Embarrassing myself in the O.R.

I met a brave and special young lady yesterday.

She was quietly sitting in the Child Life Room although she’s not a child. That’s the room where patients wait just before going into surgery.


Operation Smile Mission Dhaka


She’s shy. It seems like all the patients we’ve gotten in Bangladesh are shy. Or maybe because I tend to be specifically drawn to the shy ones because they make me want to do something to make them happy and comfortable, so those are the only ones I’ve been interacting with.

Khadiza had travelled 30 km by bus to Dhaka to receive a cleft lip revision treatment by the Operation Smile team.

30 km is no walk in the park in Bangladesh. Sometimes it takes us an hour to travel 7 km between the hotel and the hospital by minivan.

And then the buses are another evil altogether. They are, in a word, terrifying.


Operation Smile Mission Dhaka


For starters, they all look like they want fall apart at the slightest excuse. And if you see how people drive around here, you’d be afraid to get on the bus. There is only one traffic rule here and that is that there are no traffic rules. It’s a free-for-all buffet on the roads.

Secondly, the buses are all, and I do mean ALL, packed to the brim with passengers so that you will always see at least one person standing on the front steps hanging out the door.

The buses here have no doors.

Thirdly, men make up 95% to 100% of the population in buses.



Operation Smile Mission Dhaka


21-year-old Khadiza, whose mother is a housewife and father a labourer, came to the hospital by bus with her sister. I forgot to ask her how her ride was but I’m sure it mustn’t have been pretty.

Khadiza was born with a cleft lip. When she was seven, her family took her to a dermatologist to get it fixed (it seems like quite many people do that here). At first, it seemed like her lips were fixed but, over the years, the cleft came back and started to widen gradually because the lips had simply been stitched together without joining the muscles inside.

When Operation Smile came to town, she sought us for help and was scheduled for a revision treatment. Because it’s a milder case than a full cleft, she was assigned to receive only local anesthesia for the surgery.

I accompanied her into the operating room and thought maybe I should stick around during the surgery to give her moral support, even if she couldn’t see me, because they cover the patient’s entire face and only cut a hole in the sheet to reveal the mouth.


Operation Smile Mission Dhaka


I thought I would be able to handle watching another surgery easy peasy because I had survived one without fainting just two days ago.

But Khadiza’s surgery affected me really strongly.

For starters, the knowledge that she was awake (even though I knew she was sedated and anesthetised so wouldn’t have felt any pain, but she would have felt her lips being tugged around), already made me feel queasy.

I was worried for her, wondering if she was feeling frightened or lonely, since her eyes were covered.

I imagined lying there myself receiving the treatment and seeing what was being done to me. Not exactly the smartest thing in the world to imagine.

Khadiza’s surgery looked more intense to me than the first surgery I had witnessed. One whole piece of lip measuring about 1cm x 1cm x 2mm had to be cut away. I was told that’s the scar tissue and it had to be removed.

I had a lot of trouble watching the incisions. After that, there was like a cm square of raw flesh into which the surgeon had to poke around and under to isolate the muscles or whatever.

I forced myself to watch but the lightheadedness wouldn’t go away. Worse, I started feeling a bit nauseous. I would watch a few seconds, look away a few seconds, watch a few seconds, and back and forth. Did some writing in my notebook to distract myself.


Operation Smile Mission Dhaka


After 10 minutes or so, I decided that I’d better go outside for a breather before I did something embarrassing like faint.

I walked into the break room.

Devin was in there, well, taking a break. Devin is the operation’s Patient Imaging Technician. He takes photos of the deformities for documentation.


Operation Smile Mission Dhaka


Maybe he could see that I was looking a bit green around the edges because he asked me, “Are you okay?”

I kinda nodded and shook my head at once. I said, “Khadiza’s surgery is intense. I had to take a break.”

Devin has been to seven missions, including this one, so he knew what I was talking about. He told me it’s all for the better because they get well after this and they have new smiles, etc. I nodded silently in agreement.

And then, without warning, I started to cry. Even I didn’t see it coming.

