Opération Sourire - Activities Report

OPÉRATIONSOURIREACTIVITIESREPORT

›› BANGLADESH ›› BENIN ›› CAMBODIA›› MADAGASCAR ›› MALI ›› MONGOLIA ›› NIGER›› CHAD

Madagascar © Catherine Henriette

2009

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CONTENTS

// 3 Introduction

// 4 Opération Sourire’s mission:To rebuild faces and lives

// Objectives

// The Various Stages of Our Missions

// 7 Missions

// Bangladesh // Benin // Cambodia // Madagascar

// Mali // Mongolia // Niger // Chad

// 13 Map of Missions

// 14 Summary of the year

// Opération Sourire in a few facts and figures

// MdM France // MdM Germany // MdM Japan

// 18 Participants

// 19 Plans for Opération Sourire 2010

Madascascar©MdM

Madagascar©CatherineHenriette

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MÉDECINS DU MONDEOPÉRATION SOURIRE 2009

Opération Sourire celebrated its 20th anniversary in 2009.It continues to steadily grow, led and inspired by foundingmembers and new participants joining on every year.In 2009, MdM France, MdM Germany and MdM Japan treated873 patients, which, when added to those treated overthe previous years means that our teams of volunteers havegiven 7,000 people back their “smiles”.

New growth opportunities are opening up thanks to the trustthe L’Oréal Foundation has shown in us by funding the entiretyof MdM France’s activities. Embarking on new sites, improvingour training activities, strengthening our partnership with localorganisations… so many ideas, so many projects to develop…

INTRODUCTION

François Foussadier

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OPÉRATION SOURIRE’SMISSION: TO REBUILD FACESAND LIVES

Founded in 1989, the reconstructive sur-gery mission, Opération Sourire, celebra-ted is 20th anniversary in 2009. Establishedfor forgotten populations and in close collabo-ration with partners in Asia and Africa, thismission responds to the specific needs of phy-sically repairing faces, restoring the functio-ning of limbs or entire bodies.

Opération Sourire has a twofold objective:to carry out surgical operations and to trainnational staff.

The operations bring about dramatic impro-vement in the patients’ lives both physicallyand socially. They regain a normal face andthe use of their limbs. The physical restora-tion also enhances social integration for peo-ple who for the most part were living “in thedark”, hidden away because of their difference.

Training local staff and sharing techniquesholds a privilege place among all our missions.

The collaborative practical training is done byattending operations and then participating inthem. In the interim between MdM team tours,there is regular knowledge sharing with refe-rent surgeons on site in order to support themin their activities. As teams change, there isregular knowledge-sharing with on-site refe-rence surgeons in order to support these intheir activities.

In 2009, the Opération Sourire teams fromFrance, Germany and Japan carried out 22missions in 8 countries. Thanks to the dedi-cation and effort of 105 volunteers, 873patients were operated on. Thus, we havesucceeded in reaching a total of 7,493patientsoperated on since the creation of OpérationSourire. The number of operations is greatersince some patients require multiple operations.

Of the missions planned this year, four had tobe cancelled due to security reasons or theprofessional demands on surgeons.

This year, Doctors of the World participatedin the 54th Congress of Plastic Reconstructive

OBJECTIVES

Cambodia©CatherineHenriette

Mongolia©CatherineHenriette

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Made up of one or two surgeons, an anaes-thetist and a nurse, the Opération Sourireteams carry out short-term missions of 8 to 15days. Regular missions are organised at thesame intervention site over several consecu-tive years.

Local partners prepare patient recruitmentupstream in collaboration with the team leadsurgeons and by carrying out an initial triagebased on the medical conditions treated bythe Opération Sourire specialists.

THE VARIOUS STAGESOF OUR MISSIONS

and Aesthetic Surgery held in Paris from 23rd

to 25th November. The aim of this participa-tion was to publicise the Opération Sourireprogramme and to recruit specialists in orderto develop new missions. The MdM boothalso served as a place for Opération Souriresurgeons to meet. Furthermore, this event allo-wed for exchanges with organisations or hos-pitals conducting similar projects.

