My first trip as interim president of Smile Train was to India in November 2001, and frankly, I didn’t want to go. It was less than two months after the attacks on the World Trade Center, and, like so many people at that time, I was in no mood to travel. Together with my entire staff, I had witnessed the planes flying into the buildings from my office in Manhattan. The fires at Ground Zero were still burning. The whole world had been turned upside down, and all I wanted to do was to stay as close to home and my family as possible. Cricket was also reluctant for me to leave; she had given birth to our second child just a month before.

But Smile Train wasn’t my sideline anymore; it was my job. If I was serious about increasing our surgeries around the world, I had to get out in the field and learn about the work of our partners firsthand. After China, India had the greatest concentration of unrepaired clefts in the world; it was the obvious next country for us to tackle and I knew we couldn’t sit around waiting.

And so, on November 15, 2001, DeLois and I flew to Chennai to begin a weeklong trip visiting seven new partners. As it is for most Westerners encountering India for the first time, the experience was overwhelming. From the minute I arrived to the minute I left, I found myself swept up in a sensory overload that was so intense, there were moments where I had to take a step back and gasp—so many sights, noises, smells, and colors; so much traffic and humanity; streets that were crowded with buzzing motor rickshaws, broken-down bicycles, carts pulled by mules, trucks painted in every color of the rainbow, cows wandering across the street, and an endless crush of people everywhere. And the poverty stopped me in my tracks. Wherever we went, we saw barefoot children in ragged clothing; they would weave their way through the cars to find us, tugging on our clothes and holding out their hands for a few rupees. At night, we saw people living on the streets lighting fires to cook meager meals over the flames. In Chennai, we learned, nearly 800,000 people were living in slums.

But Chennai was just the beginning. From there, we traveled southwest to Thrissur, then east to Mangalore, south to Coimbatore, and north to Mumbai and Bangalore. We were up at five every morning, often not getting back to our rooms until eleven at night, traveling on airplanes, trains, rickshaws, and cars. If there are any rules of the road in India, no one seemed to follow them, and each car ride felt like my last. I held my breath as our driver raced to overtake every bus, truck, or stray cow in his path, while oncoming traffic careened toward us at a terrifying speed. The incessant game of chicken was nerve rattling, but thankfully our driver was talented. Each time I was convinced we were about to crash headlong into an oncoming vehicle, he’d tug on the steering wheel, swerving at the final second, and we’d be safe. When I asked him if he ever worried that the other drivers on the road might not be so talented, he shrugged.

“Don’t worry, sir,” he told me. “In India, all the bad drivers are already dead.”

In contrast to the teeming, thrumming chaos of India’s cities, each hospital we visited felt like a calm oasis. Stepping inside, we were greeted by devoted doctors, nurses, and staff who were working tirelessly on behalf of their patients. We had selected our partners very carefully, the first criterion being that every hospital should have a history of offering free or very low-cost treatment to poor patients. We felt this would be an excellent indication of credibility, and it turned out we were right. Each of the seven hospitals we visited impressed us immensely, but one stands out in my memory as being particularly special: the Jubilee Mission Hospital, in the city of Thrissur, in the southwestern state of Kerala.

From the moment we left the airport, Thrissur felt very different from the frenzy of Chennai. The landscape was lush with swaying palms and paddy fields. It was undeniably beautiful—but also undeniably poor. There were more than 130 slums across the city, where people lived crowded together in tiny makeshift homes without adequate water or sanitation. Children growing up here were at a high risk for sickness and malnutrition. Many only stayed in school for a few years before dropping out in order to earn money to help support their families.

We were here to visit our partner hospital in Thrissur, Jubilee Mission, known locally as “the poor man’s hospital” because it will never turn away a patient who can’t afford to pay. As we pulled into the hospital grounds, the head surgeon and founder of the hospital’s cleft clinic, Dr. Hirji Adenwalla, was waiting for us on the porch of his small cottage. The doctor was in his seventies, with a balding pate and twinkling eyes behind half-moon glasses. His wife, Gulnar, tall and elegant, with silver hair, welcomed us to their home, leading us into a small dining room where the table was set for afternoon tea. As Gulnar poured scented Indian tea from a large pot, we asked the Adenwallas to tell us their story.

