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136 images Created 10 May 2018

HAITI (Smile Train)

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  • CAPTION: Before infants are operated on, it is very important to assess their health and general wellbeing. Over the many operations that Smile Train has facilitated, it has been observed that children often arrive in a state of malnourishment. One of the most common reasons for this is an inability to suck milk from the mother's breast due to the cleft. Milk might also enter the airway as well, and breastfeeding is difficult and risky under such circumstances. Often, the parents of such children have limited means, and are unable to find or afford alternative ways of feeding them. During the days leading up to the operation on such a child, appropriate medication and a nutritious diet is funded by Smile Train, and the child is kept under close observation by a paediatrician. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Lyse Giguére (left) and Jean Roude Nailine (right).
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  • CAPTION: Smile Train publishes pamphlets and other literature, which is used by local doctors, nurses and Smile Train representatives to educate parents on the importance of nutrition and general wellbeing, ensuring that their children will be ready for surgery as well as subsequent recovery. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Jean Louissuis (left) and Jacqueline Anne Marie (right).
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  • CAPTION: Smile Train representative Jacqueline uses a standard form to collect all the required information for a patient and his family. Smile Train representatives like Jacqueline play an instrumental role in finding children and adults born with clefts, convincing them or their parents to register for the operation and educating them on the precautions and care required before and after surgery. Parents are given literature to understand how to feed and take care of babies in the run up to surgery. Then, when they are ready, the medical history and other details are taken and all the information collected, charts and images are uploaded to Smile Train's portal. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Jacqueline Anne Marie (left) and Jean Lucius (right).
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  • CAPTION: Doctors and Smile Train representatives need to ensure they assess the condition of a child correctly before deciding on whether surgery should be recommended. At times, parents desperate for their children to receive free surgery bring them along even when they have non-cleft conditions. In this case, the child has an infection that has weakened the muscles in his face. After performing an examination, the doctors inform his mother that the muscle strength will gradually improve, and that he does not require cleft surgery. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Dr Emile Damas (top left), Dr Roger Paul Delorme (second from top left), Dr Louise Caouette-Laberge (centre), unknown (bottom right), unknown (child being examined) and Suzelle Touissant (right).
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  • CAPTION: With help from Smile Train, local medical practitioners like Dr Lafontant (right) are able to learn the required procedures and become more skilled at managing complex cleft operations independently. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Micheline Pierre, Rose Dacheka Jean and Charles Lafontant.
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  • CAPTION: In Haiti, operations on unilateral clefts have been led by local doctors for some time now. For bilateral cleft surgery, which is more complex, Smile Train has been providing for skilled doctors from other countries to lead the operations. Local doctors assist in these operations and learn the techniques along the way. Transfer of knowledge and expertise in this way is an important outcome for Smile Train as it seeks to ensure long-term impact. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: N/A.
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  • CAPTION: Smile Train representatives put up posters to spread awareness on the surgery that can be performed. As patients visit the hospital and see these, they pass on the news to people they know, helping to bring in more cases and referrals. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Jacqueline Anne Marie (left) and Denis Mehu (right).
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  • CAPTION: For the doctors performing these operations, the greatest satisfaction comes from observing their patients as they look at themselves in the mirror afterwards. Dieusibon was operated on today. Glue has been used to hold the cuts in his lips together, and the result is one the surgeons feel proud of. As Dieusibon stares into the mirror, he does not smile; he is afraid that smiling will break the cuts open. However, there is happiness in his eyes, and he will soon overcome the fear of moving his lips. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Dieusibon Pierre.
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  • CAPTION: Like the doctors, local nurses also get to shadow more experienced nurses from Canada during and after the operations performed this week. The two nurses pictured here are responsible for supervising patients during their initial recovery. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Michelle Pierre, Junie Nicolas and Dieusibon Pierre.
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  • CAPTION: The Canadian doctors and nurses make a point of fostering a friendly atmosphere, as they are keen not to be perceived as having come to impose their ideas on them. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Charles Lafontant, Dr Emile Damas and Roger Paul Delorme.
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  • CAPTION: Emmanuel, who has already undergone cleft repair surgery in the past, has come for consultation. His lip retracted after the operation, so he now needs a revision. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Emmanuel Fenélus (left) and Stanley Loriston (right).
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  • CAPTION: This is the moment all mothers of cleft babies eagerly wait for! When mothers first get to see their babies after surgery, they are often overwhelmed. It is a moment of joy, of happiness, of pride. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Michelle Pierre, Anaira Jaques (mother) and Orelus Peterly (child).
