Part V in a multi-part series about Operation Continuing Promise (Parts I, II, III, & IV)
Regularly Updated Photostream Here (a glitch in the ship’s internet security currently bars my uploading more photos. Will be fixed soon.)
The people came. And came. Some came in their Sunday finest — ladies in nice summer dresses with floral prints and gentlemen wearing their dress shoes in the mud. They were lined up bright and early — around 300 when I arrived at 10AM on the first day, Tuesday. By the end of that day the line was down to 30, and those were given tickets to be first on day two. They came with ailments of all sorts — dental problems, breathing problems, malnutrition, eye problems, finger problems, heart conditions, and any other problem.
They came from all over Puerta Cabezas with their children, parents, grandparents, and anyone else who needed medical attention. The minister of a church near the center of town said when the people get sick they usually just wait for a miracle. Medical attention is expensive: the only local hospital may be able to diagnose your condition, but they have no medication to share. Transportation is expensive: a flight to the capital, Managua, where the most consistent medical attention is available, costs a month’s wages. A bus to Managua is 17 hours and involves roughly 190 stops.
Read On …Our Operation Continuing Promise medical clinic occupies most rooms in the local high school, Colegio Moravo Juan Amos Comenius. One station administers a liquid to kill tapeworms and other parasites that sap strength, stunt growth, and contribute to malnutrition. One room is used as the dental clinic. The dental chairs didn’t arrive on day one so the Navy, Air Force, and USPHS dentists and dental hygienists did examinations, fluoride treatments, and even tooth extractions with the patients sitting in the school desks in the room. The eye clinic is set up and stocked with hundreds of pairs of glasses in multiple prescriptions. An X-ray machine, available by day two, is used to detect TB, pneumonia or other thoracic distress. Doctors in the general medical examination room do basic examinations and minor surgery. They removed a growth from a woman’s thumb. One man had a growth removed from the underside of his eyelid. A boy had a wire puncture his eye two weeks ago and had had no real treatment. Our doctors were able to quell the infection, but the damage to his vision was permanent. More-involved surgeries will include a trip on a helo over to the Kearsarge’s surgical bay.
Puerta Cabezas used to be supported largely by agriculture and the Gulf of Mexico. Limes, mango, fishing, diving, pork, some beef cattle, and sea turtles were abundant nearby until Hurricane Felix last year. The Vice Mayor said Felix wiped out the lime and mango trees, killed most of the pigs and cattle, and the fishing has not been the same. Not until recently did the national government begin delivering assistance. Such a catastrophic storm obviously did not do in only the livelihood, but the infrastructure — the local park, roofs of buildings, houses — and many of the trees were heavily damaged. Economic renewal is made more difficult, the minister explained, by the layers of government fees (some legit, if exorbitant, others are bribes) for most anything you want to do. Every part of the government that touches your proposed activity requires a fee for what you want to do. The bureaucratic red tape gets so oppressive that most new endeavors are simply abandoned. A ship came into port and knocked down one of the most important piers. A company wanted to rebuild it, but as more and more fees were demanded by government officials for approval at all levels, they simply dropped their effort at rebuilding.
The people of Puerta Cabezas live in conditions most Americans cannot imagine. I have read those words written by other people, believed them to be true, but did not fully understand their meaning because I had not yet seen for myself. I have seen, and it is true. Many of the houses they live in are what we would consider dilapidated housing for livestock. Most are mid-level: they actually have paint on the exterior and a fence around them with only one material used as siding and a consistent, whole roof. More rarely are the very nice ones that have a high wall around them. Almost all have decorative security grates on the windows. Most roads are dirt, with some paved roads in the main town area. They drive around those roads with little regard for anything like traffic laws. Mangy dogs, most emaciated, roam the streets foraging for anything to eat. Trash is ubiquitous.
But the people smile a lot. They wave at us as we go by in the buses. A number of kids climb the trees hear the airstrip where the helos alight to get a look at the off-loading operations — personnel and cargo. At the medical clinic they wait patiently in the lines (for the most part — even the most placid person gets testy sometimes). In the city streets lively music can be heard from a nearby store front. Most stores are open-front. Produce, prepackaged goods, some clothing, toys, handmade jewelry, fresh prepared foods, meats cooking on the grill, and much else can be purchased at roadside stands and open-front booths in the market strip.
Kimberly, the principal at a school near the center of town voiced what has been a common sentiment. “We are thankful that the North Americans are here to do some of this. We are grateful…the more people to help the better.”
In one room at the high school the vice mayor of Puerta Cabezas and a national health official (who was proudly sporting his National Rifle Association ballcap) met with a dozen preventive medicine doctors, tropical disease specialists, and civil affairs officers from the Navy, Air Force, and US Public Health Service. The questions and answers ranged from medical facilities available in-country and those that are needed; medical training needed for nurses and the public in general; and what the Operation Continuing Promise personnel could feasibly do in the two weeks we are in Nicaragua. Training will be conducted in malaria education and prevention, proper hydration for infants — waterborne illnesses are one of the top causes of infant mortality, diving safety, as well as a nursing clinic and midwife seminar.
