GNAVIYANI ATOLL, the Republic of Maldives (SFSU) – Ahead, poncho-draped silhouettes stand and kneel along the harbor's edge. A passing motorcycle headlight reveals dozens of rain soaked faces staring in my direction. Neither the late hour nor the steady rain has concealed my intrusion. I walk between rows of parked motorcycles and into the ever-quieting throng of local Muslim fisherman.
Lines of approaching headlights indicate the impending arrival of additional men from the nearby villages. This bustling outdoor fish market serves as the unofficial local news hub. Tonight, the men speak ardently about the previous days arrival of the 11th Marine Expeditionary Unit (MEU).
On December 15, 2007 elements of the 11th MEU began a Medical Civil Action Program (MEDCAP) and a Dental Civil Action Program (DENCAP) in order to foster good will between the U.S. and the predominantly Muslim nation of the Maldives. Both Civil Action Programs are scheduled to end in just five days time.
“Who will help us after the Marines go back to their ship?” Abdulla Ibrahim, a local fisherman, asks rhetorically. “What if there are unforeseen complications? I will not let the American doctors see my family.”
Behind Abdulla, I witness the outline of a large knife in motion. The wielder, an aged fisherman, squats over a mound of dead fish. Each pass of the knife-edge cleaves through scales and bones. Rainwater combines with blood from the gutted fish and streams into the crowded street.
The next morning, I arrive at the Gnaviyani Atoll Hospital. Light from an overhead lamp is directed onto the face of eight-year-old Khadeeja Nava Ali. Commander (CDR) Jason Ross, a U.S. Navy MD is holding a number fifteen blade in his gloved hand. He slowly makes a one-centimeter incision below the right eye of Khadeeja.
CDR Ross is performing a surgical procedure called a dacryocystorhinostomy (DCR). The DCR will attempt to clear the congenital occlusion of Khadeeja’s right tear duct. An occluded duct causes the affected eye to constantly tear.
Outside the operating room, I talk with CDR Ross. He recognizes that apprehension towards the MEDCAP and DENCAP is not without merit. CDR Ross speaks about the lack of postoperative care for his Maldivian patients.
“The brevity of our medical mission is not ideal. We are unable to provide patients with long-term postoperative care.
“I will not be here in six days to remove the sutures from below Khadeeja’s eye. Under normal conditions, I would monitor her recovery over a period of six months with regularly scheduled follow-up visits.”
The next afternoon, two U.S. Marine CH-46 Sea Knight Helicopters land in a soccer field adjacent to the Gnaviyani Atoll Hospital. Ambassador Robert Blake Jr. exits from one of the aircrafts.
He is the U.S. Ambassador to both Sri Lanka and the Republic of Maldives. Ambassador Blake is followed by a small delegation comprised of both U.S. Military personnel and officials from the Maldives National Defense Force (MNDF).
During the brief visit, I speak with Ambassador Blake about the lack of postoperative care available to Maldivian patients who elect to receive treatment at the MEDCAP and/or DENCAP.
“These procedures are very simple,” Ambassador Blake says. “Our military doctors are highly trained and we plan to return again next year.”
Ambassador Blake climbs through the crew door of a waiting helicopter. The aircrafts anti-collision lights pulse as the Marine pilot takes the helicopter to an altitude of 150 feet and travels south towards the Indian Ocean.
That evening, I am invited to have dinner with Abdulla Ibrahim and his family. Marine Corporal Aaron Denning joins me. We are sitting among Abdulla’s male relatives at a table in a dimly lit room. I watch as the young Marine eats a mixture of boiled yams, rice and fish.
After the meal, we move to an outdoor patio. Green algae and water lilies conceal a nearby pond. Abdulla lights a cigarette and discusses his opposition to the U.S. Military.
“Earlier today, two of your helicopters flew over my house. I do not like the sound they make. I have both CNN and BBC on my television. My family has watched U.S. helicopters launch missiles at Muslims in Iraq and Afghanistan.
“This is how we see your military. This is how we see your country. Why should I bring my family to your doctors?”
After a long pause, Abdulla offers Corporal Denning a cigarette. The Marine hangs the cigarette in his mouth and accepts a lighter from Abdulla’s son. Corporal Denning lights his cigarette and exhales slowly. He flicks the ash off the end of his cigarette and begins to speak.
“I miss my wife. As Marines we are often apart from our families. I joined the Marines to make a difference in the world. We are here as your friends.”
The two men talk for several hours. After the last cigarette is smoked, Abdulla decides to allow his family to be screened by the Dental Civil Action Program at the Gnaviyani Atoll Hospital.
The following morning, I travel by motorcycle to the home of Khadeeja Nava Ali. The incision made during the DCR is healing well. The young girl is sitting in the living room on a bench next to her older sister.
Both girls start laughing at the sight of my camera. Khadeeja and I walk outside in search of good light for her portrait photograph. We find it on a street in her village.
Three days later, I meet with Corporal Denning aboard the USS Cleveland (LPD 7) in the Indian Ocean. Corporal Denning speaks openly about his recent experience in the Maldives.
“Abdulla did not fit my preconceived image of a Muslim. This experience has expanded my views of the world. He welcomed me into his home. He shared his table with me. We are not that different.”
Before departing from the USS Cleveland, I speak with Navy Captain John P. LaBanc, DDS, MS. He comments on the limitations of the Civil Action Programs offered at the Gnaviyani Atoll Hospital.
“MEDCAPS and DENCAPS are conducted with good intentions, but often have unintended consequences. They are aimed at helping the people using the medical and dental capability organic to the MEU.
“Most often we go into a foreign country and provide the medical and dental care that we can, not the care the people need or expect…”
James Lee is an undergraduate student at S.F. State University. He is currently embedded as a photojournalist with the 11th Marine Expeditionary Unit. Stay tuned for more from his journey.