I will confess, I’ve never had any desire to go to Bangladesh.

But it is ranked 4th in the world in terms of the largest number of cleft births a year so off I went. Left on a Thursday, arrived on Saturday after traveling for 25 hours straight.

It was even poorer than I had feared. In a country slightly smaller than Iowa live more than 150 million very poor, very frustrated, very unlucky people.

Half of them live on less than $1 a day.

It’s the most densely populated country on earth with a long list of hardships including cyclones, flooding, systematic corruption, political turmoil, religious and political violence, government incompetence, military coups and the world’s highest death rate due to infectious diseases.

Average lifespan is 55 years. Literacy rate is just 50%.

Driving around Dhaka, the capital, was depressing. At times it felt like we were driving through Iraq. Slums, shacks and shanties abound. Wild pigs foraging through rotting garbage. People too poor to afford shoes, sometimes clothes.

Not only were most people skinny, you could see the ribs on camels as they went by. One rare highlight were Smile Train posters we saw all over town telling people about our free cleft surgery programs. A small ray of hope in a sea of despair.

While stopped at a traffic light we were startled by a tap-tap, tap-tap-tap.

Someone was tapping on our car window. Beggars. Two little kids with a baby.

“Don’t look at them!” Shouted our hosts.” Look straight ahead!”

Then more tapping on the left side, tap-tap, tap-tap-tap. An old leper without a nose.

On the right, a mother with a sick child. Every stoplight we were surrounded on all sides. We looked straight ahead as ordered I am ashamed to say. But I could hear that tapping long after the light changed, and we drove away.

The next day we took a tiny, six-seater seaplane on a 2-hour flight up a river to an area where the people are “much, much poorer than the folks in Dhaka”.

In this rural area, the poverty is so bad the only way to help the sick and the disabled is to bring your own hospital. And that’s what our partners have done.

They have turned a simple barge into a floating hospital called Jibon Tari which means literally, “floating lifeline”.

For the poor who live in remote, desperate places with no hospitals or healthcare, it really is a lifeline.

The brains behind this idea is a remarkable man named Mansoor Chowdhury. Smart, passionate and selfless, Mansoor is one of a kind. He’s spent his entire life helping other people, which is even more impressive when you meet him and learn that he is completely blind.

In addition to helping hundreds of children with clefts, Mansoor and his floating hospital have helped tens of thousands of children and adults suffering with all kinds of disabilities such as club feet, cataracts, burns, etc.

Don’t let the outside fool you, the Jibon Tari has excellent, state-of-the-art surgical facilities. The only challenge is attracting surgeons to come and work on the boat. In all of Bangladesh there are only 8-10 plastic surgeons. America has more than 6,000 plastic surgeons. We’re trying to get some American plastic surgeons to come here and help.

We toured the hospital and met many children who had come from near and far. Each child we met was different and yet all told the same story. Their families were extremely poor, and the parents would never be able to afford cleft surgery. Average family income was around 50 cents a day. Many of them had trouble raising money to just to make the trip to get to the Jibon Tari.

One man sold his only means of support, his rickshaw, to pay for the trip. Others borrowed money from relatives. Some just begged on the street. It was their one chance, they did whatever they had to do to get here. You could see the desperation in their eyes.

You can’t really appreciate how poor these people are or what it means to live on 50 cents a day until you visit their homes. So that’s what we did after lunch.

We stepped ashore and it was like being transported back in time. Fishermen on boats that haven’t changed in centuries. A man plowing his small field with an ox and a wooden plow. People dressed like they were in the Bible.

With no cars, motorcycles, engines of any kind, we were transported on bicycles with wood platforms on the back to sit on. Skinny men who could not have weighed more than 135 pounds each slowly pedaled these bikes- and a few of us – down a dusty dirt road and back in time at least 500 years.

The first patient house we came to was a ramshackle house cobbled together out of odds and ends. No electricity or plumbing. No TVs, no radios, no phones. It was one of the poorest villages I’ve seen in all my travels.

The young mother who lived in this “home” was very kind and gracious. She told us how appreciative she was of the free surgery her son had received. “Thank you for making my son beautiful,” she told us.

Everywhere we went, everyone we met, was very warm and welcoming. Especially the children. We met hundreds of children that day. Each one had a big smile but not much else. Most were too poor to afford shoes. Many had no shirts. I wondered if any of these kids really knew what the future held for them and how hard their lives will be.

It was difficult to imagine that any one of these kids, no matter how smart, talented or ambitious could climb out of this village and cycle of poverty. I doubt I could.

Millions of Bangladeshis are leaving poor rural villages like this and flocking to cities like Dhaka in search of jobs and opportunity. But usually all they find is new forms of poverty, low paying jobs and many of the same hardships.

It really made me think that to be born in America is really like winning the lottery. So few of us ever really appreciate that.

In a blink we found ourselves back in Dhaka, stuck in traffic, when it happened again. Tap-tap, tap-tap-tap! I looked out the window and saw nothing. Very strange. But there it was, tap-tap, tap-tap-tap! I sat up and peered over the window and looked down at something I’ll never forget.

A three-year-old boy beggar. I knew his age immediately because I have a 3-year old son at home. This boy was not 5 or 6 – I have a 5 year and 6-year-old too! – but a 3-year-old, dirty, shoeless, little boy staring up at me while motioning like he was putting food in his mouth with the other.

I quickly lowered the window and stuffed some bills in his tiny hands. In a flash he turned and ran away, lost in the traffic of a busy city intersection.

The next thing I knew I was headed home. It had been a very successful but exhausting trip.

We visited 5 partner hospitals, held three press conferences, met with dozens of surgeons, doctors and administrators, hundreds of patients, parents, etc.

The only thing left was a brutal 17-hour, non-stop plane ride home. After watching three movies the flight attendant was kind enough to lend me her New York magazine. It was the perfect preparation for re-entry into the richest city in the richest country on earth.

The headlines all told the same story: “Dow Jones Soars to Record High”, “A Bottle of Dom Perignon Champagne Selling For $15,000”, “3 Bedroom Co-Op Available For $10 Million”, “Wall Street Year End Bonuses to Exceed $24 Billion”, “$250,000 Ferraris Sold Out”.

Wow. My head was swimming. I was trying to figure out just how many $250 cleft surgeries we could do with $24 billion when I dozed off. I remember visions of smiling little kids with no shoes dancing in my head.

And the steady beat of a tiny hand against a car door… tap-tap, tap-tap-tap.