Mission to Lima

The main entrance of the Instituto Especializado de Salud del Niños, a large state-run children’s hospital in downtown Lima, Peru, is chaotic. Parents carry or lead their children past kiosks fronted by vendors hustling stuffed animals and balloons, up the stairs, and into a corporal mass of anxious dark eyes, all waiting to see a doctor. There are a couple of specifically South American phenomena—one charming, the other disconcerting—immediately outside the entrance: a vendor selling aloe fronds with flavored syrup, and guards inspecting bags as people leave. The entire campus was long ago splashed with paint, but the equatorial sun and downtown Lima’s hot, smog-tainted air has thinned the color to a faded sky-blue that futilely masks the institutional sadness of the children’s hospital—all the sick and injured children and their parents, waiting to be seen by somebody, those dark eyes brimming with a mix of resignation and anxiety.

On the fifth floor of one of the hospital’s buildings, a Minnesota-based charity, The Smile Network International, borrows a pair of operating rooms and a few beds in a recovery ward. This week, the charity’s doctors hope to operate on more than 100 children with cleft lips or cleft palates.

Allen Van Beek is one of the surgeons on this Smile Network “mission” to Lima. This week, from Monday to Friday, the surgeons will operate on five or six children a day, spending about an hour to an hour and a half on each cleft lip. As his iPod kicks out Sting, Van Beek looks over the top of his custom-made surgical glasses (there’s a long black microscope attached to each lens) and cracks jokes to the surgical staffers packed into the tiny OR. Today the staff includes two other North American surgeons—Robert Ryan, who is semiretired and is assisting and observing Van Beek, and Srdan Babovic, who is operating at a table four feet from Van Beek—as well as their anesthetists and nurses. Over the music, Van Beek recalls the time his then-teenaged son smashed up the doctor’s Porsche while the doctor was away. Ellie Schnepf, a stunning brunette nurse who works in Van Beek’s plastic surgery clinic back home in Edina, rolls her eyes; she’s no doubt heard the tale before.

“Yup, but kids are so cute when they’re this age,” Van Beek says, referring to the five-month-old girl he’s operating on. But the girl, who was born with a bilateral cleft lip, with gaping holes on either side of her mouth, a stump of moist pink tissue protruding from under her collapsed nose, and four teeth beginning to grow out of the flesh—well, in truth, she isn’t very “cute” at all. But after Van Beek, one of the world’s most respected micro surgeons (he’s been on thirteen training missions to Peru in the past three years and to several medical sites in Asia), is finished butterflying the child’s lip tissue into six different parts, filleting the muscle tissue away from her lip tissue and rotating it across her newly constructed top lip, and then suturing it all back together, she’s as close to cute as she will probably ever be.

Van Beek won’t be completely satisfied with the result—the girl’s “new” nose will look like a nose, but the new lip tissue will pull it down slightly toward the mouth, making it wider and flatter, a common problem called “buckling.” Van Beek shakes his head. “I try to shoot for the three-foot rule,” he explains. “If she’s acceptable to society outside of three feet, I feel like I’ve done a good job. Inside of three feet? Only God can do that one.” 

For the last two years, The Smile Network has been the most talked-about charity in the Twin Cities. It’s not the only organization that fixes smiles around the world; there’s Operation Smile (the largest and first, based in Norfolk, Virginia), New York–based Smile Train, and Children’s Surgery International, headquartered in Minneapolis—all of them high profile and apparently successful in raising money and fulfilling their mission. In fact, while Smile Network is in Peru, Jessica Simpson is testifying on behalf of Operation Smile at a congressional hearing in Washington. Celebrities such as Bette Midler and Jane Kaczmarek have thrown their support behind The Smile Train. Who wouldn’t attach themselves to these organizations? There is something universally appealing about the seemingly magical before-and-after transformation of the children who have undergone this surgery.

