The U.S. Navy is no stranger to humanitarian missions. But with the emergence of “smart-power” doctrine, focused on building alliances and exporting stability, professional capacity and good governance to what Tom Barnett calls “the gap” of the developing world, Navy humanitarians have found themselves on the front lines of U.S. and world security, especially in Africa (via Africa Partnership Station) and Latin America (by way of Operation Continuing Promise). In April 2009, the Navy hospital ship Comfort set sail from Virginia on a four-month mission to deliver medical, engineering and training assistance to seven Latin American nations. David Axe interviews some of the key participants.
by DAVID AXE
Captain James Ware, pictured center, heads the hospital on Comfort, with a staff of some 200 doctors, nurses and other medical professionals. On a four-month deployment, Ware’s staff might treat some 100,000 patients.
Axe: How does Comfort compare to a civilian hospital?
Ware: We’re currently staffed for 250 beds, but our hospital could be as large as 1,000 beds. The reason for the difference is the nursing staff that we have on board. Comfort herself is staffed at Baltimore, Maryland, to develop a 1,000-bed hospital in a five-day period, but requires 200 nurses to run the hospital. Most people think in terms of doctors, but to run a hospital, it’s really the number of nurses that matters. A 250-bed hospital requires 85 nurses — that’s our current manpower structure.
In terms of capability, we have the equipment and supplies to do all types of procedures — everything a normal hospital of 1,000 beds does, except three procedures: open-heart surgery, which requires a very specific type of pump; also, total joint [replacement], because in America, hospitals require a certain type of positive, negative air pressure; the third is organ transplant, again a material thing, in that we don’t have the proper equipment.
But we have instruments to do all other major types of surgery. If I had the nursing staff, the only other key ingredient would be the specific type of surgeons aboard. For Continuing Promise, we have plastic surgeons, facial surgeons, orthopedic surgeons, general surgeons, children’s orthopedists, urologists, children’s general surgeons, OBGYN, dermatologists … we have a wide spectrum of skill-sets. The only type of surgeon we do not have on board that we would have in a war scenario is a neurosurgeon. We could have one flow on board within 72 hours.
Axe: What’s a hospital ship’s biggest advantage over a civilian hospital?
Ware: This ship was built very specifically for combat-casualty care, with a very specific way for patients to come on board. It was built for mass infusions of multiple combat casualties. Our ER is huge, with a casualty receiving area that has 50 individual bays that are very accessible in a mass casualty situation. It also has the ability to drive the [casualty] management piece. Imagine 50 wounded Marines coming aboard by helicopter in an hour … I don’t think most hospitals have that capability.
For a humanitarian mission like Continuing Promise, we are focused on structured, organized medical service, so that [mass-casualty] piece is not really utilized. What we do have is 12 operating rooms we’d use in a combat-casualty scenario. Presently we can operate four to eight of those, depending on the nursing service. We’re going to expand that with an NGO in Nicaragua, and go from five operating rooms to eight in a matter of one day. We’re like a Lego hospital. We can build in capacity very, very quickly.
Currently we have 14 surgeons, 50 physicians, 13 dentists, plus pharmacists, physical therapists and nurse practitioners: 172 health-care providers, in all. Plus 10 to 11 providers from NGOs, even an acupuncturist from California.