Commission · Guayaquil, Ecuador · 2024
Alliance for Smiles
Cleft care mission
Documentation of a volunteer surgical mission in Guayaquil, Ecuador, where children received free cleft lip and palate operations that their families could not otherwise afford. The work follows Alliance for Smiles, a non-profit that provides comprehensive cleft care and trains local medical teams around the world, from the first screenings to the moment each child was carried home.
A cleft is one of the most common congenital conditions, and its effects reach beyond the operating room. Children born with a cleft often struggle to feed and speak, and in many communities they grow up facing stares, superstition and exclusion, a weight the whole family carries.
After surgery, looking at their children, mothers repeated the same phrase: it is as if he were another child.
With thanks to The Raw Society for making this assignment possible. Photographed on the Fujifilm GFX 50S II.
A mother holds her son after his operation, in the last hours before they leave the hospital together.
A mother waits with her daughter for the evaluation that will decide whether the girl receives surgery during the mission. The team screens each child, runs the necessary tests and assigns a date and time in the operating schedule.
The family knows the process well. An older sibling was born with the same cleft and received surgery from Alliance for Smiles years earlier; the condition is often genetic and can recur within a family.
A nurse prepares one of the children in the moments before his operation, checking him over while he sits awake and alert.
The missions are intensive. Working in teams supported by anaesthetists, recovery nurses and emergency staff, each surgeon can complete up to ten operations in a single day.
A doctor and her assistant explain how to care for a child who has already been operated on: how to keep the wound clean, what he can eat, what to watch for in the days ahead.
Recovery continues long after the family leaves the hospital, and much of it falls to the mothers, who carry the instructions home along with their children.
Two surgeons review a patient's file, discussing the approach they will take in the operating room.
Every cleft is different. Before each procedure the team weighs the child's age, weight and the shape of the cleft to decide on a surgical strategy.
The anaesthetist, the surgeon and a nurse prepare a child in the minutes before the operation begins, moments before anaesthesia.
A nurse watches an operation from outside the theatre, ready to step in the moment anything is needed.
Around every surgeon works a wider team, much of it unseen from the operating table.
The surgeon marks the areas where he will work, drawing the lines that guide the repair of the lip.
The precision of these first marks shapes the repair that follows.
Near the end of the operation, the team closes the incision and sutures the lip.
The procedure itself is brief. The difficulty feeding and forming speech has shaped the child's life until this day.
A child begins to wake from the anaesthesia, the operation behind her.
From here she passes into the care of the recovery team before being returned to her mother.
Two nurses in charge of the recovery area attend to a child as he surfaces from the anaesthesia.
Here the children are cleaned and their drips removed before they are moved on to the ward where their families wait.
A baby holds a nurse's hand, still in recovery after her operation.
Back on the ward, a mother follows the instructions she was given, caring for her child as he recovers.
For these children the surgery is a turning point. It eases the daily struggles of feeding and speech, and over time it lifts some of the exclusion they have faced from other children and from adults who meet a cleft with superstition.
A mother holds her son close, ready to leave, the stripped bed behind them marking the end of their stay.