Health care and safety in The Gambia

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Health care and safety in The Gambia
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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 every Volunteer. Peace Corps medical programs emphasize the preventive, rather than the curative, approach to disease. Peace Corps/The Gambia maintains a clinic 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 The Gambia 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

Health Issues in The Gambia

Major health problems among Volunteers in The Gambia are rare and are often the result of a Volunteer’s not taking preventive measures to stay healthy. The most common minor health problems are ones that also exist in the United States, that is, colds, diarrhea, hemorrhoids, constipation, sinus infections, skin infections, headaches, dental problems, minor injuries, STDs, adjustment disorders, emotional problems, and alcohol abuse. These problems may be more frequent or compounded by life in The Gambia because certain environmental factors here raise the risk of or exacerbate the severity of certain illnesses and injuries.

The most common major health concerns in The Gambia are malaria, giardiasis, amoebic dysentery, and hepatitis. Because malaria is endemic in The Gambia, you are required to take antimalarial pills. In addition, you will be vaccinated to protect you against hepatitis A and B, meningitis A and C, tetanus, diphtheria, typhoid, and rabies.

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 The Gambia, 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 training, you will have access to basic medical supplies through the medical officer. However, 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 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 The Gambia will consult with the Office of Medical Services in Washington, D.C. If it is determined that your condition cannot be treated in The Gambia, you may be sent out of the country for further evaluation and care.

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 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 The Gambia is to take preventive measures.

The most important step in preventing malaria, and many other tropical diseases, is to avoid mosquito and other insect bites by sleeping under a mosquito net, wearing long-sleeved tops and long pants whenever possible, using insect repellent, and making sure your windows and doors have screens.

Rabies is prevalent throughout the region, so you will receive a series of immunizations against it when you arrive in The Gambia. If you are exposed to an animal that is either known to have or suspected of having rabies, you must inform the Peace Corps medical officer at once so that you can receive post-exposure booster shots.

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, tapeworms, and typhoid fever. Thoroughly washing fruits and vegetables and either boiling your drinking water or using a water filter and disinfectants (such as household bleach) can help prevent these illnesses. The medical officer will discuss specific standards for water and food preparation in The Gambia during pre-service training.

AIDS is less common in The Gambia than in other parts of Africa, but is far more common than in the United States.

Abstinence is the only certain choice for prevention of HIV/AIDS and other STDs. You are taking risks if you choose to be sexually active. To lessen risk, use a condom every timeyou 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. Generic formulations may be substituted for brand names. You may be asked to switch to a pill routinely stocked by the health unit.

It is critical to your health that you promptly report to the medical office 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 requiring medical attention but also has 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 medical circumstances that exist in The Gambia, any Volunteer who becomes pregnant is medically separated.

Few feminine hygiene products are available for you to purchase in The Gambia. If you require a specific feminine hygiene product, please bring a six-month supply with you.

Your Peace Corps Medical Kit

The Peace Corps medical officer provides Volunteers 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.

Medical Kit Contents

Ace bandages
Acetaminophen 325 mg (Tylenol)
American Red Cross First Aid & Safety Handbook
Antacid tablets (Di-Gel)
Antibiotic ointment (Bacitracin/Neomycin/Polymycin B)
Antifungal cream (clotrimazole)
Antimicrobial skin cleanser (Hibiclens)
Baby powder (Johnson’s)
Band-Aids
Butterfly closures
Cepacol lozenges
Ciprofloxacin 500 mg
Condoms
Dental floss (waxed and unwaxed)
Diphenhydramine HCL 25 mg (Benadryl)
Erythromycin 25 mg
Hydrocortisone cream
Ibuprofen 400 mg
Insect repellent
Latex gloves (one pair)
Lip balm (Aloe Vera)
Multivitamins
Oral rehydration salts
Pepto-Bismol chewable tablets
Pseudoephedrine HCL 60 mg (Sudafed)
Scissors
Soap (Dial)
Sterile gauze pads
Sucrets lozenges
Sunscreen (SPF 30)
Tetrahydrozaline eyedrops (Visine)
Thermometer
Tweezers


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, 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 The Gambia. 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, 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, 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—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. 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 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 preexisting conditions might prevent you from reenrolling 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 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. Based on information gathered from incident reports worldwide in 2003, 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).

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:

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; and Emergency Preparedness, Plans, Training and Exercise. The safety and security team also tracks crime statistics, identifies trends in criminal activity, and highlights potential safety risks to Volunteers.

The major responsibilities of the Volunteer Safety and Overseas Security Division are to coordinate the office’s overseas operations and direct the Peace Corps’ safety and security officers who are located in various regions around the world that have Peace Corps programs. The safety and security officers conduct security assessments; review safety trainings; train trainers and managers; train Volunteer safety wardens, local guards, and staff; develop security incident response procedures; and provide crisis management support.

