VZCZCXYZ0025
OO RUEHWEB

DE RUEHGE #0455/01 1311312
ZNR UUUUU ZZH
O 111312Z MAY 07
FM AMEMBASSY GEORGETOWN
TO RHMFISS/HQ USSOUTHCOM MIAMI FL IMMEDIATE 0065
RUEHC/SECSTATE WASHDC IMMEDIATE 5186
INFO RUEHBE/AMEMBASSY BELMOPAN 0002
RUEHBO/AMEMBASSY BOGOTA 0738
RUEHGT/AMEMBASSY GUATEMALA 0040
RUEHPE/AMEMBASSY LIMA 0404
RUEHMU/AMEMBASSY MANAGUA 0046
RUEHZP/AMEMBASSY PANAMA 0026
RUEHPO/AMEMBASSY PARAMARIBO 4334
RUEHPU/AMEMBASSY PORT AU PRINCE 0940
RUEHSP/AMEMBASSY PORT OF SPAIN 4034
RUEHQT/AMEMBASSY QUITO 0157
RUEHSN/AMEMBASSY SAN SALVADOR 0229
RUEKJCS/SECDEF WASHINGTON DC
RUEAUSA/DEPT OF HHS WASHINGTON DC

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 
-------------- 
 
¶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