I doubled down in my role as president of Smile Train, devoting myself to the work on a permanent basis. By now, we had a presence in eighty-five of the poorest countries on earth, with over 1,000 partner hospitals and organizations in Africa, the Middle East, Asia, South America, and Eastern Europe. We were providing close to 100,000 surgeries a year—while also training tens of thousands of surgeons and medical professionals a year. Our model was clearly working. But as time went on, we had to acknowledge that our model also had its limits.
As we looked at a map of the world, strategizing about those countries where we wanted to make new inroads and increase the numbers of surgeries delivered, we could see that there were small pockets remaining where we had yet to make an impact. One of these was Haiti. We realized that while we had been around the world, we had forgotten to go around the block. We had failed to address the cleft problem in a country right on our doorstep.
Haiti—the poorest country in the Western hemisphere—is just a three-hour flight from New York. In 2008, there were an estimated 15,000 children with unrepaired clefts on the island. Okay, we though to ourselves, at our usual rate of progress, we can take care of country’s cleft backlog in three years!
But as we began our research—attempting to identify potential partner hospitals in the capital, Port-au-Prince, as well as its outlying areas—we ran into a major obstacle. We couldn’t find any cleft surgeons. In fact, we visited every hospital in the country, but we could not identify a single Haitian surgeon who knew how to perform surgeries for clefts. In fact, surgeons of any kind were few and far between in Haiti. So many had left to come to the United States, and this meant the ones who remained were seriously overextended. Meanwhile the people of Haiti were facing so many other pressing problems. In 2008, more than two out of every twenty-five children under the age of five were dying from entirely preventable diseases such as diarrhea. Nearly half the population was unable to read or write. Unemployment had soared to 90 percent. The high price of fuel, rice, flour, and vegetables had left hundreds of thousands of Haitians without basic sustenance. And this was before the 2010 earthquake devastated the tiny nation even further. Our plan to solve the cleft problem in Haiti was off to an extremely slow start.
So we decided to switch tracks and do the very thing we said we’d never do: we were going to fund a medical mission to Haiti and send American doctors there. This constituted a serious shift for Smile Train. From the beginning, our model was based on the radically new idea of empowering local surgeons in the developing world. We’d had such tremendous success with our “teach a man to fish” model that we believed the last thing the world needed was the mission-based surgical approach. Missions were in the rear-view mirror! We were the future! But seven years into the project, we were acknowledging that there were a handful of places where our brilliant new model just wasn’t going to work. Haiti was one of them.
So we wrote to every reputable mission-based operation we could find, and they all sent in applications. We scrutinized each organization’s credentials and experience at length. Then we selected a great mission team from Miami and we sent them to Haiti. DeLois and I went too.
While our medical team was setting up at a small local hospital where the mission was being staged, DeLois and I asked our guide to take us to Cité de Soleil, one of the primary places where our advance team had been canvassing for cleft patients. On every trip into the field, we make sure not only to visit hospitals where our patients are treated, but also to see some of the places where they live, so we can better understand the communities we serve. Although the name Cité de Soleil means “sun city,” it turned out to be one of the darkest and most impoverished places we have ever visited. The largest slum in the Western hemisphere, it’s home to 300,000 men, women, and children, a place where violent crime, shootings, kidnapping, and lootings happen on a daily basis.
As we approached the shanties of Cité de Soleil, the stench of moldering garbage and human waste became overpowering. We passed a line of residents carrying plastic water containers—a reminder that the inhabitants of Cité de Soleil have no running water, let alone electricity. Ahead of us were shacks made from scraps of rusted metal and plastic, shards of wood, and crumbling cinderblocks—these fragile homes were literally built on mountains of trash. There were no trees, no streets, no sidewalks, no relief from the squalor. Suddenly we heard a terrifying snorting sound: we turned around to see wild pigs foraging in the excrement-filled wastewater flowing around the slum’s perimeter.
For the next hour, we walked around Cité de Soleil. We peered into dark doorways, glimpsing dirt floors and almost no furniture, beds made from wooden planks on bricks, with thin, filth-encrusted blankets for mattresses. A crowd of children began following us: chattering, smiling, and waving as we went. Each child showed the telltale signs of malnutrition: swollen bellies, bald patches on their heads, hair with a reddish tint. Most of the children were barefoot; some of them wore no clothes at all. And yet amid all this poverty, they were smiling. All these beautiful little kids stuck in this squalor!
I thought about all the news articles I’d read over the years about boats filled with Haitians sinking off the coast of Florida. Every time I read those stories, I would think to myself: why do they put so many people in the boat? Don’t they know there’s every chance it will sink? But after visiting Cité de Soleil, I understood why young Haitians wanted to leave, risking their lives in small boats in the hopes of making it to a better life. If I were sixteen years old and living in Cité de Soleil, I’d settle for a single plank as a raft, too, if it meant I might be able to escape.
Next our guide took us to a nearby local market. It was still morning, but even so, there was hardly any produce, meats, or grains available for purchase. Our guide explained to us that half the population of Port-au-Prince lives on less than a dollar a day; and meanwhile, the cost of rice was going up and up. A few weeks before our visit, there had been food riots, leaving seven people dead.
