
DATE: Sunday, November 16, 1997             TAG: 9711140128

SECTION: DAILY BREAK             PAGE: E8   EDITION: FINAL 

SOURCE: STORY AND COLOR PHOTOS BY TAMARA VONINSKI

                                            LENGTH:  157 lines

PRAKAI'S NEW SMILEHOW A TEAM OF AMERICAN DOCTORS MADE ONE THAI GIRL'S DREAM OF A BEAUTIFUL FACE COME TRUE.

PRAKAI KAUNMA, 7 years old, walked with her parents up a hill to an outdoor Buddhist temple deep in rural northeastern Thailand.

The trio took off their shoes and bowed in unison, praying at the feet of golden Buddha statues and inside a grotto overlooking a larger-than-life reclining Buddha.

An elderly monk swathed in saffron robes bestowed a special blessing.

The next day, Oct. 6, Prakai would undergo an operation to repair a facial deformity that had made it impossible for her to live a normal life.

The girl was born with a cleft lip and palate. A hole in her upper lip gaped, and a tooth protruded at a crooked angle. Another hole in the roof of her mouth made it hard for her to eat and talk. Children at school teased her.

A local doctor had operated on Prakai when she was 5 months old to close the cleft in her lip, but two days after the operation the lip split open again. The doctor told her mother to bring her back after a year; she didn't trust him and never returned.

During the summer, Prakai's mother, Anong Paopeng, had heard on local radio that a team of foreign doctors would treat children with facial deformities at Yasothon General Hospital, in northeastern Thailand.

The broadcast offered a glimmer of hope that Prakai, through the efforts of an anonymous group of visitors from the other side of the world, could have a brighter future.

In early October, doctors with Operation Smile, the medical relief organization based in Norfolk, began their first-ever mission in Thailand by examining 363 candidates for surgery - mostly children.

In a hot, cramped hallway at Yasothon hospital, hundreds of parents waited to show their children's cleft lips, tumors, burns and other facial deformities to a team of foreign medical volunteers.

Each time a doctor or nurse walked through the hallway, the mothers instructed their children to ``wai'' - to put their hands together, prayerlike, in a traditional Thai display of respect.

At the end of the two-day screening, the field was whittled by more than half; the names of those accepted were posted in a list on a wall.

Praika was too short to read the list. She stood patiently, covering her cleft lip with her right hand, until her mother and father found her name.

In a ritual to be repeated by 155 families, the Kaunmas went home to pick up straw sleeping mats, clothing and embroidered pillows. Prakai lives a two-hour bus ride from the hospital near the rice fields where her parents and the majority of the province work as farmers.

Neighbors and relatives gathered at their home to wish the packing family well.

The children played games, jumping over an elastic piece of string held at varying heights. Prakai giggled and smiled wide, beaming at the attention. Her grandmother wiped tears from her eyes and slipped a 100-baht note (about $3) into her hand. Prakai ``waied'' and returned to her game, laughing, until it was time to go.

Prakai wanted the surgery and a normal face, but she began missing home as soon as she lost sight of her house.

After the detour to the Buddhist temple, the van headed for Yasothon. Prakai fell into a deep sleep on her father's lap.

Her mother talked to Operation Smile volunteer Nina Kitbumrung, a Thai native and student at Old Dominion University in Norfolk. She shared her fear that she was partly responsible for her daughter's deformity: A superstition, common in parts of Thailand, holds that women who use scissors during pregnancy increase the chances that their child will be born with a cleft lip. Anong, who is five months pregnant, used scissors while pregnant with Prakai.

At the hospital, Prakai was directed to the pre-op ward, where most of the beds were full. She was examined by pediatrician Ron Snyder, from Michigan, and assigned to Bed 13. She screamed and cried as nurses took her blood and vital signs. Nina gave her a huge stuffed reindeer.

