The Butterfly Foundation is a nonprofit organization focused on teaching spinal deformity surgery in developing countries. The primary site has been the Dominican Republic, with similar projects annually in Chile, Jamaica, Malawi and Vietnam. The first trip to the Dominican Republic was in March 2003. The pattern for following trips includes and established deformity surgeon working alongside a local surgeon as well as didactic lectures and saw-bone workshops. Missions are done on a quarterly basis (over 20 to date) and last one week. Teams consist of academic spinal deformity surgeons, anesthesiologists, nurses, OR techs, perfusionists and neurophysiologists. Local "fellows" have been selected at each site for focused training. More than 350 patients with severe spinal deformities have been treated.