MAKING THE USNS COMFORT A SUCCESS

UNCLAS GEORGETOWN 000455

SIPDIS

SOUTHCOM FOR ADMIRAL STAVRIDIS FROM AMBASSADOR ROBINSON


SENSITIVE
SIPDIS

E.O. 12958: N/A
TAGS: EAID MASS MOPS PREL TBIO XK XL GY
SUBJECT: MAKING THE USNS COMFORT A SUCCESS

REF: A) USNS Comfort CONOP 1 Mar 2007
B) COMUSNAVSO DTG 022232Z May 07
(PDSS Country Clearance Request)
C) COMUSNAVSO DTG 041756Z May 07
(Comfort Operations Order)


1. (SBU) Summary: Guyana's capital and populated coastal areas
benefit from one of the more impressive primary health care delivery
systems in the low-income world. On the other hand, Guyana's
hinterland areas are in great need of the primary health care
services the USNS Comfort's ashore team could provide. Guyana is
also a sophisticated consumer of foreign medical assistance. In
order for the Comfort's mission to be successful at sending a strong
message of U.S. compassion, support, and commitment, the Comfort
will have to be seen to accomplish significantly more than the Cuban
medical brigade or a visiting U.S. church group. In Guyana, the
requirement that the USNS Comfort's medical personnel not travel
further than sixty minutes from the ship and that they be aboard
ship from dusk to dawn makes it difficult to achieve the President's
objective of providing health care to those who most need it. If
the Comfort comes to Guyana, the Country Team will do its utmost to
ensure its visit is seen as a success. However, we reluctantly
conclude that in Guyana a combination of general and surgical
MEDRETEs would be a more effective vehicle than the Comfort for
reaching the targeted underserved population. End Summary.


2. (U) The Guyanese people and government welcomed President Bush's
announcement that the Comfort's visit to Guyana would aid "people
who might not otherwise get the basic health care they need to
realize a better tomorrow" and that military medical teams will be
operating inland to help bring treatment and care to those who need
help.


3. (SBU) As a focus country of President Bush's Emergency Program
for HIV/AIDS Relief (PEPFAR),health diplomacy is a cornerstone of
this mission, occupying a major portion of this Embassy's staffing
and budget. The experienced medical professionals in our CDC and
USAID offices enjoy easy access to all levels of the medical sector,
from the Minister of Health to midwives in hinterland medical
outposts. In planning for the visit of the Comfort, Ministry of
Health officials told us at every juncture that the Comfort's
services are most needed in the remote areas far from the capital, a
conclusion shared by the Country Team.


4. (U) The Government of Guyana boasts, not without reason, that it
has one of the better primary health care delivery systems in the
low-income developing world. Indeed, Guyana has a childhood
immunization rate as good as the United States. Guyana is also a
sophisticated consumer of foreign medical assistance. In addition
to benefiting from PEPFAR--the largest health diplomacy program in
history--Guyana hosts medical assistance programs from Cuba, China,
and Nigeria. The Cuban medical brigade alone has 62 doctors and
medical professionals. There is also a continual flow through
Guyana of medical teams from U.S. and Canadian universities, NGOs,
and church groups. For example, last month a two-person University
of Mississippi team screened 100 children with cardiac complications
and performed digital catheterizations on nine of them. Missionary
medical missions to hinterland areas routinely provide primary
health care for 800 to 4000 people.


5. (U) The Guyanese have an appropriately high level of expectation
for the United States military. The Minister of Health (and many
other officials and several reporters) learned from U.S. military
websites that the USNS Comfort's facilities include twelve operating
theatres, 1000 hospital beds, and two UH-60 helicopters. Guyana's
expectations for the Comfort have been further increased by these
impressive sounding numbers.


6. (U) In order for the Comfort's mission to be successful at
sending a strong message of U.S. compassion, support, and
commitment, the Comfort will have to be seen to accomplish
significantly more than the Cuban medical brigade or a visiting U.S.
church group. In Guyana, the Comfort's primary health care services
should be aimed at the desperately poor and underserved hinterland
populations without access to medical care, rather than focusing on
urban/suburban populations who have free access to adequate
government-provided primary care and paid access to private
providers. Surgical care should concentrate on complicated cases
beyond the capability of Guyana's urban hospitals or on the large
backlogs of routine surgeries at remote regional hospitals.


