Anuraag Guleria has travelled all over the world helping children and adults with cleft conditions. From Nicaragua to Morocco, she’s been a valuable addition to the Operation Smile team, sharing her time and expertise as an anaesthetist, for free, on more than ten surgical programmes. 

In her day job, Anuraag works in Manchester as a consultant anaesthetist. Although she’s involved in adult surgery when required, her main focus is on paediatrics. Like many of our volunteers, Anuraag has also worked with other charities and organisations but enjoys the work she does with Operation Smile because of the impact it has on the lives of the children she meets.   

We caught up with her recently after her return from an Operation Smile surgical programme. 

Q: What inspired you to work for Operation Smile?

A: “I like working in countries where I think I can be useful. Working in environments which are challenging and surgeries which need specific and high-risk anaesthetic care. I like working with and helping children and it’s a way of working with those who would normally not get care. I enjoy the challenge and it’s amazing that we can do highly specialised procedures with such ease and do them safely in these kinds of environments. That’s what keeps me trying. It changes the kid’s life so much.”

Q: What keeps you motivated to continue to volunteer? 

A: “Operation Smile does a lot of support work. You go to these far-off places and it’s a welcoming environment, you get the time and space to choose the surgical programmes you can do. The work is always interesting, you know, the orthognathic work for example was hugely challenging. I think Operation Smile makes things so easy on the ground. And so conducive to doing it safely. I like the fact they have global standards, that’s very important and the way they have been launched has been a good motivator for me to continue to volunteer.” 

Q: Can you tell us about how you work with other volunteers and local teams on surgical programmes?  

A: “We do a lot of networking and communication is important, because people are from different parts of the world, different backgrounds and you don’t know who you will be working with and what their skills and backgrounds are. But it’s important to me that we have a happy working environment when we get there and work well with everyone. Sometimes the reason that I go again and again, is that once you make a connection, then you build on the connection. So for me, it’s not just about going to different countries, it’s also about building connections, like making a personal connection with a team in like Morocco, and then in Jordan. Then the next time, you’re better able to facilitate in your role with people because they know you from before. The screening day is another good example and meeting everyone in their work mode, having conversations to build trust in the challenge a patient will present will require honest conversations about skills and resources and limitations. It’s the primary example of collaboration, not just between surgeons and anaesthetists, but all the local volunteers medical and non-medical. Everybody’s in a different room doing different roles. But there’s a facilitator there, whose job is to lead and help everyone to succeed. The role of the clinical coordinators, the family and community support workers is hugely important to the success of the whole mission for the team as well as the patients, from scheduling till discharge.” 

Anesthesiologist, Anuraag Guleria during a 2018 surgical programme in Malawi. Photo: Jasmine Shah.
Q: As an anaesthetist, can you tell us more about your role during a surgical programme?  

A: “So the first bit is getting to see the patients (the children and their parents), understanding their needs and being able to get them to understand and trust us. At the pre-op screening it’s important to ensure there are no unanswered questions in the patient or parents’ mind, and that they understand what will be happening and why. This is the part of my role I enjoy the most, seeing those expectant faces, chatting to the children and their parents, often across a language and cultural divide! 

“In the team meeting we introduce everybody who’s arrived, who is going to arrive, and set out what the ground rules are. All this can be done on screening day. In many cases, patients have already been seen from local teams and routine clinical testing has been done, so it makes our job easier, because when you have so many patients, you want to be able to get through the important bits with them quickly. Then when anaesthetists see the patients, if you have any issues or if you have any questions, you liaise with the surgeons to ask what they want to do and how they propose to do it, especially if it’s a complicated or complex procedure. And then you and the clinical coordinators list the patients for their surgery and which order they will be done. It’s important not to miss anything during preparation of the patient for surgery day, so communication with all the people working with the patient from health workers to dentists, speech therapists and psychologists is part of our role. 

“On surgery day there are a lot of things to do, like making sure that the right equipment is available, making sure you have a person who can run a code if there is a problem. Everyone is introduced again too because your team then becomes a specific theatre team for that day, though you still have to be aware of who is doing what in other theatres. You need to know who to run to for help if there is a problem. 

“Our care doesn’t finish when the patient wakes up. Sometimes it continues even though there is a paediatrician in recovery, to management of a patient’s pain and breathing, we have to make sure that the handover to the paediatricians is safe. That they know exactly all the issues that we faced during the procedure, or if there are any specific concerns that they need to manage which may have an impact on the patient’s recovery. And sometimes we like to see our patients afterwards because we have concerns like, for example, it was difficult to do the procedure or difficult to intubate. I like to see them afterwards to make sure that they’re recovering well, and whatever I’ve done hasn’t impacted them adversely. ” 

Q: What do you think are the biggest issues faced by patients with cleft lip and palate?

A: “I would say nutrition is a big issue and dental problems. Social ostracism is a problem too, as these are people who are not easily visible in society because of the stigma about cleft in certain communities. Education of the parents is important too. In a lot of countries where Operation Smile works this is being addressed very well and that’s very good to see. Because mostly, I would say it’s the social stigma and the nutrition, you know, they’re so weak. And some of it has to do with the cleft lip and palate, but a lot of it has to do with the social inequalities in the country. All these children can get the promise of a healthier life due to our work with Operation Smile.” 

Q: How do you think Operation Smile has evolved since your very first surgical programme?

A: “The fact we have local Operation Smile centres on the ground in countries is a huge thing. I can see that there has been a change with standards too, we expect the drugs, we expect the equipment now.

“I didn’t realise how important speech therapy was until I saw it with Operation Smile. So I’m happy to see that option available now in almost every surgical programme. And for the patients, you know, that is real improvement after the euphoria wears off with the fact that they’ve got follow-up healthcare available close to where they live. So that positive message goes out and then other parents who might be considering surgery for their child will feel reassured that it will make a difference to their child’s life making the risk of having surgery worthwhile.”

Photo courtesy of Dr Anuraag Guleria.
Q: Do you have a favourite patient story or memory from a programme that you can tell us about?

A: “To me, every child is really the same, because I just love them for that minute that I liaise with them. I remember a baby that I met in Africa. He was amazing, so chubby and healthy and his smiles will stay with me forever!  But for me it’s also seeing how much they change after the surgery. I think it’s so important that we continue this work. We change that child’s life.”  

Thanks so much to Anuraag for taking the time to talk to us and for having such a positive impact on the lives of our patients and their families. 

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