SMILING THROUGH: (Opposite page) Sebastian in 2020; (Above) Sebastian with mother Diana in 2008, and with Peri-Op Nurse and caregiver Jeanne Paolilli in 2020.

cleft specialists – the kind of care that is standard in developed the United States. GSF firmly believes that all patients deserve the best quality cleft care regardless of geographic, religious, or socioeconomic factors.

Ever since that first meeting, Sebastian's family has been part of the GSF family, and they have expressed their appreciation to the team for providing life-changing cleft care for their son. Sebastian has indeed grown up with GSF. He and his family have returned to the outreach mission site every year to see the team without fail, bringing Sebastian's two younger sisters, born in 2011 and 2013. Javier has spoken to the team to share his appreciation and experience. They also keep in touch by email and send photos of all three children at birthdays and other important life milestones.

Relationships such as the one between Sebastian's family and GSF make it easy to see why volunteers are so dedicated to GSF's mission. Treating cleft involves a range of care throughout a patient's childhood, so GSF returns to the same locations every year to support its patients. This continuity is part of what makes the GSF family so special and why they have maintained relationships with patients and families longer than any other NGO doing similar work. Dr. Hamdan and other founding members have been involved in outreach cleft care in the country for more than 34 years.

Even as GSF's work in Ecuador has expanded, the spirit of connectedness and bonding among team members, volunteers, and patients has remained strong. As more and more patients learned about GSF and the free comprehensive cleft care that their volunteers help provide, GSF decided to open a Cleft Center to provide year-round care for patients. The Center is located at Hospital León Becerra, a facility dedicated to pediatric care for children and families of low socioeconomic status. In 2012, GSF established Fundación Global Smile-Ecuador to run the Cleft Center and advance the GSF vision for sustainable cleft care in the country.

Many former GSF patients have become volunteers with Fundación Global Smile-Ecuador and provide critical support such as patient communications, public relations, and logistical help during outreach programs. One volunteer in particular, Diego De La S, became a mentor and friend to Sebastian.

Diego and Sebastian met in 2016. Diego had undergone his first surgery as an infant in 1996 with some of GSF's founding members and could talk to young patients and their families about his own experience. At age 20, Diego was nearing the end of his cleft care treatment. He met Javier and Sebastian and formed an instant friendship with the family.