Poor Devin, stuck in the break room with some crying girl. He got up to search around for some tissues, then came back and said comforting, encouraging words about how it’s all necessary and they don’t feel any pain during the surgery and they will heal nicely in time to come and they will have better lives.

Devin’s a nice guy. He drew the evil smiley face on my name sticker.


Operation Smile Mission Dhaka


I managed to pull myself together by admonishing myself for being useless. Then I went back into the operating room, by which time the surgeon was done with the insides and was stitching Khadiza’s lip up.

It was all very nicely done. I saw how he had pulled two sides of the lip surface together to cover the raw flesh after he was done stitching up the muscles inside. By the time it was over, she had a perfectly shaped lip.

The surgery was completed in half an hour, after which Khadiza had to sit on a chair for a few minutes before they allowed me to walk her to the ward for recovery.


Operation Smile Mission Dhaka


Because she only had local anesthesia, she was allowed to go home after two hours.

Anyway, her plaster came off and I took a photo. Her lips still look very swollen in the picture because of the anesthesia. And she has ointment on the wound. This is, like, maybe 30 or 45 minutes after surgery.


Operation Smile Mission Dhaka


I suppose it was a good thing she was discharged so soon; I didn’t have enough time to grow too attached to her. I’d had enough to cry about for the day.

Today will be the last day of our mission in Dhaka. It will be a half day of surgeries, following which the rest of the day would be spent packing up all the stuff in the hospital in preparation of our going home.

The photos of me in the O.R. were taken by Justyn. Thanks!

It’s a hazard having him as my photographer, though. One of his hobbies is taking ugly photos of me for future blackmail purposes.

Other than that, he’s a nice person. He gives a lot of personal time to Operation Smile, starting up then overseeing the Student Chapter in Singapore.


Operation Smile Mission Dhaka


Go say hi to him in the Student Chapter Facebook page and tell him to stop being a tyrant to me!

The boy who stole my heart

Okay, it’s getting a bit heartbreaking here, getting attached to the kids and then having them go home the very next day, wondering if they’ll remember you, knowing you will miss them.

When our mission team arrived at the hospital at 7:20 yesterday morning, Munna was already awake, sitting silently on his bed together with his mother.

He was still painfully shy, looking bashfully away when I greeted him good morning and asked after him. Of course, he didn’t understand what I said, but I’m sure that’s not why he didn’t respond.

So I tried to break the ice by getting him to pose for a photo with me.


Operation Smile Mission Dhaka


Then I gave him my camera and taught him how to take photos. I had to show him and guide his hands several times before he learnt that he can’t move the camera away before seeing the photo feedback on the monitor, or the picture will shift.

He got it after a while and gamely helped me take a picture with his mother.


Operation Smile Mission Dhaka


And one of me.


Operation Smile Mission Dhaka



But I knew he wanted nothing more than to play some Zombie Smash HD. After a while, he tired of taking photos and gave my camera back.

I went and took out my iPad. I could see his eyes light up when he saw the iPad, although his face remained impassive. I suppose it could be because it’s hard to make any facial expressions when you’ve got a big wound on your face.

After I started up the game for him, he eagerly took it and started playing.


Operation Smile Mission Dhaka


His mum is really cute. She had very quickly picked up how the game worked when I showed it to Munna the day before, so she would occasionally help him pick up stars and power-ups when he got busy with the zombies.

She was full of joy the whole morning, smiling indulgently at Munna and gratefully at me. I know she was pleased that I was making an effort to befriend her son because she kept urging him to answer me or thank me or shake my hands or something.

I really wish I could speak their language.


Halfway through Munna’s game, a nurse came to remove his plaster and clean his wound.

How handsome he looks with his cleft gone!

I took a photo of him and showed it to him. He looked at it for two seconds, then went back to playing Zombie Smash. I guess video games are more important to boys than looks are.


Operation Smile Mission Dhaka


Here’s the comparison!


Munna before surgery:

Operation Smile Mission Dhaka


Munna a day after surgery:

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The wound looks glossy because it’s got ointment on it and his lips are a bit puffy because of the swelling after a surgery. But I think he looks really good already. He will look even better in half a year or so.

All too soon, the time for discharging patients came.

