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FM AMEMBASSY MANAGUA
TO RUEHC/SECSTATE WASHDC 1700
INFO RUEHZA/WHA CENTRAL AMERICAN COLLECTIVE
RHEHNSC/NSC WASHINGTON DC
RUEHLMC/MILLENNIUM CHALLENGE CORP WASHDC
RUEAIIA/CIA WASHDC
RUEAUSA/DEPT OF HHS WASHINGTON DC
RHEFDIA/DIA WASHINGTON DC
RUMIAAA/CDR USSOUTHCOM MIAMI FL

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