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Cablegate: Costa Rica: Medrete Treats Nearly 1000 Patients In

VZCZCXYZ0000
PP RUEHWEB

DE RUEHSJ #0800/01 2811721
ZNR UUUUU ZZH
P 071721Z OCT 08
FM AMEMBASSY SAN JOSE
TO RUEHC/SECSTATE WASHDC PRIORITY 0160
INFO RUEHZA/WHA CENTRAL AMERICAN COLLECTIVE
RHMFIUU/CDR USSOUTHCOM MIAMI FL
RUMIAGH/COMJTF-B SIMS SOTO CANO HO

UNCLAS SAN JOSE 000800

SENSITIVE
SIPDIS

DEPT FOR WHA/CEN, WHA/PPC AND PM; SOUTHCOM ALSO FOR FPA

E.O. 12958: N/A
TAGS: PREL PGOV PHUM MASS SOCI CS
SUBJECT: COSTA RICA: MEDRETE TREATS NEARLY 1000 PATIENTS IN
PUNTA BURICA REGION

REF: SAN JOSE 0003

1. (U) SUMMARY: On 25-27 September 2008, Honduran-based Joint
Task Force-Bravo (JTF-B) and Costa Rican medical personnel
conducted a Medical Readiness Training Exercise (MEDRETE) in
Costa Rica's remote Punta Burica region on the south eastern
border with Panama. The Embassy coordinated the event and
contributed six translators to help non-Spanish speaking U.S.
doctors communicate with their patients. This event follows
a MEDRETE conducted late last year in the Talamanca region of
Costa Rica (reftel) and was the first-ever conducted near the
border with Panama. Nearly 1000 people, both Costa Ricans
and Panamanians, received much-needed medical treatment.
Four patients were medevac'd by U.S. Army Blackhawk
helicopters to a nearby hospital. Three members of the
national legislature, one a medical doctor and one a dentist,
also participated. Food donated by Embassy personnel was
airlifted to the sites. Visiting the treatment centers, the
Ambassador was interviewed by national print and television
media, which focused on the positive contributions of the
U.S. to this joint humanitarian mission. Local leaders and
patients expressed their appreciation for the help and told
us that it "was like a dream come true." END SUMMARY.

=========================================
FIRST MEDICAL ASSISTANCE TO AREA IN YEARS
=========================================

2. (U) This MEDRETE to the Punta Burica region was the first
medical assistance from any source that its inhabitants had
seen in more than two years. Access to the zone is extremely
difficult due to rough terrain and the lack of roads. The
closest Costa Rica city is Golfito, on the Golfo Dulce near
the Osa Peninsula. Without evacuation assistance, even
"emergency" patients have at least a three-hour trip by
horseback to the nearest medical facilities, which are
actually in Panama. Even in those facilities, assistance is
not guaranteed.

3. (U) JTF-B doctors and nurses, with some Costa Rican
counterparts, treated patients, with Embassy staff
translating for the JTF-B staff, allowing them to understand
and treat long-running conditions. For example, one 16-year
old patient who had been suffering from chest pains and
fainting spells for some time received a diagnosis of an
irregular heartbeat (cardiac arrhythmia). Most common
ailments found by the JTF-B team were parasites, skin
infections (as a result of living in a humid climate),
diarrhea, and respiratory infections.

4. (U) The last time a dentist had visited the Punta Burica
area was five years ago, according to locals receiving oral
exams. Patients of all ages received dental exams, with
cavities being the major problem found. JTF-B and Costa
Rican dentists also performed tooth extractions and fillings.

=================
A DREAM COME TRUE
=================

5. (U) The local population in Punta Burica welcomed the
assistance with open arms and open hearts. Many patients and
local elders told us they "thought the day would never come"
when they would see the U.S. help arrive. One of the leaders
said that it truly was a "dream come true."

6. (U) The sight of U.S. Army Blackhawk helicopters also drew
large crowds everywhere they flew and landed. Each time the
UH-60s shut down at the village sites and staging zones, the
crews happily conducted tours for locals. Colorfully-clad
indigenous women and children seemed most fascinated with the
helicopters and couldn't thank us enough for our assistance.


============================================= ==
MEDRETE HIGHLIGHTS U.S.-COSTA RICAN COOPERATION
============================================= ==

7. (U) The MEDRETE, which took place in two separate sites in
the Punta Burica region (Alta Carona and La Pena) included
the participation of 36 JTF-B medical and support personnel
and nearly 40 Costa Rican medical personnel. Coordinated by
Post's Office of Defense Representative (ODR), MEDRETE
medical professionals evaluated and treated 942 people from
both Costa Rica and Panama in this isolated and depressed
region. Many patients were from the indigenous communities.
Four patients were airlifted for further treatment to a

nearby hospital. Three of the evacuated patients needed
pre-natal care and one patient needed treatment for a severe
skin condition.

