Health care and safety in Togo
From Peace Corps Wiki
|Health care and safety in Togo|
|The Peace Corps’ highest priority is maintaining the good health and safety of every Volunteer and trainee. Medical programs emphasize the preventive, rather than the curative approach to disease.
Serving as a Volunteer overseas entails certain safety and security risks. Living and traveling in an unfamiliar environment, a limited understanding of the local language and culture, and the perception of being a wealthy American are some of the factors that can put a Volunteer at risk.
The Peace Corps’ highest priority is maintaining the health and safety of every Volunteer. Peace Corps medical programs emphasize the preventive, rather than the curative approach to disease. The Peace Corps in Togo maintains a clinic with two full-time medical officers, who take care of Volunteers’ primary healthcare needs. Volunteers who become seriously ill or injured will be transported to either an appropriate medical facility in the region or to the United States.
 Health Issues in Togo
Most tropical diseases are endemic in Togo, and as a Volunteer you must be prepared to learn about health hazards and to take necessary measures to protect yourself from them. Proper food and water treatment, compliance with malaria prophylaxis, good personal hygiene practices, and adherence to personal safety measures are essential to a healthy Volunteer experience. Additionally, you must be willing to adopt appropriate behaviors to protect yourself from HIV 1 and 2 and other sexually transmitted diseases, which are prevalent in Togo.
Togo’s coastal areas are among the most dangerous in the world for unpredictable undertows and riptides. As such it is not advisable to swim in the waters off the coast of Togo.
 Helping You Stay Healthy
The Peace Corps will provide you with all the necessary inoculations, medications, first aid supplies, and information to stay healthy. It is not necessary to start malaria prophylaxis or get vaccinations before arriving for orientation. Upon your arrival in Togo, you will receive a medical handbook as well as a first-aid kit containing supplies to take care of mild illnesses and first-aid needs.
During training, you will receive information on various subjects such as food and water preparation and malaria, and you will have access to any additional basic first-aid supplies through the medical officer. However, during this time, you will be responsible for your own supply of prescription drugs and any other specific medical supplies you require. Please bring a three-month supply of any prescription drugs you use, since they may not be readily available in Togo and it may take several months for new shipments to arrive.
You will have physical examinations at mid-service and at the end of your service. If you develop a serious medical problem during your service, the medical officer in Togo will consult with the Office of Medical Services in Washington, D.C. If it is determined that your condition cannot be treated in Togo, you may be sent to a medical facility in the region or in the United States for further evaluation and care.
 Maintaining Your Health
As a Volunteer, you must accept 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 medical diagnostic and treatment facilities are not up to the standards of the United States.
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 your medical officer know immediately of significant illness and injuries.
Many diseases that afflict Volunteers worldwide are entirely preventable if proper food and water precautions are taken. These diseases include food poisoning, amebiasis, giardiasis, dysentery, Guinea worm, tapeworms, other intestinal worms, and typhoid fever. Your medical officer will discuss specific standards for water and food preparation for Togo during pre-service training. It will be up to you to adhere to standards that protect your health.
Measures to prevent malaria including compliance with malaria prophylaxis, use of mosquito nets and application of insect repellent are essential to Volunteer health (these are all provided by Peace Corps). Malaria is a very serious, sometimes fatal disease. Noncompliance with malaria prevention measures can result in medical or administrative separation. You will receive more information on malaria and prevention practices during pre-service training. [A note from a former volunteer: It is worth studying very carefully beforehand about malaria, its prevention, and the stories and histories of the prophylaxis offered, notably mefloquine, doxycycline and malarone. There are things that Western doctors do not tell you. For one, there is homeopathic malaria 30cc that can be taken to help boost the immunity. Also there is a very effective treatment, Artemisin, based on the Wormwood plant that you might carry around with you. Talk to others abroad about their experiences with Malaria and with the prophylaxis.]
Abstinence is the only certain choice for prevention of HIV/AIDS and other sexually transmitted diseases sexually transmitted diseases (STDs). You are taking risks if you choose to be sexually active. To lessen risk, use a condom every time you have sex. Whether your partner is a host country citizen, a fellow Volunteer, or anyone else, do not assume this person is free of HIV/AIDS or other STDs. You will receive more information from your medical officer about this important issue.
