The life of eight-year-old Pedro Daniel Anton was changed as doctors on board the hospital ship USNS Comfort (T-AH-20) in Paita, Peru, repaired his cleft lip and palate. Carlos Ramos, 59, from the coast of Pisorja, Ecuador, traveled seven hours with a friend to Esmeraldas, where surgeons on board the Comfort performed cataract surgery to improve his eyesight. More than 26,000 patients such as Pedro and Carlos benefited from Enduring Promise 18 (EP 18)—a humanitarian assistance mission to Central and South America—and the goodwill generated for the United States and our allies was immeasurable. Yet, commanding such a humanitarian assistance (HA) mission comes with challenges and opportunities that leaders must be prepared to meet.
Success in this environment demands a mastery of the tactical and technical “hard skills” associated with the delivery of expeditionary medicine. But leaders also need “soft skills” to navigate the nuances of strategic communication, cultural engagement, and the sensitivities of local political climate. HA mission success requires leaders to knit together military members, partner organizations, host-nation entities, and other governmental agencies into a team to tackle the unexpected challenges that come with providing life-saving services from and at sea, as well as executing a mission set with a heavy emphasis on diplomatic engagement. The leadership lessons from the Comfort’s deployment during EP 18 can inform leaders faced with establishing unity of effort and cohesion among a diverse team to address challenges unique to the HA mission set.
Build A Cohesive Team
In the fall 2018, EP 18 was directed by then-Secretary of Defense James Mattis to provide medical assistance to vulnerable populations affected by the increase in cross-border migrants fleeing from the economic crisis in Venezuela. The mission was planned by U.S. Southern Command (SouthCom) and U.S. Naval Forces South (USNavSouth) in just 70 days.
Our team came together quickly as the Comfort’s restricted operating status crew was augmented with U.S. Navy medical professionals and partner nation and nongovernmental organization providers. Destroyer Squadron 26 (DesRon 26)was tasked with providing the command element and brought together a team to oversee the planning, execution, and logistics of five mission stops. DesRon 26 also was responsible for the command and control of several expeditionary detachments, including an embarked helicopter detachment, platform force protection, and a public affairs organization.
From 11 October to 18 December 2018, commands from around the world provided 25 days of on-the-ground patient care in Ecuador, Peru, twice in Colombia, and Honduras, as well as surgical services on board the Comfort. Each evolution involved the collaboration and team integration of different organizations and cultures that had no experience working together.
Added logistical complexities and risks were imposed with all five mission stops when Comfort was at anchor, sometimes providing assistance to populations as far as 15 nautical miles from shore. During each mission stop, the Comfort not only was assisted and enabled by embarked helicopters and ship’s tenders, but also relied on a robust team of personnel from national ministries of health and defense, along with a contingent of military and civilian personnel from each local U.S. embassy.
EP 18 overcame numerous challenges as it provided medical care to more than 26,000 patients. This success would not have been possible if not for the diverse skillsets and cohesion of the EP 18 team. The team quickly learned that a climate of inclusion, maintaining open lines of communication, and aligning the priorities of participating parties were critical to establishing the unity of effort necessary for success.
Create an Inclusive Climate
In the HA environment, everyone wants to help. It is necessary to establish a climate of inclusion to provide clarity of purpose and vision. EP 18 quickly taught the team that connecting disparate stakeholders with the critical team members—or “battle buddies”—to align mission priorities and establish a structure, transcends the normal military senior-subordinate relationships. When working alongside host-nation partners, leaders must find the right battle buddy, establish rapport, and find common ground. HA missions provide numerous opportunities to develop these relationships. The difference between success and failure in this regard is the ability to set aside ossified positions and move toward common interests.
The EP 18 mission planning teams and medical site officers in charge (OICs) relied on battle buddies to ensure success. The teamwork to bring to bear the Comfort’s resources required establishing relationships quickly. Mission leaders and OICs used their contacts in the U.S. embassies and brokered relationships with host-nation ministries of health, defense, and local police to manage set-up and day-to-day operations. Planners, site leaders, public affairs teams, and host-nation personnel met daily to assess success and work through the challenges of providing health care through language barriers and strong demand. While at times challenging to solve basic problems such as providing shade, water, and entertainment to waiting patients, this face-to-face communication established trust and was instrumental to solving basic but important problems.