If a trainee or Volunteer is the victim of a safety incident, Peace Corps staff is prepared to provide support. All Peace Corps posts have procedures in place to respond to incidents of crime committed against Volunteers. The first priority for all posts in the aftermath of an incident is to ensure that the Volunteer is safe and receiving medical treatment as needed. After assuring the safety of the Volunteer, Peace Corps staff provides support by reassessing the Volunteer’s work site and housing arrangements and making any adjustments, as needed. In some cases, the nature of the incident may necessitate a site or housing transfer. Peace Corps staff will also assist Volunteers with preserving their rights to pursue legal sanctions against the perpetrators of the crime. It is very important that Volunteers report incidents as they occur, not only to protect their peer Volunteers, but also to preserve the future right to prosecute. Should Volunteers decide later in the process that they want to proceed with the prosecution of their assailant, this option may no longer exist if the evidence of the event has not been preserved at the time of the incident.

The country-specific data chart below shows the incidence rates and the average number of incidents of the major types of safety incidents reported by Peace Corps Volunteers/trainees in The Gambia as compared to all other Africa region programs as a whole, from 1999-2003. 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 the eight most commonly occurring assault types. 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 The Gambia

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. While The Gambia is considered one of the safest countries in West Africa, Volunteers have experienced petty theft, pickpocketing, and home break-ins. You can reduce your risk by avoiding situations that make you feel uncomfortable and by taking 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 favorite work sites for pickpockets. The following are safety concerns in The Gambia of which you should be aware.

Perhaps the single greatest risk to your safety in The Gambia is public transportation. While public buses, taxis, and private vehicles are generally safe, many accidents occur in “bush taxis.” Bush taxis are the main mode of transport for Gambians and may be the only type of local transportation available to and from your community. Because of bad roads, poor auto maintenance, and overloading, bush taxis are prone to breakdowns. During the rainy season, road conditions deteriorate and accidents are even more frequent.

Pickpocketing and bag snatching most frequently occur in congested areas such as marketplaces, bus terminals, ferry crossings, and while traveling on public transportation. Being aware of your surroundings and projecting a confident attitude can reduce your chances of becoming a victim of petty theft. Volunteers are safest in their host communities, where people know them and value their contributions, but house break-ins sometimes occur when Volunteers are away from their residence. Remember to always lock your doors and windows, even if you are leaving for just a short time.

Male colleagues, supervisors, and acquaintances may occasionally make inappropriate advances toward female Volunteers, but once the Volunteers become well-known in their communities, such harassment usually ends. Strategies to deal with this issue will be discussed during training, and command of one or more local languages will help you manage potential problems.

Cases of physical and sexual assault are rare, and are often associated with cross-cultural differences regarding intimate relationships. The five most common risk factors in assaults are visiting the capital, going out on the weekend, being out at night, walking alone, and being intoxicated. (Although alcohol is readily available in urban areas, drinking in your community or public drunkenness anywhere is inappropriate and socially unacceptable.) Volunteers who exhibit responsible personal behavior can minimize their risk. Volunteers are urged to report all assaults and threats of assault to the Peace Corps medical officer or security officer so that staff can respond with appropriate support.

The ongoing civil war in the Casamance region of southern Senegal (which began in the early 1980s) has not directly affected Volunteers serving in The Gambia. Although the region is off-limits to Volunteers, heightened awareness near the southwestern Gambia-Senegal border is warranted.

In the coastal areas, where tourists congregate, Volunteers are often mistaken for Europeans on vacation, and this assumption can bring with it preconceived notions about personal wealth or sexual mores. Volunteers, as well as tourists and other expatriates, are often referred to as toubab, which is not a derogatory term but merely means “stranger,” “outsider,” or, sometimes, “white person.” Young men, referred to as “bumsters,” may offer to help you or “be your friend.” These men are usually harmless, but they are annoying and can sometimes be aggressive. Once again, command of the local language, visiting the beach in a group, and being aware of your environment are key in decreasing your risk.

Any nonmedical issues involving personal security, such as those related to housing and transportation, should be directed to the security officer.

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 The Gambia, 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 The Gambia may require you to accept some restrictions on your current lifestyle.

Volunteers attract a lot of attention in large cities and at their sites, but receive far more negative attention in highly populated centers, where they are anonymous, than in smaller towns, 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. Do not keep your money in outside pockets of backpacks, in coat pockets, or in fanny packs. You should always walk with a companion at night.

Preparing for the Unexpected: Safety Training and Volunteer

Support in The Gambia

During pre-service training, you will be briefed on safety and security measures that should be taken while living and traveling in The Gambia. The Peace Corps’ safety program 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. The Gambia’s in-country safety program is outlined below.

The Peace Corps/The Gambia 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 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 The Gambia. 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.

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/The Gambia’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 The Gambia will gather at predetermined 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 medical officer or security 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.

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