The Kenyan Smile That Inspired Others
Like almost every young child, Kamse was beside himself with excitement when it was finally time for him to begin school. For him, this first day of school was hard-won. He lived with his family in an isolated settlement near Kenya’s border with Uganda, and initially, his family didn’t want to enroll him in school because of his untreated cleft lip and palate.
Kamse left that morning with a beaming smile, but he returned in tears. His peers had bullied him relentlessly because of his cleft. Day after day, their taunts didn’t stop. He began to hide in the bushes by the road when he heard them approaching. He begged to leave school, where he was falling further and further behind.
Around the globe, every three minutes, a baby is born with a cleft lip and/or palate like Kasme’s. While treating cleft requires a range of comprehensive cleft care, from nutrition to speech therapy and orthodontia, surgical care is one of the primary components of treatment.
An estimated 1.7 billion children (two out of every three children in the world) lack access to safe, affordable, and timely pediatric surgical and anesthesia care. They lack access for a variety of reasons—a global surgical workforce shortage (estimated at an ever-growing 1 million providers), a lack of surgical equipment and infrastructure, and a lack of financial protection for families seeking care. Ultimately, this means that children with treatable but neglected surgical conditions like clefts, clubfoot, burns, and broken bones can die or face a lifetime of preventable ostracism, pain, poverty and disability.
Kamse’s life was changed when a community health worker visited his village and shared that his cleft could be treated through surgical care supported by Smile Train at the CURE Kenya hospital in Kijabe. When Kamse returned home from his surgery, he had another beaming smile—and this time, it stayed.
Today, on World Smile Day, we’re reflecting on stories about smiles like Kamse’s, but the truth is that many children and individuals aren’t as lucky as he was (and the truth is also that luck shouldn’t have anything to do with whether a child receives life-saving surgery and care).
Smile Train, the world’s largest cleft lip and palate organization with local medical partners in more than 70 countries around the world, and CURE International, a Christian nonprofit operating a global network of pediatric surgical hospitals that treat a range of surgical conditions, have partnered for 15 years to support surgical care for neglected surgical conditions around the world. We’ve seen firsthand the impact that treating a single patient like Kamse can have, but we also invest in improving local surgical capacity through health systems strengthening to ensure that the impact is sustainable.
For billions of people around the world, surgical care is viewed as a luxury. But safe surgical and anesthesia care are pillars of functioning health systems, and robust, multidisciplinary surgical systems overlap with other specialties and support a wide array of medical conditions. They also support emergent, non-surgical services, like those required to respond to a worldwide pandemic, given the extensive overlap in the protocols, equipment, and skills needed for surgery and those needed for pandemic response. 
Beyond the role of surgical care in developing resilience and responding to pandemics, surgical care also represents an essential economic investment. The Lancet Commission on Global Surgery estimates that low- and middle-income countries will stand to lose an estimated $12.3 trillion from gross domestic product (GDP) due to the unmet burden of surgical disease. An economic analysis of data from Smile Train found that when a child undergoes cleft surgery, an estimated $50,000 per individual is contributed to the local economy through increased productivity.
To reap these benefits, stakeholders at every level must invest in the education, retention, and protection of surgical and anesthesia care providers, including nurses, to meet the ever-widening gap between the workforce that is needed and the workforce that exists. We must invest in research to ensure that interventions are effective (and cost-effective). To maximize impact, we must work across sectors — for example, an obstetrician or a midwife can easily perform a check for isolated cleft palates at birth, which are commonly missed, but this simple step currently isn’t integrated into birth protocols.
We must also support the implementation of policies that prioritize surgical care. Around the globe, political momentum to support surgical and anaesthesia care is growing. National surgical planning has commenced throughout Africa and is moving to new continents (though the implementation of these ambitious plans has been hampered by lack of funding). In the United States, this year’s State, Foreign Operations and Related Programs Appropriations bill highlights country-level surgical, obstetric and anaesthesia plans and how they can support USAID’s new Vision for Health Systems Strengthening 2030.
So today, on World Smile Day, Smile Train and CURE International urge you to follow Kamse’s lead and show the world your beautiful, unique smile.
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 Bouchard, M.E., Sheneman, N., Hey, M.T. et al. Investments in surgical systems contribute to pandemic readiness and health system resilience. J Public Health Pol 42, 493–500 (2021). https://doi.org/10.1057/s41271-021-00292-z