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Cablegate: Hhs Secretary Leavitt's Visit to Nicaragua To

VZCZCXYZ0000
RR RUEHWEB

DE RUEHMU #0949/01 2062057
ZNY CCCCC ZZH
R 242057Z JUL 08
FM AMEMBASSY MANAGUA
TO RUEHC/SECSTATE WASHDC 2944
INFO RUEHZA/WHA CENTRAL AMERICAN COLLECTIVE
RUEAUSA/DEPT OF HHS WASHINGTON DC

C O N F I D E N T I A L MANAGUA 000949

SIPDIS

STATE FOR WHA/CEN, HHS FOR OGHA - BSTEIGER AND RCORREA
STATE PASS TO EPA/OW - BGRUMBLES AND EPA/OIA - CHILL-MACON

E.O. 12958: DECL: 07/24/2018
TAGS: TBIO KSCA OTRA EAID PREL XK MX NU
SUBJECT: HHS SECRETARY LEAVITT'S VISIT TO NICARAGUA TO
DISCUSS WATER QUALITY AND FOOD PRODUCT SAFETY

REF: A. STATE 58850
B. MANAGUA 450
C. MANAGUA 443
D. MANAGUA 761
E. MANAGUA 361
F. MANAGUA 848

Classified By: Ambassador Paul A. Trivelli for reasons 1.4 (b and d)

1. (SBU) Summary. Secretary of Health and Human Services
(HHS) Michael O. Leavitt met with a calm and polite President
Daniel Ortega on June 25 and 26 to discuss improving the
water quality of Nicaragua's two "great" lakes. Secretary
Leavitt blended the themes of his regional visit into a
strong message connecting access to clean water to both
healthy local consumption and the safety of food products for
export, while promoting the idea of water quality training at
the Regional Healthcare Training Center in Panama. Secretary
Leavitt and President Ortega visited a public teaching
hospital together. Secretary Leavitt and President Ortega
took a one-hour boat tour on Lake Nicaragua, discussing
pollution sources and the lake's potential for supplying
drinking and irrigation water. Secretary Leavitt and
Environmental Protection Agency (EPA) Assistant Administrator
for Water Benjamin Grumbles offered to send an EPA/HHS
technical team later in July to advise the Government of
Nicaragua (GON) on its action plan for cleaning up and
protecting Lake Nicaragua. Secretary Leavitt also met with
the local American Chamber of Commerce (AMCHAM) and
representatives of industrial, pharmaceutical, and
agribusiness sectors to discuss food safety, the Bush
Administration's Action Plan for Import Safety and a proposed
Memorandum of Understanding on product safety between the
United States and Central American countries. During a
luncheon with opposition leaders and economists, participants
briefed Secretary Leavitt on the increasing political and
economic tensions around the country. Secretary Leavitt's
final stop was a public diplomacy event with some 90 medical
students at the Nicaraguan National Autonomous University
(UNAN) in Managua. Local press coverage of the visit was
ample and positive. End summary.

Meeting with the President
- - - - - - - - - - - - -

2. (U) Secretary of Health and Human Services (HHS) Michael
O. Leavitt met with President Daniel Ortega on June 25 and
26. Arriving from a Product Safety Summit in San Salvador on
the 24th and departing for Panama on the 26th to visit the
Central American Regional Healthcare Training Center,
Secretary Leavitt came to Nicaragua at the invitation of
President Ortega to tour Lake Nicaragua (Cocibolca). The
visit presented Secretary Leavitt with the opportunity to
discuss water quality and watershed management issues, and
their relation to food safety. Secretary Leavitt was
accompanied by a high-level HHS delegation and the
Environmental Protection Agency (EPA) Assistant Administrator
for Water Benjamin Grumbles.

3. (U) Secretary Leavitt's first meeting with President
Ortega, on June 25 at the Sandinista (FSLN) Political Party
Headquarters, was attended by Minister of Health Guillermo
Gonzalez, Vice Minister of Environment Roberto Araquistain,
President of the National Water Board (ENACAL) Ruth Selma
Herrera, and other government officials, including First Lady
Rosario Murillo, Nicaraguan Ambassador to the United States
Arturo Cruz, President of the National Social Security
Institute Roberto Lopez, President of the Health Workers
Union Gustavo Porras, and Chief of the Foreign Affairs
Ministry's Americas Desk Orlando Gomez.

