The Boy Who Couldn’t Smile

Osawa was born looking different from most kids. Some people were cruel to him. His future looked bleak. But then one day, his whole life changed.

By Lauren Tarshis
From the September 2018 Issue

Students will synthesize information from two texts about children who have had surgery to repair their cleft lips.

Lexile: 700L-800L, 600L-700L
Guided Reading Level: S
DRA Level: 40
Topics: Social Issues,

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UP CLOSE: Synthesizing

As you read this article and interview, look for how an organization called Smile Train changes kids’ lives.

The Boy Who Couldn’t Smile 

In a quiet village in the African country of Tanzania, inside a small schoolhouse, a group of students sang with their teacher. As the kids’ voices rose up, their faces were bright and smiling. But in the front row, one boy sat glumly, his mouth barely moving, his eyes pointed at the floor. 

This was Osawa Owiti. He was 6 years old.

Osawa [oh-SOW-uh] had few friends. Many of his family’s neighbors viewed him with suspicion and even fear. Some said he was cursed.

What did Osawa do to deserve such a lonely life? Why did people treat him with such cruelty?

In fact, Osawa had done nothing. He was simply born looking different from most people. He had a condition called cleft lip, which means that his mouth and lip were misshapen. His upper lip rose up toward his nose. His front tooth poked out through his lip. The condition made it hard for Osawa to eat and speak.

Jim McMahon/Mapman®

High Costs

Each year, one out of every 700 babies are born with clefts. Doctors aren’t sure what causes them. But they know that the problem begins while the baby is still inside its mother’s belly.

Here in America, most babies born with clefts have surgery. Their mouths are repaired, their scars quickly fade, and they live normal lives. But around the world, millions of children with clefts never have them fixed. Almost all of these children live in areas of great poverty, where trained doctors and hospitals are scarce. In Osawa’s village, a person could live an entire lifetime and never once see a doctor.

Osawa’s parents are farmers. They grow corn and raise cattle on a small plot of land. Their one-room house is made of mud bricks and topped by a roof of grass. Even if they worked for years and sold almost everything they owned, they could never save enough money to pay for surgery to repair Osawa’s cleft.

Instead, they watched helplessly as their beloved boy suffered. Like most kids with clefts, Osawa struggled to chew, to swallow, and to pronounce certain sounds. Even worse: Many of Osawa’s neighbors were cruel. His cleft, they said, was a punishment from the heavens, a curse on his parents.

Tragically, such superstitions are common in many parts of the world. Children born with clefts and other differences are bullied and teased. Many families are so ashamed that they abandon their kids with clefts.

Stefano Levi/Courtesy of Smile Train

Osawa and his mother, Ada, wait together at the hospital in Dar es Salaam.

What Would Happen?

Osawa’s parents did not abandon him. Instead, they showered him with love and tried to protect him. They ignored their neighbors’ suspicious stares and cruel whispered comments. But their hearts broke. “Sometimes I couldn’t eat,” admits his mother, Ada. His father kept Osawa close. His grandfather shed tears when he spoke of his grandson. “Will he get married?” he wondered. “Will he get a job?”

Osawa’s family had every right to be worried. In many parts of the world, kids with clefts die young or end up begging on the streets. It was hard for Osawa’s family to imagine a happy future for their son.

But that was about to change.

About 700 miles away from Osawa’s village is the city of Dar es Salaam. There, a hospital called Comprehensive Community Based Rehabilitation in Tanzania (CCBRT) works closely with an international charity named Smile Train.

Smile Train has trained about 2,100 doctors around the world to perform cleft surgeries. Working with partner hospitals, Smile Train has provided free surgeries to more than
1 million kids worldwide.

Kids like Osawa.

Osawa’s parents first found out about Smile Train’s program through an ad on the radio. When they got more information about it, they were astonished to learn that the entire cost of Osawa’s surgery would be paid for. The hospital would even send a van and a driver to pick up Osawa and his mother and take them to Dar es Salaam—for free.

Courtesy of Smile Train

Osawa (in front) four years after his surgery. His life has been transformed by his surgery. Today he has many friends and he loves to go to school.

