Health Care and Safety in Bangladesh

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The Peace Corps’ highest priority is maintaining the good health and safety of every Volunteer. Peace Corps medical programs emphasize the preventive, rather than the curative, approach to disease. Peace Corps/Bangladesh maintains a clinic with a full-time medical officer, who takes care of Volunteers’ primary health care needs. Additional medical services, such as testing and basic treatment, are also available in Bangladesh at local hospitals. If you become seriously ill, you will be transported either to an American-standard medical facility in the region or to the United States.

Contents

[edit] Health Issues in Bangladesh

Bangladesh is an extremely challenging assignment with regard to the health issues Volunteers face. The International Center for Diarrheal Diseases and Research is located in Dhaka for good reason. Food-, water-, air-, and mosquito-borne diseases such as malaria, dengue fever, hepatitis, cholera, typhoid, and tuberculosis exist in Bangladesh, along with environmental problems (i.e., air, water, and noise pollution). Volunteers should also expect to encounter health problems related to heat and humidity, limited dietary choices, and stress from unwanted attention or harassment.

[edit] Helping You Stay Healthy

The Peace Corps will provide you with all the necessary inoculations, medications, and information to stay healthy. Upon your arrival in Bangladesh, you will receive a medical handbook. At the end of training, you will receive a medical kit with supplies for taking care of mild illnesses and first-aid needs.

During pre-service training, you will have access to basic medical supplies through the medical officer. However, you will be

responsible for your own supply of prescription drugs and any other specific medical supplies you require, as the Peace Corps will not order these items during training. Please bring a six-month supply of any prescription drugs you use, since they may not be available here and it may take several months for shipments to arrive.

You will have physicals halfway through your service and at the end of your service. If you develop a serious medical problem during your service, the medical officer in Bangladesh will consult with the Office of Medical Services in Washington, D.C. If it is determined that your condition cannot be treated in Bangladesh, you may be sent out of the country for further evaluation and care. Maintaining Your Health

As a Volunteer, you must accept a certain amount of responsibility for your own health. Proper precautions will significantly reduce your risk of serious illness or injury. The adage “An ounce of prevention …” becomes extremely important in areas where diagnostic and treatment facilities are not up to the standards of the United States. The most important of your responsibilities in Bangladesh is to take preventive measures for diarrheal disease, mosquito-borne diseases (i.e., malaria and dengue fever), respiratory diseases (i.e., sinusitis, bronchitis, and tuberculosis), transportation- or sports-related injuries, and emotional problems.

Many illnesses that afflict Volunteers worldwide are entirely preventable if proper food and water precautions are taken.

These illnesses include food poisoning, parasitic infections, hepatitis A, dysentery, Guinea worms, tapeworms, and typhoid fever. Your medical officer will discuss specific standards for water and food preparation in Bangladesh during pre-service training.

Abstinence is the only certain choice for preventing infection with HIV and other sexually transmitted diseases. You are taking risks if you choose to be sexually active. To lessen risk, use a condom every time you have sex. Whether your partner is a host country citizen, a fellow Volunteer, or anyone else, do not assume this person is free of HIV or other STDs. You will receive more information from the medical officer about this important issue.

Volunteers are expected to adhere to an effective means of birth control to prevent an unplanned pregnancy. Your medical officer can help you decide on the most appropriate method to suit your individual needs. Contraceptive methods are available without charge from the medical officer. It is critical to your health that you promptly report to the medical office or other designated facility for scheduled immunizations, and that you let the medical officer know immediately of significant illnesses and injuries.

[edit] Women’s Health Information

Pregnancy is treated in the same manner as other Volunteer health conditions that require medical attention but also have programmatic ramifications. The Peace Corps is responsible for determining the medical risk and the availability of appropriate medical care if the Volunteer remains in-country. Given the circumstances under which Volunteers live and work in Bangladesh and the fact that a pregnant single woman would likely find it difficult to sustain her position in the community, it is rare that the Peace Corps’ medical and programmatic standards for continued service during pregnancy can be met.

