Our Missions

During our missions, we work with local leadership and medical professionals to not only transform our patients’ lives, but also use our time as an opportunity to help train their providers, so that they can be empowered and become more self-sustaining.

We value our relationships and believe working together, hand in hand, creates a solid model for a lasting impact not only for their patients, but also their economy.
Treating those in need, whether it is a hand abnormality, or a burn scar so thick that the limb is immobilized, or a cleft lip and palate, improves the patient’s quality of health and enables them to be productive, contributing members of their communities.

Fun Fact!

In the years 1996 – 2011, we treated 102 children with cleft lip and palate. Helping those patients prevents somewhere between 400 – 1000 total years of disability for a local community. And that, in turn, generates between $4.7 – $27.5 million dollars in economic impact!
The number is likely closer to the $27 million estimate. That means that each surgical week Hands Across the World is in Ecuador, that generates about $1.7 million.

View Patient Stories

These are all reasons why we continue to do what we do.
It shows what we can do to help the lives of others.
In some cases, it gives patients a second chance in life!


The dropdowns below provide the annual summaries written by our co-founder, Dr. Rick Silverman, regarding trip experiences. Additionally, there is a link to a paper published in the American Society of Plastic Surgeons’ Plastic and Reconstructive Surgery journal, which was written by several HAW Board members.

*Will be adding 2023 mission summary*

2018 Ecuador Mission Summary
Richard, Silverman, M.D.

This year we carried out our surgical mission in Latacunga, Ecuador from February 3 – February 11, 2018. We had a very successful trip with 24 team members providing surgical care for 84 patients. We evaluated nearly 150 patients through the week.

We did multiple major procedures which included a number of congenital and traumatic hand patients, burn reconstruction and cleft lip patients encountered. Minor procedures and non-surgical scar management were also performed. No major complications.

2017 Ecuador Mission Summary
Richard, Silverman, M.D.

This year we carried out our surgical mission in Coca, Ecuador at the Hospital of the 4th Amazon Division.  We had a very successful trip with 26 team members providing surgical care for 125 patients.  We evaluated nearly 200 patients through the week, most of them being seen on the first day, Sunday, April 30.  Surgery was performed on Monday through Friday.  There was a number of new cleft lip patients encountered, in part due to the more remote location of our intake clinic.

The most impressive patient of the week was a 35-year-old man, who presented with a recurrent left facial mass nearly the size of his head.  He’d had a pleomorphic adenoma of the left parotid gland excised three years earlier, and it came back with a vengeance.  We were able to get a CT scan, which gave us a little bit of anatomic information, and we were able to successfully remove the mass.  And the good news was that his facial nerve function remained intact.  Now we are trying to help to arrange for radiation therapy to reduce the risk of recurrence.

We purchased a number of items that have enhanced our work, including fat grafting instruments ($2425) and a new headlight ($2750). The headlight is used on every trip, as the lighting in the hospitals is not always reliable, and we also are able to utilize unconventional spaces to do our minor cases (such as an alcove in the operating room, which is typically used for equipment storage!).  The fat grafting instruments have been useful to do minor fat grafting to facial contour deformities (as well as other sites as needed).  Fat harvesting instruments have also been used to debulk occasional flaps that we encounter from previous surgical repairs that have left a result that has a higher profile than desired—for example, a flap on the foot, which was too bulky to allow for a shoe to be worn.  Other purchases include new software to help with our record-keeping, and we are purchasing a new monitor in the coming year to replace an older one which is beyond salvage ($5000 – $10,000, currently investigating options).

In addition, we are investigating the purchase of a portable anesthesia machine, which may allow us to return to Latacunga. We have found that a few of the facilities that could host us only have a single working anesthesia machine, even though space is adequate for more than one general anesthetic room.

2016 Ecuador Mission Summary
Richard, Silverman, M.D.

Hands Across the World took part in a mission to Coca, Ecuador from  January 16 – 24, 2016.  During our intake clinic, we evaluated over 200 patients, and in the course of our five days of surgery, we performed operations and some other non-surgical interventions on 125 patients.  This included surgeries to address cleft lip and palate, as well as their sequelae, along with some hand procedures, other congential deformities of the head and neck, correction of burn scar and other post-traumatic deformities, and for our third year, we offered podiatry services.  We had no major complications through the week in spite of a record number of patients treated.

We are looking into the purchase of a portable autoclave and a new portable anesthesia monitor to replace one that is no longer functioning.

2015 Ecuador Mission Summary
Richard, Silverman, M.D.

Hands Across the World took part in a mission to Latacunga, Ecuador, from January 31 – February 8, 2015.  We evaluated over 200 patients and provided procedures to 118 patients, including craniofacial procedures for treatment of cleft lip and palate as well as microtia.

