Out of necessity, medical environments are controlled environments.

Keeping everything sterile and using a vast array of medical devices – from instruments to monitors – is critical to ensure the best possible outcomes for patients.

Operation Smile care centres and surgical programme sites are no exception.

The unintentional result is that the places we use for care can meet the nonmedical definition of ‘sterile’ too – they’re stark and uninviting.

They can strike fear and anxiety into young patients and their families, some of whom have never set foot inside a medical facility before.

We understand that the paths of patients and their families to cleft surgery are often emotionally overwhelming. That’s why Operation Smile’s volunteer psychosocial care providers are at the heart of all our care centres and surgical programmes.

What is a psychosocial care provider?

These certified professionals help patients and their families to cope with the emotional, mental and social challenges that may come up around cleft care. Providers tell them about the entire surgical experience, easing their fears and anxieties through therapeutic play and activities.

“Psychosocial care providers guide children through developmentally appropriate activities to help them gain mastery and control over their situations,” says Kelly Raymond, a child life specialist from Canada. “Children coming into the hospital don’t get to wear their own clothes, eat what they want or see what they want. We help to give them a piece of control over their environment.”

A young child sits on a mat holding a doll and wearing a hospital gown while using an inhaler mask. Other people, including women and children, sit around them indoors, some smiling, in a brightly lit room.
In Madagascar, a child is shown the anaesthesia equipment so they’re not fearful ahead of their surgery. Photo: Lorenzo Monacelli

The power of play

For many children, medical equipment like anaesthesia masks – or even just being in a hospital – can feel ominous.

Psychosocial care providers use these devices as props during therapeutic play sessions, so patients aren’t surprised or frightened when those same surgical tools are used during their procedures. They also use this playtime to help nervous parents understand what they can expect through every phase of the surgical process.

The psychosocial care area is also a place where silliness and fun is encouraged through age-appropriate play and activities, allowing kids to just be kids amid a stressful and unfamiliar environment.

Receiving surgery can be a potentially frightening experience – young patients are exposed to strangers wearing strange clothes in a strange place. Play helps to normalise the healthcare experience for kids. It empowers kids and gives them coping skills. Some of the kids leave the surgical programme saying they had a fun time. That’s a powerful shift from being scared and frightened.”

Robert Wing, volunteer psychosocial care provider

Acceptance and healing

The positive effects for children go beyond preparation for their individual procedures, explains certified child life therapist Sandy Forseth:

“In the playroom, children are seeing other children with their condition. They’ve been shunned or shamed by other people in their communities, so I think there is positivity when they get to meet other kids with cleft lip and cleft palate. From being a certified child life specialist, I’ve seen research that shows that when children are prepared ahead of time, they heal faster because they know what to expect.”

A woman blows bubbles with a group of smiling children outdoors; one girl is trying to catch a bubble while a young boy laughs excitedly. Lush green plants are in the background.
Child Life Specialist Jen Burton Liang of Canada with patients at Hospital Cheik Daud El Antaki in Morocco. Photo: Marc Ascher.

The ladybird, the giraffe and a slow race to gain trust

Building trust between children, families and the programme or care centre team is another key role of psychosocial care providers.

Kelly recalls a challenging but rewarding experience in Ethiopia, when her skills were tested by a fearful child.

“She clung tightly to her mother while crying and wouldn’t make eye contact with me. Teaching children about what to expect when they go in the operating room is our priority, but without trust, this can’t be done,” Kelly says. “Instead, I pulled out two wind-up toys and positioned them on the ground so they could race. She slowly started to peer out as the ladybug toy went in circles and the giraffe toy hopped along”.

A nurse shows a colourful book to a smiling young boy in a hospital gown, who is sitting on an adult’s lap. The room is decorated with bright banners and paper hearts, creating a cheerful atmosphere.
Child Life Specialist Kelly Raymond from Canada reads with four-year-old Nelson in the Child Life area before surgery at San Felipe Hospital in Honduras. Photo: Rohanna Mertens

“That simple act of play can change a child’s perspective”

“The girl started to laugh, Kelly continues. “When they finished racing, the girl looked at me, expectantly. So I wound the toys up again, setting them on another race. This time, the girl sat up so she could watch the path the toys took. After a few more wind-up toy races, the girl crawled off of her mom’s lap, and she started winding up the toys herself.

“Eventually, I was able to teach her about the anaesthetic mask. We practised blowing bubbles and then blowing up a balloon with the anaesthetic mask. She proudly showed her mom what she had learned and even brought the mask over to her so she could try.

“When it was her time to go in for surgery, she held my hand as we walked down the hallway into the operating room. That simple act of play can change a child’s perspective and lead to empowerment and confidence. It’s situations like this that keep bringing me back to Operation Smile.”

Psychosocial care is just one part of Operation Smile’s comprehensive, wraparound care for people with cleft conditions.

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