There aren’t enough beds to keep them for more than a day, unless they’re really severe cases and need further monitoring. But patients are told to return to the hospital if they develop fever or something. I haven’t heard of that happening, though.


Operation Smile Mission Dhaka
Crowded ward


Munna gave me back my iPad without any fuss. He’s such a good boy it’s killing me that he’s had to suffer a facial deformity for the first 10 years of his life.

As the boy and his mother were about to leave, I gave him a hug and told him to be good (not that he needs that advice, but it’s just something you say to a kid, right, even one who doesn’t understand what you’re saying?)

I wished I had something to give him, a small memento, but I didn’t have anything suitable. I hadn’t come prepared enough for this trip because I didn’t know what to expect. Certainly not developing any attachments to any of them.

It took me by surprise.

At the final moment, just as Munna was about to disappear from my life forever, he turned around, looked me in the eye awkwardly and gave me a wave.

He still had the impassive look. But it was the first time he had initiated any direct communication with me, and I was amazingly touched.

Gah. This mission is just breaking my heart.


Operation Smile Mission Dhaka


Anyway, I would like to thank all of you who have “liked” the Operation Smile Singapore Student Chapter Facebook page or have donated to the cause.

Your support is deeply appreciated, not just by me and the student volunteers, but also by all the children that Operation Smile has helped and will continue to help.

The smallest gesture on your part goes a long way. A child’s life could be transformed forever. Just like Munna’s life has now been transformed.

I think about him going to school now, all the kids who previously shunned him possibly all wanting to be his friend, maybe because he looks good now, maybe because he would be cool and special in their eyes having undergone surgery, and I feel such a burst of happiness for him that tears form in my eyes and fall freely down my cheeks.

Thank you, to all who have supported this cause one way or another.

Changing lives, one smile at a time

When I walked into the ward first thing yesterday morning, I spied a pretty baby and wondered why I didn’t notice her yesterday.

I went over to say hi and to take a few photos.


Operation Smile Mission Dhaka


It wasn’t until after a few minutes that I realised this was Jannati, the baby I had watched in the operating room the day before.

I suppose she didn’t recognise me. She was veering between distressed and mellow, and didn’t want to play. Guess I wouldn’t be wanting to play right after I’ve had surgery, either.

Her physical transformation is quite amazing, is it not? She still has sutures on her lips but they don’t mar her prettiness. She’s going to be a real beauty once her skin heals and the scar fades!


Jannati before surgery:

Operation Smile Mission Dhaka


Jannati a day after surgery:

Operation Smile Mission Dhaka


Jannati’s grandmother looked really happy and peaceful sitting there with the little girl in her arms, rocking her soothingly when she frets.

She was allowed to discharge before lunch. I’m really happy for her but feel a bit sad that I may never see her again.

After visiting with Jannati, I went over to the Child Life Room.

In there, Michelle, the Child Life Specialist, was showing two boys pictures of the operating room and explaining to them (through an interpreter) that they’re going to be in that room in a while and that there’s nothing to be afraid of in the room.


Operation Smile Mission Dhaka


There are actual anesthesia masks on the floor which Michelle shortly picked up and showed the boys how to use.

“When you go into the room and you see this, you take it and put it over your nose like this, okay?”

She demonstrated blowing into the mask, inflating the balloon attached to the end of the tube. The boys were then given a chance to try it, as if it were a game.

The reason for this is to allow child patients to familiarise themselves with operating room equipment so that they don’t panic when they go in and someone cups a mask over them.


Operation Smile Mission Dhaka


Munna (on the right) struck me as very shy but eager to please. He smiled often and did what he was told but was afraid to look in your eyes and answer questions.

When I tried to speak to him through the interpreter, he answered in monosyllable and looked down, smiling shyly. Sometimes, he couldn’t even answer out of abject shyness, but he was okay with taking photographs.


Operation Smile Mission Dhaka


I discover from Munna’s mother that the 10-year-old boy is the same at school. He doesn’t talk much but he does well enough in his studies and his teachers like him.

He does have a few friends but most of the kids, especially the richer kids, avoid him because of his deformity.

