I founded Smile Train in 1999, and then served as President and a Board member for more than a decade. In 2010, When Smile Train started running out of clefts, most of my senior management team and I, left to start WonderWork, a new surgical charity that provided free surgeries for children who were burned, blind or crippled with club foot.

SMILE TRAIN TODAY IS ONE OF THE MOST SUCCESSFUL, AND LARGEST CHARITIES IN THE U.S.

After I founded Smile Train in 1999, my small team and I quickly built it into one of the largest charities in the U.S.. Today, one out of every 100 Americans is a Smile Train donor. Since 1999, 3+ million people have donated $2+ billion to Smile Train with an average donation of around $50. Through thousands of partners and programs in 89 of the world’s poorest countries, Smile Train today helps provide almost 90,000 free cleft surgeries every year. Since 1999, Smile Train has helped provide free cleft surgery for almost 2 million children, no one else would help.

 

WHERE I GOT THE IDEA FOR SMILE TRAIN

I came up with the idea for Smile Train in 1996 while I was serving as a board member for a small mission group from Virginia called Operation Smile. I spent about five years helping Operation Smile triple its size and raise millions of dollars. But my favorite part, by far, was going on two-week medical missions to China, Vietnam, and Gaza.

These medical missions were always very emotional, exciting and rewarding. But in many ways, they were also, bittersweet, as Op Smile always turned away 2-3 children for every child it helped due to lack of surgeons, resources, and time. After watching Op Smile literally turn away thousands of children on these missions, year after year, I vowed I would find a better way to deliver surgery to poor children in developing countries.

While I was on an Op Smile mission to Vietnam, I was surprised to learn that local Vietnamese surgeons and nurses were more than capable of performing safe, high-quality cleft surgery. In fact, I learned that local surgeons, in virtually all developing countries, are usually better at cleft surgery than American surgeons because they perform so many more cleft surgeries. Very few children in the U.S. are born with clefts (just 5,000 a year) while it is a huge problem in almost every developing country. (Very few American surgeons who go on missions are cleft surgeons and most haven’t done a cleft surgery since medical school.)

On that mission to Hanoi, I had an epiphany: why not empower local surgeons in developing countries to provide cleft surgeries instead of sending American volunteer surgeons on two-week missions?

I wasn’t a doctor, but my economics degree from Harvard gave e confidence that this new strategy might be much safer, cheaper and more productive than sending American volunteers on two-week medical missions that help only 100 children at a time. By empowering local doctors, nurses and hospitals, local medical teams could operate year-round — not just two weeks a year — and the quality and safety of surgeries would soar while costs and risk would plummet.

The 2-week medical missions that Operation Smile has perfected over almost 40 years, cost a fortune because they include shipping 10,000 pounds of medical equipment half way around the world, and flying 40+ volunteer surgeons, nurses and other medical personnel for just 5-6 days of surgery. Op Smile’s mission model had a cost-per-surgery of $1,000 – $2,000. In contrast, a local Vietnamese cleft surgeon, who usually is much more experienced than most of Operation Smile’s volunteer surgeons, only made $300 – $500 a month. A Vietnamese nurse made $35 a month. You didn’t have to be a math genius to see just how much cheaper this new approach would be.

At the time we were searching for a new business-model for Operation Smile, I happened to meet a man in New York City who owned a steam locomotive. He wanted to host Op Smile fundraisers in major cities all over the U.S. – on his steam locomotive train which he would bring all around America. I wasn’t crazy about this fundraising idea, but it got me thinking about using trains to deliver free training and surgeries in developing countries . Both China and India, the two largest countries in the world, with the largest number of unrepaired clefts, both run on trains. This seemed like potentially, an exciting way to include local cleft surgeons in the Operation Smile business model.

That’s how the idea for Smile Train was born.

 

THE KEY INDIVIDUALS WHO MADE SMILE TRAIN POSSIBLE

The one person who did more to help us start Smile Train than anyone, was Swiss billionaire Walter Haefner. He was our first, our biggest and our most loyal donor. He gave us a 5-year, $35 million grant to launch Smile Train and then, continued making large donations to ST for many years. His total donations exceed $50 million.

Around 2005, I invited Mr. Haefner to come with us to China with former President Bush and his wife Barbara. He declined but he sent his son Martin and his wife Marianne instead. They were welcome additions to our trip who turned into enthusiastic donors and supporters of Smile Train. Over time, we became very good friends. When cleft surgeries began to decline at Smile Train, and my team and I left to launch WonderWork, Martin and Marianne provided critical financial support. I never had the privilege of meeting Mr. Haefner as he lived in Switzerland and was somewhat of a recluse. But I always kept him up to date on our progress and results. He once sent me a personal note in which he wrote, of all his many accomplishments in his very storied and successful life, helping us start Smile Train was the one thing he was most proud of.

When I was a member of the Operation Smile Board, I met NBC Anchorman and renowned journalist, Tom Brokaw. A couple years earlier, I’d written a cold-call letter to Mr. Brokaw when I was raising money for Op Smile and he responded. Over time, I got to know Mr. Brokaw so when I asked him for a meeting to discuss a “big, new idea” that could change many lives he said sure. Mr. Brokaw loved the Smile Train idea and he did a lot to help us turn it into reality. He encouraged his good friend Bill Gates to help us and later Bill and Melinda Gates gave us a $1 million grant.

