Health care and safety in Sierra Leone

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Health care and safety in Sierra Leone
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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.

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 each Volunteer. Peace Corps medical programs emphasize the preventive, rather than the curative, approach to disease. The Peace Corps maintains a clinic in Sierra Leone with a full-time medical officer, who takes care of Volunteers’ primary health care needs. Additional medical services, such as testing and basic treatment, are also available in Sierra Leone at local hospitals. If you become seriously ill, you will be transported either to an American standard medical facility in the region or to the United States.

Contents

[edit] Health Issues in Sierra Leone

Major health problems among Peace Corps Volunteers are rare and are often the result of a Volunteer not taking preventive measures to stay healthy.

The most common health problems here are minor ones that are also found in the United States, such as colds, diarrhea, hemorrhoids, constipation, sinus infections, skin infections, headaches, dental problems, minor injuries, adjustment disorders, emotional problems, and alcohol abuse. These problems may be more frequent or compounded by life in Sierra Leone because certain environmental factors here raise the risk and/or exacerbate the severity of illness and injuries. The most common major health concerns here are malaria, amoebic dysentery, giardia, schistosomiasis, lassa fever, dengue fever, sexually transmitted diseasses (STDs), and HIV/AIDS.

Because malaria is endemic in Sierra Leone, Volunteers must take anti-malarial medication and use other recommended prevention strategies, including mosquito nets and insect repellent. Amoebic dysentery and giardia can be avoided by frequent hand washing, thoroughly washing fruits and vegetables, and treating your drinking water. Additionally, you can avoid contracting schistosomiasis by not swimming or bathing in freshwater lakes, ponds, and rivers. The risk of lassa fever can be decreased by taking measures to prevent rodent infestation in the home. Personal protection methods to prevent mosquito bites will lower the risk of dengue fever. Practicing abstinence or safer sex will protect against STDs and HIV.

[edit] 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 Sierra Leone, you will receive a medical handbook. During 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 pre-service training, you will have access to basic medical supplies through your medical kit or the medical officer. However, you will be responsible for your own supply of prescription drugs and any other specific medical supplies you require, as the Peace Corps will not order these items 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 midservice and at the end of your service. If you develop a serious medical problem during your service, the medical officer in Sierra Leone will consult with the Office of Medical Services in Washington, D.C. If it is determined that your condition cannot be treated in Sierra Leone, you may be sent out of the country for further evaluation and care.

[edit] Maintaining Your Health

As a Volunteer, you must accept considerable responsibility for your own health. Proper precautions will significantly reduce your risk of serious illness or injury. The adage “An ounce of prevention …” becomes extremely important in areas where diagnostic and treatment facilities are not up to the standards of the United States. The most important of your responsibilities in Sierra Leone is to take the following preventive measures:

It is extremely important to fully comply with the recommended drug regimen to prevent malaria. Malaria can be rapidly fatal in people who have no natural immunity to the disease (like Volunteers). Thus, it is mandatory that you take your malaria prophylaxis regularly. Your medical officer will discuss specific recommendations for the prevention of malaria when you arrive in Sierra Leone. Also important is preventing mosquito bites, with the use of mosquito nets and insect repellent.

Volunteers will be taught health preventions strategies during the medical sessions in pre-service training. It is essential to apply these lessons in your daily life in Sierra Leone to prevent significant illnesses.

Volunteers must also adhere to recommended standards for food and water preparation. Many illnesses that afflict Volunteers worldwide are entirely preventable if proper food and water precautions are taken. These illnesses include food poisoning, parasitic infections, hepatitis A, dysentery, Guinea worms, tapeworms, and typhoid fever. Your medical officer will discuss specific standards for water and food preparation in Sierra Leone during pre-service training.

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.

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.

[edit] Women’s Health Information

Pregnancy is treated in the same manner as other Volunteer health conditions that require medical attention but also have programmatic ramifications. The Peace Corps is responsible for determining the medical risk and the availability of appropriate medical care if the Volunteer remains in-country. Given the circumstances under which Volunteers live and work in Peace Corps countries, it is rare that the Peace Corps’ medical and programmatic standards for continued service during pregnancy can be met. Generally, Volunteers who become pregnant are medically separated or medically evacuated to Washingon for pregnancy counseling.

If feminine hygiene products are not available for you to purchase on the local market, the Peace Corps medical officer in Sierra Leone will provide them. If you require a specific product, please bring a three-month supply with you. Many Volunteers find that using a menstrual cup, such as the Diva Cup or the Keeper, is easier than pads or tampons. You should consider bringing several cups with you.

[edit] Your Peace Corps Medical Kit

The Peace Corps medical officer will provide you with a kit that contains basic items necessary to prevent and treat illnesses that may occur during service. Kit items can be periodically restocked at the medical office.

[edit] Medical Kit Contents

Ace bandages
Adhesive tape
American Red Cross First Aid & Safety Handbook
Antacid tablets (Tums)
Antibiotic ointment (Bacitracin/Neomycin/Polymycin B)
Antiseptic antimicrobial skin cleaner (Hibiclens)
Band-Aids
Butterfly closures
Calamine lotion
Cepacol lozenges
Condoms
Dental floss
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)
Robitussin-DM lozenges (for cough)
Scissors
Sterile gauze pads
Tetrahydrozaline eyedrops (Visine)
Tinactin (antifungal cream)
Tweezers

[edit] Before You Leave: A Medical Checklist

If there has been any change in your health—physical, mental, or dental—since you submitted your examination reports to the Peace Corps, you must immediately notify the Office of Medical Services. Failure to disclose new illnesses, injuries, allergies, or pregnancy can endanger your health and may jeopardize your eligibility to serve.

