Editor's Note: The Philippines holds a special place in the history – and future – of our organisation. It was there that Dr. Bill Magee, a plastic surgeon, and his wife Kathy, a nurse and clinical social worker, became inspired to create Operation Smile after witnessing firsthand the dire need for life-changing cleft surgeries while working an independent volunteer medical mission in 1982. Unable to provide surgery for so many children due to lack of resources, the Magees promised to return. We've been going back ever since. As we work into our 35th year, we're highlighting the birthplace of Operation Smile with this four-story series. This is the second story.

At 9 years old, Efren's schoolmates were his worst enemies. He lashed out against his bullies, who constantly targeted him with insults because of his cleft lip and cleft palate. He came home in tears almost daily, his father, Efren Sr., recalled.

After receiving life-changing surgery from Operation Smile in the Philippines, Efren now carries himself with a sense of dignity and his outlook on life has been fundamentally changed – he’s happier, more confident and now looks forward to going to school.

"Those who have bullied him have now become his friends," Efren Sr. said. "When he goes to school now, he is never in a fight. Now, the other children are happy for his sake."

Photo: Jörgen Hildebrandt.
Photo: Jörgen Hildebrandt.

In the years leading up to Operation Smile's intervention, Efren and his family lived with so much hurt in their hearts. When he was born, Efren's mother, Juditte, was stricken with overwhelming sadness when she saw first saw her baby's deformity. Juditte struggled to understand how her baby could be born this way. She thought it could be related to a fall she took when she was nine months pregnant with Efren, or it was a result of Efren sucking his thumb as he developed in the womb.

"We didn't have any relatives with cleft, so we wondered why this happened to us," Juditte said. "We felt so sad about his situation, and I have cried a lot."

Scientists do not believe that either possibility Juditte pondered causes cleft conditions. In an effort to understand all known causes of cleft, both genetic and environmental, Operation Smile and its partners are leading the International Family Study, which seeks to translate medical research findings into preventative measures to help families like Efren's in the future.

When Efren was 6 years old, the family was hopeful that he could receive surgery at a medical mission led by another nonprofit organisation. During screening, the medical staff discovered that Efren had an irregular heartbeat and believed that surgery would be too risky to perform.

Living in extreme poverty severely limited the family's options for a future surgical solution. It would be three years before the Philippines-based nonprofit Abounding In Love would connect Efren's family with Operation Smile in June 2014. During that time, the family's home was destroyed by Typhoon Yolanda in 2013. A tent provided by the United Nations Refugee Agency served as temporary housing for the family as they waited for their new home to be built.

With Abounding In Love covering their transportation costs, Juditte's sister and Efren arrived at the Operation Smile medical mission site in Cebu for another chance to heal Efren's smile. His parents had to stay home on Bantayan Island as Juditte had to care for their six other children and Efren Sr. could not afford to miss work.

A comprehensive health evaluation performed by Operation Smile medical volunteers found that the irregularity of his heartbeat was so minor that surgery posed no threat to Efren. Finally, he was cleared for surgery to repair his cleft lip.

After Efren's successful procedure was complete, his aunt could breathe a sigh of relief. She looked forward to also relieving Efren's parents' anxiety by returning to Bantayan Island with Efren and his new smile.

Photo: Jörgen Hildebrandt.
Photo: Jörgen Hildebrandt.

"I am so happy now – I can't express in words how happy I am. It hurt so much every time I saw him come back from school crying before," said Efren Sr., whose son's speech abilities dramatically improved in the months following his cleft lip surgery.

Without the help of Operation Smile, Efren's parents would not have been able to afford surgery for their son. Efren’s father is a fisherman and struggles to make enough to feed his family of nine. The older children work with their father, instead of going to school, to help supplement the family income. However, Efren Sr. envisions a brighter future for his son.

"I am hoping Efren will continue school up to a high level and go to college – I would like him to become a teacher," Efren Sr. said. “He has big dreams, but couldn’t do it without surgery – without Operation Smile.”

Photo: Jörgen Hildebrandt.
Photo: Jörgen Hildebrandt.
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“Every child that has a facial deformity is our responsibility. If we don’t take care of that child, there’s no guarantee that anyone else will.”

- Kathy Magee, Operation Smile Co-founder and President