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Welcome to "Ask the White House" -- an online interactive forum where you can submit questions to Administration officials and friends of the White House. Visit the "Ask the White House" archives to read other discussions with White House officials.

Karen Hughes
Under Secretary of State for Public Diplomacy and Public Affairs

August 24, 2007

Karen Hughes
Good afternoon. This is Karen Hughes and it is a pleasure to be with you to discuss the medical outreach being performed by the USNS COMFORT this summer in the Western Hemisphere.

The United States is committed to working with the countries of this hemisphere to meet the basic needs of their people. We are committed to bringing medical care, health and hope to our partners in the Americas -- the U.S. has provided more than $950 million to improve health care in the region since 2001.

This summer, the Secretary of Health and Human Services, Michael Leavitt, helped open a new Regional Training Center in Panama City to train a wide range of health workers to improve the quality of health care across Central America. Already the center has trained more than 100 medical professionals from six Central American countries. Another 50 students will be trained in September.

Last month, First Lady Laura Bush announced the launch of the Partnership for Breast Cancer Research of the Americas. The initiative will unite experts from the United States, Mexico, Brazil and Costa Rica in the fight against breast cancer, which is a leading cause of death for women worldwide. The partnership joins the M.D. Anderson Cancer Center and the Susan G. Komen for the Cure, and the U.S. government. These partners will work to increase research, training, and community outreach - helping more women have the confidence to take charge of their own health.

And as we will discuss today, this summer President Bush also directed one of our nation's hospital ships, the USNS Comfort, to visit 12 countries in this region to bring needed medical care.

The voyage to Latin America of the Comfort hospital ship is a voyage of healing - and a wonderful example of what I like to call America's "diplomacy of deeds," the concrete ways in which our country reaches out to help people across the world have better lives, especially in the areas of education, health care, and economic opportunity.

With that, I am happy to take your questions.

Cliff, from Brimfield, Ohio writes:
Secretary Hughes:Who's idea was the USNS COMFORT? How man people in how many countries has it helped so far and how long has this ship been helping? Are all the medical personel on the ship Navy? and how do they overcome the language berrier? Thank You and sail on

Karen Hughes
Last year, Assistant Secretary of State Tom Shannon and I traveled to five countries in Latin America and heard a shared concern in each – that because so much of the media focus is on Iraq and Afghanistan, the people of Latin America felt they were being ignored, even though President Bush had nearly doubled America’s development assistance to Latin America during his administration. We wanted to demonstrate our commitment to our own hemisphere in a visible way that would highlight our ongoing work to improve people’s lives. As a result, President Bush commissioned the USNS Comfort to travel to 12 countries in Latin America and the Caribbean to provide health care to under-served families and establish training partnerships with local medical professionals. We had witnessed the positive impact that our other hospital ship, the USNS Mercy, had in the Pacific after the tsunami, and wanted to try to foster the same positive reaction in a non-disaster situation. The smiles on the faces of the many patients I met during my visit to the Comfort during its stop in Peru proved to me that we are achieving our goals. The Comfort is providing urgently needed health care and hope to some of the poorest people in the region – and is doing so in a way that builds on and strengthens other public and private sector partnerships to improve health care. A long-time Naval officer on the Comfort told me that he believes this deployment is the most effective use of the hospital ship that he has seen in his 32 years in the U.S. Navy.

One of the greatest aspects of this mission is the teamwork – the U.S. Navy and its personnel do a great job of operating the ship, the medical personnel on board are from the Navy, U.S. Health and Human Services -- and many are American volunteers from Project Hope and Operation Smile who gave their personal time to make the mission such a success. I met a nurse who said she had been blessed in her life and wanted to give back – so she is spending four weeks on board the ship providing nursing care to others. The Department of State is also supporting the mission through our ambassadors and embassies – and in some places our Peace Corps volunteers have served as translators – so it is a truly a team effort that is a wonderful example of the concrete ways both government and private sector Americans are reaching out to the rest of our hemisphere in a spirit of respect and partnership. I describe this work to improve health care, education and economic opportunity as America’s “diplomacy of deeds” because I am convinced these ongoing acts of compassion are one of the most effective ways for our country to reach out to people of other nations.

According to the most recent report from the ship, only halfway through her deployment, the USNS COMFORT has seen more than 45,000 patients to date. Medical personnel have also done 13,000 dental exams, 12,000 optometry exams and 8,000 veterinary treatments. People on the ship told me in the future, they could use more veterinary support -- people’s farm animals are very important to their income and existence in these rural, agrarian societies.

