Tools of Healing

September 16, 2020 | Smile Train

If you walk to the back of any given hospital in a high-income country — past the waiting rooms, past the operating rooms, and past the offices - you will always find a van or truck filled with technicians. At any given time, these technicians will be busy at work repairing, sterilizing, and maintaining surgical tools for the surgical teams inside the hospital.

Medical device repair is a $50 billion industry. In high-income countries, the process is seamless and rarely affects the operating theater —  it’s a given that preventive maintenance is performed on all surgical sets.

Unfortunately, many treatment facilities in low- and middle-income countries don’t have the resources and training necessary to consistently maintain surgical equipment —  and this deeply impacts the quality and safety of surgeries for patients.

It was this inequity that inspired Keith Miles and Willie Miles, Jr. to create the Safe Surgery Initiative (SSI), an organization dedicated to building surgical capacity in developing countries by providing on-site evaluation and repair of surgical tools and medical equipment. The organization also provides training on the care, handling, sterilization, and inspection of surgical instruments for entire medical teams, from surgeons to support staff.

Keith Miles speaking with trainees

With a shared dedication to surgical safety and quality, Smile Train and SSI are joining forces to raise the quality and safety of surgery for patients with clefts —  and all patients who receive surgery at Smile Train partner hospitals.

In February of 2020, Smile Train and SSI launched a pilot initiative to further raise the standard of care at Philippine Band of Mercy, a long-standing Smile Train partner hospital. The SSI team worked with Smile Train surgical teams to perform preventative maintenance on instruments and provide training to ensure that they could, in future, easily identify equipment in need of repair.

The results were immediate. “We noticed considerable change in our surgical instruments after they were cleaned and refurbished; scissors were sharper, and their use extended. It is welcome maintenance work for our instruments,” says Dr. Edmund Mercado, a Smile Train partner plastic surgeon. 

“The partnership between Smile Train and SSI has allowed us to communicate with our partners about the importance of the proper maintenance of surgical instruments and its role in ensuring we provide safe and quality surgeries for the patients who depend on us," says Kimmy Coseteng-Flaviano, who serves as Smile Train Country Manager for the Philippines.  

Keith and trainees=

Based on the success of the pilot projects in the Philippines and Ethiopia, Smile Train and SSI are now embarking on a longer-term training project in Nigeria, where SSI Surgical Instrument Repair Technicians will provide a six-week in-depth training for surgical teams at six different Smile Train partner hospitals.

The participants will learn the latest methodologies of surgical instrument refurbishment, sterile processing techniques, and supply inventory and management. This multidisciplinary approach will give trainees a firm understanding on how to build best practices to improve safe surgical outcomes on multiple intervention points.

This training, and future trainings like it, will raise the already high standard of care at Smile Train partner hospitals — and will provide a better experience for providers, patients, and families alike. While the safety benefits of well-maintained equipment are self-evident, expertly maintained instruments also lessen the stress of surgery for patients and for their families in the waiting room.

Patient from Nigeria

“When instruments work better, this shortens operating time. This also translates to less time in the operating room for the child. For the parents, this means less stress from the waiting.” says Dr. Nikki Salvano-Valencia, a Smile Train partner plastic surgeon of 13 years.

For SSI and for Smile Train partners around the globe, the effort, and dedication of the trainers and trainees will be reflected where it matters most —  in the smiles of patients and families after a successful cleft surgery.


This piece was co-written with Keith Miles, co-founder of the Safe Surgery Initiative.