Seapower: Medical Diplomats

28.09.08

Categorie: Naval, Relief |

Note: I’m posting the entire text of my latest story for Seapower Magazine. Normally I only excerpt a story and provide links to the rest over at the publisher’s Website, but Seapower uses one of those proprietary Web platforms with no ability to link in. Still, pay Seapower a visit and check out the great offerings in the latest issue, including a thorough brief on Navy shipbuilding issues.

Reprinted with permission from Seapower, the official publication of the Navy League of the United States.

Medical Diplomacy

USS Kearsarge is conducting civil-military operations that include humanitarian and civic assistance; veterinary, medical and dental services; and civil engineering support to six partner nations in Latin America.

■ The mission is an example of “soft power,” a concept emphasized in “A Cooperative Strategy for 21st Century Seapower.”

■ Defense Secretary Robert Gates, in a Nov. 26 speech at Kansas State University, said the United States must strengthen its “capacity to use ‘soft’ power and for better integrating it with ‘hard’ power.”

■ Gates defined soft power as “America’s ability to engage, assist, and communicate with other parts of the world.”

Medical Diplomats

Kearsarge’s Latin American humanitarian cruise
tests new U.S. military ‘soft power’ concepts

By DAVID AXE, Special Correspondent

To Chief Warrant Officer Chris Pienkowski, combat cargo officer aboard the amphibious assault ship USS Kearsarge, one pallet is the same as another.

“A piece of gear is a piece of gear,” he said, barely looking up from the paperwork on his desk Aug. 9 in his office deep in Kearsarge’s bowels.

It’s Pienkowski’s job to decide where to put things in the ship’s roughly 100,000 cubic feet of cargo space. When the 15-year-old vessel is carrying its usual contingent of 2,200 Marines plus all their weapons and equipment — not to mention gear for an aviation attachment of up to 30 helicopters — storing everything can be like doing a puzzle, where the pieces weigh hundreds or thousands of pounds apiece.

But, like he said, gear is gear. So when Kearsarge was ordered to leave its Marines and usual flotilla of escorting warships behind and instead sail unescorted to Latin America to pursue a radical new “soft power” strategy, it didn’t make any difference to Pienkowski.

Instead of storing combat vehicles and ammunition, the combat cargo team crammed in pallets of medical equipment, generators, construction vehicles, lumber, tools and $600,000 worth of donated medicine. Below decks, the 840-foot assault ship looked like a cross between a hospital store room and a Home Depot.

Over four months beginning in early August, Kearsarge planned to visit Nicaragua, Colombia, Panama, the Dominican Republic, Trinidad and Tobago and Guyana, delivering free medical and engineering assistance to isolated, impoverished populations. It was actually the second phase of Operation Continuing Promise, which began in May when the amphibious assault ship USS Boxer made a humanitarian run down the Pacific side of Central and South America, eventually treating around 14,000 patients and conducting 127 surgeries, while an accompanying force of Seabees rebuilt eight schools and repaired roads.

Continuing Promise is just a single chapter in a much broader U.S. military “medical diplomacy” initiative in Latin America that began in earnest in summer 2007, with the four-month deployment of the hospital ship USNS Comfort. That trip resulted in some impressive figures: 1,170 surgeries, 32,322 immunizations and 24,242 pairs of glasses handed out.

In September of that year, USS Wasp followed up with emergency medical and engineering assistance to Nicaragua in the wake of Hurricane Felix, ultimately delivering some 10 tons of rice, 5,000 gallons of potable water and tons of food, tarps and blankets, according to U.S. Southern Command. Future medical diplomacy cruises to Latin America are already in the planning.

For Pienkowski, Kearsarge’s humanitarian mission is business as usual. But for the Pentagon brass who conceived it, the senior officers who lead it, the doctors and nurses who comprise the “medical assault force” and the tens of thousands of people whose lives they will help improve, Operation Continuing Promise and the whole concept of medical diplomacy is something new.

