PACIFIC PARTNERSHIP 2008 USNS MERCY T-AH 19

1. Thank you for inviting me to speak today at the Military Health System Mobile Health Summit! Pacific Partnership 2008 was tremendous success, as well as life changing and career defining experience. It is an opportunity for America, our Partner Nations and NGO’s to make global difference, at a reasonable cost. Objectives: Promote Pacific Region development, relationships, strength and disaster preparedness through public diplomacy and partnerships. Provide direct patient care, Public Health capacity building, veterinary medicine, construction engineering services and subject matter expert exchange. Foster synergy, cultural diversity awareness and planning for long range (strategic health infrastructure) development by Host Nations, Department of Defense, U.S. Public Health Service, Partner Nations, Non Governmental Organizations, USAID, WHO & CDC. “The purpose of this meeting is to convene a select group of government, private sector, and public health leaders to explore the challenges, opportunities and way forward in developing mobile health systems. By leveraging the latest in cellular technologies, we can improve the Department of Defense's ability to support humanitarian missions in regions experiencing complex humanitarian emergencies caused by political instability, war or natural disaster.” “I believe it's critically important to gather multiple perspectives across the health sectors to ensure a thoughtful approach to strategic planning for future capabilities. This expert consultation meeting will assist the MHS in defining the roadmap for the use of mobile platforms as part of an overall MHS global health solution.” Sincerely, Ward Casscells, MD Assistant Secretary of Defense (Health Affairs)Thank you for inviting me to speak today at the Military Health System Mobile Health Summit! Pacific Partnership 2008 was tremendous success, as well as life changing and career defining experience. It is an opportunity for America, our Partner Nations and NGO’s to make global difference, at a reasonable cost. Objectives: Promote Pacific Region development, relationships, strength and disaster preparedness through public diplomacy and partnerships. Provide direct patient care, Public Health capacity building, veterinary medicine, construction engineering services and subject matter expert exchange. Foster synergy, cultural diversity awareness and planning for long range (strategic health infrastructure) development by Host Nations, Department of Defense, U.S. Public Health Service, Partner Nations, Non Governmental Organizations, USAID, WHO & CDC. “The purpose of this meeting is to convene a select group of government, private sector, and public health leaders to explore the challenges, opportunities and way forward in developing mobile health systems. By leveraging the latest in cellular technologies, we can improve the Department of Defense's ability to support humanitarian missions in regions experiencing complex humanitarian emergencies caused by political instability, war or natural disaster.” “I believe it's critically important to gather multiple perspectives across the health sectors to ensure a thoughtful approach to strategic planning for future capabilities. This expert consultation meeting will assist the MHS in defining the roadmap for the use of mobile platforms as part of an overall MHS global health solution.” Sincerely, Ward Casscells, MD Assistant Secretary of Defense (Health Affairs)

2. USNS MERCY Background Command and Control: Unclassified Mission – Centralized Planning/Decentralized Execution 3 Coordination nodes: Mission Operation Center, Beach Detachment and MED/DEN/VET/ENG CAPS and Advance Team Medical Officer (Surgeon) Mission Operation Centers: MERCY (combined) / COMFORT (separate CMDR and MTF locations) C2 interfacing Commodore’s staff and Medical Treatment Facility: Planning, RFI, execution, logistics Capability: SIPR, NIPR, Secure Voice (Red Phone, STU/STE), SIPR Chat, VTC Ship to shore coordination nodes for patient scheduling, transportation (air/sea), consultation Internal Communication: PBX – Shore to PBX system under development by SPAWAR on behalf of MERCY W8 External Communication: POTS, and VoIP (~$1,000) BGAN and nRelief.org (centrally and select departments (OR) Advance Team/Beach Detachment – Central shore coordination: T-AH, Embassy, Country Team, HN gov’t) MED/DEN/VET CAP – OIC cell phone, BGAN/iNrelief.org Advance Team Medical (Surgical) Officer – Ministry of Health, HN medical community PDSS – International BlackBerry Primary ship to shore comms: Cell Phone – almost all communications used existing HN infrastructure Strengths: Superior mil to mil communications (Cell to Cell phone ashore and POTS Line in MOC) Superior mil to Embassy and HN Government communications Ability to communicate with HN medical community only within HN cell phone coverage area using expensive POTS lines Weaknesses: Expensive long distance calls via San Diego to USNS MERCY Poor (inefficient) ability for HN medical community and Advance Team MO to communicate while in ship Requires HN medical community to communicate via Beach Det, MED/DEN OIC or expensive long distance No VTC or telemedicine capability between T-AH and Host Nation Secondary: DoD standard Iridium Satellite Phones - less dependable and more expensive Tertiary Communications: SATCOM UHF Radios – borrowed from embarked Maritime Civil Affairs Squadron Other: VHF bridge-to-bridge radios – T-AH, Utility boats and helicopters Handheld UHF units also used ashore to communicate with the utility boats and helos. When MERCY was <1.5 miles to shore - Handheld UHF radios to communicate with the Beach Det/Boat Landing Zone and any MEDCAP sites in the immediate vicinity. Ship to shore access for Data transfer was done using Broadband Global Access Network (BGAN) units Used primarily for the Chat function from the ship for C2 and specialist consultation because iNrelief.org G-Mail not authorized BGANs can send pictures and files from shore to ship, but rarely used due to the cost (charge was in Megabits used) and the relatively limited bandwidth provided with these units. BGANs were not used in Papua New Guinea and Micronesia due to the lack of satellite footprint However, the final satellite was launched in September 2008 and should now be fully operational iNrelief.org collaboration portal: primary software tool for chat and Google Earth Easy to use, low bandwidth and therefore low cost compared to other programs (e.g. Groove) There are many programs available for this, like Groove, but we prefer iNRelief.org Expandable as applications develop – well suited for DR Non-classified, collaborative enterprise. Incorporates military, federal organizations, foreign governments/militaries, International Organizations (IO) and Non-Governmental Organizations (NGO). Ship to shore chat by mission leadership, doctors and communications personnel Post and retrieve pictures and files, allowing ship based specialists to assist shore based doctors Gmail not authorized for use Data held by a trusted third party, not the military Easily adjusted to individual users’ needs, not dictated by a single party Completely scalable, refreshed often and free of charge Permits the anonymity for NGOs and non-traditional partners required to neutrally collaborate. Limited “Telemedicine” capability through VTC in administrative spaces. This allows us limited reach back to medical expertise in CONUS. It was typically used to access higher level staffs, not outside medical assistance or HN Current quality of VTC capability is limited and not sufficient to support true TELEMEDICINE Command and Control: Unclassified Mission – Centralized Planning/Decentralized Execution 3 Coordination nodes: Mission Operation Center, Beach Detachment and MED/DEN/VET/ENG CAPS and Advance Team Medical Officer (Surgeon) Mission Operation Centers: MERCY (combined) / COMFORT (separate CMDR and MTF locations) C2 interfacing Commodore’s staff and Medical Treatment Facility: Planning, RFI, execution, logistics Capability: SIPR, NIPR, Secure Voice (Red Phone, STU/STE), SIPR Chat, VTC Ship to shore coordination nodes for patient scheduling, transportation (air/sea), consultation Internal Communication: PBX – Shore to PBX system under development by SPAWAR on behalf of MERCY W8 External Communication: POTS, and VoIP (~$1,000) BGAN and nRelief.org (centrally and select departments (OR) Advance Team/Beach Detachment – Central shore coordination: T-AH, Embassy, Country Team, HN gov’t) MED/DEN/VET CAP – OIC cell phone, BGAN/iNrelief.org Advance Team Medical (Surgical) Officer – Ministry of Health, HN medical community PDSS – International BlackBerry Primary ship to shore comms: Cell Phone – almost all communications used existing HN infrastructure Strengths: Superior mil to mil communications (Cell to Cell phone ashore and POTS Line in MOC) Superior mil to Embassy and HN Government communications Ability to communicate with HN medical community only within HN cell phone coverage area using expensive POTS