When he arrived in the area in the late 1980s, fresh from his training at Columbia University and Harvard, Dr Luis Cuadros was surprised by what he found: Families living without running water or heat, poverty, and sparse medical services. The overall societal neglect this community faced reflected in the crooked smiles and garbled speech of the many children and adults there who had been born with clefts — though they had the country's highest incidence of clefts per capita, treatment came from outside surgeons with results that left a generation of children with stunted smiles and incomprehensible speech.
Yet no sooner had Dr Cuadros begun his work here on the Native American reservations of northwestern New Mexico, USA, than he knew he had found his calling.
"The first two surgeries for cleft lip and palate are the most important things that will happen to a child in their life," he explained. "Many people don't understand that. They think anybody can do it, but really, not anybody can do it. Or should do it! If not done well, the patient's life will be vastly different. My goal has always been to make sure their surgeries were done well."
Dr Cuadros knew the first thing he needed to do to bring long-term, quality cleft care to the reservations was to earn the residents' trust. So, from his private office at the New Mexico Cleft Palate Center he and his wife, Kathleen, reached out to the local pediatricians in the Gallup and Shiprock communities on the Navajo Reservation and hired a member of the tribe to work in his office. He then formed a team of specialists in Albuquerque and, along with local specialists, set out to locate and treat as many children with clefts as they could. Together, they determined who required a first cleft surgery and who needed additional care to correct previous, poorly done surgeries.
It was hard going. Many of the people they were looking for didn't have addresses; at times the team relied on hand-drawn maps of the clan communities. Once he and his team found the families, they compiled a registry and systematically went about contacting them for surgery and other treatments, only to find that many had waited years for surgery. But in his care, they now had access to the best possible resources in the state.
In this work, Dr Cuadros was greatly inspired by Dr Paul Farmer’s model of bringing care to the people of Haiti suffering from tuberculosis.
The help was sorely needed. Though Medicaid typically covers the cost of cleft surgery, local stigmas and superstitions, plus lack of consistent treatment, communication, and follow-up had prevented many families from seeking care, even as their babies screamed from malnourishment. One of his first initiatives, therefore, was to form a “Rapid Response Team” to provide special feeding supplies and support to these babies and their families. He knew that delivering each the specialised care they needed would be an uphill battle, but he refused to become yet another outsider who left them behind. Thankfully, he soon found a partner who shared both his dedication and his passion — Smile Train.
Smile Train believes all people have the right to quality cleft care. That is why we are so proud to partner with cleft programmes across underserved communities in the United States as part of our vision of empowering local healthcare professionals everywhere on earth to provide high-quality cleft care to their neighbours in need.
For Dr Cuadros and the New Mexico Cleft Palate Center, our partnership began shortly after he started on the reservations when Smile Train called to ask how we could better support his work. The first thing he said he needed was help sending feeding kits to mal- and undernourished Navajo children with clefts. "We put together feeding kits and mailed them to the children who needed them, and Smile Train provided the funding for that," Dr Cuadros recalled. "That was wonderful; that was huge."
As Smile Train came to better understand Dr Cuadros' selfless, transformative work, the more eager we were to deepen our relationship with him. When he told us how big of an issue malnutrition was for disadvantaged children with clefts throughout New Mexico, even off the reservations, we helped him send feeding kits to every corner of the state. When he worried many of his patients could never afford to travel five hours to his hospital for cleft surgery, we covered the cost of their transportation.
Smile Train works according to a unique "teach a man to fish" model, where we give our local partners the resources they need to train other local providers in cleft care. For Dr Cuadros, this meant nurturing talent from within the Native American community itself, which is how he came to mentor Dr Joshuaa Allison-Burbank, a speech-language pathologist.
Allison-Burbank's life changed forever when Dr Cuadros hired him as a clinical research assistant while he was still an undergrad at the University of New Mexico. Immediately impressed with the young man's potential, Dr Cuadros taught him that providing specialised speech therapy for children with clefts was no less important than that the care come from someone the child feels comfortable speaking with.
Inspired by his mentor's example, Allison-Burbank went on to earn his master’s and a Ph.D. in speech-language pathology with a focus on public health and attend Smile Train trainings to better meet the unique speech needs of the Navajo cleft community.
"Dr Cuadros sparked my interest in public health when I was a student and I learned, from him, to always work on addressing systemic issues that impact access to quality healthcare," he said.
As the years went by, Dr Cuadros' persistence slowly began to pay off, and he transformed far more than children's faces.
