Returning to Neiva, Colombia: Columbia Surgeons Expand Access to Complex Reconstructive Care

Beneath rows of tents outside a hospital in Neiva, Colombia, families wait as volunteer clinicians evaluate their children. Some have traveled up to 10 hours in sweltering heat to reach the hospital. They have come seeking treatment for cleft lip and palate and other complex congenital conditions; care unavailable closer to home. Over the next four days, eight operating rooms will run from morning until night as children undergo procedures that restore their ability to breathe, eat, speak, and smile. 

For more than 30 years, volunteers with the Texas chapter of Healing the Children have returned to Hospital Universitario Hernando Moncaleano Perdomo in Neiva to provide reconstructive surgical care for children who might otherwise go untreated. This year's team included approximately 80 volunteers—surgeons, anesthesiologists, pediatricians, nurses, and other specialists—who performed more than 90 surgeries on patients ranging from just a few months old to late adolescence. Among them was Dr. Sidney Eisig, DDS, FACS, the George Guttmann Professor of Clinical Craniofacial Surgery at Columbia University College of Dental Medicine (CDM) and director of oral and maxillofacial surgery at NewYork-Presbyterian/Columbia University Irving Medical Center (NYP/CUMC), who has participated in nearly every mission since its second year. 

Eisig has watched the mission evolve beyond cleft lip and palate repair. Today, specialists also reconstruct ears for children with microtia, pediatric orthopedic surgeons treat congenital conditions affecting the legs and feet, and speech-language pathologists help children develop clearer speech while teaching families how to continue therapy at home. 

As he has done throughout the mission's history, Eisig invited Columbia colleagues to join him. This year, the team included Dr. Mohammad Amin Khoshnevisan, DMD, a pediatric craniomaxillofacial surgeon and assistant professor of dental medicine at CDM; Dr. Alex Pascal, DDS, MD, a fifth-year oral and maxillofacial surgery resident; and Dr. Tom Ben-Dov, MD, a pediatric otolaryngologist at NewYork-Presbyterian Morgan Stanley Children's Hospital and an assistant professor of otolaryngology head and neck surgery at CUMC. 

“You can't explain it unless you experience it yourself,” Eisig said. “It's just so rewarding. On the scale of global health, this is not even a drop in the bucket in terms of the unmet need. But the idea that you can change the trajectory of someone's life is amazing.” 

The Timing of Care  

Time shapes nearly every part of the mission. Families travel for hours to reach Neiva, often without knowing whether surgery will be possible. Once they arrive, volunteers have only one screening day to evaluate more than 400 children, determine who can safely undergo anesthesia, and create a surgical schedule for four consecutive 12-hour operating days. “We only have a certain amount of time to be there, so we’re trying to get through all the patients we’ve committed to treating,” Pascal said. “We don’t go home until we've finished every case.”  

The mission's schedule, however, is only one measure of time. Each procedure also has its own window, determined by a child's stage of development. Cleft lip repair is ideally completed within the first few months of life, while cleft palate repair is typically performed before a child's first birthday, provided the child is healthy and large enough for surgery. Surgery for velopharyngeal insufficiency (VPI), which helps the palate close properly to improve speech and prevent liquids from escaping through the nose during swallowing, is generally performed once a child reaches school age. 

These procedures do far more than repair a cleft. Together, they support a child's ability to eat, speak, hear, and breathe while guiding normal facial growth and the development of permanent teeth. Because cleft care is delivered in stages, each procedure builds on the one before it, making timely treatment essential to achieving the best long-term outcomes. In regions where access to specialized cleft care is limited, receiving treatment at the right time can shape a child's health, development, confidence, and ability to participate fully in school and everyday life for years to come. 

One of the children Ben-Dov operated on was a 50-day-old infant born with a cleft lip. Although the baby's size and age made the procedure more challenging, the team determined surgery could safely move forward. 

“This case is really a good example of an opportunity to help when the timing is right,” Ben-Dov said. “Otherwise, these kids often find themselves waiting until the next group arrives, which could be months and sometimes years.” 

The baby recovered well following the cleft lip repair. His mother continues to share photographs over WhatsApp, allowing the team to watch him heal from afar.  

