Hearing the cries of the poor: healthcare as human response.
The keynote address of Vice Admiral Adam Robinson, Surgeon General of the United States Navy, summarizes the integration of healthcare humanitarian assistance as central to the Navy's mission of defending and promoting world peace. Citing various examples of current programs and initiatives, the address explores the critical place of human hope as central to the fundamental act of healthcare. In this respect, the keynote gives visible expression to the central metaphor of the conference itself, "Retrieving the Human Face of Science."

Keywords: Navy Medicine, healthcare, humanitarian assistance, soft power

Article Type:
Universities and colleges (Botswana)
Universities and colleges (Conferences, meetings and seminars)
Humanitarian aid (Conferences, meetings and seminars)
Robinson, Adam M., Jr.
Pub Date:
Name: Journal of Research Administration Publisher: Society of Research Administrators, Inc. Audience: Academic Format: Magazine/Journal Subject: Business; Business, general Copyright: COPYRIGHT 2010 Society of Research Administrators, Inc. ISSN: 1539-1590
Date: April, 2010 Source Volume: 41 Source Issue: 2
Product Code: 8220000 Colleges & Universities NAICS Code: 61131 Colleges, Universities, and Professional Schools SIC Code: 8221 Colleges and universities
Organization: University of Botswana
Geographic Scope: Botswana Geographic Code: 6BOTS Botswana
Accession Number:
Full Text:

Your Grace Archbishop Tutu, Your Excellencies Ambassador Nolan and Distinguished Leaders of the Government of Botswana and the University, colleagues, students, and friends. It is a deep honor to be with you all today and lead this afternoons keynote session. I am honored and privileged to follow Archbishop Tutu's outstanding presentation this morning. To take part in this special conference with such distinguished leaders whom I have long admired is certainly one of the highlights of my naval career. Thank you for inviting me and for asking me to be part of this important conference.

I am a firm believer that events like this provide each of us with an opportunity to help advance our shared goals and interests. Today's exchange allows us to speak openly about where we are and, more importantly, where we want to go. As a result, there is a lot of incentive for us to share our opinions and ideas today. Even more importantly, we are here because we want to celebrate a significant milestone for the university and for Botswana.

The University of Botswana has enjoyed a long and distinguished history from its remote origins in 1950, through the establishment of diverse movements a decade later, to the place of honor that the university holds today in this region. You indeed are an amazing community of scholarship and learning.

I am deeply aware of the immense responsibility you continually undertake to serve those who suffer from disease and illness. We are kindred spirits in this partnership as we share an abiding commitment to stretch hands across the water in the solidarity of healthcare. I am in admiration of your leadership to stave off various infectious diseases such as HIV, malaria, cholera, tuberculosis and others. As a physician and as a healthcare leader, I am very conscious of our mutual bond to defend against disease in every nation and every culture, and to bring to everyone not just prevention or intervention, but the joy that comes with quality human living.

In our mutual mission of healthcare, our efforts are achieved when we bring to others a sense of enrichment that touches individuals, their families, their communities, their nations--and in doing so--the world.

We are joined together in this common mission. And this joint mission is why I feel privileged to join you this week and into the years to come, to build with one another a world filled with love, hope, and security founded on the premise of compassionate care for all.

In this uncertain world, the United States, as well as other nations, has continued to forge greater bonds of trust and cooperation with people and countries around the world to contribute to the common good. It is a common good symbolized by this medical convention--a first of its kind here in Botswana, a truly remarkable gathering of government, military, and industry leaders.

This past August, the university's commitment to medical leadership has taken on a new and profound depth as it has welcomed its first class of medical students. I salute you. I welcome you. I cannot tell you how wonderful it is to be here as a physician and a witness to the passion for healthcare education and leadership as it takes root here. You are delivering this university as a community of hope. Creating this atmosphere of "Hope" is what I would like to speak with you about today.

As the United States Navy Surgeon General, I have the unique opportunity to serve not only my nation, but also humanity. This service is manifested most dramatically in the notion of humanitarian assistance. Because in humanitarian assistance we lend assistance to those people around the world in need. We help them--we bolster security and stability--and, most importantly, WE CREATE HOPE.