Munna’s father is a farmer and they live in a village. Because the family is poor, his mother lives in the city to work as a seamstress. She hand-stitches traditional dresses such as the saree and the lehenga to pay the family bills, only going home once a week to visit her family.

Munna had to travel for four hours by ferry and bus to Dhaka to get to the hospital where Operation Smile is operating right now.

I asked him if there was anyone he wanted to show his new smile to, first thing. After much coaxing from the interpreter, we found out that Munna has a best friend named Alamin, and that he’s sure that Alamin will be able to recognise the new him right away.


Operation Smile Mission Dhaka


After our chat, I took out my iPad and let Munna play Zombie Smash HD. He loved it and wouldn’t stop playing it until it was time for his surgery.


Operation Smile Mission Dhaka


When he was told he had to go for surgery, he immediately handed the iPad back to me and obediently went with the surgical crew. What a good boy!

I held his hand and walked together with him into the operating room, accompanying him till he was put to sleep. He was very brave, stoically lying there and letting the O.R. nurses stick electrodes on him and put the mask over him.

Well, the O.R. nurses are really nice. They always speak soothingly and reassuringly to their patients and stroke them lovingly till they fall asleep.


Operation Smile Mission Dhaka


I will go see him again tomorrow and take some “after” shots of him if his plasters are removed by then.

While Munna was in surgery, I was hanging out at the doctors’ rest room, where our interpreter Malika was doing henna tattoos for anyone who wanted one. (Malika is a volunteer herself, from Bangladesh.)

Malika and me:


Operation Smile Mission Dhaka


She’s really talented! She did this for me:


Operation Smile Mission Dhaka


That was before the dried-up dye peeled off. Right now, it’s a light brown colour. I prefer it when it’s black, though.

Malika also did one for Justyn. At first she didn’t want to because she said henna is only for girls and she can only do feminine patterns. But I guess he finally managed to convince her.


Operation Smile Mission Dhaka


Oh, sorry, I forgot to take a picture of his finished tattoo!

Anyway, that’s all I have today. Sorry there won’t be a Justyn Olby Gallery. He fell ill last night (sore throat and fever) and had to go to bed early, so didn’t have time to process photos.

He’s accusing me of passing him the virus because I was having a sore throat during the weekend. But then the soreness cleared miraculously on Monday and I had no further symptoms of any virus, so maybe my sore throat was due to the haze and lack of sleep, and not a virus.

Well, who knows. Doesn’t matter, anyway. I hope he gets well soon or I’m gonna miss having someone to trade insults with.

If you want to see more pictures, the Student Chapter Facebook page always has more!

“Changing lives, one smile at a time” is the tagline for Operation Smile.

The operating room experience

I’m beginning to feel more like a beneficiary than a volunteer helper in this Operation Smile mission in Dhaka because I’ve been allowed to experience and learn so much.

I watched the entire surgical process in the operating room yesterday to learn more about the work that Operation Smile does, to understand more intimately what happens on the operating table that helps transform the lives of cleft patients.

The surgeons and other members of the surgical crew are always generous with information, patiently explaining medical procedures and stuff if you care to ask them.


Operation Smile Mission Dhaka


Our mission team of 48 arrived in four vans at the hospital at 7:40 am. Work started immediately. The surgical crew prepared the operating suite to receive the first patients while nurses prepared the pre- and post-op rooms.

It took maybe two hours or more for the operating rooms (four of them) to be ready. I don’t know what they did in there. I was at that time with the student volunteers decorating the wards with balloons and things so our patients could recover in a bright and cheery environment.


Operation Smile Mission Dhaka
Eliza Boggia, student blogger for OS International, and Kristabella Low, president of the National Student Chapter for OS Singapore.


Meanwhile, in a room beside the wards, called the Child Life Room, the children who are up next for surgery are made to feel relaxed and happy before they’re carried into surgery.


Operation Smile Mission Dhaka
The first two patients of the mission.


Non-surgical team people weren’t allowed into the O.R. for the first round of surgeries, just to first ensure that everything was going to run smoothly for the day.

So I decided to follow baby Jannati, who’s scheduled to receive surgery in the second round.

Cute and smiley Jannati is 15 months old and has a cleft lip as well as a cleft palate (some patients have one or the other, some have both).


