Friday, July 24, 2009

Crew Leaves USNS Comfort Changed by Mission

By Fred W. Baker III
American Forces Press Service

July 24, 2009 - It's just after 9 a.m. in this hot, humid town, and Navy Capt. Colleen Gallagher already looks tired. She is in the throes of running a medical site manned by health care providers from the Navy hospital ship, the USNS Comfort. While the ship circles just off the coast about 12 miles away, hundreds of local residents pack the streets around the town's medical clinic, hoping to be seen by one of the ship's doctors.

The scene could pass for a street fair. Vendors work the crowd selling cold drinks, snacks and fruit. Skinny, stray dogs slip through people's legs, looking for a dropped treat. Babies cling to their mothers, some crying, others breastfeeding. Bigger children kick an empty plastic soda bottle back and forth across the cobblestone.

Umbrellas blossom over the crowd as the tropical sun breaks through the overcast morning, and a local disc jockey blasts a mix of current hip-hop hits and Latin American music.

Sitting on a wooden bench outside of her operations center, which is little more than a small corner room of the clinic with a couple of computers and wires strung everywhere, Gallagher said she hopes a journalist will not take her picture.

"It's been a long trip -- very rewarding, but very exhausting. Kind of a surreal experience," she said.

Gallagher and the Comfort crew have for the past four months served on the front lines of the United States' "soft power" efforts. The ship has charted the course for aligning the U.S. military with humanitarian groups, foreign militaries and political bureaucracies at home and abroad in a synchronized effort to provide health care to some of the Western Hemisphere's poorest countries.

The ship's surgeons have seen some patients on board, but most are treated on shore at sites such as this one. The physicians, dentists, nurses and others are flown to the sites by helicopter, or shuttled on small boats. They are housed overnight in small towns and villages, sleeping several to a room in hotels that sometimes have hot water, but always have tasty local food.

The health care providers rotate to and from the ship, switching out with other staff, spending a few days at a time ashore. They work long hours – up to 16 hours a day – for 10 or 11 days straight, until they leave each country. They get their rest at sea as they head toward their next destination.

Gallagher, a Navy nurse, has led sites in each of the seven countries where the Comfort stopped. She will close this site, the final stop of the mission dubbed Continuing Promise 2009.

The staff has only one more day here. And there are still hundreds waiting for care. It's emotionally difficult for the providers to turn people away, Gallagher said. During this mission, the Comfort filtered more than 100,000 people through its ship and medical sites, but almost always not everyone who came could be seen.

The mission runs, in reality, as a military operation, and the demands of logistics mostly govern the hours the site remains open.

"There's always going to be more walking up to be seen, and we have to shut down at a certain time," Gallagher said. Still, this sometimes grates at the will of the doctors, nurses and volunteers who come with a passion for caring for the poor.

Nicaraguan military troops hold the throng at bay as volunteers work to screen them one by one and route them through the clinic. For those who make it past the guards and the yellow caution tape, this may be the first and last time they are treated by a doctor.

To prevent what officials termed "compassion fatigue," the providers must focus, Gallagher said. "Focus on the one in front of you and the next one you're going to see, and you can't worry about the hundred that may be out there that won't get in today," she said.

The Comfort's commanding officer, Navy Capt. James Ware, said some crew struggle emotionally at the start of the mission. "Initially, you have to learn to understand that the people that you're dealing with truly have much less than you have," he said. "I think most providers were able to overcome the focus on every patient and realize that they can't do everything for everybody every time."

Navy Cmdr. (Dr.) John Fortunato is a reservist and a civilian pediatric gastroenterologist. Normally, he sees about 40 children a week, he said. In his month aboard the Comfort, he averaged about 90 a day.

Because he is a specialist, Fortunato typically sees patients who already have been seen by several doctors and undergone expensive testing. On this trip, he saw his patients from "scratch," without the inches-thick folders of test results and medical reports.