4. (U) A calm and polite Ortega introduced the topic of water
quality of Nicaragua's two "great" lakes -- Lake Nicaragua
(Cocibolca) fronting the city of Granada and Lake Managua
(Xolotlan) fronting the city of Managua -- and their
importance to economic growth and human health. The entire
meeting was broadcast live on national television and radio.
Ortega described Nicaragua's two principal lakes and their
tributaries as having been polluted by industrial and
agricultural waste, aquaculture, and raw sewage. He
highlighted the potential of Lake Nicaragua as a source of
water for irrigation, drinking, hydropower, and as a tourist
destination. Ortega recognized the importance of water
quality to food safety. Noting the potential for agriculture
in Nicaragua, Ortega highlighted the need for improved
technology and foreign investment to raise productivity, and
to enhance food safety and the human health of agricultural
workers.

5. (U) Secretary Leavitt blended the themes of his regional
tour into a strong message connecting access to clean water
to both healthy local consumption and the safety of food
products for export, while promoting the idea of water
quality training at the Regional Health Training Center in
Panama. He expressed interest in preserving Lake Nicaragua
and promised U.S. technical expertise to assist Nicaragua's
efforts to clean it up, comparing the effort to that of the
United States, in cleaning up the Great Lakes. Secretary
Leavitt tied the need for clean water to the growing
U.S.-Nicaragua trade relationship under CAFTA by highlighting
the importance of producing clean, high quality food for
export, as well as local consumption. He spelled out
President Bush's Action Plan for Import Safety, which was
presented at a Product Safety Summit in El Salvador the
previous day. He acknowledged the growing importance of
Central American food exports to the United States,
specifically highlighting the prevalence of Nicaraguan labels
in U.S. supermarkets.

6. (U) Dr. Jaime Incer Barquero, President of FUNDENIC
SOS/Fondo Natura, a local nongovernment organization (NGO)
dedicated to sustainable development and natural
conservation, made an impassioned plea for environmental
policies that will preserve Lake Nicaragua as the country's
most important natural resource. He warned of the risk of
desiccation within 25 years as a result of climate change and
population pressures on the lake. Dr. Incer stressed the
first step is to conduct a comprehensive assessment and
monitoring program to determine the level, composition, and
source of contamination. Echoing Secretary Leavitt's theme,
he stated, "The state of a country's health depends on the
state of the environment; a sick people equates to a sick
ecology." ENACAL President Herrera announced that for the
past year, ENACAL has been monitoring lake water quality
along 28 fixed points, in preparation for the construction of
drinking water pipelines from the lake to three growing
Pacific Coast communities, including tourism mecca San Juan
del Sur. She acknowledged that these pipeline projects could
begin soon, which will require an immediate effort to protect
the lake from solid waste -- including plastics and tires.
She cited ENACAL's legally mandated role as protector of all
sources of drinking water in Nicaragua.

7. (U) EPA Assistant Administrator Grumbles expressed
willingness to share his agency's legal, regulatory, and
technical expertise with the GON as it makes plans to clean
up Lake Nicaragua and Lake Managua. He emphasized that the
central focus of any effort should be the prevention of
pollution through education. In response to Secretary
Leavitt's introduction of the Regional Healthcare Training
Center, Health Minister Gonzalez noted that quite a few
Nicaraguan healthcare workers had received training there in
the last year, including participation in a program on avian
influenza epidemiology. The Minister discussed a new
alliance with the Nicaraguan National Autonomous University
(UNAN) of Leon to develop a quality control laboratory for
medicines.

8. (U) Secretary Leavitt concluded by proposing a product
safety Memorandum of Understanding (MOU) between the United
States and all Central American countries. HHS's objective
is to encourage independent product safety certifications for
exports to the United States that would obviate inspections
at the port of entry. The certification program would
require common food safety regulations and inspection
standards throughout Central America. The Regional
Healthcare Training Center in Panama City would offer courses
on food safety. Secretary Leavitt highlighted that having
certified exports would increase opportunities for
Nicaragua's agricultural sector. He used the recent example
of salmonella-tainted Honduran cantaloupe exports to impart a
sense of urgency for the MOU. Ortega welcomed the program
and all U.S. assistance to Nicaragua in this area.

