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Pakistan- blog III

Note: August 19 and 20 I spent in Pakistan and wrote three postings about the experience on my way back from the region. Regrettably, in the interim, terrorists bombed the Marriott Hotel in Islamabad killing 53 people. I want to acknowledge that tragedy, express my condolences to the Pakistani people, and put my writings into proper time context.

As described in my first posting on the Pakistan trip, I traveled there at the invitation of Minister of Health Sherry Ruhman, who had visited my office weeks earlier. Our conversations convinced me I could accomplish multiple things with a trip to Pakistan. I had a couple of days between my trip to Africa and an assignment to represent the President at the closing ceremonies of the Olympic games, and Pakistan was generally on the way, so I decided to go. I had two objectives principally:

  • Learn more about how terrorist organizations use health care as means of nurturing support among local communities
  • Reinforce, by being there, the ongoing friendship of the United States with Pakistan’s leaders.

Terrorists sometimes hide in the most remote regions of the world or hide in plain sight within communities. In either case, having support, or at least acceptance among locals, is necessary to cover their existence. From what I’ve read, this is well illustrated in Iraq, where locals appear to be turning against terror organizations and assisting security forces in rooting them out.

The region along the Pakistan/Afghanistan border is notorious as a haven for al-Qaeda. Many speculate it is the hiding place of Osama Bin Laden. Periodically, the United States conducts military activities in that region to root them out.

In order to cultivate support among the local people of that region, terrorist groups work through non-governmental organizations friendly to their cause to undermine the credibility of the government in providing basic services like health care. They then set up clinics and actually provide services to the people themselves. Terrorist organizations have discovered the power of health as a tool in securing the loyalty of local people.

This happens all over the world. I spoke with Special Forces Teams who conducted health missions in Northern Mali, another place where al-Qaeda finds isolation. In Northern Mali, Cuban health teams provide medical services. In Lebanon, the government’s health role has been almost entirely taken over by Hezbollah, an Iranian supported political party.

In Pakistan, the national government is able to deliver very little health care and it is unsafe for any U.S. support to attempt delivery. In the border region, the best role for our government is to provide assistance to the Pakistani government. It is their duty and they need to be the face of health. We have a significant stake in their success, however. To the degree that people believe their government cannot deliver, terrorists are enabled.

Throughout the rest of Pakistan, the situation is different. I sense our biggest problem is that ordinary Pakistani citizens don’t have any idea how much we do for their country. When combined with their complicated politics, the United States is not currently held in high regard by the Pakistani people.

One region where the United States is greatly appreciated is in the area of Northern Pakistan that was struck by an earthquake in late 2005. I flew by helicopter over the area. Even two years later, the size and magnitude of the earthquake was evident.

The United States sent massive aid to help. The most important assets at the time were large helicopters with the words, “United States of America” written on the side. People knew the United States was there.

We have not left either. I met with community leaders at the site of one of many health centers our government is building. We are also paying to train medical workers. I stopped at a training meeting of traditional birth attendants who were learning how to deal with a particular complication.

HHS Photo by Allyson Bell
Secretary Mike Leavitt attends the opening of a training course for local doctors and nurses in an area affected by the Kashmir, Pakistan earthquake of 2005. The course, sponsored by USAID, is for local doctors and nurses and is key to reducing traditionally high rates of maternal mortality.

Most impressive was the difference in how our reception felt in that region. People compensate health diplomacy with their loyalty. Terrorists know that, and we need to use health diplomacy as a tool against terrorism.


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Hi Mike what a great blog posting. Why don't other USA agency people do what you do, like, getting out there?

Posted by: Elizabeth | October 07, 2008 at 12:43 PM

Secretary Leavitt: I lived in Islamabad from 1993 to 1994 servign the US Embassy there with my husband and two young childern. It was already a dangerous place, we learned to live with bombings, riots, poverty, refugees,etc., we also lived in the most beautiful nature preserved place. The Marriott Hotel was our regular shopping and relaxing place so I was saddened to hear about the bombing that killed so many people. While I was there, I formed a volunteer group to visit women and children in prision. Pakistan has long been plauged by corrption, poverty, reguees, and radical fanatics. Being a Chinese American, I had a different experience than most of my colleagues and friends in Pakistan; Pakistanis love Chinese.

I am glad you made a visit to Pakistan during this testing time. Your trip no doubt strenghtens the ties between the two country. I am an 8(a) contractor working at HHS. I would like to come visit you to talk about Pakistain and tell you about my experience in HHS. My cell is [edit].

Posted by: Sophia Parker | October 16, 2008 at 03:31 PM

Secretary Leavitt: Thank you for sharing your trip impressions.

Posted by: Denise Bailey-Jones, Ph.D. | October 20, 2008 at 02:23 PM

Health and food are great pr tools. When you write "Terrorist organizations have discovered the power of health as a tool in securing the loyalty of local people"

Even the mafia learned about soup kitchens and health care. Kings learned that caring for their people is good and that "letting them eat cake" could cause even a woman to loose her head.

The 320 Million the US is giving for pandemic flu has made news papers around the world. (I saw this while posting the links of 5 to 10 news stories on the FluWiki each morning)

Though the US sends the USS Comfort to countries and Gives much aide to fight HIV in Africa the good will does not make the news.

I'm glad you still blog after all these months. As one person commented "It is the example of our power but the power of our example"

I'm looking forward to Wednesday's webcast on Pandemic flu at 1 pm.


Posted by: Kobie | October 27, 2008 at 02:44 PM

Secretary Leavitt,
Your blog in general has opened my eyes to many things. Culturally I have grown by reading your words. I cannot travel to these far away places but the way that you write about them allows me to have a taste.

Your posts about Pakistan are important in particular. When a country is in the news here we hear so many negatives about a place or a people group. When I read here I see that people are people. Armies change, agendas change, but moms and dad's, children, and all other non-combatants are the same the world over. We all love and want the best for those around us.

Your blog allows this truth to shine forth.

Thank you for your writing over the years. I hope that your leadership style is emulated by others in the years to come.

Best Regards,

Posted by: Catherine Mitchell | October 28, 2008 at 06:20 AM

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