If feminine hygiene products are not available for you to purchase on the local market, the Peace Corps medical officer in Bangladesh will provide them. If you require a specific feminine hygiene product, please bring a six-month supply with you.

[edit] Your Peace Corps Medical Kit

The Peace Corps medical officer provides Volunteers with a kit that contains basic items necessary to prevent and treat illnesses that may occur during service. Kit items can be periodically restocked at the medical office.

[edit] Medical Kit Contents

Ace bandages
Adhesive tape
American Red Cross First Aid & Safety Handbook
Antacid tablets (Tums)
Antibiotic ointment (Bacitracin/Neomycin/Polymycin B)
Antiseptic antimicrobial skin cleaner (Hibiclens)
Band-Aids
Butterfly closures
Calamine lotion
Cepacol lozenges
Condoms
Dental floss
Diphenhydramine HCL 25 mg (Benadryl)
Insect repellent stick (Cutter’s)
Iodine tablets (for water purification)
Lip balm (Chapstick)
Oral rehydration salts
Oral thermometer (Fahrenheit)
Pseudoephedrine HCL 30 mg (Sudafed)
Robitussin-DM lozenges (for cough)
Scissors
Sterile gauze pads
Tetrahydrozaline eyedrops (Visine)
Tinactin (antifungal cream)
Tweezers

[edit] Before You Leave: A Medical Checklist

If there has been any change in your health—physical, mental, or dental—since you submitted your examination reports to the Peace Corps, you must immediately notify the Office of Medical Services. Failure to disclose new illnesses, injuries, allergies, or pregnancy can endanger your health and may jeopardize your eligibility to serve.

If your dental exam was done more than a year ago, or if your physical exam is more than two years old, contact the Office of Medical Services to find out whether you need to update your records. If your dentist or Peace Corps dental consultant has recommended that you undergo dental treatment or repair, you must complete that work and make sure your dentist sends requested confirmation reports or X-rays to the Office of Medical Services.

If you wish to avoid having duplicate vaccinations, contact your physician’s office, obtain a copy of your immunization record, and bring it to your pre-departure orientation. If you have any immunizations prior to Peace Corps service, the Peace Corps cannot reimburse you for the cost. The Peace Corps will provide all the immunizations necessary for your overseas assignment, either at your pre-departure orientation or shortly after you arrive in Bangladesh. You do not need to begin taking malaria medication prior to departure.

Bring a six-month supply of any prescription or over-thecounter medication you use on a regular basis, including birth control pills. Although the Peace Corps cannot reimburse you for this six-month supply, it will order refills during your service. While awaiting shipment—which can take several months—you will be dependent on your own medication supply. The Peace Corps will not pay for herbal or nonprescribed medications, such as St. Johns’ wort, glucosamine, selenium, or antioxidant supplements.

You are encouraged to bring copies of medical prescriptions signed by your physician. This is not a requirement, but they might come in handy if you are questioned in transit about carrying a six-month supply of prescription drugs.

If you wear eyeglasses, bring two pairs with you—a pair and a spare. If a pair breaks, the Peace Corps will replace it, using the information your doctor in the United States provided on the eyeglasses form during your examination. The Peace Corps discourages you from using contact lenses during your service to reduce your risk of developing a serious infection or other eye disease. Most Peace Corps countries do not have appropriate water and sanitation to support eye care with the use of contact lenses. The Peace Corps will not supply or replace contact lenses or associated solutions unless an ophthalmologist has recommended their use for a specific medical condition and the Peace Corps’ Office of Medical Services has given approval.

