Health care and safety in Micronesia

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Health care and safety in Micronesia
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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 Micronesia.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 good health and safety of every Volunteer. Because medical services may be inadequate or unavailable in some host countries, Peace Corps medical programs emphasize the preventive, rather than the curative, approach to disease.

Peace Corps/Micronesia maintains its own health unit in Kolonia, Pohnpei, with a physician’s assistant and a full-time nurse. These medical officers provide or manage Volunteer healthcare. If you are assigned to another state or Palau, healthcare will be provided by professionals in the capital center or at remote sites.

Volunteers must be prepared to use these providers and facilities for initial and follow-up care. Local hospitals, clinics, or other healthcare facilities are typically very basic—smaller, older, and less well-kept and maintained than the U.S. norm. There are fewer supplies and equipment. Providers are typically a Micronesian medical officer or another foreign national trained in Fiji in basic medicine. Trained specialists are generally limited. Local care, including basic dental and gynecological care, will be accessed and utilized by Volunteers whenever possible.

If you become seriously ill and local resources are inadequate, you will be transported to a medical facility in Guam, Hawaii, or Washington, D.C.

Remember that you have elected to serve in a developing country. Your life here will probably be very different from life back home. These differences extend to healthcare. If you have concerns about healthcare in-service, now would be a good time to re-examine your commitment to serve.

Contents

[edit] Health Issues in Micronesia

Common health problems among Volunteers include skin infections, diarrhea, respiratory infections, dental problems, gynecological infections, parasitic infections (skin and intestines), unintentional injuries and accidents (especially bike), mental health concerns, and water-related injuries or conditions. Dog bites are a concern in some states, but rabies is not found in Micronesia. Dengue fever, transmitted by mosquitoes, does occur, but not malaria. Volunteers have also been infected with leptospirosis (transmitted in contaminated water).

[edit] Helping You Stay Healthy

Peace Corps will provide you with all the necessary immunizations, medications, and information to stay healthy. Immunizations against hepatitis A and B, tetanus, typhoid, polio, measles, and influenza are required by Peace Corps and must be current during your service. Upon your arrival in Micronesia, you will receive a medical handbook. Within one week of arrival, you will receive a comprehensive medical kit with supplies to take care of routine illnesses and first-aid needs. These items are intended for your own use and can be periodically restocked through the Peace Corps health unit.

You will initially be responsible for your own supply of prescription drugs and any other medical supplies you require. You should bring a three-month supply of any prescription drugs you use; Peace Corps will provide these medications and supplies after three months.

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 Micronesia will consult with the Office of Medical Services in Washington, D.C. If it is determined that your condition cannot be treated in Micronesia, 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 is worth a pound of cure” becomes extremely important in areas where diagnostic and treatment facilities are not up to standards of the United States. Your most important responsibilities are to provide full information about your past medical history and any current problems to allow for proper evaluation and treatment; to follow all prescribed therapies and other medical recommendations; to engage only in responsible and safe sex; to keep your immunizations up to date; to drink alcohol moderately, if at all; to avoid illegal drugs; to sleep with a mosquito net in mosquito-infested areas; and to drink plenty of safe water.

HIV/AIDS occurs in Micronesia and cases are on the rise. Micronesians generally lack accurate information on the transmittal and consequences of HIV/AIDS. Abstinence is the only certain choice for preventing infection with HIV and other STIs. 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. 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 it may also have programmatic ramifications. The Peace Corps is responsible for determining the medical risk and 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 became pregnant in the past have been medically separated.

Acute and routine gynecological exams/breast exams are performed in-country with local providers or the medical officer on Pohnpei.

Tampons can be found in all capital centers, but brands/sizes are limited and they are expensive. Be prepared to bring extra tampons with you or have them mailed to you during service.