Brokaw also arranged for Ann Ziff and I to meet with his good friend Candice Bergen. At the time, Candice was starring in her hit show Murphy Brown and she was one of the most popular and respected actors in America. Candice became one of our major donors, hosted many of our events and even visited our partner hospitals in Ethiopia. Her daughter Zoe spent a summer working at a Smile Train partner hospital in India.

 

One of the best things Brokaw did was get us on The Today Show. The Smile Train Project was featured on The Today Show the same day Hillary Clinton appeared defending her husband Bill as the Monica Lewinsky scandal unfolded. An extra large audience of 6+ million viewers watched Hillary and our segment which had an animation of a Smile Train racing around the Chinese countryside. More than 500 viewers called NBC asking for more info about Smile Train.

I met Ann Ziff in 1994 and told her all about my New York charity Operation Smile, which helped provide free plastic surgery for indigent children in New York city who couldn’t afford it. As a former social worker, Ann was very interested in our work and started helping us. When I merged my charity with Operation Smile Virginia, Ann joined the Op Smile Board and continued to help us raise millions of dollars. When Charles Wang and I resigned from the Op Smile Board after two young children died in Beijing apparently from negligence, on an Op Smile mission, Ann joined us and helped us start Smile Train. She was our first Chairman of the Board and a critical part of Smile Train’s success. She gave us very generous donations, led our board of directors, and travelled around the world with us, helping us grow the charity.

In 1997, around the time I came up with the idea for Smile Train, the President of China, Jiang Zemin, came to the United States for a historic visit.  It was perfect timing for us as we saw the Smile Train Project as a US-Chinese partnership that would not only bring hundreds of thousands of free surgeries to China but also would help foster goodwill between our two countries. President Clinton hosted a state dinner for Chinese President Jiang Zemin which included hundreds of CEOs of Fortune 500 companies who were doing business in China. After the NY Times printed the list of attendees, I wrote to every CEO, almost 500, and asked for their help. Only one responded, Maurice “Hank” Greenberg of AIG. Mr. Greenberg was one of America’s most successful and admired CEOs and no one knew China as well as he did. He arranged for me to meet with his C.V. Starr Foundation and this led to almost $20 million in grants over the next decade.  I got the opportunity to thank Mr. Greenberg personally for his generous support many times and I’m still in touch with him.

Iith him.

After former President George H.W. Bush told China President Jiang Zemin about our Smile Train idea, we were invited to meet with President Zemin and his Minister of Railways. We chose China as the first country to test our Smile Train concept because China had the world’s largest train network AND because Charles Wang, the man I hoped would fund our pilot program was born in Shanghai, China.

Charles Wang was the co-founder, Chairman and CEO of Computer Associates, my ad agency’s largest client. For 4 years in a row, Wang was the highest-paid CEO in America. He had just received a $700 million bonus when I pitched him my Smile Train idea. At the time, he was getting a lot of very negative press about his compensation so the timing was perfect. I had been cultivating Wang as a donor for years. Every time I went on an Op Smile mission to China, I’d send Wang letters and photos of the kids we helped. He had already started giving us modest donations but I knew he could give much, much more.  Wang loved our Smile Train concept and the fact that we’d chosen China as our first country. He got his company, Computer Associates to pledge $10 million to get Smile Train up and running.

As President, I led Smile Train through its first decade, from 2001 until 2011. I almost didn’t take the job. In April , 2001, we had just fired our 2nd executive director in 2 years. Morale was low. Anxiety was high. And everyone was frustrated that two years after we launched Smile Train, we had tens of millions of dollars in the bank but we weren’t providing any surgeries. It was embarrassing. We had no business plan. No business model. No surgery programs. No partners. No fundraising program. No donors. Nothing. But I still very much believed in the idea of Smile Train, so I reluctantly agreed to serve as Interim President of Smile Train for one year. What I discovered after becoming President, was that Smile Train did have one asset that was invaluable: a small team of employees who were exceptionally talented, experienced, and dedicated….

THE INCREDIBLE TEAM THAT BUILT SMILE TRAIN INTO THE WORLD’S LARGEST CLEFTY CHARITY

Delois Greenwood quit Op Smile after 15+ years to help us launch Smile Train and we were so lucky she did. I’ve never met anyone with more experience, compassion and knowledge about the best ways to provide providing surgeries for the poor in developing countries. Delois wore a lot of hats. She drove programs, raised money, managed the team, you name it. Everyone loved her from the partners, surgeons, and nurses in the field to the staff and all the employees and all the donors also. Right from the start, Delois was one of the critical ingredients that made ST such a success.

Karen Lazarus worked as my personal assistant at my ad agency, Schell/Mullaney but quickly grew up and out of that position at Smile Train as she became an excellent senior manager. Karen is by far the most dedicated and hardest-working person I have ever met. Like Delois, she also wore many “hats” as she helped build Smile Train into the world’s largest cleft charity in just a few years. Karen helped create our fundraising machine which went from raising a couple hundred thousand dollars a year to raising more than $100 million dollars a year. The donors loved her as did the entire team as she was great to work with, smart, and incredibly dedicated.