A Life Transformed

The bone-rattling ride to Dar es Salaam took many hours on Tanzania’s dusty dirt roads. Neither Osawa nor his mom had ever been to a big city before. The crowds. The skyscrapers.  The deafening sounds of beeping horns and screeching tires and rumbling motors. All of this was new.

Osawa gazed in wonder at the big-city sights. At the hospital, he was brave. He barely flinched during his blood test. He shook the hand of the doctor who would operate on him: Dr. Edward Wayi. When it was time for his surgery, he fought back his tears.

Osawa was given a medicine that put him into a deep sleep so he couldn’t move or feel pain. And then Dr. Wayi went to work. Using delicate instruments, he carefully pulled together skin and muscles, reshaping Osawa’s mouth like an artist creating a masterpiece. He mended Osawa’s lip, closing the wound with rows of tiny, invisible stitches.

Within an hour, the surgery was finished. And Osawa’s life was transformed.

When Osawa saw himself in the mirror for the first time after the surgery, he stared in joyful shock.

“My mouth looks so good!” he exclaimed. “I look like my friends!”

Today, four years later, Osawa is 11. Watching him laugh and play soccer with his friends, it’s difficult to imagine him as the glum little boy he once was. He has many friends now. When his teacher needs help, he is the first to leap up.

For Osawa and his family, there is much to smile about.

1,000 Reasons to Smile 

Helping other kids makes Ella grin

Ten-year-old Ella Pastorelli of Greenlawn, New York, knows she is lucky. Born with a cleft lip, she had surgery to fix it when she was just 4 months old. But for many families outside the United States, the cost of this operation—about $250—is an impossible amount.

So each year on her birthday, Ella and her family set up a lemonade stand to raise money for Smile Train. In 10 years, Ella’s Lemonade Stand has raised $250,000 for the organization—enough to repair more than 1,000 smiles. Here’s what she says about it.

Courtesy of Pastorelli Family

Your parents started this fundraiser for Smile Train when you were just a baby. Why do you choose to keep doing it on your birthday every year?

We really just want to help more people. Thankfully, our family had enough money for cleft surgery. But some families don’t, so we want to raise money for them.

What has been the most rewarding part of raising money for Smile Train?

I think that I get the privilege to help other people. And I just feel more thankful every year for what I went through and how it wasn’t that bad.

How does it feel to have helped change so many kids’ lives?

I feel needed and important. And that just makes me very, very joyful and glad.

What are your goals for the future of Ella’s Lemonade Stand?

I hope to continue the lemonade stand when I’m older. And I want to travel to other countries to help other children with clefts in person.

What advice would you give to kids
who want to make a big difference in
the world?

If you do a little thing like a lemonade stand—like how my family and I started out—that can make a huge difference as the years go on. People will start learning about it. You can make a difference in the world so easily sometimes.

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More About the Story


synthesizing, vocabulary, summarizing, author’s craft, compare and contrast, key details, inference, analyzing, narrative writing

Complexity Factors


Through the experiences of two kids, one in Tanzania and one in the U.S., the articles explore the challenges of living with cleft lip and introduce a charity that provides free cleft surgeries to children in need.


The first article is mainly narrative, with informational passages woven throughout. The second is presented in a question-and-answer format.


The first article includes some challenging vocabulary (e.g. poverty, scarce, superstition), as well as figurative language like metaphors and rhetorical questions. The second is mainly conversational.

Knowledge Demands 

The first article takes place in Tanzania. Some background knowledge of developing countries may be helpful, but is not required.

Content-Area Connections

Social studies: geography, world cultures

Science: health

Social emotional learning: empathy, taking action

Step-by-Step Lesson Plan

1. Preparing to Read

Preview Text Features and Vocabulary (15 minutes)

  • Have students turn to page 15, or project the page for them to see. Call on a student to read the headline and subhead. Explain that the boy in the picture has a condition called cleft lip. Invite students to predict how “his whole life changed.” Note: If students respond negatively to the boy’s appearance, ask them to imagine how it would feel to have people mock how you look. Explain that the article will help them understand the boy’s situation. 
  • Then have students glance at the interview on page 19. Ask them how they think the interview is related to the article. Have a volunteer read aloud the Up Close box on page 15. 
  • Distribute the vocabulary activity to introduce challenging words in the text. Highlighted words: glumly, suspicion, cleft, misshapen, poverty, scarce, superstitions, abandon, flinched