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  • CAPTION: Dr Dorsainvil, the Head Anaesthesiologist at Hôpital Universitaire Justinien, prepares to start work with Emmanuel, who has come for a revision surgery. She is assisted by Dr Loriston, who is learning various skills from her. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Dr Martine Dorsainvil, Emmanuel Fenélus and Dr Stanley Loriston.
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  • CAPTION: Anaesthesiologist Dr Dorsainvil sets up an intravenous device for administering fluids and medication during the surgery. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Dr Martine Dorsainvil.
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  • CAPTION: Patients' blood pressure and blood oxygen levels are monitored closely during operations. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Stanley Loriston (standing) and Emmanuel Fenélus (patient).
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  • CAPTION: The oximeter, provided by Smile Train, monitors blood oxygen levels of a patient during the operation, and is a critical instrument for such surgeries. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Emmanuel Fenélus (patient).
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  • CAPTION: After anaesthesia puts the patient to sleep, a tracheal tube is installed to ensure the he keeps breathing during the operation. While this is being done, the freshly sterilised surgical instruments are laid out for the surgeon's convenience. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: N/A.
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  • CAPTION: 'Death or glory', reads this patient's shoes. Thanks to Smile Train, the result will be 'glory' about one hour from now. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: N/A.
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  • CAPTION: There is a chance that as patients' sleep after anaesthesia has been administered, their eyes will remain slightly open. They are therefore covered to ensure that nothing can get into them. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Emmanuel Fenélus.
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  • CAPTION: Dr Caouette-Laberge from Montreal discusses various possible techniques for cleft repair with the Haitian team and helps them to identify the one that will best suit the patient. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Charles Lafontant (dark blue) and Dr Louise Caouette-Laberge (lead surgeon, centre).
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  • CAPTION: In this revision operation, the doctors are closing Emmanuel's fistula. This is a hole that lies between the nose and the gum, and it needs to be repaired. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Emmanuel Fenélus (patient) and Dr Louise Caouette-Laberge (surgeon, right).
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  • CAPTION: Anaesthesiologist Dr Dorsainvil ventilates the patient using a plastic balloon. She is also responsible for noting his blood pressure, heart rate and oxygen levels during the operation, so she ventilates in parallel. This must be done throughout the entire surgical procedure. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Dr Martine Dorsainvil.
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  • CAPTION: The surgeons remove an old scar. Emannuel underwent a lip cleft repair operation in the past, which did not yield optimal results. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Emmanuel Fenélus (patient) and Dr Louise Caouette-Laberge (surgeon, right).
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  • CAPTION: During these operations, one can sense the team spirit building among the doctors as they collaborate together. The more experienced doctors from Montreal take great pride in teaching and coaching their Haitian colleagues to the best of their ability. The Canadian team came prepared for any eventuality, even power failures, for which they brought their own portable head torches. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Dr Louise Caouette-Laberge (left) and Dr Emile Damas (right).
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  • CAPTION: Saintelise has dreams like any other 14-year-old girl does. She wants to grow up to be a beautiful woman, get married and cultivate and sell carrots, beets, radishes and lettuces. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Saintelise Saint Pierre.
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  • CAPTION: Born fourth among 11 siblings, Saintelise has never been to school. Subjected to ridicule by other children, including her younger siblings, she has spent most of her life cocooned inside her house. That was until, one day, missionaries associated with a church in her area met her during a community home visit. They realised that Saintelise needed immediate help. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Saintelise Saint Pierre.
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  • CAPTION: As Judeleine and Rutchel, nurses at Hôpital Universitaire Justinien, admire baby Nashka, her mother Phanord is a happy woman. As she gazes at her child and considers what lies ahead, she beams with hope. Nashka was born with a cleft lip, a deformity that makes it difficult for both her and her family to find acceptance in society. For this reason, Phanord has travelled the hour and a half from her home in Ouanamithe to the hospital to get Nashka operated on. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Judeleine Florvil, Phanord Philomène, Nashka Joseph and Rutchel Pierre-Paul.
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  • CAPTION: Nashka is Phanord's second child. ''I was not scared", she says, recalling her reaction when Nashka was born. "I was just surprised. No one else in the family had been born with this condition". LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Judeleine Florvil, Phanord Philomène, Nashka Joseph and Rutchel Pierre-Paul.
