Feel-good Diplomacy

Though the hospital ship Comfort delivered much-needed medical care in Latin America, the recent mission seemed driven more by public relations than public health

Sun Special Report / Symbol Of Hope

October 28, 2007|By Robert Little | Robert Little,SUN REPORTER

PORT-AU-PRINCE, Haiti -- The massive white ship that appeared one morning in the city's polluted harbor was wondrous on its own, but few Haitians could have dreamed of what was inside. There were nurses and surgeons, X-ray machines, cases of clean bandages and medicines. And, most incredibly, there was hope.

Within sight of the city's squalid waterfront slums, the Baltimore-based hospital ship USNS Comfort dropped anchor to dispense free medical care, its ninth stop on a 12-country tour of South and Central America. As word of its arrival spread, thousands of would-be patients swarmed through the city's dusty streets to line up at the Comfort's makeshift clinics, patting their swollen bellies or raising their children into the air each time the Americans came near.

"I think God has made these people come," said Wilton Milford, after the ship's crew gave medicine and vitamins to his malnourished 10-year-old daughter.

The ship and the crowds it drew revealed the possibilities of the $25 million Latin American effort, part of a nascent Bush administration initiative known as "medical diplomacy." They also exposed the weaknesses of a mission conceived more for its symbolism than its substance.

During the four-month tour - which made its first stop in Belize in June and its last in Suriname in early October - the Comfort's military and civilian medical teams treated hundreds of patients whose lives were improved and, in some cases, even saved by basic medical care that would have been otherwise unavailable.

Yet when it sailed away, the ship often left a wake of frustration and unfulfilled potential, its doctors and the patients they left behind grousing about an agenda dictated by public relations and politics.

For all the good it accomplished, the mission appeared to break some cardinal rules of humanitarian medicine, according to doctors who specialize in public health.

It didn't always tailor services to the specific needs of the countries it visited, for instance, arriving at each port with essentially the same mix of medicines, equipment and specialists. And it failed to maximize the ship's greatest asset - its hospital. Anchored off countries that, in some cases, lacked simple medical supplies and even clean sheets, the Comfort rarely used any of its most sophisticated medical equipment, such as its CT scanner and X-ray machines.

The Comfort is designed to respond to military emergencies and can treat as many as 1,000 casualties at a time. For this mission, however, just four of the ship's 12 operating rooms were put to use. It carried seven surgeons and 14 public affairs specialists.

In press releases and news conferences, Navy officials kept a running tally of the patients treated - ultimately reaching 98,000. Most received services such as free eyeglasses, vaccines or fluoride treatments, which did not require a doctor or nurse.

The ship's staff performed roughly 100 surgeries in each port - 1,170 in all - but because of limited coordination with local hospitals, meager provision for local follow-up care and insufficient time to oversee recovery, doctors were forced to turn away scores of relatively simple surgical cases.

In Haiti, more advanced planning and an investment of two or three more days might have enabled the ship to offer services such as cardiac care or prostate surgery - procedures that doctors who have worked in Haiti say could save hundreds of lives.

Physicians on board described the profound effect they were able to have on many patients in the region, some of whom needed only vitamins or water to be restored to health. But they also complained of a barnstorming schedule that all but assured they could make no lasting effect on public health in the region. With an itinerary prescribed by the State Department and the White House rather than the ship's medical specialists, the Comfort's full value as a hospital never came close to being realized.

"There's a lot of medical need down here - simple stuff, really - that we can't take care of because we're not here long enough to get into it," said Navy Cmdr. Timothy F. Donahue, a urological surgeon from the Bethesda Naval Hospital. "It's frustrating for all of us."

Esmold Maxi knows firsthand. For two years, the 12-year-old had hobbled around Haiti's crumbling streets with a bum leg, cast off by a state health system that lacked the skills and equipment to help him, and which his family couldn't afford anyway. Then, somehow, he was sitting on a soft bed inside the Comfort.

Hugging his left knee, which had been locked at a tight angle and infected since an accident in 2005, the boy pondered his changing fortunes. "I want to run and play, and follow my friends again," he said. "I have been sad for a long time."

When the Comfort's crew first examined Esmold and began to cut off the ratty cloth dressing wrapped around his knee, the boy screamed for them to stop. For a moment, they thought he was in pain but then realized he was trying to save his only bandage.

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