Smile though your heart is aching,

Smile even though it’s breaking ..

The words of the old song encourage a brave front. but theydon’t take into account the people who are sad because their mouthsare so deformed they can’t manage a smile.

It’s Joe Clawson’s mission is take care of both problems.

The retired Longview surgeon circles the globe to sew up thefaces of people born with a cleft palate, a birth defect thatleaves them with gaping gashes under their noses, haphazard teethand a prognosis of shame.

Clawson, 79, has repaired 2,500 cleft palates in South Americaand Africa over the last 28 years.

At a clinic in Ambato, Ecuador last month, a 38-year-old womanshowed up with an infant who had a huge “bilateral” cleft, Clawsonsaid.

Bilateral means the gap was equally cloven on each side of thenose, as broad as the baby’s smile would be if she had one.

“Mama was crying, and she said, ‘Can you help me?’ ” Clawsonremembers.

During the surgery, the mother camped in the waiting room,crying. After the surgery, the woman gowned up and was led to therecovery room, where she sat in a rocking chair.

“She was crying again,” Clawson said.

Then the staff came in and handed her the baby, and she saw herchild’s mended face. “She stopped crying,” said Clawson. as heturned to go back to the operating room, he took one more look backat her.

“She threw me a kiss. It was the biggest thank-you I’ve everhad.”

He has seen many children transformed. but it’s that jubilantmoment that keeps the surgeon repairing the world, one face at atime.

One of out 450 births

A cleft palate describes a birth defect in which the roof of themouth does not close during fetal development. Babies with thedefect, in varying degrees of severity, often have distorted nosesand lips.

All fetuses start out with a cleft palate, Clawson said, butduring fetal development, layers of muscle grow toward each otherand fuse to form the roof of the mouth, upper lip and the midlinegroove from lip to nose.

The cleft palate child is missing the process of proteinsynthesis that grows those particular muscles, he said. in someplaces in South America and Africa, the chromosomal abnormality isas frequent as one in every 450 births.

Aside from growing up with a disfigured face, children withcleft palates have trouble speaking and eating, and a highincidence of ear infections.

Consider the tale of Solmano Harou.

The 7-year-old boy lives in a village in Niger, a westernAfrican country three times the size of Texas.

The father told Clawson that other than Somano’s cleft palate,he was a very healthy baby, and they were thankful for that.

When the child was 2, they had traveled to a city in east Nigerwhere a clinic was treating children with cleft palates.

Workers there examined the boy and told them, “Go home and wewill call you when we are ready to do his surgery.”

They went home and waited — for five years.

In the meantime, Solmano was beset by taunting children whothreatened “to mess up your mouth even worse.” Then CURE, achildren’s medical mission Clawson works with, did a campaign neartheir village. When the team came through, Solmano’s father waspraying at a mosque in another village. A neighbor later told himthat he had missed the clinic visit, so he found out where theclinic had gone next and took Solmano there.

Clawson repaired the boy’s mouth. He’s no longer harrassed, andhis family is sending him to school for the first time.

In another case, Clawson operated on Freddie Solomon ofZimbabwe, who at 31 was the oldest person in that country to comein with a cleft lip and palate. After surgery, Clawson said,Solomon’s girlfriend decided she wanted to marry him. he agreed togive his future mother-in-law six cows for the wedding endowmentbut was anxious about how he’d be able to buy them.

Clinic staff pitched in, Solomon rounded up the cows, and thecouple tied the knot.

Sixteen hours to say hello

In Ambato, in the Andes mountains of Ecuador, 60 people showedup at the week-long clinic, Clawson said.

Half needed cleft palate surgery. The rest were patients fromyears past who “just wanted to see me and say hello,” he said.”They came from Bogota, Colombia and the Amazon jungle.”

One woman traveled 16 hours by bus with her child, whom Clawsonhad operated on in 2005.

“When she was a baby, we did a bilateral cleft lip surgery. Shewas a poster girl for that type of surgery.”

The thankful families make up a kind of global community andallow Clawson and other volunteers to see thriving, attractiveyouths who had the surgery when they were babies.

Another byproduct of the cleft-palate surgeries is training.

Carolina Revello, a medical school graduate in Ambato who wantsto specialize in plastic surgery, assisted Clawson when he wasthere.

“In four or five years,” he said, “she’ll be able to do itherself.”

He said he has streamlined the procedure and simplified it fortextbooks. he wants to share the method he has devised, workingfrom the inside out, to attach the layers of muscle so that theresult will be a symmetrical array of the facial features. “We’reworking with the UC Davis Medical Center to teach (medical)residents how to do this.”

‘Joseph, I owe you’

Several big, heavily advertised charities do cleft palatesurgery. The problem affects children in Third World countries whowould otherwise have no remedies, the surgery is mostly successful,and it the before and after pictures are big motivators.

Among these giants, Clawson is a modest one-man band with asmall team of volunteers and a wide network of support.

Early on, he worked with Mercy Ships and twice wentindependently to Honduras. while Clawson worked in South America,he formed a foundation named “Operation Esperanza” and, as hebranched out to Africa, translated the name to Operation ofHope.

In 2010, Clawson formed a new foundation called the JP ClawsonMedical Missions Foundation.

He makes four trips a year, each lasting about a week. with asmall group of medical volunteers, he goes to Ecuador in January,Zambia in April, Ethiopia in October and Niger in December.

The rest of the time, he organizes, collects supplies and raisesmoney. he also goes fishing and spends time with his six grandkidsand wife Mary Ann, who used to go with him but now stays home dueto the rigors of international travel.

Team members volunteer their labor costs and pay their ownairfare. Cash and in-kind donations from medical companies,non-profit organizations and private donors cover supplies and allother costs.

Among Clawson’s backers are The World Childrens Fund out ofZurich, Switzerland, and the Ecuadorian Association of California,where member Jose Granda, professor of engineering at CaliforniaState University in Sacramento, donates generously.

North Ridge Community Church, a prosperous Phoenix congregation,has taken Clawson under its wing and this sent several membersalong as helpers.

Two companies, Ethicon and AmeriCares, together donate in excessof $20,000 worth of supplies a year, Clawson said. Ethicon suppliessutures, and for 10 years, Cia Marian at AmeriCares has arranged tosend anesthesia medicine, antibiotics, needles and syringes to theclinics.

“We’ve never met, but I send her blackberry jelly every year,”Clawson said.

In Ambato, he had the use of an entire private clinic for aweek, the surgeon said. The facility is owned by his friend of 15years, Dr. Juan Duran, who needed a surgical repair himself due toa 4-inch facial scar left from a childhood run-in with amachete.

Clawson did the surgery in 1996. Duran told him, “Joseph, I oweyou.”

Nothing is owed, Clawson told him, but his fellow doctor neverforgot the favor. Now he clears the deck every year and welcomesthe Longview doctor and his team of two anesthetists, two operatingroom nurses, two recovery room nurses and four secretaries andhelpers.

Their healing surgeries mean that thousands of people can nowflash a grin, gather cows for a dowry, or swept by gratitude, throwa kiss.

One Face at a Time: Retired Longview doc travels world to mend cleft palates