“This is the fifth time I’ve worked with theMdM team and with the anaesthetistAnne-Marie. I observe and I try toremember as much as possible. I learnedhow to use new equipment: how a syringepump works for pain relief, how to adjustthe monitor ... I also learned the dosagesof new drugs, how to calculate doses ...And our surgeons have made progress,they no longer handle all the mission’s

major operations, the schedule is lessbusy and with medication and equipmenttwice a year, working conditions are easier.We’re always very happy to work with theFrench team; we would like them to behere as often as possible.”

Otran,Nurse anaesthetist,Ulaanbaatar

( Continued on page 6 )

Mongolia©CatherineHenriette

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Recruitment is finalised after consultation withthe local team, usually on the first day of theirarrival.

Medicines and medical equipment.The Opération Sourire teams operate by adap-ting to local conditions and therefore by usingthe technical equipment of the host hospitals’surgical units. Some devices essential for theproper performance of the operations (e.g.diathermy, surgical light etc.) are given to thesehospitals. A stock of surgical kits and otherdevices are available at the MdM headquartersand sent out to the missions. Medical pro-ducts and medicines necessary for the ope-rations and post-operative care are purcha-sed by the MdM logistics department and thentransported by freight or sent along with theteams. Some products can be purchasedlocally in countries with EU-approved centralpurchasing bodies.

Products not used during the missions aregiven to our partner hospitals to treat patientsin need. MdM also provides for additional testswhen patients come in for their normalcheckups.

Consultation and schedule of operations.The missions normally begin with a half-day ofconsultations with those present. A scheduleof operations is drawn up based on the casesidentified in advance for surgical procedures.The operations are carried out at regular inter-

vals; all patients operated on are visited at theend of each workday.

Throughout themissions, the Opération Sou-rire and local teams work jointly. In addition tothe exchange of practices and paired training,theoretical training sessions are also providedby Opération Sourire professionals.

Post-operative care for patients during orafter the missions is provided by localdoctors. Complex cases receive “remote”support (i.e. off-site) from Opération Souriresurgeons. Subsequent visiting programmeteams follow up with patients with patholo-gies requiring consecutive missions.

Niger©CatherineHenriette

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From 27th February to 5th Marchand from 4th - 10th December

Launched in 2008, the surgical missions inBangladesh have been carried out by aFranco-Japanese team, which visits the hos-pital in Dhaka twice a year. In 2009, 84 patientshave been operated on.

BANGLADESH

From 3rd to 10th January

A six-person Opération Sourire team wentto the Saint-Jean de Dieu hospital of Tanguietawhere it has been carrying out missions since1999. This action was carried out in partner-ship with the Development Assistance Com-mittee of Benin (CAEB in its French acronym),which is in charge of information and recruitmentof patients and postoperative monitoring.

The team saw 42 in consultation and ope-rated on 36 patients. The main pathologyoperated on in this country was cleft lip/palates,which represented 53% of the cases. Therewere also a significant number of cases ofburns (17%) and of keloids.

BENIN MOUBARAKA’S STORY TOLD

BY DR DE MORTILLET

In this village in Benin, children born withcleft lip/palate are considered childsorcerers; they are thought to be theresult of a curse on the family. Legendhas it that this family must have madecertain mistakes in the past for which ithas been punished. Child sorcerers areusually sacrificed and this was what hadbeen decided for Moubaraka. Theceremonies by the river were held oneevening and the child was meant to bethrown into the water the next day.

Her young mother courageously refusedthe fate intended for her child and shefled, finding refuge with some membersof the CAEB organisation. This is how thesocial workers took in Moubaraka andher mother and asked me to operate on

her as part of an Opération Souriremission.

After three operations carried outbetween 2002 and 2009, her congenitaldefect was completely treated. I lookforward to seeing Moubaraka a bit lateron to see how she's come along, asmuch physically as psychologically.