Locally, the Smile Network has attracted all kinds of celebrity attention. There was the reception at Escape before last summer’s Invitational Celebrity Bass Fishing Tournament (the one where Randy Moss showed up after being traded to the Raiders) and La Belle Vie’s grand opening party. Smile Network has been featured on HBO, MTV, and ESPN, on the local news, and in the Star Tribune, where C. J. has taken a special interest in the semicelebs who show up at the parties—most notably Minnetonka’s Kelly Carlson, who serves as Smile’s official “celebrity spokesperson” and, in an ironic twist of what marketing types once called “synergy,” is the star of cable’s salacious Nip/Tuck plastic-surgery drama.

The driving force behind Smile Network is founder Kim Valentini. The forty-seven-year-old former restaurant manager has the beatific countenance and kind eyes of Meryl Streep in Defending Your Life. After serving on the board of Operation Smile for several years, she was inspired—while watching an episode of Oprah, she says—to start her own organization. She and her husband, prominent defense attorney David Valentini, have two children, and she says her reasons for founding Smile Network came down to a primal emotion. “I can’t imagine being a parent and not being able to provide something for your child,” she explains. “All people have the desire to fit in—to be part of something. But for these kids, fitting in is not part of the equation.”

Martin Lacey, who practices privately in Woodbury, is another of the Twin Cities’ top cleft surgeons. “I never get bored with this surgery,” he tells me outside the operating room in Lima. The other surgeons on this Smile Network mission agree. Marie Christensen, who works out of Park Nicollet Clinic in St. Louis Park, says that there is both an artistic and a technical challenge to repairing a cleft, especially a cleft lip. After the first day of surgery, on the shuttle bus returning to the hotel, Christensen says, “I don’t know why I made that incision on that lip a millimeter to either side. It’s just why I get paid. It’s innate. You can’t teach that stuff. It’s like asking Julia Child how much salt she uses—a pinch more or less makes a difference.” Every lip is different. “One side is never going to be perfect,” she says. “You’re doomed to failure, but the challenge is always there.”

To these surgeons, a cleft repair is a romantic procedure complete with a made-for-TV story. The major breakthrough occurred during the Korean War, when a real-life Hawkeye Pierce, a MASH surgeon named Ralph Millard, developed the “rotating” procedure while operating on Korean children. Millard cut away and rotated lip tissue and muscle to stretch across the top of the mouth, so that, with therapy, the patient would be granted fuller control of his or her face, enabling normal speech. The now widely used Millard procedure also yields a much better cosmetic result than its more primitive forebears. The procedure has since been refined, but it remains one of the most challenging and prestigious surgeries in the field. Because nearly every North American child born with a cleft is taken care of immediately after birth, however, plastic surgeons rarely get to work on a case in the United States. Even the best U.S. surgeons, such as Van Beek, Lacey, and Christensen, don’t see enough cleft cases to sustain a regular practice. In fact, Srdan Babovic, a plastic surgeon with a small practice outside Rochester (and the husband of Dusica Babovic-Vuksanovic, a doctor of genetics at the Mayo Clinic whose expertise is essential during the patient screening process in Lima), has performed the cleft surgery so rarely that on the plane from Minnesota to Lima he needed to brush up by reading a medical manual. 

According to Van Beek, the cleft is much more prevalent in Latin America than in the United States, where only 1 in 600 to 800 children is born with it (as compared with 1 in 400 in Peru). The cause of the defect is believed to be genetic, though some experts suggest that environmental pollution and malnutrition may greatly increase the numbers. Lima, for its part, is a city of 7.5 million people, with the sort of extreme poverty that prohibits many cases from being treated.

In the United States, many of the top plastic surgeons divide their practices 60/40 or 70/30 between the lucrative Dr. 90210–style cosmetic work—breast augmentation, liposuction—and reconstructive work such as skin grafts for accident victims and reconstructive surgeries of the hand, foot, genitalia, and clefts. “I think [of my cosmetic practice] like I’m selling a TV,” says Lacey. “There’s nothing wrong with selling a nice TV. And augs and lipo isn’t just scraping somebody out or sucking fat through a garden hose—there’s a finesse to it. You can leave ripples and pockmarks.” But Lacey, like his colleagues on the Lima trip, admits that there’s something special about repairing somebody who needs it in a more profoundly urgent way. “I come down here for the buzz,” he says. “And to hang out with the friends I’ve made on these trips.”

