Chapter 6: Soccer Boy

Good Reads: Before and After by Brian F. Mullaney, Co-Founder of Smile Train and WonderWork.

Before and After: Chapter 6

Up to that point in my life, I’d always thought that charity work was something you did because you were obligated to do it. That’s what I’d always been told, anyway. At my high school commencement, I remember the famous Harvard professor, sociologist and Medal of Freedom winner Robert Coles, intoning the phrase, “To whom much is given, much is expected.” The message was always that giving back was some kind of sacrifice, something mandated as a solemn duty by your parents or school or church, much like paying your taxes.

But as I amped up my involvement in Operation Smile, I knew that my own reasons for wanting to be involved weren’t particularly noble or selfless. In fact, they were downright self-interested. As I was quickly learning, the guilty secret of doing good is that it also makes you feel really good! No matter how successful I was on Madison Avenue, it didn’t come close to knowing that every dollar I helped to raise for Operation Smile was going toward changing children’s lives. That’s an incredible thing to know and it made me feel happy. This correlation between doing good and feeling good also made a lot of sense to me. As an economics guy, I saw everyone as motivated by self-interest in some shape or form. To me, do-gooders weren’t saintly and self-sacrificing. They were people who had figured out a great way to get the most out of their time on earth.

Doing good was also addictive. The more I helped, the more I wanted to help. And the November following my trip to China, in 1995, when I was asked to go on another mission with Operation Smile, I immediately said yes.

This time, our mission was being staged at a small hospital in Thai Nguyen, in what was then the northern province of Bac Thai in Vietnam. The roads in Thai Nguyen were rutted and dusty, people lived in small lean-tos with roofs made of corrugated tin or palm fronds, electricity and running water were in short supply, and flushing toilets were a luxury, yet there was a real feeling of industry and hope about the place, with people building and digging, transporting and working, as best they could.

My official job while in Thai Nguyen was to collect patient stories and photographs we could use in fundraising materials when we returned to the United States. My unofficial job was entertaining the kids while they were waiting for their surgeries. While the rest of the Operation Smile team was busy in the OR and dealing with patient intakes, I was doing a lot of mugging: making faces, goofing around, trying my best to distract the kids from any fears and anxieties they might have about what lay ahead.

The local hospital was built around a large courtyard, so the first day, once surgeries were under way, I went out to get some air. Once outside, I happened to notice a little boy with a cleft, about nine years old, standing alone with a basketball tucked under his arm. I looked around, but there wasn’t a hoop in sight, so I went over and motioned to him to kick the ball to me. He immediately did, and we started passing it back and forth, then chasing and tackling each other. The next day I went out to look for him again and we started kicking the ball around again. Soon, whenever the other volunteers on the trip had a break from their duties, they were joining us in an impromptu soccer match.

The boy’s name was Hoang Nghia Quang, but we nicknamed him Soccer Boy because he was such a good little athlete and inseparable from his beloved ball. Like Beautiful Cloud in China, Soccer Boy had a very severe cleft. His front teeth protruded from the bottom of his nose at odd angles, and when he laughed, which he did often, you could see that the cleft extended all the way back into his palate, creating a deep furrow in the roof of his mouth. While most children with clefts only have a cleft lip, for those with cleft palates, life is additionally hard. The cleft palate makes it very difficult for babies to nurse, so many end up malnourished or even starving. My new friend was a skinny kid, and I guessed he probably still had trouble getting enough nutrients. Most children with cleft palates also suffer from speech problems, which can cause people to assume that they’re developmentally challenged, even when that isn’t the case.

In the year since I’d gone to China, I had learned a lot more about clefts. I learned that it’s a problem affecting 1 in every 500 children, making it one of the most common birth defects in the world. I learned that clefts have been around since the beginning of human history, and that they can affect anyone, regardless of race or creed or class. King Tutankhamun had a cleft palate. Abraham Lincoln’s son Tad did as well. But in the days before modern surgical techniques, it didn’t matter whether you were a king or a peasant, you simply had to suffer your entire life—there wasn’t any other choice. Then, in the early 1950s, doctors developed the surgical techniques necessary to fix clefts. By 1996, the year I went to Vietnam, there was really no reason for anyone to suffer with a cleft anymore—unless you happened to a be a little kid living in a developing country, without money or access to surgery.

Soccer Boy’s cleft was one of the worst I’d seen, but although it had affected his appearance, it certainly hadn’t dampened his spirits. Anyone who met him that week agreed with me that his attitude was an inspiration. His eyes were always sparkling and mischievous, and he was fast on his feet. Every time he stole the ball from one of us, he whooped with joy. Here was a kid who had every right to feel down on his luck—it was tough for him to speak and eat, and everywhere he went, the other children made fun of him. But as long as he had a ball to kick around, he was happy. What a relief that he was going to have his surgery! I imagined him growing up to become a world-famous soccer star, scoring the winning goal for Vietnam in the World Cup. His future was bright and only getting brighter, I was sure of it.

