I often heard about Operation Smile on television until I decided to get curious and meet an important member of this charity.
I asked a few questions to Dr. Domenico Scopelliti, maxillofacial surgeon at his five-fourth humanitarian mission. An unbridled passion for deep sea fishing and the incredible ability to guarantee children born with facial deformities that they can begin to smile.
Let's start with you, when did you decide to be a doctor and when did you decide what kind of doctor you wanted to be?
I wanted to be an engineer but then I gave up. I had an uncle who was a dentist, so I decided to follow his path, at the time medicine and dentistry the two faculties were united.
In the third year I decided to start attending the general surgery department and at the same time I wanted to embrace the most manual branch of medicine possible: surgery.
Usually the medical career is divided into research work and the relationship with the patient, I have always preferred the relationship with the patient. From there my experience in maxillofacial surgery began, from 1984 to 1991 I did not have even one day of absence.
The goal for every doctor is to become primary. I became a primary at 37 years old, very young. This forging ahead made me face the fact that I could still grow a lot.
I started looking around and wondering: did I really want this for myself?
I realized I needed more. A friend invited me to have an experience with a humanitarian association but I was hesitant. After six months of convincing, I decided to leave. It was my luck.
By operating in extreme conditions you can really get the warning as to whether or not you have become a good doctor. You have to measure yourself with people in difficulty who do not speak your language, you find yourself in the operating room and you have to give very precise answers.
Thanks to this experience I understood the true meaning of the word responsibility. When you are there, with parents asking you if you can cure their child, you are overwhelmed by a condition of extreme humanity and you have to know how to juggle.
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You work with children. When and how did you choose that they would become your reason for living?
The choice to treat children is part of a long experiential journey. My interest arises in knowing the medical histories of adults operated on in childhood and analyzing their post-operative process.
Over the years, I have also begun to operate on children and this has allowed me to have a double experience.
I understood that what matters for a pathology that involves a facial malformation is the path and not just the initial surgery, which is 15% of the importance. The goal is for children born with this problem, commonly known as cleft lip, to be able to integrate into society after the operation.
We want them to be able to eat, talk, relate to people just like everyone else.
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What is Operation Smile? How do you intervene within it?
Operation Smile was founded in the United States in 1982 by a plastic surgeon and his nurse wife, after traveling to the Philippines to learn more about the problem of cleft lip and palate.
The first children began to operate, but the number of the incidence of the disease was increasing more and more. Precisely for this reason they decided to formalize their organization and to undertake this international experience.
In 2000 from Italy we became affiliated with Operation Smile. At the beginning, a team was organized and went on missions, but we were able to respond to a few cases with respect to the incidence of the disease.
Basically think that only in Asia every three minutes a child is born with this kind of facial deformity. We therefore decided to also train local doctors in order to be able to carry out operations more frequently and not just once a year on the occasion of humanitarian missions.
Operation Smile carries out a quality control of these local activities. We do not deal with the emergency and we need everything to be meticulously carried out in order to reduce any kind of risk deriving from the operation.
Smiling is a spontaneous gesture, but for many it is not possible to do so. What are the psychological implications in children after your interventions?
The psychological implications are many, as I said there is a real process to follow. During my career I have operated on many children, but there is a story that struck me most.
I operated on a four-month-old baby aboard the Cavour Aircraft Port in Taranto (which, in agreement with the Navy, we use once a month to assist Italian children in the central-southern area).
At the age of 3/4, after having developed a minimum of critical consciousness, looking at the scar on his lip, he told her mother that he knew the reason for that mark on his face.
He said he played with an evil dragon when he was in his mother's womb and that he was the one who scratched it. Fortunately he was on a ship and an army of super heroes helped him heal the wound.
The mother has transformed this moving story into a real fairy tale: “The scratch of the dragon”.
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What is the operation that you remember with greater joy?
Each mission has a special child. Empathy on those occasions is a fundamental gift. We interface with populations or tribes who speak languages unknown even to the interpreters.
In that case, non-verbal communication made up of looks and smiles becomes fundamental. This is precisely the moment when special relationships are created between doctor and patient.
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Is there a child, or a story, that has stuck with you?
Yes, when I operated on a 13-year-old patient who was also in his second operation. The boy couldn't speak well but he had a dream of becoming a singer. Obviously he did not place the slightest hope in achieving his goal, given the impediment in the word. In any case, I worked it.
After a few years, in 2004, I was on a mission to China for a mission and I put the Rai International channel on TV to see an interview I had released shortly before departure. While I was watching the broadcast, I received a phone call.
The same guy I had operated on years and years earlier had managed to find my phone number through the TV program: he was in Moscow and was a singer!
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An extra-medical passion?
I am a fisherman on loan for surgery. Fishing for me is not a passion but a disease. I am Italian champion of offshore trolling and I also participated in the world championships, finishing third with my team.
We are used to seeing children with cleft lip and palate in TV commercials exclusively in Africa. How widespread is this malformation also in the West?
There are certainly countries more exposed to the incidence of this malformation since it is a real gene sequence error. There are breeds with greater predisposition.
However, it is not widespread only in third world countries, just think that in Italy every year there is one case in every thousand births and in the United States every nine hundred. In Asia, one in every 400, practically double.
The pre-natal diagnosis is certainly fundamental as it prepares the couple of parents to understand how to intervene to solve the problem and treat their child once he comes into the world.
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Operation Smile's sms campaign is very important. Could you explain to our readers what each individual message implies?
Each message will financially support the two projects that we have decided to follow this year.
Since ours is an international project, every year we choose a country to adopt and to offer this kind of care which without our help it would not be able to access. This year we have chosen Nicaragua.
The Smile House project. It is a virtuous system thanks to which we are able to follow the entire therapeutic path, from pre-natal diagnosis, to intervention, to the moment of integration into society.
In Italy, on the other hand, we will support this model of care network which concentrates the surgical phase in the surgical hubs, based in Milan, Vicenza and Rome. At the same time we solve the problem of health migration, a family cannot travel around Italy for the post-operative phase, so we are creating a network of peripheral clinics near the patient's residences.
I am very proud of what we are doing with Operation Smile, we are at the forefront. One of the latest projects in collaboration with the Vodafone Foundation, still in an experimental phase, concerns the creation of a digital medical record on which all doctors can approach during the therapeutic process, creating a patient's medical history accessible to all.
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What are your future projects and those of Operation Smile?
As far as I'm concerned, after the pandemic I will be going to Cape San Lucas in Mexico for a couple of months. I will devote myself to deep sea fishing and those who need to be operated on by me can do it completely free of charge.
As regards Operation Smile, our will in collaboration with the Ministry of Health is to structure the Smile House project more and more.
Don't forget to support Operation Smile by sending a text message to 45582 or calling 45582 from the landline to 9th May.
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