On this mission, five surgeons have come down to Peru, and they’re supported by two pediatric anesthesiologists, a genetic specialist, and a team of pediatric anesthetists and RNs. The staff has been drawn from some of the Twin Cities’ best hospitals, including Children’s Hospitals and Clinics of Minnesota and Regions, and from Rochester’s Mayo Clinic. The surgeons’ donation of time takes care of most of the mission’s expenses, because most of the medical supplies, including the anesthesia, sutures, and pain medications, are donated by manufacturers and suppliers. The greatest expense is air transportation and room and board for the medical professionals. The cost to repair a cleft lip or a palate is about $500.

Mayo’s Randy Flick is serving as the team’s medical director. Flick is a silver-haired, gray-eyed pediatric anesthesiologist who carries himself with a sharp clinical confidence you would expect from a Mayo big shot. “We want to provide these children with the same quality of care they would receive in the U. S.,” Flick says. But even as Flick talks about keeping the children safe during and after surgery and their entitlement to the equivalent quality of care as North American kids, he is aware of the many limitations: His team is in Peru for only a week, space is limited, and the Lima hospital doesn’t conform to North American sterility standards. And Flick realizes that with the medical pursuit of excellence comes a considerable amount of ego. At the first meeting, weeks before the mission, he talked about the need to be politically sensitive. “We have to check our egos with our luggage,” Flick said. “We are guests of the Peruvian doctors and medical staff, and we must ultimately defer to their judgment.”

Flick’s directives on political sensitivity are followed by the medical team and Kim Valentini, but that doesn’t preclude friction between the Americans and the Peruvians during the mission. Officially, all is well, of course; the North Americans are guests of the Lima hospital’s lead pediatric surgeons, Wieslawa Pawikowski and Andy Wiegering Cecchi. (Pawikowski has previously accompanied Smile Network missions to Mexico.) On the first day of surgery, the hospital’s priest welcomes the team and says a prayer for their mission. On the last day, ISN’s director hosts a small reception in a surgical locker room, toasting the mission with Peru’s national cocktail, the pisco sour. The Peruvian nurses and doctors I speak to are effusive in their gratitude and praise for the North American team. Still, there is some noticeable tension in the recovery ward, a hotter, louder environment than the air-conditioned operating rooms upstairs. Here, the North American nurses share space with their Peruvian counterparts on a much more personal basis. Even in the recovery room down the hall from the surgeons, the Peruvian nurses insist on signing out patients before they leave recovery to go to the ward downstairs, though it would be more pragmatic to allow the American nurses and surgeons to make the call. Midweek, Peruvians at a higher administrative level suddenly take away two recovery beds, leading to a major last-minute revision of the surgery schedule. The curt exchanges and abrupt protocol adjustments might be frustrating to the Minnesota team, but as Dusica Babovic-Vuksanovic, working in the recovery ward while her husband is in the OR, points out, “Of course, they have egos too.”

On every Smile Network mission, there are also problems getting medical supplies through the host nation’s customs—one year, it required the intervention of Senator Norm Coleman, a longtime chum of David Valentini. For her part, Kim Valentini professes to have little patience with the push and pull of international game-playing. “Somebody told me that the United Nations would frown on the kind of work we do,” she says. “I was kind of surprised, and I asked why. And they said, ‘Well, you know, when you come in, it kind of negates the responsibility of the [national] government to take care of its own people.’ I thought about that for a few minutes and decided that I don’t care what a country’s politics are. If I’m a [cleft patient’s] mom, I just know that I have a kid who doesn’t fit in. And if I’m a [cleft patient], I know that I don’t fit in. The politics mean nothing to me. These are the kids on the lowest part of the social ladder. These are the forgottens. And if groups like ours don’t step in and do something for them, nobody is going to do it.”

In her role as a crusader for forgotten, impoverished children, Kim Valentini is responsible for raising money among some of the wealthiest, most beautiful people in the Twin Cities. She has connections of her own—during one of our conversations, she tells me that 75 percent of the revenue is from “friends of myself and David”—and she clearly understands how to make new friends. To that end, she knows how to throw a party. Before my trip to Lima, I attend a Smile Network function in Wayzata. One of the first people I am introduced to is Kathy Buchanan, the manager of Tiffany & Co. in Galleria, who seems especially pleased by the quality of the turnout. “They seem younger,” she says. “And fun, and they have the money . . . .”

