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How Seeing The Nonprofit As A Business Helps Smile Train Grow

This post was originally produced for Forbes.

Susannah Schaefer, CEO of the International nonprofit Smile Train, says, “It is a nonprofit, but it is a business.” This attitude for leading the enterprise guides much of what it does.

Consistent with the vision of the founder and Chairman, Charles B. Wang, the business started with a teach-a-man-to-fish model for providing free cleft-correcting surgeries to children in the developing world.

That approach has led to impressive scale since the enterprise was launched in 1999. Last year, 120,000 children were treated by Smile Train trained surgeons. Schaefer is quick to point out that about 170,000 cleft births occur each year in the developing world, possibly leaving 50,000 new children every year without needed treatment.

Still, 12 out of every 17 children–or more than 70%–who need treatment are receiving it from a Smile Train affiliated doctor or hospital. Schaefer says, “Smile Train works with more than 2,100 partner surgeons in more than 1,100 partner hospitals throughout 85+ countries around the world.”

With her business approach to service, she also notes that annual revenue for fiscal year 2015 was $156 million. The nonprofit employs just 65 people.

Schaefer says that the organization’s training empowers local doctors to treat their patients to the same standard of care used in the U.S.

Susannah Schaefer

“We have developed an innovative model to scale impact in a sustainable way and provide a response to more cleft children around the world. Smile Train leverages technology, such as our Virtual Surgery Simulator, an interactive, 3D simulation tool, to help train local surgeons in developing countries with information on cleft anatomy and surgical cleft repair techniques,” she says.

The approach also makes the organization more efficient and strengthens local communities. “Our teach-a-man-to-fish approach empowers communities to become less dependent on outside aid and provides a sustainable response to cleft treatment,” Schaefer says.

“A smile is universal,” she says, in an effort to explain the importance of the work they do. “A smile is the first communication with a parent.”

Clefts are more severe than has been communicated, she emphasizes. “A child sometimes can’t speak properly, can’t breathe properly, can’t eat properly.”

“Cleft repair is much more than a cosmetic issue. Many of these children are also socially isolated and unable to attend school. Treating a child’s cleft is a relatively simple procedure that has a life-changing impact on the child’s quality of life, as well as on their family and community in which they live.”

Malnutrition is a problem in the developing world that is exacerbated by clefts because children with clefts often struggle to eat.

Thomas Cronin, a Physical Education teacher at Pleasant Hill Elementary School in Lexington, South Carolina, was born with a cleft lip and palate, which were treated. As an adult, his parents introduced him to Smile Train. He has become a big fan, organizing the “Miles for Smiles mini marathon at his school to serve as a fundraiser.

After visiting Indonesia with the organization, he said, “I think that Smile Train needs to continue on the same path going forward. Their model is working. I was able to see it first hand.”

Christine Monahan, Laurie James-Katz with a rural Vietnamese patient

Laurie James-Katz is a speech language pathologist at Sylvan Avenue Elementary School in Bayport, New York, is also a supporter. She organized a fundraiser at her school that garnered $3,703. She says, “I think a major key to Smile Train’s success is that they put a clear amount on how much money it takes to complete one surgery. I think it is an attainable amount for many who are interested in fundraising. It is very special to know how many children’s lives were changed as a result of your contribution and fundraising effort. Knowing that each surgery costs $250 provided my students with the knowledge that they changed 14 children’s lives forever.”

Schaefer relishes the role of CEO and the issues that come with running the nonprofit business. She says, “I love this team. I love what we do. I love the challenges.”


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Devin is a journalist, author and corporate social responsibility speaker who calls himself a champion of social good. With a goal to help solve some of the world’s biggest problems by 2045, he focuses on telling the stories of those who are leading the way! Learn more at DevinThorpe.com!

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