As my airplane landed on the single runway at the airport in Guwahati, India, I was filled with a mixture of excitement and nervousness. I was about to begin my first medical mission outside of the United States, and frankly it was my first trip outside of North America. Upon deplaning, it was apparent that I was in a place unlike any I had been before. Cows and goats crossed the roads freely, traffic appeared to move in all directions simultaneously, and pedestrians and motorbikes were everywhere, crowding streets and sidewalks alike.

My journey to India began in the fall of 2013, when I was fortunate enough to be selected as one of the Stryker fellows for Operation Smile and, because of this, was sponsored to participate in a medical mission. My attending mentor, Dr. Arun Gosain, suggested that working with Operation Smile would be a rewarding experience and one that would likely change the way I viewed the world and my role in it. For my mission, Dr. Gosain, two anesthesiologists, and I, as well as several other residents and fellows, traveled together to the Comprehensive Cleft Care Center in Guwahati for 1 week to perform surgery there.

Guwahati is the capital of Assam, a state of India that is in the far east of the country. It is actually much closer geographically to Bhutan and Tibet than the rest of India. It is a city of nearly 1 million people, approximately equivalent in size to San Jose. Prior to March 2011, the state of Assam had approximately 15,000 untreated clefts, with more being born every day (Operation Smile India, 2014). At that time, there were only eight plastic surgeons in the entire state. For comparison, at the rate of plastic surgeons per capita of San Jose, Assam would have had 589 surgeons. It was this significant disparity in need that resulted in the creation of the Guwahati Comprehensive Cleft Care Center (GC4). The center began as a partnership between the government of Assam and Operation Smile in February 2011, with the goal of eliminating the immense backlog of clefts in the state.

When I arrived in Guwahati, the first thing that I noticed was the immense need of the people there. The idea of poverty that I had in the United States just could not compare to what I saw there-children with no clothes or shelter wandering in the streets; the tiny, clustered huts that so many lived in, and the families that traveled hundreds of miles to the Cleft Center with the hopes of repairing a cleft deformity that had been present for years. In the developed world, a cleft lip would normally be repaired at 3 months of age, but at GC4 we saw patients with unrepaired clefts who were 18 or more years old. I have never felt so fortunate to have access to comprehensive medical care, nor appreciated the extent of my responsibility as a surgeon to help bring that type of care to those who are in need.

High-quality cleft care requires a multidisciplinary team (Losee & Kirschner, 2008), and the GC4 provides this in an area where care of that sort is unheard of. The center has a tight-knit team of three local surgeons, operating room nurses, anesthesiologists, recovery nurses, a dentist, a speech therapist, a child life specialist, and recovery nurses. Along with the local staff, the center has attracted many dedicated individuals seeking to help others and master the craft of cleft surgery. During my week at the center, I met surgeons, anesthesiologists, or fellows from five different continents learning and participating in the care of these patients.

I was amazed at the number of patients that we were able to treat in a single operative day at GC4, and at the quality of care that these patients received. We met our patients in the morning, and the team would perform 12 or more surgeries throughout the day. Surgeries included both new cleft lip or palate repairs, as well as much-needed revisions of previous surgeries. Moreover, patient care at GC4 did not end in the operating room. Before and after each surgery, each patient was meticulously photographed. Between specific cases, we discussed cleft repair procedures and how techniques could be improved. After confirming the stable status of patients the morning after surgery, they would begin an often long trip home. Follow-up camps were scheduled in various areas of Assam so that surgeons could check in with their patients, ensure they were doing well, and maintain continuity if any additional procedures were needed.

Despite such a large team, things functioned seamlessly; a testament to the dedication of the local core that makes the GC4 possible. It was easy to see how committed the staff were to providing high-quality cleft care in an area where excellent care was not the norm. It is no wonder that the center has now performed more than 11,000 cleft surgeries in just a few short years. I feel privileged to have been a part of even a few of them.

Working at GC4 was a life-changing experience for me. I learned a great deal about cleft surgery, but I learned more about myself. I am inspired that such excellent care can be given in difficult circumstances, and I see first hand how a core team of physicians, nurses, and support staff can make it happen. More importantly, I now see that we have an opportunity and responsibility to bring care to those in less fortunate circumstances than ourselves. Just a few days for someone with education and training has the potential to alter the lives of many forever.

Operation Smile has opportunities for nurses, physicians, dentists, child life specialists, speech pathologists, and biomedical technicians to volunteer for medical missions all around the globe. The best way to get started is to click "Get involved" at http://www.operationsmile.org.

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