She came in for evaluation, head down, lacking confidence but filled with hope that maybe these people who came from America might be able to help her speak. Silvia was born with a cleft lip and palate. She was unable to have either birth defect corrected until she was in late childhood. It was not until she was 11 years of age that she found a visiting Interplast surgical team from the U.S. and could get these defects corrected. By that time the pattern of social rejection and debilitating speech was well established.