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"Some hospitals have equipment that is 30 to 50 years old and open electrical outlets next to the scrub sinks," Klimek said. "The biomedical technician spends several days wiring and rewiring equipment to make sure everything is not only functional but safe."

Safety is a No.1 priority with Operation Smile, and volunteers must be certified in ACLS and PALS.

Operation Smile provides its own cardiac monitors, ETCO2, pulse oximetry, vaporizers and emergency equipment for each mission. Many of the medical volunteers also bring and donate supplies.

Surgeries are performed during the course of a week, with volunteers often putting in 12-hour days. Each medical team consists of five to seven anesthesia providers (anesthesiologists and certified registered nurse anesthetists), five to seven surgeons and a host of other personnel-including nurses, medical records personnel, dentists and pediatricians. A typical team may consist of medical professionals from four to eight different countries.

Sandra Dietzel, RN, who works at Johns Hopkins Hospital Children's Center in Baltimore, has made 11 trips with Operation Smile. "I think the personal satisfaction I receive on each medical mission far outweighs what I give," Dietzel said. "It's amazing to work with a team to create a little miracle in another part of the world."

While few children born in the United States have deformities such as a cleft lip or cleft palates, it is common in developing countries that babies are born with these birth defects. Researchers attribute the large number of children born with birth defects to mothers not receiving adequate prenatal care and a lack of folic acid in their diets.

"In the United States, even the poorest families have access to medical care, but that's not the case in these counties," Dietzel said. "These families are so grateful for our efforts that they try to repay us with fruit, produce and other commodities."

Terri Klimek has received thank-you notes from patients' families she has worked with on past missions.

"One mother wrote that her 13-year-old son used to look in the mirror and ask for an operation that would fix his nose and mouth," Klimek said. "He told his mom he was ugly and that no one would fall in love with him. After the surgery, the boy said we had made his biggest dream come true."

After traveling overseas to serve on an Operation Smile medical mission, many nurses find themselves making return trips.

"People have asked me why I give up my vacation time to work 12-hour days in countries where I need a translator to help me," Kilmek said. "I tell them these missions are the most rewarding thing you will ever do in your career. The feeling you get when you see a child look in the mirror after surgery is priceless."

For more information on nursing opportunities with Operation Smile or how to support its programs, call its corporate offices at (757) 321-7645 or visit its Web site at www.operationsmile.org.

Contact Linda Childers at eastbaypr@aol.com