The trip allowed him, though, to hone his diagnostic skills, Fortunato said, forcing him to use his hands and his brains, rather than relying on technology. But that worked against him when he pressed against the belly of a boy who likely had a large tumor growing inside. Without those expensive tests, there was no way to know if the tumor was operable. There was little he could do beyond emphasizing the seriousness of the tumor to the parents and hoping they seek treatment.

"It is hard for us ... to not be able to do everything that is physically available, even though it's not readily available," Fortunato said. "We live in a society where we don't like to lose. We don't like to say it can't be done because we can't get the resources to you."

Most serious cases are referred to the local health ministries for follow-up care. Because care is limited, and because the patients have little money, the reality of them receiving that care is iffy.

But in this boy's case, Fortunato did not settle for a paperwork referral. He summoned a health ministry official to the site, personally briefing the case in the hopes of getting a hospital bed and care for the child.

"It's hard for us ... to say 'Well, you have a tumor – next patient,'" he said. "We really wanted to make sure we got this kid tied into ... the Ministry of Health and the local hospital."

Still, Fortunato said, he wished he could have done more. "You want to fix them. That's the way we're trained," he said. "You don't accept [sending] them to someone else."

Not all of Fortunato's cases were as grim. Most were typical colds, headaches, stomach pain. The patients were sent away with prescriptions for pain relievers and directions to drink more water.

For most parents, just having a doctor say their child is OK is reassuring. They think something dreadful is going to happen, but the exam eases their minds, Fortunato said.

One 15-year-old girl came through his line, complaining of stomach pain. She was coughing up blood, the girl said. Her parents were frightened, thinking the worst. Because it fell within his specialty, Fortunato arranged to perform an endoscopy, which involves running a scope from her mouth to her stomach to look for the cause of the pain and bleeding.

As luck would have it, there was an endoscopy nurse aboard the ship who could assist, and officials agreed to allow him to perform the procedure in their surgical ward.

The parents lived two hours away from the ship, though, and had to pay to get there. They sold a pig, bought bus tickets for about $23, and soon were aboard the Comfort.

Fortunato performed the procedure and found only mild inflammation in the stomach, much to the parents' and the child's relief. A huge celebration was planned – they wanted Fortunato to come to their house for a feast. He had to decline, but that didn't dampen their spirits.

"The father said he wanted to go into medicine after that and help Nicaragua," Fortunato said, adding that he, like many others on the trip, found the experience "eye-opening."

Fortunato said he learned to be more patient on this trip. He used to whine about his staff double-booking a patient at 4 p.m. on Fridays, he said.

"I think it kind of puts it in perspective in a lot of ways," he said. "We don't know how lucky we have it."

The ship's commanding officer said Fortunato's experience is typical. While most are tired at the end of the mission, they are not discouraged, Ware said. In fact, they are proud of their work, hopeful that their efforts made a difference. No one steps off the ship the same as they came on.

"I think it makes people stronger," Ware said. "I think makes them more compassionate, and I think it makes them appreciate what they really have."


Graybar Electric Company, St. Louis, Mo. is being awarded a maximum $660,000,000 fixed price with economic price adjustment, indefinite delivery and indefinite quantity contract for maintenance, repair and operation supplies and related services. There are no other locations of performance. Using services are Army, Navy, Air Force, Marine Corps, federal civilian agencies and Defense Logistics Agency. The original proposal was Web solicited with six responses. Contract funds will not expire at the end of the current fiscal year. This contract is exercising the fourth option year period. The date of performance completion is July 28, 2010. The contracting activity is the Defense Supply Center Philadelphia (DSCP), Philadelphia, Pa. (SPM500-04-D-BP11).

Supplycore, Inc., Rockford, Ill. is being awarded a maximum $320,000,000 fixed price with economic price adjustment, indefinite delivery and indefinite quantity contract for maintenance, repair and operation supplies and related services. There are no other locations of performance. Using services are Army, Navy, Air Force, Marine Corps, federal civilian agencies and Defense Logistics Agency. The original proposal was Web solicited with six responses. Contract funds will not expire at the end of the current fiscal year. This contract is exercising the fourth option year period. The date of performance completion is July 28, 2010. The contracting activity is the Defense Supply Center Philadelphia (DSCP), Philadelphia, Pa. (SPM500-04-D-BP10).

