VZCZCXYZ0009
RR RUEHWEB

DE RUEHMU #0965/01 1072001
ZNY CCCCC ZZH
R 172001Z APR 07
FM AMEMBASSY MANAGUA
TO RUEHC/SECSTATE WASHDC 9838
INFO RUEHZA/WHA CENTRAL AMERICAN COLLECTIVE

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