Forty Years Since Its Founding, Operation Smile Is Committed to Treating 1 Million More Kids Around the World

Operation Smile was founded in Naga in 1982. Since then, this homegrown NGO has reached millions of children around the world in need of free cleft lip and cleft palate care. 

There are a few things that the Philippines is known for in the medical field, but perhaps the most notable—and inspirational—might be our global commitment to treating millions of children with cleft lips or cleft palates. In 1982, Operation Smile was founded in Naga when Dr. Bill Magee and Kathy Magee treated Operation Smile’s first patient. Since then, the non-government organization has expanded to more than 30 countries, established 33 cleft care centers, partnered with 135 hospital partners, and gathered a group of 6,000 skilled health volunteers from around the world. 

And it all began right here in the Philippines. Now, Operation Smile is committed to treating one million more patients within the next decade as it celebrates its 40th anniversary. In the country alone, Operation Smile Philippines—the local branch of the now-global NGO—is hoping to provide at least 10 percent of the one-million patients target. In the last 40 years, Operation Smile Philippines has reached 839,719 patient interactions, which covers everything from surgeries and evaluations to therapy and treatments. But the NGO knows it can do more. 

The Reality of Cleft Lip/Palate Conditions 

Every three minutes, a child is born with a cleft lip or palate condition. In the Philippines, that statistic translates to at least one child in every 500 being born with the facial deformity. Despite its relative frequency in the population, there’s still much left to be done in terms of nationwide cleft lip/palate care. 

“When you look at the medical scope of things, cleft lip or cleft palate conditions are not a priority because they think it’s just an aesthetic thing. [They think] it’s just an open lip or an open palate. But the reality is more than that because if a child has an open palate, they might not be able to feed themselves properly,” explained Emiliano Romano, executive director of Operation Smile Philippines. 


Cleft conditions are spotted at birth: When a baby is born with an opening in their upper lip, the condition is called a cleft lip. When a baby is born with a gap on the roof of their mouth (palate), the condition is called a cleft palate. Both are considered birth defects, and while they might seem like an “aesthetic” issue, untreated cleft conditions can affect a person’s ability to eat, speak, smile, and essentially lower their quality of life and chance for opportunities. It’s why Operation Smile was formed in the first place, to give these babies a chance at a healthy and fully-lived life through free cleft care. 

“A 45-minute surgery can change the life of a child,” said Romano.

Without Operation Smile, the cost of cleft surgeries at a private hospital can cost parents around P80,000 depending on the severity of the situation. But with Operation Smile, everything is free. The NGO provides free surgery, consultations, pharmacy needs, dental programs, speech therapy, psychosocial care, and much more.

But according to Romano, the reality is that not enough parents and families are aware of the free services Operation Smile provides. And unsurprisingly, some Filipino families look at cleft conditions as a "curse." Meanwhile, for others in far-flung provinces, lack of means and transportation makes it impossible for them to visit cleft care centers. 

Romano says that the best age to be treated for cleft lip is at six months old and the best age for cleft palate surgeries is 12 months old. Unfortunately, this rarely happens due to the challenges mentioned above, but Operation Smile still provides surgeries to patients up to 20 years old, despite the higher risk of complications with older patients whose bones have already set. 

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The dilemma of Operation Smile Philippines is simple: Despite all the resources and skills at their disposal, their challenge is reaching the families in need of their free care in the first place. That’s why the NGO puts in effort to advertise on radio and TV, reply to social media inquiries, and reach out to hospitals. But it’s the NGO’s ecosystem that’s truly helped them overcome the issue. Because, as Romano explained, Operation Smile Philippines is a group effort. 

Photo by Operation Smile Philippines.

The Operational Smile Philippines Ecosystem 

For its 40th anniversary, Operation Smile Philippines is doubling down on its key partnerships to create a thriving and effective ecosystem where all the players are dedicated to helping kids in need. The NGO’s partners commit to sponsorship of treatment, patient recruitment, use of hospital facilities, or training and advocacy. 

Some of these partners in the ecosystem include Watsons Personal Care Stores Philippines, Inc., which sponsored the reconstructive surgeries of 50 children in 2021. This year, they’ve renewed their commitment to fund 100 more surgeries for children with cleft lip or cleft palate conditions. 


Meanwhile, Philippines Air Asia Inc. plays its part in the ecosystem by providing the free air travel needed for children born with cleft lip and palate to reach hospitals for their care. As for Johnson & Johnson Philippines Inc., the company has been supporting Operation Smile Philippines since 1997 through funding and training of doctors, dentists, and more. 

“Another focus that we're doing right now is really in investing in district hospital facilities because this is also about helping district hospitals upscale their health ecosystem so that they can take care of more patients in their provinces,” added Romano. 

“Operation Smile has been well known worldwide for having a very compelling global medical standard. These hospitals know that when we do it, our main goal is to do it safely. “ 

Aside from these companies, Operation Smile has been working with hospitals like Fabella Memorial Hospital in Manila to train midwives to prepare for when babies with cleft conditions are born. The NGO is also working with the hospital to create the first-ever cleft registry so Operation Smile Philippines can provide care to these babies immediately. The NGO has also set up cleft care centers in Davao, Manila, and Pampanga, and has facilitated surgical programs nationwide.

As of 2022, the NGO has over 300 medical volunteers in the Philippines, made up of plastic surgeons, dentists, pediatricians, and more. All of them dedicate their time and effort—for free—to learn how to treat cleft conditions, treat them pro bono, and go back to their hospitals equipped with the knowledge they need to train another batch of volunteer doctors.

Outside of big companies and hospitals, the ecosystem also includes hundreds if not thousands of on-the-ground volunteers who venture into urban and rural communities to find children in need of cleft care. Some of these advocates include former patients who grew up to be volunteers. The families of the children who have been treated have also gone on to help Operation Smile’s cause. With its inspiring mission, it’s not unheard of for part-time volunteers to become full-time volunteers.

Photo by Operation Smile Philippines.

The NGO Life

It’s NGOs like Operation Smile Philippines that really make you consider making the big shift. For Romano, he would 100 percent recommend working in an NGO if you feel the calling to do more in your life. 

Born and raised in Switzerland to Italian parents, Romano settled in the Philippines 13 years ago. Back then, he was the CEO of a tech company, which no doubt provided many perks. But like many NGO workers, he chose to leave that career to work full-time at Operation Smile Philippines because he felt the need to do more. 


“When I first landed, my first thought was about how I was so lucky to be born in a first-world country. I wanted to give back. Since day one, I’ve been engaged with NGOs, but when Operation Smile came up, it connected my call to do something good and the medical field, which is my wife’s field as a doctor,” shared Romano. “I loved what I was doing before, but tech is a completely different industry. Here, I’m happy because every day, even if I work 24 hours a day, I know I am changing the life of a child.”

Of course, the NGO life isn’t for everyone. If you’re focused on monetary benefits, then NGO work might not be for you. But if you’re looking to make a change, then this might be the journey to take. According to Romano, in an NGO, you learn how to network, how to connect with people, how to have compassion, and how to answer the calling to help. There are limitless opportunities to learn and there’s never a shortage of people who need help in the world.

Overall, it’s a “place to grow as a person,” he said.  

If you’re at a crossroads in life, consider joining an NGO, whether it’s part-time or full-time. As for Operation Smile, the NGO is open to support in any way people can offer it. Whether it’s in cash, in kind, in time, or even in references. If you know a baby with a cleft condition, then refer them to Operation Smile Philippines. 

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Anri Ichimura
Section Editor, Esquire Philippines
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