30 _ South _ WESTERN OUTDOOR NEWS _ July 29, 2016

BY PAT MCDONELL,Cabo Tuna Jackpot Director

CABO SAN LUCAS – Dr. Jeffrey Moses won’tsoon forget the conversation. A family ap-proached him at the downtown Cabo hospi-tal on the final day of the week-long Smilessurgical clinic. It was late afternoon, and withone more procedure now underway downthe hall, they could scrub out and enjoy a latedinner, pack and fly home to see their fami-lies after a grueling week. Six days of nearly40 surgeries.

The mother was holding her infantdaughter, who had a severe cleft palate, re-ferred to as a bilateral cleft (the most severetype, but correctable). The father made itclear the baby would not be coming backwith them to their small Baja town.

“If you don’t operate on her, I leave herhere,” the man said. There were whispersamong friends and family about supersti-tions, even hints that the deformity mighthave been the result of his wife’s infidelity,all comments he had endured for months.

As Dr. Moses explained, it is not uncom-mon to see a child with a cleft lip deformityshunned by family and society, especially inpoor, rural areas.

“The man simply could not take it any-more,” said Dr. Moses. “He said he wouldleave the child somewhere, we didn’t reallyknow where.” The mother clutched at herchild, fearful there would be no surgery.

“I left him and went to the team still op-erating, and said, ‘Okay, I know this is the lastone, we leave tomorrow and we’d all like tohave a nice dinner, but here’s the situation.”He explained it, and every one of his team,facing another long surgery that would keepthem there until midnight said, “Hell yes,let’s do it.’ “I knew they would,” said Dr.Moses. “But I had to ask.”

Six months later, the family returned forfollow-up surgery. Dr. Moses never knows ifthey will come back. Most do. He was re-lieved to see them. The little girl’s lip washealed and looked nearly normal – the faceof a happy toddler. Like all cleft palates, moresurgeries would be needed, but she wouldlive a normal life.

“And you know, when they came to theclinic, standing there outside, it wasn’t themother who was holding the little girl,” saidDr. Moses, “It was the father. Now isn’t thatsomething?”

This reporter flew down in late April toexperience the first day of the Smiles Inter-national Foundation clinic.

Two times a year on the fourth Monday ofevery April and October, Smiles Internationalvolunteer doctors and nurses from all overthe U.S fly to Cabo San Lucas. But it’s not toparty and fish. Far from it. They get to work,and they make a difference in people’s lives,which is why they got into the medical fieldin the first place.

This the fifth year of the program, whichbegan with a measure of wariness in Cabo’smedical sphere. The first procedure was per-formed on a young boy, a toddler. Now, 25 to30 children are operated on during each clinic.

These initial first-day screenings are fol-lowed by a grueling schedule for a full week,the teams operating to repair facial deformi-ties –primarily cleft palates and usually onyoung children from families at the povertylevel. At the clinic last April, 14 volunteerSmiles medical personnel flew into Cabo: 4surgeons, 4 anesthesiologists, 5 nurses, and 2support staff to join a small but growingcadre of local dentists, doctors and nurses

At the epicenter of these annual efforts isDr. Moses, who started the Foundation backin 1987, and his wife Maribel of Encinitas,CA, who he met years later when Dr. Moseswas performing across-borders surgeries in

Costa Rica. Maribel, a Costa Rican, was trav-eling through there to visit her ill father, andthey immediately connected through theirspirit of charitable service.

It was also around this time that Dr.Moses was seriously injured in a car accidenton an off-day from surgery. Soon thereafterhe retired.

He had an epiphany of sorts. “I was laying there in the van after the

brakes failed in a van coming down a roadfrom a trip to see a volcano after we weredone operating, and as I laid there I thought,‘I can keep doing four or five surgeries a dayif I keep working, or I can retire and devotemyself to getting five doctors to do five timesas many surgeries a day as I could.”

Dr. Moses and his wife have formed quitea team. Maribel now provides self-esteemcounseling to the children and helps thefamilies understand the entire process of fa-cial and spiritual rehabilitation, which shecontinues at the Smiles clinics, working asthe chief patient coordinator, and vice presi-dent of the Foundation.

Project Smiles of Cabo is among the citiesthat Smiles International focuses on. Thereare similar clinics set up in northern Baja,mainland Mexico, a self-sustaining clinic inCosta Rica and one in the Ukraine is in theplanning stages. It’s hard to image that Cabo,with all its fancy hotels and restaurants isstricken with poverty, but it’s there and it’svery real just a few blocks outside the tourismcorridor. For children afflicted with a cleftpalate or some other facial deformity,poverty and isolation from a normal societalstructure of family and friends and work isan almost certain future. The screeningprocess is just the first crucial step toward anew life.

