Operation Tsunami Aid

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Information and communications systems aboard the USNS Mercy helped the hospital ship live up to its name.

Since February, the crew of the Mercy has responded to two humanitarian aid missions in Indonesia.

The Mercy’s staff includes about 150 medical volunteers from Project Hope, 64 civil mariners and more than 500 Navy medical and support employees, with an information technology staff of 36.

The ship arrived offshore Bandeh Aceh at the northern tip of Sumatra, Indonesia, in early February to help victims of the tsunami that devastated much of the area last December.

After arriving at Sumatra, the crew provided medical support to more than 9,500 patients and performed nearly 20,000 medical procedures, including more than 285 surgical and operating room procedures.

The Mercy was heading home to San Diego when a magnitude 8.7 earthquake rocked Nias Island near northern Sumatra March 28. The earthquake was "larger than the San Francisco earthquake of 1906," said Lt. Bashon Mann, the Mercy’s public affairs officer. The earthquake caused 500 deaths and "totally destroyed the island’s infrastructure," Mann said.

At the request of the Indonesian government, the Mercy returned to Indonesia, arriving offshore Nias April 5, where the crew now continues to operate.

Lt. Cmdr. Erik Threet, the Mercy’s chief information officer, said in a phone interview from the ship that the Mercy has a wide range of computer and communications systems, including hundreds of networked computers running the Defense Department’s Composite Health Care System (CHCS) for electronic medical records.

Although CHCS was developed for DOD employees and their families, Threet said, the Mercy's CHCS system was adapted to serve Indonesian patients during the humanitarian efforts at Bandeh Aceh and Nias Island.

Bob Holdorf, a contractor with Science Applications International Corp. and the Mercy’s CHCS systems administrator, said the system has been heavily used for documenting patient records and tracking laboratory and radiology results and prescriptions.

The Mercy’s staff needed to change certain aspects of the system to serve Indonesian patients, Holdorf said. Patient records in CHCS are based on first and last names, Social Security numbers and birth dates. Holdorf said many Indonesians patients had only one name, some could only guess their age and none had Social Security numbers.

To resolve identification problems, Mercy officials used the one name as both first and last name, issued a false Social Security number and estimated birth dates, Holdorf said. Family members of Indonesian patients treated aboard Mercy were also entered into CHCS, Holdorf added, so that patients and their family members could receive meals aboard the ship, he said.

The Mercy’s IT staff had to train medical volunteers from Project Hope, a peacetime hospital ship that operates globally, to use CHCS, Holdorf said. Training sessions typically take five days, but crew members compressed the lessons into a few hours.

Karen Holland, a Project Hope volunteer and emergency room nurse, said she quickly learned the basics of CHCS. She said she likes how the system provides results of laboratory tests for patients, adding that entering data on a computer was quicker and more legible than handwritten notes.

Holland, who works as an emergency room nurse at Massachusetts General Hospital in Boston, said her tour on the Mercy was the first time she used a computer in a medical setting. Massachusetts General Hospital does not have computers in its emergency rooms, she said.

Dr. Harold Timboe, assistant vice president for research administration and initiatives at the University of Texas Health Science Center in San Antonio, served as leader of the Project Hope volunteers on the Mercy.

He said CHCS served as a unifying force for the volunteers from more than 50 hospitals.

Timboe, a retired Army major general who commanded the Walter Reed Army Medical Center in 2001, said CHCS ensures common business processes, which enhance patient care and safety. CHCS was the common language that united the volunteers in their medical responsibilities, said Timboe, who joined Mercy in Hawaii Jan. 10 and left the ship Feb. 24.

The Mercy and Project Hope medical staff treated tsunami and earthquake victims in areas of Indonesia populated by bands of separatist rebels. For safety reasons, the ship’s IT and communications staff needed to provide reliable communications ashore, said Bobbi Jo Williams, chief of interior communications.