lines Weaknesses: Expensive long distance calls via San Diego to USNS MERCY Poor (inefficient) ability for HN medical community and Advance Team MO to communicate while in ship Requires HN medical community to communicate via Beach Det, MED/DEN OIC or expensive long distance No VTC or telemedicine capability between T-AH and Host Nation Secondary: DoD standard Iridium Satellite Phones - less dependable and more expensive Tertiary Communications: SATCOM UHF Radios – borrowed from embarked Maritime Civil Affairs Squadron Other: VHF bridge-to-bridge radios – T-AH, Utility boats and helicopters Handheld UHF units also used ashore to communicate with the utility boats and helos. When MERCY was <1.5 miles to shore - Handheld UHF radios to communicate with the Beach Det/Boat Landing Zone and any MEDCAP sites in the immediate vicinity. Ship to shore access for Data transfer was done using Broadband Global Access Network (BGAN) units Used primarily for the Chat function from the ship for C2 and specialist consultation because iNrelief.org G-Mail not authorized BGANs can send pictures and files from shore to ship, but rarely used due to the cost (charge was in Megabits used) and the relatively limited bandwidth provided with these units. BGANs were not used in Papua New Guinea and Micronesia due to the lack of satellite footprint However, the final satellite was launched in September 2008 and should now be fully operational iNrelief.org collaboration portal: primary software tool for chat and Google Earth Easy to use, low bandwidth and therefore low cost compared to other programs (e.g. Groove) There are many programs available for this, like Groove, but we prefer iNRelief.org Expandable as applications develop – well suited for DR Non-classified, collaborative enterprise. Incorporates military, federal organizations, foreign governments/militaries, International Organizations (IO) and Non-Governmental Organizations (NGO). Ship to shore chat by mission leadership, doctors and communications personnel Post and retrieve pictures and files, allowing ship based specialists to assist shore based doctors Gmail not authorized for use Data held by a trusted third party, not the military Easily adjusted to individual users’ needs, not dictated by a single party Completely scalable, refreshed often and free of charge Permits the anonymity for NGOs and non-traditional partners required to neutrally collaborate. Limited “Telemedicine” capability through VTC in administrative spaces. This allows us limited reach back to medical expertise in CONUS. It was typically used to access higher level staffs, not outside medical assistance or HN Current quality of VTC capability is limited and not sufficient to support true TELEMEDICINE

3. How We Can Improve Current Capabilities Where We Are SHF Satellite System (WSC-8) Cell & Iridium Phone Communications Ashore Data Transfer (BGAN) Disaster Relief & Backup Comms (SATCOM) - borrowed Upgrade Recommended Upgrade to Commercial Broadband Satellite (CBS) System Connect PBX to local cell network.* Upgrade Pipe (VSAT) SATCOM Radios – organic * NB: VoIP practical during DR * What we can do to significantly upgrade our current capabilities. * ( examine left to right across slide.) We did not have any major difficulties with communications on mission during PP08 and had everything it NEEDED to execute a successful mission. We had a 1 computer to every 3 user ratio onboard which is far better than any other ship in the Navy allowing almost anyone to reach out and touch an individual on a shore mission through the iNrelief.org chat function as well as a 1 to 25 user to external phone line ratio for any one requiring phone contact with the shore sites. With the exception of the lack of satellite footprint for the BGAN in the central pacific, all systems were reliable, easy to use and readily available. However, there are systems out there that will give us the same capability but in a much more robust fashion. * BLUF: Requirement for additional technology must be defined then a funding steam sources. * WSC-8 SHF Satellite Suite Fleet standard system for all COMMS off T-AH. Though reliable has no redundancy. Without upgrades to this system (CBS), we are limited in our ability to expand telemedicine capability on board ship and ashore. All shipboard communications including phone, email and internet depend on this system, maintaining constant contact with the orbiting satellites. We would want a redundant system to backup the WSC-8, but due to financial and space constraints