Health Care and Safety in East Timor

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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. The Peace Corps in East Timor 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 at a hospital in Dili. If you become seriously ill, you will be transported either to an Australian medical facility in the region or to the United States.

American-standard dental care is not available in East Timor, so you should not expect to have routine dental care during your two years of service unless you return to the United States on vacation. If you have an emergency dental problem, you will be medevaced either to an Australian medical facility in the region or to the U.S.

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[edit] Health Issues in East Timor

Both plasmodium falciparum malaria and P. vivax malaria are rampant in East Timor. Volunteers are required to take weekly mefloquine or daily doxycycline or malarone prophylaxis to lessen the risk of contracting this potentially deadly disease. Other recommended prevention strategies include mosquito nets and a DEET-containing insect repellent. The medical office provides all necessary items for prevention of malaria.

Additional mosquito-borne diseases found in East Timor are dengue fever, Chikungunya fever, Japanese B encephalitis, and elephantiasis (lymphatic filariasis). Tuberculosis, meningitis, typhoid, and cholera, as well as a variety of bacterial and parasitic diarrheal diseases, are also endemic, mandating that proper water and food safety measures be taken on a daily basis. Bacterial skin diseases, leprosy, and yaws are not uncommon, and HIV and other STDs are present. Finally, conditions related to a tropical climate like heatstroke and sunburn are also of concern.

You should familiarize yourself with these diseases before your arrival so that you can make a more informed decision to serve as a Volunteer in East Timor.

[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 East Timor, you will receive a medical handbook and a first-aid kit with supplies to take care of mild illnesses and first-aid needs. The contents of the kit are listed later in this chapter.

During pre-service training, you will have access to basic first-aid 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 we will not order these items during training. Please bring a three-month supply of any prescription drugs you use, since they may not be available here and it may take several months for new shipments to arrive.

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

[edit] 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 old 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 East Timor is to take preventive measures for malaria and other mosquito-borne diseases, heat exhaustion and heatstroke, sunburn, food poisoning, and illnesses resulting from contaminated water. Daily brushing and flossing of teeth are also important to avoid dental problems.

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 your medical officer know immediately of significant illness and injuries.

Many illnesses that afflict Volunteers worldwide are entirely preventable if proper food and water precautions are taken. These diseases 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 East Timor during pre-service training.

Abstinence is the only certain choice for preventing infection with HIV and other STDs. 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/AIDS or other STDs. You will receive more information from your medical officer about this important issue. Volunteers are expected to adhere to an effective means of birth control to prevent unplanned pregnancies. 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.

[edit] Women’s Health Information

Pregnancy is a health condition that is treated in the same manner as other Volunteer health conditions requiring medical attention, but may 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 Peace Corps countries, it is rare that the Peace Corps medical and programmatic standards for continued service can be met. The majority of Volunteers who become pregnant are medically separated.

Though feminine hygiene products are available for you to purchase on the local market, the Peace Corps medical officer in East Timor 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

first-aid kit that contains basic items necessary to prevent and

treat illnesses that might occur during service. Kit items can be periodically restocked at your Peace Corps medical office.

[edit] Medical Kit Contents

Ace bandage
Adhesive tape
American Red Cross First Aid & Safety Handbook
Antacid tablets
Antibiotic ointment (Bacitracin/Neomycin/Polymycin B)
Antiseptic antimicrobial skin cleaner (Hibiclens)
Band-Aids
Butterfly closures
Cepacol lozenges
Condoms
Dental floss
Diphenhydramine HCL 25 mg (Benadryl)
Insect repellent
Iodine tablets (for water purification)
Lip balm (Chapstick)
Oral rehydration salts and Gatorade
Oral thermometer
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 the time 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, you should 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 shortly after you arrive in East Timor. You do not need to begin taking malaria medication prior to departure.

Bring a three-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 three-month supply, we 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. John’s wort, glucosamine, selenium, or antioxidant supplements.

You are encouraged to bring copies of medical prescriptions signed by your physician. This is not a requirement, although it might come in handy if you are questioned in transit about carrying a three-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. We discourage 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 their use has been recommended by an ophthalmologist 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 healthcare plans, you may wish to consult an insurance specialist about unique coverage needs before your departure. The Peace Corps will provide all necessary healthcare 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 healthcare 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 and/or preexisting conditions might prevent you from re-enrolling 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:

[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 East Timor 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 training competencies 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 East Timor

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 with anywhere in the world, crime does exist in East Timor. You can reduce your risk of becoming a target for crime 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. As might be expected in a post-conflict nation that underwent such turmoil as recently as 1999, safety and security remains a high priority. The U.N. peacekeeping force and U.N. civilian police force have gradually reduced in size, and have been functioning only in an advisory capacity since June 2004. The defense and civilian police forces of East Timor have assumed full responsibility for national security. United Nations forces have been withdrawn from East Timor since June 2005. Street crime, particularly in Dili, and petty theft on public transportation do occur, as is true elsewhere in the developing world. Permission to travel to or near border districts with West Timor is granted by the Peace Corps country director only after consultation with the embassy and the regional security officer.

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

You must be prepared to take on a large responsibility for your own safety. Only you can make yourself less of a target, ensure that your house is secure, and develop relations in your community that will make you an unlikely victim of crime. In coming to East Timor, do what you would do if you moved to a large 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 East Timor may require that you accept some restrictions on your current lifestyle.

Volunteers attract a lot of attention in large cities and at their sites, but receive far more negative attention in highly populated centers, where they are anonymous, than in smaller towns, where “family,” friends, and colleagues 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. 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. You should always walk with a companion at night.

Preparing for the Unexpected: Safety Training and Volunteer Safety Support in East Timor

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

The Peace Corps/East Timor office will keep Volunteers apprised of any issues that may impact Volunteer safety through information sharing. Regular updates will be provided in Volunteer newsletters and in memorandums from the country director. In the event of a critical situation or emergency, Volunteers will be contacted through the emergency communication network.

Volunteer training will include sessions to prepare you for specific safety and security issues in East Timor. 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 your two-year 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 criteria are based in part on any relevant site history; access to medical and other essential services; availability of communications, transportation, and markets; different housing options and living arrangements; and other support needs.

You will also learn about the country’s detailed emergency action plan 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, Volunteers in East Timor will gather at predetermined locations until the situation resolves itself or the Peace Corps decides to evacuate.

Finally, in order to be fully responsive to the needs of Volunteers, it is imperative that Volunteers immediately report any security incident to the Peace Corps 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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