Are Baveno V recommendations of any help in the management of extrahepatic portal hypertension in Latin America?

To the Editor, I read with interest the report byWalk et al [1] cataloguing the impressive achievements of a 2009 humanitarian mission by the US Naval Ship Comfort. The authors took pains to point out the efforts to partner with host nation surgeons and medical doctors to provide appropriate screening and—when possible—postoperative follow-up, and mentioned the goals of incorporating education of local physicians. These efforts are laudable, but the authors failed to discuss a not-so-secret truth widely acknowledged in the humanitarian sphere: providing medical care under the aegis of a military is fraught with both theoretical and actual problems. By virtue of its singular and virtually unlimited infrastructure and resources, and by its frequent involvement at the point of conflict, where local health resources are stretched or nonexistent, the military is often in a unique position to provide emergency medical care. Recent military medical experiences in the response to the earthquake in Haiti have been well documented (see Auerbach et al [2] as one example), and there is no doubt that such interventions filled a necessary gap in extreme crisis and need. What is lost in the conversation, however, is an acknowledgement that militarization of humanitarian aid is in direct conflict with the precepts set forth by most major humanitarian organizations and transnational governmental agencies, including Doctors without Borders, OXFAM International, the International Rescue Committee, the World Health Organization, and others [3,4]. At the root of the philosophical struggle is that militaries, like their overseeing governments, have agendas, and these are rarely of the “strings-free” kind. This is not to say that nongovernmental organizations do not have agendas of their own, but these may be more pure during medical decision making, abiding the principles of neutrality, impartiality, and independence. One must also consider that in the very places where humanitarian medical need is at its greatest, local military forces are often the principal perpetrators of injustice. Providing military medical aid can blur the lines between right and wrong and sometimes lead to false trust among atrisk populations. David H. Rothstein Division of Pediatric Surgery Ann and Robert H. Lurie Children's Hospital of Chicago 225 E. Chicago Ave., Box 63, Chicago, IL 60611, USA E-mail address: [email protected]