this is probably not realistic. However, we have been waiting for a system upgrade that will replace the WSC-8 with the CBSP system allowing the ship to expand its bandwidth capability from 2 Mbit/s to 21.4 Mbit/s a greater than 10 fold increase in capability. Cell Phone Communications The cell phone communications onboard worked reasonably well, however the major issue was that each cell phone call to the ship was a long distance international call. Cell calls were routed to San Diego through a shore side phone exchange and then back to the ship which may be only be a mile away from the individual making the call, costing the government tens of thousands of dollars. Solution is SPAWAR development of “Telular-like” system: Technology is currently available allowing the ship to integrate its PBX (phone exchange) into a host nations cell phone network by assigning a number of cell phone receivers to dedicated shipboard phone lines and providing access to a phone inside the ship without having to make an international call. The purchase of sim cards in each country would allow these receivers to act in an identical fashion to an actual cell phone allowing local calls to be made from ship to shore. Discussions in USNS MERCY during Pacific Partnership 2008 conceived this idea. We approached experts to consider developing for future HCA deployment application. Data Transfer – Ship to Shore MERCY used the BGAN system to do basic data transfer from ship to shore. The BGAN provides a maximum of 492 kbit/s bandwidth, which limits what type of files can be transferred over that connection. There are various systems (e.g. VSAT system), on the market that can provide up to 4 Mbit/s transfer rates in the most remote environments (10X BGAN transfer rate). This would allow us to modify how we do business by opening up the possibility of free flow of pictures, videos, voice, streaming video etc. from the shore to ship or even from the shore to CONUS and back. These units would be especially helpful in a DR environment where the Host Nation cell network may be damaged. Voice communications over a VoIP system would be the only available system outside of a satellite phone. This is the particular value of VoIP. Backup Communications This capability best serves us in a DR environment where cell phones will not work. Portable SATCOM radios are very expensive but reliable, built to work in austere environments and encryptable. MERCY borrowed a few for the PP08 deployment but would be best served to have its own for a backup COMMS. Since they are so expensive ($40K voice only), they would only be available to the larger MED/DENCAP sites for communications back to the ship. No usage fees. Satellite systems are available for voice and data transfer, but cost >$150 plus usage fees.* What we can do to significantly upgrade our current capabilities. * ( examine left to right across slide.) We did not have any major difficulties with communications on mission during PP08 and had everything it NEEDED to execute a successful mission. We had a 1 computer to every 3 user ratio onboard which is far better than any other ship in the Navy allowing almost anyone to reach out and touch an individual on a shore mission through the iNrelief.org chat function as well as a 1 to 25 user to external phone line ratio for any one requiring phone contact with the shore sites. With the exception of the lack of satellite footprint for the BGAN in the central pacific, all systems were reliable, easy to use and readily available. However, there are systems out there that will give us the same capability but in a much more robust fashion. * BLUF: Requirement for additional technology must be defined then a funding steam sources. * WSC-8 SHF Satellite Suite Fleet standard system for all COMMS off T-AH. Though reliable has no redundancy. Without upgrades to this system (CBS), we are limited in our ability to expand telemedicine capability on board ship and ashore. All shipboard communications including phone, email and internet depend on this system, maintaining constant contact with the orbiting satellites. We would want a redundant system to backup the WSC-8, but due to financial and space constraints this is probably not realistic. However, we have been waiting for a system upgrade that will replace the WSC-8 with the CBSP system allowing the ship to expand its bandwidth capability from 2 Mbit/s to 21.4 Mbit/s a greater than 10 fold increase in capability. Cell Phone Communications The cell phone communications onboard worked