top of page
  • Fletcher Security Review

Being Senior Management in Global NGO - A Conversation with Chris Cruz

March 31, 2016 | Interviewed by FSR Staff

Could you explain your role as Senior Vice President at Operation Smile?

I have oversight of the planning and execution of our international programs which includes over 160 medical and education missions every year, as well as the many country specific initiatives that are ongoing at any given time. I’m also responsible for volunteer management, education, and training for Operation Smile. We have over 5,000 medical volunteers from over 80 countries that help us to execute our missions. I have the great pleasure of leading our Program Coordinators who are key to the successful execution of our missions. They work hard on the many mission details such as team composition, equipment and supplies, flights, lodging, visas, temporary medical licensure, budgets, and the overall care and feeding of the volunteers and the many patients we seek to treat. The patient management and patient recruitment piece is an incredibly important part of what we do. Security is another area of great importance. Recent events in Brussels and Paris remind us that we live in a very different world today. Our Program Officers and Desk Officers focus their attention on specific program countries. By working closely with our country foundations and representative offices, they ensure that our global strategy and vision is being properly executed. Although we try to reach as many children as possible, we always have to perform with the highest degree of safety and quality. That’s where our Global Standards of Care come into play. Because of these standards, our mortality and morbidity rates outrank the best hospitals in the U.S. and other countries. These standards allow us to execute quality medical care on each and every mission.

We also operate several care centers around the world - 26 centers in 18 countries. These medical facilities allow us to address the comprehensive needs related to cleft care such as speech therapy, dental, orthodontics, and even family counseling to address the psychological components associated with cleft lip, cleft palate, and facial deformities. While we’re best known for our work with cleft lip and cleft palate, we do significant activity beyond cleft care. Operation Smile envisions a world where every person has access to safe, well-timed, and effective surgery. A staggering statistic that resonates with Operation Smile is that two billion people worldwide lack access to surgical care. This lack of access to surgery accounts for one-quarter of the world’s death and disability. Our efforts to improve access are in alignment with the newly adopted United Nations’ Sustainable Development Goals. A compelling point with the access issue is that more people die each year from lack of access to surgical care than from HIV/AIDS, tuberculosis, and malaria combined. We have to change this. I’m proud of the fact that Operation Smile is taking on this lofty challenge.

Have you had an opportunity yet to participate in or observe any of these medical missions?

Yes, I have. I participated in missions in Madagascar and Nicaragua and I also observed my first cleft lip surgery at the cleft care center in Bogota, Colombia. Despite having seen many different things in my Navy career, going on that very first mission and seeing first-hand the impact of what we do, of lives changing right before my eyes - it’s a very emotional thing. Actually witnessing a surgery and then the reactions when you bring the child back to their parents following the surgery - seeing their child’s new face for the first time and immediately bursting into tears of joy and happiness - it’s incredibly impactful and unlike anything I’ve ever been a part of. It’s hard not to be overwhelmed by these special moments. 

You’ve taken an unconventional path to your current position. Can you speak on how your long career with the Navy prepared you for your work with Operation Smile, and the international focus of your particular position?

After 9/11, one of the big takeaways was that the Department of Defense had to work and communicate much better with the other government agencies. The Department of Defense has to be talking with the Department of State, law enforcement agencies, and the various intelligence agencies. There were some significant lessons learned. Admiral Stavridis was instrumental to making progress in this area. When he was the commander of U.S. Southern Command, he stressed the importance of the interagency and public-private collaboration. That’s really where I began my work in earnest with the NGO community. At U.S. Southern Command, I was the NGO Engagement Chief where I led all of the NGO collaboration for South America, Central America, and the Caribbean. Humanitarian assistance, disaster response, port resiliency, education, sustainment, development, and information sharing were areas that NGOs showed interest in working together with the U.S. military. One of the things that became very clear was that we could do so much more by partnering not only with NGOs, but with private businesses and academic institutions as well. The military has taken significant steps in the interagency and public-private arena, thanks to visionaries like Admiral Stavridis. One specific change was the reorganization of U.S. Southern Command. Part of this reorganization was the creation of the new J9 Partnering Directorate. This is where I was assigned. One of my major initiatives was the U.S. Navy’s hospital ship mission. The USNS Comfort deployed to 11 countries in the span of six months, providing medical services to many in need. At any given time, there were 100-plus civilian NGO volunteers onboard the ship working side-by-side with U.S. Navy doctors and other medical personnel. In concert with the ship’s staff, I helped to coordinate the NGO volunteers for this mission. One of those NGOs was Operation Smile. The Operation Smile and Navy team were able to help many people during that deployment. Operation Smile participated in a similar mission onboard the USNS Mercy, the hospital ship assigned to Pacific Command. I was really impressed with Operation Smile, not only with the civilian-military cooperation, but their leadership, strategic vision, mission, long term planning, and the fact that they strive to do great things. Visiting the Operation Smile Headquarters in Virginia Beach was highly impactful as well. One thing led to another, and I’m happy to report that the transition from the military to Operation Smile has been great.

