Health care and safety in Kyrgyzstan
From Peace Corps Wiki
|Health care and safety in Kyrgyzstan|
|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.
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 the Kyrgyz Republic maintains a clinic with two full-time medical officers who take care of Volunteers’ primary healthcare needs. Additional medical services, such as testing and basic treatment, are also available locally. If you become seriously ill, you will be transported either to an American-standard medical facility in the region or to the United States.
 Health Issues in the Kyrgyz Republic
Money for medical care and supplies is very scarce in the Kyrgyz Republic, and healthcare at local hospitals and clinics is not at the same standard as provided by similar-size facilities in the United States. Because of this, there are risks associated with taking medication in local facilities. Needles are often used repeatedly and improperly sterilized. In addition, pharmaceutical firms are known to pass on products to foreign consumers that they are unable to sell domestically, and local manufacturing standards are often inadequate. Volunteers should not receive injections or take medications unless they are administered by the Peace Corps medical officer or a facility approved by the Peace Corps.
 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 the Kyrgyz Republic, you will receive a medical handbook and a medical kit with supplies to take care of mild illnesses and first-aid needs. However, during training, 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 shipments to arrive.
You will have physicals at mid-service and at the end of your service. If you develop a serious medical problem, the medical officer in the Kyrgyz Republic will consult with the Office of Medical Services in Washington, D.C. If it is determined that your condition cannot be treated in the Kyrgyz Republic, you will be medically evacuated to another country for further evaluation and care.
 Maintaining Your 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 the Kyrgyz Republic is to take preventive measures for the following:
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, pinworms, and typhoid fever. The medical officer will discuss specific standards for water and food preparation in the Kyrgyz Republic during pre-service training.
Tuberculosis is present in the region, so it is advisable to stay away from people who are coughing constantly or show other signs of TB infection and to regularly ventilate your home and office. You will receive a skin test for tuberculosis prior to completing your service. Volunteers assigned to the southern region of the country will take malaria prophylaxis during a significant part of the year.
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 the medical officer about this important issue.
Volunteers are expected to adhere to an effective means of birth control to prevent an unplanned pregnancy. The 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 that you promptly report to the medical office for scheduled immunizations and that you inform the medical officer immediately of significant illness and injuries.
 Women’s Health Information
Pregnancy is treated in the same confidential 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. If the Volunteer decides to continue the pregnancy, then this also has programmatic ramifications. 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.
As is the case for other prescription medications, women who take birth control pills should bring an initial three-month supply with them. Similarly, women should bring an initial supply of feminine hygiene products. Tampons and pads are available locally, but it may be difficult for you to obtain them during pre-service training.
 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.
 Medical Kit Contents =
American Red Cross First Aid & Safety Handbook
Emergency First Aid Book
Antacid tablets (Tums)
Antibiotic ointment (Bacitracin/Neomycin/Polymycin B)
Antifungal cream (Clotrimazole 1%Tinactin)
Aquatabs (Iodine water purification tablets)
Band-Aids, assorted sizes
Benadryl (Diphenhydramine HCL 25 mg)
BugX (Insect repellent) stick
Cepacol Sepathoose lozenges
Electrol Plus, tablets
Hibiclens liquid soap (Antiseptic antimicrobial skin cleaner)
Hydrocortisone 1% cream
Lip Moisturizer with sunscreen SPF15
Oral rehydration salts and Gatorade
Robitussin-DM lozenges (cough drops)
Pept Eez (Bismith Subsalicilate tabs / Pepto-Bismol)
Sterile gauze pads
Sudanyl (Pseudoephedrine HCL/ 30 mg - Sudafed)
Sunscreen Lotion SPF 30+
Tetrahydrozaline eyedrops (Visine)
Thermometer (Oral in Fahrenheit)
 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 for service.
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 the 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.
Upon arrival you will receive a comprehensive vaccination program, which will include immunization against hepatitis A and B, rabies, typhoid, poliomyelitis, measles/mumps/rubella, tick-borne encephalitis, tetanus/diphtheria, meningococcal meningitis, influenza and, for some individuals, pneumococcal.
If you wish to avoid 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 of the immunizations necessary for your overseas assignment shortly after you arrive in the Kyrgyz Republic.
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 non-prescribed 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, 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 with you—a pair and a spare (not including sunglasses). 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 wearing 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.
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 post-service healthcare benefits. 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.
 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.
 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).
- Location: Most crimes occurred when Volunteers were in public areas (e.g., street, park, beach, public buildings). Specifically, 43 percent of assaults took place when Volunteers were away from their sites.
- Time of day: Assaults usually took place on the weekend during the evening between 5:00 p.m. and 2:00 a.m.— with most assaults occurring around 1:00 a.m.
- Absence of others: Assaults usually occurred when the Volunteer was unaccompanied. In 82 percent of the sexual assaults the Vol-unteer was unaccompanied and in 55 percent of physical assaults the Volunteer was unaccompanied.
- Relationship to assailant: In most assaults, the Volunteer did not know the assailant.
- Consumption of alcohol: Forty percent of all assaults involved alcohol consumption by Volunteers and/or assailants.
 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:
- Know the environment and choose safe routes/times for travel
- Avoid high-crime areas per Peace Corps guidance
- Know the vocabulary to get help in an emergency
- Carry valuables in different pockets/places
- Carry a “dummy” wallet as a decoy Strategies to reduce the risk/impact of burglary:
- Live with a local family or on a family compound
- Put strong locks on doors and keep valuables in a lock box or trunk
- Leave irreplaceable objects at home in the U.S.