Hospital Visit
- - - - - - -

9. (U) Secretary Leavitt, President Ortega, and their
respective delegations immediately proceeded to Hospital
Manolo Morales. (Note: Much to the surprise of Secretary
Leavitt's security detail, Ortega jumped behind the wheel of
an SUV and drove Secretary Leavitt to the hospital himself.
End note.) The facility serves as a public teaching hospital
specializing in orthopedic medicine and surgery. Secretary
Leavitt and the President toured various wards, led by the
Director General of the Hospital Dr. Ariel Herrera. Ortega
and Secretary Leavitt spoke with patients and staff, and paid
specific visits to the HIV/AIDS inpatient center. The visit,
covered in full by GON-invited press, offered Secretary
Leavitt the opportunity to assess the quality of Nicaraguan
health care at a typical general practice facility. Most of
the patients directed their comments to President Ortega,
detailing their needs, the hardships endured by their
families, and the lack of resources at the hospital and in
regional medical clinics. Several patients refused to speak
to President Ortega or Secretary Leavitt.

10. (SBU) Throughout the tour the Minister of Health rattled
off statistics on the decline in Nicaragua's health over the
last 16 years. (Comment: This is common FSLN propaganda that
contradicts the National Demographic Health Survey.
President Ortega and the FSLN-affiliated media used this
visit as a propaganda opportunity in response to other media
criticism earlier in the week regarding the GON's lack of
support for HIV/AIDS victims. Several patients during the
visit specifically complained that anti-retrovirals were out
of stock. End comment.)

American Chamber of Commerce Breakfast
- - - - - - - - - - - - - - - - - - -

11. (U) On June 26, Secretary Leavitt met with the Nicaraguan
American Chamber of Commerce (AMCHAM) and representatives of
industrial, pharmaceutical, and agribusiness sectors to
discuss product safety and Secretary Leavitt's proposed MOU.
Secretary Leavitt contrasted the current method of catching
unsafe products at border inspection points against his
vision of encouraging in-country certification according to
international standards by ensuring producers build safety
into their products right from the start. He proposed the
development of a regional MOU within two months, starting
with a few product lines before expanding to others. He
expects the private sector, rather than the government, to
play a leading role in developing appropriate standards.

12. (U) Secretary Leavitt explained the Action Plan on Import
Safety through two examples. One, from a Texas processing
plant, demonstrated the "know your grower" principle, by
which the supplier must provide information on soil and water
quality, fertilizer and pesticide use, and delivery and
transport methods. The second, from a red pepper farm from
India, demonstrated the idea "from the ground up." Labels of
products made with the peppers contain traceability
information to fulfill the requirements of a large retail
chain, which shows how the private sector's response to
market demands is swifter than government regulation, as
India's Spice Board is now developing national traceability
standards.

13. (U) Secretary Leavitt emphasized that the idea is not to
invent new standards, but rather to work with
already-established standards created by reputable
organizations. Once products have earned certification, they
will enter the U.S. market more quickly; without
certification, they risk heightened border scrutiny and
delays. Secretary Leavitt recognized that producers may have
to adopt new technology, but the assured market entry should
offset the investment. Lastly, he explained that all these
changes are a direct result of globalization. There are
three responses to changes in the global market: 1) resist
and fail, 2) go along and survive, or 3) lead and prosper.

