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Cablegate: Is There a Doctor in the House? Health Minister

VZCZCXRO4282
RR RUEHLMC
DE RUEHMU #2495/01 3272320
ZNY CCCCC ZZH
R 232320Z NOV 07
FM AMEMBASSY MANAGUA
TO RUEHC/SECSTATE WASHDC 1700
INFO RUEHZA/WHA CENTRAL AMERICAN COLLECTIVE
RHEHNSC/NSC WASHINGTON DC
RUEHLMC/MILLENNIUM CHALLENGE CORP WASHDC
RUEAIIA/CIA WASHDC
RUEAUSA/DEPT OF HHS WASHINGTON DC
RHEFDIA/DIA WASHINGTON DC
RUMIAAA/CDR USSOUTHCOM MIAMI FL

C O N F I D E N T I A L SECTION 01 OF 02 MANAGUA 002495

SIPDIS

SIPDIS

STATE FOR WHA/CEN AMD FOR WHA/FO-GSNIDLE
STATE ALSO FOR PM-A/DAS RICHARD KIDD AND PM/WRA-MARK ADAMS
SOUTHCOM FOR FPA

E.O. 12958: DECL: 11/26/2017
TAGS: PGOV TBIO PARM MASS NU
SUBJECT: IS THERE A DOCTOR IN THE HOUSE? HEALTH MINISTER
RESIGNS UNDER PRESSURE

REF: MANAGUA 2376

Classified By: Ambassador Paul Trivelli for reasons 1.4 b&d

1. (U) Summary: On November 6, Nicaragua's Minister of
Health, Dr. Maritza Cuan, tendered her resignation in what
appears to have been a palace coup engineered by
Vice-Minister Guillermo Gonzalez. Over the prior several
weeks, Cuan had come under increasingly public and high-level
criticism, including from both President Ortega and First
Lady Rosario Murillo. Cuan is the third female minister and
sixteenth senior-level woman to depart the Ortega
Administration this year (Reftel). VM Gonzalez, who has
since been named Minister, was the Health Ministry's (MINSA)
main interlocutor with the U.S. during early-October
discussions concerning the exchange of Nicaraguan MANPADS for
medical equipment. We are trying to determine whether this
recent development will affect ongoing MANPADS discussions.
End Summary.

"General Hospital" Nicaragua-Style
-----------------------------------
2. (C) On November 6, with all the drama and suspense of a
good telenovela finale, Nicaragua's Minister of Health Dr.
Maritza Cuan resigned her post in an apparent palace coup
engineered by Vice-Minister Guillermo Gonzalez, with a coup
de grace delivered by First Lady Murillo. Cuan's problems
likely began when she was tapped as Minister, in place of
front-runner Gonzalez, by an Ortega trying to build a
gender-balanced cabinet. According to media reports, Cuan
privately criticized the qualifications and competency of
several mid-level MINSA officials, as well as the
FSLN-dominated health Workers Union (Federacion de
Trabajadores de la Salud; FETASALUD) for engaging in
union-building activities rather than providing medical care
to Nicaraguans. A well-placed source in the First Lady's
office told us that Cuan first considered resigning in
September, after First Lady Murillo reprimanded her for
traveling to the Atlantic Coast on the heels of Hurricane
Felix ) the first Minister to do so ) without obtaining
official permission from Murillo. Cuan's position became
untenable in late-October when VM Gonzalez, backed by several
senior MINSA officials and a portion of the FETASALUD
rank-and-file, sent a letter to Ortega requesting Cuan's
dismissal.

3. (SBU) On November 1, the story leaked to the press and the
final episode of what the media have dubbed "Telenovela
Maritza" began with a spectacularly disastrous press
conference called by FSLN Deputy, union leader, and erstwhile
Cuan supporter, Gustavo Porras. Apparently, Porras had hoped
to mediate differences between Cuan and Gonzalez, but spent
the better part of a tense hour reassuring MINSA and the
media that things were fine. The audience remained
unconvinced and Porras had to walk back from his support of
Cuan. Cuan continued to deny rumors that she would soon be
replaced. She disappeared from public view, however, at the
same time that VM Gonzalez started popping up
everywhere--launching national campaigns to eradicate dengue
and combat leptospirosis, campaigning to fight HIV/AIDS, and
sitting next to First Lady Murillo at a weekend press
conference with National Police Commissioner Granera on
police cooperation with the Comites de Poder Ciudadano (CPC).


