Something to ‘smile’ about

STEUBENVILLE – A trip to India was something to “smile” about for Steubenville native Nick Skiviat, who is on the threshold of beginning his second year of medical school at Ohio University-Heritage College of Osteopathic Medicine in hopes of becoming a pediatrician.

Skiviat recently returned from a month-long medical mission trip as part of Operation Smile, an international children’s medical charity with a presence in more than 60 countries.

In its 32-year history, Operation Smile’s network of more than 5,400 medical volunteers from 80 plus countries has provided more than 220,000 free surgical procedures for children and young adults born with cleft lip, cleft palate and other facial deformities.

The son of Dave and Patsy Skiviat of Steubenville, Skiviat shared some of his experiences and observations as the guest speaker at the Tuesday luncheon meeting of the Steubenville Kiwanis Club held at the YWCA of Steubenville. He was recruited as a speaker and introduced by his father, a Kiwanian serving as program chair for July.

“I had a really amazing experience this past month,” said Skiviat, whose trip that involved 68 cleft surgeries ran from June 5 through July 6.

“My school does offer many medical mission trips in the summer, but I decided to try my own and really wanted to work with children since I am interested in pediatrics,” Skiviat said in explaining how he came to connect with Operation Smile.

“They really do great work all around the world changing a lot of lives,” he said of Operation Smile’s mission to “mobilize a world of generous hearts to heal children’s smiles and transform lives across the globe.”

Headquartered in Virginia Beach, Va., Operation Smile was founded in 1982 by Dr. William Magee Jr., a plastic surgeon, and his wife, Kathleen, a nurse and clinical social worker, after they traveled to the Philippines with a group of medical volunteers to repair children’s clefts. They discovered hundreds of children “ravaged by life-threatening deformities,” and while they were able to help many, the medical volunteers were forced to turn away the majority who sought help, according to its website.

The Magees saw the need, and Operation Smile was born.

To build long-term self-sufficiency in resource-poor environments, Operation Smile trains doctors and local medical professionals in its partner countries so they are empowered to treat their local communities. Operation Smile also donates medical equipment and supplies and provides year-round medical treatment through its worldwide care centers, its website notes.

“We mobilize medical volunteers across the globe to treat children with cleft lip, cleft palate and other facial deformities, and leave a legacy of trained medical professionals, surgical equipment and professional partnerships to expand local medical infrastructures and create self-reliance in low- and middle-income countries,” it notes.

While the mission grew over the years, its presence in India, however, didn’t take root until 12 years ago, according to Skiviat.

“Most of Operation Smile operates around the world through mission trips, but in India, there was such a need, they have now established permanent surgical centers in India that can operate year- round as opposed to just a 10-day mission trip,” Skiviat said.

Operation Smile first came to India in 2002. Seven years later, “they moved to the northeast remote area of India, the state of Assam, where there’s a high prevalence of cleft lip and cleft palates there.” By 2011, they had formed a private-public partnership with the government and other private parties to build a permanent surgical center that can operate year-round, he said.

“It really is the premiere center of Operation Smile all around the world, so I was really privileged to go and spend a month there,” he said of his presence at the Guwahati Comprehensive Cleft Care Center (“GC4”) in Guwahati, Assam, for the majority of the trip.

Operation Smile held its first medical mission in Guwahati, Assam, in January 2009. In Assam alone, since 2009, Operation Smile has held 12 international medical missions where more than 1,100 medical volunteers from 24 different countries have worked alongside Indian medical professionals to provide free surgical treatment for children who otherwise could not afford surgery. Operation Smile also conducted some of the largest medical missions in Operation Smile’s global history in the state which includes 500-patient surgical missions, and the largest medical mission ever where 967 patients received surgical treatment over a period of three weeks in 2010, according to its website.

A 2008 graduate of Catholic Central High School, Skiviat explained that every three minutes, a child is born with a cleft, the case in developing countries but not the United States. A child with a cleft has twice the odds of dying before his or her first birthday. Children with cleft conditions may have difficulty eating, breast-feeding, speaking, hearing or breathing properly.

“It makes a lot of normal daily activities difficult. It can lead to complications with breathing and sinus infections and an array of problems down the road,” he told the Kiwanians.

His role at the center was more on the level of education, observation and helping with research projects. “We were able to work in all the departments and get an idea of how Operation Smile works,” he said. “We scrubbed in and helped with what we could.”

Skiviat was able to have a more hands-on experience, however, when he was in charge of the medical records when he accompanied staff from the center to a mission trip about seven hours away in the city of Jorhat, also in the state of Assam.

“From our team they chose two surgeons and just a few people from each department to go to the mission site and work with local volunteers to establish a whole team there and then work for a whole week there to do surgeries,” Skiviat said of his one week at the camp in Jorhat.

“We had an opening ceremony, a ribbon-cutting the first day and over a hundred families come for screening, and more trickled in throughout the week. It was a very extensive process of screening to determine who can have surgeries,” he said, explaining that Operation Smile has developed “quite an intricate system the patients go through to see if they are fit to have surgery at the mission site.”

Skiviat took paper medical charts, converting them to electronic ones. “Even in India, they’re moving to electronic medical charts,” he said.