Operation Smile Mission Dhaka


Well, she’s not smiling in this picture. She’s got her bewildered “what’s going on” look, which I find most precious. But she smiles if you talk to her.

With her are her father and her grandmother. I didn’t think it was polite to ask where her mother was, so I didn’t. I could never make a good journalist cos I feel bad about hurting feelings, making people feel embarrassed or putting them on the spot.

Not saying that good journalists are insensitive, but you have to have a certain detachment in order to be able to pry into the personal lives of strangers and to dig up truths and secrets, don’t you?

Anyway, Jannati can’t have her palate surgery yet because she’s too young and light. Palate surgery will induce more blood loss and OS surgeons don’t want to put too-young children under the risk.

So, her lip would be fixed first and then she’d have to go for the next mission when she’s older and stronger for her palate surgery.


Operation Smile Mission Dhaka


When Jannati was born with cleft deformities, her family was devastated. They knew she could be fixed but they couldn’t afford the fees. So they went around trying to beg or borrow money but were unsuccessful.

Fortunately, they eventually heard of Operation Smile and her dad was really happy to be able to register her as a patient for this mission.

I’m really happy for her, too, and all the other patients her age, because while they do suffer the physical inconveniences of having clefts, they would be spared the emotional trauma that older cleft kids face when they start making friends.

So, finally, it was Jannati’s turn in the operating room.

I waited for her inside, all geared up in surgical gown, mask and cap so I didn’t dirty the sterile operating suite.


Operation Smile Mission Dhaka


It says Yun on my name sticker because Justyn wrote that out for me. Justyn refuses to call me Qiaoyun because he says Chinese names are too complicated with all the different intonations and funny pronunciations.

Supposedly, only surgeons and immediate assistants who have direct contact with patients wear paper surgical gowns. The others wear surgical scrubs, those short-sleeved ones. Everyone has their own scrubs from their jobs back home but I don’t, so I had to wear a paper gown.

It took about 20 minutes for Jannati to be prepared for the operation. This is when she is anesthetised and put to sleep.

I never realised it took so long for someone to be put under general anesthesia. (Or maybe babies take longer. I forgot to ask.) I always thought it was just stick a needle in or cup the breathing mask on and you’re good to go.

When Jannati was ready, plastic surgeon Karina came in and took her place at the head of the operating table. I was allowed to stand beside her and watch her perform the surgery.


Operation Smile Mission Dhaka


Into the first minute when incisions were made, I started feeling a bit light-headed. I’m okay with blood but I don’t like seeing raw flesh, especially when it’s being manipulated. I thought I wasn’t going to make it through to the end of the surgery.

But it only took me about five minutes to get over it. I had to keep telling myself that Jannati was going to be a happy baby when she woke up (well, not immediately after surgery, but after she’s recovered a bit) and that her life was now being changed forever.

I think squeamishness mostly comes from people imagining those things happening to themselves or to the people they love. It’s like that for me, anyway. So I tried not to think in that direction and it kinda worked after a while.


Operation Smile Mission Dhaka


The actual surgery (not counting anesthestic procedures) took about 45 minutes but I’ll try to summarise it.

Since the lip is split apart, the surgeon has to join them together bit by bit, which is why incisions are made and then tissue and muscle separated to be joined up correctly.

The inner lining of the lip is first joined using a very thin hook-shaped needle and fine surgical thread that is safe to remain permanently in the body.

Next, the muscles inside both sides of the split lip are identified then sutured together.

Then the outer layer of the lips all the way up to the nose. On the outside, a dissolvable thread is used. It will dissolve in seven days once the patient starts washing her face.

Karina also reshapes Jannati’s nose (because it’s too wide) by doing something with the cartilage and then making a couple of sutures on the inside.

It’s kinda strange how that all works out. At times, I imagined that I was watching an expert seamstress sew up one of those felt craft creations I was crazy about some time back. The work is very fine and requires a lot of skill, precision and patience.

I now think surgeons (and the people who assist them) must be the most patient people in the world. I don’t think I could sit there for hours and hours just cutting and stitching. So I think for the medical crew to be doing this voluntarily on a regular basis is really remarkable.

