Health care and safety in Lesotho
From Peace Corps Wiki
|Health care and safety in Lesotho|
|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/Lesotho maintains a health unit with two full-time medical officers, who take care of Volunteers’ primary healthcare needs. Additional medical services, such as testing and basic treatment, are also available in Lesotho and South Africa. If you become seriously ill, you will be transported to a medical facility in South Africa or to the United States.
 Health Issues in Lesotho
Most of us take our health for granted. As a Peace Corps Volunteer in Lesotho, however, you will be expected to play a vital and proactive role in your healthcare. The medical office and the medical support system will respond to your needs. When you get here, you will realize that your emotional and physical health will depend on how you deal with social, work, and environmental factors.
Lesotho is a relatively healthy country, with none of the exotic or tropical illnesses or diseases common to most other parts of Africa. The exception to this is HIV/AIDS, which is prevalent in Lesotho at a rate of 30 percent. The Peace Corps has adopted medical policies and practices worldwide to help protect Volunteers and staff from transmission of this disease, but it is each Volunteer’s responsibility to take steps to avoid infection.
Because of the altitude and temperate nature of the climate, there is no malaria or bilharzia in Lesotho. However, since Volunteers do travel outside of Lesotho, the personal health and safety component of pre-service training covers a wide variety of illnesses, including problems you may encounter in the region. Illnesses that Volunteers in Lesotho commonly experience are diarrhea from amoebas and giardia; high fevers from varied causes; skin infections from fungus, bacteria, or insect bites; upper respiratory symptoms; and allergies from dust and dryness. Diarrhea is the number-one complaint by Volunteers worldwide, and Lesotho is no exception. Peace Corps/Lesotho recommends that Volunteers boil all their drinking water for three minutes. This method is adequate at all altitudes and helps prevent many illnesses that are water borne. Other diseases are related to poor hygienic conditions. Women might experience more frequent bladder or yeast infections as well as changes in their menstrual pattern.
 Helping You Stay Healthy
Peace Corps medical programs emphasize the preventive approach to disease rather than the curative mode. As a rule of thumb, good healthcare comes from good health maintenance. Although health conditions in Lesotho are good because of the high elevation and dryness, immunizations are still required to travel to Lesotho and must be kept current during your tour. The Peace Corps will provide you with all the necessary inoculations, medication, and information to stay healthy; however, you must accept responsibility for using the information and medication provided.
Upon your arrival in-country, you will receive a medical handbook that will provide you with all the information you need to maintain good health. We will also provide you with a medical kit of supplies to take care of most mild illnesses and first-aid needs. The contents of the kit are listed below. If you are on any prescription medication, make sure to bring at least a three-month supply with you, as it may not be readily available in the medical office here. Consult with your medical officer soon after arriving in Lesotho and the Peace Corps will begin the process of obtaining a supply of your medication.
The emphasis on prevention does not occur only during pre-service training; we hope to make prevention a lifestyle change that you will use during your two years of service and carry with you beyond your Peace Corps days. There will be opportunities for you to meet with the medical officer at the health sessions during training, at midservice, and at close-ofservice medical checkups. Other opportunities are available during site visits or consultations for medical problems.
The medical supplies that the Peace Corps provides you are fairly extensive. In addition to a standard medical kit, you will be given supplies that are specifically for Lesotho, your site, or you. A full range of over-the-counter medications is available, as is a large selection of antibiotics and other prescription medications. Condoms and other birth control products are also available. Female Volunteers should bring a three-month supply of feminine hygiene products (tampons and/or pads) and any birth control medication they may be taking. Note that the Peace Corps does not provide homeopathic medications or any other medications of uncertain medical benefit. 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. Sunglasses are not provided, so you might want to bring a pair of prescription sunglasses or clip-on glasses for the bright sunlight in Lesotho. We discourage you from using contact lenses during your Peace Corps service to reduce your risk of developing a serious infection or other eye disease. Most Peace Corps countries do not have appropriate water and sanitation to support eye care with the use of contact lenses. The Peace Corps will not supply or replace contact lenses or associated solutions unless their use has been recommended by an ophthalmologist for a specific medical condition and the Peace Corps’ Office of Medical Services has given approval.
