C O N F I D E N T I A L MANAGUA 000965

SIPDIS

SIPDIS

STATE PLEASE PASS TO HHS/OGHA FOR BILL STEIGER,
HHS/OGHA FOR DR. ROSALY CORREA DE ARAUJO, NSC FOR DAN FISK

E.O. 12958: DECL: 04/16/2017
TAGS: TBIO EAID PREL OSHA OTRA NU
SUBJECT: NICARAGUA: HHS SECRETARY LEAVITT MEETS PRESIDENT
ORTEGA AND SIGNS LETTER OF INTENT WITH HEALTH MINISTER

Classified By: Ambassador Trivelli, Reason: E.O. 12958 1.4(d).


1. (SBU) SUMMARY. U.S. Health and Human Services (HHS)
Secretary Michael O. Leavitt visited Managua on March 26-27,
2007 to sign a Letter of Intent with Minister of Health
Maritza Cuan on the establishment of a regional health-care
training center in Panama. Secretary Leavitt met with
President Daniel Ortega shortly after arriving. In a tour
d'horizon centered upon the health sector, Ortega explained
that Nicaragua needs help in almost all areas. After the
meeting with Ortega, Secretary Leavitt attended a dinner
hosted by the Ambassador for opposition leaders. On March
27, Secretary Leavitt met with Minister Cuan, who pointed to
the cost of health care, access to medicine and medical care,
and cultural barriers as significant obstacles in Nicaragua.
After the signing ceremony, Secretary Leavitt hosted a
luncheon for the heads of Nicaraguan national medical
professional associations and educators. The group agreed
that the greatest challenge in healthcare is the nursing
shortage. All major, national media outlets covered
Secretary Leavitt's visit extensively and echoed his comments
that the signing of the Letter of Intent strengthened
President Bush's commitment to advance the cause of social
justice in the region. End Summary.

Introduction
--------------


2. (U) HHS Secretary Michael O. Leavitt visited Managua on
March 26 and 27, 2007 to sign a Letter of Intent with
Minister of Health Maritza Cuan on the establishment of a
regional health-care training center in Panama. The next
step is to negotiate a Memorandum of Understanding among all
Central American countries and the United States. When fully
operational, the center will offer courses on a variety of

health-care topics, such as preventative medicine, disease
prevention, and eventually oral health, to health-care
workers, who will incorporate this knowledge in their work in
villages and towns throughout Central America.

President Ortega
--------------


3. (SBU) On March 26, Secretary Leavitt met with President
Daniel Ortega for 80 minutes (versus a scheduled 30-minute
session) at Sandinista Party (FSLN) headquarters, also
Ortega's residence in Managua. Accompanying the President
were First Lady Rosario Murillo, Minister of Health Dr.
Maritza Cuan Machado, and Foreign Minister Samuel Santos.
Panamanian Minister of Health Dr. Camilo Alleyne and
Ambassador Trivelli accompanied Secretary Leavitt. After the
meeting, the press came into the room to ask parting
questions of the participants.


4. (SBU) In a very lengthy tour d'horizon centered upon the
health sector, Ortega explained that Nicaragua needs help in
almost all areas of health care. He lamented that the
country lacks hospitals, equipment, doctors, nurses, and
medication, and impoverished citizens suffer from
malnutrition and a lack of potable water. To strengthen the
immune systems of children, the Government wants to establish
school feeding programs. In addition, the Government wants
to import generic drugs, but has no way to test them for
quality, about which the President expressed concern. Ortega
noted that he was getting considerable pressure from Europe
on Nicaragua's recent ban of therapeutic abortion, although
"no doctor would be prosecuted for saving the life of a
patient." Secretary Leavitt offered Ortega the
Administration's full support for the Nicaraguan pro-life
position, and thanked the President for his country's stand
on life and family issues at home and at United Nations fora.
Ortega discussed his recent statements on biofuels, by
stating that investment in ethanol production would likely
raise food prices for the poor. He said that "the country
should slow down, i.e., to be careful not to convert too fast
to ethanol production." (Note: In a sidebar with President
Ortega and the First Lady after the formal meeting, Secretary
Leavitt encouraged Ortega to learn more about biofuels and
President Bush's initiative on alternative fuels for the
Western Hemisphere.)


