Operation Smile-China

Canadian Operating Room Nursing Journal, Dec 2003 by Samson, Greg

Operation Smile is a private, not-for-profit volunteer medical service organization headquartered in Norfolk, Virginia. Started by Dr. Bill Magee and his wife Kathy in 1982, Operation Smile teams currently travel to 21 different countries and coordinate an average of 30 missions per year. The mission of Operation Smile is: "to provide reconstructive surgery and related health care to children and young adults with facial deformities in developing countries." Operation Smile also provides education and training to health care professionals in its mission countries to foster long-term self-sufficiency. Each international team consists of 35 to 40 health care professionals from all over the world: doctors, nurses, anaesthetists, dentists, speech pathologists, child life therapists, and biomedical technicians.

I have been fortunate to have served on a total of five overseas missions with Operation Smile since 1999, including two missions in 2002: the first to Taganrog, Russia, in June; and the second - discussed below - to Zhongshan, China, in November.

The city of Zhongshan is located in the southern province of Zhongshan on Mainland China. Travelling to that destination was a long and tiring process (the flight from my home in Halifax was via Toronto, Detroit, Tokyo, and Hong Kong). After 31 hours of travel, I joined the other members of the Operation Smile team; and after a quick meeting I was able to rest my head on a pillow for 5 hours before getting up the next morning for the final leg of the trip to Zhongshan. We travelled one hour up the Pearl River by high-speed jet boats to the port of Zhongshan. The people of Zhongshan greeted us with open arms, and I could feel the excitement as we boarded the bus to take us to our hotel.

That afternoon we saw the hospital for the first time and set-up the screening areas. The paediatric hospital, with a capacity of 350 beds, is very modern by Chinese standards. As our tour of the hospital continued, the team members who had been on other missions realized that this would be unlike any of their other past missions, as this hospital had many pieces of modern equipment that other mission sites lacked. The team ran six general OR beds and two local beds in four rooms. The recovery room had two rooms with three beds each. The pre- and post-operative ward was one of the best set-up areas I had seen on any of the missions I had attended. It consisted of 24 rooms located on one ward for each of the pre- and post-operative care areas, plus one room for resuscitation if required. There were many local nurses and nursing students on the unit to assist the five Operation Smile team nurses.

Although I am an operating room (OR) nurse, I was assigned to work in the pre- and postoperative area, as I did not have the prerequisite two years' experience in the OR. My critical care experience in my "home" hospital was in the Emergency Room.

On the first day of screening I started my day at 05:30 h. When the rest of the team arrived at the hospital at 07:00 h, people were already gathering, outside the gates of the hospital, to wait for their children to be seen by the Operation Smile team. In the hospital lobby there were more than 100 parents, with their children, sitting and waiting to be seen. The noise was deafening. By the end of the day, at 18:00 h, the team had screened 378 patients for possible surgery. Every patient was seen by all of the medical services that they would require during their surgical stay. A big challenge was dealing with the language but, with the help of local interpreters, we were able to document the children's medical histories.

After our day at the hospital we went directly to a dinner, held in our honour, at a very nice restaurant not far from the hospital. This restaurant was unlike those in our home countries - we could choose what we wanted to cat from a large selection of live seafood in large water tanks or from cages that held snakes, reptiles, and other types of birds and mammals! After a ten-course meal, of some very "interesting" food, we arrived back at our hotel around 22:00 h.

The most difficult day of a mission is always the morning after screening as this is when the team posts the list of patients who have been accepted for surgery. There are people crying as they stand and read the list. Some are tears of joy, but others are tears of sadness because their child was not selected. If the parents of a child who was not selected spots a team member in the area after the posting, they will beg for their child to receive the operation. It is impossible to operate on all of the patients that are screened. A child may be too young, underweight, too high a risk, or there simply may not be enough time. Operation Smile's objective is to operate on as many children as possible, as safely as possible, during the time allotted for surgery. All team meetings emphasize the need to minimize risk and to follow Operation Smile standards as well as the standards of our own countries' hospitals.