During my visit, I also had the opportunity to visit some of the training clinics being conducted by Project Hope for local medical personnel and community health care workers. They call it “come as you are” first aid and are focusing on practical ways that health care workers can improve community health and save lives even if they don’t always have access to the best facilities and equipment. To date, they have conducted 730 training sessions for more than 21,000 students.

Matt, from Centreville, VA writes:
Ambassador, I believe the use of naval hospital ships for humanitarian aid is an excellent start to building global goodwill. However, with only two naval hospital ships (which exist primarily to support the military and domestic emergency response) it doesn't appear that the USN can support these types of operations on a regularsustained basis.

Has any thought been given to duplicating this program on a smaller, more focused scale? Perhaps using commercial vessels to focus on a high-needs sub-region (e.g. the Gulf of Guinea) for sustained periods of time?

Karen Hughes
We are witnessing the great impact these missions can have both in improving people’s health and generating good will for our country, and I will recommend that we consider doing more of these types of public-private partnerships in the future. In addition to the naval hospital ships, the U.S. military provides medical services in various countries in Latin American through Medical Readiness Training Exercises. These on-the ground exercises are opportunities for training local medical personnel and for seeing and treating patients. The Department of Health and Human Services has also recently opened a training facility for health care workers in Panama that is designed to serve the health care community throughout Central America. The White House Summit on Malaria last year was another initiative designed to bring the public and private sector together to focus on best practices and share information in ways that allow us to improve our effectiveness in fighting this preventable disease. The American people are incredibly generous – in fact, the most recent Index on Global Philanthropy shows that private sector giving actually is more than triple the public sector development assistance – overall, private sources gave more than $95 billion in aid. We want to encourage and support that generosity, and I believe government can play a role as a catalyst and convener to bring people together around a shared goal that benefits our nation, as it has done in the case of the USNS Comfort.

Michael, from Powell, Tn writes:
What inspired the USNS to be built?

Karen Hughes
The Navy’s two hospital ships – the USNS COMFORT and the USNS MERCY – were designed primarily to provide emergency, on-site care for U.S. combatant forces deployed in war or other operations.

Both hospital ships are converted San Clemente-class super tankers. Mercy was delivered in 1986 and Comfort in 1987. Normally, the ships are kept in a reduced operating status (I think that’s the military’s way of saying “on stand-by!”) in Baltimore, Md., and San Diego, Calif., by a small crew of civilian mariners and active duty Navy medical and support personnel. Each ship can be fully activated and staffed within five days. Mercy went to the Philippines in 1987 for a humanitarian mission and to Indonesia after the tsunami in 2005. Both ships were used during Operation Desert Shield/Storm. (See another question below for a more complete listing of the ships’ deployments.) I believe it makes sense to use these assets strategically on humanitarian missions so long as it doesn’t reduce our military’s ability to meet the needs of our military personnel and will continue to support that.

samantha, from sacramento writes:
what is the history of the navy offering hospital ships, like the comfort? where did it originate from?

Karen Hughes
Comfort operated twice during 1994 — once for Operation Sea Signal's Cuban/Haitian migrant interdiction operations, and a second time supporting U.S. forces and agencies involved in Haiti and Operation Uphold Democracy. On 12 September 2001, Comfort set sail for New York City and provided housing, laundry, food, medical and other services to volunteers and rescue personnel for nearly three weeks in the wake of the terrorist attack on the World Trade Center. Comfort was activated again in December 2002 and sailed to the Persian Gulf to support Operation Iraqi Freedom. In 2005, Comfort provided hurricane relief support on the U.S. Gulf Coast and Mercy participated in tsunami relief as part of Operation Unified Assistance. Mercy also deployed in 2006 on a good-will/humanitarian tour to the Indonesian area. In 2007 Comfort deployed on a four-month good-will/humanitarian tour to the Caribbean and Latin America.

Stacey, from Oregon writes:
Hello Ms. Hughes, This sounds like such a positive program for our military. I have heard nothing about it. Why is it so quiet? Any chance of seeing a story on the nightly news or a Frontline program or something? Thanks for all your hard work on our behalf, Stacey

Karen Hughes
Stacey, you express one of my frustrations – that good news often doesn’t get nearly as much attention as bad news! When I traveled to Peru to visit the Comfort, we invited a number of television networks to come with us, but unfortunately, none was able to. The mission has received a lot of media coverage in the countries that it has visited -- by La Prensa as well as international wire services such as the AP and Reuters. Some U.S. national media – like the Christian Science Monitor and the Houston Chronicle -- have picked up on the story, too. We would very much like to see more media attention to this positive and effective mission and will continue to work to highlight it.