The party, a Fendi trunk show, is hosted by Nancy Bigos, the wife of real estate mogul Ted Bigos, and her neighbor Mary Holmes. Nancy is affectionately known in Wayzata circles as “Nancy Big-house” because she loves to entertain in her $20 million contemporary castle on Lake Minnetonka. The party came together when the Fendi boutique in Aspen agreed to send its inventory to Minneapolis for an exclusive afternoon of shopping. But before guests encounter the busty mannequins draped in $100,000 Russian sables set up in the Bigoses’ sunny front sitting room, they are drawn to the Latino children’s before-and-after cleft-surgery photos that have been mounted on Styrofoam boards and fetchingly arranged on the foyer’s grand staircase.

Nancy Bigos hired Chef Ted to assemble the hors d’oeuvres, and a full wait staff is on hand to make sure the A-list crowd is efficiently plied with mimosas. Local TV personalities Amelia Santaniello and Esme Murphy are here, as are athletes’ wives such Brandi Garnett, neighbors such as Aussie hair product queen Cindy Redmond, and society women Anastasia Hoft and Darin Opperman. The five valets hired for the occasion ensure that nobody will have to wait more than two minutes for her Mercedes SUV. Bigos, in a tasteful white ensemble, glows like a bride as she greets her guests, knowing full well that bringing Fendi to Wayzata will boost her East Bay cred: This array of $5,000 Spybags and $50,000 coats can’t be found at Nieman Marcus, and Fendi will sell $100,000 worth of merchandise this afternoon and another $40,000 the following night at a small party in Solera’s banquet room. The Smile Network will take 10 percent of the proceeds on both days.

Bigos acknowledges her good fortune. “I know, I know—‘Nancy got Fendi,’ ” she tells me. “But I’m honest. I tell them it fell in my lap and I took it.” She laughs. “I guess Fendi called The Smile Network first, actually. And they’ve been negotiating for, like, eight months.”

Valentini’s background is in marketing—she worked as the manager of tourism at the Mall of America before moving into Steven Schussler’s restaurant concepting company—and she believes The Smile Network provides an outlet for her particular gifts. “For me, it’s a combination of all the different careers I’ve had,” she says. “Public relations. Marketing. Operations. Management.”  Her experience comes across at trunk shows like the one at Nancy Bigos’s house or openings such as the one at La Belle Vie.  “In order to be really successful as a nonprofit you have to engage people on all different levels,” says Valentini. “And people have different reasons for participating. For some people, it’s the gift of a skill that [other] people can use. For some, it’s to write out a check and feel good about making a difference. And for some, it’s spending time.”

One of her most effective innovations has been to partner the charity’s medical missions with adventure travel. Her solution for making people who can’t hold a scalpel or operate a respirator feel intimately involved in helping faraway people is called “Miles for Smiles.” While the surgeons are operating on the children in Lima, eight Minnesotans—including David Valentini and their son, Gino—are hiking the Inca Trail, twenty-six miles up the ancient stone steps the Incas laid from Huayllabamba to the “lost city” of Machu Picchu. The trekkers raised $50,000 in private sponsorships before they left home, thus funding the entire medical mission. In the future, the The Smile Network plans to combine a hike along the Great Wall while the medical team is working in China, and to backpack in Phuket during a mission to Thailand.

Before beginning the surgery, The Smile Network’s medical staff must screen more than 150 children in a weathered auditorium tucked between two buildings on the ISN campus. In addition to the cleft palates and cleft lips, Van Beek, who specializes in hand surgery, will perform some hand reconstructions and skin grafts. In the old auditorium, nurses take down rudimentary medical information before sending the prospective patients on to the small circle of surgeons who examine the children, consult with each other, and begin to design surgical strategies. Outside, parents have been lined up for hours, some perhaps for days. They have learned about the gringo doctors from the television or a billboard or the paper, but most often by word of mouth, such as from the native pediatricians who initially turned them away. 