Science Applications International Corporation, Fairfield, N.J. is being awarded a maximum $40,000,000 fixed price with economic price adjustment, indefinite delivery and indefinite quantity contract for maintenance, repair and operation supplies and related services. There are no other locations of performance. Using services are Army, Navy, Air Force, Marine Corps and federal civilian agencies. The original proposal was Web solicited with six responses. Contract funds will not expire at the end of the current fiscal year. This contract is exercising the fourth option year period. The date of performance completion is July 28, 2010. The contracting activity is the Defense Supply Center Philadelphia (DSCP), Philadelphia, Pa. (SPM500-04-D-BP12).

Science Application International Corporations, San Diego, CA; L-3 Services, Inc, Chantilly, VA; and Northrop Grumman, Herndon, VA were awarded a combined $495,000,000 force protection security system contract to support any or all of ten essential elements of integrated base defense that include deceive, deter, anticipate, deny, detect, delay assess, deploy, neutralize, and mitigate at Air Force and other DoD sites throughout the world. At this time, $5,000 has been awarded to each contractor. 642nd Electronic Systems Squadron, Hanscom Air Force Base is the contracting activity. (FA8728-09-D-0004; FA8728-09- D-0007; FA8728-09-D-0009)

Integrated Marine Services, Inc., Chula Vista, Calif., is being awarded a $36,400,000 ceiling indefinite-delivery/indefinite-quantity contract to provide ventilation cleaning services to the Southwest Regional Maintenance Center's commercial industrial services code in support of Navy ships and other government vessels within a 50-mile radius of San Diego, Calif. Work will be performed in San Diego, Calif., and is expected to be completed by July 2014. Contract funds in the amount of $3,000 will expire at the end of the current fiscal year. This contract was competitively procured as a HUBZone set-aside via the Federal Business Opportunities website, with five offers received. The Southwest Regional Maintenance Center, San Diego, Calif., is the contracting activity (N55236-09-D-0018).

Science Applications International Corporation (SAIC), San Diego, Calif., is being awarded a $7,085,710 indefinite-delivery/indefinite-quantity, cost-plus-fixed-fee, contract to provide continued development of a container security device (CSD), a small, low-power sensor mounted on or within a shipping container to detect and warn of the opening or removal of container doors. The contract includes a three-year ordering period without options. Work will be performed in San Diego, Calif., and is expected to be completed July 23, 2012. Contract funds will not expire at the end of the current fiscal year. This contract was not competitively procured; this is a sole source, follow-on, contract under the authority of 10 U.S.C. 2304(c)(1), as implemented by FAR 6.302-1: only one responsible source and no other supplies or services will satisfy agency requirements. Development of the CSD was initiated by SAIC under contract N66001-05-D-6013 which was competitively awarded. SAIC is the only source qualified and capable of performing the work at a reasonable price to the Government; the use of any other contractor would involve a substantial duplication of costs not expected to be recovered through competition. The Space and Naval Warfare Systems Center Pacific is the contracting activity (N66001-09-D-0034).

Rayhteon Company, Integrated Defense Company, Andover, Mass. was awarded on July 23, 2009 a $8,926,847 cost-plus-fixed-fee contract for FY09 PATRIOT engineering services contract option award for 37,822 man-hours of effort. Work is to be performed in Andover, Mass. (1.39%), and Tewksbury, Mass. (98.61%) with an estimated completion date of Jan. 31, 2014. One bid solicited with one bid received. U.S. Army Aviation and Missile Command, Redstone Arsenal, Ala. is the contracting activity (W31P4Q-09-C-0057).

