children. From successful operations to rehabilitative measures, these stories offer insights into the positive impact of our work in these regions.

In November 2021, we operated on little Minja, who had a soccer-ball-sized tumor on her neck (a so-called teratoma), and little Ephrem, whose large abdominal wall defect (a so-called omphalocele) could not be closed after birth, presenting us with a challenge. Furthermore, we treated Nanati, a 10-year-old girl with a lymphatic tumor on her neck. We still vividly remember each of these children, as well as their entire journey before, during, and after the operation. Because every story is very special, simply unique. Because you don't forget the smile that a child or a family gives us after a successful procedure, and the feeling that they have given back to us.

Minja was born with a tumor on the right side of her neck, called a "teratoma." The name of this tumor is derived from the Greek teras "monstrous image, monster" and the suffix -oma. Teratomas can reach "monstrous" sizes, as was the case with little Minja. Families with such illnesses are shunned by society. Without surgical therapy, the disease is fatal.

Congenital tumors of this kind are removed immediately after birth in medically more developed countries. However, this was not the case with Minja, so the mass continued to grow, reaching a size that made it impossible for the girl to develop physically and mentally. Minja's bloodstream also had to "supply" the tumor, which was very taxing. As a result, she herself stopped growing and looked much younger physically. Especially in recent weeks, the tumor had grown significantly and ruptured in several places, developing so-called "ulcerations." These had to be covered with bandages and plasters to prevent infection. As the teratoma grew expansively and pressed on the esophagus, the patient developed dysphagia. The trachea was also constricted - Minja was at risk of suffocating in the coming weeks.

For the family, the situation was very stressful psychologically and familiarly. The constant fear for their daughter's life and her helplessness made a discharge home impossible. As a German children's aid organization, we are also active in Africa to help children and their families in various life situations.

When we met Minja in Awassa, it was clear that something had to be done quickly. Of course, as a team of doctors, we realized that only the complete removal of the tumor was an option for the girl. However, this was a high-risk procedure, as many vital anatomical structures run through the neck and we had no intensive care unit "backup" in Awassa. Even the smallest complication of the upper respiratory tract could have given the operation a catastrophic turn.

On the third day of our stay, we dared the procedure. Critical from the start was the so-called "intubation," the moment when the ventilation tube has to be inserted into the trachea. Dr. Dietmar Crass, a renowned pediatric anesthetist, had brought a special instrument, a videolaryngoscope, especially for this procedure. With this, the precise placement of the ventilation tube was successful.

The surgical removal of the 3 kg tumor took about 3 hours. The teratoma was meticulously separated from vital structures such as the esophagus, trachea, salivary glands, and vital nerves, all of which could be preserved.

The mother was overjoyed when she saw her daughter again: for the first time as a "normal" child without the disfiguring, stigmatizing, and threatening tumor.

Even for experienced pediatric surgeons, such procedures are extremely nerve-wracking because we always fear one thing in such procedures: not helping a child and even harming them through a complication. We are very grateful that we were able to give Minja's fate a positive turn and that she can now be a completely normal girl.

Nanati was born with a tumor on the right side of her neck that originated from hair-thin lymphatic vessels (= lymphatic vessel tumor, medically: "lymphangioma" or "hygroma"). Lymphatic vessels are vessels that allow tissue fluid (edema) to flow via the thoracic duct to the veins and thus to the heart. Lymphangiomas usually increase in size proportionally to the child's growth and show no tendency for spontaneous regression. Girls with such conditions are sometimes shunned by other children. Without surgical therapy, they continue to grow.

Lymphangiomas of this type are either sclerosed in more medically advanced countries with sclerosing (so-called "sclerosing") substances injected into larger cysts. An alternative is surgical removal.

When we met Nanati in Awassa, the beautiful girl was very serious, scared, and didn't smile. Lymphangiomas are "iceberg tumors": often more extensive than they appear from the outside. This is precisely the challenge during surgery. Therefore, we hoped that we would be able to perform the procedure technically well.

On the first day of our stay, we operated on the girl. The removal of the tumor was challenging, especially the separation from healthy structures in the area of the large neck vessels and salivary glands. Overall, however, it was well removable.

When we saw Nanami again on the first day after the operation in the pediatric ward, we could already see her broad and beautiful smile from afar. Just look at the pictures yourself. The family was so overjoyed that our camera crew was invited home for a coffee ceremony. Nanati also showed us that she can draw wonderfully. Unfortunately, the medical team could not be there; we were busy in the operating room with other cases.

As an international children's aid organization in Africa, we support local doctors with our pediatric surgeons and general pediatricians to improve the quality of life for children.

We are always very touched when we can help "conjure" a smile onto a child's face and receive such gratitude. Such a moment puts many of the problems we experience daily at home into perspective and focuses the moment on what has great value in life.