4. (SBU) None other than First Lady Murillo delivered the
coup de grace for Cuan on November 5. Cuan had organized the
Fifth Central American Congress on HIV/AIDS scheduled for
November 5-8 and attended by the Pan American Health
Organization (PAHO), the UNAIDS Fund, and UN AIDS Ambassador
HRH Princess Mette-Marit of Norway. Cuan had put together an
advertising spot welcoming the 2,000 participants in the
Congress, which had begun to air locally. However, First
Lady Murillo ordered Cuan and MINSA to pull the spot on the
first day of the conference because Cuan had "not consulted
about the content of the sport nor asked permission from
Murillo's Council for Communications to put the message on
the air." It is widely known that Murillo jealously guards
her "responsibility" to coordinate all government messaging
and advertising; however, it is unclear whether Cuan failed
to consult Murillo about the spot or if permission was

MANAGUA 00002495 002 OF 002


withdrawn ex post facto by Murillo.

Minister not the only target
----------------------------
5. (SBU) In her letter of resignation, Cuan stated that she
was leaving for personal health reasons, but the press and
local political activists continue to speculate. VM Gonzales
told the press that Cuan resigned over a disagreement about
Ministry reorganization. Porras told the press that multiple
personal health issues interfered with Cuan's ability to do
her job. Meanwhile, Cuan's entire staff has reportedly been
asked to step down. During the last couple of weeks, several
other director-level officials have been dismissed.
Anonymous MINSA insiders have told the press that they were
under a gag order regarding the shake-up, and would be
dismissed if their names were revealed.

Effect on U.S. Programs
-----------------------
6. (U) USAID: The changes in MINSA should not affect our
ongoing assistance programs. USAID had developed a good
working relationship with VM Gonzalez and expects the same
level of collaboration to continue after the transition.
Prior to government service, Gonzalez was on the faculty of
Nicaragua's School of Public Health (CIES) and worked as a
consultant for various donors, including USAID, thus he is
familiar with donor programs and operations.

7. (C) MANPADS: Gonzales was the Health Ministry's main
interlocutor with the United States during early-October
discussions on the exchange of Nicaraguan MANPADS for medical
equipment. It is unclear whether this recent development
will affect upcoming discussions in a meaningful way. MINSA
has not responded to our formal request, made prior to Cuan's
resignation, for a meeting with Cuan (or Gonzalez) regarding
MINSA acceptance of a USG offer to have military medical
assessment teams visit Nicaragua and evaluate MINSA needs.
The delay is likely due to the recent internal turmoil at
MINSA.

Comment
-------
8. (C) Cuan, who is a doctor by training and profession, and
a bona fide Sandinista, appears to have run afoul of the
Administration by asserting autonomy. The pattern is a
familiar one. Conflict, either real or instigated, occurs
between technocratic Ministers and party stalwart Vice
Ministers or Secretaries General. If the Minister does not
adhere diligently to the party line, party activists work
closely with the FSLN-dominated unions in the ministries to
create unrest and force the resignation of the minister. The
Ministers of Environment, Trade, and Tourism (and now Health)
all left in this fashion. Dr. Cuan is the third female
minister to lose her job in less than a year and the
sixteenth senior-level female to leave the Ortega
administration. Many of these dismissals seem to have been
at the direction of Rosario Murillo.

9. (C) Gonzalez may have been working towards Cuan's demise
from the beginning. By all accounts, Gonzalez is loyal to
Ortega, appears to have Murillo's confidence, and was the
leading candidate to replace Cuan. An FSLN-affiliated
National Assembly contact, who attended university with
Gonzalez, told us that he was "very good and very ambitious."
He thought highly of Dr. Cuan as well, and expressed
disappointment at her political demise. When pressed to
comment on the conclusion of the "Telenovela Maritza," which
has erupted in the midst of an ongoing internal FSLN feud
over selecting a 2008 mayoral candidate for Managua, our
contact stated that "recently Ortega has been making some
personnel changes that do not instill much confidence." The
reference applied to both Ortega's competence to govern as
well as to external perceptions of Nicaragua's stability and
investment attractiveness.
TRIVELLI

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