When this reporter arrived, the screeningsand scheduling were being conducted in theremnants of a defunct first floor PuertoParaiso Mall restaurant. Concrete floors, barewalls, bathrooms gutted. But by the timeSmiles personnel arrive, it’s been transformedinto a true clinic with rooms created by par-titions and tables and chairs. It’s not theMayo Clinic, but it’s free to use for the day,

thanks to the mall’s management, and thelocal tamales brought in are tasty and fuelthe work.

While Smiles is U.S. based, the RotaryClub in Cabo is critical to making this hap-pen on the ground floor. Rotarian ClicerioMercado, well known in tournament circles,seems to know everyone in town. He and fel-low Rotarians work to get free rooms andlodging for families and doctors and medicalpersonnel for the week, and the local hospi-tal’s operating room to use. Donations keepcosts down, providing more money to pur-chase surgical supplies in the U.S. and shipthem south.

At the clinic WON witnessed, patientswould wait outside under a shade tent andon folding chairs, awaiting their meetingwith U.S. and local Cabo medical personnel.Many were back for follow-up surgeries;some were hoping to have their child oper-ated on. The consultations take into consid-eration health and age. If a child is sick inany way, fever or cold, they wait a few days,or they reschedule. If the child is too young,Maribel tells them to come back in sixmonths.

“When they hear this, they are devas-tated,” sai Maribel. “but we cannot operate.We have to use the right protocols, and weexplain that. It is still hard. But we are in forthe long haul with these children.” In somecases of infants turned away, they are givenspecial medical tape, told how to use it onthe deformed lip to close up the gap, and itcan make a big improvement in those sixmonths.

“After the screenings,” said Dr. Moses,“we then operate a few cases that very after-noon and then throughout the week dailyfrom 6:30 a.m. until 8 p.m. at the Hospital

Video, Websites, Guidestar and Smiles A video on Smiles by Erwin Witt of Beduino Productions commissioned by theCabo Tuna Jackpot was filmed in April and will be filmed again in October as a fol-low-up. The short video will be shown at the Yo-Zuri Welcome Party at the outdooramphitheater Nov. 2.

For a look into the Foundation, check Guidestar, a watchdog for such nonprof-its. Their assessment can be seen online. For more information on the foundationand where it conducts other clinics, go to www.smilesinternationalfoundation.org.

Go to: GUIDESTAR Smiles International Foundation Smiles International Foundation Website

MORE THAN $37,000 was raised last year in Cabo by sponsors, staff and anglersin a variety of ways last year to continue the long term surgical efforts of SmilesIn-ternationalFoundation.org headed by Dr. Jeffrey Moses and his wife Maribel, pic-tured here with a father and his son as videographer Erwin Witt’s camera rolls.WON attended the recent clinic and is creating a short video to be shown at thetuna tourney. The young boy was one of the clinic’s first children operated on. WON PHOTO BY PAT MCDONELL

GIVING CABO’S KIDS, FAMILIES A REASO Cabo Jackpot Director Pat McDonell flew down last April to ex-perience the Smiles International Foundation clinic in action;like last year, all funds raised will go toward purchasing equip-ment needed on-site for the one-week surgical clinics in Apriland October by volunteer U.S. doctors and nurses and Cabomedical personnel with the help of Cabo Rotary.

A YOUNG FAMILY, 1-YEAR-OLD REINA,HER MOTHER AIDA AND FATHER SAL-VADOR, returns with their daughter, sixmonths after the one cleft lip surgery. Thedifference is startling, but it is not yetcomplete. WON PHOTOS BY PAT MCDONELL

July 29, 2016 _ WESTERN OUTDOOR NEWS _ South _ 31

Especialidades. The hospital is owned by Ro-tarian Dr. Alejandro Avalos, who donates itsuse during the visit.

“We operate on approximately 25-30 chil-dren during the week with facial reconstruc-tions performed under pediatric specialtygeneral anesthesia,” said Dr. Moses.

Fundraising is critical, as with all charita-ble work. But there is a remarkable cost-to-success ratio going on with Smiles. Dr. Mosessaid that last year, the relative value of surgi-cal procedures combined with cost for facil-ity, anesthesiology, intensive care nursingand supplies totaled over $380,000 if done inthe U.S. – and this was accomplished witharound $7,000 worth of sterile supplies actu-ally purchased by the Foundation due to somany in-kind donations.

