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DoD Press Briefing with Dr. Ward, Capt. Boynton, Mr. Leitch on USNS Comforts Four-Month, 12-Country Humanitarian Mission To South America, Central America and the Caribbean from the Pentagon Briefing Room, Arlington Va.

Presenters: Dr. S. Ward Casscells, Assistant Secretary of Defense for Health Affairs; Navy Capt. Bruce Boynton, Medical Treatment Commanding Officer; and Mr. Robert Leitch, Director of Project Hope Aboard USNS Comfort
August 17, 2007
 
         BRYAN WHITMAN (Pentagon spokesman): Well, good afternoon and welcome. Midway through -- or midway into their 120-day, 12-country deployment to the Caribbean, Central and South America, USNS Comfort medical provides have conducted more than 170,000 consultations seeing patients in Belize, Guatemala, Panama, Nicaragua, El Salvador and Peru, and just this week arrived in their seventh port of service, Manta, Ecuador.
            While in Ecuador, members of the United States Navy, Air Force, Army and Coast Guard as well as U.S. Public Health Service, Canadian forces and nongovernmental organizations, such as Operation Smile and Project Hope, will continue to provide the type of world-class care that they have been giving to date to literally thousands more. 
            Let me introduce to you who you see on the screen today. Working from left to right -- I think you will recognize some of these individuals -- first is Dr. Ward Casscells. He is the assistant secretary of Defense for Health Affairs and is down south visiting and is onboard the Comfort today. Captain Bruce Boynton, who you've met before in the previous VTC that we did with the Comfort. He is the commanding officer of USNS Comfort and its medical treatment facility. As such, he is the top doc onboard, and he oversees the entire medical staff and is responsible for all medical procedures conducted both on ship and ashore by military medical personnel. And today, who we missed last time actually, welcome Mr. Robert Leitch, who is the director of operation Project Hope aboard the Comfort. Hope stands for Health Opportunities for People Everywhere, and these volunteers have been working hard educating health care professionals, providing medicine and supplies, and helping fight communicable diseases. 
 
            So I want to welcome all three of you. Thank you for taking some time today to be here with the Pentagon press, and let me turn it over to you for any opening remarks before we get into some questions. 
            CAPT. BOYNTON: Thank you. Welcome to USNS Comfort. Today, we're at Ecuador midway through our 120-day, 12-nation mission of training, humanitarian assistance and partnership, and this mission is part of the U.S. Southern Command's Partnership for the Americas. And the people of the Americas are bound together by ties of history and geography. We're all Americans, and this mission is part of President Bush's commitment to our neighbors. It is truly Americans helping other Americans. 
            The crew of the Comfort has been mentioned. It includes members of the Army, Navy, Air Force, Coast Guard, Public Health Service, civilian mariners and Canadian forces. In addition, we've been joined by the health professionals of Project Hope and Operation Smile, and they represent the spirit of U.S. volunteerism and community involvement. And furthermore, in each of the countries we've visited, we've been joined by the doctors and nurses of our host nation who have partnered with us in caring for their own citizens. 
            Thus far we've visited Belize, Guatemala, Panama, Nicaragua, El Salvador and Peru, and we will visit Colombia, Suriname, Trinidad, Haiti and Guyana in the weeks to come. 
            In each of these countries our doctors and nurses go ashore and set up clinics that provide primary care for children and adults, dental care, eye glasses, pharmacies, immunizations and laboratory. Our surgeons have held pre-operative screenings and bring back patients to the ship for surgery and post-op recovery. And we do over 20 surgeries a day in general surgery, ear, nose and throat, urology, gynecology, maxillofacial, plastics and orthopedics. In addition, our Seabees carry out construction projects and repairs at hospitals, clinics and schools. Biomedical repair techs fix broken medical equipment, and health educators conduct classes for patients and health care professionals. 
            At this point I would like to turn it over to Dr. Casscells, who will give us some details on the mission so far. 
            DR. CASSCELLS: Thank you, Captain Boynton. 
            My name is Ward Casscells. I'm a heart doctor and the new assistant secretary of Defense for Health Affairs for the past three or four months, so this is my first visit to the Comfort. I had the privilege of working with the sister ship, the Mercy, after the tsunami in the first week of January of '05, and so I've had a little perspective on the great work they did there and on the lessons they've learned since then. 
 