Lake Nicaragua Boat Tour
- - - - - - - - - - - -

14. (U) While waiting the next morning for President Ortega
to arrive at the Port in Granada for a tour of Lake
Nicaragua, Secretary Leavitt and EPA Assistant Administrator
Grumbles met with Environment Vice Minister Araquistain,
ENACAL President Herrera and Dr. Incer. The group discussed
the GON's creation of an "environmental network" among the 32
municipalities around Lake Nicaragua and Lake Managua, called
AMUCRISAN. The GON will develop a national action plan for
cleaning up and protecting the lake based on action plans
formulated by each municipality. The action plan will center
on sustainable development, cleaning up the lakes, protecting
the environment, and educating the population. The
environmental aspects of the plans include reforestation,
watershed management, soil conservation, and establishing
protected areas. Incer requested assistance in conducting a
baseline assessment of pollutants in the lake and an
effective response. Herrera presented ENACAL's plan for
cleaning up the lake that focused on four key areas:
elimination/reduction of agrochemicals used by farmers along
the rivers that feed into the lake (most polluting),
reforestation, education of producers, and construction of
waste water treatment infrastructure. Assistant
Administrator Grumbles committed to sending a technical EPA
team augmented by HHS to help the GON with its action plan
and to share lessons learned and best regulatory practices.

15. (U) Secretary Leavitt and President Ortega then took a
one-hour boat tour on Lake Nicaragua aboard a Nicaraguan Port
Authority ferry. Dr. Incer served as guide and discussed the
history, geographical dimensions, ecological diversity, and
sources of pollution of the lakes. He also described the
lake's potential for supplying water for drinking and
irrigation. Vice Minister Araquistain presented the GON's
efforts to develop the action plan with the 32 municipalities
around the lakes. Secretary Leavitt and Assistant
Administrator Grumbles repeated to Ortega their commitment to
send an EPA/HHS technical team to offer advice on the lake
action plan. They insisted, however, that the GON must have
a preliminary plan on paper and be ready for detailed
discussions to make the effort productive. Secretary Leavitt
introduced Chief Environmental Health Officer Captain Craig
Shepherd from the Department's Centers for Disease Control
and Prevention, who highlighted the key role of educating the
population about water sanitation and waste control. While
it takes a generation to show permanent results, education is
"the best preventative medicine."

16. (C) In a final one-on-one meeting with Ortega at the
dock, Secretary Leavitt recapped the purpose of the visit and
tied together water sanitation with food safety. He
emphasized the need for product safety standards that include
water used to irrigate crops. He promised that his staff
will work with the Ministry of Health regarding an MOU on the
product/export safety. In closing, Secretary Leavitt
emphasized that change is possible when the economy is
growing since new investors will seize the opportunity to set
up clean businesses in Nicaragua, develop an industrial base,
pay taxes, and contribute to Nicaragua's export development.
Secretary Leavitt warned, however, that investors will only
come if they believe they will be treated fairly and
predictably. Secretary Leavitt told Ortega that he needs to
send positive signals to investors. Ortega assured Secretary
Leavitt that while "there is a lot of noise in Nicaragua,
investment is up and (the government) is interested in more
U.S. investment."

Opposition Leader Luncheon
- - - - - - - - - - - - -

17. (C) During a luncheon with opposition leaders and
economists, Secretary Leavitt learned about the increasing
political and economic tensions around the country.
Secretary Leavitt's guests were Eduardo Montealegre, Managua
mayoral candidate and opposition political leader; Francisco
Aguirre Sacasa, a leading Constitutional Liberal Party (PLC)
deputy and President of the National Assembly Economic
Commission; Mario Arana, Executive Director of the Nicaraguan
Foundation for Economic and Social Development (FUNIDES) and
a former Minister of Trade and Central Bank President; Erwin
Kruger, former President of the Nicaraguan Federation on
Business Associations (COSEP) and current publisher of the
finance magazine Dracma; and Roberto Zamora, President of
Bancentro, Nicaragua's second largest commercial bank.

18. (C) The discussion highlighted Nicaragua's current
economic challenges of high inflation (caused by high food
and oil prices, and wage hikes), slowing U.S. and Nicaraguan
growth, a deteriorating investment climate, and management of
domestic debt (Refs B and C). Participants noted that there
are opportunities in high food commodity prices, the banking
sector is strong, the country is close to major markets, and
labor costs are low, but politics has hampered growth.