Whether it remains a novelty, or finds a lasting place in the Pentagon’s playbook, however, is an open question.

‘I’m not worried at all’

Kearsarge’s most valuable cargo as it pulled away from the pier in Norfolk, Va., on Aug. 6 was not the tons of medicine and relief supplies it carried, but the roughly 300 skilled medical and engineering professionals berthed in the ship’s living spaces. Instead of a Marine Expeditionary Unit, Kearsarge had embarked general practitioners, surgeons, nurses, medical technicians, optometrists, ophthalmologists, civil engineers, public health experts, entomologists, medical equipment repair specialists, linguists, cultural experts, journalists and even veterinarians.

The medical specialists represented all the U.S. military services; the U.S. Public Health Service; the Canadian, Dutch and Brazilian militaries; and a range of civilian institutions, including the plastic surgery nonprofit organization Operation Smile, which specializes in repairing severe cleft palates.

All the medicos call Cmdr. David Damstra boss. By day, Damstra is the commander of Fleet Surgical Team Four. For Continuing Promise, he embarked with Commodore Frank Ponds, commander of Amphibious Squadron Eight, as the top medical officer.

For Damstra, Kearsarge’s week-long transit, from Norfolk to its first stop at Puerta Cabezas on Nicaragua’s remote eastern coast, was a chance to get his people organized. It was an overwhelming job. Kearsarge medical staff represented a grab-bag of disciplines. He had to organize them into teams and marry them up with the right equipment, then forge plans for getting them ashore and working.

Already there were problems. Kearsarge was underway when planners discovered shortages of generators and interpreters. There would not be enough of either, so some teams would have to make do without electrical power and with Spanish-speaking Kearsarge crew members filling in for trained interpreters. One Canadian dentist complained that without a generator, he would be reduced to simply pulling rotten teeth under local anesthetic.

On Aug. 7, Damstra sat back on his desk in his tiny one-man stateroom and sighed.

“Planning for this has been exceedingly painful,” he said.

Some help came from 55 Kearsarge crew members who had been with Boxer during the first phase of Continuing Promise. From the present jumble, Damstra was expected to achieve near-strategic results.

“Warming relations on the personal and national level — that’s the intent,” he said. “The goodwill will come in two ways: from the people we meet, and also on the national level. The majority of people we won’t see. But we do want to get the word out.”

Hence the roughly dozen journalists accompanying Kearsarge — and the scores of local journalists planning to trek to the onshore clinics to cover the medical care as it happened. The “strategic communications” aspect of the mission was no less important than the actual medical care, according to Ponds.

The commodore made a point of dropping in on the journalists nearly every day at their makeshift workspace adjacent to Kearsarge’s always-busy gym. But for all the media’s importance to the mission, Ponds stressed that actions still would speak louder than words.

“Strategic communications is not what you put on paper,” he told the journalists. “It’s what you do.”

So the emphasis was on providing top-notch care. In the days before reaching Nicaragua, in Kearsarge’s expansive medical bay — the largest in the Navy behind the hospital ships — doctors and nurses sorted pills, swapped stories and bonded. They were from a half-dozen countries, but they all spoke two common languages: English and that of medicine.

Lt. Cmdr. Paul Wickard, from the 7,000-strong U.S. Public Health Service (USPHS), was “doing time” as a prison doctor at a federal penitentiary in Georgia when the opportunity arose to join Kearsarge for Continuing Promise. He sorted pills alongside Cmdr. Julie King, a USPHS nurse, and two Canadian Army nurses, Capt. Kim Templeton and Lt. Lauren Vera.

“There’s a lot of people here with tons of experience,” Templeton said. “I’m not worried at all.”

Still, no one knew what to expect.

Jeroen De Vries, a Dutch Navy general practitioner, said he wasn’t sure what he would be doing ashore. He said he would count on his broad training to keep him flexible.

“We’re jacks of all trades,” Templeton said.

