After the trip to Ethiopia and Dadaab, I felt even more motivated to expand Smile Train’s mission. We had the money, and now I had not just data but real-life examples. Everyone on the senior management team was extremely excited to begin this new chapter in Smile Train’s story.

I took a close look at our financial projections for the coming year. If our fundraising trends continued, we were going to be looking at another year-end budget surplus of more than $40 million.

So my team and I worked night and day for weeks. We put together all kinds of presentations and financial projections as well as summaries of all the surveys we had sent our partners around the world. And finally, we created a simple proposal to take a small percentage of the surplus, and use it to fund a pilot project on blindness that could restore the eyesight of more than 100,000 blind children and adults. This would test the waters and allow us to see if the Smile Train model could be applied to another problem.

I thought it was a brilliant plan and of course assumed everyone else would, too.

But I was wrong. There was a small group of people at Smile Train who hated the idea.

Expand beyond clefts? Absolutely not! Help restore the eyesight of blind children? No way! Come up with a plan to address the surplus of unused donations? Let it pile up!

I was completely blindsided by the vehement opposition to our plan. At first I thought they just didn’t understand it and I had done a poor job of explaining it. But no, that wasn’t it at all. In fact, the more I explained the more the opposition grew.

Their argument in a nutshell was this: Smile Train was started to help children with clefts and that was that.

I did my best to stay calm even though I was getting very upset.

“You can’t ‘let the money pile up,’” I responded. “This isn’t like a college or a hospital where donors know their donations are funding an endowment. Our donors believe their donations are going to be used to provide surgeries for children. I’m worried that if our donors ever found out we were accumulating such a large surplus of unused donations they might feel betrayed and never give us another nickel. I believe it is unethical for us to raise money we may not need and may never spend.”

Again, I launched into all the compelling reasons to expand our mission, reiterating that we could use our surplus donations to double and triple the surgeries we were providing every year.

But still I got nowhere. This small group had decided they were against this idea, and it didn’t seem like there was anything I could do to change their minds.

And in a sense, they were right. One of the founding principles of Smile Train was that we would focus on one problem—clefts—and solve it. There was no doubt that our laser focus on clefts had been one of the reasons we were so successful.

But times had changed. Surgeries had stopped growing. We had plenty of money in the bank to fund cleft surgeries. There were millions of other children waiting for other types of surgery. We had millions of donors supporting us. This wasn’t about the past; it was about the future.

For a long time now, I had been pursuing two missions. The main one was to eradicate unrepaired clefts throughout the world. But my secondary goal had been to run a nonprofit so effective that it would challenge the public perception of nonprofit organizations altogether. In 2010, according to a survey conducted by NYU, more than 70 percent of Americans believed that most charities waste donations. No wonder. It seems that every year that goes by, there’s another scandal in the newspapers about a charity misusing donations. To give one example, at the same time I trying to expand our mission, CBS ran an exposé on the charity Feed the Children, accusing it of spending a small fraction of what they raised.

With Smile Train, we had worked hard to break the mold. As Steven Levitt had described us in New York Times, we’d been called “one of the most productive charities, dollar for deed, in the world.” Our overhead spending was less than 1 percent and we had striven for all these years to make our operations as cost-effective as possible. We were data-driven, high-tech, and forward thinking. We had a very small, smart staff, and together we had brought awareness of the problem of clefts to just about every household in America.

Now everything I’d always feared about charities—that they hid their massive inefficiencies behind the veil of doing good—might come true for mine. My name was on every single one of the close to 100 million direct-mail letters we sent to prospective donors every year. I couldn’t betray their trust and goodwill by continuing to solicit donations we didn’t need. I would have been completely ashamed if I had to explain to our partner surgeons and nurses and social workers that we were accumulating hundreds of millions of dollars that could otherwise be used to save lives.

But we were at an impasse. Clearly, there were two competing visions for the future of Smile Train. One was focused on staying the course we had charted for all these years, working only on clefts and not worrying about the surplus.

The other was to use the surplus to expand the mission and double or triple the number of surgeries we were funding every year. I was very proud of the work Smile Train had done, but I was far from being “done.” I couldn’t imagine being part of an organization that would intentionally allow a surplus to keep growing, with no plan for how to spend it. The thought of it violated every principle I held.

“I don’t want to run a bank,” I said. “I want to run a charity.”