The vice mayor is a very important figure in the Puerta Cabezas area. He is responsible for more than 200,000 people in 52 communities throughout the region. He voiced his appreciation for our efforts, especially after the devastation of Felix. “We believe that we really need the doctors to come here so that we can have a better life.”
But it hasn’t been all perfect. Any endeavor as large as this with the Navy and all its many moving parts working with other governmental agencies and NGOs will have its glitches — especially when it’s trying something never really done before. On day two, the medical personnel didn’t arrive ashore until 11AM and then stood at the airstrip awaiting a Nicaraguan military escort for another hour. The people had begun lining up at the clinic much earlier. The generators being used to power the large equipment, including the X-ray machine, are smaller than the ones they had slated for the site. The larger ones are on the way. The civil affairs officer — the officer who is supposed to be The Expert on the local culture — is not a Latin American specialist, but was assigned to this mission to Latin America anyhow. Only half of the dental equipment had arrived the first day and the rest — including the chairs — didn’t arrive until the afternoon of day two. On the way home Wednesday, the same medical personnel team that was late getting to the clinic was taken to the beach to catch a ride on the LCU (Landing Craft, Utility) for the one-hour boat ride back to the USS Kearsarge. I and other media were included in this part of the adventure. They shuttled us all to the LCU from the beach on amphibious trucks called Larks, only to have us all return to the beach when they realized they needed the LCU for cargo and vehicles. We then had to wade out to a smaller Mark 8 assault craft — pretty much a miniature LCU and likely very similar to the craft that delivered the Rangers ashore on D-Day and the Marines ashore all over the South Pacific during World War II. The water only got up to our knees, but with splash and waves my pants were drenched. They did allow us to take our shoes off — it was an all-sand surf and it felt great to walk through the lukewarm water in the late afternoon. We departed the beach at dusk and got back into the Kearsarge late. I was sapped. Not only could I not sit and string intelligent sentences together, but I discovered that something had changed in the internet security permissions they had afforded us so that now we cannot log in to most web-based email accounts — including the two I most need.
I spoke with a Navy doctor who is stationed in Japan, but who volunteered to come on this mission. He readily acknowledged that the glitches exist but explained that this mission is a training mission as much as it is a humanitarian mission. According to him, Congress just approved more than $700 million annually in the military budget to conduct missions like this, both here in the western hemisphere and also in other parts of the world, every year. Here in OCP, Navy personnel are learning how to do this sort of mission so that when the next one rolls around they will have a much smaller learning curve and will already have a firm grasp of what and who they need.
In spite of the glitches, by the end of day three of the clinic, Thursday, they had seen roughly 200 patients with eye problems, 700 general medical exams (especially pediatric check ups), 100 dental examinations, including fluoride treatments and extractions, and 240 de-worming treatments. That’s more than 1,200 patients seen in only three days.
This mission is not cheered enthusiastically by all, however. Some officers and a few enlisted have expressed their opinion that, while it’s great we’re doing good things for these people, we ought to fix the problems “at home” first. I asked a number of officers about this sentiment and what they thought of it. One Lieutenant Commander became emotional as he responded to my question. “We’re very fortunate and blessed in the United States and this is a way to give back,” he said. “This is about building partnerships among countries and being good neighbor.” This is his first humanitarian mission and was unable to fully express his feelings on it. “I’m overwhelmed,” he managed to say after grasping for words and failing. The Navy doctor who came from Japan quickly went into message control mode and made sure I understood that those officers were speaking for themselves and not for the Navy. “With the end of the Cold War,” he offered, “we could pay more attention to taking care of people next door. Well these are the people next door.” This officer had been aboard the USS Boxer for the first phase of Operation Continuing Promise along the Pacific coast of Central and South America. On the last stop of that mission they came to a town which sorely needed a new electric pump for their one and only well. The Seabees’ construction plate was already full and they were already over-budget. This officer passed the hat among the medical officers, went down to the hardware store in town, and bought a new electric well and all the electrical fitting needed for it.
This mission is not about fixing all the world’s ills, just as we cannot fix all the ills “at home.” This mission, as I’ve shared before, is about renewing our commitment to our nearby neighbors. In a sense, this is about bringing the New Colossus to the tired, poor, huddled masses, rather than keeping our largesse stockpiled to rot. This is about bringing the New Colossus to the “wretched refuse” where it is found along teeming shores — such as these built our nation in centuries past; most of us can count such “wretched refuse” among our ancestors. My Irish and Ukrainian forebears certainly qualify my history. These people “yearn to breathe free,” but are hampered due to lack of access to needed care. We are able to bring it; the people eager to accept. As I was about to board the bus at the end of the day a man walking by called over to me in decent English: “Are you American?” “Yes, I am American.” “God, I love you Americans!” We bumped fists, and I boarded the bus, mostly speechless.