Meanwhile, the rest of the Operation Smile medical team reached Ubon Ratchathni, a two-hour bus ride away, after a short flight from Bangkok. Some of the team had traveled for more than 20 hours from places like Norfolk, Nova Scotia and Michigan, arriving in the tropical heat of Thailand jet-lagged and weary.

Early the next morning, Child Life Specialist Candie Marchand, from Annapolis, Md., and Thai nurse Sujjaporn Kuntuput set up a playroom attached to the pre-op ward. They gave children dolls to decorate and personalize.

`If you want a beautiful face,'' Sujjaporn told them in Thai, ``then draw a beautiful face on the doll, and tomorrow your face will change into a beautiful face.''

To help prepare the children for what lay ahead, Candie demonstrated the use of oxygen masks on a doll's face and a child's. The children passed the oxygen mask around the room, placing it over their mouth and nose to practice breathing.

A boy and girl were chosen to dress up in scrubs like a doctor and nurse. Prakai played the nurse. ``See, even though their mouth is covered,'' Candie said, pointing to the surgical masks, ``you can still see a smile. Look at their eyes.''

Prakai's eyes were wide, and she looked scared. The children were quiet.

Prakai held her mother's hand in pre-op for as long as possible. She would be the second case of the day for Dr. Sekhar Chandrasekhar, a plastic surgeon from Los Angeles, whom everyone called ``Dr. Sekhar.''

He came out to greet her. Kneeling, he examined her mouth and lips.

``You are already beautiful,'' he said, ``and the operation will make you more beautiful.''

After his words were translated to Thai, Prakai put her hands together and said the only two words in English that she knew: ``Thank you.''

She shyly took the doctor's hand, and her mother watched as he picked her up and carried her to the OR.

She awoke from the 1 1/2 hours of surgery screaming as the anesthesia wore off. The clefts in her lip and palette were gone, closed with lines of stitches. She was bleeding from her nose, and her face was swollen. American and Thai nurses comforted her and three other children crying for their mothers.

Her stretcher was wheeled past her parents, who watched quietly as she was rolled to the post-op ward on the other side of the hospital. As she was placed in another bed, Anong watched the nurses trying to make her comfortable, and she began to cry, burying her head in her hands and stealing glances at her daughter.

A woman in a nearby bed gazed down at her sleeping baby after surgery and said, ``If someone had not told me that this was my daughter, I would not have recognized her.''

Mothers and fathers kept vigils around the clock, wiping the blood and tears away and, later, feeding their children rice soup.

Early the next morning, Sekhar made his rounds. Using a small flashlight, he examined each child's lip and palate repairs.

Prakai and the other patients would go home soon, sleepy and still in pain. The pain and bleeding would subside and the stitches would become less noticeable. In six months, the healing would be finished and the smiles complete.

Sekhar, a veteran of eight other Operation Smile missions to Colombia, Kenya, China, the Philippines and Guatemala since 1989, said the people, manners and customs differ widely, but the sense of satisfaction he feels is a constant.

``I'm filled with a sense of gratitude that I've been given a chance to make a difference in a child's life,'' he said. ``These are the defining moments that make us glad that we've become surgeons. It makes us realize why we became surgeons in the first place when a child puts their hands together and says `thank you.'

``Surgery changes a child's life, the family's and mine. Deformity is something that is unacceptable for most people, especially facial deformities. The teasing and taunting that goes with it leaves emotional scars. One hundred fifty-five children had their lives changed, and 155 families felt better that we were here.'' ILLUSTRATION: Color photos

Prakai Kaunma, middle, and her parents, Anong Paopeng, left, and

Sommai Kaunma...

Prakai sleeps on her father's lap

Dr. Sekhar Chandrasekhar...

In the pre-op ward, Prakai...

Prakai, center, and her mother, Anong Paopeng...

Dr. Sekhar Chandrasekhar sews the final stiches in Prakai's cleft

lip...

After surgery, Prakai is wheeled...

The day after surgery, a nurse shows Prakai her reflection...