As if he didn’t have a name

Our promise of improving health and dignity during the Covid-19 pandemic endures. We’re helping frontline health workers stay safe, nourished and empowered to better serve their patients by providing life-saving supplies and equipment, as well as remote training to bolster their response. We’re also providing nutritional assistance, hygiene kits and virtual health services to support people and their health needs so they can thrive. If you can, when you can, help us keep our promise to care for children and create hope for tomorrow.

Joseph walks in his flip-flops behind his father and stepmother through their neighbourhood in San Remigio on the Philippine island of Cebu.

The 6-year-old carries a big plastic bag to collect recyclables and scrap metal, asking neighbours to sell him empty plastic bottles, pieces of metal, cans and glass jars.

The family gathers anything that might be worth a few more pesos before they sell it on to “the boss,” who then sells those items to turn a profit.

“The boss” pays Joseph’s father, Julito, a fixed price: 3 pesos per kilogramme of cans, 2 pesos per kilogramme of glass bottles and only 1 peso per kilogramme of plastics. On a good day, the family of five receives 100 pesos, which totals out to $2 at the most.

Joseph is the family’s youngest child and the only one born with a cleft lip and cleft palate.

Boy with a cleft condition
Joseph, 6 years old. Photo: Jörgen Hildebrandt.

His mother, who died several years ago due to heart disease, also collected scrap metal and recyclables.

While there are still many misconceptions surrounding the cause of cleft conditions, which can be environmental or hereditary, Julito believes his son’s cleft condition may have been caused by hours of bumpy motorbike rides Joseph’s mother endured while she was pregnant.

Boy with a cleft condition surrounded by rubbish
Joseph helps to sort his family's haul before taking it to "the boss." Photo: Jörgen Hildebrandt.

Joseph doesn’t attend school.

“He tried once, but came home crying. They call him ‘bungi,’” a derogatory word for cleft, Julito explains.

Sometimes the neighbourhood children throw stones at him — the same treatment they give the stray dogs in the area.

“Then, he fights back and comes home angry, crying and upset,” Julito said.

For unknown reasons, Southeast Asia, including the Philippines, is a region where cleft conditions are more common than the rest of the world — around one in 500 children are born with cleft lip and cleft palate.

The global average is closer to one in 750 births. Even though there are skilled plastic surgeons in the country — some who volunteer for Operation Smile — most families cannot afford the cost of surgery.

Joseph’s family is no exception.

Even the bus fare to the hospitals of Cebu City is too costly for some families.

However, when Julito learned about Operation Smile and the free surgeries it provides to children like Joseph, he became hopeful for his son’s future.

Boy with cleft standing in line with his father at an Operation Smile medical mission
Photo: Jörgen Hildebrandt.

After a local non-governmental organisation, Abounding In Love, provided Julito and his family with free transportation and lodging to an upcoming Operation Smile medical mission, Joseph was closer than he’d ever been to receiving a new smile.

Following their bus trip to the mission, Julito gazed around at the scene before him, surprised to see how many other children had the same condition as Joseph. While relieved to learn that his son wasn’t the only child to have a cleft, Julito soon became worried.

“I have mixed feelings,” he said. “I’m happy Joseph is not alone, but also afraid he will not qualify for surgery since there are so many in need of help.”

Amid the bustling atmosphere of the mission, Joseph tries to make sense of the situation.

He keeps asking his father why they are there, and when Julito explains, Joseph looks at him with surprise: “So they are going to fix my lip now?”

Boy with a cleft condition being screened by an Operation Smile medical volunteer
Photo: Jörgen Hildebrandt.

After a passing a comprehensive health evaluation, Joseph became one of many children who were selected to receive surgery.

The day after his cleft lip is repaired, Joseph stares at himself in the mirror for a long time.

With love and hope for his son, Julito won’t give up until Joseph receives cleft palate surgery.

Dad in medical gown smiling as he looks at his son who's just undergone cleft surgery
Photo: Jörgen Hildebrandt.

A year has passed since Joseph’s surgery.

While Julito still struggles to provide for his family, life has drastically changed for Joseph since arriving home after the mission.

“When we were discharged from the hospital and arrived at home, all our neighbours were very excited to see Joseph and told him he looked so handsome,” Julito said. “When we came to our house, he got a mirror and looked at his face and said, ‘Oh, I’m very handsome now!’”

But Joseph’s confidence isn’t the only bright spot in life after surgery.

Smiling boy after cleft surgery
Photo: Jörgen Hildebrandt.

Joseph has returned to school, eager to learn and become friends with those who once bullied and teased him.

“The first day at school, Joseph prepared himself carefully,” Julito explains. “He washed himself and prepared his school bag and dressed in his school uniform. When we got to the classroom, he asked if I was going to stay there with him. I said, ‘Yes, of course, I’m going to wait for you,’ but my son then explained that there was no need; he could manage to go home on his own.

“He’s not shy anymore. Unlike before, he likes going outdoors. And even if children still tease him sometimes, he doesn’t get mad at them — he knows his face is different now. Hopefully, the surgeries will bring him a different life than mine. He has more confidence now, and maybe this will give him a chance to get a proper job in the future.”

Help us keep our promise to patients like Joseph amid the Covid-19 pandemic. Your support today means we can continue to help them through these uncertain times and provide them with the surgery they deserve when it’s safe to resume our work around the world.

Smiling boy in school classroom
Photo: Jörgen Hildebrandt.