Partnership Projects of Children’s Lifeline™ & Smiles International

• Total # Patient records reviewed/treated follow-up scheduling = 500
• Total # priority cases listed for case selection = 200
• Total # of patients operated at the clinic hospital = 57
• Total # Procedures performed on 57 cases = 220
• Total # of alternates reviewed/treated HNN = 16
• Total # of Ped-Anesthesia Surgical Patients = 16
• Speech/Language Pathology Patient Treatments =
• Nasopharyngoscopy evaluations = 3
• Days of HNN operating room use = 6
• Hard Onsite Clinic Expenses
  • Expense of Disposable and Sterile Supplies $10,300 (shown in orig budget)
  • Surgery and Treatment’s Relative US Value Total: $875,650.00

The Team

Team members working at the April 2026 Costa Rica Mission:

This mission trip started April 18, with unpacking and a visit to the HNN hospital, and lasted through April 26, 2026. Professional volunteers from Costa Rica, Canada, Colorado, Texas, and California donated their skills, time, and love to 57 operated children who were selected from the waiting list of over 500. Most of these children were previously held back from having surgery due to hospital staffing losses subsequent to the COVID crisis and early retirements of critical staff at the hospital.

Some clinical practices of the social security health system also result in fewer surgeries, as they currently have most surgery admitted overnight as routine practice). This leads to a bed shortages as well as a reluctance to modifying the amount of sedation the children get under anesthetic. They have not yet adopted any of the advances in same-day surgery anesthesia and surgery protocols commonly practiced in the USA over the past several decades.

Additionally, due to the law in Costa Rica, if any children arrive at the door of the HNN, they are obliged to treat all their needs gratis no matter their origin of birth or parent’s citizenship. This has created a flood of medically compromised children arriving with their parents from poor neighboring countries, making a “perfect storm” of sorts, depleting the medical resources of Costa Rica.

Thus, there is a critical need for assistance from our volunteer teams, not only to operate many children on the waiting list, but to work side-by-side with the local professionals to demonstrate our techniques and to teach them the safe protocols at their HNN medical system’s Grand Rounds conference.

Notably, due to the lack of sufficient numbers of available pediatric anesthesiologists and operating room/recover nurses, the HNN local Craniomaxillofacial surgeons at the hospital are only able to operate two or three cleft children cases per week, thus our mission operating 57 cases in one week has produced for them nearly six months worth of productivity.

Additionally, as in all our mission projects, in line with our philosophy of maximizing the valuable and
limited resource of advanced pediatric anesthesia, multiple complex procedures were performed on these patients during their surgeries. On the fifty-seven children operated, over 220 reconstructive treatment procedures were accomplished during the week of treatment at the clinic and hospital facility. A relative numerical financial value if performed in USA institutions with cash payment would be $875,650.00 USD. Although there is not a private pay system in Costa Rica that would allow an easy comparison for locals, the value of this work does not go unnoticed.

A Surgery – Before and After Cleft Palate Closure

System Devised to Produce Maximum Mission Benefit

• Plan for 60 Cases in Six Days of Surgery Lasting from 6AM–6PM in Two Operating Rooms
• Preselect Cases and Confirm w/ ONE screening day on Sunday for Case Confirmation
• Book the Cases with Safe Considerations: Youngest First/Airway Risk First
• Work CLOSELY with Anesthesia & Recovery PACU perioperative teams.

Lessons Learned for 2027

Having 60 cases pre-selected from a screening of nearly two hundred (200) priority cases could be modified slightly to account for last minute changes. One of the reasons for prioritizing a case was their age of maturation. When reaching age sixteen, they are eliminated from eligibility from the HNN pediatric hospital system and will likely never be able to obtain access to this level of care. Exams were performed on many backup patients to provide an alternates list for daily filling of the schedules. Only two cases had anesthesia cancellations due to signs of an oncoming illness, and one unusual situation of a child who was refused surgery due to a parental/child communication problem.

So the planned 60 cases over six days was reduced to 57. Nonetheless, lessons were recorded and this situation will be handled differently going forward, with closer location of alternate patients housed at governmental apartments nearby, in particular for those coming from a longer distance to receive care.

Each cleft lip/palate might have to undergo this type of reconstruction towards the end of their sequence of surgical reconstructions, depending upon the severity of their original cleft palate deformity. Careful treatment plans are developed at the onset of these children’s care, so that the whole team, including the parents and caregivers, may prepare for this around the child’s teenage years. No cases of orthognathic surgery were planned to be done on this mission due to the priority need of children waiting for their earlier procedures.

Orthognathic surgery takes longer and requires preparation that was not feasible while the HNN is experiencing such staffing shortages. The following, however, illustrates how an ideal situation might be created in the right setting at the excellent Craniomaxillofacial LPH (labio-palate hendidio) clinic at the HNN. This was a case operated by me in Costa Rica many years ago before the crisis came in 2020. Pre/post photos Raymundo and mural created from this patient’s story which was painted by the famous latino painter Mario Torrero for the First Lady of Costa Rica at the time, Dona Bejarano, and which is hanging at their Costa Rica Children’s Museum.

CLI’s Ongoing Support

Overall, as noted in prior reports, it is apparent that these clinics produce a valuable outcome for the longitudinal care of the children affected with facial cleft differences, with a good return on immediate expenses. The value of heartwarming volunteer experiences, the connections to children and families, and beneficial outcome to the community at large, by adding functioning young adults, is immeasurable. This particular mission expanded our purpose to include efforts to change an aging system which had delayed implementation of modern world standards, perfected in the USA, for producing more treatment for less cost, and with equivalent safety, thereby increasing the number of treatments possible prior to patients reaching the age of treatment eligibility exclusion. We thank all the professional and non-professional volunteers, industry manufacture leaders, Rotary Global 2462119 Matching Grant partners, KLS Martin and Stryker Corporations, and notably the ongoing partnership of SIF and Children’s Lifeline International for the sustainable nature of our relationship and providing support for this mission.

Prof. Jeffrey J. Moses DDS, FAACS
Diplomate, Amer. Board Oral/Maxillofacial Surgery President/Founder,
Smiles International Foundation

Costa Rica April 2026 Slideshow Video