R. Zoppo Corporation, Stoughton, Mass. was awarded on July 22, 2009 a $ 5,534,000 firm-fixed-price contract for the deck repair and paving of Sagamore and Bourne Bridges located in Bourne, Mass. Work will include the removal of existing pavement and waterproofing membrane for the full length of the Sagamore Bridge deck and the Bourne Bridge abutments. Necessary repairs to the underlying concrete will be made. A new single component modified bituminous pavement containing a waterproofing additive will be applied to the repaired bridge deck and abutments. At the bridges the following work will be performed; concrete parapets at the north and south abutments will be replaced and repairs to the concrete sidewalk, curb, expansion joints and electrical work. Work is to be performed in Bourne, Mass. with an estimated completion date of June 2, 2010. Bids were solicited on the World Wide Web with one bid received. Corps of Engineers-New England District, Concord, Mass. is the contracting activity (W912WJ-09-C-0007).

Mullen Encourages Young People to Pursue Global Service

By Gerry J. Gilmore
American Forces Press Service

July 24, 2009 - The U.S. military's senior uniformed officer saluted a group of high school student leaders interested in learning about the U.S. government and political processes during a meeting at the Pentagon Auditorium today. "I think of you as our future," Navy Adm. Mike Mullen, chairman of the Joint Chiefs of Staff, told some 200 members of the Junior State of America, a student-managed, nonpartisan civic-education group that cultivates young peoples' interest in governmental and political affairs.

"We help channel and train students who are interested in civic engagement and politics and law," said Chris McMahon, associate executive director of the San Mateo, Calif.,-based Junior Statesmen Foundation that supports the JSA. About 15,000 JSA members, he said, participate at about 500 high schools across the country. The JSA membership also includes international students.

The students at today's Pentagon program, McMahon said, had competed to participate in the annual Junior Statesmen Summer School program. Participants spend three or four weeks at one of four universities -- Georgetown in Washington, D.C.; Princeton in Princeton, N.J.; Stanford in Palo Alto, Calif.; and Yale in New Haven, Conn. -- where they take advanced courses in U.S. government and politics, history and public speaking.

Mullen, who also addressed a JSA group last year, congratulated the participants in this year's summer school program. "There is a huge need," he said, for young Americans to serve as paid or volunteer participants in U.S.-government-sponsored endeavors conducted both stateside and around the world.

In addition to military service, Americans can serve others through teaching, volunteering, the Peace Corps and other parts of government, Mullen said, and the nation needs young, bright people to join in that service.

Mullen said he didn't know he'd become a career Navy officer when he enrolled at the U.S. Naval Academy in Annapolis, Md., in 1964. Today, Mullen is the senior military adviser to President Barack Obama and Defense Secretary Robert M. Gates.

"So, you just never know" where life can take you, Mullen pointed out. Therefore, he urged the students to be aware of their career options and not to "burn any bridges early."

Mullen said he decided to stay in the military after graduating from the Naval Academy in large part because he was impressed by his fellow midshipmen, noting they were "the best people I've ever been around."

The chairman added that he continues to admire the "extraordinary" young men and women in today's military who "are serving something bigger than themselves."

It's a universal desire for parents around the world to want better lives for their children than they've had, he said. Yet, promoting peace and economic and social stability across the world, he said, also requires contributions from nonmilitary governmental agencies, as well as nongovernmental organizations.

"It's all of us together," Mullen said, nothing that the JSA students would "be more affected by the global world than any generation that we've ever had."

The current and future challenges America faces, he said, "will demand great leadership, demand great sacrifice, demand service from everybody, so that we all can move forward in a world that is stable and peaceful where people can prosper."

Little Bear 714

The following true story is a tribute to the men of A-Company, 25th Aviation Battalion also known by the call sign, "Little Bear", who served their country in the Republic of Vietnam.In the final days of October 1967, an armored personnel carrier with numerous troops on board rolled on top of a powerful anti-tank mine. The ensuing explosion killed four men and severely injured several others on and around the vehicle. Vulnerable and alone, their distress call for a dustoff (medical evacuation) was responded to by the closest helicopter in the area. The UH-1D ("Huey") Little Bear 714 was returning back to base from its lone previous mission. Two round trips were needed to deliver the wounded to a base hospital. It would take a perilous third trip in darkness to retrieve the bodies of the dead.

