Operation smile logo. A blue globe with a red smiling line beneath.

Operation Smile: An Investigation into the Business of Humanitarian Medicine

Cover image courtesy of Operation Smile

–by Nicole Zandier–


In Western society, especially the United States, mission trips are one of the most giving and unselfish things a person can do. Of course it’s noble to give your time and money to those who are less fortunate, right? But is that really the motivation for most volunteers? Perhaps people volunteer out of passion for a cause, but maybe it’s also because helping others can make someone feel good about themselves. This paper will explore how humanitarian medicine affects both volunteers and patients alike. Operation Smile’s presence in the global community shows how Western ideals and opinions have taken stake throughout the world. Western countries dominate industrial ventures and economic opportunities, so developing countries are left no other option but to turn to them for necessary goods. Over time, Western countries have imposed their cultures on others by influencing what is considered desirable and establishing what is viewed as good and normal.


Operation Smile is a nonprofit medical service organization founded in 1982 by Dr. William P. Magee, Jr., and his wife Kathleen. After a medical mission trip to the Philippines, the Magees founded Operation Smile with the sole purpose of providing lifesaving cleft lip and cleft palate surgeries to children and young adults in impoverished areas. While in the Philippines, William, a plastic surgeon, and Kathleen, a nurse and social worker, were in awe at the number of children afflicted with this condition. Though there were 300 families hoping for the surgery for their child, the Magees and other volunteers were only equipped to help 40 people. The Magees then founded Operation Smile to help children and young adults throughout the world who have this condition (“Our Story”). The children receiving these surgeries often come from impoverished backgrounds and are unable to pay expensive medical bills. For this reason, the surgeries are completed at no cost to the family. Operation Smile attributes the ability to complete these free services to their (often onetime) donors. But how can a donor guarantee that their money is even going toward the surgery or the pre-operative and post-operative care that is vital to a successful surgical outcome? Additionally, what unintended consequences could these surgeries have for the recipients of this surgery? This article will explore the assumptions that drive Operation Smile’s mission to provide surgeries to impoverished children throughout the world. I will discuss the public opinion on Operation Smile and donating to similar organizations, and what these donations claim to solve. However, throughout this article, I will also discuss the various unintended outcomes of humanitarian medicine.

What are Cleft Lips and Palates and Who Do They Affect?

Many children and young adults have received treatment from Operation Smile for their cleft lip and/or cleft palate, but what exactly is it? A cleft is a birth defect that is a result of a gap in the mouth that did not close during pregnancy. This cleft can be seen easily if it occurs in the lip, but a cleft palate can be harder to see as it is in the roof of the mouth (“About Cleft Lip & Cleft Palate”). Birth defects such as these clefts can occur for all kinds of reasons, but the most common factors attributed to a cleft lip and a cleft palate are: genetic history, environmental irritants, and poor maternal nutrition. Globally, both cleft lips and cleft palates occur regularly, but they are easily treatable with surgery. Plastic surgeons typically perform these surgeries, often within the first year of a child’s life. A cleft lip is repaired when a child is between 3 and 6 months old, while a cleft palate is repaired between 9 and 12 months of age (Gupta). Depending on the extent of the defect, the child may also require further dental or orthodontic treatment and speech therapy. Dr. Rupal Gupta, author of the article “Cleft Lip and Palate” presented by Nemours Children’s Hospital, writes that cleft lips and cleft palates can affect any child regardless of their race or geographic location.

If this birth defect is present all throughout the world, then why does Operation Smile only send personnel to developing nations? Thousands of children are born with this defect in the United States, but Operation Smile only operates in developing nations. At any given time, there are teams of medical professionals and volunteers in several countries in the world, but some are frequented more than others. Southeast Asian, Central American, and East African nations are among the most popular locations visited by Operation Smile (“Mission Schedule”). While Operation Smile states that these nations are the most affected by the birth defects, there is not much evidence to support this claim as many cases of cleft lips and cleft palates go unreported. If the chance of a child being born with this defect is equal across the world, then why are those countries visited the most often? To many citizens of Westernized nations, countries like Vietnam, Colombia, and Malawi carry a certain sense of exoticism. In the media, these nations are portrayed as being dirty, run-down, poverty-laden lands that desperately need aid from the West. When photos of children from these nations are shown, they are frequently of children who are covered in dirt and stricken with various medical issues. This leads many Westerners to believe that this is what every child from these nations look like. While this depiction may be accurate for a portion of the population, it is a very small portion. However, Operation Smile benefits from these inaccurate stereotypes. Some people are so overwhelmed with a compulsion to “save the poor children” that they donate to the organization. Though these donations are viewed as being good and selfless, they have the potential to cause more harm than good. The main reason donations are being made in the first place is because of the Western stereotypes that are continually prolonged in the media and in popular culture. Many of the donations to Operation Smile are made under the assumption that the citizens of those countries are uncivilized and need a “better” or “more civilized” life. 