[edit] Your Peace Corps Medical Kit

[edit] Medical Kit Contents

Acetaminophen tablets (Tylenol)
Adhesive tape
Allergy or cold tablets (Actifed)
American Red Cross First Aid & Safety Handbook
Ana-Kit® or EpiPen® (for those with a history of significant allergies)
Antacid tablets
Antibiotic ointment (Bacitracin or Bactroban)
Antiseptic skin cleanser (Hibiclens)
Band-Aids
Butoconazole vaginal cream (Femstat or other vaginal yeast cream)
Butterfly skin closures
Clotrimazole cream or lotion (Mycelex)
Condoms with and without nonoxynol
Cough lozenges
DAN Emergency Handbook (for certified SCUBA divers)
Dental floss
Diphenhydramine capsules (Benadryl)
Elastic bandages (various sizes)
Ibuprofen tablets (Motrin)
Isopropyl alcohol pads
Gauze wrap (various sizes)
Latex gloves (one pair)
Lip balm
Mosquito repellent
Multivitamins and mineral supplements (generic Centrum and calcium carbonate)
Nasal decongestant spray
Oral rehydration solution
Permethrin rinse (Nix or similar product)
Pseudoephedrine (Sudafed)
Scissors
Sunscreen (with SPF 15-30)
Swimmer’s ear drops
Tetrahydrozoline eyedrops (Visine)
Thermometer (digital)
Throat lozenges (Cepacol)
Triamcinolone cream (Aristocort)
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 pregnancies 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 Micronesia. Micronesia is malaria-free, so you will not need to take anti-malaria pills.

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 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. If one 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 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:

[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 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 FSM/Palau as compared to all other Inter-America and Pacific region programs as a whole, from 2002–2006. 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] 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.

[edit] Security Issues in Micronesia

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 being a target of crime. As with anywhere in the world, crime does exist in Micronesia. 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 capital towns; people know each other and generally will not steal from their neighbors. The following are safety concerns in Micronesia of which you should be aware.

Volunteers in Micronesia may find themselves spending a significant amount of time crossing open water to reach other islands. Since boating accidents can occur, Peace Corps requires that you wear a life jacket whenever you are traveling by boat. (Peace Corps provides a life jacket)

Physical or sexual assault, harassment (e.g., being called derogatory names or receiving overt sexual comments), and theft can occur in Micronesia, just as they do in the United States. As in the United States, you can avoid much of the risk by changing your behavior. Conditions that contribute to risk include being out after the local curfew, being alone in the evening or in isolated areas, being in a known high-crime area, and sleeping in an unlocked place. During pre-service training, you will learn how to minimize the risk of assault and discuss strategies for dealing and coping with harassment in Micronesia. Should you ever be assaulted, the medical staff will be available to help you on a confidential basis.

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

You must be prepared to assume a large responsibility for your own safety. Only you can make yourself less of a target, ensure that your belongings are secure, and develop relations in your community that will make you an unlikely victim of crime. In coming to Micronesia, 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 Micronesia undoubtedly requires that you accept restrictions on your current lifestyle.

Volunteers attract a lot of attention, some of it negative. This is especially true in the capitals, where they are more anonymous. In their villages, Volunteers have “family,” friends, and colleagues who look out for them. While whistles and exclamations are fairly common on the street, this behavior can be reduced if you dress conservatively and do not respond to unwanted attention. Keep your money out of sight by using an undergarment money pouch; 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 Micronesia

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. Micronesia’s in-country safety program is outlined below.

The Peace Corps/Micronesia office will keep Volunteers informed of any issues that may impact Volunteer safety through information sharing. Regular updates will be provided in Volunteer meetings and in memorandums from the country director and safety and security coordinator. Additionally, high surf conditions, which may interfere with Volunteers’ intended travel plans, are communicated through each field office. 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 Micronesia. 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 criteria are based in part on any relevant site history, access to transportation and other essential services, availability of communications, quality host families, and other support needs.

You will also learn about the Peace Corps/Micronesia’s detailed emergency action plan in the event of a natural disaster or civil or political unrest. 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 Micronesia will gather at predetermined locations until the situation resolves itself 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 safety and security coordinator. 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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