Many of the people assembled at the Can Tho, Vietnam, hospital had walked miles to get a whole smile. They filled the courtyard and kept coming. Families had camped out on the roof for days so they would be the first to see the 40-odd surgeons, anesthesiologists, and nurses who had traveled there to operate for the first two weeks in November. Charles Madison stood dumbstruck as he looked out at the sea of faces, many bearing the trademark upside-down V of a cleft lip.
        The scene was set by Operation Smile, a private, nonprofit volunteer medical services organization that provides reconstructive surgery and related health care to indigent children and young adults in developing countries and the United States. In the Can Tho mission, the medical team performed 186 surgeries in five days.
        Madison, a speech and language pathologist at WSU Spokane, joined one of two teams that went to Vietnam last fall to perform surgery. His team headed south to Can Tho, a university city of about 100,000 people in the Mekong River Delta.
        From the moment the medical professionals reached the city, they were swept into action, working in conditions much different from what they were accustomed to in the United States.
        For starters, the five tables used for surgeries were never empty; the operations began at 7:30 a.m. and continued over the next 12 hours. Aside from anesthesia and antibiotics, patients were given only Tylenol 2 to relieve pain; other painkillers were not flown over with the teams because of import barriers. The doctors and nurses also had no radiology equipment.
        Madison shared information written in Vietnamese with families about language, speech, and hearing. Children born with cleft lips and palates face a number of challenges, including nasality, poor articulation, and hearing loss. Almost 90 percent of cleft palate individuals are likely to have middle-ear problems from fluid buildup and infections. Cleft lip or palate is a developmental abnormality that occurs in approximately one in 1,000 live births. It is best corrected shortly after birth.
        Madison also scheduled surgeries and moved and entertained patients, preparing the children and adults for their operations. People came to regard his presence as something of a confirmation that they could be next for a facial repair.
        "As soon as I came up, I was mobbed," he said.
        Madison recalls specific patients, one a horribly burned boy whose mother had saved him from an explosion. His surgery—to repair multiple, continuous facial contractions—was a delicate, complicated procedure, a departure from the "snip-and-suture" pace the medical team maintained otherwise.
        And in the mission's last days, there was the young patient who, when his time arrived, despite waiting all day with nothing to drink before his surgery, ran down the hall and through the surgery doors, practically hopping up on the table.

—Nella Letizia

During their Can Tho
mission, medical personnel
with Operation Smile
performed 186 surgeries
in five days.