This year, we performed three stage 1 ear reconstructions, two using rib cartilage graft and one using a medpore (Porex) framework, which had been donated.  We are also doing a number of hand and lower extremity procedures, and treating burn scars as well as various soft tissue lesions and scar excisions.

Our mission was conducted at the Social Security Hospital in Latacunga (IESS) with 28 participating surgeons, nurses, techs, and our speech therapist.

Overall, a very successful mission.

2014 Ecuador Mission Summary
Richard, Silverman, M.D.

Hands Across the World took part in a mission to Coca, Ecuador, January 31 – February 9, 2014. We evaluated between 250 and 300 patients and provided procedures to 121 patients, including the typical array of craniofacial procedures for cleft lip and plate, ear reconstruction, rhinoplasty (congenital and traumatic), hand procedures, and this year, we offered podiatry procedures. In addition, speech therapy and evaluations were carried out with all of our cleft lip and palate patients including those who have had surgery in the past as well as current surgical candidates.

We did multiple major procedures as well as numerous minor procedures and non-surgical scar management. We had no major complications.

Based on funding provided through a grant, we acquired a new headlamp as well as fat grafting instruments, both of which we used during the trip.

2013 Ecuador Mission Summary
Richard Silverman, M.D.

We have just returned from another productive surgical mission to Ecuador, which involved more than forty of our own volunteers, along with assistance from many local individuals in Coca and Latacunga. Our two-week mission began with a flight from Quito to Coca, provided by the Ecuadorian army, followed by a week of work in the Military Hospital of the 4th Division in Coca. There, we evaluated over 200 patients, and provided surgical care to 112 over five days of operating. In spite of 5 to 8 power-outages each day, the cases proceeded uneventfully, with team members quickly donning battery-powered LED headlights and springing to assistance with flashlights each time the hospital went dark. The week ended with a surprise, when we were informed that our flight back to Quito had somehow been arranged for Sunday, rather than Saturday. Volunteers returning to the States made a mad dash for the airport to catch the last commercial flight of the day, while additional volunteers found themselves on a bus to Quito. Luckily, that group made their connections, while the group heading for a second week of work in Latacunga opted for a guaranteed bus-ride to Latacunga in lieu of less than certain air transport the following day. What was billed as a 6-hour trip lasted 9 hours, and our arrival in Latacunga at 4 AM wasn’t the best way to start the second week. All agreed, however, that we were happy to have arrived in time to meet our patients, as scheduled, on Sunday morning.

During our second week, we evaluated over 150 patients, and provided 85 surgical procedures and scar treatments, as well as speech therapy for our cleft lip and palate patients. One of the highlights of the second week was a “pollicization,” in which the index finger of a young boy born without a normal thumb, was repositioned and re-purposed to function as his thumb. Additionally, through the two weeks, we operated on numerous cleft lip and palate patients, a number of patients with absent or abnormal ears, a variety of other hand issues, both congenital and traumatic, and many patients with scars from burns and other injuries.

The work that we’re able to do is dependent on the efforts and generosity of many individuals, including members of the social service organization, Fundacion Solidaria de Orellana in Coca, and members of the Latacunga Rotary Club. The local support that we receive in Ecuador is invaluable, and it is, in part, one of the reasons our program has had such success for over 20 years. Additionally, many friends and family provide gifts of money, supplies, as well as toys and clothing, that we share with our patients. It is due to this sort of generosity that we are able to continue this work, and for that, we thank you.

In looking forward to next year, we plan to work in Coca from February 2 to 8, returning to a one-week mission to give some of our volunteers a little rest from the longer missions. Undoubtedly, however, we will be able to accomplish a great deal in that week. Please check our website,, to see updates, to view the trailer to a documentary, which is still in production, and to make a donation. Your donations are invaluable in supporting our missions, allowing us to provide what we consider routine care that otherwise might not be available to people in Ecuador. Our gratitude for your support is immeasurable.

2012 Ecuador Mission Summary
Richard, Silverman, M.D.

Hands Across the World took part in a mission to Latacunga, Ecuador, from February 2 – February 12, 2012.  We evaluated over 165 patients and provided procedures to 77 patients, including craniofacial procedures for treatment of cleft lip and palate, hand abnormalities and burn reconstruction.  We also treated multiple minor procedures.

Our mission was conducted at the Social Security Hospital in Latacunga (IESS).

A productive and successful mission.

Why We Do What We Do
by Rick Silverman, M.D.

Evelyn was one of the cutest babies I’d ever seen. The small split in her upper lip somehow failed to diminish her infantile beauty, though left un-repaired, it would have eventually resulted in social stigma and perhaps a life less productive and less meaningful than it would otherwise be. As such, she was destined to a challenging life of poverty with little chance for upward mobility, a fate she shared with many who populated her small town south of Quito, the Ecuadorian capital. The visible cleft in her lip, as well as the less obvious cleft in her palate would shape her early life more than just about anything else this small baby would experience prior to reaching puberty.

