VZCZCXYZ0000
PP RUEHWEB

DE RUEHSJ #0800/01 2811721
ZNR UUUUU ZZH
P 071721Z OCT 08
FM AMEMBASSY SAN JOSE
TO RUEHC/SECSTATE WASHDC PRIORITY 0160
INFO RUEHZA/WHA CENTRAL AMERICAN COLLECTIVE
RHMFIUU/CDR USSOUTHCOM MIAMI FL
RUMIAGH/COMJTF-B SIMS SOTO CANO HO

UNCLAS SAN JOSE 000800 
 
SENSITIVE 
SIPDIS 
 
DEPT FOR WHA/CEN, WHA/PPC AND PM; SOUTHCOM ALSO FOR FPA 
 
E.O. 12958: N/A 
TAGS: PREL PGOV PHUM MASS SOCI CS
SUBJECT: COSTA RICA: MEDRETE TREATS NEARLY 1000 PATIENTS IN 
PUNTA BURICA REGION 
 
REF: SAN JOSE 0003 
 
¶1. (U) SUMMARY: On 25-27 September 2008, Honduran-based Joint 
Task Force-Bravo (JTF-B) and Costa Rican medical personnel 
conducted a Medical Readiness Training Exercise (MEDRETE) in 
Costa Rica's remote Punta Burica region on the south eastern 
border with Panama.  The Embassy coordinated the event and 
contributed six translators to help non-Spanish speaking U.S. 
doctors communicate with their patients.  This event follows 
a MEDRETE conducted late last year in the Talamanca region of 
Costa Rica (reftel) and was the first-ever conducted near the 
border with Panama.  Nearly 1000 people, both Costa Ricans 
and Panamanians, received much-needed medical treatment. 
Four patients were medevac'd by U.S. Army Blackhawk 
helicopters to a nearby hospital.  Three members of the 
national legislature, one a medical doctor and one a dentist, 
also participated.  Food donated by Embassy personnel was 
airlifted to the sites.  Visiting the treatment centers, the 
Ambassador was interviewed by national print and television 
media, which focused on the positive contributions of the 
U.S. to this joint humanitarian mission.  Local leaders and 
patients expressed their appreciation for the help and told 
us that it "was like a dream come true."  END SUMMARY. 
 
========================================= 
FIRST MEDICAL ASSISTANCE TO AREA IN YEARS 
========================================= 
 
¶2. (U) This MEDRETE to the Punta Burica region was the first 
medical assistance from any source that its inhabitants had 
seen in more than two years.  Access to the zone is extremely 
difficult due to rough terrain and the lack of roads.  The 
closest Costa Rica city is Golfito, on the Golfo Dulce near 
the Osa Peninsula.  Without evacuation assistance, even 
"emergency" patients have at least a three-hour trip by 
horseback to the nearest medical facilities, which are 
actually in Panama.  Even in those facilities, assistance is 
not guaranteed. 
 
¶3. (U) JTF-B doctors and nurses, with some Costa Rican 
counterparts, treated patients, with Embassy staff 
translating for the JTF-B staff, allowing them to understand 
and treat long-running conditions.  For example, one 16-year 
old patient who had been suffering from chest pains and 
fainting spells for some time received a diagnosis of an 
irregular heartbeat (cardiac arrhythmia).  Most common 
ailments found by the JTF-B team were parasites, skin 
infections (as a result of living in a humid climate), 
diarrhea, and respiratory infections. 
 
¶4. (U) The last time a dentist had visited the Punta Burica 
area was five years ago, according to locals receiving oral 
exams.  Patients of all ages received dental exams, with 
cavities being the major problem found.  JTF-B and Costa 
Rican dentists also performed tooth extractions and fillings. 
 
================= 
A DREAM COME TRUE 
================= 
 
¶5. (U) The local population in Punta Burica welcomed the 
assistance with open arms and open hearts.  Many patients and 
local elders told us they "thought the day would never come" 
when they would see the U.S. help arrive.  One of the leaders 
said that it truly was a "dream come true." 
 
¶6. (U) The sight of U.S. Army Blackhawk helicopters also drew 
large crowds everywhere they flew and landed.  Each time the 
UH-60s shut down at the village sites and staging zones, the 
crews happily conducted tours for locals.  Colorfully-clad 
indigenous women and children seemed most fascinated with the 
helicopters and couldn't thank us enough for our assistance. 
 
 
============================================= == 
MEDRETE HIGHLIGHTS U.S.-COSTA RICAN COOPERATION 
============================================= == 
 
¶7. (U) The MEDRETE, which took place in two separate sites in 
the Punta Burica region (Alta Carona and La Pena) included 
the participation of 36 JTF-B medical and support personnel 
and nearly 40 Costa Rican medical personnel.  Coordinated by 
Post's Office of Defense Representative (ODR), MEDRETE 
medical professionals evaluated and treated 942 people from 
both Costa Rica and Panama in this isolated and depressed 
region.  Many patients were from the indigenous communities. 
Four patients were airlifted for further treatment to a 
 
nearby hospital.  Three of the evacuated patients needed 
pre-natal care and one patient needed treatment for a severe 
skin condition. 
 
