During a typical week, Poughkeepsie-based doctor Manoj T. Abraham offers a formidable model of the multitasking professional. The accomplished plastic surgeon shuttles between offices in Poughkeepsie and Rhinebeck, providing reconstructive work for faces that have been harmed by injury, cancer, or the simple ravages of age. At least once a week he travels to Manhattan, either to lead an operating team or to teach a residency program at the New York Eye & Ear Infirmary.

During one week last November, however, Dr. Abraham was far from the Mid-Hudson Valley; he rode in a truck heading down an unpaved road through the rain forest of Guatemala. Mud slathered both sides of the vehicle. The hurricane season had just ended, but not before roads were submerged and rail bridges twisted into elbow pasta. Abraham, a member of a nine-member party, was headed for a small cement-block hospital in Mazatenango, where he would spend the  next four days in 90-degree tropical weather, restoring the cleft palates of Mayan children.

A child with a large cleft-lip deformity before and after an operation to repair his palate

It is not the first time Abraham, 34, has been to Guatemala; he first made the trip in 2002, invited by Ron Strahan, a UCLA-based doctor who began these medical missions nearly 30 years ago. Strahan, now in his 70s, conducts two humanitarian missions each year, focused on providing facial reconstruction to needy people. Previous destinations have included rural areas in Pakistan and Central and South America. Strahan's own foundation, the Children's Rehabilitative Institute and Surgery Program (CRISP), solicits the donations needed for their journey and surgery.

The first time he went, Abraham admits, he was an ambitious medical student merely looking for fellowship experience. Now, as he surveys the dense foliage ahead and the familiar volcanoes rising in the distance, Abraham realizes that he has returned this time with a sense of purpose.

"Physically, it takes a lot out of you," Abraham says, "but it's very, very mentally clarifying. You just get so much back."

Guatemala ranks as the second-poorest country in Central America, behind the Dominican Republic. The Mayan people live among the descendants of the Spanish colonists who rule this country, yet these indigenous people cling to ancient standards, living in wooden huts and working the land as farmers or jade miners. Poverty is crushing for the Mayans, and a virtual lack of health care is one of the measures of that indigent status. "It's terrible in terms of the amount of need that they have," Abraham says. An unstable political situation, reinforced by guerilla soldiers, further exacerbates the problem.

A muddy track in rural Guatemala

Six weeks before Strahan's group arrived, the major bridge leading to Mazatenango was destroyed by Hurricane Stan. A replacement has been hastily constructed, but it offers only one lane of passage. This explains why the usual three-hour trip from the Guatemala City airport has taken more than twice that time. Abraham turns to offer a weary but encouraging smile to his wife, internist Dr. Kavita Aggarwal, part of the medical team. When they finally lumber into the hospital compound later that afternoon, a long line already snakes around the building. "People trek for days, sometimes on foot," Dr. Abraham says, "to come in and see us." They stand quietly, respectfully, holding children by the hand or in their arms. They know of the work that Strahan and Abraham are capable of.

The group begins unloading their cargo: donated supplies from the Mid-Hudson Valley hospitals: Vassar Brothers, Northern Dutchess, Kingston, and Benedictine. "Typically, when you go on these missions, you take whatever you get," Abraham says. Expired prescriptions are generally the standard. However, Dr. Abraham lobbied hard locally and obtained fresh medications, including antibiotics and antifungal medicines.

The condition known as a cleft lip and palate occurs when the normal fusion of cells in a fetus fails. Rather than growing together from the left and right side of the lip and roof of the mouth, the sections do not meet, leaving a gap. This malformation has serious consequences, impairing breathing, speech, eating, and swallowing. In the United States, this happens to one in every 800 babies. But due to ethnogenetics, it happens more often in the Mayan population, Abraham explains. While American children have the defect corrected during infancy, it is common to see Mayan adults with cleft palates.

Patients in the "waiting room"

Once the rest of the medical team arrives, Abraham begins his work. The clinic, partially funded with CRISP funds, is modest: five treatment rooms, one examination room, and an operating room. Over the course of the next five days, the medical team will evaluate more than 200 patients. To expedite matters, three patients are prepped simultaneously. Abraham works steadily from 8am to 7pm in the room whose walls are painted seasick-green. Dr. Strahan, suffering from arthritis, offers advice but mostly observes.  Repairing a cleft lip and palate requires making an incision on either side of the gap from the mouth into the nostril. For the lip, the dark pink outer portion of the cleft is pulled down and the muscle and the skin of the lip are brought together to close the separation. To repair the palate, the surgeon makes an incision on both sides of the separation, moving tissue from each side of the cleft to the center or midline of the roof of the mouth. For Abraham, the process takes 90 minutes per patient. The team works on through the day into early evening. On occasion, when the power fails, a generator grinds into action. "You kind of make do with what you have," Abraham says.

Meanwhile, Dr. Aggarwal journeys farther into the jungle to see patients unable to make the journey to Mazatenango. By Saturday evening, Dr. Abraham will have reconstructed the lips and palates of 50 patients, most of them between  the ages of two and five. The surgeon also has the chance to see patients from his previous trip whose incisions have long healed. While Abraham does not speak Spanish, there is something universal in the shy smiles of the Mayan parents and their children.

"You know that you make such a big difference in these kids' lives," Abraham says, "because if we didn't go, then the chance of that particular child getting that operation is essentially none."

Dr. Abraham is now back in his Poughkeepsie office, again tending to the growing number of patients needing emergency surgery to save faces damaged by accidents or ravaged by cancer. Just yesterday, a restorative surgery in Manhattan took half a day. But a major part of Abraham's practice involves facelifts and eye tucks, browlifts and Botox. After spending a week with Mayan children, repairing cleft palates, does he view his facelift patients differently?

Drs. Abraham and Aggarwai

"I'm often asked that by colleagues and friends," Abraham says. "Why do I even do cosmetic surgery?" But he emphasizes the parallels between the Mayan children and his stateside patients: In restoring a face, he restores individual self-esteem. "My elective cosmetic-surgery patients are often the most grateful patients in the world."

Abraham is already planning another trip to Mazatenango. Besides the satisfaction, what compels him to return? The doctor falls silent for a moment, his handsome face suggesting a reluctance to say more. But then he explains that as a child in Sri Lanka, he lived through an era of political unrest. He is a Tamil, a member of the ruling minority that came under attack by the Singhalese. One evening in 1979, a Singhalese mob rioted in his neighborhood, a ritual before elections. They killed men, raped women, looted, and destroyed houses. The Abrahams' next-door neighbors were incinerated in their home. That night, the Abraham family huddled in their bathroom as stones rained through the window. But the bars on the doors saved their lives.

"I don't look back on those experience as scarring," Abraham says, "but as tremendously powerful motivation. One of the reasons I want to give back is because of a lot of my history."

All photos provided.