She said that when teams from the ship are deployed ashore, they are equipped with AN/PRC-117 radios from Harris. The radios have line-of-sight and satellite communications capabilities so they offer redundant communications paths to call for help if needed.

Nortel Networks officials donated a wireless system consisting of two base stations, a cellular PBX and 56 handsets for use by the Mercy teams that go ashore. But Threet said the equipment has not been taken ashore.

Instead, Mark Wolfe, an interior communications electrician first class, said antennas from the base station, which hooked into a Nortel switch, were mounted on the ship’s rear masts. The system has been problematic for users ashore, depending on their location and the ship’s position.

Wolfe said the ship-mounted cellular system has a 12-mile range to shore some days, but coverage is spotty on other days. Therefore, the system should not be used as a primary means of communication. Threet said he looks at Mercy’s use of the Nortel gear as a proof-of-concept demonstration.

He said the Mercy can tap DOD’s secret and unclassified networks, e-mail and commercial Web sites through a broadband satellite dish that provides the ship with the equivalent of a T1 connection at 1.54 megabits/sec. It uses the Navy’s Commercial Wideband Satellite Program.

The Mercy's satellite signal terminates in Hawaii and is sent via Defense Information Systems Agency circuits to the Naval Computer and Telecommunications Station in San Diego. Because the Mercy’s broadband satellite is based in San Diego, the ship has a 619 area code. Phone calls to the ship are routed to Cisco Systems voice-over-IP handsets.

Threet said the Mercy has communications and computer systems and a dedicated IT staff, which are necessary to qualify the ship to handle a humanitarian aid mission.

— Bob Brewin

Policies and procedures frustrated efforts to share information across civilian and military boundaries during post-tsunami humanitarian operations in Indonesia, according to a report prepared for the Defense Department's chief information officer.

The report, prepared by Cmdr. Eric Rasmussen, a doctor stationed at Naval Hospital Bremerton in Washington state, states that policies and procedures initially limited access to military networks. Employees from the United Nations, other nongovernmental organizations (NGOs) and U.S. civilian agencies, such as the U.S. Agency for International Development (USAID), could not fully use networks aboard the USS Abraham Lincoln aircraft carrier, which operated off Sumatra, the Indonesian island hardest hit by the tsunami.

Under orders from Linton Wells, DOD's acting CIO, and Rear Adm. Elizabeth Hight, director of net-centric warfare in the Office of the Chief of Naval Operations, Rasmussen spent 11 days in Indonesia in early January working "to identify, document and address constructively issues impeding optimal work at the civil/military boundary."

Although the Lincoln has wideband satellite links, security policies prevented UN and NGO workers — and Rasmussen — from using Web-based e-mail services such as Microsoft’s Hotmail, said Rasmussen, who is also special adviser in humanitarian informatics for the Office of the Secretary of Defense.

Because United Nations, USAID and NGO employees needed to be aboard the Lincoln for most of a week, this policy "meant the relief effort might be significantly hampered for no obvious reason," Rasmussen wrote in his report. He added that when officials told the Lincoln's executive officer about the problem, "he allowed Web-based e-mail in about 15 minutes."

To avoid this problem in future U.S. military operations, Rasmussen recommended that military systems be opened to the greatest extent possible.

Rasmussen also urged officials to open daily briefings to civilian participants. The briefings aboard the Lincoln were classified and closed to UN, NGO and USAID employees, even though the briefings contained unclassified information that would have helped them during relief operations. For example, relief workers were denied access to unclassified security reports about helicopter landing zones along the Sumatra coast, Rasmussen wrote in his report.

When Rasmussen found information he could use, such as assessments made by a Navy surgeon, incompatible technology frustrated attempts to transfer the information. He could not obtain the information because his USB memory sticks were incompatible with the Lincoln’s Microsoft Windows NT 4.0 operating system, which lacked the necessary drivers.

