• South Lee School

Operation Smile

On Thursday 4th February, Dr Clive Duke hosted a Virtual Parent Talk on Operation Smile. Dr Duke shared his experiences working with such an important charity, changing lives one smile at a time.

Dr Duke – Consultant Anaesthetist

Dr Duke began his presentation by explaining his background and how he ended up working with Operation Smile.

For the past 16 years, Dr Duke has worked at West Suffolk Hospital as a Consultant Anaesthetist.

Ten years ago, Dr Duke realised he wanted to try something and give something back to the community. Operation Smile provided him with the perfect opportunity to do just that, sending him all over the globe to help children with cleft lips and palates.

Dr Duke has been fortunate enough to travel abroad 18 times in the 10 years he has been a part of Operation Smile. Travelling worldwide he has visited Central and South America, Africa, India, China, Vietnam and the Philippines.

About Operation Smile

Operation Smile believes that every child deserves to smile and live a healthy life. As the world’s largest cleft medical volunteer-based charity, they provide free and safe surgery to children born with cleft lips and palates.

With operations to repair a cleft lip costing as little as £150 and taking just 45 minutes, it is a small amount of money to change a life for the better.

The charity first started in America 38 years ago and has now spread globally, with offices all over the world. There are over 400 surgical sites, over 5,200 medical volunteers and 31 care treatment centres across the globe.

They are not just limited to treating cleft lips and palates – they teach and train doctors, surgeons, nurses and medical staff not only on how to deal with birth defects.

Cleft Lip & Palate Facts

  • Cleft lips and palates are the third most common birth defects worldwide.

  • Every 2.5 minutes, a child is born with a cleft lip/palate.

  • One in ten children born with a cleft die before their first birthday.

  • 75% of cleft cases in the developing world go untreated.


A cleft lip is a birth defect that occurs when the tissue of the upper jaw and nose do not join. The result is that one or more splits in the upper lip that may extend up into one or both nostrils.

A cleft palate is an opening in the roof of the mouth that develops when the bones and tissues do not completely join during foetal development.

Causes of Cleft Lips & Palates

Clefts are congenital defects that occur early in embryonic development. Although the exact causes are unknown, scientists believe that they are caused by a combination of genetic and environmental factors such as maternal illness, drugs or malnutrition, genetics, or lack of folic acid.

Why Don’t We See People with Clefts in England?

Children are born with cleft lips and palates in England, however they are usually sent to a nearby hospital for the operation. Children around Suffolk would usually be sent to Addenbrookes Hospital.

As we have an excellent care system in the UK, children usually have such operations whilst they are still a baby which is why they aren’t seen as prominently in England.

Stigma & Discrimination

Clefts can cause a range of issues such as eating difficulties, infections, dental problems, breathing difficulties, ear diseases, speaking issues, discrimination and stigma.

When the children would come to the charity for their pre-assessment, the children are notably happy and smiling. However, this is not the case as the children get older. There is a large stigma surrounding those with a cleft. For example, one adult the charity operated on didn’t go to his daughter’s wedding due to the discrimination he felt. This is not unheard of, with many older children not attending school due to fear of bullying because of their appearance.

Cleft surgery is life changing procedure, with the quality of life improving dramatically. Even older adults who have the surgery notice how much their lives improve after having the surgery. Abena, a 66 year old woman, said after receiving the surgery “I didn’t know that a solution was available, I feel like a new woman and I can finally live a normal life without being humiliated and ostracized anymore.”

Hearing stories about babies that have been abandoned or buried alive because they have a cleft lip or palate is sadly not unheard of. This is due to the lack of education surrounding the defect. Parents do not understand what it means and communities believe that it is a sign of the devil etc.

Dr Duke met a little girl called Afia, who was being starved to death because she had a cleft lip. She was so malnourished and anaemic that the team were not sure they would be able to operate. However, they decided that the mother was unlikely to be able to bring her back again, so with a blood transfusion they were going to try. For this little girl it truly was a life or death situation.

The operation went well and she is now a happy and bouncing child who aspires to be a nurse when she grows up. Her mum said to the team “thank you Operation Smile, now no one laughs at her again”. This is just an example of how Operation Smile saves lives.

The Team

The number of people in a team depends on their mission – whether this is to operate or to train medical staff. The team is made up of a number of different people with a range of skills; plastic surgeons, anaesthetists, theatre and ward nurses, paediatricians, dentists, speech therapists, nutritionists, photographers, team co-ordinators etc.

Individuals come from all over the world to be part of these teams, however this can lead to slight language barriers. Dr Duke experienced this on an Italian-led mission to Ghana. All the staff in the operating theatre were speaking Italian to each other, with Dr Duke not being able to understand what was being communicated. As it is the anaesthetist that is in charge of the patient’s safety, it is vital that they know what is going on during the procedure. To combat this issue, he printed out a Union Jack flag and place it where he was working to remind those around him to speak in English!