 Maintaining Your Health
As a Volunteer, you must accept a certain amount of responsibility for your own health. Proper precautions will significantly reduce your risk of serious illness and 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 Lesotho is to take the following preventive measures:
Adherence to recommended standards for 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, parasitic infections, hepatitis A, dysentery, Guinea worms, tapeworms, and typhoid fever. The medical officer will discuss specific recommendations for your area.
Strict adherence to recommended drug regimen for the prevention of malaria. Malaria is endemic in most areas of the Peace Corps world. Fortunately, Lesotho is a malaria-free country. This does not mean, however, that when traveling outside of Lesotho you do not need to take a malaria prophylaxis. Consult your medical officer during pre-service training or two weeks prior to travel to malaria-infected areas.
Prompt reporting to the medical office. You must visit the medical office or other designated facility for scheduled immunizations, and you must immediately report any significant illnesses or injuries to the medical office, including any possible exposure to rabies. Rabies is present in nearly all Peace Corps countries. 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. All necessary rabies immunizations (pre- and post-exposure) will be given by the Peace Corps medical office.
Use of an effective means of birth control. Volunteers are expected to adhere to an effective means of birth control to prevent an unwanted 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 Peace Corps medical office.
Use of condoms to protect against the spread of HIV/AIDS and other STDs. Volunteers are expected to use condoms in every sexual encounter in which bodily fluids might be transferred. Condoms will be provided by the medical officer.
 Women’s Health Information
Female Volunteers will have an annual Pap smear as part of their midservice medical evaluation and their close-of-service medical checkup. If you need to have more frequent Pap smears, let the medical officer know during your meetings at pre-service training. The Peace Corps provides annual mammograms for all Volunteers over age 50 or whenever there is a specific indication. If you have had any previous mammograms, you need to bring all films with you. Do not send them to Washington, D.C. The medical office will keep them and return them to you when you complete your service.
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.
 Your Peace Corps Medical Kit
The medical kit provides Volunteers with items necessary to prevent illness and treat minor illnesses that may occur during your service. The items in the kit have been chosen with the help of Peace Corps medical officers around the world. In addition to the basic kit described in these pages, your medical officer will add items that he or she feels are appropriate for your individual situation.
The items in this kit are intended for your own use and can be periodically restocked at the Peace Corps medical office.
 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) Mycelex cream (for vaginal yeast infections) Oral rehydration salts and Gatorade Oral thermometer (Fahrenheit) Pseudoephedrine HCL 30 mg (Sudafed) Robitussin-DM lozenges (for cough) Scissors Sterile gauze pads Tetrahydrozaline eyedrops (Visine) Tinactin (antifungal cream) Tweezers
 Before You Leave: A Medical Checklist
Taking care of your health while you are in Lesotho is an extremely high priority of the Peace Corps. Because conditions in Lesotho cannot approximate U.S. standards of care, we are obliged to send to the country only those Volunteers whose healthcare needs can be met in Lesotho’s medical care system. Your entrance into the Peace Corps training program is therefore dependent upon your obtaining medical and dental clearances from the Office of Medical Services in Washington.
Because each medical qualification is linked to conditions at a particular post, the medical clearance is not transferable. That means that if for some reason you are ultimately unable to fulfill your assignment in Lesotho, there is no guarantee that you can be medically qualified for the next post that needs your skills. We sincerely regret that we must adhere to such stringent standards, but it truly is for your own welfare that we do so.
Following is a list of things to take care of before you leave:
- Complete any needed dental and medical work.
- Obtain medical clearance from the Office of Medical Services.
