SMILES attract people and bring them together, but smiles don't come easily to children born with cleft lips and cleft palates. And the world often does not smile at them.

Aiming to put a smile on every child's face, 55-year-old Chinese Canadian facial reconstructive surgeon Dr Joseph K. Wong visits remote areas in China at least once a year to provide free surgery for poor kids.

Wong, a resident of Toronto, has been doing this for around 10 years as the founder of the nonprofit Smile China project. Every year, many top surgeons from China and around the world take part.

Since 2001, around 600 surgeries have been performed; Wong and his team visit at least once a year and also train local doctors.

Repairing a cleft lip and palate is life-changing for children who otherwise are typically shunned, kept home, out of school and later unable to find work or marry. Quite a few are abandoned and there are many such disfigured children in orphanages. Infants have starved to death because they cannot nurse and many with the congenital malformation have difficulty in speech.

For these reasons, a number of charities in China repair cleft lips and palates, commonly known as "tu chun," hare lip.

"Smiles are infectious. Giving smiles back to kids fills me with the greatest satisfaction as a plastic surgeon," says Wong. "A child's smile is just the start of a happy chain of contacts."

In August Wong signed a memorandum of understanding to cooperate with the Shanghai No. 9 People's Hospital, famed for its reconstructive and cosmetic surgery. The agreement establishes long-term training in the city for doctors from remote areas.

Wong founded the Smile China project in 2001 as a registered charitable organization in Canada. The aim is to provide specialized surgical, medical and health care services to children affected with facial deformities. Wong has visited remote areas of Yunnan, Gansu, and Jiangxi provinces and the Guangxi Zhuang Autonomous Region.

During each visit, foreign surgeons train local surgeons in specialized techniques so they can help more patients.

Shocking reality

Wong grew up in Hong Kong and moved to Canada when he was 17.

He first visited the Chinese mainland in the early 1980s when he was still in medical school. He visited Guilin in the Guangxi region and visited spectacular mountainous landscapes. In an ethnic market, Wong was shocked to see a few teenage girls with cleft lips. In his experience, most babies with the malformation receive corrective surgery when they are a few months old; at least two more surgeries follow as they get older. In many cases the adult shows no evidence of the condition. Treatment involves surgeons, speech pathologists, orthodontists and other specialists.

"I asked them why they didn't have the lips repaired, and they gave a simple and helpless reply - because they came from remote villages," Wong recalls.

He realized then that relatively routine reconstructive surgery was far beyond the reach of most children in distant areas. Poverty and poor medical care condemn them to live with the condition.

He decided to specialize in plastic surgery.

When he became president of the Canadian Academy of Facial Plastic Reconstructive Surgery, Wong spoke about the cleft lip-palate problem with a Chinese official at a medical conference in 1999. He made his second visit to China that year, as a volunteer doctor instead of a tourist.

His first treatment stop was in Kunming, Yunnan Province, and he performed dozens of operations.

"There were many patients and some came from as far away as the Himalayas of the Tibet Autonomous Region," says Wong. "They all came hoping for a chance of a better life."

A six-year-old girl and her mother came from the Himalayan foothills. The girl wore her best clothes, which were old and torn. Her mother was a typically kind yet tough-minded woman who said she never asks for more than god gives.

After the surgery, the mother clasped Wong's hands and insisted he come for her daughter's wedding. Though the date was far off, if not for Wong's help, there would be no wedding.

1 in 700

Approximately one in 700 children are born with a cleft lip and/or a cleft palate, and the overall rate is about one in 550 in China. Each year 20,000 to 30,000 babies are born with the deformity. The rate tends to be higher in remote areas where there is a higher rate of family intermarriage. In most cities, surgery is available to babies - the earlier it is performed, the better the outcome.

"Life is especially hard for poor kids with cleft lips," says Wong. "They are often discriminated against and sometimes bullied by kids their age. They dare not go out, let alone go to school or make friends.

"Fortunately I met with some strong-minded parents who never give up on their children."

When Wong initiated the Smile China project, he himself visited China twice a year, performing around 30 surgeries each time in remote areas.

In 2009, the project in Guangxi Zhuang Autonomous Region involved 10 doctors, including eight foreign surgeons from America, Brazil, Canada and Japan.

"We consider this not simply giving, we are gaining as well," says Wong. "We have their smiles as feedback.

"We hope that our help can help them live complete lives; knowing that they are cared for also helps them learn to care for others."

Wong carefully preserves a painting of a lotus as a "trophy." He was given the painting by a 10-year-old boy with a cleft lip who was abandoned at infancy and raised by a kind farmer. Though he was still in pain from the surgery, the boy insisted on painting the lotus and giving it to Wong before he left.

"He told me that he is determined to become a doctor and provide surgery to kids just as I did," says Wong. "At that moment, I was even more certain that everything we had done was worthwhile."

Repairing cleft lips and palates is not simply "sewing together," as many people think, says Wong who specializes in head and neck surgeries. The best repair requires surgery at infancy, early teens and around 18 years of age. The first is crucial since a child's growth makes it difficult to correct a poor repair. Most of the first patients in China are now ready for their second operations.

The Smile China project has been training local doctors since 2004. The agreement with the No. 9 People's Hospital provides for surgeons from remote areas to be sent to Shanghai for regular training for standard repair surgery.

"As the saying goes, teaching people how to fish is more effective than just giving them fish," says Wong. "Though most local doctors still cannot manage the surgery at this time, I believe that in the future they will be able to help more kids smile."