If you are eligible for Medicare, are over 50 years of age, or have a health condition that may restrict your future participation in health care plans, you may wish to consult an insurance specialist about unique coverage needs before your departure. The Peace Corps will provide all necessary health care from the time you leave for your pre-departure orientation until you complete your service. When you finish, you will be entitled to the post-service health care benefits described in the Peace Corps Volunteer Handbook. You may wish to consider keeping an existing health plan in effect during your service if you think age or preexisting conditions might prevent you from reenrolling in your current plan when you return home.

[edit] Safety and Security—Our Partnership

Serving as a Volunteer overseas entails certain safety and

security risks. Living and traveling in an unfamiliar environment, a limited understanding of the local language and culture, and the perception of being a wealthy American are some of the factors that can put a Volunteer at risk. Petty thefts and burglaries are not uncommon. Incidents of physical and sexual assault do occur, although almost all Volunteers complete their two years of service without serious personal safety problems. In addition, more than 83 percent of Volunteers surveyed say they would join the Peace Corps again.

The Peace Corps approaches safety and security as a partnership with you. This Welcome Book contains sections on: Living Conditions and Volunteer Lifestyle; Peace Corps Training; and Your Health Care and Safety. All of these sections include important safety information. The Peace Corps makes every effort to give Volunteers the tools they need to function in the safest and most secure way possible, because working to maximize the safety and security of Volunteers is our highest priority. Not only do we provide you with training and tools to prepare for the unexpected, but we teach you to identify and manage the risks you may encounter.

[edit] Factors that Contribute to Volunteer Risk

There are several factors that can heighten a Volunteer’s risk, many of which are in the Volunteer’s control. Based on information gathered from incident reports worldwide in 2003, the following factors stand out as risk characteristics for assaults. Assaults consist of personal crimes committed against Volunteers, and do not include property crimes (such as vandalism or theft)

[edit] Summary Strategies to Reduce Risk

Before and during service, your training will address these areas of concern so that you can reduce the risks you face.

For example, here are some strategies Volunteers employ:

Strategies to reduce the risk/impact of theft:

Strategies to reduce the risk/impact of assault:

[edit] Support from Staff

In March 2003, the Peace Corps created the Office of Safety and Security with its mission to “foster improved communication, coordination, oversight, and accountability of all Peace Corps’ safety and security efforts.” The new office is led by an Associate Director for Safety and Security who reports to the Peace Corps Director and includes the following divisions:

Volunteer Safety and Overseas Security; Information and Personnel Security; and Emergency Preparedness, Plans, Training and Exercise. The safety and security team also tracks crime statistics, identifies trends in criminal activity, and highlights potential safety risks to Volunteers.

The major responsibilities of the Volunteer Safety and Overseas Security Division are to coordinate the office’s overseas operations and direct the Peace Corps’ safety and security officers who are located in various regions around the world that have Peace Corps programs. The safety and security officers conduct security assessments; review safety trainings; train trainers and managers; train Volunteer safety wardens, local guards, and staff; develop security incident response procedures; and provide crisis management support.

If a trainee or Volunteer is the victim of a safety incident, Peace Corps staff is prepared to provide support. All Peace Corps posts have procedures in place to respond to incidents of crime committed against Volunteers. The first priority for all posts in the aftermath of an incident is to ensure that the Volunteer is safe and receiving medical treatment as needed. After assuring the safety of the Volunteer, Peace Corps staff provides support by reassessing the Volunteer’s work site and housing arrangements and making any adjustments, as needed. In some cases, the nature of the incident may necessitate a site or housing transfer. Peace Corps staff will also assist Volunteers with preserving their rights to pursue legal sanctions against the perpetrators of the crime. It is very important that Volunteers report incidents as they occur, not only to protect their peer Volunteers, but also to preserve the future right to prosecute. Should Volunteers decide later in the process that they want to proceed with the prosecution of their assailant, this option may no longer exist if the evidence of the event has not been preserved at the time of the incident.