INSERT PHOTO: SoccerBoyBrian

Our week in Thai Nguyen was unforgettable in many ways. The schedule was grueling—the medical team was up at six in the morning, with surgery starting at seven and going all day nonstop into the night. We were running three surgical tables, where each doctor operated on about a dozen patients a day. The wards were full of children either waiting for their surgeries or recovering afterward. Everyone on the Operation Smile team veered from exhaustion to elation and back again. But it was a labor of love, and the harder everyone worked, the more they loved it. It was so inspiring to think that all these volunteers had come here, using their vacation time, to help others. The parents were so overjoyed and grateful that their kids had been helped, it made your heart burst. Every day brought new tears, new smiles, new hugs. I was blown away by my experiences. This was essential, vital, life-changing work—the kind of work that made you feel completely alive. I knew that my life back in New York was going to feel like sleepwalking by comparison.

After five days, it was time to pack up and go home. Everyone had such a feeling of accomplishment—our surgeons had completed more than 150 surgeries. We had positively impacted the lives of so many people. The day we left, there was a farewell ceremony, which was attended by the mayor, the head of the hospital, local officials, and our mission team. We all posed for photographs, smiling with our thumbs up. Then we loaded up the equipment we’d brought and packed it all into a giant bus to head to the airport.

As we said good-bye to the local doctors and nurses, I kept looking around for my friend Soccer Boy, but he was nowhere to be found. So I reluctantly climbed aboard the bus with all the other volunteers. The townspeople gathered around, waving and smiling, calling, “Hello, hello, hellooo!”

As we pulled away, a group of kids started running behind the bus. I sat in the back so I could wave and make funny faces at them. And that’s when I saw Soccer Boy, running behind the others.

To my shock and dismay, he still had his cleft.

What had happened? Why hadn’t he received his surgery? I turned around, looking for answers. DeLois Greenwood, the former nurse who had organized the mission, was sitting right next to me. She had seen Soccer Boy, too. She didn’t know what had happened. She felt awful. But what could we do? We didn’t have the capacity to treat everyone. She put a hand on my shoulder, not knowing what to say.

I could still make out Soccer Boy in the distance, waving and smiling, accepting his fate, as if he was grateful to have had the opportunity to kick a ball around with a bunch of Americans who’d failed to live up to their promise to him.

The other, more experienced mission members on the bus shook their heads in sympathy. They knew how I felt—but this was just the nature of things. We had treated 150 children in five days. Now it was time to go home and raise more money so we could fund more missions. I knew this was the reality. I’d seen it on our mission to China as well: everyone trying to console the mothers whose children had been turned away, promising that we’d be back.

“Come on, Brian,” someone said, trying to placate me. “It happens. You know that. It’s just the way it is.”

But I didn’t want to be placated. Soccer Boy was my friend and I felt like I had betrayed him. On the long ride back to Hanoi, I couldn’t shake the image of that little guy running behind the bus, waving and smiling. I no longer felt like a noble hero changing the world. I felt like a fraud.

Months later, I was still haunted by the thought of Soccer Boy. And it wasn’t just him; for every child who received surgery on a mission, there were three to four others who were being turned away. I kept thinking about all those families investing and risking so much, often traveling hundreds of kilometers to the hospital, only to be told that there wasn’t enough room. There had to be a better way.

My economist’s brain kicked into gear. Demand for surgeries was massive, yet we kept showing up with an inadequate supply of surgeons and resources. Clearly we needed to scale up.

To do that would mean raising a lot more money so we could go on a lot more missions and help a lot more children. I started crunching numbers, trying to calculate how many children were born with birth defects like clefts globally each year, and how many of their families were unable to afford surgery. The answer was in the millions—many millions. Meanwhile, the cost of providing the surgeries was also prohibitive. We were shipping tens of thousands of pounds of hospital equipment halfway around the world to set up temporary operating rooms for just a week, so each mission’s costs ran into the hundreds of thousands. I calculated that to fund a million surgeries, we’d have to raise a billion dollars. I was ambitious, but I also had to be realistic. The chances of us raising a billion dollars were slim to none.

So I went back to the drawing board. How could we tweak our business model to accommodate many, many more patients? The only way to do it would be to find a way to significantly reduce the costs of delivering surgeries.

I thought back to my time in Thai Nguyen. At the hospital, I’d happened to strike up a conversation with the resident surgeon one day while he was on a break. I’d asked him if local surgeons knew how to do cleft repair surgery. He told me yes, of course—as long as the patients have the money to pay. The problem was, so many of the patients couldn’t afford the cost and the hospital didn’t have the resources to offer the surgeries free of charge. I asked how much a surgeon in a hospital in rural Vietnam earned, and the doctor replied, “About $200 a month.”

Back home, I thought: Why don’t we just pay local surgeons $500 a month to do free cleft surgeries? That would certainly be a lot cheaper than flying our doctors and equipment halfway around the world. If local doctors performed the surgeries, we’d be able to help many more children because those doctors would be working 365 days a year, not just for one week at a time.

Once I worked out the numbers, I couldn’t believe how cost-effective this idea would be. For the same amount that we were currently spending to fly a team of surgeons to Vietnam for five days, we could pay the annual salaries of 375 Vietnamese surgeons for an entire year—at twice their current rate! And what if we could teach more surgeons like the one I’d met in Vietnam to do cleft surgeries? The availability of cleft surgery would increase exponentially, perhaps by many tens of thousands of surgeries a year. As the saying goes: “Give a man a fish and he’ll eat for a day, but teach a man to fish and he’ll eat for a lifetime.”

Of course, the idea not only made economic and practical sense; most importantly, it made moral sense. It simply wasn’t right to turn away children who needed our help. We needed to be fully accountable to the people we were helping, otherwise we had nothing to feel good about—nothing at all.