Haiti. This young woman is due for her second surgery to repair a cleft palate. Cleft lip (cheiloschisis) and cleft palate (palatoschisis) remain a serious issue in developing countries, where millions of people, mostly children, try to exist the best they can. Most cannot eat or speak properly, some aren’t allowed to attend school, or even hold a job.

Haiti. Cleft Pallate.

Mogadishu, Somalia. A mother tries to calm her frustrated child who is hungry, but can’t produce enough suction to take to her breast.

Haiti. In America alone, more than 5,000 babies are born each year with a cleft lip and/or a cleft palate, making it one of the most common major birth defects.

Orofacial clefts are openings in the lip or palate (roof of mouth) that are caused by an incomplete development during early fetal formation. In addition to various cultural and social stigmas, associated problems include: feeding issues, middle ear infections, hearing loss, dental abnormalities and speech difficulties.

Parents of a child with an unusual bi-lateral cleft make their way to the Baptist Mission Hospital in Fermathe, Haiti. A team of surgeons and nurses from Surgical Volunteers International led Smile Train's first initiative to Haiti in 2009.

Haiti. The cause of cleft lip and palate is generally unknown. Scientists believe that clefts are largely due to a combination of genetic and environmental factors. Another factor to consider relates to medication taken during the time of pregnancy or a virus.

Haiti. Being born with a cleft in a developing country often carries a stigma. In Uganda, a baby born with a cleft is given the name “Ajok”, which translates to “cursed by God.” Some newborns are either abandoned at birth or killed.

Mogadishu, Somalia. This is one of three young children I came across in an IDP (Internally Displaced Persons) camp in Mogadishu, Somalia while documenting another project.

Due to my affiliation with Smile Train, I was able to help facilitate two corrective surgeries during my time in Somalia. This image was taken the morning of his surgery.

Special thanks to the head surgeon at Medina Hospital in Mogadishu for accommodating my efforts to give these boys a fresh start.

Haiti. Children born with a cleft lip and palate frequently have dental problems. These include small, missing, teeth or malpositioned teeth. This may led to a defect in the gums or the bone that supports the teeth. Defects of the ridge can displace, tip, or rotate permanent teeth, or prevent permanent teeth from coming in properly

Hebron, Palestine. A child with a bi-lateral cleft lip during a medical screening day at the Al-Ahli hospital.

Haiti. An anesthesiologist re-checks the lung fields of a baby with a common cold. Due to the baby’s age and weight, it was decided to reschedule the surgery for another time.

Mogadishu, Somalia. Medina Hospital.

Haiti. A mother calms her baby down shortly before his surgery to repair a bi-lateral cleft.

Haiti. A typical volunteer medical mission lasts about two weeks. Potential candidates for the corrective surgery are pre-screened and evaluated by an anesthesiologist, pediatrician and the surgeon performing the surgery. A routine surgery to correct a cleft lip is approximately 45 minutes.

Haiti. A mother with her daughter waiting to be seen by a volunteer pediatrician. In some cultures, marriage plays a vital role in the economic well being of a family. Often the subject of ridicule, children born with a cleft are the least likely to wed, thus becoming a financial burden to the already desperate living conditions of a household.

Fermathe, Haiti. A doctor for Surgical Volunteers International evaluates a potential patient for cleft surgery during a two-day pre-screening at the Baptist Mission Hospital.

Haiti. A pre-screening triage is conducted by local volunteer nurses. During the process, various personal information is collected as well as height, weight and blood pressure.

Patient pre-screening in Haiti. Clefts remain a serious issue in developing countries, where millions of people, mostly children, try to exist the best they can. Most cannot eat or speak properly, some aren’t allowed to attend school or even hold a job. Those suffering with an unrepaired cleft tend to live in shame and isolation. The deformity often goes untreated because the family is too poor to pay for corrective surgery.

Hebron, Palestine. A Palestinian woman gets ready for surgery to repair her cleft lip at the Al-Ahli hospital.

