Dr. Der Sarkissian regularly travels to underserved countries to offer his technical expertise and perform surgeries on children and adults. His travels have taken him to Ecuador, Ukraine, El Salvador, Armenia and Vietnam. He often returns to countries he has visited before to follow up on several occasions to follow up on previous years’ work and perform secondary and tertiary surgeries. He and his team often give lectures and offer hands on didactics to instruct local doctors on techniques they can use long after the team has gone. Many patients and their families travel from great distances by public transportation or even on foot to have access to care from the team of physicians from the US. The weeks spent away involve screening of 40-150 patients on arrival, identification of good candidates for surgery, health screening of those chosen for surgery, 12-16 hour days in the operating room followed by review of cases each evening. Success is measured in the appreciation of the patients and families who often bring home cooked meals, fresh fruit and flowers and in some countries, local vodkas and varieties of brandy to share with the American doctors. The medical mission trips are often exhausting with long distance travel to the Caucuses, Southeast Asia or Central and South America followed by busy work schedules. Despite operating long hours, each team member wishes they could do more and leaves knowing there is more work to be done. As Dr. Der Sarkissian notes “we get back so much more than we give” as the rewards of seeing a smile on a child’s face and the joy of their families is clearly worth the effort.