any of the other people on the team. We’re all high-skilled healthcare professionals who know our job, but it’s bringing a team together on a day. The following day we’re working straight off; we can’t waste any time. This isn’t a holiday.

So, I’ll give you an example of a medical mission we did to Addis, the first mission we did to Ethiopia, in fact. We arrived there, we got all the gear to the hotel, met all the people coming from all over the world, we met all the local people who were going to help us as well, and the next day we started screening.

Screening involves looking at all the patients who have been recruited to come for the operation, and so we go to the Black Lion Hospital and there we were faced with 600 children waiting. Now, 600 children, that’s all very well and good, but they’ve all got a parent, or two parents, or a brother or sister, so there was approaching 2,000 people lined up around the hospital in the middle of Ethiopia, in the middle of Addis, waiting to be seen by us. And what we do do is that, in the team, there will be surgeons, anaesthetists, nurses, speech therapists, dentists, ENT specialists sometimes, and paediatricians, so that every patient that comes to a mission site will get seen. It’s crucial that everyone gets seen. And they’ll get seen by everyone in the team. So, you can imagine the logistics of that in two days, we have to screen 600 patients.

And then we have to decide who we’re operating on. The really heart-breaking, devastating side of all this is that these aren’t just numbers, these are 600 real patients who need operations, and we know that in five days’ operating that we’re going to be doing, that we’ll only be able to operate on 200. And that’s really heart-breaking when you start off in that position. The idea is that, whenever we go to a site, that we keep going back time and again, and the idea is that we train the local people to do the operations, so we see all of the patients and, over these two days, this is where a lot of the really amazing stories come out.

We’ve travelled for days to get there and it’s so hard for us to decide who we’re going to operate on. We have a very set criteria to how we do it, and to give you an example of the stories we hear, just a very simple example of a 16-year-old boy, who was called Sam, who lives in Ghana, I remember sitting there in front of him a couple of years ago, and there was Sam, who’s wearing a Manchester United football top, he looked like my son, my son was the same age – maybe it’s one of the reasons these stories often resonate, very similar to yours – and this child, 16 years with a cleft lip, not being operated on, and I just said, ‘How’s it affected you over the years? How have you felt about it?’, he just said four words, ‘I have no friends’. And you just sit there, and it brings a tear to my eye now just even thinking about it, and I just think, if that had been my 15/16-year-old son going to school every day, and being in the playground in the corner, no one talking to him, it’s just devastating. And that week we changed that child’s life. His life was changed. He would actually be able to go and play football with other people.

So anyway, we see a lot of patients, we see a lot of really heart-breaking stories, and then of course we have to decide who we can operate on. And that day’s a very difficult day, because you have to talk to everyone and say, ‘Well I’m really sorry we can’t do it this time around, but you will come back’, we give them a piece of paper to say, we were here last year, will you come next year, we’ll be here again. As a parent, that isn’t very helpful, but we can only do what we do, and we’ve got to do it safely and we can only do so many patients.

Then we have a day when we tend to set up the operating theatres and do a bit of education for the people who are helping us while we’re there, and then we have five days of operating. And we normally run five or six tables. So, we’ve set off 5/6 o’ clock in the morning, operate until we’ve finished all the patients that we’ve planned to do for the day. Sometimes that may take us on until 8, 9, 10 o’ clock at night, but it’s absolutely crucial that we only do it in a safe manner and we do it to the same standard that we would do in our own countries.

And the thing that I always go back to is that I always look at every operation we do as being a training opportunity. We have the local surgeons, local anaesthetists, local nurses, so when we’re doing the operation, we’re also training them to do the operations, so that, ultimately, they’ll be able to take over that role for us.

Then post-operatively, the kids – it’s really sweet – in the evenings, the older ones who can appreciate it the most, obviously the babies can’t, you have a 6/7-year-old, you give them a mirror to look in at the operation and how their face has changed. And the change in the face, the glowing smile that comes out is just amazing really and it‘s incredibly rewarding for us to see that afterwards. You’re never too old to have the operation, I mean, another story of an Ethiopian that’s in the Addis mission that we did. This guy was about 70, and he’d been very fortunate, he’d had a cleft lip all his life, he had got married, he had children, and the first thing he said after he had the operation, he just stared into the mirror for ten minutes, he just said, ‘I can now kiss my granddaughter for the first time’. And when you hear stories like that, it just really hits you and I get emotional thinking about it. I’ve told that story about 1,000 times, but it doesn’t stop really having quite an impact.

