Creating Smiles, Improving Lives


We are at the halfway mark already and this blog has barely gotten off the ground. Something strange has happened. The more I see on this mission, the less I have to say. I’m like a deer caught in headlights—stunned silence brought on by the magnitude of the experience. I think, Blog, perhaps it’s time to break up. It’s not you; it’s me. We’ve grown apart. I need someone with a little more depth and intelligence. But this can’t happen. I’ve committed to writing this blog. It’s my “job.” I’ve chosen a style, a voice, but is my approach a little too…stupid? I feel a little boxed in by it. I don’t know, maybe hanging out with all these MDs is having a bad influence on me.

Ask me a question, any question, and I’ll answer it. There is so much going on here, and I’m having a hard time focusing on any one thing. So I’m going to pretend to be you right now and ask myself a bunch of questions that I will answer. (If anyone other than my mom is reading this and wants to know something, please ask me in the comments section and I’ll be happy to get you an answer).

Why aren’t these patients taken care of by their own doctors?

There are not many plastic surgeons in El Salvador who are willing to make regular work of performing surgery on patients who can not pay them, and there are even fewer who have the training to do the complex surgeries done by the Austin Smiles volunteers. The complex jaw surgeries being performed on this mission have never been done here before. One of the Salvadoran doctors told me that medicine is socialized in El Salvador and it can take up to three and a half years for a person to receive even a basic plastic surgery procedure, so you can see why an organization like Austin Smiles provides an invaluable service.

Is it really poor there?

The poverty here doesn’t seem that unlike the really poor underserved areas of DC, NYC, Los Angeles and Austin (the places I’ve lived). But I’ve only seen the five-mile area between our hotel and the hospital, which part of, I’m told, is like the Beverly Hills of San Salvador. The cab driver I had yesterday told me most people live on about $200 a month. He pays $125 a month for a four-bedroom, one bathroom apartment. He works 12 hours a day. I’m sure a google search could get you real numbers and statistics, but this is my impression so far given my limited view.

What’s the hospital like?

It’s old and run down and it’s not very clean, but it’s not horrible. Many of the lights don’t work and the air-conditioning works only intermittently. The Salvadoran staff is very cooperative, polite and kind. The many volunteers from El Salvador make this mission possible. The Rotarians, for example, are a great organization. They provide interpreters, help with all of the logistics, bring us lunch, drinks and snacks, and so much more. We couldn’t do it without their help.


Above: Hospital waiting area.

Are the volunteers really doing this out of the kindness of their hearts?

Yes, they are. They really do care. The hours are long and hard and their only reward comes in the form of knowing they helped someone. They pay to be here and most of them use their vacation time. They are on their feet for 10-14 hours, some of them only sitting down for 15 minutes the entire day. One dedicated scrub tech was severely dehydrated, had an IV put in, pushed in a couple bags of fluids and continued working. (You go, Steve Miley!) I’ve seen several volunteers reach for the Motrin, Imodium and other little pharmaceutical friends. This is an endurance sport, my friends, and these people are Olympians in my opinion. We have people working who are well into their 60s and I can’t keep up. I’m joining a gym when I get home!

Are you enjoying the experience? (My mom asked this question in an email.)

Yes, very much. It’s corny to say, but I will never forget it, and I will look at the world a little differently, I think. I hope. I wish I had some medical training or spoke Spanish so I could help more, but my co-volunteers are so nice and they never make me feel like I have less of a reason for being here than anyone else.

The blog job was a bit of a stretch, but hopefully someone out there is getting something from it. Austin Smiles has wanted to blog for a while. This is a start at least. I never set out to describe the mission experience. I set out to share my experience. I tried to be upfront about my limited perspective. I’m toddling my way through this. I’m trying, people! Really I am.

That’s the end of the question-answer session, and now I will recap our day yesterday (I’m running a day behind.)

You learn to expect the unexpected. Something will happen—a delay, a complication. The commute to the hospital was uneventful (there were two late volunteers running after the bus, but Dr. Cullington was in a good mood and he let the driver stop). We got off to a slow start because there were issues with instrument sterilization, and there was a baby from the day before who needed additional care. It was stressful and scary, but the response from the doctors was impressive. A lot of experience and brainpower was in that room and the patient is going to be ok.


Above: While we waited for things to get started, I spotted this in the lounge.

We went upstairs to check on the patients who had their surgeries yesterday. What a difference a day makes! They were all doing great and were able to go home later in the day.




After rounding, I went downstairs and peeked into Dr. Robison’s room while he was removing a nevus and a huge ganglion cyst from a young patient. He let me stand right next to him and gave me a mini anatomy lesson. It was fascinating. The human body can endure a lot of tugging and pulling—and sawing and plating, which I got to see later when my husband did a big double jaw surgery. This type of surgery has never been done at this hospital before. The patient, Giovanni, is studying to be a lawyer. I love this man. He has such a positive attitude and he was very excited about getting the surgery done. It went perfectly and Giovanni, whose jaw was wired shut, was already writing notes to the nurses in the recovery room soon after he woke up—very impressive given this was a major surgery.


Above: Giovanni before. Notice the jaw alignment. His upper jaw is sunken in and his lower jaw is jutting out. Below: He is taken back to the operating room. Look at the smile on his face!


ImageAbove: Drs. Harshbarger and Lima perform a double jaw surgery on Giovanni.

I think we did about ten surgeries yesterday. In addition to the ones I mentioned above, there were surgeries on syndactyly (webbed fingers and/or toes), cleft palate and cleft lip.


Above: Nurse Daira holds a baby after a unilateral cleft lip repair.


Above: Parents see their baby for first time after unilateral cleft lip repair.


Above: Mama holds her baby for first time after surgery.

It is the rainy season in this part of El Salvador right now, and we have had two torrential downpours so far. Last night there was so much rain, the hospital flooded with two inches of water. The hospital is only about 25 years old, but it looks and feels a lot older than that. I don’t think it has been maintained very well. Clearly, it needs a new roof!

A very prominent Salvadoran family invited us all to dinner at their lovely house last night. They made delicious pupusas, a traditional Salvadoran dish made of thick corn tortillas filled with beans, cheese and pork, and we had bananas filled with cheese and beans. It was a great way to end the day.

Stay tuned.

1 in 700 children are born with a cleft lip or palate

$250 covers the cost of one life-changing surgery

150 volunteers annually will change a child’s life forever

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