For more information, you can visit the United States Southern Command website, which has a lot of information about this mission and other military activities, such as Medical Readiness Training Exercises, in Latin America and the Caribbean. The address is

Daniel, from Great Barrington, MA writes:
Besides sending the UNS Comfort to South America, what is another thing the U.S. is doing to help the people of South America?

Karen Hughes
The U.S. government has a variety of programs to assist the people of South and Central America and the Caribbean in the areas of economic development as well as education, health care and housing. I’ve had the privilege of visiting some of these programs and witnessing the positive difference they are making in people’s lives. In Mexico, I visited with rural farmers whose crop yields and incomes are increasing because of a partnership with USAID, America’s development agency, and Starbucks – the farmers are learning techniques to improve the quality of the coffee beans they produce. On a trip to Colombia last year, I visited a program that is helping widows from the war against terrorism there market their decorative art work in the United States – and some of the beautiful candles they made are now decorating my Washington condo! Our embassies throughout Latin America sponsor programs that promote democracy and human rights, support free trade and encourage economies that make it possible for workers to provide for their families, and assist in meeting basic needs such as education, healthcare and housing.

Assistance levels to Latin America under the Bush administration have almost doubled, from $826 million in FY2001, to the $1.47 billion in the FY08 budget. Since 2004, we have contributed over $150 million for education programs alone in Latin America and the Caribbean. And since 2001, almost $1 billion in health assistance has been channeled to the region through the U.S. Agency for International Development (USAID).

In addition to U.S. government activities in Latin America, the private sector -- through NGOs, professional associations, religious congregations, civic groups and others – contributes millions of dollars annually in goods and services.

Joseph, from Green Bay, Wi writes:
Why don't we have more of these humanitarian missions, they do more for diplomatic relations than having these sumbit with leader and less comes from them. You look at some of the world religions and they have the respect of countries that hate america why because they help there people without anything in return we need to do more of these, this will improve out relations around the world than anything else. What will you do to ensure more funds and volunteers are recruited so that more of these ships can be built?

Karen Hughes
I agree that our concrete actions to improve people’s lives have a great impact – that’s why I call them America’s “diplomacy of deeds.” After two years as Under Secretary of State for Public Diplomacy, I find myself increasingly focused on three major areas: 1) expanding our education and exchange programs, which I believe have been among our single most effective public diplomacy tools over the last fifty years, 2) improving our communications and telling America’s story more proactively in the media across the world, and 3) expanding America’s diplomacy of deeds, especially in areas people across the world care most about – health care, education and economic opportunity.

I believe we are making great progress on all three fronts. We have increased participation in our education and exchange programs from 27,000 participants in 2004 to almost 40,000 participants this year. These programs include well-known academic exchanges like the Fulbright program, which is at all-time record highs for both American students studying abroad and foreign students coming here – in fact, we have reversed the trend of decline in student exchanges that began with the need for more stringent security checks after the terror attacks of September 11th. Last year, we issued a record number – 591,000 -- student visas.

We have documented through evaluations that when people come to America to study or visit, they end up with a much more positive view of our country – a view that lasts a lifetime. World leaders including the new Prime Minister of England, Gordon Brown, and the new President of France, Nicholas Sarkozy, have participated in our exchange programs – this is tremendous intellectual capital for our country and I want to make sure we continue to bring the future leaders of the world to America to get to know us!

This year, we are also teaching English to 10,000 young people in more than 40 countries with a significant Muslim population – I’m a big believer in English language programs because it gives young people a marketable skill, and opens the window to a wider world of knowledge. As we work to combat extremism and efforts to radicalize youth, we want young people to have open minds – our ideological opponents in groups like Al Qaeda want closed minds, rigid interpretations, only one point of view – their way or no way and death to all who disagree. We want young people to appreciate and respect diversity and understand that our differences enrich us. This summer, I launched a new youth enrichment program for young people age 8 – 14 that are too young to participate in our traditional exchange programs. Working with our embassies, local governments and youth organizations and American Peace Corps volunteers, we are introducing these young people to America and Americans as well as teaching them English and leadership and citizenship skills. We are conducting the programs in 13 countries and the West Bank and Gaza and are getting tremendous feedback. I just visited one of the youth enrichment programs in Morocco where we partnered with the government and provided scholarships for under-privileged young people to attend the English camp. Many of these young people told me it was the first time they had ever met an American – and you would have been so proud of the outstanding American Peace Corps volunteers who were teaching them songs, games, English and life lessons – and providing such a positive view of America!