            And one of the things that I was delighted to find out about today was that they have not only learned the lessons from the Mercy mission in the tsunami in Indonesia, but they have -- they continue to build on that and learn new things.   
            So obviously at half -- the halfway point, with 45,000 patients seen already, and a total number of doctor visits or patient encounters of over 178,000, you would hope that people would continue to learn, and indeed they are. They continue to improve.  
            So some of this is a function of having all the services on board, and it's -- want to thank the Navy for welcoming some of my Army colleagues and HHS colleagues, Public Health Service and the Coast Guard, and in particular for applying some of those lessons that their colleagues learned a few years ago: that when you go to places like this, you need to make sure you have enough dentists, because dentists are so appreciated, and there's a backlog of dental needs that, if not met, will contribute to pneumonia and heart attack and infections and a lot of unhappiness. And they've got the dental piece down nicely. 
            The immunization effort has really ramped up. In addition, they have addressed this issue we found in Indonesia where you need a lot of optometrists, you need -- people really need glasses. If people don't have reading glasses, they can't read the materials you give them to get educated and take care of their health. And of course when the Comfort steams out of here, they want to leave behind people who can take care of themselves. 
            So you know, it's not just the fantastic doctors from Operation Smile who come in and operate on kids in conjunction with the Navy doctors and the great doctors and volunteers from Project HOPE, like Bob Leitch, who's going to speak in a minute; but the fact that when they operate here, they invite the local doctors to come on board and operate with them. And they have that experience, which is useful. It builds new friendships and partners. And the patients go home feeling like their doctor was involved in their care from start to finish, not that they went to someplace where their doctor wasn't welcome or wasn't good enough, because the doctors here are very good.  
            We've learned another lesson in the recent years of these kinds of missions, which is that they have well-trained health care workers who welcome the opportunity for further technical updates, but they need biomedical engineering support. So one of the ongoing lessons that I'm taking back -- and I'm grateful to Dr. Boynton for this -- is that it's not just about doctors and nurses; it's about the biomedical technicians who can run the equipment and fix the equipment.  
            So to extend the analogy that we're not here just to teach -- to hand out fish but to teach people to fish, I would add that the things they're doing so well now are, they're teaching people to maintain their fishing equipment. And one day, they'll be making their own fishing equipment and manufacturing it, and then the job will be done. 
 
            So they continue to get better. 
            Let me just close by saying thanks to Hugs Across America for their -- all the bears they donated to Project Handclasp, to the whole city of Green Bay, Wisconsin, for several hundred thousand dollars of medical equipment and for the -- to the unnamed volunteer who took all that equipment and drove it Portsmouth, Virginia, and stored it in a warehouse to make this possible. So that's huge. 
            You know, let me just say also that -- in closing that this mission changed people. When Admiral Stavridis first started talking about this mission a couple years ago, there wasn't any funding for it, and he took a risk. And Admiral Stavridis, who is the combatant commander, the -- what we used to call the commander of chief of the Southern Command, believed in the humanitarian mission. He believed, as I do, that it's a bridge to peace, an instrument of diplomacy, it's just the right thing to do. And he gave the green light on this mission, even though the money wasn't available. 
            So they don't have all the money they need, but it's been a 90 percent solution, and it's been extraordinarily successful. You can see that by the numbers of patients being operated on today, some 29, and the smiles on the faces of the mothers, the wives who come with these patients, and the doctors who come with them. 
            I mentioned a couple of other people who have been changed by this mission.  Lieutenant Finnegan, who flies the Dustoff Evacuation Helicopters, now says he wants to go to medical school. I'm so delighted to hear that. 
            Manny Santiago who gave the -- conducted the tour today for all the visiting dignitaries from the government and from the private sector here in Ecuador, discovered and showed the commodore, Captain Kapcio, that he is one heck of a diplomat and one fine showman, and he has made these tours a delight for the people of the countries he's visited. So we're grateful to Manny Santiago for this newly discovered talent. 
            The commander of the boat, Captain Bob Kapcio, wouldn't tell you this, so I can tell you. 
            He is so caught up in this mission that he has begun to keep a web log. You can read it on the SOUTHCOM website. Lots of people are reading it now, and you can see how inspired Captain Kapcio is. He's not a doctor; he's a line commander. He cares about the medical mission.   
            Obviously we doctors are very grateful to Captain Kapcio and we're also grateful to his mother. Why do I say that? Because Captain Kapcio's mother has given -- has sent five boxes of toys for children, so you know that he is on fire about this. He's gotten his mother fired up. This is really an extraordinary thing.   
 
