Health care and safety in Rwanda
From Peace Corps Wiki
|Health care and safety in Rwanda|
|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 programs emphasize the preventive, rather than the curative, approach to disease. The Peace Corps in Rwanda maintains qualified staff to take care of Volunteers’ primary health care needs. Additional medical services, such as testing and basic treatment, are also available in Rwanda at local, and equivalent American-standard hospitals. If you become seriously ill, you will be transported either to an equivalent of American-standard medical facility in the region or to the United States.
 Health Issues in Rwanda
Rwanda ranks poorly, even for Africa, in terms of health indicators. UNDP’s 2006 Human Development Indicator (HDI) ranks Rwanda 158 out of 177 countries. Life expectancy at birth is only 44 years for men and 47 for women, according to 1995 World Health Organization data.
Peace Corps Volunteers may experience health issues such as diarrhea, malaria, malnutrition, tuberculosis, HIV/ AIDS, and mental health issues. Other health risks include transportation-related injuries, and schistosomiasis.
 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 Rwanda, you will receive a medical handbook.
At the end of training, you will 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.
During your training, you will have access to medical attention through the medical office. However, during this time, you will be responsible for your own supply of prescription drugs and any other specific medical supplies you require, as we will not order these items during training. Please bring a three-month supply of any prescription drugs you use, since they may not be available here and it may take several months for new shipments to arrive.
You will have physicals at mid-service and at the end of your service. If you develop a serious medical problem during your service, the medical office in Rwanda will consult with the Office of Medical Services in Washington, D.C. If it is determined that your condition cannot be treated in Rwanda, you may be sent out of the country for further evaluation and care.
 Maintaining Your Health
The foundation for staying healthy in Rwanda will be your mental outlook: knowing that you can adjust to a varied climate, a different diet, a new language, culture and job.
As a Volunteer, you must accept a certain amount of responsibility for your own health. Proper precautions will significantly reduce your risk of serious illness or injury. The old adage “An ounce of prevention …” becomes extremely important in areas where diagnostic and treatment facilities are not up to the standards of the United States. The most important of your responsibilities in Rwanda is to take preventive measures for the following:
Food and water preparation. Many diseases that afflict Volunteers worldwide are entirely preventable if proper food and water precautions are taken. These diseases include food poisoning, amebiasis, giardiasis, hepatitis A, dysentery, all types of worms, and typhoid fever. Your medical office will discuss specific standards for water and food preparation for Rwanda during pre-service training.
Prevention of malaria. Malaria is endemic in Rwanda. Malaria can rapidly become fatal in people who have no natural immunity to the disease. It is extremely important to fully comply with the recommended drug regimen to prevent malaria.
Immunizations. The majority of your immunizations will be given to you during your pre-service training. Most immunizations are good for the duration of your time in Rwanda. The exception is typhoid, which will require a booster if you extend for a third year of service.
Rabies. Rabies is present in nearly all Peace Corps countries. Any possible exposure to a rabid animal must be reported immediately to the medical office. Rabies exposure can occur through animal bites, scratches from animals’ teeth, and contact with animal saliva. Your medical officer will take into consideration many factors to decide the appropriate course of therapy necessary to prevent rabies.
Pregnancy. Volunteers are expected to adhere to an effective means of birth control to prevent unwanted 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 Peace Corps medical office. A reliable method of birth control should be chosen before you leave the United States. Condoms, diaphragms, contraceptive jellies and foams, and some commonly prescribed birth control pills are available on request.
The spread of sexually transmitted diseases and HIV/AIDS. Abstinence is the only certain choice for preventing infection with HIV and other sexually transmitted diseases. 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.
HIV/AIDS is a major health concern in Rwanda. In the United States, high-risk groups include sexually active homosexuals and bisexual men with multiple partners, intravenous drug users, and heterosexuals with multiple partners. It is important to emphasize that while HIV/AIDS in the United States has occurred primarily (though not exclusively) in these high-risk groups, in Rwanda the disease affects men and women equally, regardless of sexual preference, and is primarily transmitted by heterosexual contact. It is the responsibility of Volunteers to protect not only themselves but also a sexual partner.
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 without charge 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.
 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.
Feminine hygiene products are available in most towns and cities in Rwanda. Feminine pads are more widely available than tampons. The cost of these products will be covered by your living allowance. If you require a specific product, then you will need to bring an adequate supply with you.
 Your Peace Corps Health Kit
The Peace Corps medical officer provides Volunteers with a health kit that contains basic items necessary to prevent and treat illnesses that might occur during service. Kit items can be periodically restocked at the medical office.