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.
The AIDS pandemic strikes across all social strata in many Peace Corps countries. The loss of teachers has crippled education systems, while illness and disability drains family income and forces governments and donors to redirect limited resources from other priorities. The fear and uncertainty AIDS causes has led to increased domestic violence and stigmatizing of people living with HIV/AIDS, isolating them from friends and family and cutting them off from economic opportunities. As a Peace Corps Volunteer, you will confront these issues on a very personal level. It is important to be aware of the high emotional toll that disease, death, and violence can have on Volunteers. As you strive to integrate into your community, you will develop relationships with local people who might die during your service. Because of the AIDS pandemic, some Volunteers will be regularly meeting with HIV-positive people and working with training staff, office staff, and host family members living with AIDS. Volunteers need to prepare themselves to embrace these relationships in a sensitive and positive manner. Likewise, malaria and malnutrition, motor vehicle accidents and other unintentional injuries, domestic violence and corporal punishment are problems a Volunteer may confront. You will need to anticipate these situations and utilize supportive resources available throughout your training and service to maintain your own emotional strength so that you can continue to be of service to your community.
 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 may also have programmatic ramifications. The Peace Corps is responsible for determining the medical risk and the availability of appropriate medical care if a pregnant 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 become pregnant are medically separated.
The Peace Corps medical officer in Togo will provide feminine hygiene products. You don’t need to bring anything with you, but if you require a specific product, bring a three-month supply with you.
 Your Peace Corps Medical Kit
The Peace Corps Medical Officers provide each Volunteer with a first-aid kit that contains basic items necessary to prevent and treat illnesses that might occur during service. Kit items can be periodically restocked at the Peace Corps medical office.
 First Aid Kit Contents
American Red Cross First Aid & Safety Handbook
Di-Gel (or Gelusil, Maalox or Mylanta)
Gauze pads (to cover wounds)
Hibiclens (to clean wounds)
Ibuprofen (Advil, Motrin)
Iodine pads (to clean wounds)
Iodine tablets (for emergency water purification)
Latex gloves (to avoid contact with other people’s blood and bodily fluids)
Malaria slide kit (for blood smears if you suspect malaria and cannot get to the health unit; you will be taught how to make them)
Malaria stand-by treatment
MIF kit (with vials for collecting stool samples to diagnose giardia, amoebas, and other parasites)
ORS (Oral Rehydration Solution) or Gatorade
Pepto-Bismol or Pink Bismuth
 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 2 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 taking duplicate vaccinations, you should contact your physician’s office, obtain a copy of your immunization record, bring it to your pre-departure orientation, and keep a copy with you in Togo. If you received 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 Togo. You do not need to begin taking malaria medication prior to departure, since you will begin it at your orientation.
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 provide you with your prescription medication during your service.
There may be instances when a particular brand of birth-control pills is not available, so it may be necessary to switch brands upon arrival or during service. 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, although it might come in handy if you are questioned in transit about your on-hand 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. It is very dusty in Togo and therefore difficult to keep contact lenses clean. 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, 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 and/or pre-existing 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. 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 ususally 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 provide 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 Togo as compared to all other Africa region programs as a whole, from 2001–2005. It is presented to you in a somewhat technical manner for statistical accuracy.
To fully appreciate the collected data below, an explanation of the graph is provided as follows:
The incidence rate for each type of crime is the number of crime events relative to the Volunteer/trainee population.
It is expressed on the chart as a ratio of crime to Volunteer and trainee years (or V/T years, which is a measure of 12 full months of V/T service) to allow for a statistically valid way to compare crime data across countries. An “incident” is a specific offense, per Peace Corps’ classification of offenses, and may involve one or more Volunteer/trainee victims. For example, if two Volunteers are robbed at the same time and place, this is classified as one robbery incident.