It is sometimes common for students and scholars in the fields of international security and national security to narrowly define the role that NGOs play in the process of ensuring security and stability around the world. In your opinion, what role do you think the non-profit sector plays in security and stability?

Now that I’ve seen both sides—the military and the NGO world – it’s my personal opinion that there is access, influence, and visibility that NGOs possess that the Department of Defense and other U.S. Government agencies will have difficulty obtaining. Because of the principles of neutrality, impartiality, and independence that are foundational to many NGOs, they’re able to rally people behind a cause and affect situations that other entities cannot. For example, when it comes to taking care of children, people can get behind that despite differences in race, religion, nationality, politics, or other beliefs. These potentially divisive differences evaporate when people are focused on the humanitarian task of goodwill towards children in need. Operation Smile has multiple examples of this positive cohesion. In the late 80s, tensions were high between the U.S. and Vietnam. A major priority for President Reagan was returning the remains of those missing in action back home to their families. Despite many efforts, there was little progress made in repatriating the remains of U.S. POWs from Vietnam. That is, until President Reagan and General Vessey (former Chairman of the Joint Chiefs of Staff) helped pave the way for the first Operation Smile medical mission in Vietnam in 1989. Three months after that first mission, the missing in action began coming home to the U.S. This historic medical mission opened the doors to normalization when so many other attempts failed. Other examples include medical missions in FARC-controlled territory in Colombia and Gaza, Palestine even when tensions were high in these two areas. It’s that ability to bring people to the table with the primary focus of helping children. In countries like North Korea and Cuba, I believe opportunities exist to improve relations through humanitarian actions, whether it’s through Operation Smile or other organizations. I think it’s something we should look at very closely. When you consider the lack of real progress that has been made with countries like Cuba or North Korea, why not try a new approach? We’ve seen how Operation Smile can be a catalyst in helping entire communities and even nations improve relations. I think this approach is something to consider with other countries. Even if country relations weren’t improved, at the very least, we would’ve taken care of some children in need.

What are some of your longer term goals at Operation Smile?

The main goal is to improve access to surgical care around the world. Two billion people lack access to surgical care. So what does that even mean? In the field, we see many things, and unfortunately, not all of them are good. During one mission, a bad accident resulted in a severe injury to a man’s leg. On the same mission, a caesarean-section became complicated. Both of these cases were separate from the Operation Smile mission but co-located at the same hospital. I’d like to say that both cases had positive outcomes, but unfortunately, I can’t because this hospital - like many other hospitals in resource-poor environments - did not possess the infrastructure, equipment, or personnel needed to conduct safe surgery. My two children were both born via caesarean-section. This common procedure and many other surgeries happen every single day in the U.S. And yet all around the world, billions of people suffer and die from afflictions that could’ve easily been treated, if only they had the access to surgical care. People make the false assumption that surgery is an expensive luxury available only to the rich. It’s not a luxury – it’s a necessity. And so that’s one of our goals, that we positively impact access to safe surgery in a significant way in the coming years. We have specific plans to increase surgical capacity in with some of our program countries. It won’t be easy, but these efforts will help to improve the entire healthcare systems of these countries, and it may even serve as a model to be replicated in other countries.

One of the contributing factors to the lack of access is the paucity of qualified health workers. As an example, in the Democratic Republic of the Congo, there are only 60 surgeons for a country with 70 million people. Because of numbers like these, we’re looking at task-shifting and task-sharing concepts in order to increase the capacity of healthcare professionals. Task-shifting encompasses things like nurses conducting anesthesia work. As part of this effort, we would seek to implement a training program that produces surgical technicians that are able to perform basic yet life-saving procedures. Especially in areas where there is next to nothing as far as surgical care, these initiatives can have significant impact.  

And lastly, we want to continue to be as efficient and effective as possible with all of our medical programs. This includes improvements in the way we do patient management and patient recruitment. We want to continue to reach and impact as many children as we possibly can.


Chris Cruz is currently the Senior Vice President of International Programs at Operation Smile. Before joining Operation Smile, Chris served over 24 years in the US Navy. He was born in San Fernando, Philippines and raised in Virginia Beach, Virginia. Chris attended the Virginia Military Institute and earned a Bachelor of Science degree in Civil Engineering in 1991. He also earned a Master of Arts degree in National Security and Strategic Studies from the Naval War College. In September 2012, he reported to US Southern Command where he served as the NGO Engagements Branch Chief in the J9 Partnering Directorate. In this capacity, he collaborated with over 100 NGOs, private businesses, and academic institutions on humanitarian assistance, disaster response, and sustainment and development initiatives. At the end of his tour at J9, he retired from the Navy and joined Operation Smile.

Recent Posts

See All

A Conversation with Col. Liam Collins

March 2020 | Interviewed by FSR Staff FSR: Colonel Collins, thanks for coming in for your interview with the Fletcher Security Review. You gave an ISSP luncheon lecture at The Fletcher School on Russi


bottom of page