Regular followers of the Rotaplast blog know that each mission begins with a screening of all potential patients for surgery. The host organizers spread the word for weeks prior to the mission that free reconstructive surgery will be available for children and teens afflicted with clefts. Our supply boxes still have not arrived so some creative improvisation was in order. Despite the glitch, we were still able to screen over 80 patients today with another 80 on tap to go through the process tomorrow.

Basic requirements of age, weight and general health must be met to qualify for surgery. Post-it notes on white boards and large colored posters were brought into service to begin triaging the patients and setting the surgery schedule. When we arrived, about 100 people – patients with parents, siblings and friends – were gathered in a large lecture hall watching a video about the dental school where the clinic was held. We're right on the coast, only about 10 degrees south of the equator, so although it's technically winter here, it's pleasantly tropical. A tad hot and humid to be in the direct sun but just right in the shade when breeze blows. And it's always blowing. 

One interesting observation on this mission is the number of older patients who had their cleft lips repaired at a very early age but were left with their cleft palates unrepaired. The ability to acquire correct speech patterns must occur before about age five, so those who are now older will have far more difficultly speaking clearly even if their palates are corrected.

This led to a most interesting debate among a few team members. If you could only have one operation, would it be better to correct a cleft lip or palate? Is outward appearance and the ability to fit in socially more important than the ability to eat and speak properly? A fascinating but obviously frustrating and sad point to have to consider. Life is not always fair.

Jerry Meshulam, Photojournalist