A Typical Mission

Usually the children are found through local volunteers and hospitals beforehand and are then transported with their family to accommodation before pre-assessment. Access is incredibly important as some families wouldn’t otherwise be able to afford to get there.

There are between 40-60 volunteers who help organise and run the mission. Each mission usually lasts around 12 days, including pre-assessment, setting up the theatre and the operations themselves.

During COVID-19

A response team was set up early on, to identify where help is needed to support resource poor communities. Dr Duke was one of the last teams out in the field in February, before returning from Honduras due to COVID.

From March 2020, international team program missions had to be cancelled. However, local team missions have now restarted in areas such as in Ghana, Vietnam and China.

Local teams are incredibly important in such difficult times, as they continue their community outreach programme to find and support children, whilst also providing essential supplies such as nutritional support and PPE to third world countries.

International volunteers have been continuing their hard work by setting up online teaching, fundraising opportunities and lecturing, whilst also trying to survive the pandemic themselves.


At the end of the informative presentation, the audience of pupils, parents and staff were given the opportunity to ask Dr Duke questions about his time with Operation Smile.

Why did Dr Duke want to take part in Operation Smile?

He wanted to give things back to the community and reminds him of why he studied medicine in the first place. Dr Duke said that his life is richer because he does it and although he feels tired when he returns from a mission, he always feels refreshed.

How does the team decide between the children who need the operation?

The charity goes back to the same area throughout the year, depending on the demand. Those working in the local community keep a list of those needing their help so when the group does return, they are able to contact them.

If there are identical twin children, are they likely to both have cleft palates?

The twins will have the same genetics, however this doesn’t mean they will necessarily both have cleft lips or palates. This is because clefts form after the embryo splits.

Is Operation Smile welcomed in by local governments, or are there any issues?

The charity tries to maintain good relationships with local governments and hospitals as much as possible. Dr Duke explained that they had issues in Vietnam as a charity had used their name to try and help those with clefts. This was a problem as the charity was not as reputable and a couple of children had died.

When Operation Smile turned up in Vietnam three months later, they were blocked at so many different levels that the chief executive had to fly over from America and speak to the Department of Health.

Afterwards, the Department of Health decided to take Operation Smile’s global standard of care documentation and make it the standard that all NGO’s in Vietnam must work by.

Are there many occasions that the team cannot operate on someone?

There are occasions where the team will not operate on someone, however they do try to help where possible. When children are particularly young and under 6 months old, they are too small and there are too many dangers in the operation. If the child is particularly malnourished, this can cause issues after operations as they are not able to heal as well. All of these children are monitored and treated by nutritionists to build them up ready for surgery during a future mission.

The team will also not operate if there are other complications such as heart problems. Having the surgery could cause life-threatening issues therefore the team send them to receive the right care before the child returns to a future mission for surgery.

What has been the most amazing moment?

Dr Duke’s favourite moment was taking Afia into the recovery room to be with her mum. He realised that a life had been saved and the impact the surgery has on not just the patient’s life, but their families too.

Does Operation Smile go to countries all over the world?

There is not a lot of point of the charity going to places where there is a lot of money such as America or the UK. They travel to countries where there is a lack of access and money for the life changing surgery.

Only in Honduras did Dr Duke feel a bit uncomfortable and concerned about his safety. When they arrived in the airport, the team were moved quickly onto a minibus and travelled with an armed motorbike escort.

Do the operations last their whole of their life or do they need follow up surgeries?

A child may not receive as many operations as they would in a first world country, but will still have an end result which is adequate and far superior than if no surgery had occurred. Operation Smile returns frequently to mission countries and if a revision operation is required then they always strive to offer further surgery.

If Dr Duke hadn’t volunteered for Operation Smile, would have gone to a different medical NGO?

There are a lot of charities out there that help people such as Mercy Ship, however he felt that personally, he preferred to be working amongst the community and develop the personal relationships which Operation Smile allows him to do.

What was Dr Duke’s favourite subject at school?

He thoroughly enjoyed Science at school, particularly Biology and Chemistry. As a 16 year old, his dream was to be a producer or camera man for the BBC! However his tastes changed when he attended an open morning at Bristol University and found himself interested in the medical school there.

How long has Dr Duke been with the NHS before joining Operation Smile?

After qualifying in 1992, Dr Duke worked in the NHS for 18 years before getting involved with Operation Smile.

To join the team, all doctors have to be at the level of a consultant. This is to ensure they would be qualified and able to work on their own without needed the help of a supervisor.

Are local doctors able to be trained to do the surgery themselves?

Some of the local doctors are involved in conducting their own missions, which goes to show the success of Operation Smile’s training. The legacy of the training is that they are not just operating on children, but they are also teaching medical professionals how to do the job themselves.

A huge thank you goes to Dr Duke for his fantastic presentation on Operation Smile – to find out how you can get involved with the charity, please see the links below.

If you’d like to donate – www.operationsmile.org.uk

Facebook, Instagram, Twitter: @operationsmile