Delegate, Negotiate, and Communicate
Senior leaders frequently should remind themselves that the details of mission execution can be left to subordinates. It is the responsibility of senior leaders in HA missions to prioritize establishing a climate of inclusion among stakeholders. Each stakeholder is there to make a contribution. The team photo is almost as important as the outcome on the ground. Without a climate of inclusion founded on trust and shared values, the mission will suffer. This recognition can be hard to come by when execution details are piling up and a solution seems far away.
EP 18 was a top-heavy organization. There were numerous senior naval officer and U.S. civil servants, all with significant experience. Establishing lanes of responsibility, delegating authority, and encouraging subordinate development was crucial to success. This approach to leadership allows the mission commander to focus on bigger details, such as communication with higher headquarters, relationship building with country team leaders, and tapping into niche-talent personnel such as foreign policy and strategic communications advisors. This focus solved execution and coordination issues and improved alignment with higher headquarters.
Inclusion implies that everything is a negotiation. Even in an environment where everyone wants to help, solutions quickly bin in big categories: What works vs. what is right? How do we get to yes? Senior leaders must demonstrate political deftness and understand how influence works. It unwise to get caught in self-imposed traps of what 20 years of subject matter expertise says must happen. There are few lopsided bargaining positions in an HA mission; no one truly loses in the end. In this environment, style rules over substance. In instances of substance, pick battles wisely; there are few hills to die on. In instances of style, err on the side of being deferential—there always is another way to catch a fish.
HA missions often are put together quickly. Preplanning and established habitual relationships ensure an early 80 percent solution. Mission leaders must work the remaining 20 percent and tackle the challenges that remain in execution. In some instances, local institutional demands, organization politics, and history cause unforeseen friction. Practicing medicine in foreign countries, donating medical supplies, and finding the right fit for sometimes overqualified or unnecessary specialties while dealing with a language barrier pose additional challenges. Leaders must take these challenges in stride, address each on its merits, and avoid allowing bureaucratic positions to stall progress.
Establishing effective communication channels challenges every new organization. Everyone has a contribution to make, and providing the opportunity to communicate that contribution establishes trust. Creating a battle rhythm and structure to give voice to the team’s experience, inform decisions going up to higher headquarters, and preserve decision space is crucial. The amount of communication exchanged among stakeholders can overwhelm the most experienced planner and provider. Structure forces the team to listen to understand versus listening to offer solutions.
The EP 2018 battle rhythm was designed to plan mission stops, report the day’s status, capture real-time lessons learned, and align communications with higher headquarters. Each meeting was attended and led at the appropriate level for its desired outcome: planning, coordination, synchronization, and status. Task force leaders met with planners daily to provide guidance, review action items, and discuss execution. Meetings were held face-to-face, by virtual teleconference, and even in WhatsApp and Slack chat rooms. Ad-hoc meetings were required to provide audiences to key stakeholders. In those instances, face-to-face was the preferred method to allow for good active-listening skills. Regardless of the meeting type or method, clear agendas, rules of order, and tracking action items helped keep communications effective.
HA mission commanders must be comfortable communicating externally to both higher headquarters and through local, national, and international media. During EP 18, task force staff generated a daily wrap-up email to USNavSouth which included measures of performance, material readiness status, and challenges. The USNavSouth staff used this email in its daily communications with SouthCom staff and the staff of the Chief of Naval Operations.
HA has a robust public affairs/strategic communications component. Commanders should structure their battle rhythm to include opportunities for synchronization. The EP 18 public affairs staff included an OIC, two additional officers, a chief petty officer, and ten production specialists. This staffing allowed for a current/future operations approach to production with U.S. embassy public affairs and to stay aligned with SouthCom/USNavSouth public affairs organizations.
EP 18 team’s leadership skills were tested, but through their tactical and technical expertise they overcame challenges associated with moving patients, personnel, and equipment ashore daily, and provided excellent care to support the mission. Beyond quantitative numbers, the team’s soft skills strengthened relationships with partner nations and advanced strategic communications, highlighting the partnership necessary to success. At every step, the EP 18 team learned how important it is for mission leaders to build a cohesive team, establish an inclusive environment, and be willing to delegate, negotiate, and communicate to ensure mission success.