IS THERE A DOCTOR IN THE HOUSE? HEALTH MINISTER

C O N F I D E N T I A L SECTION 01 OF 02 MANAGUA 002495 SIPDIS SIPDIS STATE FOR WHA/CEN AMD FOR WHA/FO-GSNIDLE STATE ALSO FOR PM-A/DAS RICHARD KIDD AND PM/WRA-MARK ADAMS SOUTHCOM FOR FPA E.O. 12958: DECL: 11/26/2017 TAGS: PGOV TBIO PARM MASS NU SUBJECT: IS THERE A DOCTOR IN THE HOUSE? HEALTH MINISTER RESIGNS UNDER PRESSURE REF: MANAGUA 2376 Classified By: Ambassador Paul Trivelli for reasons 1.4 b&d ¶1. (U) Summary: On November 6, Nicaragua's Minister of Health, Dr. Maritza Cuan, tendered her resignation in what appears to have been a palace coup engineered by Vice-Minister Guillermo Gonzalez. Over the prior several weeks, Cuan had come under increasingly public and high-level criticism, including from both President Ortega and First Lady Rosario Murillo. Cuan is the third female minister and sixteenth senior-level woman to depart the Ortega Administration this year (Reftel). VM Gonzalez, who has since been named Minister, was the Health Ministry's (MINSA) main interlocutor with the U.S. during early-October discussions concerning the exchange of Nicaraguan MANPADS for medical equipment. We are trying to determine whether this recent development will affect ongoing MANPADS discussions. End Summary. "General Hospital" Nicaragua-Style -------------- ¶2. (C) On November 6, with all the drama and suspense of a good telenovela finale, Nicaragua's Minister of Health Dr. Maritza Cuan resigned her post in an apparent palace coup engineered by Vice-Minister Guillermo Gonzalez, with a coup de grace delivered by First Lady Murillo. Cuan's problems likely began when she was tapped as Minister, in place of front-runner Gonzalez, by an Ortega trying to build a gender-balanced cabinet. According to media reports, Cuan privately criticized the qualifications and competency of several mid-level MINSA officials, as well as the FSLN-dominated health Workers Union (Federacion de Trabajadores de la Salud; FETASALUD) for engaging in union-building activities rather than providing medical care to Nicaraguans. A well-placed source in the First Lady's office told us that Cuan first considered resigning in September, after First Lady Murillo reprimanded her for traveling to the Atlantic Coast on the heels of Hurricane Felix ) the first Minister to do so ) without obtaining official permission from Murillo. Cuan's position became untenable in late-October when VM Gonzalez, backed by several senior MINSA officials and a portion of the FETASALUD rank-and-file, sent a letter to Ortega requesting Cuan's dismissal. ¶3. (SBU) On November 1, the story leaked to the press and the final episode of what the media have dubbed "Telenovela Maritza" began with a spectacularly disastrous press conference called by FSLN Deputy, union leader, and erstwhile Cuan supporter, Gustavo Porras. Apparently, Porras had hoped to mediate differences between Cuan and Gonzalez, but spent the better part of a tense hour reassuring MINSA and the media that things were fine. The audience remained unconvinced and Porras had to walk back from his support of Cuan. Cuan continued to deny rumors that she would soon be replaced. She disappeared from public view, however, at the same time that VM Gonzalez started popping up everywhere--launching national campaigns to eradicate dengue and combat leptospirosis, campaigning to fight HIV/AIDS, and sitting next to First Lady Murillo at a weekend press conference with National Police Commissioner Granera on police cooperation with the Comites de Poder Ciudadano (CPC). ¶4. (SBU) None other than First Lady Murillo delivered the coup de grace for Cuan on November 5. Cuan had organized the Fifth Central American Congress on HIV/AIDS scheduled for November 5-8 and attended by the Pan American Health Organization (PAHO),the UNAIDS Fund, and UN AIDS Ambassador HRH Princess Mette-Marit of Norway. Cuan had put together an advertising spot welcoming the 2,000 participants in the Congress, which had begun to air locally. However, First Lady Murillo ordered Cuan and MINSA to pull the spot on the first day of the conference because Cuan had "not consulted about the content of the sport nor asked permission from Murillo's Council for Communications to put the message on the air." It is widely known that Murillo jealously guards her "responsibility" to coordinate all government messaging and advertising; however, it is unclear whether Cuan failed to consult Murillo about the spot or if permission was MANAGUA 00002495 002 OF 002 withdrawn ex post facto by Murillo. Minister not the only target -------------- ¶5. (SBU) In her letter of resignation, Cuan stated that she was leaving for personal health reasons, but the press and local political activists continue to speculate. VM Gonzales told the press that Cuan resigned over a disagreement about Ministry reorganization. Porras told the press that multiple personal health issues interfered with Cuan's ability to do her job. Meanwhile, Cuan's entire staff has reportedly been asked to step down. During the last couple of weeks, several other director-level officials have been dismissed. Anonymous MINSA insiders have told the press that they were under a gag order regarding the shake-up, and would be dismissed if their names were revealed. Effect on U.S. Programs -------------- ¶6. (U) USAID: The changes in MINSA should not affect our ongoing assistance programs. USAID had developed a good working relationship with VM Gonzalez and expects the same level of collaboration to continue after the transition. Prior to government service, Gonzalez was on the faculty of Nicaragua's School of Public Health (CIES) and worked as a consultant for various donors, including USAID, thus he is familiar with donor programs and operations. ¶7. (C) MANPADS: Gonzales was the Health Ministry's main interlocutor with the United States during early-October discussions on the exchange of Nicaraguan MANPADS for medical equipment. It is unclear whether this recent development will affect upcoming discussions in a meaningful way. MINSA has not responded to our formal request, made prior to Cuan's resignation, for a meeting with Cuan (or Gonzalez) regarding MINSA acceptance of a USG offer to have military medical assessment teams visit Nicaragua and evaluate MINSA needs. The delay is likely due to the recent internal turmoil at MINSA. Comment -------------- ¶8. (C) Cuan, who is a doctor by training and profession, and a bona fide Sandinista, appears to have run afoul of the Administration by asserting autonomy. The pattern is a familiar one. Conflict, either real or instigated, occurs between technocratic Ministers and party stalwart Vice Ministers or Secretaries General. If the Minister does not adhere diligently to the party line, party activists work closely with the FSLN-dominated unions in the ministries to create unrest and force the resignation of the minister. The Ministers of Environment, Trade, and Tourism (and now Health) all left in this fashion. Dr. Cuan is the third female minister to lose her job in less than a year and the sixteenth senior-level female to leave the Ortega administration. Many of these dismissals seem to have been at the direction of Rosario Murillo. ¶9. (C) Gonzalez may have been working towards Cuan's demise from the beginning. By all accounts, Gonzalez is loyal to Ortega, appears to have Murillo's confidence, and was the leading candidate to replace Cuan. An FSLN-affiliated National Assembly contact, who attended university with Gonzalez, told us that he was "very good and very ambitious." He thought highly of Dr. Cuan as well, and expressed disappointment at her political demise. When pressed to comment on the conclusion of the "Telenovela Maritza," which has erupted in the midst of an ongoing internal FSLN feud over selecting a 2008 mayoral candidate for Managua, our contact stated that "recently Ortega has been making some personnel changes that do not instill much confidence." The reference applied to both Ortega's competence to govern as well as to external perceptions of Nicaragua's stability and investment attractiveness. TRIVELLI