            And lastly the man sitting to my left -- Captain Doctor Bruce Boynton -- I met him in Cairo, Egypt a couple years ago when we were working on the bird flu planning. I never saw him smile. Since I've been on this boat, he hasn't stopped smiling.   
            So here's to the Comfort. You all have -- you're changing lives. And it's changing you, I believe it's fair to say. And I'm just so proud to be with you Captain Boynton. Thank you very much.   
            CAPT. BOYNTON: Thank you, sir.   
            Now I want to give the mike over to Bob Leitch of Project HOPE.   
            MR. LEITCH: Thank you, sir. 120 days -- it seems a lot longer. I feel a little like the chap who shot the albatross in "The Rime of the Ancient Mariner," and I have another 120 to go.   
            I say this because I'm a soldier and I normally live in Africa and I'm here as a volunteer for four months -- truth in advertising, when they tried to convince me to take this job and I did. I have been fascinated by this past 120 days and I consider myself to be part of a huge experiment. It's called medical diplomacy and it was elaborated to me last week by the undersecretary of State, Karen Hughes, when she visited -- a charming and persuasive lady, and I understand entirely what the idea is.   
            My friends who work in NGOs -- normally they have French accents -- bat their eyes in horror when I talk about working with the military. It's an experiment, and it will be interesting to see how it ends up. I think there are hugely interesting trends already. And I see this -- and the people that have volunteered with us so far, and we're -- up to about 60 have been through.   
            They all feel the same way, that this is a great way to do things, firstly because the Navy provides us with a very clear logistic and security system; and the water's hot in the morning, you never have to worry about showers; and a structure that enables to do us what we came to do.   
            It also, I think, gives us a chance to innovate. There's no question that the volunteers I've met so far, they exemplify what Dr. Casscells talked about, which is this volunteerism. You can tell from my accent I don't come from hereabouts, and we've had a lot of people who have been volunteers who don't come from here either. Our next iteration, we've got an ex-Indian Army Medical Corps captain, a doctor from the Indian army, and on the last one we had a lady from Tanzania, an Indian; both of them recent immigrants, both now working in America and living happily in America, and giving back as volunteers. And there have been a number, too, of people from this part of the world, recent immigrants, who have come back to work. So the volunteerism has been huge. 
 