A Higher Quality of Life?

With few rare exceptions, cleft lips and cleft palates come with little to no physical disability (“Gupta”). Cleft lips and cleft palates are repaired largely for cosmetic reasons. The belief of many involved with Operation Smile is that a “normal” appearance will leave a child more likely to succeed in life. Since cleft lips and palates are typically repaired before a child turns one, how can you possibly measure their potential to succeed? Children that young can barely walk, talk or even think by themselves, but they are given a surgery that permanently affects the course of their life. A child of that age cannot vocalize whether they want their defect fixed, so why does it continue to happen? The assumption of need. Western society holds the assumption that people in developing countries only need a few certain things to pick themselves up out of poverty and turn their lives around. However, things donated and provided to developing countries are often things that will not aid the long-term growth of a nation. Things like food and clothing may seem like a good short-term solution, but food will eventually run out and clothing will rip and become unwearable. Rather than donating supplies that will aid in the development of the country, people donate the things that they perceive to be needed. People end up confused as to why these countries are unable to grow despite the aid they receive, but developing countries are never asked what would be truly beneficial for development. Western culture often dominates what is considered “normal” in terms of appearance, so cleft lips and palates are repaired for this reason. Many parents of children born with this defect do not see anything wrong with their children, but organizations like Operation Smile come into their countries and convince parents to let their child have this surgery. Western countries view themselves as being the most advanced and developed, so therefore, they should know the most about what is considered right, good, and normal. Volunteers are compelled to donate their money and time because they want to show other people how they should live. Unfortunately, some medical volunteers use the opportunity to volunteer in another country as a resume booster. This is not true for all volunteers, but most people continue to support Operation Smile because it makes them feel good about themselves, not because they want to aid in the repair of a cleft lip or palate.

“Your Gift Can Change the Lives of Countless Children

The assumption of need in developing countries also drives people to continually donate sums of money to humanitarian organizations like Operation Smile. Operation Smile states, “As long as there are children in the world who need our help, we’ll do whatever it takes to give them the quality care they deserve” (“Why We Exist”). However, humanitarian medical organizations often exacerbate the extent of a certain disease or defect to ensure a continual flow of donations. When looking for donations, organizations will make an appeal to their audience’s emotions to raise more money. Operation Smile does this by continually showing photos of children with cleft lips and cleft palates. The intended outcome is that people will feel compelled to save the child and that they will donate to their cause, aiding in the continuation of the group’s interests. Though cleft lips and cleft palates are common birth defects, they still do not happen all that frequently. Throughout the world, cleft lips and palates occur in approximately one in every 700 live births (“Cleft Lip and Palate: Overview”). The inaccurate depiction of the prevalence of oral clefts has awarded Operation Smile a fairly large sum of money with which to operate their organization. The cost of operating an organization of this magnitude, especially one abroad, is very high, but people do not seem to take issue in donating to Operation Smile. While people are very eager to donate to an international organization like this, they are hesitant to donate to local groups and charities. Donating to humanitarian medical groups is viewed as both glamorous and selfless. The idea that your $15 donation could permanently change a Vietnamese child’s life is very enticing but using that $15 to buy groceries for the homeless in your hometown is looked down upon. American media bolsters the idea that everyone in America should be able to pick themselves up by their bootstraps and become successful regardless of their struggles. People who receive this type of aid in America are viewed as being lazy and unmotivated, but those in the same situations in foreign countries are not. Donating to a cause that will contribute to the development of a nation makes a person feel good. Repeat donors continue to donate to ensure they feel generous and selfless rather than donating because they truly want to make a difference.

Unintended Outcomes of Humanitarian Medicine

Despite children and adults receiving previously unavailable medical care, humanitarian medicine often creates more problems than it solves. In the article “Seven Sins of Humanitarian Medicine”, author David R. Welling states how medical missions are often skewed by politics, leave a large mess behind, travel where they are not wanted, and do the right things for the wrong reasons (Welling). Traveling to the far reaches of the planet can be problematic to both the volunteers and the recipients. Both parties are subjected to an unnecessary culture shock, but it especially affects those receiving the aid. The exposure to new technology and a different language can affect the care they receive. Also, some people may have never seen a doctor before, so they may not be able to provide the necessary information needed to form a correct diagnosis and treatment plan (Wolfberg). An error in patient care can be detrimental to the patient, but it can also tarnish the reputations of the doctors and organizations involved. When caring for a patient, it is vital that all medical professionals involved work together to avoid an incorrect diagnosis that could further harm a patient.

