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There I was, 500 miles off Ecuador's coast last spring on a cruise ship looking up at the night sky as we sailed to another island in the Galápagos Archipelago. I stood transfixed by the Milky Way. But more vividly I saw in my mind's eye the children I had met the previous week in Guayaquil, Ecuador. I had just finished working with a volunteer team of surgeons and nurses and witnessed as they transformed the faces of Ecuadorian children born with cleft lips and palates in a hospital in that city. It was the first time I had participated in such a mission. It was also the first time in 30 years I had been to Ecuador, my homeland.

Several months previously I had overheard Dr. Steven Roser, George Guttman Professor of Clinical Craniofacial Surgery at Columbia University School of Dental and Oral Surgery, discussing his next mission with Healing the Children Northeast, a chapter of a medical volunteer organization that provides free medical care throughout the world to children who lack resources or health insurance. My ears perked up when I learned the medical-surgical team would travel in April to Guayaquil, Ecuador, the city of my birth. I quickly volunteered and Dr. Roser, who is also director of graduate medical education at Columbia University Health Sciences and at the Cornell-Weill campus, enlisted me as the team administrator and translator.

The months that followed included planning meetings with Dr. Roser, Laura Flanigan (pediatric nurse practitioner), and Dr. Patricia Crespo (SDOS orthodontic fellow and an Ecuadorian national) who made contacts here and in Ecuador. The Fundación Nacional de Rehabilitación Máxilo Facial in Ecuador, our co-sponsor, referred children with cleft lips and palates.

Above: Vincent Carrao, assistant clinical professor of dentistry at Columbia University School of Dental and Oral Surgery and assistant attending at NewYork-Presbyterian Hospital, with a mother and her child after reconstructive surgery at the Hospital del Niņo in Guayaquil, Ecuador, and Zoila Noguerole, who served as the Healing the Children team administrator and translator in April. Below: Ecuadorian children in the Hospital del Niņo enjoy donated toys.

April 21 arrived and the team—14 from Columbia-Presbyterian, including seven of us from the dental school—converged at LaGuardia Airport. An additional three team members from other parts of the United States met us in Miami. Nurses, anesthesiologists, maxillofacial surgeons, and me, the new kid on the block. Upon our arrival in Ecuador, our documents and baggage quickly moved through customs thanks to our Ecuadorian collaborators. And then, for the first time in three decades, I stepped out into the tropical heat of Guayaquil and the warmth of its people and my family.

Early the next morning, we traveled to our host facility, Hospital del Niño, and were escorted past a long line of waiting mothers with babies and children who had heard that norteamericanos would be providing free corrective surgery for children born with cleft lips and palates. After an official welcome by Dr. Miguel Tenorio, medical subdirector of Hospital del Niño, the screening process began. Part of the team unpacked the boxes with supplies and equipment to set up the three quirófanos (surgical suites). Others set up tables, scales, forms—and the children and parents began to stream in. Staff evaluated and photographed the children, and those referred for surgery were then screened by the team's anesthesiologists. Several were scheduled for surgery later that day. Screening and surgery continued for five days.

What did I see in the stars that night after my unforgettable week at the hospital? The children, often frightened, but also delighted with their gifts of stuffed animals and clothing. Their mothers' eyes, filled with hope and gratitude, and their murmurs of "Dios los bendiga." (God bless you.) A small boy's cries as I carried him into the O.R. And a 17-year-old girl, aptly named Bella, who had her final lip reconstruction. (Her mother and grandmother had died the previous year, and she now cared for two younger siblings while living with an aunt who was raising her own three children.)

I also recalled the surgeons' skills and their delight upon meeting the children and examining them during post-surgical rounds; the nurses' compassion and efficiency; the anesthesiologists' soothing reassurances for these small and frightened patients; and the team's collegiality and respect for the staff at Hospital del Niño.

I always will be grateful for my special homecoming. I was able to reunite with my cousins and 98-year-old aunt, after having not seen them for years. And I was able to witness the team's special compassion to the children of Guayaquil. These children and the team members became my extended family and I look forward to working on other missions. I wept when I hugged the Hospital del Niño's staff and the families goodbye. But I may see a few of them again in Ecuador next year, when I return.

That night on the boat, I also gained a deeper understanding of my parents who had had the courage (with me at the age of 2) to leave their homeland and families and start anew in New York City where, a month after our arrival, my sister was born at Presbyterian Hospital.

Zoila E. Noguerole is the administrative manager for the Columbia University School of Dental and Oral Surgery.

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