Health care and safety in Peru
From Peace Corps Wiki
|Health care and safety in Peru|
|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 good health and safety of every Volunteer. Peace Corps’ medical and safety programs emphasize preventive approaches. Peace Corps/Peru maintains a clinic in the Lima office with two full-time medical officers, both of whom are experienced physicians, who take care of Volunteers’ primary healthcare needs. If you become more seriously ill, you will be referred to local American-standard medical facilities or evacuated to Panama or the United States. To assist Volunteers with safety and security issues, Peace Corps/Peru employs a full-time safety and security coordinator. In addition, the Peace Corps regional safety and security officer, who covers eight countries, is based in Lima and assists in safety and security training and response as well.
 Health Issues in Peru
Infectious diarrhea, tuberculosis, hepatitis, dengue fever, and typhoid fever are among the illnesses that are widely found in Peru. Malaria, bartonellosis, leishmaniasis, and yellow fever are endemic in specific areas of the country. All of these diseases can be prevented through vaccinations or preventive health measures. Immunizations are required for all Volunteers in Peru and are kept current during their tour. You do not need to take any special medications or get any vaccinations before your arrival in Lima. The Peace Corps medical officer will determine your immunization and medication needs based on your medical history and site assignment. For Volunteers assigned to areas where malaria is found, taking an antimalarial medication and sleeping inside a mosquito net are mandatory.
About half of the Volunteers in Peru are assigned to high-altitude locations (above 8,000 feet). A quarter to a half of all people who travel to high altitude locations experience an unpleasant period of acclimatization that may persist for several days. Symptoms of altitude sickness may include headache, nausea, vomiting, respiratory distress, and insomnia. On rare occasions, altitude sickness may transform itself into pulmonary edema and other life-threatening illnesses. It is not possible to tell in advance who will have problems, although those who have had previous difficulties are likely to have similar problems each time they go to high altitudes. Those with respiratory infections, such as colds, bronchitis, or pneumonia, should delay travel to high altitudes until they are fully recovered. People with certain pre-existing medical conditions, such as hypertension, diabetes, angina pectoris, asthma, or emphysema, should get clearance from a physician before traveling to high altitudes. The Peace Corps medical officer is available to consult with Volunteers prior to their travel or assignment to high altitude locations. There are medicines that help prevent or relieve the symptoms of altitude sickness, which the medical officer prescribes when appropriate. Lima and the training center are located close to sea level, and there are no altitude issues.
 Helping You Stay Healthy
The Peace Corps will provide you with all necessary vaccinations, medications, and information to stay healthy. Upon your arrival in Peru, you will receive training and written information on diseases and medical problems you may encounter while in-country. You will also receive 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.
The Peace Corps medical officers are on call to address Volunteer medical problems 24-hours a day. The first consultation is typically carried out by telephone. The medical officer may instruct the Volunteer on how to handle the illness, may ask the Volunteer to come to Lima, or may refer the Volunteer to medical facilities closer to the Volunteer’s site.
There are many good, American-trained medical specialists in Lima and in many departmental capitals. If you develop a serious medical problem during your service, you may be sent to one of these specialists for consultation or treatment. The medical officer will also consult with the Peace Corps Office of Medical Services in Washington, D.C., on your condition. If it is determined that your condition cannot be effectively treated in Peru, you may be sent to Panama or the United States for further evaluation and care.
You are responsible for bringing a three-month supply of any prescription drugs and any other medical supplies you regularly use. Once you swear-in as a Volunteer, the Peace Corps will order additional supplies to carry you through your service.
Volunteers have two routine physical examinations, one approximately one year after beginning service, and the other just before leaving the Peace Corps. These examinations also include dental X-rays and cleaning.
With a few exceptions (e.g., cosmetic surgery), the Peace Corps covers the cost of all medical care during a Volunteer’s service.
 Maintaining Your Health
As a Volunteer, you must accept a considerable amount of responsibility for your own health. Proper precautions will significantly reduce your risk of illness or injury. Preventive measures are particularly important for food-borne and waterborne intestinal disorders, respiratory illness, other infectious airborne diseases, illnesses related to substance abuse, STDs, preventable skin disorders and infections, cuts and bruises, sunburn, and heatstroke. Also, most accidents can be prevented. In addition, you should follow recommendations to avoid aggravation of any preexisting medical condition.