“The hunger is so bad they call it ‘Clorox,’” our guide told us. “Because the feeling is bleach eating away at your insides.”
We passed a stand selling cookies. On closer inspection, we learned that these were made from mud with a tiny bit of sugar sprinkled on top.
“People buy these and eat them to stave off the hunger,” our guide explained.
I bought one of those mud cookies so I could bring it back to New York with me, as a reminder that, just two hours off the coast of America—a country where one of our biggest health problems is obesity—there are many thousands of Haitians who are so hungry that they will eat cookies made of dirt.
Just a few miles away from Cité de Soleil, at a small private hospital where our mission was being staged, the surgical mission group we had sponsored from Miami were already preparing to operate on patients. By the time we arrived that afternoon, crowds of people were already waiting in the courtyard for screening—more than two hundred in total, many of them from the slums we had visited that morning. We knew our surgeons could only help a hundred patients in three days. Just as with every mission I’d witnessed, we were going to have to turn many people away, with nothing but the promise that we would return in the near future.
This was the day I met Andrea. At first glance, I had assumed that Andrea was about sixty years old. When I asked for her age, she told me she was thirty-five. Her cleft was more like a chasm, the floor of her nose had collapsed making it look permanently broken, her right eyelid was swollen, making it hard for her to see.
I shook Andrea’s hand and asked her to tell me a little bit about her life. She’d come from Cité de Soleil. She had never gone to school, never gotten an education, never married. Andrea worked menial jobs—selling charcoal, carrying water. All her life, everyone had told her she was cursed. I recalled our guide telling us about local witch doctors instructing families to drown babies with clefts to wash away the bad luck—it was a miracle she’d survived. As she answered my questions, Andrea looked at the ground in shame, as if mortified by her very existence.
That afternoon, Andrea saw one of our doctors and was scheduled for her cleft repair the very next day. I was happy she had been chosen, but my heart remained heavy all the same. I knew we had arrived much too late. We’d never be able to give back the thirty-five years Andrea had lost.
Coming back to New York after my first trip to Haiti, I felt raw, as I always did after these trips. Like a diver experiencing the bends after coming up for air, transitioning between the extreme poverty of a place like Haiti and the everyday excesses of life in New York always left me feeling queasy. It usually takes me a few days to shake off the sense of dislocation and to get back into the flow of work and family, but recovering from the intensity of my experience in Haiti took much longer. I kept trying to reassure myself that we would go back to Haiti very soon, but thought did little to allay my sense of disquiet.
About a year later, in February 2009, we returned to Haiti with another mission team, this time out of Texas. Our doctors set up in an old Baptist hospital in the hills outside of Port-au-Prince. Again, over two hundred children and adults showed up— more than twice the number we’d be able to help.
There was such a feeling of anxiety and tension in the line as patients waited to be screened. Parents clutched the hands of their children, their faces fraught with concern. Who was going to be helped and who would be turned away? Among the families, we noticed more than a few older patients, men and women who, like Andrea, had gone many years without treatment. One of these older patients was a forty-two-year-old man, Bartholomew, who cautiously approached us to shake hands. He had two deep slits in his upper lip, his teeth sticking out at angles from under his nose. Bartholomew told us he had seen the many children registering for surgery and was certain that the youngest patients would be our first priority and that he would be sent home.
Nonetheless, he continued waiting patiently in line. When a doctor finally examined him, Bartholomew learned that he would be able to receive surgery the next day. At this moment, a look of complete disbelief came over his face. And then something astonishing happened: Bartholomew tried to change the doctor’s mind.
“Let one of them be helped instead,” he insisted, pointing to the crowds of children behind him. “They need the surgery more than I do.”
Bartholomew knew exactly how hard life was going to be for a child with a cleft. He didn’t want to deprive one of those children of a chance at a future he knew he had already lost.
But the doctor wasn’t persuaded. “I’ll make sure to schedule your surgery for the end of the day,” the surgeon explained, “once I’ve finished with everyone else.”
Bartholomew nodded and walked away into the crowd, cradling the piece of paper with the date and time of his surgery in his hands.
Over the years, I’ve encountered so many older patients like Bartholomew. Once, when I was in India, a thirty-five-year-old woman tugged at my arm and told me, “I was never able to get married because of my cleft.” At the Kenyan border, I met a sixty-three-year-old woman who was finally getting her cleft repaired. Our partner surgeons have told us about adult patients as old as eighty-five coming to their hospitals for the operation.
Soon after I returned from Haiti a second time, I was scheduled to speak at a small fundraising dinner for Smile Train. I talked about our most recent trip, and showed the donors at the dinner some photos of the people we had met there, including a picture of Bartholomew.
INSERT PHOTO: Bartholomew
One of the donors at the dinner raised his hand.
“I’m confused,” he said, furrowing his brow. “I was under the impression that was a children’s charity!”
“Yes, sir,” I told him, “we are a charity for children. But sometimes it takes us a little longer than anticipated to reach the children we serve. Look closely at this picture, and you will see a little boy who has been waiting for someone to help him for over forty years.”
Good Reads: Before and After by Brian F. Mullaney, Co-Founder of Smile Train and WonderWork.