MISSIONS

Moubaraka after the operation

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Médecins du Monde has been involved inCambodia since 1989, chiefly to operate onfacial deformities. Over the years the objec-tives of the mission have evolved, particularlyin terms of diversification of pathologies trea-ted and training local staff. In 2009, seven mis-sions were carried out as follows:• MdM Germany: from 14 to 28 March, from26 June to 11 July and from 21 November to6 December• MdM Japan: from 31 May to 13 June andfrom 15 to 25 December• MdM France: from 18 to 21 March; from 18June to 28 July and from 21 November to 5December

Since 2004, MdMFrance has been develo-ping a new training course on treatment ofmeningoencephalocele cases that combinesthe expertise of a maxillofacial surgeon and aneurosurgeon.

The Junemission saw the culmination of awonderful collaboration of Cambodian andFrench surgeons:Dr Ngiep defended his doc-

CAMBODIA

toral thesis in medicine, completed under thedirection of Dr Frank Roux, which was unani-mously approved with high honours. “This isthe culmination of so much investment, itmakes our educational work with Cambodiandoctors palpable”, explained Frédéric Lau-wers, director for this mission. To the twoannual missions coordinated by Dr Lauwerswas added that of Dr Micheau. A foundingsurgeon of the Cambodia mission, he hasbeen very involved in mission planning andfollow-up after their departure. Present twoweeks before the arrival of the surgical team,he met the partner hospitals or other facilities(faculties of medicine, organisations etc.) inte-rested in reconstructive surgery. Dr Micheaualso performs an initial triage of the patients,operates or assists local surgeons with com-plex cases. As he knows this country so well,he is also responsible for exploration of newsites (Pursat, Païling, Mongolborey etc.).

In total, 425 patients were operated on inCambodia.

When Nuon Lok was born,everyone urged me to go to thehospital. I didn’t want to. It was amobile team of doctors who travelfrom village to village who talked tome about the opportunity of havingmy daughter operated on byFrench surgeons. So I came. Afterthe operation, Nuon Lok is doingwell. She is tired but I know she isgoing to get back to having anormal life and most importantlyI’m going to send her to school!

›› Meningoceles, encephaloceleand meningo-encephalocele

This is a deformity in the vault ofthe skull, with a hernia of themeninges, of the brain tissue orboth. It is common in South EastAsia. The causes of the diseaseare difficult to identify due to alack of means for conducting

large-scale epidemiologicalstudies. In the so-calleddeveloped countries, it hasvirtually disappeared, so fewresearchers are interested in it.One cause could be a toxin thatdevelops during the hot andhumid months in rice that’s beenstored in a poorly ventilated areafor a long time.

Nuon Lok, 2 years old, operated on formeningoencephalocele and her mother

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This year fourmissionswere carried out inMadagascar: three to the hospital in Antana-narivo (20-26 April, 7-16 August, 2-8 Novem-ber) and one to Diego (15-24 October); 108patients were treated.

The two reconstructive surgery missionsat Antananarivo andDiegomade it possiblefor 70 patients to be operated on; the primarypathology being a cleft. The Antananarivo mis-sion was carried out by a team from Paris;that for Diego by a team from Clermont-Fer-rand. Follow-up of patients operated on duringthese missions was performed by three Mala-gasy surgeons. Organisation of the local mis-

MADAGASCAR›› Hirschsprung’s disease

It occurs during pregnancy andresults in an embryologicaldeformity that affects the colon,the sigmoid or the rectum. Itaffects one birth in 5,000, mostlyboys. The disease is treated bysurgery that removes the segmentof bowel without ganglion cells,then reconnecting the healthycolon over this segment to theanus.

sions was managed by a medical coordinatorbased in Antananarivo.

During the Diego mission, the number ofpatients almost doubled compared to pre-vious missions, with 85 patients seen in consul-tation. This increase is mainly due to the expan-sion of the area of communication even inremote areas. In addition, the provision of tra-vel expenses for indigent patients has encou-raged these people to travel for the surgicalprocedures.

