BioCommunications Association

Operation Smile

A medical photographer whose expenses were partly paid by EFFE accompanied Project Smile's volunteer doctors to Ecuador to document patients undergoing corrective surgery of cleft palates. Text and photographs by Ken Holt.

Dr. Doug Ririe of Winston-Salem, North Carolina comforts a child who is about to undergo surgery.

Dr. Kevin Bush of Nova Scotia, Canada examines an infant during screening day.

Recovery Nurse Valerie Barrett of Kaysville, Utah holds a child who has just had surgery.

Operation Smile was founded in 1982 by Kathy Magee, a nurse and clinical social worker, and her husband, William Magee, a plastic surgeon. The Magees had worked as substitute volunteers on a medical mission to the Philippines and were profoundly affected by the unmet medical and surgical needs of children there. Upon their return to their home in Norfolk, Virginia, they immediately began work to raise money and enlist volunteers to help make the lives of children better by providing free facial reconstructive surgery services for conditions such as cleft lips and palates, tumors, etc. Since that beginning they have worked in more than 20 countries including the United States, recruited more than 5,000 volunteers, and helped more than 20,000 children.

Each Operation Smile mission includes a team photographer to document the work, and in September of this year, I had the privilege of serving as team photographer to Op Smile's first mission to Machala, Ecuador. Having only six weeks notice before the departure date, I was pushed to get a passport, vaccinations, equipment and supplies, funds and time off approved in time to make the trip. Thanks to support from family, friends, an understanding hospital director, and the BPA EFFE Fund, I was able to gather everything I needed.

Operation Smile uses its photographs for calendars, books, slide shows, and pamphlets, all of which are used for fund raising and promotion. The job is not so much medical in nature, but more human interest: before and after photos of the children, team members at work, children playing, parents and children together, etc. I knew that my experience as a medical photographer would be an advantage in that I would be comfortable in medical and surgical settings while getting the kind of pictures needed. But because of the nature of the photographs and the fact that newspapers publish articles about their missions, Op Smile nearly always uses photojournalists as team photographers. My first job, therefore, was to convince the Op Smile coordinators that medical photographers did more than take pictures of specimens and on-camera flash photos of patients sitting on their beds.

There were plenty of challenges on the mission: shooting slow speed slide film in dark hospital rooms; language barriers; getting good photos of children who were scared and uncomfortable; and working with a team of 35 people I had never met before. One of the biggest photographic challenges came on the last two days we were in Machala. The post-op days were very important for the medical team because they were able to see if any of the patients had developed any complications since surgery. After-surgery photographs are very important to the Op Smile mission because it shows dramatically the changes that cleft lip and palate repairs make in a child's appearance and general feeling of well being and confidence.

The space I was given in which to make these important photographs was approximately four feet by five feet, some of that taken up by office furniture. Ceilings were too high for bounce flash and there were too many reflective surfaces for anything bout bounce. However, I was able to take advantage of what I did have to get good photos. I positioned the children so that there was window light falling on them to their left. Behind them was a translucent glass divider, which separated my "studio" from a hallway. Thanks to a window behind the divider, the background was softly lit, which made a nice backdrop for the children. The next problem was what to do about the unlit side of the subjects. With no light on the right side, the photos would have too much contrast. I brought in a room divider,draped it with a white sheet and had a nice fill light to the other side. Light level was still low, but most of these photographs were made at 1/15 second but for a makeshift studio, it worked quite well and I was able to get the photographs that Op Smile needed.

Operation Smile makes about 20 trips a year to various countries all over the world. They go to each site once each year, healing small faces and teaching local medical professionals how to do what they do. The goal is to have the site become self-sufficient so that they will no longer need help from Op Smile. My experience with Operation Smile was one of the most important and meaningful ones I have ever had, professionally or personally. As Bill and Kathy Magee have said, "Life's greatest reward is being able to take care of one another." Operation Smile is a great way to do that.