reasonably well, however the major issue was that each cell phone call to the ship was a long distance international call. Cell calls were routed to San Diego through a shore side phone exchange and then back to the ship which may be only be a mile away from the individual making the call, costing the government tens of thousands of dollars. Solution is SPAWAR development of “Telular-like” system: Technology is currently available allowing the ship to integrate its PBX (phone exchange) into a host nations cell phone network by assigning a number of cell phone receivers to dedicated shipboard phone lines and providing access to a phone inside the ship without having to make an international call. The purchase of sim cards in each country would allow these receivers to act in an identical fashion to an actual cell phone allowing local calls to be made from ship to shore. Discussions in USNS MERCY during Pacific Partnership 2008 conceived this idea. We approached experts to consider developing for future HCA deployment application. Data Transfer – Ship to Shore MERCY used the BGAN system to do basic data transfer from ship to shore. The BGAN provides a maximum of 492 kbit/s bandwidth, which limits what type of files can be transferred over that connection. There are various systems (e.g. VSAT system), on the market that can provide up to 4 Mbit/s transfer rates in the most remote environments (10X BGAN transfer rate). This would allow us to modify how we do business by opening up the possibility of free flow of pictures, videos, voice, streaming video etc. from the shore to ship or even from the shore to CONUS and back. These units would be especially helpful in a DR environment where the Host Nation cell network may be damaged. Voice communications over a VoIP system would be the only available system outside of a satellite phone. This is the particular value of VoIP. Backup Communications This capability best serves us in a DR environment where cell phones will not work. Portable SATCOM radios are very expensive but reliable, built to work in austere environments and encryptable. MERCY borrowed a few for the PP08 deployment but would be best served to have its own for a backup COMMS. Since they are so expensive ($40K voice only), they would only be available to the larger MED/DENCAP sites for communications back to the ship. No usage fees. Satellite systems are available for voice and data transfer, but cost >$150 plus usage fees.

4. Left: USNS MERCY Mission Operation Center and MOC Conference Room for Ops Planning and VTC Center: VSAT – significantly better than BGAN Right: WSC-8 – worked well with pre deployment Groom and trained technicians, though a single point of failure Bottom left: PSC-5 SATCOM Radio Bottom right: BGAN The USNS MERCY NGO network, as well as use of Microsoft Share Point and VoIP phones were highly successful during PP 08 USNS MERCY utilized the Red Phone located in the MOC to communicate with C7F following the shooting of our helicopter by unfriendly operators in Cotabato, RP. We did not have a STU or STE phone in the MOC, necessitating use of the STE in Radio, a considerable distance away. Addition of STU or STE phone capability to the MOC is an important lessons learned for PP 2010. W8 Groom pre-deployment with trained technicians key PSC 117F Used by USMC Transfers voice and data over same channel ~$40K (?) ADNS: Will give us the capability to easily reallocate bandwidth based on demand, making bandwidth utilization more efficient. Left: USNS MERCY Mission Operation Center and MOC Conference Room for Ops Planning and VTC Center: VSAT – significantly better than BGAN Right: WSC-8 – worked well with pre deployment Groom and trained technicians, though a single point of failure Bottom left: PSC-5 SATCOM Radio Bottom right: BGAN The USNS MERCY NGO network, as well as use of Microsoft Share Point and VoIP phones were highly successful during PP 08 USNS MERCY utilized the Red Phone located in the MOC to communicate with C7F following the shooting of our helicopter by unfriendly operators in Cotabato, RP. We did not have a STU or STE phone in the MOC, necessitating use of the STE in Radio, a considerable distance away. Addition of STU or STE phone capability to the MOC is an important lessons learned for PP 2010. W8 Groom pre-deployment with trained technicians key PSC 117F Used by USMC Transfers voice and data over same channel ~$40K (?) ADNS: Will give us the capability to easily reallocate bandwidth based on demand, making bandwidth utilization more efficient.

