Health care and safety in Ukraine

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Revision as of 18:14, 29 May 2008

The Peace Corps’ highest priority is maintaining the good health and safety of every Volunteer. Peace Corps medical programs emphasize the importance of health maintenance behaviors. The Peace Corps in Ukraine maintains a clinic with four full-time medical officers, who take care of Volunteers’ primary healthcare needs. Medical services, such as testing and basic treatment, are available in Ukraine at carefully screened local facilities. 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 Ukraine

Health issues vary according to the social, economic, and environmental conditions of each region in Ukraine. Following are some of the health issues that pose challenges for all Ukrainians.

Radiation and nuclear safety. Forty percent of Ukraine’s electricity is provided by nuclear power. The U.S. Department of Energy and the Ukrainian State Nuclear Regulatory Commission collaborate in monitoring and improving safety at all operating facilities in Ukraine. Volunteers are not placed within 30 kilometers of an operating power station. All currently operating stations meet Western safety standards.

The last reactor at the Chernobyl nuclear power plant was shut down in December 2000. The effects of the 1986 accident at that plant on areas surrounding Chernobyl continue to be monitored by the international community.

No Volunteers are placed at any site with higher-than-normal levels of radiation. The Ukrainian government monitors fresh foods and meats sold in central markets to ensure that no food that exceeds European norms for radiation is sold in Ukrainian markets.

Industrial pollution. During the Soviet era, the central and eastern regions of Ukraine were highly productive and heavily industrialized, resulting in air pollution and ground and water table contamination. Volunteers are not placed at sites with unacceptable levels of air and ground pollution.

Air pollution. Vehicle exhaust is unregulated, so joggers in larger towns and cities should avoid running during peak traffic hours. While smog in cities may be no worse than in the United States, Volunteers with a history of asthma may find their condition exacerbated. In addition, cigarette smoking is common in Ukraine, and public areas are seldom designated as “no smoking” areas.

Insufficient infrastructure. The economic challenges of becoming an independent country have had a negative impact on the ability of Ukraine’s cities and towns to provide basic services to residents. For example, water supply systems in some cities and towns do not guarantee potable water. In other locations, availability of water is limited to peak use hours. Hot water, which was generated centrally in cities during the Soviet era, is often not available. In cities with heating plants, the availability of heat in winter is determined by each city’s financial resources. If the local government lacks sufficient resources, residents must use space heaters, coal- or wood-burning stoves, or other means to heat their homes. In general, living quarters in the winter are cooler than what Americans are accustomed to.

Helping You Stay Healthy

The Peace Corps will provide you with all the necessary immunizations, medications, and information needed to help you stay healthy. Upon arrival in Ukraine, you will receive a medical handbook and instruction that cover health challenges in Ukraine in more detail. You will also receive a medical kit with supplies to take care of mild illnesses and first-aid needs. The contents of this kit is listed later in this chapter and the medical office will replenish items as needed throughout your service.

During pre-service training, you will have access to basic medical supplies through the medical officers. 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 dental and physical examinations at midservice and at the end of your service. If you develop a serious medical problem during your service, the medical officers in Ukraine will consult with the Office of Medical Services in Washington, D.C. If it is determined that your condition cannot be treated in Ukraine, you may be sent out of the country for further evaluation and care.

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 Ukraine is to take the following preventive measures:

Social isolation and the stress of coping with a new culture can be overwhelming at times, particularly in one’s first months in-country. Ukrainian winters can be quite cold, and short days and long nights prevail from early December to early March. Seasonal changes in the amount of sunlight can affect one’s emotional health. Peace Corps medical officers provide support for mental health issues, and a variety of peer support workshops help defuse the stress associated with adjustment issues. Your proactive commitment to regular exercise, a good diet, and sufficient hydration will also help.

Alcohol consumption is common at social events in Ukraine, and the subtleties of appropriate alcohol use can be difficult to understand. Alcoholism is not commonly recognized as a disease in Ukraine, and support networks for abstinence and treatment are not extensively developed. Volunteers with a history of alcohol abuse may feel challenged by the pervasive use of alcohol in the culture. Nevertheless, those who choose not to drink have found that maintaining that choice does not interfere with developing positive relationships with Ukrainians.