As part of the paediatric gastroenterologi-cal surgery project launched in 2005, a team

from Reunion Island visits the university hos-pital of Antananarivo twice a year. The patientsare mostly children; 38 were operated on in2009. Thepathologymost oftenoperatedonbeing Hirschsprung's disease.

The MdM team is treating increasingly heavycases of visceral diseases compared to thoseof the initial missions. Despite the skills of oursurgeons, the measures taken during the mis-sions in the hospital are limited due to a lackof essential equipment. Some patients weretransferred to Reunion Island to be operated on.

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From 24 April to 4May and 9 to 17October

For eight years now, the Burn and Recons-truction Surgery Clinic in Ulaanbaatar has beenreceiving an Opération Sourire team twice ayear. The area of specialisation of the Mon-golia mission is reconstructive surgery ofsevereburns. Other trauma and scarring after-effects, which have gone untreated for monthsor even years, are operated on here. In total,68 patients were operated on during two mis-sions conducted in Ulaanbaatar.

MONGOLIA

From 12 February to 21 March

The only orthopaedicmission of OpérationSourire, the Mali programme carried out by ateam of two to three people and for a longerterm than other missions (approximately sixweeks). Learning by “shadowing”, the Maliansurgeons are trained in collaborative surgicalprocedures. Each patient is presented by aMalian surgeon called a “referent”. This refe-rent will have seen the patient in consultation,he operates or participates in the operationswith the Opération Sourire surgeon and pro-vides post-operative follow-up. Maintaininghigh hygienic standards is essential for thesesurgical procedures. Our team with fellow sur-geons, anaesthetists and operating unit staffhas established a checklist that must be vali-dated before each operation.

MALI

During the February mission, 71 patientswere seen in consultation and 25 caseswere operated on, 10 of which were hip repla-cements. Before now, patients needing thissurgery had been sent abroad. Operating onthem locally represents a significant savingsfor the Malian government. As a result, healthauthorities are very supportive of the conti-nued prosthetic surgery and of trauma sur-geons teaching the relevant techniques. Threeoperating units have been equipped since2004.

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r

-na-fr-s,-

The main causes of theburn after-effects operatedon are from householdaccidents, very common inMongolia: many families livein yurts, where the stoveused to heat and cook is onthe floor. The cold,

aggravated by numbingalcoholism, is also asignificant vector foraccidents and frostbite:there are twice as manypatients in winter than insummer.

"In every country in the world,treatment for burns is a bit like thelast--and least important--wheelon the cart. When we arrived therewas practically nothing at the burninjuries hospital. You can’t ask themedical and paramedical staffs todo in a few years what we’vedone in a century. It’s changingslowly, but that’s good. In a fewyears they will be independent formost of the operations”.

Didier GuinardDirector, Mongolia mission

›› A gangrenous infection, noma is afatal disease for 90% of all cases. Themost affected are children under sixliving in extreme poverty and sufferingfrom malnutrition. If the disease isdetected early, its progression can beprevented by antibiotic treatment, abalanced diet, and a few simple rules oforal hygiene. If, as happens in themajority of cases, the disease is nottreated, the ulcer spreads rapidly andpainfully: the cheeks and lips swell andthe progress of the gangrene isestablished. Deep lesions can quicklydevelop, destroying part of the face andsometimes involving ankylosis of the jawand preventing eating.

From 6 to 16 Februaryand from 6 to 16 November

Since 1993, regular missions were organisedto the national hospital of Niamey in partner-ship with the Sentinelle organisation in orderto treat the after-effects of noma, but also ofclefts and of burns. In 2009, 69 patients weretreated.

Surgical procedures for the after-effectsnoma are part of an academic work initiatedand coordinated by Professor Jean-Marie Ser-vant. Several operations are needed for thereconstruction of the face. Each case is listedand monitored. For some patients, samples arebrought back to France and analysed at theSaint Louis hospital in order to conduct furthertesting.