“So leave,” I was told.

I almost laughed when I heard this. Leave Smile Train? Smile Train was my baby, my life. I could never leave Smile Train! I had spent a decade of my life building this organization into one of the biggest, most successful, and most respected charities in America. I wasn’t going to leave. I would just have to regroup and find a way to do a better job of convincing the naysayers to adopt my expanded vision. Obviously I just hadn’t gotten them to understand the incredible opportunity we had to put all of these unspent donations to good use.

So my staff and I went back to the drawing board. We did more research, created new presentations, and constructed new arguments about all the new medical problems we could be working on, as well as the challenges and opportunities we would face if we were to try to tackle them.

We spent months working to convince the naysayers that our plan was in the best interest of everyone: Smile Train donors, partners, and, most importantly, patients worldwide.

But in the end, despite all the presentations, all the special meetings, all the data, and all of my pleading and begging, I failed.

Smile Train was going to remain focused on clefts alone, and that mountain of unused donation money was just going to get bigger.

This left me with a very big decision to make.

Was I going to stay at my job running one of the most successful, best-known charities in America? Was I going to keep raising money for clefts when I feared that much of that money might not ever be needed and might never be spent? Was I going to forget about the millions of children around the world waiting for other surgeries?

Or was I going to leave?

Could I start over with no money? No donors? No staff? I knew exactly how hard it was to start a charity—because I’d already done it. Back when I became interim president of Smile Train, I was forty years old. Now I was nearly fifty, with three growing children. Maura was nine years old, Charlie was eight, and our little guy, Quinn, was six. I couldn’t go flying around the world all the time as I had in the past, and I couldn’t work eighty-hour weeks anymore.

Was I just too old to start over?

During this time, I thought a lot about the work we had done with Smile Train and what it meant to me.

The trip DeLois and I had taken to East Africa had been galvanizing in so many ways. Meeting Asrat, the boy with the cleft who was also blind, and seeing the overwhelming need at the Dadaab refugee camp had convinced that there was so much more work to be done. But there was another experience that had stuck with me since my return from East Africa.

Before we left Ethiopia, we had hosted a dinner for our partner surgeons at our hotel in Addis Ababa. Some of these doctors I had met in the past, but there was one I didn’t recognize, so I went over and introduced myself. His name was Dr. Paul Lim, and he was a Korean American plastic and reconstructive surgeon from Minneapolis. The other doctors and staff at the dinner were all African by birth, so I assumed that Dr. Lim was here on some kind of mission trip.

“Are you visiting to do surgeries?” I asked him.

“No,” Dr. Lim replied. “I live here with my wife, who is a pediatrician, and our two kids. This is our home.”

Wow, I remember thinking. Dr. Lim and his wife could have made a million dollars a year back in the States, yet they had chosen to live in one of the most impoverished places in the world.

I asked him why they had made that choice.

Dr. Lim paused, then answered. “I want to lead an intentional life,” he told me. “I want to help people. I want to do meaningful work. I want to make a difference in the short time I’ve been given on this earth. I can think of no other place in the world where I can make as big a contribution as here in Ethiopia.”

“But isn’t it hard to live here with a young family?”

“Yes, it’s been very challenging in many ways,” he told me. “There are power outages, lack of water—but in other ways, these have been the happiest years of our lives. We’re able to see the impact of our work, and that gives us a deeper, more lasting kind of satisfaction than we could ever have at home in the States.”

The conversation with Dr. Lim had a profound impact on me. After I came back from East Africa, I knew I needed to ask myself some hard questions. What about my life? Would I look back on it and have regrets? Was I making the most of my time here on this earth? Was I living an intentional life?

I thought about all the incredible doctors I had met over the years, from Dr. Adenwalla and Dr. Subodh in India to Dr. Poenaru and Dr. Lim in Africa. To me, these surgeons were heroic examples of how to live with integrity, honesty, and devotion. I couldn’t aspire to be as good and as self-sacrificing as they were—I would never be able to move my family halfway around the world to help others—but I could find a way to continue the work I had started with Smile Train, striving to empower doctors around the world and to make lives easier and healthier for their patients.

I knew what I had to do. I knew what my mom would have told me to do.

And so in October of 2010, after ten years at Smile Train, I made a completely intentional decision about the next chapter of my life.

I resigned.

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