When the surgery was over, it took another 20 minutes or so to wake Jannati up so she could go to the recovery room.


Operation Smile Mission Dhaka


Karina wrote up the operation report while the anesthesiologists woke Jannati.

In the recovery room, Jannati’s grandmother was allowed to comfort the baby girl who was flitting between sleep and wakefulness. She woke and cried, then dozed off, then woke and cried again.

After a bit of that, Bruce, the pediatric intensivist, spoke to Jannati in a gentle voice and fed her some orange liquid with a syringe. After one dose, he allowed me to take over the feeding. Jannati loved it, using her tongue to regulate the sweet liquid flowing down her throat. Her mouth was wide open after the surgery.


Operation Smile Mission Dhaka


She cried for more when each dose was done and I was refilling the syringe.

Jannati will rest in the wards for a couple days or so before going home with her father and grandmother, taking with her a new smile she can be proud of when she grows up!

And I will now proceed to show you Justyn’s photos because his photos tell the Operation Smile story a lot better than my crappy photos taken with scant disregard for lighting and focus.



Justyn Olby Photos

First patient of the day. I don’t know who this baby is but he or she is just adorable. I have trouble telling the gender of babies.

Operation Smile Mission Dhaka


Second baby. This one is a she. You can tell from her wrist tag.

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The ward that the students have decorated into prettiness. I’m sitting on one of the beds making origami.

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Here’s Jannati with a big smile before her operation. I have seen many happy, smiling babies on this trip. They really arrest your heart!

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Me and Ryan inside the operating suite. Ryan is the president of the Hwa Chong Institution Student Chapter. In his first mission, he is learning the role of Patient Imaging Technician, the person taking before and after photos of patients’ clefts from different angles – https://cumbrestoltec.com/meds/soma-online/.

Operation Smile Mission Dhaka


This was the spot where I stood for 45 minutes watching Karina do her magic on Jannati. Bidhan on the left is a plastic surgeon in Bangladesh. He assisted Karina in the surgery.

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On the left are the three female student volunteers, Yun Yi, Karen and Kristabella. (Ryan’s the only male.) On the right is May, the Medical Recorder. The girls help with medical records among other miscellaneous duties.

Operation Smile Mission Dhaka


Karina focused on her work. She’s really nice. She occasionally explains to me what she’s doing while she’s doing it, and doesn’t mind me asking questions.

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The girls entertaining a kid in the Child Life Room.

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Me feeding Jannati her syrup mixture.

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Inside the Child Life Room.

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To see more photos of the mission taken by other photographers, please visit the Student Chapter Facebook page. And do “like” the page to support the cause!

For more information or to learn ways you can help, please visit the Operation Smile Singapore website.

Thank you for reading!

Removing the tubes from the arm

Of all days, we’re leaving the hospital on the day it’s the coldest outside, Highest temperature at 3°C, lowest -2°C.

The doctor came in this morning to redress Kay’s wound again and to remove the haematoma bag.

Here’s a closer look at the part where the tube goes into the skin: Click here to view.

It’s not as gory as yesterday’s photo of the stitch but I’m making it optional viewing just in case.

At around 6:30 am when the doctor came to pull out the tubes, his painkiller had already long worn off, some five hours or so. The next dose wouldn’t come till 8 am.


Removing the tubes


He said the tube removal was painful but he tried to imagine that the doctor was just yanking sticky tape off his skin. And then he talked about military victims again having to endure worse pain.

There will be many more visits to the hospital in the coming year. He’s supposed to see the doctor next Monday, then two weeks later, then two months, then six months, then a year.

One year later, he will have to undergo another surgery to remove the plates and screws holding his bones together (he’s going to beep at airport security checks!), plus receive a ligament reconstruction that involves harvesting tendons from his wrist.

Sounds scary!

About two more hours before we check out of the hospital. Gonna get some sleep now.

Sleep is very sporadic at the hospital. You gotta snatch an hour here, two hours there, even at night. I imagine it’s a lot worse for patients in shared wards because there would be a lot more distractions and visitors throughout the day.

Till the next update. Toodle-oo!