NIGER

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From 21 to 28 Februaryand from 6 to 14 November

The missions in Chad began in 1999 at thegeneral referral hospital in N’Djamena, but theirfrequency depends on the political and secu-rity situation of the country. Due to the irregu-larity of the missions, local staff cannot be pro-vided with regular training.

This year twomissionswere organised. Theteam operated on clefts in particular, 47% ofthe surgical procedures, but also on tumoursand cysts. A total of 58 patients were opera-ted on.

CHAD

›› The cleft lip and palate or “hare lip”is a deformity of embryonic origin ofthe upper lip and palate. Between the35th and the 40th day of pregnancy,two parts, called buds (or arches),unite: the maxillary bud forms thecheek and the lateral part of theupper lip and the nasofrontal budforms the nose and forehead. Thesetwo buds must fuse to create aharmonious face, otherwise, a cleft isformed. This deformity, also known asa harelip, affects about one in 500newborns. In developing countriesthe incidence is approximately the

same as in Europe. The cleft lip andpalate can be isolated or associated,totally or partially, from one side orboth. If the cleft is not treated, severalcomplications arise such asrespiratory problems, difficulty infeeding, difficulty in hearing, frequentear infections and speech disorders.The treatment is exclusively surgical.In Europe, before the age of 6months, we correct the lip, the velumpalatinum (soft palate) and the nose.A bit later it is possible to operate onthe palate. Intrauterine surgery issometimes possible. Some cases

require subsequent small re-operations. As it is not life-threatening, this type of deformity isseldom operated on or not at all indeveloping countries.

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Abakar, 10 years old. Single bilateral cleft lip

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MISSIONS MAP

Benin

NigerMali

Madagascar

Chad

Bangladesh

Cambodia

Mongolia

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SUMMARY OF THE YEAR 2009

Most people operated on have beenyoung people under 30 years of age(76%) (Graph 1). Among these, 39%are children several months old to 10

Graph 1Age of patients operated on

Graph 2Gender of patients operated on

39 %

0-10 years

21 %

11-20 years

16 %

21-30 years

9 %

31-40 years

7 %41-50 years

5 %

51-60 years

2 %

61-70 years

1 %

+ de 70 years

46 %

Female Male

54 %

Graph 3Number of patients by country

Regarding the proportion of the num-ber of patients by country,we saw thatCambodia had the highest number with49% of the total number of people ope-rated on (Graph 3). As the first countrywith an Opération Sourire programme,Cambodia today received seven mis-sions annually, carried out by teams fromFrance, Germany and Japan. Similarly,in Madagascar, the significant numberof cases is due to the four missions thatMdM France organises every year.

This year, females represented 46% ofpatients operated on and males 54%(Graph 2).

In 2009, 873 patients were operated on, of which 515 patients by teams from MDM

France, 210 by teams from MDM Germany and 148 by the teams from Japan.

years. There are also patients aged bet-ween 30 and 50 years old (16%) andseveral cases being over 50 years old.

Cambodia49%

Madagascar12%

Bangladesh9%

Niger8%

Mongolia8%

Chad7%

Benin4%

Mali3%

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Pathologies Cambodia Madagascar Bangladesh Niger Mongolia Chad Benin Mali Total Total (en%)

