For Denver Carranza, undergoing surgery as a child was a turning point in his life-but it was not the end of his journey.
Born with bilateral cleft lip and cleft palate, Carranza underwent his first operation with the help of the Philippine Band of Mercy, Smile Train and his grandmother. Yet as he grew older, he encountered challenges that could not be addressed in an operating room.
When he entered school, he experienced bullying and sometimes struggled to speak clearly. There were moments when he lost hope. What helped him overcome those challenges was the love and emotional support of his grandmother.
‘A child with cleft lip does not just need an operation,’ Carranza said. ‘They need true acceptance from their parents. Love, emotional support, and long patience.’
Today, Carranza works as a support staff member at the Philippine Band of Mercy, helping families of newborns with cleft conditions find the information and treatment they need. For him, the work is more than a job; it is a way of helping children have a better start and a brighter future.
His experience underscores a message highlighted during Smile Train Philippines’ Beyond the Smile community fair: cleft care goes far beyond surgery.
A journey that begins at birth
Cleft lip and palate are among the most common birth differences worldwide and are highly treatable. However, many families continue to face barriers to timely and comprehensive care, according to the information presented at the event.
For Dr. Gene Gerald Dr. Tiongco, a Smile Train volunteer surgeon who has performed cleft operations for two decades, the journey begins the moment a child is born.
The first concerns may not even involve surgery. Pediatricians can help parents understand how to feed a baby with a cleft and ensure that the child receives adequate nutrition. Other specialists, including dentists and orthodontic professionals, may become involved as the child grows.
Surgery itself also depends on the child’s condition and nutritional status. Dr. Tiongco said cleft lip surgery generally requires the baby to be at least three months old, while cleft palate repair is typically performed before the child begins speaking, with timing depending on the individual patient.
But even after an operation, care continues.
‘It’s not just the surgeon’s responsibility,’ Dr. Tiongco said. ‘When we say we, it’s all about a team.’
That team can include nutrition experts, dentists, orthodontic specialists, psychologists or psychiatrists, nurses and speech therapists. The goal is to follow the patient beyond the operating room and address the different needs that may arise throughout the child’s development.
More than a surgical outcome
John Manuel Flores, Smile Train’s Area Director for Southeast Asia, said the first surgery can be a life-changing milestone, but it is only the first step in a much longer journey.
Children with clefts may face difficulties with feeding and nutrition in infancy and may later require speech therapy, orthodontic care, hearing support and psychosocial counseling. Comprehensive cleft care means accompanying the child and family through these different stages, from infancy into adulthood.
This broader approach also changes the way success is measured.
For Dr. Tiongco, the impact of surgery can be dramatic. He recalled how parents may become emotional when they see their child after an operation-not simply because of the physical change, but because they begin to imagine a future in which the child can face less stigma and pursue opportunities with greater confidence.
‘It’s not just an operative success,’ Dr. Tiongco said. ‘It’s a success and contentment of the whole community.’
Breaking the cycle of misinformation
Providing medical care is only one part of the challenge. Awareness is equally important.
Dr. Tiongco said some parents blame themselves when their child is born with a cleft, asking what they might have done during pregnancy to cause the condition. He emphasized the need for healthcare professionals to reassure parents that it is not their fault.
Misconceptions can also persist within communities, including beliefs that cleft
conditions are caused by traumatic events or other unfounded explanations. Such misinformation can contribute to stigma and discourage families from seeking care.
For Smile Train, addressing these misconceptions requires bringing accurate information beyond hospitals and clinics.
The organization has partnered with the REX Education Foundation Inc. to expand cleft education through literacy and community-based initiatives. The partnership seeks to help children, schools and communities understand cleft conditions while encouraging empathy and inclusion.
Dominic Leandre D. Buhain, Vice Chairman of REX Education Foundation Inc., said education can influence not only what children know but also how they treat others.
The partnership is also exploring educational materials that can give children with clefts greater representation while helping other children understand experiences different from their own.
Bringing care closer to families
Access remains another major challenge, particularly for families who live far from major medical centers.
Smile Train said it has been operating in the Philippines since 2001 and currently works with more than 60 partner hospitals across the country. Through these partnerships, the organization provides funding, training and other support to local healthcare professionals so patients can receive free cleft care closer to their communities.
Flores described the approach as a sustainable, local-first model. Rather than depending on short-term medical missions, Smile Train works with local doctors, hospitals and healthcare workers, providing resources and training to support year-round care.
The support extends beyond surgery to services such as speech therapy, orthodontic treatment and nutritional care, depending on the patient’s needs.
For families, bringing these services closer can mean less travel, fewer barriers and a greater chance of receiving care when it is needed.