And then of course, at the end of the two-week medical mission, we usually have a big celebration, everyone lets their hair down, and then we all go back home, changed people.

Paul: Some of the stories you’ve mentioned there, I know some of the stories are online on the website as well, and personally it was one of the reasons why I picked up the phone to reach out to you guys, because I just realised how lucky I was going through this situation in the UK and it was almost expected that it was going to be sorted. Whereas in these types of countries you’re helping in, there’s a lot of people who have to wait a long time, as you’ve mentioned.

The waves of emotion you must go through in that two-week period, you go from one side where you’ve got to sit down with the child and the family and say, ‘Well you can’t have the operation this time around’, and then the other side when the operation is done, looking back at the photos and so on, emotionally it must be really draining for you to be in that situation. Because, even talking about it, that’s got to be really tough – rewarding, but a really tough few weeks. Is there a way you try to deal with it yourself, I guess emotionally, it’s very tough?

Phil: It is emotionally very tough. For me, the thing which is really fantastic about it is that you have a group of 40/50 people coming together and there’s only one answer, and it’s yes. And it’s a real can-do attitude. It’s a team of people, there’s no blockers there, it’s only solutions. And I think this is what I take home back with me, that actually if someone says, ‘I can’t do this because of this’, well let’s find the solution, we’ll find a way of doing it. I think that’s what I’ve really learnt from the whole Operation Smile projects I’ve been on, is this real can-do attitude. You take it back to the NHS, to your own workplace.

And your overriding emotions are that, when I talk to people who are raising money for us, I say, ‘Our part’s the easy part, the hard part is for you guys, who are raising money for us’. Because we go there and we’re the tip of that iceberg, and we’re actually doing the work and seeing the results and getting instantaneous rewards for it, whereas you guys in the background, without you guys raising the funds and supporting us, we wouldn’t be able to do the work. Our part, in a funny sort of way, working on the frontline, is the easy part.

Paul: You’ve mentioned about when you’re on the missions, it’s helping to educate the people to do the work locally as well. Is that the ultimate aim for Operation Smile, where the skills are available locally so that people can have these operations on a local scale?

Phil: Absolutely, Paul. This is the most incredibly important part of the programmes. I’ll give you a few examples. Firstly, I go back to when I went on my first medical mission to Bogota in 1995. The whole team was from outside of Colombia, so we have 45 healthcare professionals going in and they were all non-Colombian. Now, we did that mission, we operated on 200 children. We have the local nurses and doctors coming in and helping us during that time. And we started doing education programmes and teaching.

They have their own cleft centres, they even raise their own money, they have Colombian surgeons operating on Colombian children, being anaesthetised by Colombian anaesthetists, being looked after by Colombian nurses. And that is job done. It means, going forward, they are looking after their own people, and we’re not having to go in and do the extra stuff.

And that, if I were to encapsulate what we’re trying to achieve, that’s what we’re trying to achieve. And every country is a little different in how developed they are, and obviously it takes shorter or longer periods of times in different countries, and often there are huge backlogs, but that’s our aim, that we’re no longer needed. It’s beautiful to see that in somewhere like Colombia, where I went on my first mission.

We don’t only do education in our programmes – I’ve got to go there for a few other schemes as well, and just looking at Ethiopia, for example. In Ethiopia, back in 2005, when I first went, virtually all anaesthetics were given by anaesthetic nurses, so there were only 23 doctors who gave anaesthetics at the time in the whole of Ethiopia. I met one of those, Yumani, in Jimma, where I spent an awful lot of time.