- Obtain two pairs of prescription glasses if applicable.
- Obtain a three-month supply of any prescription medication you take and an adequate supply to last your entire service of any homeopathic medication(s) you take. (The Peace Corps does not provide homeopathic medications or any medications of uncertain medical benefit.)
- Obtain a three-month supply of birth control pills or hormone replacement therapy if applicable.
- Arrange to bring any special creams or lotions needed for immediate use.
- For female Volunteers over 50, bring any previous mammogram films. 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 unaccompannied 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 Lesotho as compared to all other Africa region programs as a whole, from 2000–2004. 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.
 Security Issues in Lesotho
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 Lesotho. Recent increases in unemployment have led to increases in crime in Maseru. It is mostly street theft and of a nonviolent nature, and those who are obviously not Basotho are often targets. Volunteers are advised to come to Maseru only when necessary and, when there, to be wary of their location and activities. You can reduce your risk by avoiding situations that make you feel uncomfortable and by taking precautions. Crime in villages and rural communities is less frequent than in cities. Tourist attractions in large towns, for instance, are favorite work sites for pickpockets. But the Peace Corps cannot foresee every safety problem that might occur during your service. Your safety is ultimately your responsibility, but we hope the skills we provide you in language and cross-cultural training will help you modify your behavior in a way that will enhance your safety in a different cultural setting.
Young men and women are likely to be asked about their marriage plans. It is common for female Volunteers to be proposed to by young Basotho men. Volunteers must use good judgment when forming relationships with married men and women. Intimate relationships, or those perceived as intimate, may put Volunteers at risk and cause them to lose credibility in the eyes of their peers, counterparts, and community members.
 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 Lesotho, do what you would do if you moved to a new 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 Lesotho may require that you accept some restrictions on your current lifestyle.
Volunteers attract a lot of attention in large cities and at their sites, but they are likely to receive more negative attention in highly populated centers than at their sites, where “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. In addition, keep your money out of sight by using an undergarment 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 outside pockets. It is advisable not to use backpacks or fanny packs in Maseru, as local thieves look for them. And always walk with a companion at night.
If you were in the United States, would you leave your house unlocked while you were at work? Would you walk alone at night in a new area? Would you get into a car with a drunken driver? Would you invite strangers into your house? Use common sense while at your site, in Lesotho, or traveling in Africa. After learning some more about the Basotho culture during training, it will be your responsibility to draw your personal boundaries with regard to your safety.
You will be provided with a safety handbook during the course of training to help you avoid dangerous situations but, above all, to keep yourself safe.
Preparing for the Unexpected: Safety Training and Volunteer Support in Lesotho
The Peace Corps’ approach to safety is a five-pronged plan to help you stay safe during your two-year service and includes the following: information sharing, Volunteer training, site selection criteria, a detailed emergency action plan, and protocols for addressing safety and security incidents. Lesotho’s in-country safety program is outlined below.
The Peace Corps/Lesotho office will keep Volunteers informed of any issues that may impact Volunteer safety through information sharing. Regular updates will be offered in 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.
Volunteer training will include sessions to prepare you for specific safety and security issues in Lesotho. 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. You will find language to be an important factor with respect to your safety.
So will your knowledge of the culture and ability to pick up Basotho cultural cues. The Gift of Fear by Gavin Becker (Dell Publishing, 1999) is recommended reading that Peace Corps/Lesotho uses extensively in pre-service training.
Certain site selection criteria are used to determine safe housing for Volunteers before their arrival. The Peace Corps staff works closely with host communities and counterpart agencies to help prepare them for a Volunteer’s arrival and to establish expectations of their respective roles in supporting the Volunteer. Each site is inspected before the Volunteer’s arrival to ensure placement in appropriate, safe, and secure housing and work sites. Site selection 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/Lesotho’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, Volunteers in Lesotho will gather with other Volunteers 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 medical officer. 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.