Cleft lips and/ 62 48 16 30 0 27 19 0 202 23 %or palates

Burns 28 10 13 13 45 5 6 0 120 14 %

Deformities 53 1 31 0 0 0 2 0 87 10 %

Tumours 61 0 7 2 0 10 1 0 81 9 %

Cysts and lipomas 55 0 1 0 0 7 0 0 63 7 %

Gastroenterological 0 38 0 0 0 0 0 0 38 5 %surgery

Orthopaedic surgery 9 0 0 0 2 0 0 25 36 4 %

Trauma injuries 17 0 2 6 7 3 0 0 35 4 %

Meningoceles 19 0 0 0 0 0 0 0 19 2 %

Noma 1 0 0 16 0 2 0 0 19 2 %

Keloids 4 9 0 0 0 1 2 0 16 2 %

Other 116 2 14 2 14 3 6 0 157 18 %

Total 425 108 84 69 68 58 36 25 873 100 %

Table 1Pathologies by country

Themost commonpathologywas cleft lipsand/or palates with 23% of the total num-ber of operations carried out (Table 1). Thispathology was furthermore treated in six ofthe eight programme countries. Followingthese were after-effects of burns (14%), defor-mities (10%) and tumours (9%). Cysts andlipomas operated on particularly by the Ger-

man and Japanese teams represented 7% ofthe total number of patients operated on andthe cases of gastroenterological surgery, ope-rated on exclusively in Madagascar, represen-ted 5%. Less numerous but more complexwere programmes against meningoceles andafter-effects of noma (2%).

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The MdM France teams operated on 515patients in 15missions. An exploratory mis-sion was carried out in Armenia from 29 Augustto 2 September in order to assess the needsfor treatment for after-effects of burn injuries.The results of this mission demonstrated thecompetence of the local medical staff and itsability to meet the demands placed on it. In factthere is no plan to open a mission here.

MDM FRANCE

Pathologies Benin Cambodia Madagascar Mali Mongolia Niger Chad Total Total (en%)

Cleft lips and/or palates 19 23 48 0 0 30 27 147 29 %

Burns 6 20 10 0 45 13 5 99 19 %

Tumours 1 25 0 0 0 2 10 38 7 %

Gastroenterological 0 0 38 0 0 0 0 38 7 %surgery

Orthopaedic surgery 0 8 0 25 2 0 0 35 7 %

Trauma injuries 0 6 0 0 7 6 3 22 4 %

Noma 0 0 0 0 0 16 2 18 4 %

Deformities 2 13 1 0 0 0 0 16 3 %

Meningoceles 0 16 0 0 0 0 0 16 3 %

Keloids 2 0 9 0 0 0 1 12 2 %

Kystes et Lipomes 0 0 0 0 0 0 7 7 1 %

Other 6 40 2 0 14 2 3 67 14 %

Total 36 151 108 25 68 69 58 515 100 %

Table 2Pathologies operated on by country

As the table below shows, 29%of all caseswere cleft lip/palate; the country with thegreatest number of these is Madagascar. Then,after-effects of burn injuries, particularly ope-rated on in Mongolia, representing 19% of thetotal number of surgical procedures. Casesof tumours, gastroenterological and orthopae-dic surgery were all treated in equal propor-tions, that is, in 7% of the surgical procedures.

Complex pathologies requiring several ope-rations, such as the after-effects of noma andmeningoceles, were operated on in Niger andCambodia. Besides these priority pathologies,several cases of keloids, cysts, snakebites,ankylosis etc. were operated on in eachmission.

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This year, MdM Germany organised threemissions inCambodia. These missions madeit possible to operate on 210 people presen-ting cysts and lipomas (20%), cleft lip/palates(14%), tumours (13%) or deformities (10%).

MDM GERMANY

The MdM Japan teams operated on 148patients in fourmissions carriedout inCam-bodia and Bangladesh. The most commonpathologies were deformities (35%), followedby cleft lip/palates (18%) and then tumours(10%). After-effects of burns and cysts andlipomas were also treated.

