Health care and safety in Ecuador

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Health care and safety in Ecuador
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The Peace Corps’ highest priority is maintaining the good health and safety of every Volunteer and trainee. Medical programs emphasize the preventive, rather than the curative approach to disease.

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.

Flag of Ecuador.svg

See also:
Pre-Departure Checklist
Staging Timeline
The Health of the Volunteer The Safety of the Volunteer

The Peace Corps’ highest priority is maintaining the health and safety of every Volunteer. Peace Corps medical programs emphasize the preventive, rather than the curative, approach to disease. The Peace Corps in Ecuador maintains a medical office staffed with medical officers who are registered nurses with many years of experience in caring for Volunteers. They are qualified to take care of Volunteers’ primary healthcare needs, but Volunteers are referred to local physicians, labs, and hospitals when necessary. If you develop a serious medical problem, the medical officers will consult with the Peace Corps’ Office of Medical Services in Washington. If it is determined that your condition cannot be cared for in Ecuador, you may be sent to the United States or Panama for further evaluation and care.


[edit] Health Issues in Ecuador

Although you may suffer some minor illnesses in Ecuador, if you take the proper precautions you can expect to have a healthy and safe two years. If you become seriously ill, however, Ecuador has some of the best hospitals and specialists in South America. Details of some health issues in Ecuador follow.

Diarrheal illness is the biggest health problem for Volunteers around the world, including Ecuador. This problem can be prevented with proper food and water preparation, which will be discussed during pre-service training.

Altitude varies greatly among Ecuador’s four geographical zones, and Quito is at 9,300 feet above sea level. Problems common in the first few days at a high altitude are headaches, indigestion, and shortness of breath.

Malaria is a serious health threat in the coastal and jungle areas of Ecuador. In addition to using insect repellent and mosquito nets (provided by Peace Corps), Volunteers assigned to these areas are required to malaria prophylaxis to prevent malaria.

Peace Corps service can be a stressful experience, and you may need to put all your positive coping skills to work. The Peace Corps medical officers are available to help you with your emotional needs and can refer you to English-speaking counselors. Peace Corps/Ecuador also has a Volunteer peer support network.

[edit] Helping You Stay Healthy

The Peace Corps will provide you with all the necessary inoculations, medications, and information to stay healthy. Unless you present proof of prior vaccination, you will receive immunizations against yellow fever; measles, mumps, and rubella; diphtheria and tetanus; polio; typhoid; hepatitis A and B; and rabies. Upon your arrival in Ecuador, you will receive a medical handbook and a medical kit with supplies to take care of mild illnesses and first-aid needs. The contents of the kit are listed later in this chapter. Peace Corps/Ecuador does not provide water filters to Volunteers. Volunteers are expected to boil water for consumption, as this is the most effective means of purifying water.

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 for you 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 shipments to arrive. You might consider switching from name-brand to generic drugs, as the Peace Corps medical officer may not be able to purchase certain name-brand prescriptions. Note that the medical office does not carry every type of birth control pill.

You will have a medical checkup at midservice and a complete physical exam at the end of your service. After you have been in-country for a year, the Peace Corps will also provide an annual dental checkup and cleaning and, for women, an annual Pap test.

[edit] Maintaining Your Health

As a Volunteer, you are the person most responsible for maintaining your 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 may not always be up to the standards of the United States.

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 reduce 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 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 Peace Corps countries, it is rare that the Peace Corps’ medical and programmatic standards for continued service during pregnancy can be met.

Sanitary pads are readily available in Ecuador. Tampons, however, are difficult to find and very expensive. If you use tampons, you should bring your own supply, as Peace Corps/Ecuador does not provide them.