His surgery was one of many over the four-day mission. In addition to cleft lip and palate repairs and surgery for VPI, the team also performed alveolar bone grafts, transferring a small piece of bone from part of the pelvis to rebuild the upper jaw where the cleft extends beneath the nose. The graft allows the upper jaw to heal as one continuous bone and supports the normal eruption of permanent teeth. 

Not every family receives the answer they hope for. Khoshnevisan, who previously participated in humanitarian surgical missions to Bangladesh and Pakistan, screened a child who had undergone a cleft palate repair but was left with an opening in the roof of the mouth after the repair broke down. The child needed additional surgery, but the team determined it was too early to safely proceed. The family left disappointed, but waiting offered the best chance for a successful outcome. 

“Of all the cases, that's the one that stood out to me,” Khoshnevisan said. “We couldn't really help them at that time. I hope I can go back and treat that child.” 

Care Measured in Decades 

While each mission unfolds within the constraints of just a few days, it is part of a commitment that has endured for more than three decades. 

When Eisig first traveled to Colombia, the country was in the midst of a civil war. Families sometimes traveled by small boat along a river before boarding a bus to the hospital. Some needed special permission to leave the regions where they lived, and only one parent was allowed to accompany a child for surgery. Volunteers traveled between cities with military escorts, often taking different routes each day for security. Today, Colombia is significantly safer. Eisig now walks back to his hotel from the hospital, a routine that would have been impossible during the mission's earliest years. 

Over time, professional partnerships became personal ones. Each trip brings Eisig back to familiar faces. The local nurses, physicians, hotel staff, and others who have welcomed the team for decades have become part of the mission itself. 

“I enjoy visiting, seeing the nursing staff, the front desk assistants at the hotel, the woman who serves us lunch. Never mind the surgeons I operate with. They’ve all become my friends over the years.”  

The volunteers’ work depends on the physicians in Neiva, who continue caring for patients after the team returns home. Although the hospital operated with limited resources, Ben-Dov found himself working alongside highly skilled surgeons who often care for both children and adults, reflecting the broad scope of practice required to meet the needs of the communities they serve. 

“There’s a lot about humility and understanding the system and the culture of the place you're going to, and being respectful to the local staff. We had the opportunity to work with excellent local plastic surgeons who were incredibly helpful with diagnosis, teaching, and surgery. It really was a team effort to help these kids.” 

CUMC's involvement also continues after the mission ends. For years, Eisig has partnered with Dr. Catherine Crowley, a professor at Teachers College, Columbia University, to extend care beyond surgery. She has brought bilingual master's students and faculty to Colombia to run speech camps, teach families home speech therapy exercises, and provide continuing education for local speech-language pathologists. After returning to New York, they continue supporting families through virtual follow-up.

That long-term commitment has also extended to research. CUMC faculty and their Neiva colleagues have conducted two IRB-approved studies, including a genomic analysis to better understand the underlying causes of cleft lip and palate. Their collaboration has led to two co-authored publications.

Care That Endures 

Ben-Dov said the mission reflected something distinctive about Columbia’s culture of collaboration, where the chair of one department invited a faculty member from another to join an international humanitarian mission. 

“It’s not typical. I don't think many places have that kind of collaboration between departments. It’s something we should be proud of. I’ll be more mindful in the future to help those who follow me join mission trips when I have the privilege to invite people.” 

For the surgeons joining the mission for the first time, that same spirit shapes how they envision their own careers. 

Pascal said the opportunity to work alongside experienced surgeons from across the country broadened his perspective, but it was the overwhelming need for specialized care that stayed with him.

"It's really hard to appreciate unless you're there in person and can experience how much need there really is. This made me realize that this is something I would like to continue doing throughout my career and stay involved in giving back."

Humanitarian work had been part of Khoshnevisan’s life long before he joined the Colombia mission. His father, a public health researcher whose doctoral work focused on the epidemiology of cleft lip and palate, instilled in him the importance of caring for people who lack access to treatment. When Eisig invited him to join the team, he accepted immediately. 

“When I operate on these kids, some of them are the same age as mine. I want to help families just like mine, but who happen to be born in another country. It gives me a sense of gratitude for what we have here, but also a sense of responsibility to not stop doing this. I really do feel the responsibility to continue.”