 Health Kit Contents
American Red Cross First Aid & Safety Handbook
Antacid tablets (Tums)
Antibiotic ointment (Bacitracin/Neomycin/Polymycin B)
Antiseptic antimicrobial skin cleaner (Hibiclens)
Diphenhydramine HCL 25 mg (Benadryl)
Insect repellent stick (Cutter’s)
Iodine tablets (for water purification)
Lip balm (Chapstick)
Oral rehydration salts
Oral thermometer (Fahrenheit)
Pseudoephedrine HCL 30 mg (Sudafed)
Sterile gauze pads
Tinactin (antifungal cream)
 Before You Leave: A Medical Checklist
If there has been any change in your health—physical, mental, or dental—since the time you submitted your examination reports to the Peace Corps, you must immediately notify the Office of Medical Services. Failure to disclose new illnesses, injuries, allergies, or pregnancy can endanger your health and may jeopardize your eligibility to serve.
If your dental exam was done more than a year ago, or if your physical exam is more than two years old, contact the Office of Medical Services to find out whether you need to update your records.
If your dentist or Peace Corps dental consultant has recommended that you undergo dental treatment or repair, you must complete that work and make sure your dentist sends requested confirmation reports or X-rays to the Office of Medical Services.
If you wish to avoid having duplicate vaccinations, you should contact your physician’s office, obtain a copy of your immunization record, and bring it to your pre-departure orientation. If you have any immunizations prior to Peace Corps service, the Peace Corps cannot reimburse you for the cost. The Peace Corps will provide all the immunizations necessary for your overseas assignment, either at your pre-departure orientation or shortly after you arrive in Rwanda. You will need to begin taking malaria medication prior to departure while at the staging event.
Bring a three-month supply of any prescription or over-thecounter medication you use on a regular basis, including birth control pills. Although the Peace Corps cannot reimburse you for this three-month supply, we will order refills during your service. While awaiting shipment—which can take several months—you will be dependent on your own medication supply. The Peace Corps will not pay for herbal or nonprescribed medications, such as St. John’s Wort or antioxidant supplements.
You are encouraged to bring copies of medical prescriptions signed by your physician. This is not a requirement, although it might come in handy if you are questioned in transit about carrying three-month supply of prescription drugs.
If you wear eyeglasses, bring two pairs with you—a pair and a spare. If a pair breaks, the Peace Corps will replace it, using the information your doctor in the United States provided on the eyeglasses form during your examination. To reduce the risk of developing a serious infection or other eye disease, we discourage you from using contact lenses during your Peace Corps service. 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 health care plans, you may wish to consult an insurance specialist about unique coverage needs before your departure. 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 the post-service health care benefits described in the Peace Corps Volunteer Handbook (pages 10-12). You may wish to consider keeping an existing health plan in effect during your service if you think age and/or preexisting conditions might prevent you from re-enrolling in your current plan when you return home.
 Safety and Security—Our Partnership
Serving as a Volunteer overseas entails certain safety and security risks. Living and traveling in an unfamiliar environment, a limited understanding of the local language and culture, and the perception of being a wealthy American are some of the factors that can put a Volunteer at risk. Petty thefts and burglaries are not uncommon. Incidents of physical and sexual assault do occur, although almost all Volunteers complete their two years of service without serious personal safety problems. In addition, more than 83 percent of Volunteers surveyed in the 2008 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 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 in the Volunteer’s control.
By far the most common crime incidents that Volunteers experience are thefts. Frequently these occur in crowded locations, such as markets or on public transportation, or are due to Volunteers leaving items unattended. More serious assaults, however, do occasionally occur. Based on information gathered from incident reports worldwide in 2007, the following factors stand out as risk characteristics for crimes against Volunteers, many of which can be avoided with appropriate actions. Assaults consist of physical and sexual assaults committed against Volunteers; property crimes include robbery, burglary, theft, and vandalism.
- Location: Most assaults (53 percent) occurred when Volunteers were in public areas (e.g., street, park, beach, public buildings). Specifically, 36 percent of assaults took place when Volunteers were away from their sites. Most property crimes occurred in the Volunteer’s residence or another Volunteer’s residence, followed closely by public areas. Forty-eight percent of property crimes occurred when Volunteers were away from their sites.
- Time: Assaults usually took place during the evening, between 6 p.m. and 11 p.m.— though the single hour with the largest percentage of assaults was 1:00 a.m.(8 percent) Property crimes were more common in the middle of the day, from noon to 9 p.m.
