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Stanford Report, May 29, 2002

A frequent traveler to Cuba is honored for surgical work and an award-winning film


On the face of it, Yank Tanks is a documentary about cars -- big old American Cadillacs and Buicks that cruise the sun-bleached streets of Havana like a museum on parade. But dig a little deeper and it becomes clear that these automotive behemoths are merely an excuse for a movie. The real story is Cuba.

Not that plastic surgeon Stephen A. Schendel, MD, the movie's co-producer, needed an excuse to travel there. Once a year for the past five years, he's visited Havana to operate on children and instruct local doctors in the advanced techniques of the maxillofacial surgery that he performs as chief of plastic and reconstructive surgery at the medical center.

Schendel examines one of his young patients at Juan Manuel Marquez Hospital Pediatrico in Havana. He has made five trips to Cuba to provide state-of-the-art plastic surgery to children.

Along the way, he has brought a hospital anesthesiologist, a pediatrician and several nurses. Then, a few years ago, he brought his brother, David, a recent film school graduate, with the idea of filming the medical work. The decision led, ultimately, to the making of Yank Tanks, winner of this year's Audience Award for Best Documentary at the Cinequest Film Festival in San Jose.

Schendel has his own reasons for returning. Impelled by a desire to help people in dire straits, he began donating his expertise with Interplast, a nonprofit organization that sends volunteer medical teams to developing nations to perform reconstructive surgery. Schendel, who specializes in treating children at Lucile Packard Children's Hospital, has traveled to other countries, too, but Cuba repeatedly has drawn him back.

Partly, he's attracted by the simplicity of working directly with patients, without the shadow of a large medical system over him -- "to get away from our big health-care system with all the insurance problems," he said. "It's always nice to work as just doctor and patient."

He eventually took to funding his own way and recently filed for foundation status to support his work there. The biggest problem is medical supplies. On his latest visit, he brought 20 crates of materials, including medication, gauze, dental supplies and an electric drill.

Then, when he saw that five medical students were sharing the same stethoscope, Schendel gave his own away.

Despite the supply problem, he said local physicians are well trained. "In Central America, we'd do cleft palate surgery on 100 to 200 children in a week or two," he said. "But in Cuba, there's a good regional system and so they take good care of those kinds of problems. What they lack is knowledge of the newer techniques."

Chief among the techniques Schendel has introduced is jaw distraction, a minimally invasive procedure to correct an undeveloped jawbone. Like many problems in Cuba -- medical, economic and otherwise -- a surfeit of cases of mandibular hypoplasia reflects political reality. The small jaws he sees in Cuba are the result of an infection of the jaw joint rarely seen in the United States because of aggressive antibiotic treatment.

Until recently, the condition was typically corrected with multiple surgeries that included wiring the jaw and making bone grafts. Jaw distraction, by contrast, is a one-stage operation in which the jawbone is cut and an appliance called a distractor is anchored to each end of the bone. Over two weeks, the space between the bones is gradually increased, allowing new bone to slowly grow. Schendel is an internationally recognized expert in this technique, and Packard Children's Hospital is one of the main U.S. centers for the procedure.

Whenever he operates in Cuba, Schendel insists on using a dual team of American and Cuban doctors, as well as televising the surgery to an auditorium full of medical personnel. "A lot of what we do is education," he explained.

He has also helped organize an international conference, cosponsored with Stanford, in Havana this November. The First International Symposium on Maxillofacial Surgery is expected to bring 300 to 400 specialists from around the world, including the medical center.

His patients at Packard recognize his wanderlust, if a mother's thank-you card is any indication. "Dr. Schendel," it reads, "You could go to the end of the world and a few places in between as long as I know you'll be back."

Neurobiology professor volunteers services so budding scientists can learn (4/10/02)

Packard physician still focused on community after 30 years of grassroots service (5/1/02)