Email

Kathmandu — Program Associate Zach Shuster writes about the astonishing efforts of B&B Hospital's outreach team.

Without their willingness to seek these patients out through sheer dogged perseverance, Smile Train’s mission to reach every child with a cleft would go unrealized.

I recently got back from a trip to Nepal, where I traveled with South Asia Program Director Mamtaa Carrol as she interviewed prospective treatment centers and checked in on well-established Smile Train partners. Smile Train has sponsored surgeries in Nepal since 2001, when a joint partnership with ReSurge International produced 74 surgeries at six treatment centers in one year. Since then, Smile Train’s presence has grown dramatically; over 1,500 surgeries were funded last year, and regional staff has been pushing to increase overall coverage.

One of the country’s most active treatment centers is B and B Hospital in Kathmandu. Their surgical volume is due in large part to the efforts of their outreach team, a band of young Nepalese men with boundless energy and a sense of purpose that compels them to serve their country.

At the country level, Smile Train’s efforts rely on multiple layers of dedicated individuals all working together to connect cleft children with the doctors who can help them. Oftentimes, the hard work of finding cleft patients falls to outreach teams like the one at B and B Hospital. Nepal is a country with highly variable topography and wild shifts in elevation, which is a major draw for adventurers and trekkers, but it presents a unique set of challenges to surgical teams. Dramatic, mountainous terrain means isolation, and remote communities often lack access to medical care and information, which means that a child born with a cleft might never receive the medical treatment they need. Parents may not even realize that their child is afflicted with an easily treatable medical condition because they may never have seen another person with a cleft lip or palate.

It is in countries like Nepal that outreach efforts are crucial. Mamtaa is fond of saying “surgery is the easy part. It’s getting kids in the door that’s difficult.” B and B Hospital’s outreach team takes this message to heart as they travel for days at a time to reach some of the remotest parts of the country and bring the patients they find back to Kathmandu. When we visited the hospital, Mamtaa and I sat with the guys as they described their experiences. Since they started going on outreach treks, they’ve contended with leeches, landslides, torrential rain, and an absolute lack of amenities (read: bathrooms). Team leader Shanker Lama described walking for 18 hours straight simply because he had no place to stop. It’s no wonder remote populations don’t know about free surgery in cities like Kathmandu; they may never have been there in their entire lives simply because the trip is too daunting. Without the dedication of outreach teams and their willingness to access these populations, there are literally thousands of cleft patients around the world who would go untreated simply because they haven’t been reached.

Watch interviews with the Smile Train outreach team members.

I couldn’t help but notice the enthusiasm with which the members of B and B’s outreach team described their experiences. With huge smiles on their faces, they told stories of the hardships they faced by trekking to reach patients, sharing tidbits like the secret for keeping leeches out of your shoes (“soak your boots in tobacco overnight”) and the best place to use the bathroom (“the river”). The reason for this enthusiasm is simply the pride these young men take in being able to help their country’s people. A young outreach worker named Ayush summed up his motivations best when he said, “I’m just doing it for my country. That’s it.”

As Smile Train’s programs grow, outreach teams like the one at B and B hospital will become more and more crucial to the mission of eradicating untreated clefts worldwide. Hospitals are more common in cities, where awareness efforts tend to rely on urban infrastructure – media like TV and radio, flyers in public places, and word-of-mouth shared among a densely concentrated population. As urban cleft patients receive treatment, the backlog is increasingly pushed to rural areas, and the outreach teams that strive to reach patients in remote communities become the real heroes of Smile Train’s efforts. Without their willingness to seek these patients out through sheer dogged perseverance, Smile Train’s mission to reach every child with a cleft would go unrealized. We need more teams like the one at B and B hospital because they are the backbone of Smile Train’s efforts, and they will ensure the success of its programs for years to come.

Program Associate Zachary Shuster visited Smile Train's largest partner in Nepal and gathered information on their amazing outreach program.


What do you think of this story? Post your comments below.

See what others say about this story:


Real Stories. Real Heroes.

Comprehensive Cleft Care in Honduras

Tegucigalpa, Honduras – Comprehensive cleft care addresses every aspect of the life-long care required by children born with cleft lips and/or palates, dramatically improving their physical and psychological health and providing them the best chances to live full, productive lives.

You Don’t Have to Hide Your Love Away

Tegucigalpa, Honduras – Keren is a two and a half year-old who was born with a unilateral cleft lip. Her family had never heard of cleft lips or palates prior to her birth.