Proper food and water preparation prevent many of the illnesses that afflict Volunteers worldwide. The medical officer will discuss specific standards for water and food preparation in Peru during pre-service training, and will caution you on what foods and practices to avoid.
Abstinence is the only certain choice for prevention of HIV/ AIDS and other STDs. If you choose to be sexually active, it is critical to 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. Condoms are available at no charge from the medical officer or at low cost throughout Peru. 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 unplanned pregnancies. The medical officer can help you decide on the most appropriate method to suit your individual needs. Contraceptive methods are available free of charge from the medical officer.
While Peace Corps does its part to provide excellent medical care, Volunteers need to do their part as well. It is critical that you promptly report to the medical office for scheduled examinations and immunizations, and that you let the medical officer know immediately of significant illnesses and injuries.
 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 napkins are available and affordable in most towns. Tampons are available in larger cities, but relatively expensive. The cost of these supplies is the responsibility of each Volunteer.
 Your Peace Corps Medical Kit
The Peace Corps medical officer provides Volunteers with a medical 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
Antiseptic antimicrobial skin cleaner
Aquatabs (for water purification)
Diphenhydramine HCL 25 mg (Benadryl)
Emergency First Aid Pocket Guide
Insect repellent stick
Oral rehydration salts
Pseudoephedrine HCL 30 mg (Sudafed)
Sterile gauze pads
Sunblock (SPF 30)
 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 will 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 updated examinations. 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.
If you wish to avoid having duplicate vaccinations, contact your physician’s office, obtain a copy of your immunization record, and bring it to Peru. The Peace Corps will provide all the immunizations necessary for your overseas assignment shortly after you arrive in Peru. The Peace Corps does not reimburse for the cost of immunizations prior to Peace Corps service.
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 provide you with refills for the remainder of your service. While awaiting shipment— which can take several months—you will be responsible for your own supply. The Peace Corps will not pay for herbal or many 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, but they may come in handy if you are questioned in transit about carrying a supply of prescription drugs.
If you wear eyeglasses, bring two pair with you—the pair you regularly use and a spare. If the first pair breaks, the Peace Corps will replace it, using the information your doctor in the United States provided on the eyeglass form during your examination. We discourage you from using contact lenses during your service, to reduce your risk of infection or other eye disease. Peace Corps will not supply or replace contact lenses or associated solutions unless an ophthalmologist has recommended their use for a specific medical condition and the Peace Corps Office of Medical Services has given approval.
If you are eligible for Medicare, are over 50 years of age, or have a health condition that may restrict your future participation in healthcare plans, you may wish to consult an insurance specialist about your 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 or obtaining a new 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 Volunteer 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 clothing
- 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 Peru as compared to all other Inter-America and Pacific (IAP) 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-aday, 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 [email protected]
 Security Issues in Peru
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. Crime exists in Peru. You can reduce your risk by taking precautions and by avoiding dangerous situations. One of the best deterrents is to make friends and be an active part of your community. Crime at the town or neighborhood level is less frequent than in the heart of large cities; people know each other and generally will not steal from their neighbors.
While most Peace Corps Volunteers in Peru complete their two years of service with no incidents, some Volunteers have been victims of crime. Most of the incidents have involved theft or burglary of property, but there have been physical assaults as well. You will receive considerable pre-service training on safety issues, and the safety and security coordinator is available 24hours a day to answer questions, address concerns, and help when incidents do occur. Although there are no guarantees of complete safety in any country, we feel that the more informed and aware you are, the greater the likelihood that you will be able to avoid risky or dangerous situations.
Peace Corps Volunteers are often the targets of crime when they are viewed as rich North Americans. Wearing expensive clothing, or carrying accessories such as expensive backpacks, cameras, or a portable music player, may make you an attractive target for petty thieves.
The Peace Corps does not cover the loss of personal property, and it recommends that you obtain insurance coverage for your valuable belongings. The Peace Corps will provide you with information on how to obtain personal property insurance at the pre-departure orientation session.
Peru is prone to earthquakes, and several major quakes have caused considerable damage over the course of its history. Peru is also affected by occasional floods, landslides, droughts, and tsunamis. During pre-service training, Volunteers are taught how to prepare for disasters, and what to do in case one does occur.