5. Potential for the Future Telemedicine Capabilities in clinical spaces CONUS/OCONUS consultation CONUS Educational opportunities Host Nation consultation and education Strategic Health Infrastructure Development Telemedicine Capabilities Ashore for consultation and potential for HN reach back to T-AH (USUHS, etc) CBS System afloat & VSAT capability ashore required All solutions must be expeditionary, durable & easy * What we can do with FUTURE capability. * Missing from the MERCY IT toolbox is true telemedicine capability. We have a VTC system for Staff and doctors onboard to communicate face to face with Chain of Command and ashore experts. The VTC units are only available in administrative spaces are slow and difficult to coordinate. Rarely used by the medical staff. We have a robust talented staff, but being a ship we are constrained by specialists onboard. We cannot fly in a consultant for a week or two while steaming across the Pacific or in a HN. Installing a robust telemedicine capability would allow CONUS expert consultation (e.g. surgical, ICU). Education for/by DoD, NGO’s and Partner Nations, as well as for/by Host Nations, to include HN reach-back consultation and potential for HN to U.S. Academic institutional relationships. Telemedicine Capabilities in Clinical Spaces and Classroom MERCY currently does not have true telemedicine capability. Installation of the CBS system required to permit the telemedicine capability to perform at sufficient speed. Camera and computer systems for clinical spaces and classroom requires funding and development. Potentially would expand MERCY’s access certain specialists in CONUS required only rarely and unpredictably, especially for ultra sophisticated aspects of medicine as these capabilities are added to the T-AH (e.g. molecular Pathology, etc). With challenging NAVMED manning requirements, this type of technology would be useful in a full scale contingency where BUMED is staffing MERCY, COMFORT and EMF hospitals ashore in support of the USMC. During PP 08, USNS MERDCY conducted an OSD(HA) directed HCA CHE program very successfully, developed jointly with USUHS. Telemedicine would expand the possibilities for this underway by linking to USUHS and Academic Institutions in CONUS. This would facilitate education in both directions. Also possible is bilateral Telemedicine opportunities between the USNS MERCY and the Host Nation. Telemedicine Capabilities Ashore This item is similar to what was discussed previously, but on the shore as opposed to aboard MERCY. By being able to utilize a more robust shore data connection with a VSAT (or equivalent) unit it gives us the opportunity to potentially set up a portable VTC system ashore for direct communications with specialists either onboard the MERCY or even in CONUS, to provide expertise on patient issues that may arise at various MEDCAP/DENCAPs, or HN educational opportunities. Perhaps the most difficult aspect of what the MERCY sees as possible in the future is making it simple enough and reliable enough for the average Navy IT sailor to be able to operate it. Given some of the remote locations MERCY operates, making it man-portable and durable are highly desirable. MERCY chose the BGAN units for its data transfer tool of choice because any ITSN with a few hours of training can set the unit up almost anywhere and begin data transfer in about 15 minutes. Though we did extremely well and were very pleased, to go along with our expeditionary mission for every situation, MERCY does not always have access to the highest level of technical support while executing its mission. We were fortunate to be provided a civilian network engineer, providing us with organic technical expertise on the vast majority of IT technical issues. However, that is a contracted non permanent position, so it is imperative any system installed onboard or provided for use ashore be SIMPLE enough to operate by Navy staff.* What we can do with FUTURE capability. * Missing from the MERCY IT toolbox is true telemedicine capability. We have a VTC system for Staff and doctors onboard to communicate face to face with Chain of Command and ashore experts. The VTC units are only available in administrative spaces are slow and difficult to coordinate. Rarely used by the medical staff. We have a robust talented staff, but being a ship we are constrained by specialists onboard. We cannot fly in a consultant for a week or two while steaming across the Pacific or in a HN. Installing a robust telemedicine capability would allow CONUS expert consultation (e.g. surgical, ICU). Education for/by DoD, NGO’s and Partner Nations, as well as for/by Host Nations, to include HN reach-back