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  • CAPTION: "The doctors told me that surgery could correct Nashka's condition", Phanord recounts. "They referred me to Smile Train, and I was given good counselling on post-natal care". Genard, her husband, works as a mason, while Phanord herself sells cookies and candies for a living. She adds, "without assistance from Smile Train, my husband and I could not have afforded the surgery because we have very limited means". LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Judeleine Florvil, Phanord Philomène, Nashka Joseph and Rutchel Pierre-Paul.
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  • CAPTION: Phanord feels optimistic that surgery will ensure a bright future for Nashka. "I do not want my child to face any kind of discrimination," she affirms, "and that's why I've brought her here to be operated on". LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Phanord Philomène (mother) and Nashka Joseph (baby).
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  • CAPTION: As Phanord searches for the room she needs to report to at the hospital, she is feeling positive. "I know that Nashka's mouth will soon become normal", she thinks. Though she is a little anxious, she is also excited. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Phanord Philomène (mother) and Nashka Joseph (baby).
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  • CAPTION: Before an operation can be approved, Phanord must be interviewed by doctors to check Nashka's age, her feeding habits, her weight and her general wellbeing. The baby will then be examined by the surgeons and anaesthesiologists. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Phanord Philomène (mother) and Nashka Joseph (baby).
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  • CAPTION: It is essential for Phanord to understand the care that Nashka will require following the operation. In particular, she needs to ensure that her child receives the medication she'll need to stave off pain and infection. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Phanord Philomène (mother) and Nashka Joseph (baby).
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  • CAPTION: As Phanord waits for someone to collect Nashka for her operation, she thinks about how she feels her prayers are being answered. "When my relatives see the results of her operation, they are going to be surprised!", she says. "Some of them have told me that after the success of the surgery, it will be proved that God really does exist". LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Phanord Philomène (mother), Nashka Joseph (baby), unknown, unknown and unknown.
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  • CAPTION: Phanord waits with Nashka in the ward before the surgery begins. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Phanord Philomène (mother) and Nashka Joseph (baby).
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  • CAPTION: Seeing other children emerging from surgery, Phanord has observed that they now look 'normal'. This has buoyed her spirits. "Today, Nashka's operation will fix her cleft", she declares. She knows that the palate will then have to be operated on around six months from now, however. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Phanord Philomène (mother) and Nashka Joseph (baby).
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  • CAPTION: Dr Damas talks Phanord through what will happen during the operation. In addition to carrying out surgical procedures, he is also responsible for monitoring patients' recovery and, in Nashka's case, he will determine the most appropriate date for operating on her cleft palate. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Dr Emile Damas, Phanord Philomène and Nashka Joseph.
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  • CAPTION: Likenson, a missionary, has known Saintelise for three years now. When he was told about what Smile Train could do for her, he resolved to arrange for her to have surgery as soon as possible. The final decision on whether she'd be operated on was, however, Saintelise's. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Likenson Capré (left) and Saintelise Saint Pierre (right).
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  • CAPTION: Saintelise felt she needed to think carefully about the prospect of surgery because it was a slightly scary idea for her, so she assured Likenson that she would call him once she'd thought it through. When she'd made up her mind, she told him to his delight that she had decided to go ahead with the operation. "I once had a dream in which I woke up and everything had been fixed and corrected", she remembers. "Now, there was a possibility that my dream would come true". She is full of hope that after surgery, people will no longer laugh at her. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Likenson Capré (left) and Saintelise Saint Pierre (right).
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  • CAPTION: It is the day of the operation, and Likenson has accompanied Saintelise to the hospital. "I was not prepared to come, but I realised that she had no one to accompany her", he says. "Her mother had to take care of another child who was sick and her father was showing no interest and made us wait for three hours. Finally, I asked her elder brother to come along with us, though at first he was unaware of what the operation was even about". LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Likenson Capré (left) and Saintelise Saint Pierre (right).
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  • CAPTION: Hôpital Universitaire Justinien anaesthesiologist Dr Dorsainvil enters Saintelise's details onto a record sheet before her surgery. She has to ensure that all the required tests have been completed before the operation, including haemoglobin count, weight, HIV status, etc. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Saintelise Saint Pierre, Dr Martine Dorsainvil and Likenson Capré.
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  • CAPTION: Dr Dorsainvil chats with Likenson and Saintelise before the operation and lightens up the mood. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Dr Martine Dorsainvil, Saintelise Saint Pierre and Likenson Capré.