So often I’ve been asked why there are so many of these children with cleft lip and palate in Ecuador, and there are reasons why so many of these children flock to surgical missions like ours. But the main reasons are because they are poor, because they have some genetic predisposition, at least in most cases here, and because without groups like ours to do the surgery, many of these children would spend their lives hidden in the shadows of society. And the next question is frequently directed at the role Ecuadorian plastic surgeons play in the lives of these children, if any. Indeed, over the years we have gotten to know many very generous Ecuadorian surgeons, who donate their time and even costly supplies to provide for the underserved among their fellow citizens. But even if they don’t charge for the surgery on a routine basis, the patients could hardly afford to buy the ingredients to the surgery—the sutures, the blades, the intravenous fluids and antibiotics, the pain medication—all of the necessities of an operative procedure. These supplies could cost one or two years worth of hard-gained earnings, an impossibility in this often subsistence-level society.

Local plastic surgeons do what they can, but this may also an involve an invitation, like the one to which we first responded about eighteen years ago, to come with a small team, to bring supplies, surgeons, nursing staff, and to share in the opportunity to care for the children of Ecuador. We answered the invitation with a resounding yes, and now for eighteen years, we have been coming to be with our dear friends—our family in Ecuador—and care for our children. These are our patients, who come to us year after year after year, like Evelyn. I saw her, a couple of months old, and I thought I would enjoy watching her grow up. And I have. I remember her second visit with us, when we repaired her palate.  Her face was changing, she was no longer a baby, more a toddler, and she was still just about small enough to control. But not the following year. I remember hearing her cry while being examined. That wasn’t unusual, of course, because so many of our patients are small children, and they don’t understand the purpose and meaning of our actions. They only know they are being poked and prodded, and Evelyn had had just about enough. The adorable baby in the white bunny suit, donated by some caring soul in central Massachusetts, was no more. Evelyn was a little girl, and she was having none of it!

That visit yielded a smaller surgery to repair a residual hole in her palate called a fistula, that occurs all too commonly after these operations, and can contribute to speech problems as well as food and liquid coming out of the nose.  In fact, with smaller defects, where speech is unimpaired, we will often not treat the fistula, since it is frequently very far forward in the mouth, and would normally be repaired when the patient is ready to have some bone put into the cleft to allow dentition to develop properly.  The normal course of events includes orthodontic treatment prior to bone grafting, and since so many of these children will never have the orthodontics, we put the bone in and repair that last little open area only rarely on our trips. In Evelyn’s case, it’s unlikely that she’ll ever get braces, so she’ll never have the bone grafting done either. In fact, her fistula repair when she was two was the last surgery she had until this year.

At nine, Evelyn is a bright little girl. She has the facial appearance typical of many of these children, with some flattening of her midface, some thickening and shortening of her upper lip, as well as the scar that is readily apparent. She doesn’t have a problem with a fistula anymore, but she continues to have difficulty speaking, with lots of air coming out of her nose during speech, described by the term “velopharyngeal insufficiency” or VPI. Her palate was repaired originally in a way that usually produces a long palate, in order to prevent VPI, but in her case, the palate is short and doesn’t move very well. Based on her examination, she is scheduled for a procedure called a posterior pharyngeal flap. This operation raises two opposing flaps in the back of the throat and sews them together to create a blockage in the back of the pharynx to prevent the air from going out through the nose. If this sounds like it would hurt, it should—and it does. There’s a raw area on the throat afterwards, which results in the worst sore throat you could imagine.

The surgery is uneventful. In the recovery room after the surgery, Evelyn makes little noise. She’s old enough to realize that crying will just make things hurt more, and like so many of these children, she is very stoic. Although we try to explain to the patients and their families what we are doing in a procedure like this, it’s not very likely that they understand fully, but she knows that her throat is very sore. In the meantime, I pulled up her photos from her original lip repair to share them with newer members of the group, many of whom are on their first mission. Someone asks me if I can print the photos for Evelyn and her mother, and I go about doing that as the nurses prepare to transfer Evelyn to the ward to recover further. As her stretcher is wheeled past the desk where the computer and printer sit, I take the freshly printed copy of this adorable baby—with and without her cleft lip—and hand it to the young girl, who has been lying so quietly, afraid to make a noise lest it worsen her pain. At first, I think she is going to smile when she sees the photos, but her smile turns into tears, as she hands the photo to her mother, now also crying. Are these tears of regret for this child who might have been born perfect, avoiding the struggles she’s had to look and sound like her friends? Are they tears of thanks that somehow they’ve been provided with the care to repair the defects with which she arrived in this world? My Spanish isn’t good enough and the moment isn’t right to try and determine that. And it’s all I can do to try and reassure both of them without breaking into tears myself.