- Day: Assaults and property crimes were more commonly reported on weekends (48 percent and 49 percent, respectively).
- Absence of others: Assaults and property crimes (64 percent and 53 percent, respectively) occured more frequently when the Volunteer was alone.
- Relationship to assailant: In most assaults and property crimes (64 percent and 85 percent), the Volunteer did not know or could not identify the assailant.
- Consumption of alcohol: 23 percent of all assaults and 4 percent of all property crimes 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.
- Purchase the Peace Corps recommended personal property insurance
- Follow Peace Corps guidelines on maintaining home security
Strategies to reduce the risk/impact of assault:
- Make friends with local people who are respected in the community
- 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.” This office is led by an associate director for safety and security who reports to the Peace Corps Director and includes divisions which focus on Volunteer safety and overseas security and crime statistics and analysis.
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 the Volunteer is safe and receiving medical treatment as needed. After assuring the safety of the Volunteer, Peace Corps staff members provide support by reassessing the Volunteer’s worksite 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.
 Security Issues in Rwanda
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 Rwanda. You can reduce your risk of becoming a target for crime by avoiding situations that make you feel uncomfortable and by taking advance precautions. Crime at the village or town level is less frequent than in the cities; people know each other and generally will not steal from their neighbors. Tourist attractions, especially in large towns, are the favorite worksites for pickpockets. Following are some safety concerns in Rwanda of which you should be aware. Rwandan cities are growing rapidly, and with increasing economic difficulties, they have the potential of becoming dangerous.
Travel is by far one of the biggest concerns for Volunteers in general. The safest response is to avoid travel whenever possible; yet, the reality is that for work, medical, or other reasons Volunteers do travel from time to time. As part of Peace Corps/ Rwanda ’s overall preventive strategy to reduce road travel, we have developed a safety and security plan that includes bringing service closer to Volunteers (e.g., conducting regional meetings), and we have developed detailed safety policies regarding Volunteer travel. Regional meetings provide opportunities to review safety and security information at Volunteer sites, discuss preventive strategies, and review or revise locator maps and the emergency action plan.
 Staying Safe: Don’t Be a Target for Crime
You must be prepared to take on a large responsibility for your own safety. Only you can make yourself less of a target, ensure that your house is secure, and develop relations in your community that will make you an unlikely victim of crime. In coming to Rwanda, 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 Rwanda may require that you accept some restrictions on your current lifestyle. Remember that no matter how well you get to know your community, you still need to be careful with your possessions. Having goods stolen is a major source of stress, and this can make Volunteers even more vulnerable. You need to consider strategies to protect yourself and your possessions during the day and night.
Volunteers attract a lot of attention in cities and at their sites, but receive far more negative attention in highly populated centers where they are anonymous. In smaller towns, “family,” friends, and colleagues look out for them. While whistles and exclamations are fairly common on the street, this behavior can be reduced if you dress conservatively, avoid eye contact, and do not respond to unwanted attention. Keep your money out of sight by using an undergarment money pouch, such as the kind that hangs around your neck and stays hidden under your shirt or inside your coat. Do not keep your money in outside pockets of backpacks, in coat pockets, or in fanny packs. Avoid walking or cycling at night. Peace Corps/ Rwanda has developed a Volunteer safety and security handbook that will be issued to you when you arrive in the country.
 Preparing for the Unexpected: Safety Training and Volunteer Support in Rwanda
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 reporting and responding to safety and security incidents. Rwanda’s in-country safety program is outlined below.
Information sharing—The Peace Corps/Rwanda office will keep Volunteers informed on any issues that may impact Volunteer safety. 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. Training will include sessions to prepare you for specific safety and security issues in Rwanda. 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, crosscultural, health, and other components of training.
Certain site selection criteria are used to determine safe housing for Volunteers before their arrival. Peace Corps staff works closely with host communities and counterpart agencies to help prepare them for the 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 worksites. Site selection criteria are based, in part, on any relevant site history; access to medical, banking, postal, and other essential services; availability of communications, transportation, and markets; different housing options and living arrangements; safety and security; and other support needs.
You will also learn about the country’s detailed emergency action plan in the event of civil or political unrest or a natural disaster. When you arrive at your site, you will complete and submit a site locator form with your address, contact information, and a map to your house. If there is a security threat, Volunteers in Rwanda 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 medical officer. The Peace Corps has established protocols for addressing safety and security incidents in a timely and appropriate manner. In addition to responding to the needs of the Volunteer, the Peace Corps collects and evaluates safety and security data to track trends and develop strategies to minimize risks to future Volunteers.
See also: Rwanda