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  • CAPTION: Likenson enquires about the operation procedures and subsequent care during the recovery process. He is slightly apprehensive; he fears that if the operation doesn't go well, Saintelise may have an even tougher time within her community. Thankfully, Dr Dorsainvil has no difficulty in assuring him that the surgery will be a success. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Dr Martine Dorsainvil, Saintelise Saint Pierre and Likenson Capré.
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  • CAPTION: It is important that as many people as possible know about the work being done with Smile Train's support at Hôpital Universitaire Justinien. Publicity campaigns emphasise how the surgery is free to beneficiaries, as well as how assistance can be given with the cost of medicines and travel. This interview, being conducted in the Hospital Director's office, will be telecast on Haitian national television. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Michel Nakum, Emmanuel La Couronne, Charles Lafontant, Pamela Sheeran and Jeangeto Dube.
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  • CAPTION: During operations, fluids are administered intravenously. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: N/A.
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  • CAPTION: Having been prepped for surgery, Saintelise is feeling rather nervous about what's to follow. Dr Dorsainvil and the nurses reassure her that she need not be worried, she's in good hands. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Saintelise Saint Pierre.
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  • CAPTION: In preparation for Saintelise's operation, probes are attached to her. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Saintelise Saint Pierre (patient) and Stanley Loriston (standing).
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  • CAPTION: Before any operation, it is essential that all possible checks have been done to eliminate the chance of human error. Presence of the necessary instruments, antibiotics, etc. is verified. After the surgery, it is also important to check whether the operation went according to plan and whether any complication needs to be taken care of. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Saintelise Saint Pierre (patient), Dr Beulah Alexandre (standing, centre) and Lyse Giguére (standing, right).
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  • CAPTION: The time has come for anaesthesia to be administered to Saintelise. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Saintelise Saint Pierre (patient) and Stanley Loriston (standing, right).
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  • CAPTION: Anaesthesiologist Dr Loriston inserts an intravenous (IV) tube into Saintelise's vein, which hurts a little at first. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Stanley Loriston.
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  • CAPTION: Dr Dorsainvil asks Saintelise not to worry, and assures her that although putting the IV tube in place was slightly painful, the rest of the operation will not hurt at all because she'll be sound asleep. This reassurance makes her feel a whole lot better. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Saintelise Saint Pierre (patient) and Dr Martine Dorsainvil (standing).
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  • CAPTION: Dr Dorsainvil explains to Saintelise that the IV tube has been inserted into her vein so as to give her fluids and medication during the time that she'll be asleep. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Saintelise Saint Pierre (patient) and Dr Martine Dorsainvil (standing).
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  • CAPTION: Dr Dorsainvil puts her hand gently on Saintelise's forehead, caressing it softly to calm the young girl down. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Saintelise Saint Pierre (patient) and Dr Martine Dorsainvil (standing).
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  • CAPTION: Anaesthesiologist Dr Alexandre fits an oxygen mask over Saintelise's mouth. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Saintelise Saint Pierre (patient) and Dr Beulah Alexandre (standing).
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  • CAPTION: Anaesthesiologist Dr Alexandre fits an oxygen mask over Saintelise's mouth under the watchful eyes of the nurses. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Standing, from left to right: Dr Andrelle Suy, Dr Beulah Alexandre and Dr Tracy Louis-Jacques; Saintelise Saint Pierre (patient).
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  • CAPTION: Presence of each medicine at the required dosage is verified before surgery commences. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Standing, from left to right: Dr Beulah Alexandre, Dr Andrelle Suy, Dr Tracy Louis-Jacques and Dr Stanley Loriston; Saintelise Saint Pierre (patient).
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  • CAPTION: Surgery requires a great deal of coordination and understanding among the team. It is necessary for them to be speedy, precise and clear in their communication. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Standing, from left to right: Dr Beulah Alexandre, Dr Andrelle Suy, Dr Tracy Louis-Jacques and Dr Stanley Loriston; Saintelise Saint Pierre (patient).
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  • CAPTION: During an operation, it is necessary for the team to be speedy, precise and clear in their communication. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Standing, from left to right: Standing, from left to right: Dr Martine Dorsainvil, Dr Beulah Alexandre, Dr Andrelle Suy, Dr Tracy Louis-Jacques and Dr Stanley Loriston; Saintelise Saint Pierre (patient).