Navy Medicine, along with the rest of the United States Department of Defense, realizes that the promotion of world peace is dependent upon more than weapons and/or political alliances. World peace is also dependent upon security and stability. Where there is security and stability, we also find hope. And hope is the essence of what fires our souls and provides light in our world. Hope becomes the beacon that shows us the way from darkness and desolation (abandonment) to light and (community) life.

The United States Navy's Cooperative Strategy for 21st Century Seapower serves as an example of this light/beacon. This strategy is a beacon that shows just how important are military forces and trained health professionals around the globe to the international order.

This strategy promotes security and stability; but it also serves to establish hope and prosperity by emphasizing "soft power"--the power of humanitarian assistance that serves to provide training, education, and security for all and in so doing establishing an infrastructure of health, wellbeing, and contentment that are the necessary ingredients of hope. For only in hope can we build the foundation of respect and tolerance that becomes crucial in establishing and maintaining world peace. If you will allow me, I would like to serve as the catalyst for that discussion, by giving you my perspective on the subject.

First and foremost, our people expect their military forces to remain strong. They want us to protect them and our homeland, and they want us to work with partners around the world to prevent war.

Nothing threatens world security and prosperity like war. Our new strategy says that it is as important to prevent war, as it is to win war.

To prevent war, we must attack the seeds of instability and hopelessness where they exist. Human suffering moves us to act, and the expeditionary character of our maritime forces uniquely positions them to provide assistance as the vanguard of interagency and multi-national efforts. While we still train our forces to fight and win our nation's wars alongside our allies, we have adopted a serious focus on humanitarian assistance and disaster response to help those in need to attack instability and insecurity, so that we help our partner nations create conditions where hope can flourish.

This recognition has resulted in the increased focus on the importance of proactive humanitarian assistance operations. Yes, we have been involved in these types of missions since our beginnings, but they were done in a rather ad hoc manner. As a result of our newest maritime strategy, we now have elevated these important missions to the same level of importance as war fighting. We now actively train and equip our maritime forces to perform this important mission that brings about partnerships as well as fundamental and meaningful relationships resulting in hope.

Our Navy-recruiting slogan reflects the importance of this new course we have set for ourselves. We refer to our Navy as a "Global Force for Good," and we have found this message has resonated among our nation's youth.

You see, the ultimate mission of our United States Navy is simple: To defend those who cannot defend themselves. Arising from this spirit, United States Navy vessels over the centuries have been the mechanism that the American people have used to extend themselves outward to help others in need. Wherever there has been poverty, famine, disease, war, injustice, or danger, the people of the United States have launched Navy vessels to provide protection, food, clothing, healthcare, and the compassionate care of young Sailors lending a helping hand and heart to those in need of safety and security. Whether it has been in Indonesia after the tsunami, or helping the people of New Orleans after Hurricane Katrina, this is the platform of selfless service from which Navy Medicine will always build its mission around the world. This is the meaning of humanitarian assistance--protecting others even when it places us in harm's way--extending ourselves for the benefit of those in need.

As Surgeon General, I lead Navy Medicine every day in putting a human face on the words "humanitarian assistance." Navy Medicine is not only willing and able to participate in these missions; we do so enthusiastically. Our healing hands symbolize soft power, which forges stronger relationships with other nations and lessens the chances of armed conflict. By doing this, humanitarian assistance missions enhance the protection of our homeland and way of life.

Let me illustrate my point of the importance of these missions by relaying a story from the devastating earthquake that hit Pakistan in 2005. Thirty days after the Kashmir earthquake hit the isolated, mountainous region of Pakistan-administered Kashmir, an injured man hobbled into a United States disaster relief hospital near Muzaffarabad *, approximately 12 miles from the quake's epicenter.

He said he had followed the "Angels of Mercy," the local Pakistani-nickname for the U.S. Navy helicopters that were making countless runs every day--day after day--to provide food, medicine and supplies while shuttling people back and forth to safety. Somehow this man got down off the mountainside, hobbled in and walked past all the other hospitals to get to us. He had a compound fracture of his leg and our doctors could not believe that this man could travel so far with this injury. They immediately took him into surgery; they were there for hours just trying to cleanse his bones. I am pleased to report that he survived, with his leg.

