The Girl in the Valley

On a Saturday afternoon, we came to the Isabela United Doctors Medical Center. A pediatrician listened at an examination table as mothers walked their children up for evaluation.

For years, tarpaulin banners and radio waves ran through Cagayan Valley advertising medical missions that offer free cleft services. Many of Isabela’s poorest residents had availed to the opportunity, because they could not afford the P100,000 procedure (USD 2,000) elsewhere. For the cleft-affected child, an operation offers a path to education, employment, and meaningful relationships.

Physicians who have been studying the effect of medical missions in the Philippines would say that the burden is lessening. Children are presenting for operation at younger ages, which suggests real progress when it comes to addressing unmet cleft needs.

The pediatrician was examining the patterns of the last infant for the day. Oral cavity, Cardiovascular, Lungs: check, check, and check. We gave families instructions to return in exactly 7 days for a final screening, then packed our supplies. As we walked to the car, a visual of all the young babies I had seen came to mind. Our programs are working, I thought.

Had it not been for what happened next, I never would have asked myself Working for whom? Out of a public transport van, a 13-year-old girl with a unilateral cleft lip stepped out. Later, I called into question whether our programs were reaching the most far-flung areas of the Philippines.

Criselda resides on the south side of Quirino province and lives a lonely life by choice. The difficulties started around age 6 when she began going to school. Her sense of worth and belonging were consistently attacked by playmates. On most days, her self-concept consisted only of embarrassment. There simply wasn’t a reason to continue enduring the bullying, so by age 11, she quit going to school. She had only completed the 6th grade.

Where Criselda lives

It is rare for anyone from Criselda’s community to finish a college degree, to inter-marry with outsiders, or even to live in an urban area of the Philippines. She is a descendant of the Bugkalot tribe, an indigenous group especially known for colorful traditional dress, crafts, and musical instruments. I meet her again the next week on the day of her operation. She is wearing jeans, a pink t-shirt, and a blue jacket. She is ashamed to speak aloud when addressed, and if she catches you looking at her, she immediately turns away. Her arms are crossed as she observes waves of young babies around her. I wonder whether she wishes she had been dealt their lives: To have received treatment earlier in life.

Kennedy is Criselda’s uncle. He is the only Tagalog-speaking member of Criselda’s family, so it makes sense that he would be the one to lead her on the 12-hour journey from home to hospital. It began at the boundary of a large forest in Keat, one of 16 barangays in Nagtipunan, Quirino province, just south of Isabela. There are no computers, no cellular towers, and no radio signal. Locals describe how the ground turns to mud during the rains and frequently covers the wayfarer’s knees. One would have to travel by car for 4 hours just to enter within cell phone coverage. Kennedy answers all my questions, and I get the sense that the place he’s describing is all but a distant world in both time and geography.

His numbers would give you a better sense of the life there. Out of the 500 residents in the Keat barangay, only one person has been to university. He estimates only two out of every ten people finished high school. Poor education begets more poverty. When asked about daily income, Kennedy can’t provide a clear answer. “It depends on the prices of our crops,” he says. “In 2015, I could sell 1 kilo of ginger for 120 pesos and have a decent year selling around a 1,000 kilos. But this year, the prices sank to 8 pesos per kilo for about the same harvest.” I do the math in my head and am horrified by the impossibly difficult results: In under two years, his main income stream had dropped by nearly 95%, from $2,400 to $150.

I recognize there are other parts of his reality that we have not uncovered through conversation. Some more positive. Some maybe not. I am awestruck how anyone lives like this.

He continues, giving me his assurance. “The government helps us with a P150,000 grant (around USD 3,000). But more than anything — anus namin.” In the vernacular, it means that although life is hard, he and their family remain patient and calm.

I give him my mobile number, but he cannot reciprocate for lack of a phone. My concern is compounded by the fact that tomorrow I will go home to my unit in Taguig, also known as Global City, but Criselda will go back to Keat, where over three-fourths of the residents are, as Kennedy puts it, “still uncivilized”.

On August 22, 2017, Criselda underwent a 45-minute surgery that repaired the cleft in her upper lip. I decided to ask Criselda what she will do tomorrow.

Criselda does not express herself with me directly. Instead, a smiling Kennedy with wet eyes conveys to me all that she had confided in earlier, private moments. Criselda has decided to go back to school. Criselda is ready to engage her classmates. Criselda, at the core, is beaming with joy over what has transpired in the last week.

Now, more than ever, I understand what a simple service, like surgery, can do. When you see an outcome, you come to witness individual transformations in a person’s appearance, expression, and mindset. But to glimpse those moments as decisions over time must altogether be something different and something more telling. I try to imagine this young girl’s life. I consider a day in the future where Criselda, Kennedy, and her future family look back and view the paths that may’ve been and the path her life had coursed. I wonder whether this will be one of a few major inflection points she will conjure up. I conclude, judging by our hours of interaction, that this will be hard to forget.

Criselda before surgery
Criselda (after surgery), Kennedy, and me

A volunteer hands her a bag that contains a blanket, some toys, hygiene supplies, and a mirror. A mirror that makes me take a hard look at my own life and what I have learned from our interactions.

It’s been 30 days since I met the girl in the valley. She comes to mind often, like a cognitive banner, showing two sides of a bifurcated reality.

The former should remind us that everybody loses when human potential is smashed by poverty.

The latter, however, should make us aspire. Aspire to discover a more coherent narrative for our world. Aspire to think more creatively, tenaciously, inclusively. Aspire to deliver on the promise of our children, those near or far — like Criselda. Aspire to deploy humanity’s essentials, barangay by barangay, to every person alive.

- Timothy Lu, Director of Strategic Partnerships, Operation Smile Philippines

Operation Smile is an international medical charity that has had a presence in more than 60 countries and has provided hundreds of thousands of free surgeries for children and young adults in resource poor countries who are born with cleft lip, cleft palate or other facial deformities. It is one of the oldest and largest volunteer-based organizations dedicated to improving the health and lives of children worldwide through access to surgical care. Compassion, equity, and sustainability are at the heart of everything we do. Through the use of collaborative knowledge-exchange, problem-solving, and deliberative dialogue with local talent and global resource partners, Operation Smile seeks to develop solutions that will close the gaps in care for children in the Philippines still living with cleft conditions.

If you’d like to donate to support the work of Operation Smile Philippines or if you’d like to sponsor a surgery, please visit