¶8. (U) We coordinated with many GOCR agencies to make this 
MEDRETE happen, but most importantly with the GOCR's Caja 
Social (similar to the U.S. Social Security Administration, 
but they also administer all of the public hospitals in Costa 
Rica).  The Golfito-area Caja Social physicians welcomed the 
MEDRETE, helped with the planning and supported it with many 
medical personnel.  The Caja Social even advertised the event 
in local media, something Embassy Locally-Employed Staff 
could not remember ever happening before.  A wide range of 
other GOCR agencies helped make this event happen, including 
the Ministries of the Presidency, Public Security, Health, 
Civil Aviation, and Immigration. 
 
======================================== 
LEGISLATORS TREAT PATIENTS; VIPS OBSERVE 
======================================== 
 
¶9. (U) Similar to the unusual example of bipartisan 
cooperation we observed last December, two of the three 
legislators that visited the MEDRETE sites, Federico Tinoco, 
PLN (a dentist) and Orlando Hernandez, opposition PAC (a 
medical doctor), also participated, with both of them rolling 
up their sleeves and treating several patients.  Olivier 
Jimenez, the Golfito-based PLN legislator who represents the 
region, accompanied Tinoco and Hernandez for a brief visit to 
the site on September 26. 
 
¶10. (U) Several senior members of the GOCR also visited the 
MEDRETE sites during a "VIP visit" on September 26, including 
the Minister of Public Security (MPS) Janina Del Vecchio, MPS 
Vice-Ministers Jose Torres and Ana Duran, and the National 
Chief of Police Erick Lacayo.  The Ambassador, along with the 
DCM and POLOFFs, accompanied the GOCR delegation. 
 
¶11. (U) In addition to the support for the MEDRETE, JTF-B 
helicopters ferried several hundred pounds of food donated by 
the U.S. Embassy community.  The food included basic staples 
such as rice, beans and salt.  The cooperation between 
various USG and GOCR entities, as well as with some private 
enterprises that provided the use of an airstrip that 
facilitated the VIP visit on September 26, was excellent. 
 
========================================= 
EMBASSY ENGINEERS POSITIVE MEDIA COVERAGE 
========================================= 
 
¶12. (U) Thanks to closely coordinated efforts of the Embassy 
Public Affairs Section (who facilitated the transportation of 
journalists to one of the MEDRETE sites as well as coverage), 
prominent media organizations reported this event.  Four 
national television channels and one local channel (6, 7, 11, 
and 42; and 14) devoted prime-time stories to the MEDRETE. 
Their stories focused on the medical needs of the community 
as well as provided the Costa Rican national audience a 
positive view of U.S. military humanitarian assistance. 
Additionally, the most widely read daily, Diario Extra, and 
the most respected daily, La Nacion, ran comprehensive 
features.  One other national daily, La Prensa Libre, and a 
regional daily, Estrella del Sur, also had positive coverage. 
 (Details and the actual press coverage of the MEDRETE have 
been sent to WHA/CEN and SOUTHCOM.)  Spanish-language 
interviews of Ambassador Cianchette, ODR Chief Commander 
Camacho, and several of the JTF-B medical professionals 
figured prominently in the television coverage. 
 
======= 
COMMENT 
======= 
 
¶13. (SBU) The importance of this second MEDRETE in less than 
a year in Costa Rica cannot be overemphasized, both in terms 
of real medical benefits to an isolated local population as 
well as to the positive image of the United States.  While 
bureaucratic hurdles to conduct MEDRETEs remain burdensome, 
the Costa Rican national leadership is firmly behind this 
type of humanitarian assistance from DoD.  Facing a last 
minute curve-ball from the Colegio de Medicos (the AMA 
equivalent), which set impossible-to-meet standards to 
"certify" the JTF-B physicians to treat patients in Costa 
Rica, President Arias himself intervened, approving the 
MEDRETE based on humanitarian needs. 
 
¶14. (SBU) The Caja Social's leadership was most instrumental 
 
in making this event happen.  Far from being "forced" on 
Costa Rica, this MEDRETE was to a great extent, a Costa Rican 
show, conducted at their request and supported outstandingly 
by JTF-B.  In fact, opposition PAC legislator (and doctor) 
Hernandez hoped we might be able to conduct a MEDRETE in his 
province (Cartago) in the Turrialba area, another very poor 
area with limited lines of communication.  U.S. MEDRETEs are 
clearly "treating" attitudes as well as patients in Costa 
Rica! 
 
¶15. (SBU) This MEDRETE built upon the foundation laid by last 
December's successful event (reftel) and resulted in even 
more goodwill towards the United States and the Embassy in 
Costa Rica.  While Costa Rica is relatively more developed 
than the rest of Central America, it still has areas of 
extreme need, and we can help to meet those needs.  The 
assistance provided was deeply appreciated by the patients 
and the GOCR.  The overall results are fully in keeping with 
USG and SOUTHCOM "soft power" goals for Costa Rica and the 
region.  We hope to continue the success of this military 
humanitarian assistance in Costa Rica in 2009. 
 
¶16. (U) Post sends a special thank you to the great men and 
women of JTF-B who made it all happen.  We appreciate their 
outstanding support and medical professionalism, which will 
benefit both patients and USG goals in the region.  Kudos for 
a job very well done! 
CIANCHETTE