"There were a lot of rumours about Navajo patients being unreliable when I started," Dr Cuadros remembered. "But what I found was once you gained their confidence, it makes all the difference. These parents wanted their kids to be as happy as any kids growing up anywhere else, so making that connection, crossing that cultural barrier, made all the difference, and that's how we overcame a lot of the superstition."
That confidence doesn't only build trust; it saves lives. Once, a 15-year-old girl who had previously received very low-quality surgeries on her cleft and on her nose came into his office. Her surgeries had not healed well, and she had known little but verbal abuse and stigma her whole life; Dr Cuadros was not surprised to learn she also had a history of suicidal intent. He redid all three surgeries, and a few weeks later, she returned to his office with a smile that outshone the desert sun. "She turned into just the happiest person, and she now has a boyfriend. I don't know if it was because of the surgery itself or the fact that we just showed how much we cared about her, but it goes to show how important it is that all children receive surgery to the highest standards," Dr Cuadros said.
But perhaps no family shows the true impact of Dr Cuadros' work — and Smile Train's partnership — better than the Sullivans. When Krista Sullivan had the ultrasound that showed her her son was going to be born with a cleft, "I felt doubt, anger, frustration, fear and even devastation," she said. "But my eyes were opened to a new ideal of true perfection when I held my son for the first time. And Dr Cuadros was a ray of hope to us the whole time. He changed our lives, just like he does for the whole community."
Inspired by his example, Sullivan wanted to do something to give every cleft-affected child and family in New Mexico a place where they could come together to love and support one another, where there would be no stigma, where children with clefts could form friendships with other kids who knew what they were going through and where parents could connect with others who understood. The result was Smile Fest, a yearly party for the entire New Mexico cleft community. At first, Sullivan ran the whole event herself, pouring her love into every tiny detail.
But when it grew to more than 400 people each year — including some families who travelled more than 200 miles to attend — she knew she could no longer run it to her standards without help and worried for its future. Dr Cuadros knew exactly who to call. From then on, Smile Train stepped in with a grant to cover expenses — and invited some very special guests along the way, including Miss Teen USA.
Thanks to Dr Cuadros, having a cleft in this region is no longer a sentence to a life of isolation and sickness. Today, when a Native family has a child with a cleft, they no longer expect that an inexperienced surgeon will fly in to use them for practise; they know they have a place where they will be treated with the dignity, respect, and world-class, long-term care they deserve.
In true "teach a man to fish" fashion, Dr Cuadros has further built a lasting infrastructure of care, training a new generation of passionate and highly skilled professionals, like Allison-Burbank, across many disciplines of cleft care.
It is a tribute to the strong foundation he built over the last 30+ years that Dr Cuadros recently announced his retirement from cleft surgery. He is leaving the institution he built in the capable hands of two surgeons he trained, Drs Erica Bennett and Tania Kraai, who will continue his work with Smile Train to give every child with a cleft in New Mexico the care they deserve.
Though his practise is in good hands, he will be truly irreplaceable to all who knew him.
Shannon Lambert, Smile Train's Vice President and Regional Director for the Americas and Europe said:
It was immediately obvious to me what a special doctor Dr Cuadros is. From the first moment I met him, I was astounded by the highly personal care he and his team offered to every patient. They always took the time to discuss treatment plans with each family, who in turn demonstrated their appreciation for the team’s ongoing support by bringing gifts of fruit or traditional handmade goods; it was an honour to witness these interactions. Dr Cuadros is not only an experienced surgeon who produces phenomenal results, he is also a deeply sensitive and empathetic man who created lasting bonds with his patients and their families. Smile Train is deeply grateful for our years of partnership with Dr Cuadros, and we look forward to continuing to support his legacy through those he has mentored.
Dr Cuadros, you have changed many lives. You made a difference across all New Mexico tribal communities. Your passion to serve has always been contagious, and I hope to be as passionate as you throughout my career. You helped mould me into the clinician and researcher that I am today. Thank you. -Dr Joshuaa Allison-Burbank
Thank you, Dr Cuadros, for your many years of service, love, and dedication to our family and our New Mexico cleft community. Thank you for changing the world's perception of what a plastic surgeon does and for putting a smile on my son's face. Your career has inspired cleft-affected families to live each day to its fullest and to plant seeds of love, joy, hope, and smiles wherever their road travels. We love you and are so excited for what this next journey has in store for you! -Krista Sullivan
"I'm proud that I was able to make a change when help was needed. I had hoped to do more, but I'm very proud that I was able to make these kids better. I think they remember me, and I remember them," Dr Cuadros said.
"Thank you, Smile Train, for recognising the work we are doing. To my colleagues around the world, I say: Find the kids and heal them as best as you can. And accept that you can bring the highest level of care to the most remote, difficult areas. It is possible."
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