Hastily we loaded the last of the dead into the helicopter. Above me the rotor blades were spinning; frantically grasping for enough air to remove us from the engulfing jungle. A voice in my flight helmet cried out, "We're taking hits!" The crewchief's machine gun responded with a burst of yellowish orange tracers that disappeared into the night-shrouded jungle. "I'm in," I shouted and squeezed into the small space behind my own machine gun. We started to lift off when flashes of white appeared from the shrinking earth below. I could hear the splats as the bullets searched the ship for another host. I yanked back on the triggers of my weapon and fired and fired. The burning armored personnel carrier remained as a marker to soon fade and be forgotten, like its unfortunate crew. In the real world, grieving parents would be left with only tears and memories.
"Where are you hit?" "What?" I replied. "Where are you hit?" again questioned the medic. We were back at the landing pad of the base hospital. The last body was being carried away on an olive green colored stretcher. The medic pointed to my blooddrenched arm. "It's not mine," I informed him coldly and turned back to re-enter my ship. Light from the well-lit pad revealed a palette of blood left by our passengers. The rotor blades fan effect had spray painted the inside of the Huey with a red sticky coating. Three bullet holes ventilated the area around my perch. Jerry, the crewchief, was staring down at a puddle of reddish-black fluid growing under the tail boom. The pilot was shutting down the engine to examine a strange whistling sound coming from one of the rotor blades. It would soon reveal a .30 caliber incision.
Once again, in my seat behind the machine gun, I leaned back against the bulkhead and closed my eyes. "I'll be back in the States in ten more days and all of this will be forgotten," I said to myself. I was wrong.
I have never forgotten.

Spec. 4 Tony Lazzarini
Door Gunner-714
October 27, 1967 Iron Triangle

By Army Sgt. James Waltz
Special to American Forces Press Service

July 24, 2009 - Army Spc. Amanda Cleveland is a self-described simple girl who is "not into drama." But it's tough for an Army medic to avoid dramatic situations, especially during a deployment to Iraq. Cleveland's comrades say it is her ability to consistently help people -- not the drama -- that drives the Williamsport, Pa., native to excel at her job.

Cleveland graduated from high school in 2007 at 17 and immediately took on basic combat training and combat medical school.

"I really wanted to go into the medical field and wasn't sure how I was going to do it," she said. "A recruiter was able to get me into the health care field and give me a $20,000 bonus on top of it."

Cleveland was 18 when her six months of rigorous medical training began. She admits being a bit nervous. "It was the longest time I had ever been away from my family," she said. "I don't know if I could have graduated if it had not been for a few older friends I had made who shared their previous experiences with me."

While at training, she learned the ins-and-outs of emergency medicine and basic medical skills. She recalled one exercise, which she called "blood lanes."

"We went through these blood lanes where we had to treat mock casualties in a stressful environment," she explained. "It was fast-paced training, and we had to deal with them screaming, among other things."

Cleveland went through similar training at the regional medical training site at Fort Indiantown Gap, Pa., in preparation for her nine-month deployment here, where she is serving with Task Force Keystone. Leading up to the three-month, pre-deployment mobilization, she was one of several medics tasked with training 28th Combat Aviation Brigade soldiers in basic combat medical skills. The training allows each soldier to act as a bridge between an emergency and the arrival of a medic -- often the most critical time in ensuring a patient's survival.

Her supervisor, Army Sgt. 1st Class Collin Bowser of Indiana, Pa., said Cleveland is extremely proficient at medical training.

"She has done an excellent job teaching several hundred soldiers the basics of first aid," he said. "And these are mostly soldiers who are novices at this stuff and have minimal medical experience."

Cleveland is humble about her teaching ability, but is quick to acknowledge the importance of it. "I really enjoy teaching, but it's not always easy keeping a student's attention because I'm not a dominating person," she said. "I just keep reminding myself that what I am teaching these soldiers will not only affect them, but also the people they may have to save. I may be helping my students save a life."

