Comfort Mission Shows Renewed MHS Humanitarian Focus

By Matt Pueschel,
FHP&R Staff Writer

As part of a new emphasis on DoD global humanitarian health care efforts, the mammoth 900-foot long, 70,000-ton U.S. Navy Hospital Ship Comfort is on course in the Southern Command region and delivering on its medical relief goals for "Continuing Promise '09."

The converted 1976 oil tanker, painted white with giant red crosses on the sides, now serves as a beacon of advanced medical support for conflict- or disaster-stressed areas around the world. "It's a floating hospital and that in of itself is just a magnificent thing," said David Lieberman, the ship's chief officer. "Depending on the limitations of the port, we can go anywhere in the globe along the coastlines of the seven continents and we can provide medical care to anybody within reach."

Onboard personnel report that the Comfort's Continuing Promise '09 mission is close to meeting projected efficiencies in terms of patient numbers and services provided in the midst of its April 1-July 31 disaster relief training and health care mission to seven countries in Central and South America (Haiti, Dominican Republic, Antigua and Barbuda, El Salvador, Nicaragua, Panama, and Colombia). The estimated $24 million mission has gathered medical personnel from across DoD, the Public Health Service, and more than a dozen nongovernmental organizations to work together with providers in each of the host nations to provide a full range of surgical and primary care services to local patients in need.

Five countries (Canada, France, El Salvador, Netherlands, and Nicaragua) also have personnel onboard to assist with care and translation at each of the stops. Ship personnel will further provide dental care, veterinary medicine, engineering and construction services, biomedical repair, and measures of effectiveness analysis. The ship is equipped with two helicopters and two 10-meter boats with canopies, as well as a new fixed platform on the side of the ship, to aid in the transport of patients and providers to and from shore.

In all, about 900 personnel are onboard and 1,300-1,400 will have rotated through by mission's end. Four operating rooms and about 250 beds will be utilized on the ship, and personnel will also go onshore to provide primary care at two sites in each country.

The fourth such Continuing Promise mission to the Southern Command region, this year's mission differs from the '07 Comfort mission in that it features an increased level of partnering among all of the military Services, Coast Guard, PHS, NGOs and the foreign medical contingent. It is also visiting a fewer number of countries this time, seven compared to 12 in '07, to allow more recovery and quality time with patients.

Surgical patients were pre-selected in extensive planning efforts before the mission began with each host country's Ministry of Health, and a pre-surgical screening is further done early on after arrival at each stop. "One of the keys truly for this mission is to select the proper patient with a predictable outcome and the surgical staff has those capabilities, so that we make sure that we provide the maximum benefit without causing a burden for the health care system in the country," said Capt. James J. Ware, MC, USN, the mission's medical commander. "That was coordinated early on in our plan with the Ministries of Health."

The Comfort brings advanced capabilities such as X-ray, ultrasound, MRIs, CT Scans, EKG monitors, backup power, oxygen and suction, centrally located operating rooms to reduce rocking, intensive care unit isolation and overflow capability, lab, vaccination and pharmacy services. The mission also features a full spectrum of specialists¬--from ophthalmologists, cardiologists, general and orthopedic surgeons, Ear, Nose and Throat and oral maxillofacial specialists, to physical therapists, head and neck surgeons, dermatologists, and pulmonologists. In addition to about 300-400 surgeries that will be performed on the ship in each country, primary care will be provided onshore to 1,000-1,500 patients a day. Comfort personnel will work side by side with local physicians and nurses on the ship and onshore clinics.

Acute needs in primary health and tropical medicine will be examined, and specialized services will include cleft palate and lip repair, cataract surgery, club foot correction and treating hernias, among other chronic conditions that local patients may not have had the opportunity to address previously. "A multitude of things that in this country sometimes are corrected early on after it issues," said Capt. Ware. "Some of the patients in these countries are burn victims that may have had burn scars for 5-10 years. We have plastic surgeons onboard and pediatric surgeons that can help a lot of these patients that haven't had the benefit of seeing those types of specialists in their country."

Patient health records, diagnoses and accessible prescription determinations will be handed off to the Ministries of Health so that patients can receive appropriate follow-up care with their local doctors and medical societies. "That's our biggest goal, is that we want them to be able to have good follow-up care afterwards," said Lt. Cdr. Thomas Olivero, USN, a Navy perioperative nurse and department head of the ship's main OR, pre-op and casualty receiving area. "It's a lot of communicating with the host nations, working with the Ministries of Health and making sure they understand not only what was done, but providing them a good document on follow-up care. That is a big part of it, and that's something that we're really going to strive to accomplish."

NGOs will assist with patient movement back to their communities. "It's really the human interaction that's going to drive the success of this mission," said Capt. Ware. "We're there in a helping hands scenario to learn from them because there is a lot that we can learn from them, and to also share our experience and our knowledge base."

The number of NGOs participating has risen to about 18, up from three in the '07 mission--in an attempt to grow the humanitarian civilian aspect of the mission. The improved coordination dovetails with a 2005 National Security Presidential Directive calling for the Departments of State and Defense to integrate their health stabilization and reconstruction planning and training efforts. "The partnering is much greater this time," said Continuing Promise mission commander Capt. Bob Lineberry, USN. ¿We¿ll continue to work closely with the State Department, PHS folks, but I think what has really changed for this time is that (increased) partnering with our NGOs. We (also) want to work very closely with our host nation partners because they're the ones who are inviting us into the country (and) we will have some of their medical professionals onboard. A major part of this is being able to share information and collaborate in an environment such as this. If called upon, certainly in some sort of catastrophic event, we might have to go down into this area (to assist). It's much better for us to know and understand the medical complications that there might be in this type of environment, so we are learning as much from our host nation partners as they are probably learning from us."

The humanitarian assistance and disaster response training aspect of the mission is one of the Navy's key maritime strategies. Furthermore DoD recently gave global health stability and humanitarian operations a comparable priority to combat operations, so missions such as Continuing Promise, as well as a similar humanitarian civic medical assistance Navy-led mission to the Pacific Command region called the Pacific Partnership have become important components of this policy. DoD is also involved in military-to-military medical training initiatives with the Africa Partner Station and Global Partner Station, and has further provided disaster relief by delivering health care, conducting rescues or transporting aid in recent disasters such as the Indonesia tsunami, earthquakes in Pakistan, Peru and Costa Rica, and flooding in Honduras. "I think with President Obama's interest in volunteerism, the capability the USNS Comfort brings to the table as far as medical is right in line, and what I've found is there are thousands and thousands of Americans who would like to join up with a mission like this to provide health care in areas of the world where people might not be so fortunate and to partner with host nations," said Capt. Ware.

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