Theresia Gets a New Smile After 73 Years

Rutare, Rwanda – 73-year-old Theresia is an inspiration to her whole community. She recently had the courage to have free cleft surgery, having lived with an unrepaired cleft lip her entire life. Friends and family agree that the results are life-changing, and her new smile hardly leaves her face.

Journey of Smiles: Guatemala

Guatemala – Smile Train and Kaplan, the world leader in test prep, partnered together and provided four pre-health students a once in a lifetime experience. These students, pursuing careers in medicine and dentistry, were given the opportunity to visit local Smile Train partners and patients in Guatemala.

Journey of Smiles: Myanmar

Kachin, Myanmar – Follow Smile Train to one of the most isolated countries in the world as a new Smile Train partner hospital performs its first cleft surgeries.

Journey of Smiles: Egypt

Egypt – Documenting the best of cleft care in Egypt, Smile Train supporter Stefano Levi traveled to Egypt and returned with this photo update, capturing Smile Train’s dedicated partners and grateful patients.

Smile Train Russia: Photo Stories

Volgograd, Russia – Take a peek inside Smile Train partner hospital, Volgograd City Hospital #1 through these captivating photos. With over 20 years of experience, maxillofacial surgeon Dr. Irena Fomenko, has been instrumental in changing the lives of the Smile Train patients she helps, including Kirill, Stella, and Valentina.

Fly My Dream

Changsha, China – Smile Train patient He Yumei describes her determination during Smile Train-sponsored speech therapy treatment, provided for free by Smile Train. She was born with cleft lip and palate, which were repaired, but needed further help correcting her speech.

Baby Robson's Journey Of Smiles

Lilongwe, Malawi – Follow the journey of baby Robson and his parents as they travel to the city for the first time to receive Robson’s Smile Train surgery. This tale is told through the lens of Dr. Robin Wyatt’s camera, as he photographs the family from start to finish.

Hope, Dedication, Promise

Sulawesi, Indonesia – Follow a Smile Train favorite, Natsir, as he travels throughout the island of Sulawesi searching for cleft patients.

Surgeries and Smiles In Ghana

Kumasi, GhanaKatelyn Edwards, a student at the University of Tampa, recently traveled to Ghana to visit Smile Train partner hospital Komfo Anokye Teaching Hospital. Thanks to the generosity of Katelyn's community, she was also able to donate over $4,000 to the hospital’s Smile Train program

A Song In Her Heart

Mixquiahuala, Mexico – Smile Train patient Monserrat has overcome a lot in her young life, and has turned adversity into strength.

Mili's Second Chance

Kota, India – Mili's adoptive mother shares her story.

In Cameroon, the Surgeries Are the Easy Part

Douala, Cameroon – Program Manager Amber Webb writes about her experience to help expand best practices in patient outreach.

The Butterfly Effect: Natsir's Mission

Sulawesi, Indonesia – Natsir's simple act of kindness to a stranger resulted in his sons' free cleft surgeries. Now he volunteers his time to find other children with cleft.

Smile Pinki Update

Varanasi, India – In 2007, Pinki was a frightened little girl in need of free cleft repair surgery. Today, she is confident and loves to show off her smile.

A Smile Years In the Making

Xi'an, China – For some people, four years is a short period of time. For a surgeon, four years is the amount of time spent in medical school. For Smile Train, four years is just shy of a third of our existence. However, for a child with a cleft, four years can change his fate. Four years moved Hua Tai'an and his family from sadness and helplessness to happiness and hope.

A Smile At the Roof Of the World

Tibet, China – Soaring more than 4,500 meters above sea level in the highest region on earth, an incredibly brave little boy and his family received a modern-day miracle.

Smile Train International Scholars

New York, NY – Smile Train partner surgeons Dr. Lisa Hasibuan and Dr. Ataklitie Berhea recently received scholarships to travel to the United States for advanced training in Interdisciplinary cleft care. The award was sponsored through a collaboration of the American Society of Plastic Surgeons, The Plastic Surgery Foundation, and Smile Train.

A Fresh Start for Taslia

Dhaka, Bangladesh – Khondoker and his wife Tasmin eagerly expected the birth of their third child, but were shocked when she was born with a cleft lip and palate and was diagnosed with dwarfism.

The Longest Journey

Veracruz, Mexico – Pedro and Griselda traveled with their children over 500km in 1 1/2 months to fix their son's cleft lip.