That is just one story in a calamity that claimed the lives of more than 75,000 men, women and children while leaving another 100,000 injured and 3.5 million homeless in one of the most isolated and desolate areas of Pakistan.

This was certainly an area where hopelessness was flourishing.

Our naval forces arrived there within 48 hours after the earthquake hit and got to work to help alongside other United States and international agencies under the guidance of the United States Ambassador to Pakistan.

We brought a hospital with medical capabilities--including orthopedic, general surgery and internal medicine assistance--and worked with the government of Pakistan to provide food, supplies and medical assistance. We also sent another self-sustaining land-based hospital and 125 engineers from Naval Mobile Construction Battalion 74 (Seabees) who immediately cleared roads, set up shelters, and built schools.

Prior to this earthquake, more than 80 Pakistani healthcare facilities existed in this area; however, the event destroyed all but two, and they could barely operate.

The villagers were not used to the quality and scope of American medical care. Among other things, we brought in a Navy hospital from Okinawa. We had 2 surgical suites, 24 intensive-care-unit beds, 36 medical-surgical beds and 60 medium-to-minimal-care beds.

Humanitarian assistance is so important because it has a powerful impact on people, on relationships and an understanding of our American values. According to estimates, our relief and follow-up efforts saved half a million lives in Pakistan during this mission, which led to overall improved relations and trust with the country itself. Through our humanitarian assistance missions, we learn about one another, and in so doing we develop relationships--relationships on a personal level, professional medical relationships, military-to-military relationships, and relationships between our governments.

From relationships comes the concept of trust--a reliance on integrity, strength and surety--and the ability to have confidence in one another.

Trust is vital. While our naval forces can be surged, trust cannot. Trust is built over time, through dialogue and working together on common goals. Cooperation and trust built in times of calm become the major building blocks for effective crisis response when it is needed. Many of us saw this first hand during the tsunami relief effort in South East Asia over three years ago. We were able to have a tangible impact on human suffering arising from that horrible and devastating event. Ships designed for battle provided help to people in need as our forces responded without hesitation, with the kind of enthusiasm that arises when the mission involves rendering assistance to fellow human beings.

Responses such as this require an unprecedented level of integration among our military forces and enhanced cooperation with the other instruments of national power, as well as the capabilities of non-governmental agencies and others. By sustaining dialogue and understanding, we can build confidence and trust, whether in formal alliances, partnerships or simple exchanges of information. This is the essence of providing care and assistance and enduring security and stability. This is the foundation of establishing world peace.

Today, our ships and Sailors are engaged in proactive humanitarian aid missions all over the world--from South America to the Pacific to the West Coast of Africa. These humanitarian engagements are now part of our normal routine, and Navy Medicine is a vital part of this mission.

We support regional humanitarian operations by providing preventive medicine services, healthcare training, and other similar efforts, while always respecting the host country's culture and customs. From our experience, we have developed a successful model of healthcare education and training for host country providers. This will lead to local sustainable activities that will provide long-lasting benefits to help overcome healthcare barriers in resource poor communities.

Please allow me to highlight a few of our recent missions:

1. In 2007, the amphibious ship, USS Peleliu, conducted a 4-month humanitarian mission called "Pacific Partnership," visiting the Philippines, Vietnam, Solomon Islands, Papua New Guinea, and the Republic of the Marshall Islands. During this mission, Peleliu provided a variety of medical, dental, educational and preventive medicine services to more than 31,600 patients.

2. In 2008, the hospital ship, USNS Mercy, also participated in "Pacific Partnership," serving as a platform for military and nongovernmental organizations to build and cultivate relationships with the Republic of the Philippines, Vietnam, the Federated States of Micronesia, Timor-Leste, and Papua New Guinea. This mission treated more than 90,000 patients. Among those treated were more than 14,000 dental patients and more than 1,300 surgery patients in various locations throughout the Western Pacific.