Over the last 15 years, he’s become a very good friend, a very dedicated doctor, who’s an anaesthetist there, and his dream was to train more doctors to become anaesthetists and have a whole residency programme, so that all the anaesthetics in his hospital were being given by doctors. So we got together and we were trying to work out a way of doing this, and I suggested that – I give a lot of talks at home to my trainees all around the country, and they come to me and say, ‘I’d really like to help’, they get really excited about it, and they can’t go on normal Operation Smile medical  missions, because they’re not fully trained – we put together this scheme, a five-year programme, where my senior trainees would volunteer to go to Jimma for three to six months, and would help to encourage and train the doctors in Jimma to become anaesthetists, and help set up a residency programme.

So, over that period of five years, I had nine of my senior trainees go out there, and every single one of them has said it’s the most rewarding thing they’ve ever done. They’ve all gone back and helped out later on, as well. And now, in Ethiopia, we have a residency programme where there are 30 doctors training to be anaesthetists over a three-year programme. And every year, there’s another ten doctors signing up to train to be an anaesthetist.

We consider that, 15 years ago, there were only 23 doctors in the whole of Ethiopia who were anaesthetists, now we’ve got 30 training to be anaesthetists in Jimma alone. And it was very touching, I was very humbled, when Yumani asked me to go over and help do the examinations of the first cohort coming through, and it was just lovely after three years of seeing these people come through to be able to examine them, and they all passed with flying colours, and now Yumani has a residency programme. He has colleagues and he has a sustainable programme going forward, which is going to make a huge difference.

We’ve done it as well, we’ve tried to do it with surgeons, in the same kind of way, and that education is so important. Me going there for two weeks is going to have an impact, but to train someone who’s going to be there forever, is going to have a much bigger impact.

When I give talks, if I were going to put one slide up, it would be a picture of this operating table in the Jimma operating theatre. At the end of the table, there’s this young trainee surgeon, Yohana, and she’s just started training to be a surgeon, and she’s operating on a child for a cleft lip. Standing next to her is Yonas, who is a trained surgeon, who we’d trained to do cleft lips on the previous year, and he’s standing there training his trainee to do the operation. Then, looking after the patient, a one-year-old child, we have Miliyon, who is an anaesthetist, who I met virtually on his first day of anaesthetic training – we’ve trained through the years – and he’s there giving the anaesthetic to this one-year-old. He’s a highly trained paediatric anaesthetist. So, you’ve got an Ethiopian anaesthetist, anaesthetising a child to be operated by an Ethiopian trainee, being trained by an Ethiopian surgeon. And that is the picture I put up at the end of all my talks and it’s what we’re trying to achieve. It’s just lovely to manage to do that.

Paul: You’ve touched on so many amazing things that yourself and the team have achieved. What is next for you? Is there a specific mission that will be lined up when you can get out or is there anything specific that you have in the pipeline for Operation Smile?

Phil: As you well know, we’re in very difficult times at the moment [due to the COVID-19 pandemic]. For example, last year (2019), we had programmes in 32 countries across the world. We ran 172 medical missions. We operated and changed the lives of over 16,000 children with cleft conditions. Obviously since March this year, we haven’t been able to do any of that. And that’s been quite devastating for us really.

I quite like my maths, and when you consider that there’s one child born every three minutes with a cleft lip or palate, that means that, every year, there are 175,000 children born with a cleft condition. Of those, one in ten will die before the age of one, which is frightening when you think about it, they don’t need to die. If they were living in the UK or the US, that wouldn’t happen. And the other really awful thing is 70% of those children won’t get an operation at all.

So, in these five to six months, there’s been approximately 80,000 children being born with a cleft lip or palate, of which 56,000 will never have an operation. Now, we would do some of those operations and we would be training people to do those operations, but not only did we have the backlog previously, we now have another 56,000 people who won’t get any operations. This is very heart-breaking for us, so what we’re doing in the interim, what we’ve been doing over the last six months, is that, because we have warehouses and offices in all these countries we work in, with a lot of medical equipment, we’ve redistributed all our equipment, we’ve given it all away to local hospitals, so that they can use it in this fight against COVID, so at least we’ve managed to do something there.