19. (C) Montealegre and Aguirre warned that Ortega's goal was
to eliminate his political opposition and remain in power for
as long as possible by changing the political system from a
presidential to a parliamentary one. Aguirre observed that
Ortega has two sides, "Like Dr. Jekyll and Mr. Hyde. You
(Secretary Leavitt) have been meeting with Dr. Jekyll; we
Nicaraguans get Mr. Hyde." Montealegre said that the
political situation is worse than seven years ago, when
corrupt former President and convicted felon Arnoldo Aleman
provoked an economic and political crisis. Ortega is preying
upon an opposition fractured and distracted by Ortega's and
Aleman's shared control of government institutions and the
judiciary. Political apathy plays into the hands of Ortega.
Montealegre and Aguirre both agreed that the combination of a
dangerous economic situation and a "closing of political
space" through the recent deregistration of two small
opposition parties (Ref D) could result in political and
social upheaval. At one point, Montealegre called Ortega an
"opportunist . . . interested only in the money." In
response to Secretary Leavitt's question as to what the
United States can do to help, Montealegre and Aguirre agreed
that the United States needs to remain engaged by sending
visitors, setting conditions on assistance, focusing on rule
of law issues, and insisting on accountability.

University Public Diplomacy Event
- - - - - - - - - - - - - - - - -

20. (U) Secretary Leavitt's final stop was a public diplomacy
event with some 90 medical students at the Nicaraguan
National Autonomous University (UNAN) of Managua. After
presenting a biographical sketch, Secretary Leavitt took
questions from the students. A question on environmental
assistance allowed Secretary Leavitt to link clean water,
health, and safe food exports. In response to a question on
health insurance reform, Secretary Leavitt expounded on his
belief in healthcare competition, the power of the consumer,
and the role of the market in safely and efficiently
distributing products. Secretary Leavitt summed up his
preventive approach to health care by stating, "If you change
a heart, you can change a nation."

Media Assessment
- - - - - - - -

21. (SBU) Coverage of Secretary Leavitt's visit was robust
across all media. The "official" Sandinista television and
radio stations used the hospital and lake tours to portray
President Ortega as friendly to the United States, in sharp
contrast to his usual anti-U.S. rhetoric. Official radio
broadcast live coverage of most of Ortega's activities with
Secretary Leavitt, including Secretary Leavitt's visit to the
FSLN headquarters, the hospital tour, and the boat tour.
Official television later broadcast hours of video from the
visit with propaganda voice-over promoting Ortega.

22. (U) Independent and opposition media generally treated
the United States favorably, highlighting Secretary Leavitt's
commitment to product safety while criticizing
inconsistencies in Ortega's public messages. Both major
print dailies focused on the fact that President Ortega
personally "chauffeured" Secretary Leavitt from the FSLN
Secretariat to the Hospital. Channel 2, cable-only channel
11, and Pacific Coast-coverage Channel 10 covered the
hospital visit. Channels 2 and 10 interviewed HHS Special
Assistant for International Affairs William Steiger regarding
the visit, while official Sandinista stations shied away from
giving U.S. officials air time. At least 6 national and
cable TV stations, both major newspapers, and 3 radio
stations reported on Secretary Leavitt's visit to the
Nicaraguan National Autonomous University (UNAN) of Managua.
Center-left national daily El Nuevo Diario (circulation
30,000) featured an exclusive interview with Secretary
Leavitt, mainly focused on product safety issues. The
article mentioned that Secretary Leavitt's visit was not
related to the MANPAD missile-medical assistance exchange
proposal currently under discussion (Ref E).

Comment: Dr. Jekyll, Mr. Ortega
- - - - - - - - - - - - - - - -

23. (C) As we have seen with other high-level U.S. visitors,
Ortega shelved his bellicose rhetoric in favor of cordiality
during Secretary Leavitt's visit. While Secretary Leavitt
was treated to "Dr. Jekyll," GON cooperation on organization
of the visit epitomized the "Mr. Hyde" characteristics of
this administration. Messages came and went through various
Ministries, the Office of the First Lady, and even the
Nicaraguan Embassy in Washington, before it became clear that
First Lady Rosario Murillo was handling the visit herself.
Murillo limited contact between the Embassy and the GON, and
waited until the last possible moment to interact. Decisions
on a meeting and a joint visit to a hospital were left until
hours before Secretary Leavitt arrived, and the lake tour was
left for Ortega and Secretary Leavitt to decide at their
first encounter. Ministry officials were completely
uninformed about their role and relied upon the Embassy as
their primary source of information.

24. (U) Secretary Leavitt's staff cleared this cable.
TRIVELLI

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