Joseph walks in his flip-flops behind his father and stepmother through their neighborhood in San Remigio on the Philippine island of Cebu.
The 6-year-old carries a big plastic bag to collect recyclables and scrap metal, asking neighbors to sell him empty plastic bottles, pieces of metal, cans and glass jars.
The family gathers anything that might be worth a few more pesos before they sell it on to “the boss,” who then sells those items to turn a profit.
“The boss” pays Joseph’s father, Julito, a fixed price: 3 pesos per kilogram of cans, 2 pesos per kilogram of glass bottles and only 1 peso per kilogram of plastics. On a good day, the family of five receives 100 pesos, which totals out to $2 at the most.
Joseph is the family’s youngest child and the only one born with a cleft lip and cleft palate.
His mother, who died several years ago due to heart disease, also collected scrap metal and recyclables.
While there are still many misconceptions surrounding the cause of cleft conditions, which can be environmental or hereditary, Julito believes his son’s cleft condition may have been caused by hours of bumpy motorbike rides Joseph’s mother endured while she was pregnant.
Joseph doesn’t attend school.
“He tried once, but came home crying. They call him ‘bungi,’” a derogatory word for cleft, Julito explains.
Sometimes the neighborhood children throw stones at him — the same treatment they give the stray dogs in the area.
“Then, he fights back and comes home angry, crying and upset,” Julito said.
For unknown reasons, Southeast Asia, including the Philippines, is a region where cleft conditions are more common than the rest of the world — around one in 500 children are born with cleft lip and cleft palate.
The global average is closer to one in 750 births. Even though there are skilled plastic surgeons in the country — some who volunteer for Operation Smile — most families cannot afford the cost of surgery.
Joseph’s family is no exception.
Even the bus fare to the hospitals of Cebu City is too costly for some families.
However, when Julito learned about Operation Smile and the free surgeries it provides to children like Joseph, he became hopeful for his son’s future.
After a local nongovernmental organization, Abounding In Love, provided Julito and his family with free transportation and lodging to an upcoming Operation Smile medical program, Joseph was closer than he’d ever been to receiving a new smile.
Following their bus trip to the program, Julito gazed around at the scene before him, surprised to see how many other children had the same condition as Joseph. While relieved to learn that his son wasn’t the only child to have a cleft, Julito soon became worried.
“I have mixed feelings,” he said. “I’m happy Joseph is not alone, but also afraid he will not qualify for surgery since there are so many in need of help.”
Amid the bustling atmosphere of the program, Joseph tries to make sense of the situation.
He keeps asking his father why they are there, and when Julito explains, Joseph looks at him with surprise: “So they are going to fix my lip now?”
After a passing a comprehensive health evaluation, Joseph became one of many children who were selected to receive surgery.
The day after his cleft lip is repaired, Joseph stares at himself in the mirror for a long time.
With love and hope for his son, Julito won’t give up until Joseph receives cleft palate surgery.
A year has passed since Joseph’s surgery.
While Julito still struggles to provide for his family, life has drastically changed for Joseph since arriving home after the program.
“When we were discharged from the hospital and arrived at home, all our neighbors were very excited to see Joseph and told him he looked so handsome,” Julito said. “When we came to our house, he got a mirror and looked at his face and said, ‘Oh, I’m very handsome now!’”
But Joseph’s confidence isn’t the only bright spot in life after surgery.
Joseph has returned to school, eager to learn and become friends with those who once bullied and teased him.
“The first day at school, Joseph prepared himself carefully,” Julito explains. “He washed himself and prepared his school bag and dressed in his school uniform. When we got to the classroom, he asked if I was going to stay there with him. I said, ‘Yes, of course, I’m going to wait for you,’ but my son then explained that there was no need; he could manage to go home on his own.
“He’s not shy anymore. Unlike before, he likes going outdoors. And even if children still tease him sometimes, he doesn’t get mad at them — he knows his face is different now. Hopefully, the surgeries will bring him a different life than mine. He has more confidence now, and maybe this will give him a chance to get a proper job in the future.”