Many illnesses that afflict Volunteers worldwide are entirely preventable if proper food and water precautions are taken. These diseases include food poisoning, parasitic infections, hepatitis A, and dysentery. Proper food preparation and storage decrease the incidence of bacterial and viral gastroenteritis, and avoiding raw milk products decreases the likelihood of contracting bacterial illness associated with unpasteurized milk. The medical officers will discuss specific standards for water and food preparation in Ukraine during pre-service training.

Sanitation facilities in Ukraine run the gamut: Western-style toilets and “Turkish” toilets are present in equal numbers, and in smaller villages and towns outhouses are common. The level of cleanliness in public facilities and on public transportation varies greatly.

Because of the heavy metal content and possible microbial contamination of most of the water supply in Ukraine, Volunteers are discouraged from drinking tap water. Inexpensive bottled water is readily available in kiosks and stores, and the Peace Corps will provide funds for purchasing it.

Abstinence is the only certain choice for preventing infection with HIV and other 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 Ukrainian, 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 office.

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 illnesses and injuries.

Women’s Health Information

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

Feminine hygiene products are available in local markets. If you require a specific product that may not be available in Ukraine, you will have to either bring a supply with you or make arrangements to have the product sent to you.

Your Peace Corps Medical Kit

The Peace Corps medical officer provides Volunteers with a medical 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
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 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

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 shortly after you arrive in Ukraine. 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 provide refills for all personal medications 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. If you need custom orthopedic devices, such as splints, braces, or compression stockings, bring them with you. (Note that attachable shoe crampons can help in negotiating ice- and snow-covered cobbled streets.)

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. 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 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 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. 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).

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; 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 Ukraine as compared to all other Europe, Mediterranean, and Asia (EMA) 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.

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 Ukraine

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 Ukraine. 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 in large towns, for instance, are favorite work sites for pickpockets. The following are safety concerns in Ukraine that you should be aware of:

Robbery and burglary. Volunteers in Ukraine have been burglarized in the past, so you will need to take the same precautions you would take in the United States to deter such incidents. The Peace Corps will cover the cost of installing new locks, security doors with peepholes, and window security devices if required.

Alcohol. Unfortunately, some Volunteers in Ukraine have been robbed or assaulted while intoxicated. Intoxication decreases awareness and reaction time, leaving the intoxicated individual more vulnerable to predators. In addition, it is not uncommon to encounter intoxicated individuals while traveling on public transportation. During pre-service training, you will practice skills that are useful for identifying and avoiding situations related to alcohol use that can pose a threat to your personal safety.

Scams and fraud. Because of the high incidence of credit card and ATM fraud, the U.S. embassy strongly discourages the use of credit cards and ATMs in Ukraine. Volunteers should exchange money at a bank and not with money exchanges near the bank, on the street, or with strangers. Volunteers have experienced various scams, and you will receive more information about potential scams during training and throughout your service.

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. 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 Ukraine, 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 Ukraine may require that you accept some restrictions on your current lifestyle.

Volunteers attract a lot of attention both 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 stares 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 of backpacks, in coat pockets, or in fanny packs. And always walk with a companion at night. Female Volunteers should always ask someone they trust to walk them home. Having a male escort does not make you less independent, it makes you safer.

Safety Training and Volunteer Support

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. Ukraine’s in-country safety program is outlined below.

The Peace Corps/Ukraine office will keep you informed of any issues that may impact Volunteer safety through information sharing. Regular updates will be offered in the Volunteer newsletter 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.

Volunteer training will include sessions to prepare you for specific safety and security issues in Ukraine. 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, cross-cultural, health, and other components of 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; housing options and living arrangements; and other Volunteer support needs.

You will also learn about Peace Corps/Ukraine’s detailed emergency action plan, which is implemented in the event of civil or political unrest, a natural or technological disaster or terrorism. When you arrive at your site, you will complete and submit an emergency contact and 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 Ukraine 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 safety and security coordinator. 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.

Peace Corps, however, believes that there is a discrepancy between the number of reported incidents and the actual numbers of incidents. The discrepancy may be attributed to under-reporting by Volunteers who may not want to report having been under the influence of alcohol when the incident occurred, or having been absent from site without notifying Peace Corps, or simply thinking that the incident was too insignificant to report. Therefore,the Safety & Security Council (SSC) was created so that trainees and Volunteers could speak to their peers regarding these incidents, and, in turn, the incidents would be anonymously reported to SSC so that Peace Corps Staff will have more accurate statistics to report, and can better meet trainees’ and Volunteers’ safety and security needs.

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