We learned that the couple was originally from Bombay (now known as Mumbai). When they first met and married, Dr. Adenwalla had finished his medical training and was working as a junior doctor at a well-known children’s hospital in the city.

“I enjoyed the work, but I knew my true vocation lay elsewhere,” he told us. “I wanted to live a life of meaning and purpose. I had read the philosophical works of Albert Schweitzer, the German-born medical missionary who traveled to West Africa and founded a hospital there. I decided I wanted to serve as a medical missionary in Africa.”

His new wife Gulnar agreed to go with him. The only problem was that her parents were against the plan.

“You can go to Africa if you like,” Gulnar’s father told him, “but you’re not taking my daughter with you.”

Dr. Adenwalla loved Gulnar, and he wasn’t going to leave for Africa without her. So he resigned himself to staying in Mumbai. It was a cousin who observed that if he really wanted to help the poor and needy, there were plenty of opportunities to do that closer to home.

Soon after that, Gulnar saw an advertisement in the newspaper for a small mission hospital in Thrissur that was looking for a doctor. Dr. Adenwalla applied and was accepted. The couple packed their belongings and headed south, arriving at the hospital in 1961. At that time, their little cottage had no plumbing, so they had to draw water from a well, and they had only one table fan that they would carry from room to room to try to stay cool in the humid temperatures.

“But we were young and in love,” Gulnar said. “To us, it was an adventure.”

Meanwhile, Jubilee Hospital was little more than a prescription dispensary, with twenty beds, four nuns serving as nurses, a makeshift operating theater with no anesthesiologist, and hardly any surgical instruments. In those early days, Dr. Adenwalla performed many roles, starting work at seven every morning and often not returning home again until one the next morning. He did all his own lab work and took his own x-rays. He taught Gulnar to administer anesthesia for surgeries. He delivered babies and set fractures, dealing with every imaginable health issue, from head injuries to hernias. When a patient came to the hospital and couldn’t afford to pay, the Adenwallas knew they could send the bill to the Catholic archdiocese of Thrissur, which had founded the hospital and funded its activities.

Back in Mumbai, family members and friends questioned the couple’s sanity. Why would they put themselves in such a difficult and unpleasant situation when they could be living a nice comfortable life in Mumbai? But both Dr. Adenwalla and Gulnar felt that their new life gave them something more valuable than material comfort.

“When you remove money from the business of being a doctor, the gratitude of the patient becomes your reward,” Dr. Adenwalla explained to us. “Once you have experienced practicing medicine on these terms, it is hard to imagine working any other way.”

One day, after the Adenwallas had been at Jubilee for a few months, a fourteen-year-old girl came to the hospital with a cleft lip. Dr. Adenwalla had performed cleft surgeries before, during his time in Mumbai, so he immediately reassured the girls’ parents that he could help her.

“The nuns who worked alongside me had seen a lip repaired before, but in their experience it had always fallen apart when the sutures were removed,” Dr. Adenwalla told us. “You can imagine their surprise when my repair stood its ground! In their eyes I had graduated, and after that they thought I could do no wrong—or at least no harm.”

Over the next decade, Dr. Adenwalla and his team built up their little hospital until it gained an excellent reputation. They transitioned it into a teaching hospital and began training new doctors. Once more surgeons joined the staff, Dr. Adenwalla could stop being a generalist and begin to think about specializing. He found himself drawn to plastic and reconstructive surgery.

He began to focus on treating burns, performing skin grafts, fixing lacerations, straightening club feet, removing tumors, and, of course, repairing clefts. The challenge of restoring a body to normalcy after a trauma or a defect was extremely satisfying to him. It was grueling work, but he felt passionate about it. The years passed, and one day, Dr. Adenwalla realized he’d been at Jubilee for thirty years. Not long after that, at the age of sixty-four, he suffered a coronary. The year after that, he needed a bypass. He was forced to face the fact that he was no longer able perform surgeries at the volume he had in the past. So he decided to scale down, focusing on a single surgery, the one that brought him the most satisfaction: clefts.