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  • CAPTION: After checking the airway down Saintelise's throat, anaesthesiologist Dr Alexandre inserts a tube so that she'll be able to breath. This is required when operating on the mouth, as it can be dangerous for a patient to breath through the mouth during the operation. This procedure is called 'intubation'. It controls the airway and ensures an adequate supply of oxygen. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Standing: Dr Beulah Alexandre (left) and Dr Tracy Louis-Jacques (right); Saintelise Saint Pierre (patient).
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  • CAPTION: The doctors need to ensure that the tube is in precisely the right place. They test by blowing air into the tube, and then monitor the ventilation of the chest and the lungs. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Standing: Dr Beulah Alexandre (left) and Dr Tracy Louis-Jacques (right); Saintelise Saint Pierre (patient).
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  • CAPTION: After the tube is fixed into place, it is taped and plugged to ensure it cannot fall out during the operation. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Standing, from left to right: Dr Beulah Alexandre, Dr Andrelle Suy and Dr Stanley Loriston; Saintelise Saint Pierre (patient).
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  • CAPTION: Nashka's operation is now underway. Her cleft lip is being repaired; in addition to this, because her nose appears sunken on the side of the cleft, the surgeons will fix this such that it will appear more rounded. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Nashka Joseph.
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  • CAPTION: The doctors mark the points on Saintelise's lips where they intend to make incisions. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Saintelise Saint Pierre.
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  • CAPTION: After Dr Lafontant marks where he expects to make incisions, Dr Delorme from Montreal erases these markings and makes the marks that will ultimately be followed. On-the-job training helps the Haitian doctors learn how to make precise markings. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Standing, from left to right: Dr Roger Paul Delorme, Dr Emile Dumas, Dr Stanley Loriston and Dr Jose Junior Luis; Saintelise Saint Pierre (patient).
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  • CAPTION: Jean Yves has been living with a cleft palate for the last sixteen years. "I was called 'little nose' by other children", he recalls with sadness. "I felt angry when I was younger, but my friends stood up for me", he continues. "I had eight close friends who would support me. My best friend was called Bruce Lee, named after the famous action star". With a smile, he remembers how they would play soccer together. It's his grandmother Louise's hope that he'll grow up to be a policeman, and she understands that he'll need to learn to speak much clearer if he's to pursue such a profession. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Louise Marie Bolivar (left) and Jean Yves Preval (right).
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  • CAPTION: Jean Yves was first operated on when he was less than a year old, so that his cleft lip could be corrected. However, it was not possible for him to undergo a second operation in order to fix his cleft palate when he needed it. Louise feels that the delay in surgery has aggravated his condition. Jean Yves has considerable difficulty speaking due to the gap in the roof of his mouth. As they wait with other patients to be called for the operation to begin, Louise says, "I am ready for the doctors and for the Lord to conduct this surgery and fix everything in his mouth. I believe everything will change; in fact, I KNOW his mouth is going to change. The Lord and the doctors have this power”. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Rose-Marie Franciné, Mercitane Franciné, Jean Yves Preval and Louise Marie Bolivar.
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  • CAPTION: The operation has been successful! Nashka has been taken to the recovery room. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Nashka Joseph.
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  • CAPTION: Though Nashka's mouth will swell following the operation, this is not a cause of worry as it's actually a part of the healing process. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Nashka Joseph.
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  • CAPTION: After the operation, Phanord spoke to her mother and brother on the phone. "I told them that everything is alright and that you will be surprised when the baby is back", she says. "I am so excited about showing my baby to everyone!" LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Phanord Philomène (mother) and Nashka Joseph (baby).
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  • CAPTION: Phanord plans to celebrate her daughter's cleft correction in her church, and says that she'll testify in front of her congregation as to how great the Lord is. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Phanord Philomène (mother) and Nashka Joseph (baby).
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  • CAPTION: Saintelise is aged 14 as she undergoes surgery. These operations are less complex when done on babies and young children. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Standing, from left to right: Dr Roger Paul Delorme, Suzelle Touissant, Dr Emile Dumas and Stanley Loriston; Saintelise Saint Pierre (patient).
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  • CAPTION: Owing to the mature state of her adolescent lips, a greater loss of blood is to be expected during Saintelise's surgery. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Standing: Suzelle Touissant (left) and Dr Emile Dumas (right); Saintelise Saint Pierre (patient).
