It is 7:30 a.m. on Monday in the hospital of the Fundacion Tierra Neuva in Quito, Ecuador. A team of surgeons and medical personnel is screening young patients and preparing the operating facilities. Several children and adults are in the waiting area. The young people have been pre-screened by the hospital to assess their eligibility for surgery. Social workers have visited the homes of all the hopeful patients to evaluate their health care and financial situations. Some live in huts without water or electricity. The poverty rate is high and there is no health insurance.

Carlos sits on the floor coloring in a book. A man is with him, talking softly, admiring the crayoning. Other children play games while they wait. The man is not related to Carlos, but he has adopted him. Children born with facial deformities in Ecuador are often abandoned by their birth parents because of the overwhelming obstacles to raising such a child. The parents are poor, there is a stigma attached to deformed children, and they know they cannot provide adequate care. But all over Ecuador, when this happens, a family takes the child in and raises him or her as their own. The enormous love these people have for the children is humbling.

The patients arrive at the hospital at 6 am. Some have traveled for a day or two to get there, usually on a bus. The first patients scheduled for surgery are the ones who were unable to be seen the previous year. Some will wait six or seven hours for their turn. Some will go back home without the surgery. It is heartbreaking for the children and the adults and the medical team to turn away patients.

Carlos is fortunate. He will be called to surgery a little before noon and by 2:30 he will be on his way home. Marguerita is not so fortunate. There are too many patients ahead of her. Her parents brought her 130 miles to the hospital and she will not have surgery today. They will be told “come back next year, that is as soon as we can see her.” She cries, her parents cry. But 70 children will be operated on during this week.

We thank all the generous people who make it possible for us to carry out these medical missions. We hope someday to be able to make two yearly trips to Quito to care for more children and send fewer home disappointed. This is truly what we mean when we say,  "Help Us Give Smiles."