“With a cleft surgery, I felt that I could have a real impact on the life of each patient,” Dr. Adenwalla explained. “The goal of plastic surgery is perfection, and many times as a surgeon, you fall short. But with clefts, the results are immediate and substantial—and you know they will last for the rest of the patient’s life.”

Although he received grants from a Dutch charity and the local diocese, funds for surgeries were generally scarce, and until recently, Dr. Adenwalla had been forced to spend a large amount of his time fundraising. But now, with support from Smile Train, he was able to focus all his energies on helping his patients—and his number of surgeries had doubled as a result.

After tea, the Adenwallas invited us to tour the hospital with them. We followed the doctor and his wife along the winding path that led to the wards. As we entered the hospital, it was clear that Jubilee had come a long way since its early days as a dispensary. The hallways were bright and clean, with smiling nuns in white saris bustling by, carrying meals in small metal pails, and crosses hanging on the walls. Dr. Adenwalla explained that while the hospital was still run by the local Catholic diocese, the community it served is made up mostly of Muslims. The Adenwallas themselves followed the Zoroastrian faith, one of the oldest monotheistic belief systems in the world. I thought about the rifts and divisions happening in the world after 9/11—and yet here at Jubilee Hospital, there didn’t seem to be any sign of religious animosity. This was a place of peace and healing, regardless of belief.

We followed Dr. Adenwalla into the cleft ward. The children there had already received surgeries, and their little arms were in splints and bandages so they wouldn’t try to scratch their stitches. All eyes turned to face the doctor as he walked along the rows of neat metal cots. He seemed to know the name of every mother—and her story as well. He took time to stop and speak to each of them; many so young they were still in their teens. He reassured them all in a soothing tone and with total focus, and each mother in turn gazed up at him with relief.

I shook hands with the mothers. I patted their children’s arms. I asked questions, eager to learn more about their lives and their journeys.

“Everyone in my family blames me for my child’s deformity,” one woman told me. “They say it’s my fault because I held a knife during an eclipse while I was pregnant.”

“I was forced to run away from home,” another mother explained. “My mother-in-law threatened to throw my baby in the river because she thinks he is cursed, that my child is bearing the karma of the sins of my ancestors.”

Dr. Adenwalla explained that he had heard these superstitions time and again: that a child had been born with a cleft because the mother had looked at another man, or eaten the wrong thing, or laughed at the wrong person. The doctor had become expert at dispelling these myths, explaining to these mothers that a cleft is a birth defect, that surgery is available to repair it completely, and that here, at Jubilee, it would be free.

The head nurse walked through in her white habit, smiling as she went. There were local women in colorful saris also attending to patients, as kind and focused as Dr. Adenwalla. It was clear that the doctor and his wife had set the tone in the hospital, and everyone else followed suit.

Sunlight streamed in through the windows and everything inside seemed touched by warmth and goodness. The mothers whose children had already been treated sat close to their babies, looking at them with new hope. The “curse” had been lifted and they could go home and start afresh.

Next we visited the operating room. Here, Dr. Adenwalla asked us a question: “What do you think is the most vital piece of equipment here?”

I told him I wasn’t sure.

“It’s the surgeon’s light,” he explained. “If the surgeon cannot see, then he cannot perform his duties. To be a good surgeon, you need an excellent headlamp. Your lamp is the difference between a mediocre and an excellent surgical outcome. Do you know I struggled with a third-rate headlamp for forty years? Now, thanks to your organization, I have a first-rate, brand new headlamp. If only you had come along when I was a younger man!”

I told him that I truly wished we had. Dr. Adenwalla was in his early seventies; how many years did he have left to practice surgery? Maybe five or ten at the most. At least for these final years he would have all the equipment and support he needed.

After our tour, Dr. Adenwalla took us back to his cottage for a glass of his favorite single-malt whiskey before we departed. It was early evening now, and the rich, velvet Indian night had descended, wrapping the hospital and its grounds in darkness. As we sat on the porch swirling our glasses, I could hear something that sounded like crying in the far distance.