5. (SBU) In response, Secretary Leavitt told Ortega that his
Department recently conducted a test on generic medications
offered for sale via the Internet (ostensibly from Canada),
and found a wide disparity in quality and provenance. He
mentioned he had talked to Costa Rican authorities about
possible assistance for a laboratory in Costa Rica that would
test imported and domestically produced pharmaceuticals to
make sure they contained the active ingredients they claimed
and were not counterfeit. On the subject of water, Secretary
Leavitt suggested that nongovernmental organizations that
specialize in this area might be able to provide small,
portable purification systems to Nicaragua.


6. (SBU) Secretary Leavitt explained that he was in Managua
to sign a Letter of Intent with Minister Cuan on the
establishment in Panama of a regional training center for
community health workers. The genesis of the center came
from a desire to help Central America prepare for a potential
outbreak of avian influenza, or other such pandemic or health
crisis. The United States agreed to provide some funding and
technical support, and Panama offered facilities in the
former Panama Canal Zone. (Note: The first training course
will take place at the City of Knowledge (Ciudad del Saber),
but the exact permanent location for the Center remains under
discussion.) The idea now is to enlist support from and
governance by all countries in Central America -- with the
objective of signing a Memorandum of Understanding in June

2007. In the interim, the Center will offer a short-term
training course to 50 students from the region on skills
necessary to prepare for the threat posed by avian influenza.
When fully operational, the center will offer courses on a
variety of healthcare topics, such as health and disease
prevention, and, eventually, oral health, to local
health-care workers who will return to their villages and
towns with this knowledge.


7. (SBU) At the close of his opening remarks, Ortega told
Secretary Leavitt, "We know that (Nicaragua) has the
cooperation of the Government of the United States. We know
that this will continue and perhaps strengthen." Secretary
Leavitt closed by telling Ortega, "The United States wants to
build a long and sturdy friendship with Nicaragua, to work
together as friends and neighbors."

Dinner with Opposition Figures
--------------


8. (C) After the meeting with Ortega, Secretary Leavitt
attended a dinner hosted by the Ambassador and attended by
Eduardo Montealegre, former presidential candidate and
opposition leader of the Nicaraguan Liberal Alliance (ALN) --
as well as a former Foreign Relations Minister and Finance
Minister; the President of the Conservative Party Azalia
Aviles; and the President of the National Business Council
(COSEP,) Erwin Kruger, who is also a former Economic Planning
Minister. The discussion ranged from healthcare topics to
the state of current politics in Nicaragua. During the
dinner, Kruger half-jested that the Alliance should "keep the
Government busy" so that it "would leave business alone."
Later, however, Kruger urged Montealegre to strengthen ties
with COSEP and offered to meet with him more often to discuss
common concerns and objectives. For his part, Montealegre
noted the FSLN's intentions to amass power, and warned that
Ortega's goal is to remain in office for a second term, which
would require changing the constitution.

Meeting with Minister Cuan and Signing Ceremony
-------------- --


9. (SBU) On March 27, Secretary Leavitt, accompanied by
Minister Alleyne and Ambassador Trivelli, met with Minister
Cuan, Foreign Minister Samuel Santos, Vice Minister of Health
Dr. Guillermo Gonzalez, and Director-General Dr. Adrian
Zelaya prior to the signing of the Letter of Intent.
Minister Cuan pointed to the cost of health care, access to
medicine and medical care, and cultural barriers as the
significant obstacles Nicaraguans face in receiving health
care. She stated that guaranteed access to free, universal
health care is a priority of the Ortega administration. She
wants to eliminate bogus charges in public hospitals and
clinics and said that a new "consumer hotline" seemed to have
reduced illicit charges as well as improved public access to
medical services by 40% in the month of February. Minister
Cuan explained that the GON plans to promote "National
Medical Brigades" that will transport physicians to
geographically isolated areas to work in mobile clinics. She
also emphasized the need to train doctors to communicate
cross-culturally, especially as it related to populations on
the Atlantic Coast.


