My job was to take photographs of the people who came for screening. There were specific anatomical landmarks that needed to be photographed for surgeon reference as "before" and "after" photos to view patient progress. They also served as records for Operation Smile to track patients. Patients may come back for continued treatment in months and years following their initial visits. I was responsible for taking a frontal, basal and two profile views of each person. Often more than one photo was needed to obtain these four positions. There also were additional photos of those whose problems were other than the cleft lips or palates. This is not an easy task to accomplish when many of your candidates for surgery are babies who wiggle and cry, and adults who speak a form of Swahili and not English and who are in an unfamiliar atmosphere and situation. Being shuttled from one "station" to another (medical records, photography, vitals, dentistry, speech pathology and check-out can be difficult. During our first day of screening, 200 people showed up for evaluation...a heavy load.

After screening, the photographers took photos during surgery (immediately before incision and prior to waking from surgery.) All these photos were to be catalogued in software provided by Operation Smile--another lengthy task. In the end, 160 patients were operated on and the results were fantastic. Mothers, fathers, grandmothers and teachers who brought children in cried in amazement and joy as the children marveled at themselves, staring in mirrors unable to get over the transformation that had occurred.

The impact on me was an experience of a lifetime. It was the first time I'd been involved in a medical mission. To see the poverty, the limited resources, to experience the failure of running water and electricity at times in the hospital, and to see villages in the area where water and electricity were simply not available, all these things altered my perspective on issues of needs in developing countries. One hears about these issues all the time, yet it is something altogether different to witness these conditions and to try to work in them. The hospital in Kisumu struggles with access to many supplies for things even so simple as sheets for beds. They did an amazing job of bringing in Kenyan doctors and nurses from the local based Operation Smile in Nairobi, of welcoming American and Canadian volunteers by providing their facilities and feeding the workers during the ten days of our stay. The hospital had a total of 250 beds and four operating theaters that we could use where each had one, two or three surgical beds in use at one time. There was one post-op area and a few rooms for recovery. Every bed served two patients with their parents there or adult guardians. Coming from an American hospital, it was truly amazing to see all the doctors and nurses and anesthesiologists safely accomplish the tremendous goal of serving so many patient and families.

Professionally, in my work at Fairview, I am a surgical technician. My involvement in Operation Smile as a photographer came about in a twisting and turning chain of events that are not pertinent to recounting in this essay. In fact, I was considerably under qualified as a photographer, and I should not have tried to participate in this capacity. I was unaware of just how demanding and just how proficient the photographer would need to be. If I participated in such a mission again, I would try to go as a surgical technician. Part of my hope in being part of Operation Smile was to see first hand how they conduct their missions and whether or not I could somehow become an advocate to get surgical technicians accepted as part of the volunteer teams in the future. I still may pursue this possibility in the future. I also am going to investigate what international opportunities exist for surgical technicians.

One of the plastic surgeons on the team expressed a desire for me to scrub in for him, which I was unable to do. As an experienced surgeon with many missions under his belt he also informed me that there are opportunities for surgical technicians. I am a member of the Association of Surgical Technologists (the main association for my field) and have only found a few opportunities available from their guidance. I will be investigating more possibilities and hope to promote this experience for those in my field.

The teams of Operation Smile number around fifty, which does not include the nurses and doctors from the hosting hospital. From my perspective, one important criterion was that the organization not be promoting religion while on the mission. Another important feature of Operation Smile's work is that they serve as a sort of "start up" organization which then gets locals involved to become self-sustaining. In Kisumu, they are nearly self-sustaining. They have hosted Operation Smile for seventeen years and now provide the same services with all Kenyan volunteers every three months. Operation Smile is a very large organization with great credibility and which has achieved much success and served as a model for many other organizations (such as Smile Train) that now provide similar services.

There are not words to describe the impact of this experience, on me, on all the volunteers and most importantly for the children and families. It was joyful and bitter sweet to see everyone working together, under tough conditions, but ultimately was inexpressibly astounding to be part of the results.