After months of anxious planning and impatient waiting, I was on my way to Guatemala where, along with a small group of Smile Train staff and donors, I would visit Smile Train’s local partner clinics. My Journey of Smiles had commenced.
A half-hearted attempt to learn a smattering of Spanish before the trip had ended in total failure. I used to be able to speak a fair bit of French, Italian and Bulgarian, but now that I was trying to teach myself Spanish as well, all these languages were getting mixed up in one unintelligible linguistic broth.
My six-year-old daughter learns Spanish at school and offered to teach me:
“Spanish is easy peasy, mummy. Repeat after me: Hola, que tal, muy bien, gracias. That’s it; now you speak Spanish.”
My final destination was Antigua, a charming city with colourful houses, Spanish colonial architecture and cobbled streets. Until 1773, when it was hit by a series of devastating earthquakes, Antigua served as the capital of Guatemala.
On arrival, I was introduced to the other Journey of Smiles participants, most of whom had flown in from the US and Mexico. We were all strangers to each other but our shared commitment to supporting Smile Train’s vital contribution to cleft care around the world had brought us together, and by the end of our journey we all had, I believe, formed a special bond.
More than half of Guatemala’s population is of indigenous Mayan origin, and they often live in rural parts of the country where poverty is widespread and access to medical facilities scarce. Cleft-afflicted children and their parents, therefore, have to travel long distances from their home villages to the nearest clinic.
Although Smile Train pays for the surgery and aftercare and helps with transportation, missing a couple of days’ work makes a huge difference for a Mayan father who depends on his meagre wages to feed his family.
The first item on our ambitious itinerary was an early morning visit to a clinic in the heart of Antigua: Centro Infantil de Estomatologia is a private, non-profit clinic that focuses exclusively on cleft care. First established in 1966 by Guatemalan doctor Oscar E. Asensio, the clinic has since been taken over by his son, Dr Rodolfo E. Asensio, who works with a multidisciplinary team to provide comprehensive cleft repair at no cost to the patients.
Two operations were scheduled for the morning of our visit: a lip repair and a palate repair. As a general rule, a baby born with a cleft lip and palate will undergo lip repair first, followed by a separate operation to close the palate.
There had been some talk about the possibility of us viewing an operation during our visit, but due to the clinic’s small size, only three of us would be allowed in the operating theatre, Cecilia, the clinic manager, regretfully announced.
On hearing this, my hand immediately shot up, and like an overexcited child I waved it vigorously in the air: “Choose me, choose me!”
For this was my once-in-a-lifetime-chance to see what a cleft surgery similar to the ones I went through as an infant was really like, and I wouldn’t miss it for the world. Luckily I didn’t have to.
While we waited for the doctors to prepare for the first operation, we got to meet the patients: a three-month-old boy having his first operation that morning; two toddlers whose lips had been repaired and were now awaiting palate surgery; and two seven-year-old boys just about to be discharged following bone graft procedures.
The baby was asleep, oblivious to our presence, but the other children glanced apprehensively at us. Who were we? And why had we come? It reminded me of a time when I was five or six-years-old and was called to attend a hospital conference. There, a room full of doctors examined my cleft repair, discussing what had been done and what could still be done to improve on my appearance. No one seemed to notice how frightened I was.
While we were getting to know the young patients, another baby arrived at the clinic, his operation being scheduled for the following day. He was wide awake and looked at us curiously.
I asked the nurse if I could hold him. She nodded and the moment I had him in my arms I fell helplessly in love with this beautiful, cheerful baby. Even with a cleft, he was nothing less than whole.
We’d been at the clinic for about an hour when Cecilia announced that the first operation was about to commence. The three of us who’d be viewing the procedure were ushered into a cramped dressing room to change into scrubs.
My heart was beating fast as I fumbled with the blue cotton garments handed to me. I was starting to sweat a little from the sudden rush of excitement and slight trepidation.
“If you think you’re going to faint in there, sit down on the floor,” Cecilia cheerfully advised. “We don’t want you falling over and hitting anything or anyone.”
With that we were shown into the operating theatre where Dr Asensio and his team were waiting.
The room was smaller than I had expected and to my great relief, it didn’t smell of ‘hospital’ the way I was used to. The atmosphere was relaxed and friendly, and Dr Asensio urged us to step closer to be able to see what they were doing and to ask questions throughout the operation.
The baby boy who only a short while ago had been asleep in his cot, blissfully unaware of what was awaiting him, now lay incubated on the narrow operating table and apart from his nose and mouth, his body was entirely covered in sterile green sheets.
The moment I saw him, a painful realisation hit me: once upon a time, it had been me on the operating table. I quickly brushed the thought away, adamant that I was neither going to faint nor have a breakdown.
The artist-like skill with which Dr Asensio carried out the lip repair was mind-blowing. I suppose I’d never really thought about the mechanics of cleft repairs – they stitch you up somehow – but this was something else.
Using a measuring tape and an instrument that resembled my ten-year-old daughter’s maths compass, Dr Asensio carefully measured the proportions of the baby’s face to make sure he got a result that was as balanced as possible. He then made small incisions in the baby’s lip, creating several flaps that he puzzled together with very fine stitches.
The result was beautiful and, to my eye, far superior to many cleft repairs I’ve seen, including my own.
It was only when the procedure was over, and the anaesthesiologist prepared to wake the baby, that I began to wobble.
“Is he in pain?” I asked worriedly as the baby coughed and jerked.
“Oh no,” the doctors assured me, but I couldn’t help thinking that the baby must be feeling some discomfort. For I know painfully well that waking up from anaesthesia can be an awful experience.
A few minutes later we followed the nurse holding the baby into the recovery room and watched as she tucked him into a bed amidst his increasingly vocal protests.
By now I couldn’t hold back the tears. Why won’t the nurse just cradle him, I thought to myself. Pick him up, please. He needs to be held.
Another nurse brought a bottle of honey water for the baby, but he still wouldn’t stop crying so finally the nurse picked him up. I heaved a sigh of relief.
If only the baby’s mum and dad could be with him now, I thought, he’d be a lot happier. But the clinic only allows parents to watch through a window post-op, to minimise the risk of infection.
I felt a twinge of guilt that I was allowed in the recovery room with the baby when his parents were not. So when they appeared in the window, anxiously gazing at their son, I tried to give them an encouraging smile as to say, “all is good, your son is ok.”
It was hard leaving the clinic and the baby and even now as I’m back in London I think about him. I hope he’s doing well and that the operation wasn’t as traumatic for him as it was for me all those years ago.