            The tactical level of this great experiment seems to be usually effective. People enjoy working with the Navy, which as a soldier amazes me -- (laughter) -- but they do. And we have great fun day in and day out. 
            As far as the innovation is concerned, there are a just a couple of things that are worth talking about, I think. One of them is the whole idea of using people who have greater experience and have worked on their own. We started something called the Trojan Horse. And if I can explain it to you, when we first went to Nicaragua, in particular, we were slightly concerned because there was some antipathy towards us there. And so we put out in front of us the Public Health Service and their vets, and they went and treated the horses. And the local people took an instant shine to them. And so once we treated their horses, then they allowed us to look at their children and wives and mothers. And we called it the sort of Trojan Horse.   
            And I've talked to Dr. Casscells about this, and we're both convinced that the idea of mixing veterinary and human medicine together is enormously important. And in fact, today while we're speaking, the Public Health Service and Navy and HOPE are out and they're de-worming a couple of thousand pigs and about 400 children. And you notice they're doing them together, because that's the cycle, worms and kids. 
            We're also doing something in terms of teaching which is different, and most of what HOPE does is teaching and training. 
            And this teaching has tried to use local resources. We call it come- as-you-are first aid. We don't use high-tech. And my favorite, again, is something we call the MRE box, the Cabbage Patch doll and the paracord, and rather than use a sophisticated mannequin to teach obstetrics, emergency obstetrics, we took an MRE box, put a hole in it, found a Cabbage Patch doll, gave it a(n) umbilical cord that was made out of a parachute -- a lengthy parachute cord. And we've taught them how to deliver babies through the hole in the MRE box, and the local people love it because it's something they understand, a piece of technology that they can take home and use to teach in their villages. And quite frankly, it's a case of: If it's good enough for Americans, it's good enough for us. And they don't feel that we're showing off, and I think that, again, is enormously important. 
            As to the future, this must be about capacity building, and we see ourselves very much as piggybacking on the back of the Navy. They're doing the armed reconnaissance, they're going looking, they're finding the problems, they're seeing the needs. Our job is to pick up the long-term capacity, and we've already seen that in Panama City, where we're looking very closely at Secretary Leavitt's brainchild, the regional training center, and we want to partner there. We want to partner in Peru on HIV/AIDS, and we want to partner here with an organization called Junta de Beneficencia de Guayaquil, which is a big private not-for-profit hospital organization. 
 
            So that's how we see it. Enormous benefit for us; a partnership of equals, a partnership that allow us to use the Navy to find capacity building in the long term. 
            Thank you. 
            MR. WHITMAN: Well, gentlemen, thank you for that overview, and let me see if we have some questions here. If you would like to direct them to a specific individual, please go ahead and indicate that; or they'll determine who the best person is to answer the question for you. 
            Q     Hi. Kirit Radia with ABC News. Our latest understanding was that your ship has not been directed to go to Peru to work on these earthquake efforts. I'm wondering if that's changed at all, and if you could enlighten us anything you guys are doing to prepare for that in the case you are directed to go. 
            CAPT. BOYNTON: And I want to let Dr. Casscells answer that, who has the most up-to-date information. 
            DR. CASSCELLS: Thank you. 
            The question about going to Lima. Admiral Dave Smith and I -- he's the joint staff surgeon -- will be headed to Lima either this evening or tomorrow depending on how fast we can get there. It's very difficult to get flights right now, and we need a lot of help from the Navy to do that. They're trying to arrange that. 
            Obviously, it's a humanitarian emergency, and it's time- sensitive, unlike this one. We're in touch with as many people as we can be there, and we know that there's still a need for water, for chlorine tablets to clean water. 
            There's still some need for simple things like food and blankets.   
            And there's a surgical team that's been dispatched from Joint Task Force Bravo. It's departing as we speak, with 30 personnel, from Honduras.   
            And in addition, we have a number of people on the ground there, doctors and students, from the Uniformed Services University of the Health Sciences. And the Navy has the NAMRU research lab there, with a number of doctors and nurses. And there are many, many NGOs who have already arrived. 
            So we are -- a group of us are heading over to do needs assessment, to thank the people involved, to be sure that all of our people are safe, and to see what we can do to assist in the next steps, which typically are such things as the need for more definitive surgery, for immunizations. And in the poorer areas children will often need Vitamin A, and they need public health surveillance to make sure that the water supply has not become contaminated -- simple things.   
 