MDM JAPAN

Pathologies Number Total %of patients

Cysts and lipomas 43 20 %Cleft lips and/or palates 29 14 %Tumours 28 13 %Deformities 20 10 %Trauma injuries 11 5 %Burns 7 3 %Keloids 4 2 %Meningoceles 3 1 %Other 65 32 %Total 210 100 %

Table 3Number of patients by pathology

Pathologies Number Total %of patients

Deformities 51 35 %Cleft lips and/or palates 26 18 %Tumours 15 10 %Burns 14 9 %Cysts and lipomas 13 9 %Trauma injuries 2 1 %Other 27 18 %Total 148 100 %

Table 4Number of patients by pathology

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PARTICIPANTS

Bahe LaurentBarabas JozsefBarcat EmmanuelBataille BenoîtBathelemy IsabelleBeaujard HélèneBeauval AgnèsBerg-Börner Britt-IsabelleBrusset Marie-ClaireCaptier GuillaumeCataldo DanielChâteau FrançoisCollin Jean-FrançoisCrenn RollandDe Mortillet StéphaneDe Rouvray ThibaultDekoleadenu PeterDjonga OuangbiDobremez EricDos Santos SéverineEvano FrançoiseFauché PauletteFourcade LaurentFoussadier FrançoisGay AndréGouvet Anne-MarieGuinard DidierHanusch JoergHarada MasakoHarper Luke

Heindl WalterHonda TakayukiHuber BertrandIngallina FabioIshihara MegumiJacob AlainJames SophieJoly BrunoJosbé AlainJürgens PhilippKlumpp FabianKramer FlorianLacombe PascaleLandru JérômeLauer GünterLaure BorisLauwers FredéricLiguori AnneLuce JohanMahieu GérardMartinaud CatherineMartineau MarieMatéo GérardMaurin SophieMayer Marie-NoëlleMicheau PhilippeMiyao YoichiMoellendorf InesMole BernardMompeyssin Bruno

Monteil Jean-PaulMorioka DaichiMüller AnnettMüller SteffenNguyen LucOussmane Issa ElhadjiOtsubo NorikoOura NorihikoPage Jean-PhilippePhilandrianos CécilePinzer ThomasPochet FrançoisPoussain CatherineRapidel JeanRaulo YvonRoux RobertRoux FranckSam AuteurSandorfi YolandeSchwenzer-Zimmerer KatjaSerein AgnèsServant Jean-MarieSiebold MarthaSimonnet SylvieSirakanyan ArmenakSmail NadiaSoum RathaSterckx BernadetteTerashima SawakoThomas Dominique

Tissedre JeanineTougloh AyayiTouré AbdoulWvatt BonVilain GabriellaVitkovitch StéphanieVoulliaume DelphineWatcher KlausWilliger BabettYamada NobuyukiYoza SatoshiZimmerer Stephan

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COORDINATOR:HÉLÈNE VALLS

EDITOR:LAVINIA ILIÉ

IMAGE SELECTION:AURORE VOETLAVINIA ILIÉ

GRAPHIC DESIGN:ISABELLE MARTIJA-OCHOA

THANKS TO:GISÈLE LEMIERRE,DOMINIQUE PESSOTTI,NAO KUROYANAGI,HILKE SCHNEIDER,NIVO RAMAMONJISOA

PLANS FOR OPÉRATIONSOURIRE 2010

Weare going to continue to pursue the pro-grammes we led in 2009- i.e., 25 missions in eight countries:Bangladesh, Benin, Cambodia, Madagascar,Mali, Mongolia, Niger, Chad.

However,wewill focus equally on twoaxes:- Exploration of new sites of intervention andthe reopening of the mission in Pakistan.- Consolidation of some projects through deve-loping activities with local partners: for exam-ple, in Cambodia, where local practitionerswere trained over 20 years ago in treating cleftlips/palates, there is thought about a projectthat would help them toward greater auto-nomy.

Wealso plan to step up recruitment efforts:- by opening recruitment for medical teamsvia MdM United Kingdom and MdM Nether-lands, organisations from the Doctors of theWorld international network.- and by pursuing communication and sha-ring activities (participation in surgery con-gresses etc.)

Madagascar © MdM

Médecins du Monde/Doctors of the World62 rue Marcadet 75 018 Pariswww.medecinsdumonde.org

Tel. +33 01 44 92 15 15Fax. +33 01 44 92 99 99

Opération SourireLavinia IliéTel. +33 01 44 92 14 09

Opération Sourire - Activities Report

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