consultation and potential for HN to U.S. Academic institutional relationships. Telemedicine Capabilities in Clinical Spaces and Classroom MERCY currently does not have true telemedicine capability. Installation of the CBS system required to permit the telemedicine capability to perform at sufficient speed. Camera and computer systems for clinical spaces and classroom requires funding and development. Potentially would expand MERCY’s access certain specialists in CONUS required only rarely and unpredictably, especially for ultra sophisticated aspects of medicine as these capabilities are added to the T-AH (e.g. molecular Pathology, etc). With challenging NAVMED manning requirements, this type of technology would be useful in a full scale contingency where BUMED is staffing MERCY, COMFORT and EMF hospitals ashore in support of the USMC. During PP 08, USNS MERDCY conducted an OSD(HA) directed HCA CHE program very successfully, developed jointly with USUHS. Telemedicine would expand the possibilities for this underway by linking to USUHS and Academic Institutions in CONUS. This would facilitate education in both directions. Also possible is bilateral Telemedicine opportunities between the USNS MERCY and the Host Nation. Telemedicine Capabilities Ashore This item is similar to what was discussed previously, but on the shore as opposed to aboard MERCY. By being able to utilize a more robust shore data connection with a VSAT (or equivalent) unit it gives us the opportunity to potentially set up a portable VTC system ashore for direct communications with specialists either onboard the MERCY or even in CONUS, to provide expertise on patient issues that may arise at various MEDCAP/DENCAPs, or HN educational opportunities. Perhaps the most difficult aspect of what the MERCY sees as possible in the future is making it simple enough and reliable enough for the average Navy IT sailor to be able to operate it. Given some of the remote locations MERCY operates, making it man-portable and durable are highly desirable. MERCY chose the BGAN units for its data transfer tool of choice because any ITSN with a few hours of training can set the unit up almost anywhere and begin data transfer in about 15 minutes. Though we did extremely well and were very pleased, to go along with our expeditionary mission for every situation, MERCY does not always have access to the highest level of technical support while executing its mission. We were fortunate to be provided a civilian network engineer, providing us with organic technical expertise on the vast majority of IT technical issues. However, that is a contracted non permanent position, so it is imperative any system installed onboard or provided for use ashore be SIMPLE enough to operate by Navy staff.

6. USNS MERCY (T-AH 19) Questions… Steaming to Assist! Commitment, Cooperation and Compassion      In summary Pacific Partnership 2008, led by COMDESRON 31, the Medical Treatment Facility and the Civil Service Mariners, enhanced strategic relationships in Southeast Asia and Oceania by demonstrating goodwill and commitment in tangible and enduring ways.  Pacific Partnership celebrated the cultural diversity of our race, and its impact will span generations, enriching us all. The USNS MERCY’s Theater Security Cooperation achievements were monumental, forging new, and strengthening established partnerships.  The synergy of commitment, cooperation and compassion during Pacific Partnership 2008 set a new high standard for HCA missions through unparalleled innovation and Host Nation centered public diplomacy! Viva Pacific Partnership!    James P. Rice Captain, Medical Corps, United States Navy Commanding Officer Medical Treatment Facility USNS MERCY (T- AH 19)   “Mission First, Sailors and Families Always!”     In summary Pacific Partnership 2008, led by COMDESRON 31, the Medical Treatment Facility and the Civil Service Mariners, enhanced strategic relationships in Southeast Asia and Oceania by demonstrating goodwill and commitment in tangible and enduring ways.  Pacific Partnership celebrated the cultural diversity of our race, and its impact will span generations, enriching us all. The USNS MERCY’s Theater Security Cooperation achievements were monumental, forging new, and strengthening established partnerships.  The synergy of commitment, cooperation and compassion during Pacific Partnership 2008 set a new high standard for HCA missions through unparalleled innovation and Host Nation centered public diplomacy! Viva Pacific Partnership!    James P. Rice Captain, Medical Corps, United States Navy Commanding Officer Medical Treatment Facility USNS MERCY (T- AH 19)   “Mission First, Sailors and Families Always!”