Cleveland is the primary instructor of the 28th Combat Aviation Brigade's first aid refresher course here, which is taught monthly to a rotation of soldiers. When she is not training, she is receiving clinical experience in her unit's medical clinic. She takes vital signs, screens patients, performs asthma treatments and stitches sutures.

During her 12-hour shifts, she uses downtime to write home. Many soldiers here use e-mail, but Cleveland prefers to put pen to paper.

"I like to physically write letters for two reasons. First, some of my family members are technologically impaired," she joked. "But really it just feels more personal. It feels good to have that letter in your hand, knowing there was more time and energy put into it."

(Army Sgt. James Waltz serves in the 28th Combat Aviation Brigade public affairs office.)

West Bank Improves

The well travelled Michael Totten talks about a NYT report on the West Bank and relates it to his own experience there. He says cities like Ramallah and Nablus are doing 'OK' and said the former is actually a nicer place to visit than Cairo.

The corrupt kleptocracy of Makmud Abbas may pay lip service to the cause of Israeli destruction, but right now it is at war with its rival, Hamas. Whose presence in the West Bank is much weaker than in Gaza. Here the Israelis allow some movement, though there are still numerous
checkpoints and roadblocks, and there is some economic interaction between the two states.

Israel is using Abbas and his Fatah party to fight Hamas, and helping them by allowing arms shipments and fostering economic growth. This is the only effective way of fighting an insurgency, a proven method that has worked against numerous insurgencies, from the Apaches in Arizona to the Sunnis in Iraq.

It is now up to the United States to find some way to make it work in Afghanistan.

Will's book about the 2nd Armored Cavalry Regiment and the Battle of 73 Easting, is called A Line Through the Desert. It may be purchased at Amazon.

Biden Vows Support for Georgia's NATO Hopes

By John J. Kruzel
American Forces Press Service

July 24, 2009 - Vice President Joe Biden emphasized U.S. support for Georgia's aspirations to join NATO and said a new bilateral charter will focus on modernizing the country's military. In a speech to the Parliament in the Georgian capital of Tbilisi yesterday, Biden also assured the audience that a reset of U.S.-Russian relations would not come at the expense of Georgia, a former Soviet satellite that became embroiled in a five-day conflict with Russia last August.

"We understand that Georgia aspires to join NATO. We fully support that aspiration," Biden said to applause. "And, members of Parliament, we will work to help you meet the standards of NATO membership."

Biden's backing of Georgia's NATO hopes echoes the support voiced by the alliance at an April 2008 summit meeting in Bucharest, Romania, when member nations promised that Georgia eventually would join the organization.

The vice president's pledge comes at a time when President Barack Obama's administration is seeking to "push the reset button" with Russia, which saw its relations with NATO strained after last year's conflict with Georgia. Tension continues to surround two disputed enclaves of Abkhazia and South Ossetia along the Georgia-Russia border -- flashpoints of the August war -- with Moscow last month ordering international peacekeepers to leave the provinces.

With NATO membership contingent on states resolving their border disputes, Biden cautioned Tbilisi against renewed fighting with Russia as its means for reclaiming the breakaway regions. He added that the United States does not recognize the provinces as independent states, and he urged the world to disregard their statements of independence.

"It is a sad certainty, but it is true there is no military option to reintegration," he said, adding that reintegration would be achieved by "showing those in Abkhazia and South Ossetia a Georgia where they can be free and their communities can flourish -- where they can enjoy autonomy within a federal system of government, where life can be so much better for them than it is now."

"Show them the real benefits of your nation's motto," he said. "Strength is in unity."

Georgia is one of the world's largest per capita recipients of American aid, and received $1 billion from the United States last year. Biden praised a charter signed last month by the United States and Georgia that will modernize Georgia's military and increasing the two countries' defense and security partnership.

"These partnerships are not being built against anyone," Biden said. "They are being built to the benefit of everyone who seeks a more democratic, prosperous and secure world."