Facial-surgery team helps children get their smiles
San Diego Union Tribune 
Physicians travel around the globe
By Marcia Manna
February 24, 2007

SEAN DuFRENE / Union-Tribune

Dr. Jeff Moses of Smiles International Foundation has helped children with cleft lip and palate defects.

OLIVENHAIN - Ten years ago, Francisco Montoya sat in his mother's lap for an 800-mile bus ride on the remote roads of Baja California.

Silky black curls framed the toddler's brown face, in contrast to the deep pink gashes that split his upper lip. His parents were too poor to afford the medical care Francisco required, but they had heard of a free surgical clinic in Ensenada, staffed with specialists who would repair cleft lips and palates during the few days they were in town. The surgical team was headed by Jeff Moses, a recently retired maxillofacial surgeon and the founder of Smiles International Foundation, which he operates from his Encinitas home.

Francisco was a case that Moses remembers well. He overheard the boy's parents arguing in the waiting room, apparently about putting Francisco up for adoption if they could not get help.

“I saw this beautiful young boy, all that was wrong was a bilateral cleft,” said Moses, 54. “But our schedule was full to the point where nurses and doctors would work well into the night the next day. I asked the team, can we do this? To their credit, they all pitched in.”

Getting specialists to contribute has turned out to be the doctor's forte.

His nonprofit organization brings together teams of doctors and lays the foundation for periodic clinics that provide free surgery to children born with facial deformities.

When he launched Smiles International 20 years ago, Moses took on two substantial roles. He organized the mission teams and performed many of the surgeries. But there were so many children in need that he often felt frustrated.

“I found that I could only operate on so many cases,” he said. “Now we can bring in four surgeons and do numerous cases at the same time.”

To understand how Moses accomplished that goal, one has to go back to 1987, when Smiles International Foundation was formed under the umbrella of Pacific Clinical Research Foundation.

The goal of PCRF was to build a pool of doctors who offered continuing education credits through major universities. The money Moses earned through teaching and presenting symposiums funded mission trips. As more doctors learned of the cleft lip and palate surgeries Moses was performing in developing countries, more got involved.

A member of the Rotary Club of Carlsbad, Moses was also successful in obtaining financial support from his local group and from Rotary International, which has 32,000 clubs worldwide.

The organizations have helped to purchase medical equipment and supplies for mission clinics, including the one that helped Francisco in Ensenada.

Moses has formed surgical teams that have traveled to Mexico, Costa Rica, Panama, Guatemala, Ecuador and Ukraine.

The clinics are set up at regular intervals, and Moses said the physicians who donate their skills get a “tremendous sense of satisfaction” from being part of an ongoing effort.

Cleft lip and palate defects occur randomly in about 700 to 1,000 births annually worldwide, and multiple operations are needed as a child grows. The cleft can be slight or severe, extending through the lips and gums and into the nasal cavity.

Affected children in developing countries have little chance of getting the costly medical attention they require and they are frequently abandoned. Feeding problems, middle ear infections, orthodontic abnormalities and speech difficulties are just some of the challenges these children face.

Socially, the condition can be devastating. Children with facial defects and their families may become outcasts, especially in areas where religious and cultural superstitions are prevalent.

Several interventions, including surgery, dental and orthodontic care, speech and psychological therapy are typically required.

“Now I'm blessed to be retired and working full time in the foundation,” Moses said. “I can arrange for people to meet the needs of other people.”

The growing group of surgeons serving mission clinics has started a ripple effect that benefits everyone involved. Doctors learn techniques they normally wouldn't encounter in private practice, and children with long-term medical needs are treated by a team of specialists. Occasionally, those specialists include local doctors who try to sustain the clinic after the U.S. physicians leave.

The children who return to the clinic for additional procedures get to know one another, too, which helps them understand they are not alone.

In March, Moses will head for Tecate, joining longtime colleague Dr. Kevin Smith, co-director of The University of Oklahoma J. W. Keys Cleft and Craniofacial Clinic and The University of Tulsa Mary K. Chapman Cleft and Craniofacial Clinic.

The two have worked together at many mission clinics and Smith said Moses spurred him to start his own Rotary-funded foundation.

Smith, in turn, has inspired others. A Guatemalan doctor who volunteered at a mission where Smith performed surgeries decided to train with Smith in the United States. Then he returned to Guatemala with advanced medical skills.

As for young Francisco Montoya, Moses performed a series of surgeries on the boy over five years. The medical care changed the boy's destiny. “The mother and father were together with him in a whole different way,” Moses said, “and there was a good chance his face would look normal.”