The entire program is volunteer-run andoverseen by Dr. Moses and Maribel. All ad-ministrative costs, if any, come out of theirown pockets.

“All of our team pays their own expensesfor travel and takes time off of work or usesvacation days to perform these donation sur-geries,” said Dr. Moses. “In Cabo we arehosted by the Rotary Club of Los Cabos andthe Smiles Advisory Panel members for teammeals during the clinic and supported bythem for transportation needs. Our hotels inCabo have been gifted and graciously sup-ported by the Solmar Foundation.”

Last year’s tourney raised $38,000 overfour days. Where does the money flow? First,there are sterile surgical supplies for eachclinic that cost approximately $7,500. Each$1,000 collected can support four surgeries.Think about that for a moment.

“We have been having a little bit of diffi-culty finding the annual funds for this, andthus we struggle each year for these purchaseseven though we obtain them at a tremendousdiscount through our nursing staff’s connec-tion at San Diego hospitals, purchasing oursmall orders along with their large volume or-ders.”

Additionally, the team currently bringsportable surgical instrumentation from theU.S. with them by plane and is subject to thewhim of the customs agents at the airport,who charge them customs importation feeseven though they are only using their own

instrumentation during the week for a char-itable purpose. That’s frustrating.

“This increases the expense for the vol-unteers and Foundation that is totally un-necessary,” said Dr. Moses. “The desiredsolution for this would be to gradually fundthe purchase of instrumentation that wouldbe kept on-site here in a secure warehouse foruse during the clinics and even loaned out toour local doctors who we have included onour team to provide the children’s care allyear long.”

Donated money grows through matchingfunds.

“I’ve already obtained matching commit-ments from the U.S.-based instrument man-ufacturing company KLS Martin, who willgive us a 50 percent discount on any instru-mentation purchased for this clinic, bringingour cost over the next year or so to providethe necessary cleft lip and palate sets alongwith bone grafting and reconstructive kits toapproximately $50,000.”

Dr. Moses said a grant funding of thisamount would provide a set that would bekept in use on-site and always here avoidingthe unnecessary customs problems.

“Also, if we obtained a larger sterilizer, wewould be able to process the limited surgicalinstruments faster between cases and operatemore cases that involve similar defects ratherthan putting some of the children off untilanother visit,” said Dr. Moses. “The Tutten-haur Autoclave Sterilizer, though purchasedat a great charitable discount, still runsaround $12,000.”

Smiles International’s work is not done injust one surgical effort. Not even close.

“Many people in the public don’t realizethe children afflicted with facial cleft defor-mities are not fixed with more than just clo-sure of the lip. They actually require up toseven surgeries in order to restore them to fullfunction in order to be able to eat, speak, hearand smile,” said Dr. Moses.

As Dr. Moses explained, the cleft lip is re-paired at around 10 weeks of age, and thepalate repaired at around age one. Then theears are evaluated for the ability to clear theears (popping pressure), and if needed, eartubes are placed to prevent permanent deaf-ness. The bone in the upper jaw is graftedfrom the hip at around age 6 in order toallow teeth to erupt properly, and the nose iscorrected to allow breathing properly. Bracesare often placed to prepare the bite for facialbone alignment surgery in the early teens,and this surgery is performed mid-teen yearsto allow the facial form and the chewingfunction to become fully functional, he said.

Dr. Moses said the goal is to make all ofthese stages possible for each child in addi-tion to giving them speech therapy, psycho-logical counseling on self-esteem and ageneral head start back into health.

“The cleft face is not indicative of any in-tellectual deficiency; it is just an error in theformation of the face in the embryo. One in650 live births in all of the Americas have this,including the U.S., and the only reason we donot see more on the streets is the effectivenessof our methodology of care in developed na-tions. These children deserve this chance.”

Working with local doctors is critical forfollow-up care throughout the year. The goal,said Dr. Moses, is to give the region’s spe-cialty doctors the ability to provide care allyear long.

“Then we will only be needed to update

the techniques, provide better equipmentand share ambassadorial surgical relation-ships together with them working on diffi-culty cases,” he said.

The goal is simple. Give the kids a chance. Among the many U.S. and local medical

personnel I met in Cabo last April at theclinic was Dr. Wilson Chimbira, who wasborn in Zimbabwe and trained in the U.K. Heis an anesthesiologist at the University ofMichigan’s School of Medicine. He hasserved as a volunteer in other programs inPeru and Kenya as a doctor without borders.This is his second “tour” in Cabo. He enjoyscoming to Cabo. It is highly unlikely he hasever seen Medado Beach or Cabo Wabo infull gear.

