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Nurse volunteers: Why I’m proud to be part of charity’s first-ever all-female mission

Meet the NHS staff nurse enhancing her skills while helping to transform children’s lives
Operation Smile nurse Clark Agno-Gonzales treats a child held by a woman in Cebu, Thailand

Meet the NHS staff nurse enhancing her skills while helping to transform childrens lives as a volunteer for a cleft surgery charity

Most of the time, Clark Agno-Gonzales is a staff nurse at Macclesfield District General Hospital.

However, several times a year she steps into another life, as a volunteer with the charity Operation Smile.

This takes her to locations around the globe as part of missions to provide surgery for people, usually children, with cleft conditions.

Seeing peoples transformation brings me joy

Faustina Tsifokor, who underwent a cleft procedure with Operation Smile in Koforidua, Ghana

Her role as an Operation Smile recovery nurse obviously has a big impact on her patients and their families, but it also makes a huge difference

...

Meet the NHS staff nurse enhancing her skills while helping to transform children’s lives as a volunteer for a cleft surgery charity


Operation Smile nurse Clark Agno-Gonzales cares for a child undergoing a cleft procedure
in Cebu, Philippines

Most of the time, Clark Agno-Gonzales is a staff nurse at Macclesfield District General Hospital.

However, several times a year she steps into another life, as a volunteer with the charity Operation Smile.

This takes her to locations around the globe as part of missions to provide surgery for people, usually children, with cleft conditions.

‘Seeing people’s transformation brings me joy’


Faustina Tsifokor, who underwent a
cleft procedure with Operation Smile
in Koforidua, Ghana

Her role as an Operation Smile recovery nurse obviously has a big impact on her patients and their families, but it also makes a huge difference to her personally.

‘I can’t describe the feeling,’ she says simply. ‘The surgery that we do is a physical surgery – within 45 minutes, you see the transformation from a cleft lip to a smile. It brings me joy, really, and that’s why I keep doing it.’

This month, Ms Agno-Gonzales will take part in her 30th mission with the charity – and this time it’s a little different. To celebrate International Women’s Day on 8 March, Operation Smile is conducting its first ever international medical mission with an all-female team.

Run by 54 volunteers from 27 countries, the mission in Morocco aims to shine a light on the impact that women have had on the charity’s work; generally, six out of ten of the volunteers on each mission are female.

According to Operation Smile’s UK chief executive officer Karen Jaques, this mission celebrating women is special for broader reasons too: ‘In every country, nurses are the backbone of the healthcare system.

‘Surgery is still male-dominated – there are more male doctors in the surgical system than female. But women, including nurses, make a real and valuable contribution to healthcare, and we want to highlight that.’


Ms Agno-Gonzales with a young patient during the Operation Smile mission to Cebu, Philippines

Cleft has often serious social as well as physical health implications 

According to Operation Smile, a child is born with a cleft lip or cleft palate (see box) every three minutes. Without surgery, they will struggle to eat, drink and communicate; some are shunned by their communities, or even their families.

‘Nurses from the NHS get an amazing amount from the interaction with nurses from other nationalities and the local nurses’

Karen Jaques, UK chief executive officer of Operation Smile

While the NHS treats people in the UK with cleft conditions, the equivalent is not the case in countries where medical resources are scarce, and where, even if surgery is available, it is prohibitively expensive.

Key facts about cleft lip or palate

  • Cleft lip or palate is the third most common birth defect, affecting about one in every 500-750 births worldwide
  • A cleft is a gap in the mouth that did not close properly in early fetal development. Sometimes it’s an opening in the lip (which is easier to see) or sometimes in the roof of the mouth (palate)
  • In most cases, the causes of cleft lip and palate are unknown, but genetics, family history, pre-existing medical conditions, poor nutrition and environmental factors may all play a part
  • If not corrected, a cleft can create serious health problems, including difficulty with feeding, which can lead to malnutrition, ear infections, which can lead to hearing loss; poor dental development can be affected, as can speech and language
  • Children with cleft may experience bullying and social isolation; in some parts of the world they may be shunned by their community and seen as ‘cursed’
  • In the UK, the NHS provides free surgery to babies born in the UK with cleft lip/palate. Most surgeons agree that a cleft lip should be repaired before three months and cleft palate between the ages of 12 and 18 months.

Source: Operation Smile

 

An opportunity to learn from an international cohort of nurses

Since it was founded in 1982, Operation Smile has performed hundreds of thousands of procedures on those born with cleft lip and cleft palate with the help of volunteers from around 80 countries.

For Ms Agno-Gonzales, who is from the Philippines, it was a chance suggestion from her professor at the Manila university where she was working part-time as a neonatal clinical instructor that led her to Operation Smile. This was in 2010, two years after she qualified as a nurse.

‘The magnitude of a tiny thing that we do is so big’

Clark Agno-Gonzales, NHS staff nurse and Operation Smile volunteer


Former Operation Smile patient
Mohamed Zmar, who had a cleft
procedure in Casablanca, Morocco

Since then, she has travelled to countries including Nicaragua, Guatemala, Myanmar and Morocco with the charity, as well as completing many local missions in the Philippines.

‘It’s a good experience,’ she says. ‘When you’re in a mission you meet different people, you go to different places. Everybody has their own technique and the way they do things.