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  • CAPTION: When Jean Yves first visited Hôpital Universitaire Justinien, it was for speech therapy to improve the clarity of his speech. While here, a doctor told him about Smile Train, and assured him that surgery was available to fix the gap in his palate. Needless to say, he was thrilled. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Jean Yves Preval (patient) and Dr Louise Caouette-Laberge (surgeon).
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  • CAPTION: Dr Caouette-Laberge from Montreal is leading Jean Yves's operation, while Dr Damas from Haiti is here to assist and learn from Dr Caouette-Laberge. The main intention for the Canadian team's visit is that they will help the Haitian medics skill up for future cleft palate and bilateral cleft lip operations in the future. Smile Train helps local doctors to gain exposure to new surgical techniques and build their expertise. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Dr Louise Caouette-Laberge (surgeon, left), Dr Emile Dumas (surgeon, right) and Jean Yves Preval (patient).
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  • CAPTION: The surgeons begin suturing. There is no need to remove the protruding front tooth, as the pressure from the sewn up lip will pull this into place over time. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Saintelise Saint Pierre (patient).
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  • CAPTION: Dr Damas learns from Canadian Dr Caouette-Laberge's experience, so that he'll become familiar with the procedures for repairing cleft palates and bilateral cleft lips in the future. Smile Train helps local doctors to gain exposure to new surgical techniques and build their expertise. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Standing, from left to right: Dr Jose Junior Luis, Dr Louise Caouette-Laberge and Dr Emile Dumas; Jean Yves Preval (patient).
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  • CAPTION: Besides Dr Damas, a few medical students are also present in the operating theatre to observe and learn the procedures. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: N/A.
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  • CAPTION: A clamp is affixed to keep the mouth open during this complex operation. Jean Yves also has a fistula, which needs to be fixed, too. Outside the operating theatre, Louise waits for the operation to get over. A visitor observes that she looks nervous, and helps her to become calm and feel more positive. Their conversation has a soothing effect on Louise's frayed nerves. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Jean Yves Preval (patient) and Dr Louise Caouette-Laberge (surgeon).
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  • CAPTION: The operation is over, and it's time to start tidying up and then wake Saintelise from her anaesthesia-induced slumber. The first thing that she remembers following the operation is a little pain that she experienced on both sides of her upper lip. "At the same time, I saw a lot of people around me", she says, "though I can't remember them clearly. I recognised Likenson, and it was really good to see him". LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Saintelise Saint Pierre.
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  • CAPTION: Gerlanda first heard about Smile Train from the doctors at Hôpital Universitaire Justinien. She had been admitted here for the delivery of her daughter Georgeline, who was born with a bilateral cleft lip. Gerlanda recalls that the doctors assured her that there were specialist surgeons who could operate on her child and repair the cleft. LOCATION: Route Nationale 2, Fougerolle, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Brunel Florvil, Georgeline Florvil and Gerlanda Donatien.
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  • CAPTION: Gerlanda lives in Northwest Haiti with her partner, Brunel. They have been together for five years, and Georgeline is their second child. LOCATION: Route Nationale 2, Fougerolle, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Brunel Florvil, Georgeline Florvil and Gerlanda Donatien.
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  • CAPTION: Brunel and Gerlanda are currently without jobs, and stay with Gerlanda's parents. Considering their limited means, they were worried about how much the operation would cost them. LOCATION: Route Nationale 2, Fougerolle, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Brunel Florvil, Georgeline Florvil and Gerlanda Donatien.
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  • CAPTION: "I had heard about a woman who'd paid 60,000 gourdes [about US$ 1,250] for her son's surgery", says Gerlanda. "I was worried about whether we would ever have enough money for surgery; we’d not even been able to muster 1,500 gourdes for an ultrasound during my pregnancy". LOCATION: Route Nationale 2, Fougerolle, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Gerlanda Donatien (left) and Georgeline Florvil (right).
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  • CAPTION: When Gerlanda finally held her baby after her delivery, she says that did not really feel that anything was wrong. The doctors' counselling had prepared her to accept her daughter's deformity. LOCATION: Route Nationale 2, Fougerolle, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Gerlanda Donatien (left) and Georgeline Florvil (right).
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  • CAPTION: Brunel and Gerlanda have been thoroughly enjoying parenthood so far, and their acceptance of how Georgeline was born different has made this considerably easier. Thanks to Smile Train, the couple have now been able to secure free surgery to repair their beloved daughter's cleft lip. LOCATION: Route Nationale 2, Fougerolle, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Brunel Florvil (father), Georgeline Florvil (child) and Gerlanda Donatien (mother).
