Zhang Zhengyun is 14 years old and her greatest wish is that she could smile. The young girl was born with a cleft lip and palate, a birth defect that left her mouth resembling a black hole beneath her nose. Now, as she finally lay on the operating table to get her long-awaited surgery, she dreamed of a life with a promising future and looked forward to that first smile.

"Her life had been miserable. She dared not smile because she thought it made her look more ugly," said Zhang's mother Li Guoping. Because of her looks she was shunned by other children and her deformed mouth was often a cause of curiosity, stared at by strangers in the way people do when they encounter someone different from themselves. It was devastating for the young girl, who was always covering her mouth with her hands. "She suffered from self-disappointment. And she had never communicated with other people since I was the only person able to understand her speech," said Li.

The handicap, bringing about enormous humiliation and psychological pain to the girl, had made a normal schooling impossible. She repeatedly dropped out of school over the years and had only mastered the courses of grade two. Fixing her lip and managing a smile were all she lived for.

Helping hand

Zhang's family lives in a rural area of southwest Sichuan Province. Her father is a roving manual laborer and her mother takes care of the family farm. For a family struggling to make ends meet, the 9,000-yuan cost of cleft lip and palate surgery was way out of reach. Despite this, the parents took their girl to a hospital several years ago, where she was refused admittance due to the complicated nature of the surgery involved. The girl wept for a whole week after coming back from the hospital.

It was then that fate stepped in.

One day in October 2006, Li Li, manager of a tourism agency in Panzhihua City of Sichuan Province, happened to see Zhang in a corner of an open market. "I saw this girl with a cleft lip standing in the corner alone, watching the hustle and bustle with hopeful eyes, which left a deep impression on me." After returning to Panzhihua, Li, still haunted by the girl's eyes, was thrilled to read in a newspaper report that the Smile Train program had been recently expanded to Panzhihua and free surgery was available to families too poor to afford it. Li immediately made arrangements with a local partnership hospital and then rushed back to the market to find the girl.

As the world's leading charitable organization offering free cleft related surgery for children from poor families, the Smile Train started its cooperation with China's leading charity China Charity Foundation shortly after the former's inception in 1999. The two parties signed an agreement under which the American charity donates money for surgeries and the Chinese organization is in charge of the logistics. The program has now developed into a national project. The selected partner hospitals have expanded from four in four provinces to over 150 in over 30 provinces, municipalities and autonomous regions. The maximum age for recipients has been extended to 40 years and to date the program has provided free cleft surgery to some 101,000 people.

Zhang's operation, which lasted for a little over three hours, was a success, and predictably the girl hasn't stopped smiling.

"Without the kindhearted people and the Smile Train, I don't know when my daughter's cleft lip would have been fixed," said her grateful mother with tears in eyes.

The first Chinese "passenger" aboard the Smile Train was 17-year-old Wang Li. Her parents are farmers in Jiangsu Province. The father, who earns less than 200 yuan a month as a laborer, had thought the family could never afford the surgery his daughter needed.

After the surgery, Wang is now a grade four student at a local primary school. "My dream is to become a surgeon after growing up and offer free treatment to patients suffering from cleft deformities like myself," said the lucky girl.

More patients needed

"Partner hospitals throughout China have the capacity to perform 50,000 cleft surgeries every year, while only 20,000 people come for help. Therefore, we need to conduct more publicity campaigns to let more cleft lip and palate sufferers know about the Smile Train program," said Peng Yu, Vice Director of the Chinese Charity Federation.

Charles B. Wang, Cofounder and Chairman of the Smile Train, once said, "We don't have the fear that we have no time to do more but that people who need help don't know what we can do for them. We want more publicity so that the more people know about us, the more we can do for the public."

According to current statistics, China has a population of 2.4 million suffering from cleft deformities and 25,000 babies are born with this affliction every year. Of these patients, many live in rural areas and a lack of information has inhibited their access to timely treatment.

To solve this problem, the global charitable organization has established a toll free hotline at 800-810-0059 in China, which has made medical assistance only a call away from families in need. Moreover, the Smile Train adopted a policy that ensures every cleft lip and palate sufferer from poor families in cities or rural areas can receive the surgery in the nearest hospital. Families in abject poverty can even apply for transportation expenses for the surgery.

Emphasis on training

Currently, hospitals in China conduct over 1,500 free cleft surgeries in partnership with the Smile Train every month. Unlike other global charitable medical programs that only enlist foreign surgeons, the Smile Train program empowers Chinese surgeons to conduct the operations. The Smile Train also has a budget for training local medical staff, in addition to doing medical research on treating and preventing cleft deformities in China. Every Chinese hospital or clinic where the cleft surgery is conducted also shoulders part of the operation's expenses.

To fulfill the mission of offering cleft lip and palate-related training for local doctors and medical professionals, the Smile Train has launched Smile Train Express, an unprecedented free and Web-based patient database accessible to the global cleft lip and palate community, and a virtual surgery CD-ROM collection that includes training videos. The CD-ROM content adopts virtual technology and advanced 3D animation software.

Victoria Moy is the Managing Director of the Smile Train's China office. She said over a period of nearly eight years the Smile Train has allocated $35 million to the operation in China. Brian Mullaney, Cofounder and President of the Smile Train, said the charity is grateful to donors from around the world, whose generosity makes a tremendous impact on salvaging lives of shame, isolation and pain.

Through developing strict budget management, the Smile Train has succeeded in maintaining the average expenses per surgery at $250, the lowest among all similar charities. Members of the board pay for all non-program expenses, like administration expenses, so that 100 percent of donations will go towards programs that help children. "We are moving toward becoming the most cost-effective and efficient cleft lip and palate program in the world," said Mullaney.

Charles Wang said an important task of the board of a non-profit organization is to manage the donations and guarantee its financial health. "By shouldering the non-program expenses, we show donors our confidence in the Smile Train and give them a good reason to make a contribution."