Logistical Experience in Health Will Be the Largest Lesson in the Exchange

Logistical Experience in Health Will Be the Largest Lesson in the Exchange

By Dialogo
July 30, 2015

Read the story of Medical Lieutenant César Cima, who works at Brazil’s Fortaleza Air Base (BAFZ) and narrates another aspect of the professional life of military doctors. He is participating in an exchange program as part of the 2015 Continuing Promise mission, on board the largest hospital ship in the world.

After concluding the treatments in Colombia on July 18, Medical Lieutenant César Cima traveled at sea for eight days before arriving in the city of Dominica, in El Seibo, Dominican Republic. The city is the next stop in the itinerary for the world’s largest hospital ship, the USNS Comfort, which is hosting the United States Southern Command’s 2015 Continuing Promise mission.

“This is training and diplomacy. In almost all countries, the country’s president has visited,” Cima said.

In addition to a cardiologist from Brazil’s Army and a pediatrician from the country’s Navy, Cima, an orthopedist from the Air Force, is part of the first group sent by Brazil’s Ministry of Defense to participate in the exchange. In July, after completing three months of the mission, the physician returned to Brazil for a five day break – R&R, in military parlance – and spoke with the Air Force News Agency.

“The main thing we learned, one of the strong points, is understanding how logistics are handled for a large-scale, international health mission. I know of no other humanitarian mission as large as this one,” said Cima about the amount of materials and the bureaucratic procedures involved in preparing credentials for professionals from different countries and organizations. He said he believes that the lessons learned during the exchange can help improve the Air Force’s systems for humanitarian and disaster response missions.

The 182-day mission, which will visit11 countries, carries 1,100 people on board, including 80 physicians and approximately 200 nurses, in addition to veterinarians and engineers.

The largest hospital ship in the world features a level of healthcare infrastructure that many cities do not even have. There are nearly 800 beds, 12 operating rooms and 80 beds in the intensive care unit. “They needed to use their full capacity just once, when it traveled in response to the earthquake in Haiti [in 2010],” he said. The Comfort, a modified oil tanker, has a “twin”: the Mercy, which is based out of San Diego, on the US west coast, and which performs similar missions to countries in the Pacific.

In addition to healthcare personnel, the ship needs to accommodate the entire crew. “It is practically a city,” he said. “On board, there is a gym, a chapel, a supermarket and a restaurant to support the team.”

His account

When asked about the cases that made the biggest impressions on him, as a doctor, Cima told the story of a situation that, according to him, truly reflects the reason for the mission, which spends 10-15 days at cities near small ports along the coast of countries in Latin America and the Caribbean.

In Belize, the first stop for 2015 Continuing Promise, an eight-year-old boy had been in a car accident and had two severe fractures in his arms and legs. He had surgery at the time, but because more advanced equipment was not available – a fluoroscope is the most-often used instrument to observe organs within the body – one of the two breaks did not heal properly. The original, local orthopedist submitted the case and attended the new surgery on board the ship together with the family.

“It is an aid mission, because the ship has the equipment. It is not that the healthcare professionals are better or worse than the local ones, but simply, sometimes, they have more technology on board, and they provide it. Everyone was very happy because it was one of the most complex cases,” he said.

By the middle of the mission, they had provided more than 40,000 treatments. Patients also receive medication. The number of surgeries has already exceeded 500; 60 in orthopedics alone.


The Brazilian orthopedist works together with one from the United States. “I participate effectively as a member of the mission, discussing cases and learning how plans for global projects are made,” he said. The two orthopedists’ routine, which may be reinforced by residents for a month, included performing triage for the first two days after arriving at a new country.

For physicians who would like information on a military career, Cima would invite his colleagues to learn more about the Air Force’s activities in healthcare. “There is a section that serves service members and their dependents, but there are also sections for search and rescue, humanitarian missions, disaster response and air medical transportation. I am certain that very good people will arise who are trained to help,” he said.