10. (SBU) Secretary Leavitt pointed out that the U.S.
military has provided health care to more than 18,000
Nicaraguans through the New Horizons program in only the past
two months, and commented that these types of mobile clinic
operations can be very effective. On the subject of cultural
barriers, Secretary Leavitt commented that HHS has developed
a variety of health-care programs for Native American tribes
and Alaskan Natives, programs focused on community public
health and training doctors, community health aides, and
dental assistants in the culture and language of the
communities they serve. Secretary Leavitt suggested that
these programs could serve as a model for Nicaragua. He
noted that providing medical care cross-culturally is the
kind of training envisioned for the center in Panama.


11. (U) Following the meeting with the Minister, Secretary
Leavitt signed the Letter of Intent with Minister Cuan, with
full-press coverage. In his remarks, Secretary Leavitt
expressed the Administration's desire to continue working to
strengthen Nicaragua's ability to deliver quality health care
to its population. In her remarks, Minister Cuan outlined
the challenges Nicaragua faces in guaranteeing access to
health care for all Nicaraguans, and reiterated the Ortega
administration's plans to move the country closer to that
goal -- much as she had stated in her private meeting with
Secretary Leavitt.

Luncheon with Health-Care Proffesionals and Educators
-------------- --------------


12. (C) After the ceremony, Secretary Leavitt hosted a
luncheon attended by Minister Cuan, the deans of Nicaraguan
public and private medical schools, the Director of Training
at a leading private-sector hospital, the President of the
Nicaraguan Public Health Association, and the Director of
Nursing at the Ministry of Health. The group agreed that the
greatest challenge in health care is the nursing shortage.
Low wages, lack of prestige, and responsibility without
authority were reasons participants cited why young people
are not attracted to the nursing profession. (Comment: The
loquatiousness of the Minister and her staff prevented the
luncheon from achieving its intended purpose -- gaining
candid feedback and advice from Nicaraguan medical and dental
professionals on the goals and strategies of the regional
training center in Panama. By dominating the conversation
with ideological lectures, the Sandinista Ministry officials
left little time for anyone else to speak, let alone offer
useful input. End Comment.)


13. (U) Secretary Leavitt explained that he became aware of
the need for a regional training center during a 2006 meeting
with Central American Health Ministers. He stated that the
program for the regional training center could address some
of the problems raised during the luncheon. He asked the
guests to think of ways that they might further identify
health training needs as well as trainers. Minister Cuan
emphasized that collaboration between health training
institutions and the Ministry of Health is critical in
supporting the new Ortega Administration's health policies.
She counseled that training institutions should orient
themselves to support Government initiatives. She agreed to
contact luncheon invitees to further discuss possible
training themes and to designate a Health Ministry staffer to
act as the point of contact for HHS and the formation of the
regional training center.

Press Coverage
--------------


14. (U) All major, national media outlets covered Secretary
Leavitt's visit. They picked up on his comments that the
signing of the Letter of Intent strengthened President Bush's
commitment to assist with advancing the cause of social
justice in the region. The visit generated four print
articles in national dailies. Secretary Leavitt's meeting
with President Ortega also resulted in extensive coverage on
local and national radio and television. All major media
outlets covered the signing ceremony, aired on over 20 local
and national radio stations and all major Nicaraguan local,
national, and cable television stations. In addition,
Secretary Leavitt granted an exclusive interview to leading
national newspaper La Prensa, which resulted in an article
entitled "Regional Center for Health Training Will Be
Created." The article quoted Secretary Leavitt as saying,
"The United States promotes this type of initiative because
we desire for friends and neighbors in the hemisphere to have
the opportunity to live in nations where justice and liberty
prevail."
TRIVELLI