‘When we go on a mission we always say that none of the nursing skills are “wrong” – we need to be open-minded and adapt and learn from each other.’

Volunteers from 80 countries

She has so many missions under her belt because at one point, while working in the Philippines, she was taking part in one every couple of months. This slowed as her career took her elsewhere – she worked in Egypt for three years, then moved to the UK in 2017.

Each mission is made up of volunteers from 80 countries worldwide, giving lots of opportunity for shared learning – and not just in terms of surgical or nursing skills.

‘We learn from each other’s experience,’ she says. ‘We chat a lot. We work with each other for five days a week and they tell you stories about how they deal with things at their workplace, and how they manage it. So if something similar happens to you personally you know how to deal with it because you’ve heard from others about how they’ve managed a situation.’


The memory of seeing lives changed for the better

Ms Agno-Gonzales recalls one situation four years ago at a local mission in the Philippines.

‘A grandad came in with his grandson, who had a bilateral lip problem, and he wanted him fixed. He had a bilateral lip problem as well and so we were pushing him to do the surgery because it would be beneficial for him.

‘He refused and said he hadn’t come for himself, but so that we could operate on his grandchild. We said we would do it if he was fit enough – and he was, so we did. He and his grandchild both went home with smiles.

‘I can’t put it into words how that made me feel. It’s like a tiny thing that you do and the magnitude of the impact is so big.’


‘My voluntary nursing work enhances my people skills’

Asked whether her patients and bosses at Macclesfield get a ‘better’ nurse because she does this volunteering and she laughs hesitantly. ‘It’s very different to what I do at work, because I do adult nursing there and this is paediatric nursing. I think it is better because I can deal with people better.’

Few people in her current place of work know she does this, she adds. ‘I use my annual leave for missions and try to swap shifts and work around my schedule so that I can go.’

Most Project Smile volunteers are in a similar situation, says Ms Jaques, but she stresses that they, and their employers, benefit.

‘From an NHS nurse’s point of view, coming to a country in a state of development is an amazing thing. They think how blessed we are in England to have the NHS despite the issues we have internally, and I think they come back with a renewed appreciation of the care we offer in our own country.

‘They get an amazing amount from the interaction with nurses from other nationalities and the local nurses, and the mentorship between the international nurses and the local nurses is very rewarding for them. It’s quite humbling and I also think it’s quite inspiring at the same time.’

How you could become an Operation Smile volunteer


Ms Agno-Gonzales cares for a patient during Operation Smile's mission to Cebu, Philippines,
 joined by the charity's UK chair, Maria Moore, centre

  • Nursing volunteers with a range of skills and expertise – specifically pre and postoperative, operating and recovery room nurses – are welcome: check the website for credentialing details
  • Paediatric experience is required and nurses must have recent (past two years) experience of working in a medical/surgical unit
  • Nurses must be certified in Basic Life Support (BLS) or equivalent course & Pediatric Advanced Life Support (PALS) or equivalent course
  • Volunteers must be able to work in a team and expect to work long hours and at pace; physical, mental and emotional stamina are required (medical missions are usually 10-12 days long)
  • Recruitment of medical volunteers usually takes place two to four months before a mission
  • Flights and accommodation costs are covered by Operation Smile, but volunteers are expected to cover a team fee of £300

More details here

 

Strategy to develop local nurse workforces


Chutima Tossapanon, who was
treated in Sisaket, Thailand

Increasingly, the charity is working to train and enable local workforces to ensure sustainability, bringing opportunities to local nurses. ‘Local nurses get accredited. Once they’ve been accredited with us they can then go on other Operation Smile missions to other countries. For example, I was in Ethiopia a while ago and the nurse running the Ethiopian mission of about 30 people was a Kenyan nurse who had been accredited in Kenya and then had the opportunity to come out and run a mission.

‘It gives great exposure to local nurses who probably wouldn’t have the funds to travel out of their own country, and gives them the opportunity to participate and also to lead missions, which is fantastic for their leadership skills and their own development.

‘It gives them exposure to other nationalities – in a mission, the team comprises maybe 20 nationalities, so it means they get the opportunity to work with other people outside their healthcare systems, to learn, to share skills, to see how they’re faring in their own countries. It’s an amazing way for nurses to gain experience and professional development with other people in their own peer group.

‘It’s important that we build up capacity in all the countries we go to, because our ambition is to have all the countries where we provide cleft care able to deliver cleft care services in-country. I think 80% of our missions are done by local teams, which is really fantastic.’

Parents’ gratitude makes the work worthwhile

Ms Agno-Gonzales for one is very grateful that she took up the suggestion of her professor in Manila all those years ago – and for her, it’s the patients and their families that make the difference.

‘In the recovery room, if the hospital will allow it, we always welcome the mother or the primary care giver,’ she says. ‘This is the first time that they see their kid after the surgery. It’s also the first time that they can feed their kid with water, without it coming out of the lip.

‘You see them, every time and whatever country you go to, and they have mixed emotions on their faces. They are scared in case they are doing something wrong, they are really happy because we’ve actually done it, and they’re really grateful. Some will bring us gifts, such as fruit – whatever they can bring. And it’s at that point where I can actually say that I’d love to do it forever.’


Jennifer Trueland is a health journalist

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