- Follow Peace Corps guidelines on maintaining home security Strategies to reduce the risk/impact of assault:
- Make local friends
- Make sure your appearance is respectful of local customs; don’t draw negative attention to yourself by wearing inappropriate cloth-ing
- Get to know local officials, police, and neighbors
- Travel with someone whenever possible
- Avoid known high crime areas
- Limit alcohol consumption
 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 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 Kyrgyz Republic as compared to all other Europe, Mediterranean, and Asia (EMA) region programs as a whole, from 2001–2005. 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.
 What if you become a victim of a violent crime?
Few Peace Corps Volunteers are victims of violent crimes. The Peace Corps will give you information and training in how to be safe. But, just as in the U.S., crime happens, and Volunteers can become victims. When this happens, the investigative team of the Office of Inspector General (OIG) is charged with helping pursue prosecution of those who perpetrate a violent crime against a Volunteer. If you become a victim of a violent crime, the decision to prosecute or not to prosecute is entirely yours, and one of the tasks of the OIG is to make sure that you are fully informed of your options and help you through the process and procedures involved in going forward with prosecution should you wish to do so. If you decide to prosecute, we are here to assist you in every way we can.
Crimes that occur overseas, of course, are investigated and prosecuted by local authorities in local courts. Our role is to coordinate the investigation and evidence collection with the regional security officers (RSOs) at the U.S. embassy, local police, and local prosecutors and others to ensure that your rights are protected to the fullest extent possible under the laws of the country. OIG investigative staff has extensive experience in criminal investigation, in working sensitively with victims, and as advocates for victims. We also, may, in certain limited circumstances, arrange for the retention of a local lawyer to assist the local public prosecutor in making the case against the individual who perpetrated the violent crime.
If you do become a victim of a violent crime, first, make sure you are in a safe place and with people you trust and second, contact the country director or the Peace Corps medical officer. Immediate reporting is important to the preservation of evidence and the chances of apprehending the suspect.
Country directors and medical officers are required to report
all violent crimes to the Inspector General and the RSO. This information is protected from unauthorized further disclosure by the Privacy Act. Reporting the crime also helps prevent your further victimization and protects your fellow Volunteers.
In conjunction with the RSO, the OIG does a preliminary investigation of all violent crimes against Volunteers regardless of whether the crime has been reported to local authorities or of the decision you may ultimately make to prosecute. If you are a victim of a crime, our staff will work with you through final disposition of the case. OIG staff is available 24 hours-a-day, 7 days-a-week. We may be contacted through our 24-hour violent crime hotline via telephone at 202.692.2911, or by e-mail at violentcrimehotline@peacecorps. gov.
 Security Issues in the Kyrgyz Republic
When it comes to your safety and security in the Peace Corps, you must be willing to adapt your behavior and lifestyle to minimize the potential for becoming a target of crime. As with anywhere in the world, crime does exist in the Kyrgyz Republic. 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, especially in large towns, are favorite work sites for pickpockets.
While the Kyrgyz Republic is generally a safe country, poverty and alcoholism have taken their toll on the population, and street crime is on the increase. In addition, ethnic conflicts between the Uzbek and Kyrgyz populations in the south flair up from time to time, and the Kyrgyz Republic has played a major role in international efforts to fight terrorism. There is a Coalition military airbase outside Bishkek that has been a major staging ground for the international forces fighting in Afghanistan. While there have been no threats against Americans or overtly expressed anti-American sentiments, as a safety precaution, the Peace Corps does not place Volunteers to the south and west of the city of Osh or along the borders with Uzbekistan and Tajikistan.
 Staying Safe: Don’t Be a Target for Crime
You must be prepared to take on 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. You need to adopt a lifestyle sensitive to host-country cultural norms and exercise common sense and good judgment to promote your own safety and reduce risks. In coming to the Kyrgyz Republic, do what you would do if you moved to a large city in the United States: Be cautious, vigilant, check things out, ask questions, learn about your neighborhood, know where the more risky locations are, use common sense and street smarts, 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 the Kyrgyz Republic may require that you accept some restrictions on your current lifestyle.
 Preparing for the Unexpected: Safety Training and Volunteer Support in the Kyrgyz Republic
The Peace Corps’ approach to safety is a five-pronged plan to help you stay safe during your two years of 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. The Kyrgyz Republic’s in-country safety program is outlined below.
Peace Corps/Kyrgyz Republic staff will keep Volunteers informed of any issues that may impact Volunteer safety through information sharing. Regular updates are 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 Warden system).
Volunteer training will include sessions to prepare you for specific safety and security issues in the Kyrgyz Republic. 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.
Specific 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; appropriate housing arrangements; and other Volunteer support needs.
You will also learn about Peace Corps/Kyrgyz Republic’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, and a map to your home and to the Peace Corps office. If there is a security threat, Volunteers in the Kyrgyz Republic will gather at predetermined locations (primary or secondary consolidation points) until the situation is resolved or the Peace Corps decides to evacuate.
Finally, 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 staff. 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.
Peace Corps/Kyrgyz Republic has a very strict out-of-site policy. Peace Corps service is a 24/7 job. Therefore, Volunteers are expected to remain in their sites as much as possible in order to earn and keep the confidence and respect of their communities. The Peace Corps office must be informed of all out-of-site travel prior to your departure. For all out-ofsite travel, you must provide the post with detailed contact information, routes, itineraries, schedules, dates of departure and arrival, and, if relevant, the name of your local escort. Violation of the out-of-site policy is grounds for administrative separation.