“We do service here, but we would not doit without all the protocols we have in theUnited States. Safety is our number one con-cern,” said Dr. Chimbira. “But by coming wecan have an impact on the lives of the chil-dren and the parents, and when you are backat home, it makes you feel as though youhave a greater purpose in life.”

“You can see tremendous happiness intheir faces and those of their families as wellas a general appearance of developing confi-dence,” echoed Dr. Moses.

In addition to providing self-esteem ses-sions with the children, Smiles also offersspeech therapy as part of the surgical recov-ery process. Tannia Hecht is a speech pathol-ogist who lives in Puerto Los Cabos. Herhusband, Dr. Emil Hecht, is a former profes-sor at the University of Washington Schoolof Medicine and was involved with bothSmiles and the Cabo Tuna Jackpot and lastyear. Professionally, he joined the surgicalteam in April. It was his second Smiles clinic.Last November, two weeks after his firstSmiles clinic, he also competed on the For-tuna in the 2015 Cabo Tuna Jackpot Tourneyand weighed in a 160 pounder. “When wecaught that fish, I thought ‘Hey, we’ve wonthe tournament!’ he recalled with a laugh. Ofcourse, a 210 pounder by C-Rod won the title.

“Well, I live here now full-time, for thepast seven years, and it was really karma howwe both got involved with this (Smiles),” herecalled. “We were at a party hosted by alady, Onahg Ash, who puts on parties to sup-port organizations like Smiles, and one of theneeds at that time was a speech pathologist.I happened to be there. Turns out, they gottwo for one, a speech pathologist and a doc-

tor.” His forte in the U.S. was cosmetic headand neck surgery but his focus was mainlyear, nose and throat. A perfect fit to the team.

Dr. Moses was not in Cabo for the tour-nament last year, when $38,000 was raised,but he and his wife will return to Cabo thisyear for the tournament two weeks after theirOctober clinic.

“I hope that your group will look at thisproject as one they can really own into, andwith their support, hundreds of thousands ofleveraged dollars of care will be given for afraction of the cost, and thousands of chil-dren over the years will grow and benefitfrom their help.”

LOCAL MEDICAL PERSONNEL join Smiles volunteer doctors with help from Cabo Ro-tary. From left is Rotarian Clicerio Mercado (Smiles), Noemi Leon (Cabo ), MirabelMoses, Dr. Heidi Barerra (local dentist) Mariam Kamyab (RN), and Dr. Petry Salva (Cabodoctor).

ON TO SMILE AGAIN

WORD GETS OUT and the patients come. More than 40 procedures are performed on20 to 25 patients during the week. Some parents and patients are turned away – butonly for being too young. The first operations can be performed at 10 weeks.

DR. JEFFREY MOSES sits in on an inter-view with surgical team, which on this clinicis led by Dr. Mike Perrino, surgeon of Co-lumbia University School of Medicine, andDr. Whitney Florin, chief resident at Colum-bia University. It is Perrino’s fourth clinic inCabo, and headed up the 14-person U.S.team made up of 4 surgeons, 4 anesthesi-ologists, 5 nurses and 2 support staff.

FRIENDS OFTEN GROW UP knowingeach other from the clinics as they gothrough the surgical process through theyears as they grow into their teens.

SPEECH THERAPY IS part of the surgicalrecovery process Smiles provides. TanniaHecht is a speech pathologist who lives inPuerto Los Cabos. Her husband Dr. EmilHecht, former, professor at University ofWashington’s School of Medicine, wasalso part of the team in April.

SEVERAL CHARITY EFFORTS PLANNEDThere are several ways to donate at theCabo Tuna Jackpot to the Smiles Inter-national effort. There will be clothingoffered by Minerva’s at check-in andall proceeds will go to the fund, as wellas all $10,000 Grand Raffle ticket salesat $5 a ticket (or 5 for $20).

There will be a Silent Auction at theawards dinner, Costa and Gray Taxi-dermy and Yo-Zuri are always dream-ing up fun contests live auction items,and there is the Costa Charity Charteron the official start boat Cabo Escape.The minimum donation is $20 on Fri-day.

Representatives of Smiles Interna-tional will have booth at check-in ifyou need more information andwould like to meet Maribel Moses andDr. Jeff Moses, who head up Smiles.

A SURGERY IN progress at the local hos-pital. About 40 procedures on 20 to 25 pa-tients are completed in the week-longclinics. Each $1,000 donated pays for foursurgeries.