We’ve also managed to keep a register of as many new children who are born with cleft, and so that when we can start going away and we can start helping the local people do the operations, at least we have a register of our patients. And one of the key things is, if you’re born with a cleft lip or palate, you’re going to have difficulty with nutrition, so we’ve been having nutrition programmes for each country, where we’ve been helping to provide these families with nutrition, so the children are fed well enough so that when we get around to actually being able to operate again, at least they won’t be malnourished and they’ll be fit enough to have the operations.

We’re hoping that, come January next year [2021], we’ll be able to hopefully start sending international medical volunteers to these countries again; it’s going to vary from country-to-country and we’re hoping that we’ll be able to start doing that.

We’re also supporting, in a similar way to this, Zoom education and things like that. Surgeons, like Ethiopian surgeons and Colombian surgeons, giving them support and encouraging them to be able to do the operations while we’re not there. So, moving the charity forward, at the moment, we’re dealing with what we’re having to deal with due to COVID.

Long-term, what I’d really like to see is partnerships between non-NGOs around the world to all work together. I’m very keen that we don’t reinvent the wheel, so that different charities work together to not only provide cleft surgery, so for every anaesthetist that I train, they might anaesthetise 1,000 children with cleft, but they’ll also be anaesthetising 10,000, 100,000 people in their own careers for other operations, and provide safe anaesthesia and safe surgery for everyone going forward. And it’s bringing organisations together to make surgery safe throughout all these countries that, at the moment, are having great difficulties.

Paul: Is it too simplistic to say that the only thing that holds Operation Smile back is the funding? If you had more funding, it’d obviously be easier for you to reach out to more countries, to educate more people and to get to where you want to be sooner. Or is that too simplistic to put it that way?

Phil: Funding is hugely important. Across the world, we have about 5,000 Operation Smile volunteers. The more funding we have, the more missions we can do, and the more people we can send out to help educate the local people. There are other issues that are involved with that as well, because you need healthcare professionals to train in the countries we go to and, therefore, we need to also work alongside countries, encouraging them to support training of their own healthcare professionals, so that we can help train their professionals.

So funding is massive, it’s absolutely massive, and obviously, the more we get, the more we can do. It’s absolutely crucial. But we also need more volunteers, and we need governments to be able to encourage and help us move forward in their healthcare systems.

Paul: I’ve found it amazing to speak to you, because clearly, as I mentioned right at the start, it’s something that I’ve got a personal connection with, and I think the work that you and the team do is amazing. There aren’t many other words I can use to describe it. The help that you’re giving to these people is unbelievable. Those stories you told today and the ones you can see online, the difference in before and after the operation is huge, and the impact it makes on people’s lives is inspiring, and I think it’s amazing work that you guys are doing.

For us to be partnering with you on this is great, and we’re obviously going to do as much as we can to keep raising awareness of it and helping to raise funds towards the cause as well. Obviously, anything we can do to help, we’ll be on the case with that, as well.

Phil: Thank you very much, Paul. It has been a pleasure talking to you and I think you very much have a very personal attachment to this organisation, having gone through it yourself. I think, as you said earlier on, the fact that you had all the support in this country and you had the operations at the right time, a fantastic outcome, you’ve been able to have a fantastic, successful career. Without us doing this work, without you supporting us, there’s people who will be like you in other countries, who would never have that opportunity, and I think it’s absolutely crucial that we give that support to as many of those children as absolutely possible.

Paul: If any of the listeners want to reach out to you directly, Phil, what’s the easiest way they can do that?

Phil: If they want to reach me directly, I am on LinkedIn, which is where you got this connection from, they can go directly to the Operation Smile UK website, and there’s a direct link there. There’s a phone number, they can phone the office if they want to speak to someone in person, there’s always someone manning the phones, virtual or not. And I’m very happy for anyone to contact me, you have my email address, phone number. If anyone wants to chat about anything, feel free to contact me. I’m always available and, personally, I love the organisation and I love talking about it.

Paul: What we’ll do, when the podcast goes out, we’ll make sure your contact details align with the podcast and Operation Smile’s details on there, as well. So if people want to reach out to you, the organisation, or indeed myself, they definitely can do on that side. All that’s left for me to say is huge thanks today again, Phil, for doing this with us. Really appreciate your time and I look forward the partnership.

Phil: Thank you very much.

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