Since the early 1980s, two terrorist organizations, Shining Path (Sendero Luminoso) and the Túpac Amaru Revolutionary Movement (MRTA) have operated in Peru. Most of the leadership of these organizations have been captured and jailed, and the organizations are a small fraction of their previous size. Nonetheless, remnants remain active, particularly in areas where coca is grown, providing protection to narcotics traffickers. Peace Corps does not place Volunteers in areas where coca is produced or where the terrorist organizations are active. Peace Corps Volunteers are also not allowed to travel in or through those areas.
Peru has a high incidence of openly expressed political unrest. Demonstrations, transportation strikes, and road blockages are common. Peace Corps notifies Volunteers when it obtains information that such incidents are about to occur. Many times, however, Peace Corps does not have advance notice. Volunteers need to remain vigilant, and keep their distance if they encounter a demonstration. Peace Corps/Peru may on occasion declare certain geographic locations off limits.
 Staying Safe: Do Not Be a Target for Crime
You must be prepared to take on a large degree of responsibility for your own safety. Only you can make yourself less of a target, ensure that your house is secure, and develop relationships in your community that will make you an unlikely victim of crime.
In coming to Peru, do what you would do if you moved to a new city in the United States—be observant, 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, acting responsibly, and abiding by Peace Corps policies and procedures. You may have to accept some changes from your current lifestyle.
Volunteers may receive negative attention, especially outside their sites. Unwanted attention can be reduced or managed if you dress conservatively, avoid eye contact, and do not respond to street comments. Keep your money out of sight by using a 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 backpack pockets, coat pockets, or fanny packs. Watch your belongings on buses and other public transportation. Take only registered taxis (not unlicensed “gypsy cabs”)Avoid using ATMs that are in public view. At night, always walk with a companion.
 Preparing for the Unexpected: Safety Training and Volunteer Support in Peru
The Peace Corps’ approach to safety is a five-pronged plan to help you stay safe during your two-year service and involves the following: information sharing, Volunteer training, site selection criteria, a detailed emergency action plan, and protocols for addressing safety and security incidents. Peace Corps/Peru’s in-country safety program is outlined below.
Volunteers are kept informed of any issues that may impact their safety through information sharing. Routine updates will be provided in e-mails and newsletters. In the event of an emergency situation, you will be contacted by telephone or through another Volunteer. Peace Corps/Peru maintains a communications network, that it periodically tests, enabling every Volunteer to be quickly contacted. For their part, Volunteers need to keep Peace Corps informed when they are out of their site.
Volunteer training includes sessions to prepare you for specific safety and security issues in Peru. This training will prepare you to adopt a culturally appropriate lifestyle and exercise good 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 a safe site and safe housing for Volunteers before their arrival. Peace Corps/Peru goes to great efforts to identify appropriate communities for Volunteer assignments. Peace Corps staff works closely with community leaders and counterpart agencies to help prepare them for a Volunteer’s arrival and to define their roles in supporting the Volunteer. Factors such as crime statistics, access to medical and other essential services, availability of transportation and communications, and housing availability are all taken into account when deciding where to place Volunteers. Counterpart agency staff, community leaders, and Peace Corps staff typically work together to identify an appropriate family with which the Volunteer will live. Housing must fill specific safety and security criteria. For example, the Volunteer must have a private room that can be locked; and if there are windows directly facing a street, the windows must be barred. Volunteers are expected to stay with their initial host family for at least three months and preferably for the majority of their service. If a Volunteer wishes to move in with another host family, Peace Corps staff must inspect the housing and interview the new family before the move, and approve the house and family based on Peace Corps’ safety and security criteria.
Peace Corps/Peru has a detailed emergency action plan, which is implemented in the event of severe civil or political unrest, or a major 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. Your locator form will include both routine and backup methods of communication. If there is severe unrest or a major disaster, you will be contacted and provided with appropriate instructions. Depending on the situation, you may be asked to stay put at your site, or to move to a designated consolidation or evacuation point.
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 appropiate Peace Corps staff person. 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. In addition, Volunteers are encouraged to speak with staff members about security concerns or possible threats to security at any time.