2. Close Reading

Read and Unpack the Text (45 minutes)

Read the article and the interview as a class. Then put students in groups to answer the close-reading and critical-thinking questions

Close-Reading Questions

  • What do you learn about Osawa in the first section of the article? (summarizing) You learn that he had a condition called cleft lip, which made eating and speaking difficult. The condition made him unhappy, and people treated him with cruelty and suspicion.
  • Reread the fourth and fifth paragraphs. Why do you think the author asks questions and then answers them? (author’s craft) The questions in paragraph 4 suggest that perhaps Osawa had done something to deserve cruel treatment; the answers in paragraph 5, showing that he hadn’t done anything, make such treatment seem even worse. They help readers have more sympathy for Osawa.
  • Reread the sections “High Costs” and “What Would Happen?” How does being born with a cleft lip in the U.S. differ from having the condition in some other parts of the world? (compare and contrast) In the U.S., most babies with clefts have them repaired and they live normal lives. In parts of the world with high poverty, the surgery is much too expensive to afford. The children are often thought to be cursed, and some are abandoned. Many die young or end up begging on the streets.  
  • What does Smile Train do? (key details) Smile Train trains doctors around the world to perform cleft surgeries and provides the operation for free to kids who need it.
  • When Osawa first saw his mouth after the operation, he said, “I look like my friends!” Why do you think this was important to him? (inference) Osawa had been excluded and treated terribly because of the appearance of his mouth. Looking like his friends meant he would fit in and be accepted, which is something everyone wants. 
  • Reread the introduction to “1,000 Reasons to Smile.” How was Ella’s situation similar to Osawa’s? How was it different? (compare and contrast) Ella and Osawa were both born with cleft lips. But Ella had surgery when she was 4 months old, so for most of her life she had no physical problems from the condition, and she was never teased about it. Osawa had difficulty eating and talking, and he suffered loneliness and cruelty. He had surgery when he was 6 years old.
  • Based on the interview, why do you think raising money for Smile Train is especially important to Ella? (synthesizing) Ella’s answers show that she is grateful her family could afford the surgery she needed, and she wants other kids to get the same treatment she did. Helping other people makes her very happy. 

Critical-Thinking Questions

  • In what ways has Smile Train affected the lives of both Osawa and Ella? (synthesizing) Smile Train has given Osawa the opportunity to live a normal life, have friends, and be accepted in his community. It has provided Ella with a way to help other kids and turn her compassion into action.
  • At the end of the interview, Ella says, “You can make a difference in the world so easily sometimes.” Do you agree? In what ways might you make a difference? (analyzing) Answers will vary.

3. Skill Building

Featured Skill: Synthesizing

Distribute our synthesizing activity and have students complete it in pairs. Then have the pairs use their responses to the activity to write an imaginary conversation, as described in the writing prompt on page 19.

 Make a Book Connection! As an additional pairing, have your class read Wonder by R.J. Palacio. Invite students to talk or write about how Auggie’s experiences are similar to Osawa’s. 

Another related book is Words in the Dust by Trent Reedy, about a 13-year-old girl in Afghanistan who, with the help of American soldiers, undergoes cleft-palate surgery. (We recommend reading the book yourself first to make sure all content is appropriate for your students.)

Differentiate and Customize
For Struggling Readers

After reading the lower-Lexile version of the article, gather students in a small group and discuss how Osawa’s life changed from the beginning of the article to the end. Together, make a chronological list of the events that caused Osawa’s life to change. 

For Advanced Readers

Have students explore more stories like Osawa’s by going to and clicking on “Our Stories” then “Patient.” Invite them to choose one of the children they read about there and write an article about him or her, using the Storyworks article as a model.

For ELL Students

Remind students that most past-tense verbs in English end in -ed; look through the article together to find examples. Then put students in pairs to complete a scavenger hunt for these irregular verbs: sang, sat, rose, made, found, took, and fought. Regroup to discuss the present tense vs. past tense of each one.  

For TEXT Reading

Give students the option to read this feature during independent reading time. Check comprehension by having a brief conference with them, or by asking them to complete the higher- or lower-level summarizing activity.