Saving Face: Disfigurement and the Politics of Appearance

5 Saving Face: Redeeming a Universal Face

106 > 107 HIV—certainly not a “new” phenomenon—is the leading cause of death among adults in Africa.3 Warnings forecast the impending death of entire generations. But AIDS is not the only global health emergency . The specter of disfigurement motivates international efforts to repair the face, too. In fact, facial work, specifically repair of cleft lip and palate, has advanced as a vital intervention at the same time and in the same places that children die of HIV/AIDS, malaria, and malnourishment. Facial work might appear to be a trivial intervention when deaths due to disease and hunger persist and when international health experts have developed a “human suffering index” in order to rank places in intense need of global attention.4 And yet, unlike the forms of “disfigurement” treated via extreme makeovers and facial feminization, the phenomena of untreated congenital facial difference in particular parts of the world is both produced and exacerbated by structural violence—the political and economic arrangements that expose populations to harm. Ultimately, the persistent unavailability of necessary resources—medical care, medicine, clean water, or food—in parts of the globe due to enduring disparities underlies these largely preventable emergencies. Transnational facial work is conducted by several medical philanthropic organizations, but one in particular, Operation Smile, spearheaded the effort and has dominated the enterprise. The story of Operation Smile recounted on its website and in many media accounts about the organization begins in 1982 in the Philippines. During a trip with other medical volunteers, Dr. William P. Magee, a plastic surgeon, and his wife Kathleen Magee, a nurse and clinical social worker, encountered “hundreds” of children “ravaged by deformities.” After encountering such overwhelming need, the Magees founded Operation Smile. Through what the organization terms “medical missions,” free reconstructive surgery is provided to “indigent” children to repair facial anomalies.5 The most common facial anomaly treated is cleft lip and palate. Simply put, cleft lip describes an opening in the lip, while cleft palate refers to a gap in the roof and soft tissue of the mouth. Sometimes, cleft lip and cleft palate co-occur. While these congenital disabilities are fairly simple to repair using basic reconstructive techniques, cleft lip and palate have significant consequences if left untreated. For example, untreated 108 > 109 not, responded not only to the problem of cleft but also to the ways that problem was exacerbated by ongoing US military presence. In addition to providing surgery, Operation Smile offers physician training to local medical providers, dispenses referrals to US-based clinics , and provides support services, including speech therapy. US-based high school and college student groups sponsored by the organization build awareness about Operation Smile’s efforts in local communities and on campuses. According to its website, over 600 student organizations exist. In line with the growth of philanthropic tourism, active college students are invited to volunteer on medical missions as Patient Imaging Technicians.13 The organization also increases public awareness of cleft lip and palate through ads, which function to generate donations, in media outlets such as the Financial Times and National Geographic.14 As compared with medical tourism—travel from the “developed world” to less expensive destinations for elective or even long-term medical care—and bioprospecting—the extraction of native resources for commercial gain by health industries—Operation Smile represents a reverse biomedical flow.15 Instead of exporting resources from a vulnerable locale, Operation Smile invests locally. Both medical tourism and bioprospecting are highly problematic. Services and resources that could be used to meet basic health care needs are diverted from the public to the private sector, from local populations to relatively privileged recipients.16 And yet the reversal of these patterns is not without its own distinct complications. Because this site of facial work is a charitable international organization , its work is unique from other sites of facial work. Operation Smile, like other sites analyzed in this book, engages in technical work aimed at normalizing facial difference. But to complete this work it relies on donations and volunteer labor, and thus is also intensely invested in mobilizing public support for its missions. Given the fact that Operation Smile requires collective investment, it is imperative to ask: How does Operation Smile portray its work in order to elicit volunteer participation and donor dollars? Specifically, how is facial work represented and how is the disfigurement imaginary employed as Operation Smile continually negotiates its public image in...