If your dental exam was done more than a year ago, or if your physical exam is more than two years old, contact the Office of Medical Services to find out whether you need to update your records. If your dentist or Peace Corps dental consultant has recommended that you undergo dental treatment or repair, you must complete that work and make sure your dentist sends requested confirmation reports or X-rays to the Office of Medical Services.

If you wish to avoid having duplicate vaccinations, contact your physician’s office to 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 after you arrive in Sierra Leone. You do not need to begin taking malaria medication prior to departure.

Bring a three-month supply of any prescription or over-thecounter medication you use on a regular basis, including birth control pills. Although the Peace Corps cannot reimburse you for this three-month supply, it will order refills during your service. Your refill may be a generic or an equivalent medication. 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, 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 (both with your current prescription)—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. The Peace Corps discourages 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 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 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. You may wish to consider keeping an existing health plan in effect during your service if you think age or pre-existing conditions might prevent you from re-enrolling 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 theft 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.

Beyond knowing that Peace Corps approaches safety and security as a partnership with you, it might be helpful to see how this partnership works. The Peace Corps has policies, procedures, and training in place to promote your safety. We depend on you to follow those policies and to put into practice what you have learned. An example of how this works in practice—in this case to help manage the risk of burglary—is:

This Welcome Book contains sections on: Living Conditions and Volunteer Lifestyle; Peace Corps Training; and Your Health Care and Safety that all include important safety and security information to help you understand this partnership. The Peace Corps makes every effort to give Volunteers the tools they need to function in the safest 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, reduce, 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. By far the most common crime that Volunteers experience is theft. Thefts often occur when Volunteers are away from their sites, in crowded locations (such as markets or on public transportation), and when leaving items unattended.

Before you depart for Sierra Leone there are several measures you can take to reduce your risk:

After you arrive in Sierra Leone, you will receive more detailed information about common crimes, factors that contribute to Volunteer risk, and local strategies to reduce that risk. For example, Volunteers in Sierra Leone learn to:

As you can see from this list, you have to be willing to work hard and adapt your lifestyle to minimize the potential for being a target for crime. As with anywhere in the world, crime does exist in Sierra Leone. You can reduce your risk by avoiding situations that place you at risk and by taking precautions. Crime at the village or town level is less frequent than in large cities; people know each other and generally are less likely to steal from their neighbors. Tourist attractions in large towns are favorite worksites for pickpockets.

The following are particular security concerns in Sierra Leone of which you should be aware:

Volunteers tend to attract a lot of attention both in large cities and at their sites, but they are more likely to receive negative attention in highly populated centers, and away from their support network —friends and colleagues—who look out for them. While whistles and exclamations may be fairly common on the street, this behavior can be reduced if you dress conservatively, abide by local cultural norms, and respond according to the training you will receive.

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

You must be prepared to take on a large degree of responsibility for your own safety. You can make yourself less of a target, ensure that your home is secure, and develop relationships in your community that will make you an unlikely victim of crime. While the factors that contribute to your risk in Sierra Leone may be different, in many ways you can better assure your safety by doing what you would do if you moved to a new city anywhere: 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 Sierra Leone will require that you accept some restrictions on your current lifestyle.

[edit] Support from Staff

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 any medical treatment that is required. After assuring the safety of the Volunteer, Peace Corps staff members’ response may include 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.

Few Peace Corps Volunteers are victims of serious crimes and crimes that do occur overseas are investigated and prosecuted by local authorities through the local criminal justice system. If you are the victim of a crime, you will decide if you wish to pursue prosecution. If you decide to prosecute, Peace Corps will be there to assist you. One of our tasks is to ensure you are fully informed of your options and understand how the local legal process works. Peace Corps will help you ensure your rights are protected to the fullest extent possible under the laws of the country.

If you are the victim of a serious crime, you will learn how to get to a safe location as quickly as possible and contact your Peace Corps office. It’s important that you notify Peace Corps as soon as you can so Peace Corps can provide you with the help you need.

[edit] Volunteer Safety Support in Sierra Leone

The Peace Corps’ approach to safety is a five-pronged plan to help you stay safe during your 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. Sierra Leone’s in-country safety program is outlined below.

The Peace Corps/Sierra Leone office will keep you informed of any issues that may impact Volunteer safety through information sharing. Regular updates will be provided in Volunteer newsletters and in memorandums from the country director. In the event of a critical situation or emergency, you will be contacted through the emergency communication network. An important component of the capacity of the Peace Corps to keep you informed is your buy-in to the partnership concept with the Peace Corps staff. It is expected that you will do your part in ensuring that Peace Corps staff members are kept apprised of your movements in-country so that they are capable of informing you.

Volunteer training will include sessions on specific safety and security issues in Sierra Leone. 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 service and is integrated into the language, crosscultural aspects, health, and other components of training. You will be expected to successfully complete all training competencies in a variety of areas, including safety and security, as a condition of service.

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 worksites. 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; different housing options and living arrangements; and other Volunteer support needs.

You will also learn about Peace Corps/Sierra Leone’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 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, you will gather with other Volunteers in Sierra Leone at predetermined locations until the situation is resolved 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 office. The Peace Corps has established protocols for addressing safety and security incidents in a timely and appropriate manner, and it collects and evaluates safety and security data to track trends and develop strategies to minimize risks to future Volunteers.

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