Comfort Care Shapes Lives, Course for International Aid

By Fred W. Baker III
American Forces Press Service

July 22, 2009 - Since he was a small boy, Juan Carlos Manzanares wanted to be a surgeon. Growing up in Leon, Nicaragua, Juan admired the skills of the doctors on television and dreamed that one day he could join their ranks. But for most of his 17 years, it looked as if Juan would not be able to slip on a surgeon's gloves. He was born with the skin on his two middle fingers on both hands fused together in a web-like fashion. In effect, he had only four fingers on each hand. Webbed fingers are the most common abnormality on a newborn's hand. If he'd been born in the United States, Juan's hands would likely have been fixed when he was child, probably before he started school.

Last week, surgeons on this Navy hospital ship separated Juan's fingers and at the same time opened the door for him to realize his dream.

"If I didn't have this type of surgery, I wouldn't be able to study medicine," Juan said, smiling and sporting two heavily-bandaged hands after the surgeries. "This way, I will be able to fit my fingers in the gloves."

The Comfort will pull back into its home port of Baltimore in the next few weeks after finishing up Continuing Promise 2009, a four-month humanitarian trip to seven Latin American countries. Nicaragua was its last stop, and the crew wrapped up there last week.

During the mission, the Comfort's physicians, dentists, nurses, optometrists and staff served more than 100,000 patients. Its surgeons conducted more than 1,600 operations aboard the floating surgical ward. More than 135,000 prescriptions were filled.

Beyond direct medical aid, doctors and nurses set up 1,300 training sessions for more than 37,500 host-nation students. Veterinarians cared for more than 13,000 animals. Engineers took on 13 projects, helping to rebuild schools and the like. The ship even carried aboard a military band that performed in venues such as the ship's waiting rooms and at local orphanages.

At each stop, local residents massed in the streets and villages of some of the Western hemisphere's poorest countries. They waited hours, and sometimes days, for a shot at being seen by health specialists from some of the world's finest health care systems.

Most of the medical problems were routine by U.S. standards: upset stomachs, near- or far-sightedness, tooth decay.

But for many, the Comfort's visit was their first, and possibly last contact with good medical care, officials said. And the patients traveled for miles and waited in the searing heat for a chance to be treated by the Comfort staff.

"I feel that this is absolutely the most important [mission] I've ever been involved in. The tangibility of our work is so incredible," said Navy Capt. Tom Negus, the mission commander.

Negus has served in the Navy for nearly a quarter of a century and has deployed on several military missions. This is his first such humanitarian mission, though, at the helm of what he called "the most powerful ship in the Navy."

The Comfort's mission was supported by nearly 20 civilian humanitarian groups offering up hundreds of volunteers. Doctors and nurses from 10 nations, nearly 100 medical providers, also joined its efforts. Teenagers and grandmothers worked side by side with military members from around the world to provide care.

The result was a precision military operation delivered with somewhat of a summer camp atmosphere. The mess galley was a melting pot of languages and backgrounds. Surgeons and nurses in scrubs sat next to college students in T-shirts alongside sailors, airmen, Marines and soldiers, all in their combat uniforms. Military commanders briefed every evening on the next day's operations. At the end of each section brief, the staff applauded. One lucky soul was recognized nightly as the "person of the day" for outstanding efforts.

This joint, interagency, international, diversity was critical to the mission, Negus said, and symbolizes the way ahead for U.S. efforts in the region.

"My sense is this is the future of operations," Negus said. "If we as a nation are going to hope to have an effect, then we are going to operate in an arena like this, with [nongovernmental organizations] and partner nations ... all collaborating, all focused on achieving a purpose, having that alignment, that unity of mission."

The United States traditionally has established individual relationships with countries, especially on a military level, Negus said. But working with the mix of agencies and nations -- and learning to work through the bureaucracies of each -- makes this mission unique.

"We're doing things now in this mission that haven't been tried before," Negus said. "Often times, it's very easy for people to get along. It's quite another for bureaucracies to get along or to understand each other. This is very helpful in doing that."

Negus said these relationships will prove valuable in the event the ship is called on for aid. Its sister ship, the USNS Mercy, was called on following the tsunami that struck countries in the Indian Ocean in 2004.

"We know firsthand who to call – the people who can make things happen," Negus said. "That capability makes all of us much more ready in the event of a disaster. But it also fundamentally strengthens the trust between our nations. And the more ... that we understand each other on so many different levels, then the stronger our ties are with those nations."

This was the fourth time a U.S. military ship ventured into these waters to provide aid. Continuing Promise launched in 2007 with a trip here by the Comfort. Last year, the USS Kearsarge and USS Boxer, both Navy amphibious assault ships, provided aid.

During the 2007 trip, the Comfort stopped at a dozen countries for only a handful of days each. This time, officials decreased the number of stops to seven, but averaged 11 days at each country.

And at each stop, the crew honed their skills at providing care to as many as possible. In the first stops, they averaged about 7,000 patients. By the end of the mission, they were seeing 20,000 patients, and with no increase in staff, officials said.

But the impact of the $25 million mission cannot effectively be measured in terms of gross numbers, but more so in the individual lives it changes, said Peggy Goebel, a volunteer nurse working aboard with Project Hope, one of the first groups to team up with the Navy for these types of missions. It was Goebel's second trip on the Comfort.

"The difference can't be measured in bottles of Tylenol passed out ... that's not it," she said.

Goebel recalled a teenager she saw in a remote village in Nicaragua. She was 16, poor and hungry. Her baby was swaddled in rags, and at 2 months old, weighed less than a newborn. The young mother was trying to breastfeed, but hadn't eaten enough to produce milk. The baby was starving, listless and covered in scabies, Goebel said.

A Navy physician at the site took money from his pocket, gave it to an interpreter to buy formula and diapers, and asked the mother to return the next day. When she did, both mother and baby were bathed and clothed. The doctor and Goebel taught her how to mix the formula. They cleaned her only bottle and fed the baby.

More importantly, Goebel made contact with a local Project Hope coordinator, who will follow up with the mother and child to ensure care. The formula the doctor bought was enough to last only a few days, but the follow-up care could mean the difference between life and death for the baby.

"That baby may not have lived a week. That was a life-changing experience," Goebel said. "We can't help them all. We can't do everything. But hopefully, we can plant a seed that we can make a difference."