Assuming initial treatment goes smoothly enough, what happens if a patient suffers a complication later? Local surgeons in many areas frequented by Operation Smile have accused the organization’s doctors of abandoning the care of their patient at the end of their mission trip. Unfortunately, many doctors fail to ensure continuity of care for their patients. As there are few countries who have regulations in place to ensure continuity of care, many patients are left worse than they were before. To combat this, it would be more beneficial to travel with the intention of educating local doctors on how to better diagnose and treat their own patients. Treating patients for free also hinders the local economy. Why would someone pay for medical treatment when they can receive the same treatment for free? Operation Smile and other organizations take business away from local doctors. These doctors are often forced to find another source of income to support their lifestyle. Additionally, volunteer doctors often use treatments that are not readily available in the country they have traveled to, so this can make it hard or even impossible for a local doctor to treat a patient in the event of a complication. The departure of medical volunteers can lead to emotional and mental health issues, especially with children who receive treatment. Medical mission trips are not usually longer than two or three weeks, but during that time the volunteers and patients spend lots of time together while receiving treatment. The close proximity during treatment allows the patients to bond and form a close relationship. While a comforting relationship like this can be beneficial when a patient is recovering from surgery or other procedures, it can be equally as devastating at the end of the mission trip, especially for children. The kids receiving treatment get used to being cared for by these volunteers, so when they leave it can be especially hard. The revolving door of caretakers exposes these children to undue psychological trauma due to the repeat feelings of abandonment they are dealt. These abandonment issues in childhood can spiral into deep-seated relationship and trust issues as the child grows (Welling). Additionally, these children are at an even greater risk to have problems with depression and anxiety due to the inability to sustain healthy interpersonal relationships (Wolfberg).


The savior complex present in many Operation Smile volunteers, donors, and executives hinders developing countries from improving. This savior complex is driven by the assumption of need by Western countries, but how does the West know that aid is even needed in the first place? The people of the areas in which Operation Smile travel, rarely, if ever, come out and plead for their assistance. Humanitarian missions of this nature are an intrusion into the regular function of villages and towns. The forceful and rapid imposition of a foreign culture can be harmful to residents. Being pulled from an everyday routine can gravely affect a person’s mental state and put them at risk for greater challenges with depression and anxiety. Operation Smile works without malicious intentions–they provide free medical care to underprivileged children and adults in developing countries. However, it is my belief that the founders of Operation Smile did not truly think about the potential consequences of this endeavor. The dominating presence of Western culture throughout the world has influenced what is viewed as good and desirable. The West holds the idea that deformities must be corrected to be successful in life, so that is how the rest of the world has come to believe. After all, what parent doesn’t want the best life for their child?

This post may have been edited by admin for clarity and length.

Works Cited

“About Cleft Lip & Cleft Palate.” Operation Smile, Operation Smile, 2018, www.operationsmile.org/about-cleft-lip-and-cleft-palate.

“Cleft Lip and Palate: Overview.” Averican Speech-Language-Hearing Association, American Speech-Language-Hearing Association, 2018, www.asha.org/PRPSpecificTopic.aspx?folderid=8589942918.

Gupta, Rupal Christine. “Cleft Lip and Palate.” KidsHealth, The Nemours Foundation, Oct. 2014, kidshealth.org/en/parents/cleft-lip-palate.html.

“Mission Schedule.” Operation Smile, Operation Smile, 2018, www.operationsmile.org/content/mission-schedule.

“Our Story.” Operation Smile, Operation Smile, 2018, www.operationsmile.org/vision/our-story.

Welling, David R, et al. “Seven Sins of Humanitarian Medicine.” SpringerLink, Springer, Dordrecht, 9 Jan. 2010, link.springer.com/article/10.1007/s00268-009-0373-z.

“Why We Exist.” Operation Smile, Operation Smile, 2018, https://www.operationsmile.org/vision/why-we-exist.

Wolfberg, Adam J. “Volunteering Overseas – Lessons from Surgical Brigades.” New England Journal of Medicine, Oxford University Press, 2 Feb. 2006, www.nejm.org/doi/full/10.1056/NEJMp058220.

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