Rasmussen recommended that officials prepare for "every reasonable eventuality for data sharing" when planning future collaborative humanitarian efforts. They should be prepared to work with CDs, DVDs, USB memory sticks, Zip disks, floppy disks, ad hoc wireless networks and wired crossover cables.

Rasmussen said DOD units also need to pay more attention to social networking, or person-to-person communications among U.S. military and UN, NGO and USAID staff, which "is the dominant part of collaboration in the field." Rasmussen wrote in the report that those relationships need to be developed through frequent exercises before a disaster hits.

Despite the glitches, Rasmussen said, after 11 days observing U.S. humanitarian operations in Indonesia, "I can honestly state that in 23 years of service, I have never been more proud of the sailors and Marines I serve alongside."

— Bob Brewin

Brian Steckler, a professor of information sciences at the Naval Postgraduate School (NPS) in Monterey, Calif., had planned to go to Thailand in early January to set up a wireless border surveillance network.

In cooperation with Thai authorities, Steckler organized the network based on commercial long-range WiMax and short-range Wi-Fi technologies.

In the aftermath of last December’s tsunami, which devastated much of Southeast Asia, Steckler and the NPS team decided to quickly convert the Coalition Operating Area Surveillance and Targeting System (COASTS) into a system that supports humanitarian relief operations in Thailand.

Robert Schena, chairman of Rajant, COASTS’ Wi-Fi equipment supplier, said company officials sent about $100,000 worth of the company’s BreadCrumb 802.11g gear Jan. 5 to help Steckler and the NPS team build humanitarian networks. The company also sent two technicians, Barry McElroy, a retired Army warrant officer who is fluent in Thai, and Chad Bowen, a former Army captain.

Bowen, McElroy, Steckler and John Pierson, a member of the NPS Information and Technology Services Department, moved the network equipment to the town of Khao Lak Jan. 8. The town is about two hours north of Phuket along the tsunami-battered Thai coastline.

Steckler said team members set up their equipment at the Wat Yanyao Buddhist temple, which served as a morgue, graves registration center and hub for families -- both Thai and foreign -- looking for news of relatives who had been in the tsunami zone.

By Jan. 13, the NPS team turned on a Wi-Fi network using the wireless BreadCrumb access points linked to a broadband satellite. Steckler said he had to beg Thai officials to get permission to use the broadband connection.

Almost immediately, laptops within range connected to the network. Volunteers from nongovernmental organizations (NGOs) and media representatives logged on, Steckler said. Within two hours, 50 to 60 people had signed on to the network, he said. Steckler said families from Europe and Thailand used the network to send photos of missing relatives to the temple, where relief workers printed posters of the missing and tried to match the pictures with bodies in the morgue.

The network was also used to access DNA databases to aid identification, Steckler added.

Once the temple network was running, Steckler said, the NPS team used 802.16 WiMax hardware from Redline Communications to extend the humanitarian network to the Bang Moung tsunami survivor camp four miles away. Internet access in that camp was available Jan. 24.

Redline officials have donated two 802.16 units to ensure continued operation of the humanitarian network in Thailand, said David Paolini, the company’s marketing communications director. Schena said the wireless gear used in the humanitarian network is on long-term loan; company officials are in no rush to get it back.

Steckler said the NPS team plans to use the Thailand experience as a model for quickly developing networks during future humanitarian and military operations. NPS officials are developing a WiMax and Wi-Fi kit that could be easily transported and quickly set up.

They have also formed a partnership with California State University at

Monterey Bay to set up an NGO training center.

Steckler returned to Thailand in March and, with the assistance of Marine Capt. Dwayne Lancaster, increased the power of the humanitarian network with another satellite terminal at the survivor camp and a dual-redundancy router. Officials at the World Wide Web Consortium have provided initial funding for survivor camp satellite connections, Steckler said.

He and several other colleagues pooled their funds to build a classroom at the survivor camp, he said. Volunteers use the classroom for Internet training, including lessons for survivors about using eBay to sell locally produced goods, Steckler said.

— Bob Brewin