7. (SBU) As requested in the Comfort's ConOp and Pre-Deployment Site
Survey (PDSS) country clearance message (refs A and B),our USNS
Comfort working group arranged in-country air travel to remote sites
for the PDSS and overland transport to local clinics and treatment
facilities. However, while the PDSS team was in Guyana, the
Comfort's Operations Order (ref C) announced that medical activities
will be conducted during daylight hours only and no medical
personnel will remain ashore overnight. The PDSS team explained
that the Comfort's ashore team will be restricted to a strict
60-minute radius from the Comfort. Since the Comfort has to anchor
15 miles (45 minutes) off shore, that restricts primary health care
delivery and Seabee community relations projects to a 15 minute
radius from central Georgetown--the area with the least need in the
country. It also makes continuing medical education impossible
unless we pull physicians away from their daytime patient care
responsibilities.


8. (SBU) Guyana's surgical needs are two-fold: doing the complicated
cases beyond the capability of Guyana's urban hospitals (e.g.,
complex burn care and congenital deformities) and working on the
large backlogs of routine surgeries at remote and understaffed
regional hospitals. We learned from the PDSS team that there will
be only 20 patient beds plus a 12 bed recovery unit and a small
intensive care unit available on the Comfort to support the four
functioning operating theaters. Thus, if each patient requires two
or three days of on-board recovery, the lack of beds will restrict
the Comfort to 40-70 surgeries during its week-long call in Guyana.


9. (SBU) The Country Team also has serious unresolved concerns about
contingency planning for patients who suffer complications or who
are not stable enough to transport when the Comfort departs. The
deputy Minister of Health readily agreed that public sector
practitioners would assume full responsibility for all
post-operative care, suggesting that he might rent a warehouse to
set up recovery beds for the surge of patients needing postoperative
care. However, we must remember that these patients will receive
their surgeries on the Comfort because the local medical
infrastructure did not have the expertise and/or capacity to care
for them. We cannot assume that local hospitals will be able to
manage follow-up care for patients who suffer complications but who
must be off-loaded before the Comfort sails to its next port.

--------------
Recommendation
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10. (SBU) If the Comfort comes to Guyana, the Country Team will do
its utmost to ensure its visit is seen to be a success. However,
the Country Team's reluctant conclusion is that with its existing
restrictions, the USNS comfort might not be an appropriate mechanism
for humanitarian assistance/health diplomacy in Guyana. It might be
more appropriate to use this resource in locations where the
Comfort's restrictions do not interfere with delivery of service to
the targeted unserved populations. The fact that mud flats will
force the Comfort to anchor 15 miles offshore in an area of rough
seas could provide a convenient rationale for canceling the Guyana
stop.


11. (SBU) If the Comfort is not able to come to Guyana, we could
achieve significant public diplomacy objectives by identifying a
handful of high-impact surgical cases to send to Trinidad for
surgery on the Comfort during its stop in Port of Spain.


12. (SBU) As an alternative to the Comfort visit, Country Team
suggests SOUTHCOM program MEDRETEs for Guyana. General
multi-medical specialty MEDRETEs covering primary medical care,
immunizations, dental and veterinary activities would have major
impact in hinterland areas. Specialty surgery MEDRETEs could have a
major impact in clearing long surgical backlogs in remote hinterland
hospitals serving the indigenous population, and in helping with
complex cases the Georgetown hospitals are not able to handle. The
Mission's Humanitarian Assistance Program could support four
MEDRETEs a year.

Surgical Needs That Could be Met by MEDRETEs at Regional Hospitals
in Lethem, Charity, Suddie, Bartica, Skeldon:
- GENERAL SURGERY: Acute trauma, surgical emergencies, gallbladder
disease, hernias, thyroid diseases, tonsillectomies, general surgery
cases (breast and colon cancer, lumps and bumps, hemorrhoids, etc.)
- HAND SURGERY: Acute hand injuries
- OPHTHALMOLOGY: Cataract, strabismus, reconstructive orbital and
lid surgery.
- OTOLARYNGOLOGY: mastoidectomies to control chronic middle and
inner ear infections, hearing aids, trauma surgery.
- PEDIATRIC ORTHOPEDICS: acute trauma
- UROLOGY: urinary tract stones, trauma

Surgical Needs That Could be Met by MEDRETEs at Georgetown
Hospitals:
- HAND SURGERY: old hand injuries including nerve, and tendon
reconstruction.
- OPHTHALMOLOGY: reconstructive orbital and lid surgery.
- OTOLARYNGOLOGY: Tympanic membrane reconstruction, mastoidectomies
to control chronic middle and inner ear infections, hearing aids,
trauma surgery.
- PEDIATRIC ORTHOPEDICS: Correcting hip dysphasia, clubfoot,
congenital malformations.
- UROLOGY: Urethra stricture reconstruction, pediatric congenital
urinary tract malformations, female incontinence.

ROBINSON