With the aid of an interpreter, I walk along the line of parents who stand or sit quietly, patiently waiting their turn. These are clearly poor people, many of them with dark skin denoting indigenous blood, wearing worn-out clothing, usually sweatshirts or T-shirts and jeans, although the children, especially the youngest ones, often wear newer things, sometimes with Winnie the Pooh or some other familiar characters emblazoned on the front. Getting a day off work must have been difficult for many of the adults in line, but there is no discernible grousing or complaining, perhaps for the sake of the children, or perhaps because the adults are reticent to share their hardships with a North American. Some do tell me their stories. A little girl who was burned in a propane accident in her mother’s kitchen has been teased so much she no longer attends school (which is the case with many school-age kids, whether burn victims or those born with clefts). Another child’s mother has brought her family here by bus: a twenty-four-hour trip from the mountain village of Ayacucho. The four of them—mother, daughter, and two sons—are staying with distant relatives somewhere in Lima, and the mother is afraid she will lose her job when she returns home. A father has returned to the mission for a second time; his son was too ill to be operated on during their first visit. The adults are all too dignified to appear desperate. They simply want the best for their children, and this is the best chance they can find.

Between 110 and 115 out of the 150 children gathered here will be selected for surgery. They will be chosen according to their condition (are they healthy enough to withstand surgery?) and chance for success (a younger child will get the nod over an older child, for instance, because it’s easier to correct speech in a younger child). There is also the “golden ratio”—ten hemoglobin (red blood cell count), ten months, and ten pounds—but the doctors will deviate from those numbers if necessary and in certain cases. Patients who have come especially long distances through the jungle or the mountains may get special consideration. 

At the end of the two days of screening, the doctors sit down at one of the tables to decide who will be operated on and who will operate on whom. The patients’ names are written on cards: pink for first priority, blue for second, green for third. Because of the high demand, only pink cards will be scheduled for surgery this year. At more than one point during the decision-making process, the surgeons’ conversation becomes heated, and the group’s lead nurse, Carrie DeBoer, politely asks if I would excuse myself from the table. At the end of the discussion, the doctors are visibly exhausted, and the shuttle ride back to the hotel is quiet and tense.

The results are posted on a board outside the auditorium and met with either elation or heartbreak by the waiting Peruvian adults. A happier scene will come a day or two later, when the children who are successfully operated on—according to Randy Flick, there has never been a fatality on a Smile Network mission—go home with their families and begin what should be a more normal life. Babies who didn’t have the whole lips necessary to suck at a nipple will be able to nurse (additionally sparing their parents the hardship of spending half of their income on expensive baby formula). Serious cleft complications such as respiratory ailments will be alleviated. With a repaired mouth, many of the children who haven’t been able to speak will, with therapy, be able to communicate normally. And children who were shunned or teased will be able to attend school, pursue boyfriends and girlfriends, and eventually get jobs.  Once “forgotten,” they will now be able to “fit in.”

Back home, Nancy Bigos, who’s also involved with other, more venerable charities, such as the Symphony Ball and Children’s Cancer Research, points out that The Smile Network’s “list” of potential invitees to events like her East Bay party is “hot” right now, because the women are younger and sexier than women who participate in other charities. “It’s because it’s such an awesome cause, especially for all these young mothers,” she says. “It takes $500 to fix a child’s face. Here [a cleft] is automatically fixed. I mean, nobody even discusses it.”

At the trunk sale, Nancy’s eleven-year-old daughter Madison points at a brown, orange, and turquoise sequined Spybag (though, at $4,700, I’m pretty sure they’re not called sequins) and informs me, “That’s the same purse Lindsay Lohan has.”

After the party, Nancy reflects on the charity’s work in her community. It’s easy to “lose track of who you are” if you live a certain lifestyle, she says. “There’s a lot of wealth here. We’re kind of in a bubble, and we need to kind of reach out and touch other people who don’t have what we have. It’s easy to get so involved with your lifestyle and everything else—you have healthy children, your husband is making a lot of money, you’re going out to lunches with your girlfriends—and then you think, ‘Gosh, there’s more to life than this.’ ” 

Mpls.St.Paul Magazine associate editor Steve Marsh wrote about Soul Asylum in the May 2006 issue.