Show Me That Smile


The following is the second in a series of guest posts by UNMC third-year medical student Eric Nagengast, who is taking a year off from med school to serve with the Program in Global Surgery and Social Change (PGSSC) at Harvard Medical School.

I have no need for an alarm clock in Guwahati. Like the roosters on the farms of Nebraska, the crows here alert everyone to the first sign of daylight around 4:45 a.m. At 5 a.m. the drivers begin bleating their horns on the street below, and by 5:30 a.m. the elder men of Guwahati clear their lungs, throats and sinuses with an aggressive, hacking cough. After years of breathing the Indian air, I probably would have to do that too, but the sound is certain to end any hope of a few more minutes of sleep.

I get up and efficiently use the 60 seconds of hot water my shower allows me each morning. A long hot shower is one of the things I miss the most about home. After a quick breakfast of one of the twenty protein bars I brought with me, along with some local fruit, I am out the door and thrust into all that is India.


The streets of Guwahati.

India has a way of overwhelming all your senses all the time. The first thing I notice is the thick, polluted air. I will never get used to it as it’s my least favorite thing about Guwahati. The air is so polluted that some members of the team use an inhaler. Next is the noise. On my walk to the hospital, I am honked at by rickshaws, cars, buses, motorbikes and bicycles. In India it is custom to honk anytime you are approaching another vehicle or a pedestrian. Since the streets are crowded with both, the result is continuous honking. Of course, I see plenty of things that would be completely out of the ordinary back home like monkeys, massive amounts of garbage or a fight between stray dogs.


You can imagine why everyone in the Delhi airport double-and triple-checked my connecting flight. Why would an American want to travel to this poor, isolated part of India?

When I step into the ward, I am reminded why I am here. The most deserving patients in the world fill the large room full of 40 hospital beds and today they will receive care they have waited many years for. The operating room in the Guwahati Comprehensive Cleft Care Center is just awesome! I learn so much assisting the expert surgeons here. There is not a center in the world that does more cleft operations.


Nagengast assists a surgeon from the Democratic Republic of Congo who spent four months at the center learning cleft surgery. Before arriving he had never done a cleft operation. The surgeon, who goes by Desi, is now back in the Congo providing care for his people.

Yesterday’s patients are being discharged and today’s are undergoing preoperative assessment. I look for patients to interview for our quality of life study. Our goal is to determine how living with a cleft affects the quality of life for a person and his or her family. I interview a 14-year-old boy and his father. This boy has a cleft palate. His father makes $3 a day mining coal. For 14 years, this boy has lived with a defect in the roof of his mouth that leaves his nasal cavity open to his mouth. You can imagine the difficulties this has caused with speech and eating among other things.

The next patient is a 40-year-old woman with a cleft lip. This woman has lived 40 years without seeing a surgeon for something that would have been fixed at three months of age in the United States. At the center, I have seen patients as old as 65 with unrepaired clefts. I will say it again; these are the most deserving patients in the world.

boybefore boyafter

Patients without access to surgical care exist in many parts of the world. It is not just cleft lip and palate that they suffer from, but also obstructed labor, injuries, appendicitis, and on and on. Most of you reading this probably have had at least one operation, and if not, someone close to you has. What would life be like if you did not have access to safe surgery?

The greatest advancement in surgery in the coming decades will not be a new, high-tech invention. Instead, it will be finding a way to deliver surgical care to the people who need it most, and I hope to be a part of this discovery.

A dinner party with the Guwahati team. Pictured are members from the United States, Puerto Rico, Colombia, Argentina, Spain and the Democratic Republic of Congo.

A dinner party with the Guwahati team. Pictured are members from the United States, Puerto Rico, Colombia, Argentina, Spain and the Democratic Republic of Congo.


  1. Lisa Spellman says:

    God bless you Eric.

  2. Soumitra bhuyan says:

    I grew up in Guwahati and still remains very close to my heart. Thank you for spreading the love.

  3. Kyle says:

    I love that you are helping so many people! This is truly inspiring and gives me an entirely new perspective on how unmc gives back!

  4. Great team!
    Keep doing this great job … every day that pass is getting better!

    A big hug.

  5. Marty Carter says:

    This is a very inspiring post. Continue to be a blessing to others. This really inspires me to help others who are less fortunate in my own way. What inspires me the most is you leave your comfort zone and decided to help others. Thank you!

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