The country-specific data chart below shows the incidence rates and the average number of incidents of the major types of safety incidents reported by Peace Corps Volunteers/trainees in Bangladesh as compared to all other Europe, Mediterranean, and Asia (EMA) region programs as a whole, from 1999–2003. It is presented to you in a somewhat technical manner for statistical accuracy.

To fully appreciate the collected data below, an explanation of the graph is provided as follows:

The incidence rate for each type of crime is the number of crime events relative to the Volunteer/trainee population. It is expressed on the chart as a ratio of crime to Volunteer and trainee years (or V/T years, which is a measure of 12 full months of V/T service) to allow for a statistically valid way to compare crime data across countries. An “incident” is a specific offense, per Peace Corps’ classification of offenses, and may involve one or more Volunteer/trainee victims. For example, if two Volunteers are robbed at the same time and place, this is classified as one robbery incident.

The chart is separated into the eight most commonly occurring assault types. These include vandalism (malicious defacement or damage of property); theft (taking without force or illegal entry); burglary (forcible entry of a residence); robbery (taking something by force); minor physical assault (attacking without a weapon with minor injuries); minor sexual assault (fondling, groping, etc.); aggravated assault (attacking with a weapon, and/or without a weapon when serious injury results); and rape (sexual intercourse without consent).

When anticipating Peace Corps Volunteer service, you should review all of the safety and security information provided to you, including the strategies to reduce risk. Throughout your training and Volunteer service, you will be expected to successfully complete all trainingcompetencies in a variety of areas including safety and security. Once in-country, use the tools and information shared with you to remain as safe and secure as possible.

[edit] Security Issues in Bangladesh

When it comes to your safety and security in the Peace Corps, you have to be willing to adapt your behavior and lifestyle to minimize the potential for being a target of crime. As is the case anywhere in the world, crime exists in Bangladesh. You can reduce your risk by avoiding situations that make you feel uncomfortable and by taking precautions. Crime at the village or town level is less frequent than in the large cities; people know each other and generally will not steal from their neighbors. Tourist attractions in largetowns, for instance, are favorite work sites for pickpockets.

Following are some aspects of Bangladeshi culture that you should be aware of because they could affect your safety and security:

Bangladesh has a very conservative culture, and to live and work successfully in the country you will constantly have to consider your behavior, appearance, and lifestyle within a Bangladeshi context. If you show respect for the culture, your co-workers and members of your community will look out for you, and you are likely to feel safer than you ever have before.

If you ignore or violate their cultural expectations, they may care less about your welfare, and you could experience the consequences. Because you are an adult, you will make your own choices. But if you do not heed the expectations about dress and behavior, you will compromise not only your own safety but possibly that of other Volunteers. That being said, foreigners have a lot of leeway, and you will eventually become better equipped to decide what you absolutely must conform to and where you can take liberties without compromising your reputation and thereby your safety. Bangladesh is particularly hard for female Volunteers in that its male-dominated society leaves women with limited personal rights. For instance, women and girls are not free to walk around their own town without being harassed. The lack of social interaction between men and women means that dating is not part of the culture, and premarital sex is so taboo that it is rarely discussed. The frustrations of young males spill out onto the streets, and passing females often become the target of catcalls, touching, and sometimes violence. Though this issue is regularly discussed in the national newspapers, a general disregard for the value and individuality of women remains integral to the social order. Female foreigners are also vulnerable to harassment wherever they go, and it is not uncommon for them to be yelled at, teased, and sometimes touched while walking along the street, with bold invitations to engage in sexual activity. Male Volunteers are also called names.

Unmarried female Volunteers have to be careful to avoid giving even the slightest sign that they are “friendly.” People in Bangladesh generally do not smile at strangers, so it is inappropriate to smile at a passing stranger of the opposite sex.

On the job, Volunteers also have to avoid the ease and friendliness with co-workers of the opposite sex they may be used to at home—the idea of men and women being “buddies” is not understood. To avoid unwanted advances, female Volunteers must at least start out being all business. As you get to know your town, your workplace, and your co-workers, you will begin to learn the ropes of appropriate social behavior. You will learn where and when you can relax, and where and when you must keep up your guard.