In the course of most any 10-day mission trip, anywhere from 50 to 250 surgeries are performed. “It’s pretty fast, amazing work,” Skiviat said.

“Some of the benefits of having a local center like that in Guwahati they have transitioned over 90 percent of their staff is local people so they know the language and can communicate with the children and parents, and it just makes things flow more smoothly as opposed to some surgeons from America going to a country where they don’t speak the language. Continuity of care is achieved,” said Skiviat, who noted natives speak Assamese or Hindi, the second language.

Showing some slides from his trip, Skiviat said Guwahati, is “a pretty large city, not like a capital, but an interesting place to spend a month.”

The center, which has “quite a vast team” of more than 75 staff, surgeons, pediatricians and anesthesiologists, prides itself on quality of care.

“They want to make sure they fix it, fix it well and follow up to assess if further surgery is necessary,” Skiviat said.

“I really liked the idea that they don’t just bring in these children, have their surgery and send them away,” said Skiviat, whose studies at OU have included holistic medicine. “They have quite an extensive screening process, and the children and their families work with incredicble patient care teams that walk them through this whole process, nutrition, counseling and speech therapy. These children can have many problems with nutrition and speaking, so it’s a great, huge team that works with every patient to really improve the lives of these kids,” he said.

“The centers have established training programs in affilitation with universities around the globe, so students in nursing and physicans in training can go there and see five to 15 cleft surgeries a day,” Skiviat said. “You can’t get that training in most other areas of the world, so it’s a great place for education as well as so many research projects, where they’re still trying to determine the cause of these clefts, the best surgical treatments and long-term treatments for these children,” he said.

While genetics may play a role in the presence of cleft deformities, a lack of folic acid in the mother-to-be’s diet also is a leading theory.

The center staff includes a team of doctors, photographers, nurses, specialists in nutrition and speech therapy and pateint recruitment, according to Skiviat.

Ideally, surgeries occur in infants as young as 6 months, according to Skiviat, “but some families especially in India are quite apprehensive. Some of this sounds too good to be true – a completely free service with free transportation. We bring the patients as far as they need to come, provide food for them while they’re at our center, and they stay in the ward the night before and after the surgery, so some families are a little apprehensive.”

“There at the mission center I didn’t get as much interaction with the patients as I would have liked, but the language barrier was a real issue,” he said. One thing he especially liked about the process, however, was how a play time was held with the children before their surgeries so they would be more relaxed and not so fearful of the impending procedure.

“I thought it was a great part of the process,” he said.

Skiviat said it was more common for Americans to be at the center and not necessarily generate a reaction from the children, but at the mission site in Jorhat, it was a little different story.

“I got a lot of very funny reactions. Some people coming up to me without words were just trying to thank me and show me their immense gratitude for me to come from the United States and help on the mission in India. I think based on visual expressions, some people were apprehensive of me. I got a lot of stares and a lot of people taking my picture or coming up to me with a camera and wanting a picture taken with me and at first I felt a little strange about it, but they explained to me I might be the only white man to ever enter that city.”

Skiviat said children and their families demonstrated not the emotion he thought they would when surgeries were over. “It was such a striking difference after surgery, after these really serious facial deformities, but I was told people of this state are very stoic and proud people, so they didn’t express a whole lot of emotion after the surgery. They were grateful to us for the free work we provided, but not the extreme emotional reaction after seeing their child come out of surgery,” he said.

Another facet of the trip that Skiviat described as one of his favorite parts of being there was befriending a young girl from California and other Americans who on Sundays helped cook and distribute food to the homeless in slums.

“That was a really moving experience,” Skiviat said.

Skiviat, who recently finished his first year of medical residency at Ohio University-Heritage College of Osteopathic Medicine, earned his bachelor of science degree in biology from John Carroll University in 2012, taking a year off to volunteer with AmeriCorps at a hospital in Cleveland.

He said his interest in becoming a doctor dates back to his experiences as a fourth-grader seeking medical attention for a series of non-life-threatening medical problems.

“Operation Smile truly is an incredible organization bringing smiles to children and their families all around the world. I took my limited medical knowledge to share, but they shared so much more with me,” Skiviat said after the meeting. “The local staff and volunteers did everything possible to make me feel welcomed and comfortable, as well as teach me about international medicine and a new culture. The language barrier prevented verbal communication with patients, but a quick smile or acknowledging head nod were enough to warm the heart,” he said.

“Participating in a surgical mission was an honor and privilege to be part of a team making a real difference and having some fun, too. Although I couldn’t perform the cleft repair procedures myself, observing the surgeons was great motivation to continue my studies with the goal that one day I can use my medical degree to make a difference for patients, too,” he continued.

“And as always, when you spend a month away from the comforts of home, you come back appreciating the little things much more – and feeling very spoiled. I hope this is just the beginning of my journey with Operation Smile and international medicine.”

Skiviat described the time in India as a combination of an educational experience, holiday and challenging new adventure.

And a forum in which to be inspired and thankful for the work being done.

“The real heroes are the physicians who spend a whole year or even their entire careers repairing clefts and the staff of the center who work so hard to find the patients and give them a positive experience but are compensated modestly,” said Skiviat.

“These people deserve the credit, not me. And now I can see that the donations really do go toward an amazing cause.”