Hana Fuchs had decades of international auditing experience at Avon, Hana was the perfect person to be our CFO and VP of administration. Hana was unflappable, cool, calm and collected, she oversaw a tiny financial and admin team that expertly managed and guided Smile Train’s meteoric growth from 200 donors to 2 million and from 2,000 surgeries a year to 125,000 surgeries a year as we scaled our programs and partners from one country to 92 countries. Hana did a flawless job of managing our growth from a $2 million a year budget to $150 million a year.

Melody Farrin was our very first program manager and helped us design, build and grow all of our surgery and partner programs around the world. Melody was very smart and professional, all of the employees and partners really liked and respected her.

Michele Sinesky: she was the best donor relations person I have ever met in my life. She connected with literally thousands of our donors and helped us earn their trust and support.

Priscilla Ma was extremely hard-working, intelligent, and passionate about our work. She helped create, build and manage one of the most successful direct mail/fundraising programs in history. We scaled our first direct mail effort of 50,000 letters, to a massive, super cost-efficient fundraising machine that mailed 120+ million letters a year in the U.S. and the UK. We broke virtually every record for non-profit direct mail including response rates, size of average gift, retention, etc.

Troy Reinhart started out as our receptionist but quickly grew out of that job becoming a superb donor database guru and talented manager.

Satish Kalra was our first major country manager and single-handedly built Smile Train India into our largest program in the world which today provides 50,000+ surgeries a year for the poorest children in India. Satish was integral to the success of Smile Train’s programs not just in Asia but all around the world.

Mike Schell was my advertising agency partner, an award-winning creative and immensely talented art director. He created the Smile Train logo and graphics that helped us pitch the idea and raise $50+ million in start-up donations. And for our first decade, Mike designed and produced virtually all of our fundraising materials including advertising, direct mail, brochures, websites, etc.

SMILE TRAIN’S FOUNDING PRINCIPLES (FROM 1999)

More than two decades ago, before we developed our business plan or any programs, or raised any money, we developed Smile Train’s Founding Principles. They reflect our goals, attitudes and what we hoped would make Smile Train different, more effective, and productive than any other cleft charity.

Insure the safety of the patient is always our #1 priority.

Focus exclusively on the problem of clefts. 

Provide free surgery for children who can’t afford it.

Foster self-sufficiency through free training and education.

Embrace an inter-disciplinary team approach. 

Invest in research to find a way to prevent clefts.

Empower local surgeons, anesthesiologists, nurses, medical professionals, social workers, speech therapists, etc. to solve the problem themselves.

Partner with other cleft organizations and share resources. 

Operate the most cost-efficient cleft organization in the world.

Leverage technology as much as possible. 

Run Smile Train like a business. 

Work ourselves out of a job. 

 

 

 

One of the reasons we chose clefts as our one and only focus was because we knew there were 1-2 million children suffering with unrepaired clefts and if we did our jobs right we could solve this problem in our lifetime. And we did. Today, in 95% of the developing world, every baby born with a cleft now has access to the life-changing surgery that can repair it. In addition, with the 1.5+ million cleft surgeries Smile Train has helped make possible, it has cleaned up the enormous backlogs of children with unrepaired clefts who are waiting for surgery. Smile Train’s annual cleft surgeries peaked around 2010, and have been declining ever since. The cleft backlog in China has been taken care of and India is next.

 

 

SMILE TRAIN WAS ONE OF THE BEST-MANAGED, MOST PRODUCTIVE CHARITIES IN AMERICA

We took great pride in managing Smile Train like a business – not a charity. We had a solid business plan, an innovative business model and we held employees accountable. If you did a good job you got a bonus – if you didn’t, you went to work for some other charity. We leveraged all the latest technology and built an electronic patient record database long before any American hospitals did. We created virtual surgery software that’s been used to train thousands of cleft surgeons.

With our tiny staff of fewer than 50 people, we managed 1,000+ partner hospitals in 92 of the world’s poorest countries. In just a few years, we scaled our cleft surgeries from zero to up to 120,000+ surgeries a year. Our direct mail program was one of the best-managed and cost-efficient fundraising programs in America. Our cost-to-raise-a-dollar was less than 5 cents for our donor mailings. We quickly scaled up to 120 million direct mail letters a year and a newspaper/magazine advertising program that reached 100+ million Americans every year. Through direct mail and innovative, remnant advertising that we bought for 10 cents on the dollar, we earned the trust and support of millions of donors. Since inception, ST has raised $2+ billion dollars with an average donation of just $50.

In 2007, The New York Times called us “perhaps the most productive charity dollar-per-deed in the world” and two years later we won an Oscar for a movie we produced about clefts. More than 25 million people saw it and it helped us raise tens of millions of dollars from all around the world.

Today, Smile Train’s surplus of unused donations is more than $500 million dollars.

I’m hopeful that these unused donations can be redirected to provide other desperately needed surgeries for children and adults who are seriously burned, crippled with clubfoot or blind.