Personal safety will be discussed by current Volunteers during pre-service training, and you will be provided with coping strategies. Volunteers do learn how to deal successfully with the stress of always being observed and even the rudeness of inappropriate remarks. In the end, they have a rich and rewarding two years of living and working in Bangladesh.

[edit] Staying Safe: Don’t Be a Target for Crime

You must be prepared to take on a large degree of responsibility for your own safety. Only you can make yourself less of a target, ensure that your house is secure, and develop relationships in your community that will make you an unlikely victim of crime. In coming to Bangladesh, do what you would do if you moved to a new city in the United States: Be cautious, check things out, ask questions, learn about your neighborhood, know where the more risky locations are, use common sense, and be aware. You can reduce your vulnerability to crime by integrating into your community, learning the local language, acting responsibly, and abiding by Peace Corps policies and procedures. Serving safely and effectively in Bangladesh may require that you accept some restrictions on your current lifestyle.

Volunteers attract a lot of attention both in large cities and at their sites, but they are likely to receive more negative attention in highly populated centers than at their sites, where “family,” friends, and colleagues will look out for them. While whistles and exclamations are fairly common on the street, this behavior can be reduced if you dress conservatively, avoid eye contact, and do not respond to unwanted attention. In addition, keep your money out of sight by using an undergarment money pouch, the kind that hangs around your neck and stays hidden under your shirt or inside your coat. Do not keep your money in outside pockets of backpacks, in coat pockets, or in fanny packs. And always walk with a companion at night.

[edit] Preparing for the Unexpected: Safety Training and Volunteer Support in Bangladesh

The Peace Corps’ approach to safety is a five-pronged plan to help you stay safe during your two-year service and includes the following: information sharing, Volunteer training, site selection criteria, a detailed emergency action plan, and protocols for reporting and responding to safety and security incidents. Peace Corps/Bangladesh’s in-country safety program is outlined below.

Information sharing—The Peace Corps/Bangladesh office will keep you informed of any issues that may impact Volunteer safety. The country director will offer regular updates in the Volunteer newsletter and in memorandums. In the event of a critical situation or emergency, you will be contacted through the emergency communication network.

Training will include sessions on specific safety and security issues in Bangladesh. This training will prepare you to adopt a culturally appropriate lifestyle and exercise judgment that promotes safety and reduces risk in your home, at work, and while traveling. Safety training is offered throughout service and is integrated into the language, cross-cultural, health, and other components of training.

Certain site selection criteria are used to determine safe housing for Volunteers before their arrival. Peace Corps staff works closely with host communities and counterpart agencies to help prepare them for a Volunteer’s arrival and to establish expectations of their respective roles in supporting the Volunteer. Each site is inspected before the Volunteer’s arrival to ensure placement in appropriate, safe, and secure housing and work sites. Site selection is based in part on any relevant site history; access to medical, banking, postal, and other essential services; availability of communications, transportation, and markets; different housing options and living arrangements; and other Volunteer support needs.

You will also learn about Peace Corps/Bangladesh’s detailed emergency action plan, which may be implemented in the event of civil or political unrest or a natural disaster. When you arrive at your site, you will complete and submit a site locator form with your address, contact information, and a map to your house. If there is a security threat, you will gather with other Volunteers in Bangladesh at a predetermined location until the situation is resolved or the Peace Corps decides to evacuate.

Finally, in order for the Peace Corps to be fully responsive to the needs of Volunteers, it is imperative that Volunteers immediately report any security incident to the Peace Corps country director or medical officer. The Peace Corps has established protocols for addressing safety and security incidents in a timely and appropriate manner, and it collects and evaluates safety and security data to track trends and develop strategies to minimize risks to future Volunteers.

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