3. Our other hospital ship, USNS Comfort, deployed this past April to participate in "Continuing Promise 2009," a 120-day mission to South and Central America. The ship traveled to Haiti, the Dominican Republic, Antigua and Barbuda, Colombia, Panama, E1 Salvador and Nicaragua, spending between 10 to 12 days in each port. During the course of the deployment, our medical teams treated more than 100,000 patients, completed 1,657 surgeries, dispensed 193,961 prescriptions, 30,785 pairs of glasses and 11,940 pairs of sunglasses. The dental department extracted 4,444 teeth and treated more than 15,000 people. The local animal population was also seen by ship's veterinarians, who treated 13,238 animals. Both domestic and farm animals were seen for a variety of medical issues.

4. Early in the year, Navy Medicine Reservists participated in four medical readiness training exercises in Jamaica, Honduras, Dominican Republic, and Guyana. These two-week deployments provided primary care at remote locations in conjunction with the Ministry of Health of each host nation.

Each successful mission, performed with joint and coalition forces, other U.S. government agencies, non-government agencies, and host nations, builds strong and lasting partnerships. From the foundation of mutual respect and understanding grow the best quality healthcare and partnerships. This environment of trust between U.S. military services, agencies, and our international partners is the legacy of these humanitarian missions and helps secure our future.

Our humanitarian assistance efforts continue, with missions planned and underway. Our hospital ships, Mercy and Comfort, have been invaluable assets in this role as they are unobtrusive and neutral. They are all about compassion. We offer humanitarian assistance because, when you look at human compassion on a global scale, this is an opportunity for us truly to help people in need.

We are now implementing a wide range of programs in Africa as well that are preventive in nature and are designed to help build capacity in the African nations, so that they can have a better chance of providing for their own security, as they have expressed a will and a desire to do. The Navy is proud to be a part of those efforts throughout the continent. We seek to be a friend to the continent of Africa, its nations and its institutions. All of our efforts focus on adding value to our engagement efforts and neither disrupting nor confusing ongoing United States government and international programs.

Many of you may have also heard of our African Partnership Station mission that has maintained a continuous rotation of ships throughout West African/Gulf of Guinea countries to help build capacity training with local African forces to help bolster maritime security in this important region. This effort has now been expanded to include countries in South and Southeast Africa.

We take a proactive and forward-looking stance to ensure that the partnerships we build today last well into the future and that they are relevant for meeting the goals set by our government as we partner with the nations of Africa. We will continue to support our U.S. government partners and civil military activities. These activities not only provide outstanding training and experience for those in our military communities such as doctors, engineers, and veterinarians, they support African humanity and capacity building and bring goodwill to the African people.

I am proud of this work. Our strategy focuses on opportunities--not threats; on optimism--not fear; and on confidence--not doubt.

It recognizes the challenges imposed by the uncertain conditions in a time of rapid change. Furthermore, it recognizes the incredible responsibility each of us has in working together on common objectives. We will not always agree on words; but we must always agree to talk. I believe we have entered a new era, one in which our countries, in forging bonds of friendship and cooperation, can lead the way to a time of peace, prosperity, and security.

It has indeed been a pleasure to be here to recognize the importance of Botswana and the commitment of the United States to forge a stronger relationship with one of Africa's most important and dynamic states.

Thank you again for this opportunity to speak with you today.

Editorial Note

This following is the text of the second of the opening conference keynote addresses. This keynote was presented in the afternoon of Monday, December 7, 2009. It was followed by three responses.

Authors' Note

The author gratefully acknowledges the remote and proximate contributions of CAPT Michael Krentz, CAPT Brian Dawson, CDR Joseph Surette, and the members of his staff in the preparation of the manuscript. The opinions represented are those of the author and do not reflect the official policy or positions of the United States Government, the Department of Defense, the Department of the Navy, or Navy Medicine.

Vice Admiral Adam M. Robinson, Jr., MD

Medical Corps

Surgeon General of the United States Navy

Chief, Bureau of Medicine and Surgery

Washington, DC


* Muzaffarabad is a town in northwest Kashmir, at the confluence of the Jhelum and Neelam rivers. It is the chief city and capital of Azad Kashmir, which is administered by Pakistan. Muzaffarabad is a trading center. Much of the city was destroyed by an earthquake in 2005.
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