Hospital Corpsman 2nd Class Steve Heiss, a U.S. Navy medic, amended the sentiment somewhat.

“We all feed off each other,” he said. “Everyone has a specialty. Everyone learns off each other.”

They would have to. Despite being the third major medical mission to Latin America in two years, Kearsarge’s deployment was still very much a learning experience at all levels.

For the Pentagon, Chief of Naval Operations Adm. Gary Roughead and the staff of the new U.S. Fourth Fleet, it was a chance to see if a “soft power” strategy can actually work to improve the nation’s national security. For Ponds, the mission was a communications trial. For Damstra, the chief surgeon, it was test of planning skills. For the medical personnel on the front line, it would be all about improvisation in the face of big unknowns. And for Capt. Walter Towns, Kearsarge’s new skipper, the mission was an exercise in human resources management.

On the morning of Aug. 11, Towns sat down in his spacious (for a warship) office to talk about the challenges of a new command. He had taken over Kearsarge just two days prior to its leaving Norfolk for Continuing Promise. He said his training had prepared him well. Besides, he was no stranger to LHDs, having served on one as operations officer.

“What’s unique is who we have onboard,” he said, referring to the diverse humanitarian staff.

But learning to accommodate — and work with — doctors, engineers and assorted civilians is critical to emerging missions in an unstable world, Towns said. And what better place to do it than aboard a big floating box that exists to carry big groups of people between two points, and deliver them from ship to shore safely and efficiently.

Setting Up in Puerta Cabezas

Aug. 12 was the big day. Landing craft laden with construction material backed out of Kearsarge’s well deck and chugged toward shore. Marine Corps CH-53E and Navy MH-60S helicopters spun up on the flight deck. Doctors and nurses waited along the ramp leading to the flight deck, deaf underneath their ear protectors and segmented “cranium” helmets.

By sea and by air, 100 humanitarians landed in Puerta Cabezas in the early morning hours. While Seabees convoyed out to construction sites with Nicaraguan police escorts, the medicos piled into a school bus for the short ride to the local high school, which would double as the central health clinic for the next two weeks.

Navy Lt. Cmdr. Sugat Patel, from Portsmouth Naval Medical Center, was in charge of the clinic. He raced between classrooms as, inside, specialists set up stations for optometry, dentistry, surgical consulting, medicine distribution and general care. Each station was supposed to have an interpreter, but there weren’t always enough to go around, so “terps” were always on their feet, running to fill any gaps. By noon everyone was drenched in sweat.

Hundreds of patients were lined up outside, corralled by Nicaraguan soldiers. Soon the Kearsarge people had settled into a steady rhythm, seeing patients at a combined rate of around one per minute. Among the patients were Lizzie Mae Morris, her two children and aged mother. Morris said her eyes had been bothering her. She had been waiting for more than five hours for her consultation, but was still quite chipper.

“I’m glad,” she said in nearly perfect English. “This is a very nice service. Sometimes we need medicine and cannot get any.”

Day one ended at 3 p.m. Patel gathered his people, congratulated them, and counted heads for the ride back to the landing zone. “Things are going well,” he said.

In truth, there would be setbacks. Maintenance problems with helicopters and landing craft, interpreter shortages and growing skepticism about the mission’s intentions in the regional press would complicate Continuing Promise in coming days. But for now, there had been no major disasters, and some 300 Nicaraguans were slightly better off, and certainly more favorable toward Americans and their allies than they were before. ■

(Photo: me)

Related:
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Devastation greets Kearsarge
Haiti brief
Kearsarge diverted for storm relief
Kearsarge series
Navy ship explores Africa soft-power strategy
Catamarans = small sea base

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One Response to “Seapower: Medical Diplomats”

  1. Joel's Blog says:

    Medical Diplomacy…

    Over four months beginning in early August, Kearsarge planned to visit Nicaragua, Colombia, Panama, the Dominican Republic, Trinidad and Tobago and Guyana, delivering free medical and engin…

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