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Medical diplomacy

Military hospital ships from China and US are plying across Pacific islands

Military Sealift Command hospital ship USNS Mercy (T-AH 19) was deployed to the Indo-Pacific region in May 2022 as part of the Pacific Partnership 2022. Photo courtesy of U.S. Navy.

Large white hulled ships are big public relations yet do little

to address significant health system issues in the region.


By Eileen Natuzzi


China recently announced a mission to send its military hospital ship, Peace Ark, to the Pacific islands. This is not surprising, given regional head-to-head competition between the United States and China has been growing over the past two years. What is surprising about the upcoming Peace Ark visit to Tonga, Kiribati, Solomon Islands, Vanuatu and Timor-Leste is how long it took to be decided.


In March, at Solomon Islands Prime Minister Manasseh Sogavare’s request, the U.S. Navy agreed to have its hospital ship USNS Mercy at port in Honiara during the November 2023 Pacific Games.


Both the Peace Ark and Mercy hospital ship programs add new levels of escalating tension between the United States and China – military medical mission competition. So it is important to understand what these types of missions do, don’t do, and why they are done.


And perhaps most importantly, from a global health development perspective, what long-term benefits such military medical missions provide.


According to the Chinese Navy, Peace Ark’s mission is a “pragmatic initiative” aimed at shoring up China’s ties with countries in the South Pacific. The U.S. Navy’s "Pacific Partnership," as its hospital ship visits are dubbed, supports “regional interchangeability and disaster response capabilities, increases security and stability in the region, and fosters new and enduring friendships in the Indo-Pacific.”


Teams of military and civilian medical specialists visit pre-selected countries holding clinics for defined periods of time. Surgery is performed by orthopedic, ENT, and general surgeons, usually on board the ship. Sometimes construction or building repair is included. At the end of a port call, the mission sails off to the next country.


Both China’s and the U.S. missions report the total number of people seen in clinics, the number of operations performed and building projects completed. These numbers are impressive and do reflect hard work on the part of the mission teams. But they fail to move the needle in strengthening the health system in a Pacific island country.


Why such missions are held is clear. A large white-hulled ship arriving off the coast of a Pacific island country is big public relations.


In a region with growing geopolitical tension and competition, it’s not surprising that the white hulls are plying the waters. Military medical missions keep personnel forward ready to deploy in case of disasters, unrest or war.


These visits also strive to address the low percentage of surgeons who meet the knowledge and operative caseload metrics established by the American College of Surgeons. Missions that include surgery are a way to increase surgeon operative experience.


There are potential ethical issues with this. The World Journal of Surgery article “Seven Sins of Humanitarian Medicine," authored by the Uniformed Services University of the Health Science, analyzed one-off enterprises such as these military medical missions.


Their “sin #5” states: "Allowing politics, training, or other distracting goals to trump service, while representing the mission as “service.”


Regardless of which country provides them, military medical missions do not address the significant health system issues that people living in Pacific Island countries currently face. These problems require a much deeper long-term commitment than the Mercy or Peace Ark can achieve."


Such issues were highlighted at the Pacific Community Pacific Heads of Health meeting in April this year. Critical infrastructure vulnerability is one. An estimated 58 percent of Pacific Island country hospitals are highly vulnerable to damage from rising sea levels and extreme weather events such as cyclones and storm surges, collectively putting 63 percent of the population at risk of losing their hospital.


Regional Heads of Health recently made support for adaptation and resilience to address health facility infrastructure a priority. A multinational approach toward this problem should start with a detailed vulnerability and engineering assessment of healthcare facilities similar to the one the Ministry of Health and Medical Services in Fiji undertook in 2021.


Another issue is the healthcare workforce. Low doctor-to-patient ratios, uneven distribution of healthcare workers and limited access to advanced medical education are challenges throughout the Pacific islands. Both on-island and off-island training programs for healthcare workforce are needed to increase service capacity and skills.


Fiji National University and Papua New Guinea School of Medicine and Health Sciences provide most of the medical education in the Pacific. Development programs could assist them in expanding medical education so more doctors and nurses are trained.


Then follows medical supply and medicine shortages. Medical supply chains break down due to management problems including accurate inventories, timely ordering, distribution, and payment of arrears to prevent port delays.


Poor quality and counterfeit medicines also contribute to the problem. Running out of gauze or antibiotics results in delayed surgeries and inadequate infection treatment when less effective antibiotics need to be substituted. The World Bank and Australia’s aid program are addressing this on a country-by-country basis – but a comprehensive regional approach is needed.


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Just as important is the challenge associated with the digitalization of medical records, medical inventories and data, as well as telehealth connectivity. Such technology will facilitate sharing of crucial patient information, supply chain ordering and population health data.


By way of example, health statistics on diseases such as cancers are needed. Currently, the Interagency for Research on Cancer GLOBOCAN estimates cancer rates in the Pacific islands based upon modelling.


With accurate data modeling estimates can be replaced by actual disease prevalence data making prevention and treatment programs more effective in how they are implemented.


Telehealth, for its part, can connect remote health facilities with tertiary care referral centers and allow doctors and nurses to consult with medical specialists in other countries. The use of hybrid connectivity linking submarine fiber broadband with bi-directional geostationary satellites can facilitate reaching remote outer islands. The Asian Development Bank offers a digital health implementation guide for the Pacific.


None of these challenges will be met by the developing competition between Chinese and U.S, military hospital ships. These missions will not sustainably change the health landscape in Pacific island countries.


Instead, such competition fosters a two-tiered system where the visiting ship is seen as good and local providers, which are chronically under-resourced, are seen as inferior.


Most importantly military medical mission competition carries the risk of contributing to the destabilization of the Pacific islands region.


Dr. Eileen Natuzzi has worked on health capacity building in the Solomon Islands for 18 years. She holds an affiliate faculty position at the Georgetown University Walsh School of Foreign Service Centre for Australian, New Zealand and Pacific Studies. Originally published in The Interpreter/Lowy Institute.



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