            You know, depending on how long the refugee situation lasts, and it depends -- it varies dramatically from situation to situation -- I don't think that the commodore has yet made a decision about whether the -- when and if the Mercy -- excuse me -- the Comfort might return to Peru. They were just there, and I think that's a commander's decision. I have to turn it over to the commander himself. 
            COMMODORE KAPCIO: We have received no direction or guidance to go to Peru. I sent an assessment in yesterday with where we are in the ship. We're ready to go, if called upon. It's approximately about 800 miles from where we are right now. And it would take us about two days or just a little over two days to get down there.   
            MR. WHITMAN: Very good. We can hear you just fine. Actually, we lost you just about the time you started to answer the question.   
            COMMODORE KAPCIO : I don't know. Maybe that was a good thing.  
            MR. WHITMAN:   Well, they want to be the judge of that back here. So maybe you could give us another shot at it.   
            COMMODORE KAPCIO: I have not received any further guidance from U.S. Naval Forces Southern Command, or SOUTHCOM. I have been in contact with them most of the night. And as the secretary pointed out, our current U.S. responses are as he outlined, and we are ready to go. 
            I'd say we're about 800 miles away from the area of the devastation. It'd probably take us about two, two and a half days to get there once we depart. 
            MR. WHITMAN: Very good.  Thank you for that. 
            Any other questions? Jeff, go ahead. 
            Q     Dr. Casscells, Jeff with Stars and Stripes. If I understand it correctly, you are going to Lima, and then you're going to make a needs assessment of what further aid might be needed there. Is it possible we could have more active duty troops involved? 
            DR. CASSCELLS: That's not my call. You know, as the assistant Secretary of Defense for Health Affairs, we primarily look at policy, we try to learn how we can do things better the next time. I'm not an operational line commander, nor in the operational medical care. I have been as an Army Reserve doctor, but this is a policy job. 
            And the point of getting there early for my team is to say that we care about this, that humanitarian relief counts, that we will set aside other things to go there, that the United States cares about Peru, that we want to thank them for looking after our students and our citizens who are down there, and that we stand ready to advise the ambassador and the line commanders about our -- from our -- based on our experience in other humanitarian disasters through the years. So for us, it's a way to get in and say thanks, to begin the needs -- to participate in the needs assessment but mainly to get our after action review started early. 
            MR. WHITMAN: Well -- go ahead. 
            Q: Have you run into any setbacks to the mission, like not having enough supplies to help everyone or personnel? 
            CAPT. BOYNTON: I think so far for the entire mission, if you're speaking not about Peru but about the mission that we're on -- we have had some personnel come and go as we lose and gain capabilities with the Project HOPE people, public health service, but for the most part, we've had a pretty steady supply of personnel and all the needs that we -- have met all the needs there. 
            Medicine-wise, we've been able to keep our supplies up. We have a replenish -- USNS Saturn is going to replenish here towards the end of the month. We have plenty of supplies for the next couple of ports, so we're doing okay with supplies, and we're doing okay with personnel. 
            MR. LEITCH: One of the functions on this mission of HOPE, Project HOPE is to -- what they call gifts in kind, and we brought on the ship some millions of dollars worth of medical equipment, stores and drugs and so on, medications, that were actually asked for by the various ministries of Health when we did the original, and we're delivering those. We're actually delivering those medications. And we're actually, as we speak, delivering medications to Peru. 
            (Technical difficulties.) 
            (Audio break.) 
            MR. WHITMAN: Some technical challenges here, and I do believe that we've come to the end of our questions. If you can hear us, I think we'll bring this to a close. If you have any final comments, now would be the time to impart them to us. 
            (Technical difficulties.) 
            I appreciate you sticking with some of the challenges that we've had with the technology today, and it's been useful. And if you can hear me on the other end, we again thank you for your time and wish you the best as you continue your mission. 
            Thank you.
 
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