8. (U) We coordinated with many GOCR agencies to make this
MEDRETE happen, but most importantly with the GOCR's Caja
Social (similar to the U.S. Social Security Administration,
but they also administer all of the public hospitals in Costa
Rica). The Golfito-area Caja Social physicians welcomed the
MEDRETE, helped with the planning and supported it with many
medical personnel. The Caja Social even advertised the event
in local media, something Embassy Locally-Employed Staff
could not remember ever happening before. A wide range of
other GOCR agencies helped make this event happen, including
the Ministries of the Presidency, Public Security, Health,
Civil Aviation, and Immigration.

========================================
LEGISLATORS TREAT PATIENTS; VIPS OBSERVE
========================================

9. (U) Similar to the unusual example of bipartisan
cooperation we observed last December, two of the three
legislators that visited the MEDRETE sites, Federico Tinoco,
PLN (a dentist) and Orlando Hernandez, opposition PAC (a
medical doctor), also participated, with both of them rolling
up their sleeves and treating several patients. Olivier
Jimenez, the Golfito-based PLN legislator who represents the
region, accompanied Tinoco and Hernandez for a brief visit to
the site on September 26.

10. (U) Several senior members of the GOCR also visited the
MEDRETE sites during a "VIP visit" on September 26, including
the Minister of Public Security (MPS) Janina Del Vecchio, MPS
Vice-Ministers Jose Torres and Ana Duran, and the National
Chief of Police Erick Lacayo. The Ambassador, along with the
DCM and POLOFFs, accompanied the GOCR delegation.

11. (U) In addition to the support for the MEDRETE, JTF-B
helicopters ferried several hundred pounds of food donated by
the U.S. Embassy community. The food included basic staples
such as rice, beans and salt. The cooperation between
various USG and GOCR entities, as well as with some private
enterprises that provided the use of an airstrip that
facilitated the VIP visit on September 26, was excellent.

=========================================
EMBASSY ENGINEERS POSITIVE MEDIA COVERAGE
=========================================

12. (U) Thanks to closely coordinated efforts of the Embassy
Public Affairs Section (who facilitated the transportation of
journalists to one of the MEDRETE sites as well as coverage),
prominent media organizations reported this event. Four
national television channels and one local channel (6, 7, 11,
and 42; and 14) devoted prime-time stories to the MEDRETE.
Their stories focused on the medical needs of the community
as well as provided the Costa Rican national audience a
positive view of U.S. military humanitarian assistance.
Additionally, the most widely read daily, Diario Extra, and
the most respected daily, La Nacion, ran comprehensive
features. One other national daily, La Prensa Libre, and a
regional daily, Estrella del Sur, also had positive coverage.
(Details and the actual press coverage of the MEDRETE have
been sent to WHA/CEN and SOUTHCOM.) Spanish-language
interviews of Ambassador Cianchette, ODR Chief Commander
Camacho, and several of the JTF-B medical professionals
figured prominently in the television coverage.

=======
COMMENT
=======

13. (SBU) The importance of this second MEDRETE in less than
a year in Costa Rica cannot be overemphasized, both in terms
of real medical benefits to an isolated local population as
well as to the positive image of the United States. While
bureaucratic hurdles to conduct MEDRETEs remain burdensome,
the Costa Rican national leadership is firmly behind this
type of humanitarian assistance from DoD. Facing a last
minute curve-ball from the Colegio de Medicos (the AMA
equivalent), which set impossible-to-meet standards to
"certify" the JTF-B physicians to treat patients in Costa
Rica, President Arias himself intervened, approving the
MEDRETE based on humanitarian needs.

14. (SBU) The Caja Social's leadership was most instrumental

in making this event happen. Far from being "forced" on
Costa Rica, this MEDRETE was to a great extent, a Costa Rican
show, conducted at their request and supported outstandingly
by JTF-B. In fact, opposition PAC legislator (and doctor)
Hernandez hoped we might be able to conduct a MEDRETE in his
province (Cartago) in the Turrialba area, another very poor
area with limited lines of communication. U.S. MEDRETEs are
clearly "treating" attitudes as well as patients in Costa
Rica!

15. (SBU) This MEDRETE built upon the foundation laid by last
December's successful event (reftel) and resulted in even
more goodwill towards the United States and the Embassy in
Costa Rica. While Costa Rica is relatively more developed
than the rest of Central America, it still has areas of
extreme need, and we can help to meet those needs. The
assistance provided was deeply appreciated by the patients
and the GOCR. The overall results are fully in keeping with
USG and SOUTHCOM "soft power" goals for Costa Rica and the
region. We hope to continue the success of this military
humanitarian assistance in Costa Rica in 2009.

16. (U) Post sends a special thank you to the great men and
women of JTF-B who made it all happen. We appreciate their
outstanding support and medical professionalism, which will
benefit both patients and USG goals in the region. Kudos for
a job very well done!
CIANCHETTE

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