NICARAGUA: HHS SECRETARY LEAVITT MEETS PRESIDENT

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