“What’s that sound?” I asked.

“It’s the babies in the infant ward,” Dr. Adenwalla explained.

I looked over at the doctor. He was smiling, still alert and spry, even after a long day of work. I tried to imagine the stamina required to look after patients all day and then to be able to come home and not feel disturbed by the cries of your youngest patients.

“Doctor,” I asked, “what’s your secret? Why don’t you tire of your work?”

Dr. Adenwalla followed my question with another question.

“May I tell you story?” he asked.

I said of course.

“Not so long ago, a woman walked into my consulting room,” Dr. Adenwalla began. “She was carrying a little boy with an unrepaired cleft. I happened to notice that the woman had a scar on her upper lip, an indication that she, too, had once had a cleft, but that it had been repaired. Clefts often run in a family, so I wasn’t surprised.

“The woman walked up to me and placed her child in my lap and then started crying. Her name was Bushara, and she told me that she had indeed been born with a cleft. She was the fifth child in the family, and her parents were determined to have her cleft repaired. Bushara had five surgeries, all of them expensive and problematic. In order to raise the money for her treatment, her father sold their house, their farm, and their belongings. During this period, Bushara’s mother died of tuberculosis and her father became a worker on another man’s farm. Not long after that, Bushara’s father also passed away, his heart and spirit broken. At eighteen, Bushara married, and not long after that, her children were born, four in a row. And then came her fifth child.”

This was Mohammed, the little boy with the cleft that Bushara had placed in Dr. Adenwalla’s lap.

“Bushara told me, ‘The day Mohammed was born, I promised that I would never allow my fifth child to ruin my family’s life, the way I had ruined life for my parents. I would never seek out surgery for my child. Never.’”

It was only when Bushara heard about the free surgeries offered at Jubilee Mission, that she had changed her mind. That day, the doctor reassured Bushara that he would perform the surgery free of charge, that it would cause no harm to her family’s life. She didn’t need to worry anymore. The nightmare was over.

“It is moments like those that provide me with the drive to continue,” Dr. Adenwalla told us. “Every day, women come to the hospital with looks of such deep shame and sadness on their faces. They’re hiding their babies under their saris, hoping no one will notice the child’s deformities. But after the operation, the cleft is gone—and so is the stigma. And the shame and sadness on the mothers’ faces vanishes, too. When these women leave, they are smiling, holding their children up with pride. That is why cleft surgeries have become such a crusade for me.”

I told Dr. Adenwalla that I knew exactly what he meant. This was what I had seen when I witnessed my first cleft surgery in China. It was the reason I’d helped to found Smile Train, and the reason I was sitting there with him that evening.

“Everyone talks about the children who are transformed by this surgery,” Dr. Adenwalla observed. “But people rarely talk about the surgeons. For us, it’s also transformative—and so rewarding. Every day when I go to work, I see the smiles of mothers and their children leaving this hospital. My job is to throw a smile into a pool of water, and to watch the ripples of smiles grow all over.”

In Thrissur, sitting out on the porch, it seemed to me that Dr. Adenwalla was the antidote to everything that was wrong with the world. In the aftermath of 9/11, the world hovered on the brink of a new and terrifying era, where the old ideas of safety and freedom no longer applied. When I’d boarded the plane to India, I’d felt shaken, my faith in humanity and my security uncertain. But that night on the porch, my heart felt full. I wished that everyone I knew could see this place, the pure, simple humanity of this doctor and his wife, the nurses in their white saris on the wards, and the smiles of the mothers who knew that they could go home and start their lives anew. I felt that if people could come here and witness this for themselves, maybe they would feel reassured—as I did—that despite all the things that were wrong with the world, at least there were people like Dr. Adenwalla in it.

“I raise my glass,” I said, “to the Mother Teresa of clefts, Dr. Adenwalla!”

“Oh please,” the doctor said, brushing away the compliment. “Did Mother Teresa sit out on her porch at the end of the day with a glass of single-malt?”

We clinked glasses. Then the good doctor took another swig, winked in my direction, and smiled.

INSERT PHOTO: DrAdenwalla

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