[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 (DiGel)
Antibiotic ointment
Antifungal cream
Antiseptic antimicrobial skin cleanser
Aspirin or acetaminophen
Benadryl (antihistamine)
Butterfly closures
Calamine lotion
Dental floss
Insect repellent
Iodine tablets (for water purification)
Lip balm (Chapstick)
Lozenges for sore throat and cough
Oral rehydration salts
Oral thermometer
Sterile gauze pads
Sudafed (nasal decongestant)
Sunscreen (SPF 15)

[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 with you to Ecuador. 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 Ecuador. 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, it will order refills during your service. You are encouraged to consult with your physician about changing any prescription medicine you take to the generic equivalents. The Peace Corps will not pay for herbal or nonprescribed medications, including special vitamins (E, B, antioxidants, etc.), personal hygiene or beauty products, nicotine patches, Viagra, hair growth products, or St. John’s wort. 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 three-month supply of prescription drugs.

If you wear eyeglasses, bring two pairs along with your current prescription. If a pair breaks, the Peace Corps will replace it. While many Volunteers wear contact lenses without problems, the Peace Corps discourages their use because of the increased risk of developing eye infections. 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. The Peace Corps will not pay for or replace sunglasses but strongly encourages you to bring sunglasses to Ecuador because of the strong equatorial sun.

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 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.

Property 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 84 percent of Volunteers surveyed in the 2004 Peace Corps Volunteer Survey 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 and security 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 within the Volunteer’s control.

Based on information gathered from incident reports worldwide in 2004, 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; Emergency Preparedness, Plans, Training and Exercise; and Crime Statistics and Analysis.

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 provide 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 Ecuador as compared to all other Inter-America and Pacific (IAP) region programs as a whole, from 2000–2004. 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 eight crime categories. 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 Ecuador

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 Ecuador. 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 large towns, for instance, are favorite work sites for pickpockets.

The Peace Corps has not been immune to the violent crime that seems to be on the upswing in so many societies. In Ecuador, incidents of home burglaries, robberies, assaults, and sexual harassment have become more common. Overconsumption of alcohol is one of the highest risk factors for assaults against Volunteers in Ecuador. During training, you will receive information on safety issues specific to your home, your community, and travel. Although the Peace Corps cannot guarantee complete safety anywhere in the world, the more informed and aware you are, the more likely it is you will be able to avoid risky or dangerous situations.

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

Peace Corps Volunteers sometimes are the targets of crime because people view them as “rich” North Americans. Living with an Ecuadorian family is one way to reduce this risk, as your “family,” friends, and colleagues will look out for you. Indeed, your site is the safest place you can be.

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 home is secure, and develop relationships in your community that will make you an unlikely victim of crime. In coming to Ecuador, 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 Ecuador requires that you accept some restrictions on your current lifestyle.

While whistles and verbal harassment 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. Wearing expensive clothing or carrying accessories such as backpacks, cameras, or MP3 players can make you an attractive target for thieves. Keep your money out of sight by using an undergarment money pouch, the kind that 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. Especially when traveling, it is a good idea to distribute money in several places. You should always walk with a companion at night.

Do not bring expensive items to Ecuador, whether they be clothes or electronics. The Peace Corps does not cover the loss of personal property and highly recommends that you insure any valuable belongings that you bring with you. The Peace Corps will provide you with information on purchasing personal property insurance, but it is your responsibility to obtain and pay for it.

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

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 addressing safety and security incidents. Peace Corps/Ecuador’s in-country safety program is outlined below.

The Peace Corps/Ecuador office will keep Volunteers informed 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 Ecuador. 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. The 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; housing options and living arrangements; and other Volunteer support needs.

You will also learn about Peace Corps/Ecuador’s detailed emergency action plan, which is implemented in the event of civil or political unrest or a natural disaster. When you arrive at your site, you must complete and submit a site locator form with your address, contact information, a map to your house, and the name of a person in the community who will know your whereabouts. If there is a security threat, Volunteers in Ecuador will follow predetermined procedures, which could entail staying at one’s site and refraining from travel or gathering at prearranged locations until the situation is resolved or the Peace Corps decides to take further action.

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 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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