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  • CAPTION: Brunel says that when they first tried to book an operation for their daughter, the doctors at Hôpital Universitaire Justinien told them that surgery would have to wait for three months, as Georgeline was anaemic at that time. He adds, "we received financial assistance to buy medicines for her anaemia, and we were given help with ensuring a nutritious diet for our child". LOCATION: Route Nationale 2, Fougerolle, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Georgeline Florvil (child), Brunel Florvil (father) and Gerlanda Donatien (mother).
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  • CAPTION: Georgeline could eat quite a few things and also drink and gargle without difficulty. However, there were some foods such as rice that were difficult for her to chew, owing to the shape of her mouth. LOCATION: Route Nationale 2, Fougerolle, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Georgeline Florvil (child) and Brunel Florvil (father).
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  • CAPTION: Brunel observes that since his daughter is still young, she has not really experienced any allied problems beyond the physical issues associated with having a cleft lip. LOCATION: Route Nationale 2, Fougerolle, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Georgeline Florvil (child), Brunel Florvil (father) and Gerlanda Donatien (mother).
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  • CAPTION: Since Georgeline was still anaemic three months after the couple had initially tried to secure an operation for her, and because she also needed to have vaccinations, the surgery was fixed for a month and a half subsequently. LOCATION: Route Nationale 2, Fougerolle, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Georgeline Florvil (child), Brunel Florvil (father) and Gerlanda Donatien (mother).
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  • CAPTION: Georgeline is an inquisitive and playful child, blissfully oblivious of the cleft that's so obvious to those older than her. LOCATION: Route Nationale 2, Fougerolle, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Gerlanda Donatien (left) and Georgeline Florvil (right).
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  • CAPTION: As Gerlanda watches her child play, she observes, "this operation is so important for Georgeline and us, I do not want her to be humiliated and miserable in life". LOCATION: Route Nationale 2, Fougerolle, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Gerlanda Donatien (left) and Georgeline Florvil (right).
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  • CAPTION: "If she were not to be operated on, other children would increasingly look at her mouth as she grows up and ridicule her”, Gerlanda adds. LOCATION: Route Nationale 2, Fougerolle, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Gerlanda Donatien (left) and Georgeline Florvil (right).
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  • CAPTION: "When I walk with her", Gerlanda goes on, "I sometimes hide her face so that people won't see her deformity. I will be very happy after the operation because I won't have to hide her anymore. In fact, I will be so proud to show her off!" LOCATION: Route Nationale 2, Fougerolle, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Gerlanda Donatien (left) and Georgeline Florvil (right).
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  • CAPTION: "The surgery will be such a big relief to us", Gerlanda smiles. "Without outside help, I would have never have been able to afford the cost". LOCATION: Route Nationale 2, Fougerolle, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Georgeline Florvil.
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  • CAPTION: "I cannot thank Smile Train enough”, emphasises Gerlanda. "I'm so grateful to them!" LOCATION: Route Nationale 2, Fougerolle, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Georgeline Florvil.
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  • CAPTION: And the big day is here. As Gerlanda walks down to the hospital, she experiences a gamut of emotions: relief, nervousness and happiness all seem to come at once. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: From left to right: Gerlanda Donatien, Georgeline Florvil and Rose-Marie Franciné.
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  • CAPTION: Gerlanda and Brunel are now hopeful and optimistic about Georgeline's future. They dream that one day, she will become someone important in her community. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Gerlanda Donatien (left) and Georgeline Florvil (right).
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  • CAPTION: With this in mind, Brunel says, "we need to find a way for her to have a very good education, so that she'll grow up to be independent". LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Gerlanda Donatien (left) and Georgeline Florvil (right).
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  • CAPTION: Before the operation, all required tests are conducted to ensure the child is fit and ready for the surgery. Here, Gerlanda is waiting with Georgeline to hear the results. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Gerlanda Donatien (mother) and Georgeline Florvil (child).
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  • CAPTION: Hôpital Universitaire Justinien's Dr Loriston goes through Georgeline's test results with Gerlanda. LOCATION: Hôpital Universitaire Justinien, Cap-Haïtien, Haiti. INDIVIDUAL(S) PHOTOGRAPHED: Stanley Loriston (left), Gerlanda Donatien (mother) and Georgeline Florvil (child).
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