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The Cost of a Smile

Providing life-changing medical care in rural Zambia

by Mark Roth

This Sunday, I saw Charity in church. Charity is an eight-year-old girl born with a cleft palate and cleft lip. I first met her two years ago when she was six. Her cleft palate and cleft lip had been repaired when she was an infant, but I noticed she always seemed to have a runny nose. (Yes, this is how we surgeons are distracted during church.)

I got a good look at her a couple months ago, and I noticed a defect in her nose above her previous repair. A tooth had grown up into her left nostril and created a draining sinus.

I sent a picture to a plastic surgeon in Lusaka that was coming to Macha Mission Hospital for an outreach in October. Charity was scheduled for a revision surgery, and the plastic surgeon was able to remove the tooth and revise the previous repair.

It was good to see Charity singing and dancing in church this week as the choir led us in worship.

The revision surgery was a simple two hour procedure with a permanent result which forever will make a huge difference in a child’s life. But what does it cost to make this kind of a difference?

  • Three trips by airplane from Lusaka to Macha for the only plastic surgeon in the country: one to repair the lip, one to repair the palate as an infant, and this last trip for a revision
  • Keeping a dirt airstrip in the bush functioning after the rainy season requires one week of labor by a dozen men on several occasions and $1,000 U.S. dollars per year to license the airstrip
  • Keeping the hospital stocked with the needed medications
  • Getting running water to the wards where the child received care
  • Renovating and regularly maintaining all the facilities

Now think of the 150 other patients being admitted to the hospital or the 600 patients being seen in the outpatient department every week, each with a unique story of their own. All being attended to in a remote part of Zambia where they otherwise would not receive care. That is a lot of moving parts and a lot of money that goes into taking care of each of these patients.

Some days it’s hard to see progress amid the struggles we are facing, and we wonder why we are here. This past week was especially hard. I gave the anesthesia from 12-3 am so one of our doctors could deliver two healthy baby girls. On Saturday, I was woken up at 5 am to do an emergency bowel obstruction surgery. All three patients are doing fine, and that is a blessing to see. Amid the frequent power outages and the heat and humidity of December, I was tired and frustrated by the time Sunday rolled around, wondering is it all worth it.

But Charity’s smile greeting me across the aisle in church reminded me that, yes, it is worth it.

This article was adapted from Mark and Maggie Roth’s December 2022 Newsletter. Learn more about the Roth’s ministry. Learn more about Macha Mission Hospital.

Some names have been changed to protect privacy.

Mark Roth is the general surgeon and hospital superintendent at Macha Mission Hospital in Zambia. He and his wife Maggie have served there as missionaries since 2019.

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