Haiti. An anesthesiologist for Surgical Volunteers International prepares the monitoring system that will be used to evaluate the patient’s vital signs during surgery.

Mogadishu, Somalia. A nurse takes a sample of blood prior to surgery to correct a cleft lip deformity.

This is one of three young children I came across in an IDP (Internally Displaced Persons) camp in Mogadishu, Somalia while documenting another project.

Due to my affiliation with Smile Train, I was able to help facilitate two corrective surgeries during my time in Somalia. Special thanks to the head surgeon at Medina Hospital in Mogadishu for accommodating my efforts to give these boys a fresh start.

Hebron, Palestine. Palestinian medical residents observe as volunteers from an American based surgical team prep a patient at the Al-Ahli hospital.

Haiti. Anesthesiologists for Surgical Volunteers International sedate a patient in preparation for the corrective surgery of a cleft lip.

Haiti. A surgeon makes reference marks in preparation for a surgery to repair a cleft lip and palate.

Haiti. Dr. Larry Hollier, a volunteer surgeon from the Texas Children's Hospital, taking a short break between surgeries.

Haiti. A volunteer surgeon from Texas Children's Hospital ties off the closing suture on a cleft repair. The procedure took less than an hour. In most cases, the actual cost of the surgery is approximately $250.

Haiti. A mother is reunited with her child following a surgery to correct a cleft lip.

Hebron, Palestine. Palestinian medical residents observe as volunteers from an American based surgical team operate on a child with a cleft lip and palate at the Al-Ahli hospital.

Haiti. Shortly after coming out of anesthesia, the surgical site is debrided and cleansed with antiseptic to prevent infection.

Haiti. Patients are advised to stay at the facility for at least a day in the event of bleeding or other unforeseen complications developing as a result of the surgery.

Palestine. After an operation lasting a little over 45 minutes, this 25-year-old Palestinian woman sees her new smile after a surgery to correct a cleft lip.

This is one of three young children I came across in an IDP (Internally Displaced Persons) camp in Mogadishu, Somalia while documenting another project.

Due to my affiliation with Smile Train, I was able to help facilitate two corrective surgeries during my time in Somalia. This image was taken less than an hour after one of the surgeries. Special thanks to the head surgeon at Medina Hospital in Mogadishu for accommodating my efforts to give these boys a fresh start.

Haiti. Cleft repair - two days post op. Haiti

SmileTrain

Haiti. After six years of disfigurement, Bergaline Moise looks at her new smile for the first time.

Haiti. Before and after images of an adult born with a bi-lateral cleft lip and palate. The progress is after two corrective surgeries. This patient went on to receive one more.

Haiti. Six-year old Bergaline Moise became one of our medical team mascots during Smile Train’s first mission to Haiti in 2009. She had corrective surgery for a cleft lip and was visited by American actor Chris Meloni who came along to support the charity.

Mexico City, Mexico. Speech therapy workshop for post operative cleft lip and palate patients.

Mexico City, Mexico. A post-operative child that underwent surgery for a bi-lateral cleft, at a speech therapy workshop.

Mexico City, Mexico. Students work on annunciation along with a speech therapist during an intense month-long workshop.

Mexico City, Mexico. Problems with language delay can occur due to a child's inability to produce certain sounds. Compensatory speech patterns can develop and be very difficult for adults to understand. This in turn affects the child's interaction with adults and children.

Mexico City, Mexico. A post operative palate repair patient wearing an orthopedic appliance that will correct her anterior cross-bite.

Mexico City, Mexico. Speech pathologists at this camp in Mexico City use various methods of stimulation to assist in speech development. Children in the class are learning the relation between certain words and annunciation.

Mexico City, Mexico. Problems with language delay can occur due to a child's inability to produce certain sounds. Compensatory speech patterns can develop and be very difficult for adults to understand. This in turn affects the child's interaction with adults and children.

Speech therapy workshop in Mexico City, Mexico. Postoperative patients (cleft lip and palate surgery) work on articulation... well, not exactly at this moment.

Mexico City, Mexico. Post operative cleft surgery.