Three-year-old boy’s life-transforming surgery on hospital ship leaves neighbours stunned and smiling

When Roseline gave birth to her son, Armane, no one in her Madagascan village had ever seen a cleft lip before. The condition occurs when the lip doesn’t form fully in the womb, leaving a gap. It left baby Armane struggling to eat, speak, and be accepted.

“When I finally saw him, I kissed him and cried,” said Roseline. “I was worried. People in the village said he was cursed, not human.”

Globally, an estimated 4.1 million people live with orofacial clefts, contributing to more than 400,000 lost disability-adjustment life years (DALYs). According to a study published by the Global Burden of Disease Study 2021, most of the children affected live in low-and middle-income countries.

In countries like the UK, babies with cleft lip are diagnosed before birth and receive corrective surgery within the first three months of life. But in low-income countries, access to safe, affordable surgery remains out of reach for millions of families.

For babies born with cleft lip and palate in these regions, the consequences can be life-threatening. Parents struggle to feed their infants successfully, leading to malnutrition and, in some cases, death. Cleft lip and palate is the most common facial birth defect, affecting one in 700 of all live births worldwide. 

​​In Madagascar, Roseline tried everything she could: “He was very weak; we had to give him vitamins, and he struggled to speak too.”

In the countries where the international Christian healthcare charity, Mercy Ships, operates, surgical treatment for these conditions is often unattainable. Infants fortunate enough to receive surgery through the hospital ship frequently first join Mercy Ships’ Infant Feeding Programme to gain the strength needed for life-changing treatment. Here, babies facing severe malnutrition receive the nutritional support they need to become strong enough for surgery. These interventions offer the opportunity for a healthy beginning and a hopeful future.

For the now three-year-old Armane, he undertook a four-day journey to the Africa Mercy to discover that he was able to receive the life-transforming surgery. 

“This is a surgery that takes just one hour, but changes everything,” said Mercy Ships volunteer nurse Mollie Felder, who cared for Armane after his operation. “It’s not just about appearance, it’s about dignity, confidence and being seen.”

Armane’s recovery was smooth. And when he returned to his village, his transformation left neighbours stunned.

“Many people came to see him,” said Roseline. “They couldn’t believe it. They had thought this couldn’t be fixed.” When Armane’s father first saw him, he held him in his arms and kissed him. “My worry is gone from now on,” he said with relief.

For Roseline and her husband, the surgery didn’t just restore their son’s face; it restored their hope. Once surrounded by shame and whispers, Armane is now surrounded by love, smiles, and a future full of promise.

“I’m so happy, so happy,” says Roseline, her eyes shining. “My son will no longer be mocked. He will always be loved.”

Strengthening Healthcare with Operation Smile for Future Generations

In addition to completing thousands of urgent operations on board the hospital ships, Mercy Ships volunteers work closely with host nations to improve the delivery of healthcare across African nations by training and mentoring local medical staff, as well as renovating hospitals and clinics.

In 2024, as the Africa Mercy continued to offer direct medical services in Madagascar, Mercy Ships and NGO Operation Smile collaborated to train and mentor local health professionals in comprehensive cleft care. Together with the Malagasy government and through Mercy Ships’ Education, Training and Advocacy programme, Malagasy surgeons, anaesthetists, nurses providing nutrition and speech therapy, and a dentist – volunteering in the country with Operation Smile – came on board for specialised training. 

Malagasy Paediatric Surgeon and Professor Romain Raherison has devoted his career to performing surgeries in Madagascar’s capital and remote parts of the country as a volunteer with NGOs like Operation Smile.

Yet, he remains acutely aware of the gaps in the system. “We don’t have enough Malagasy surgeons who can really master cleft lip and palate surgery,” he said, highlighting one of the challenges confronting the healthcare system.

On board the Africa Mercy, Professor Romain joined Mercy Ships volunteer surgeons in the operating theatre – picking up new techniques to elevate his practice.

Building Comprehensive Cleft Care in Madagascar

Mercy Ships’ on board training also encompasses essential aspects of cleft care like nutrition, speech therapy, and dentistry. 

Paediatric Nurse and Nutritionist Nivoharilala Niry Rakotoarimanana was part of the training. She’s passionate about finding solutions to reduce malnutrition in Malagasy children, particularly children with cleft lip and palate.

While working alongside volunteer nutritionists on board the Africa Mercy, Niry learned how to support patients with proper nutrition before and after surgery.

“Since I have been here, I’ve learnt many things,’ says Niry. “For us, to ‘share smiles’ means restoring patients’ smiles so that they can be whole again and go back to their communities.”

In the last year, Mercy Ships’ Education, Training and Advocacy programme has provided over 150,000 hours of healthcare training to over 900 healthcare professionals.

To find out more about Mercy Ships, visit mercyships.org.uk