Here are some of the reactions from those young people: “Americans have big hearts and they help everybody regardless if they are poor or rich.”

“I had another picture of Americans and I learned from them here and have changed that picture.”

“They want peace just like we do.”

“Americans respect diversity.”

“People are good in both countries; we all want to do good things together.”

“Americans are generous.”

“I learned how to have a relationship with Americans and to learn about myself better.”

I am a big believer in the kind of early English training these young people are receiving – it gives young people an employable skill – and a window to a wider world.

Kim, from Kentucky writes:
Hi Karen, Is the USNS COMFORT unique to this administration or has it been in operation through the years? Also, how has it been received by both foreign governments and patients? Would you say that it's mission has been a success? Thank You

Karen Hughes
The hospital ships have operated in the past, but this type of deployment is unique, and judging from people’s reactions, it is an overwhelming success. Long lines of people were waiting in Peru, and they all had big smiles and ready “thank yous” for the health care workers. The response from Latin American governments has likewise been uniformly positive and gratifying. President Tony Saca of El Salvador said during the USNS Comfort visit, “This type of diplomacy really touched the heart and soul of the country and the region and is the most effective way to counter the false perception of what Cuban medical teams are doing in the region.” When the doctors got off the buses in Guatemala, people started cheering and chanted, “We love the Americans.” Vice President Jaime Morales in Nicaragua told the American Ambassador, Paul Trivelli, that he was most impressed by “the deep love, respect and professionalism demonstrated by the medical staffs toward their Nicaraguan patients.”

Fred, from Irvine, CA writes:
Hi, Ms. Hughes:Thanks for your government service. It seems that our current leaders seem to think that we have a problem communicating US goals and ideals to others in the Arab world, and that you were supposed to fix that. Since that time, it seems our standing among Arabs and others has declined. Is that a failure of our message, or of your work, or can you otherwise explain it?


Karen Hughes
Fred, I knew when I agreed to come back to government service that the negative polls would not turn around in the short term, just as they didn't during the Cold War. The ideological struggle that we are facing is a long-term, generational challenge. Keith Reinhard, who is the head of a group called "Business for Diplomatic Action" that seeks to engage the business community in America's public diplomacy, told me that his group conducted a poll in October of 2001, at the height of sympathy for America during the aftermath of the terror attacks, yet his poll showed that foreign publics thought Americans were arrogant, ignorant, too self absorbed and too powerful (I hope I'm remembering that right -- the findings were very negative). I like to say that people's views of America are a complex tapestry that is woven by many different artists, from pop culture to policy, from people to products. Publics in many Arab nations dislike America's support for Israel's right to exist and do not give us credit for being the largest bilateral donor of aid to the Palestinian people and for working toward the creation of a Palestinian state. Many Muslim populations object to the presence of American troops in Iraq and Afghanistan, even though the democratically elected governments of both of those countries want our presence there. The picture is mixed -- America is popular in places like India, in much of Africa, in countries like Peru. We are also contending with a dramatically different media environment in today's world. During the Cold War, we were trying to get information in to largely closed societies whose people were hungry for that information. Today we face a media explosion -- on recent trips to Algeria and Morocco, I saw that almost every house or apartment has a satellite dish -- and audiences throughout the Middle East now have a choice of approximately 200 television stations, many of them very critical of America, Israel and the West. Our nation faces a great challenge, and it is a shared challenge. As I said during my confirmation hearings, America's public diplomacy is neither Democratic nor Republican, but American. I've been gratified to have had strong bipartisan support in Congress for my work, and I believe we must continue to expand our education and exchange programs, improve our communications and highlight our diplomacy of deeds to reach our to people across the world in a spirit of respect and friendship. This is a long-term challenge, not a short or easy one. On my desk, I keep an excerpt from a Chinese proverb that talks about "planting the seeds of trees under whose shade you will never sit." I hope as we introduce young people across the world to Americans as we are this summer with a new youth enrichment program, we are planting the seeds of friendship with those who will be the future leaders of their countries and our world.

Karen Hughes
Thank you for the opportunity to answer your thoughtful questions, and for your interest in the life-saving and life-changing work of the USNS COMFORT.

I was pleased to be able to witness the wonderful humanitarian work that is being done by the COMFORT with our friends in this hemisphere. This medical outreach is a terrific example of the kind of outreach that will substantially improve our people-to-people relationships around the world.

Thanks again and many best wishes to you all.

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