Volunteers include Quentin Li (right) who has served as assistant director on several missions. Photo by David Fowler
I make decisions in life based on how I can help the most people,” says Martin Postma.
In September 2008, Postma volunteered as a medical photographer in Harbin, China, with Alliance for Smiles, a San Francisco-based nonprofit that provides corrective surgeries and follow-up care to patients with cleft lips and palates. Since 2004, the organization’s volunteer teams have performed more than 2,000 surgeries, mostly in China.
“Having a child with this condition can be a difficult thing to accept – particularly for a poor family who may have little opportunity to have it repaired,” says Postma, a member of the Rotary Club of Westminster 7:10, Colorado, USA. “The difference that these surgeries will make in the lives of these children in the years to come is profound. They may not be lifesaving surgeries, but the results are life changing.”
In simple terms, a cleft lip or palate is a failure of the upper lip or roof of the mouth to come together in the early stages of fetal development. Children born with clefts have difficulty eating and speaking, and if left untreated, the condition can lead to permanent speech, hearing, and respiratory problems, as well as social isolation.
Although the causes are not always identifiable, certain groups, including Asians and Central and South Americans, are genetically predisposed to the condition. Clefts occur in 1 in every 350 births in China, compared with 1 in 850 in North America. (In California, a state with large Asian and Hispanic populations, the rate is 1 in 550.) Environmental triggers such as pollution and a lack of prenatal care also may play a role.
Alliance for Smiles is rooted in the same ideals as Rotary, says its president and CEO Anita Stangl: “The creation of international understanding and goodwill is absolutely the basic philosophy of the organization.” Stangl is one of five members of the Rotary Club of San Francisco who founded the alliance in 2004, and Rotarians remain central players, serving as board members, volunteers, and donors. Clubs in the United States and Hong Kong, as well as individual Rotarians, have provided significant funding, and the organization has benefited from Rotary Foundation Matching Grants.
Like Postma, most Rotarians who join Alliance for Smiles missions are nonmedical volunteers. They work as photographers or in administrative roles to support the volunteer surgeons, anesthesiologists, and other medical professionals. David Fowler, the group’s lead photographer, sees that all patients are photographed before and after surgery as part of a rigorous documentation procedure. A member of the Rotary Club of Ogallala, Neb., he captures the intense and intimate scenes that unfold before surgery and in recovery.
“It’s an incredibly emotional experience,” says Fowler, who has been on eight missions. “Sometimes, parents don’t recognize their children. The change is so dramatic – it’s absolutely incredible.”
Although Alliance for Smiles has also sent teams to Bangladesh and the Philippines, 16 of the organization’s 18 missions have been to China. According to Stangl, the group chose to focus on China not only because the country has a high rate of clefts but also because its medical infrastructure could support long-term treatment centers.
“We wanted to create an organization that went beyond just surgical intervention – to create a two-pronged organization that would establish relationships with the local doctors with the hope that the type of treatment found in the United States could be replicated,” she explains.
Even when clefts are corrected early, follow-up care is critical. Fistulas that can form after surgery must be treated, and many patients need bone grafts and orthodontic procedures in early childhood. “In most developing countries, lots of times they’ll have the surgery, but long-term services are not available,” Stangl says. “And that is what differentiates us from other organizations. A lot of the organizations that deal with cleft lip and palate just do the surgical intervention. The long-term is unique to us.”
Alliance for Smiles established its first permanent treatment center in April 2007 in Jiujiang, China. The facility, located at Jiujiang University Hospital and run by a local physician who trained at the University of California, San Francisco, with backing from Alliance for Smiles, provides speech pathology, dentistry, orthodontia, and additional surgical care.
Within the year, a second center in Wenzhou should be fully operational. Alliance for Smiles has plans to send teams there to train doctors and monitor progress, says Stangl. “It will change the protocol of treatment for all children in China. That’s our goal.”