Ten years and thousands of smiles

MANILA, Philippines – It is heartbreaking to see a child born with a serious deformity. The most common of these birth defects is cleft lip and palate, and in the Philippines, more than 4,000 children a year are born with such defects. Worldwide, the number is high as 200,000 children a year, and millions more live with the affliction.

The negative effects of this disability are fairly obvious – difficulty in speech and food intake. But there is a social aspect that is just as, if not more, devastating. There is the social stigma, a sense of being “not normal” and consequently ostracized by other kids and even some adults. In some countries, these children are abandoned, neglected and, even worse, disposed of – all for the lack of a simple surgical procedure that takes as little as 45 minutes to accomplish.

For these unfortunate children the world over, there is hope, and it comes on a very special ride – The Smile Train.

“Changing the World, One Smile at a Time” is what the people on The Smile Train do. Established in 1999 with the sole purpose of helping kids with cleft lips and palates, the organization is celebrating 10 years of providing surgery to over 500,000 children in 76 countries.

“I’ve been very busy for the past 10 years,” says DeLois Greenwood, vice president of New York-based The Smile Train. She last visited the Philippines in 1987 as a volunteer working on children with cleft palates, and Greenwood has been a member of The Smile Train since it started. She returns to the country for the first time since then to check on an ongoing Smile Train program in Navotas.

What exactly causes a cleft lip or palate? There is no clear answer but experts agree that it could be a combination of genetic and environmental factors. Greenwood says, “In developing countries there are literally millions of children who have this problem.” Is poverty to blame? Not entirely, she asserts, but it can aggravate the problem. Malnutrition and a lack of essential nutrients during pregnancy may contribute to the development of cleft lips and palates.

“We don’t know 100 percent what causes it, but the cure is right here, and the cure is simple surgical treatment at the right age,” she says.

In societies with better access to proper medical care, a child born with a cleft lip receives surgery at three months, and those with a cleft palate as soon as they are a year old. “That’s our goal, to make sure every child in the Philippines, no matter how poor, has that care,” continues Greenwood.

While The Smile Train has had a presence in the country from the start, that presence has accelerated and strengthened in the past few years with partnerships established across 30 hospitals throughout the Philippines. Greenwood says, “Any poor child that contacts us, we’ll make sure they have surgery. They won’t be turned away.”

The Smile Train’s achievements throughout the world can be attributed to their effective use of partnerships in the countries they operate in. Greenwood notes, “The key to the success of The Smile Train is the local surgeons in the Philippines. They are very talented, very committed and they are the ones providing the care. I’m from New York, but that’s it. The rest of the program is locally-based. They are the real unsung heroes of the whole project.”

Success formula

The New York Times once called The Smile Train “one of the most productive charities – dollar for deed – in the world.” It is also hailed as a non-profit organization run like a “for-profit.” This mix of business and non-profit work may take some by surprise but it has proven beneficial to the work of The Smile Train.

“Our board is made up of businessmen, not medical people,” explains Greenwood. “I happen to have a nursing background and I bring that to the table. What they’ve brought is the business sense. Although we’re a charity, they want us to be run like a ‘for-profit’ and to be very accountable, productive and observant of our efficiencies. That’s why we have someone like Cooey (Rogelio C. la O’ Jr., Philippine country director for The Smile Train) coming from the business world, who knows how to manage and run projects effectively and efficiently.

“When you look at it from a business perspective, The Smile Train is doing everything right. We keep our overhead low, and our staffing flat and small. We look at maximizing the funds that we provide by working with local surgeons versus flying in Americans from all over the world and helping a small number. We look at the problem and try looking for scalable solutions so that a hospital which might help 20 children today, when The Smile Train comes in, is able to help 200.”

Considering that The Smile Train provides over 110,000 surgeries in 75 countries in a year, more than double that of other similar charities, there is no comparison. Also, unlike other charities, The Smile Train maintains its presence by backing and funding local surgeons who continually work the whole year repairing cleft lips and palates. This long-term treatment also means post-surgery rehabilitation and medical support for the children.

Smile Pinki

A couple of years ago, The Smile Train commissioned filmmaker Megan Mylan to make a documentary about the issue of cleft lip and palate and the organization’s work. Greenwood recalls, “We told her about a partner hospital in India. She went and followed a patient and did something that I’ve always hoped to be done, which is to see what I see and tell the story to many, many people.”

What resulted was a documentary called “Smile Pinki” which went on to win the 2009 Academy Award for Best Documentary Short Subject. “It’s a wonderful story,” Greenwood enthuses. “When the film was nominated for an Oscar, the media in India just went crazy. It was amazing.”

The star of the film is a five-year-old girl named Pinki, who had a severe cleft. Born in one of the poorest areas of India, Pinki was not allowed to attend school and was ostracized for her deformity. This all changed when her parents met a social worker from The Smile Train traveling from village to village, gathering patients for a hospital that provided free cleft surgery to thousands of poor children.

The Oscar win wasn’t just an acknowledgement for a well-made documentary. More than that, it brought the problem of cleft lip and palate to the world stage.

Here for the long term

On its 10th year, The Smile Train has reinforced its plans for the Philippines. “As long as we’re around, children will be helped,” says Greenwood. “To be able to provide the access to care is of paramount importance to us. We’re not a mission-driven organization that flies teams in and leaves again. We have an ongoing presence, and the local surgeons are operating seven days a week. We have a long-term commitment to the Philippines: we want to stay here until the problem is solved.”

The Smile Train Philippines can be contacted through cellphone +63917-52-TRAIN(87246). Email [email protected] or visit their website at www.smiletrain.com.ph