The chart is separated into eight crime categories. These include vandalism (malicious defacement or damage of property); theft (taking without force or illegal entry); burglary (forcible entry of a residence); robbery (taking something by force); minor physical assault (attacking without a weapon with minor injuries); minor sexual assault (fondling, groping, etc.); aggravated assault (attacking with a weapon, and/or without a weapon when serious injury results); and rape (sexual intercourse without consent).
When anticipating Peace Corps Volunteer service, you should review all of the safety and security information provided to you, including the strategies to reduce risk. Throughout your training and Volunteer service, you will be expected to successfully complete all training competencies in a variety of areas including safety and security. Once in-country, use the tools and information shared with you to remain as safe and secure as possible.
 What If You Become a Victim of a Violent Crime?
Few Peace Corps Volunteers are victims of violent crimes. The Peace Corps will give you information and training in how to be safe. But, just as in the U.S., crime happens, and Volunteers can become victims. When this happens, the investigative team of the Office of Inspector General (OIG) is charged with helping pursue prosecution of those who perpetrate a violent crime against a Volunteer. If you become a victim of a violent crime, the decision to prosecute or not to prosecute is entirely yours, and one of the tasks of the OIG is to make sure that you are fully informed of your options and help you through the process and procedures involved in going forward with prosecution should you wish to do so. If you decide to prosecute, we are here to assist you in every way we can.
Crimes that occur overseas, of course, are investigated and prosecuted by local authorities in local courts. Our role is to coordinate the investigation and evidence collection with the regional security officers (RSOs) at the U.S. embassy, local police, and local prosecutors and others to ensure that your rights are protected to the fullest extent possible under the laws of the country. OIG investigative staff has extensive experience in criminal investigation, in working sensitively with victims, and as advocates for victims. We also, may, in certain limited circumstances, arrange for the retention of a local lawyer to assist the local public prosecutor in making the case against the individual who perpetrated the violent crime.
If you do become a victim of a violent crime, first, make sure you are in a safe place and with people you trust and second, contact the country director or the Peace Corps medical officer. Immediate reporting is important to the preservation of evidence and the chances of apprehending the suspect. Country directors and medical officers are required to report all violent crimes to the Inspector General and the RSO. This information is protected from unauthorized further disclosure by the Privacy Act. Reporting the crime also helps prevent your further victimization and protects your fellow Volunteers.
In conjunction with the RSO, the OIG does a preliminary investigation of all violent crimes against Volunteers regardless of whether the crime has been reported to local authorities or of the decision you may ultimately make to prosecute. If you are a victim of a crime, our staff will work with you through final disposition of the case. OIG staff is available 24 hours-a-day, 7 days-a-week. We may be contacted through our 24-hour violent crime hotline via telephone at 202.692.2911, or by e-mail at [email protected]
 Security Issues in Togo
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 Togo. 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 large cities; people know each other and generally will not steal from their neighbors. Tourist attractions, especially in large towns, are the favorite work sites for pickpockets.
 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 Togo, do what you would do if you moved to a large city in the United States: be cautious, check things out, ask a lot of 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 Togo may require that you accept some restrictions to your current lifestyle.
Volunteers attract a lot of attention in large cities and in their sites, but receive far more negative attention in highly populated centers where they are anonymous. In smaller towns, “family,” friends, and colleagues will 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 such negative and unwanted attention. Other methods have helped Volunteers avoid becoming targets of unwanted attention and crime. Keep your money out of sight – use 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. You should always walk at night with a companion.
Preparing for the Unexpected: Safety Training and Volunteer
 Support in Togo
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. Togo’s in country safety program is outlined below.
The Peace Corps Togo office will keep Volunteers informed of any issues that may impact Volunteer safety through information sharing. Regular updates will be provided in Volunteer newsletters and in memoranda from the Country Director. 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 Togo. 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. 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 role 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 medical, banking, postal, and other essential services; availability of communications, transportation, and markets; different housing options and living arrangements; 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 Togo will gather at pre determined locations until the situation resolves itself or the Peace Corps decides to evacuate.
Finally, in order to be fully responsive to the needs of Volunteers, it is imperative that Volunteers immediately report any security incident to the Peace Corps Safety & Security Coordinator and/or 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.