Health care and safety in Nicaragua
From Peace Corps Wiki
|Health care and safety in Nicaragua|
|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 medical programs emphasize the preventive, rather than the curative, approach to disease. The Peace Corps in Nicaragua maintains a clinic with two full-time and two part-time medical officers, who take care of Volunteers’ primary health-care needs. Additional medical services, such as testing and basic treatment, are available at a local, American-standard hospital. If you become seriously ill, and adequate care is not available in country, you will be medically evacuated to the United States, or possibly Panama.
 Health Issues in Nicaragua
The most common health problems among Volunteers and the Nicaraguan population in general, which also occur in the United States, are upper respiratory infections and diarrhea. These problems may be more frequent, or compounded, by life in Nicaragua because certain environmental and cultural factors in the country raise the risk or exacerbate the severity of illnesses and injuries. Some gastrointestinal problems can be avoided by boiling drinking water and thoroughly washing fruits and vegetables before eating them.
Two additional major health concerns in Nicaragua are malaria and dengue fever. Because malaria is endemic here, the Peace Corps requires all Volunteers to take weekly antimalarial medication. The antimalarial medication currently approved by headquarters and used by Volunteers is chloroquine phosphate. Other options are available for individuals who can’t tolerate the side effects of chloroquine, though most Volunteers have no problems taking it. It is crucial that all Volunteers strictly follow medical office guidelines to prevent mosquito bites in addition to taking antimalarial profilaxis. You will also be vaccinated against hepatitis A and B, tetanus/diphtheria, polio, typhoid, measels, mumps, rubella, and rabies as part of our preventive health program.
 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 Nicaragua, you will participate in a series of medical sessions designed to assist you in assuming responsibility for your own health. At the beginning of training, you will receive a Peace Corps medical kit with supplies to take care of mild illnesses and first-aid needs. The contents of this kit are listed later in this chapter.
During pre-service training, you will have access to additional basic medical supplies through the medical office. However, you will be responsible for your initial supply of prescription drugs and any other specific medical supplies you require, as the Peace Corps will not order these items during training. Therefore, please bring a three-month supply of any prescription drugs you use, including birth control pills, since they may not be available in Nicaragua and it may take several months for shipments to arrive.
You will have medical and dental evaluations at the midpoint and end of your service. If you develop a serious medical problem during service, the medical officers in Nicaragua will consult with the Office of Medical Services in Washington, D.C. If it is determined that your condition cannot be treated in Nicaragua, you may be evacuated to the United States or Panama for further evaluation and care.
Peace Corps dental care supports an annual check-up and prophylaxis to perform routine cleaning and early identification and treatment of disease. Medical evacuation is not authorized for the purpose of annual check-ups. However, dental care, including annual check-ups, can be authorized to be performed in the U.S. if visiting there on personal business. Peace Corps does not provide dental care to treat aesthetic conditions (e.g., orthdontia, dental veneers, and whitening procedures) or to fix or correct pre-existing structural problems (e.g. malocclusion).
 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 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 step in preventing malaria, dengue, and many other tropical diseases is to avoid bites by mosquitoes and other insects. In fact, you cannot get malaria or dengue fever if you are not bitten. The best ways to avoid bites are to sleep under a mosquito net, wear long sleeves and pants whenever possible, and use insect repellent. You will be given a mosquito net at the beginning of training. Since no one can entirely prevent all mosquito bites, you must take antimalarial medicine throughout your service; failure to do so is both risky and can lead to administrative separation from the Peace Corps.
Parasitic infections come from eating contaminated food or drinking contaminated water. During training, you will learn how to properly wash and prepare foods and how to boil your drinking water. You will also receive training on how to recognize symptoms and what immediate actions to take if such symptoms occur.
Nicaragua has a significant number of cases of STDs, including HIV/AIDS. 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. (The medical office provides condoms on request.) 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. Birth control pills are available without charge from the medical officer. If you are taking a specific contraceptive, you should bring a three-month supply since they may not be available in Nicaragua and may take several months to order. Also, your current brand of contraceptive may be changed to an equivalent or similar medication by the PCMO, should your brand prove difficult to obtain in-country.
It is critical to your health that you promptly report to the medical office or other designated facility for scheduled immunizations and that you let the medical officer know immediately of significant illnesses and injuries. By maintaining open communication, we can work together to support a healthy and safe service for you.
 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 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 can be met. Volunteers who become pregnant are typically medically separated.
A variety of feminine hygiene products are available locally, though a preferred brand may not be available. If you require a certain product, bring a sufficient supply with you. If you prefer to use tampons, they are expensive in country and hard to find, nor does the office provide them, so be sure to pack accordingly.
 Your Peace Corps Medical Kit
The Peace Corps medical officer will provide you with a kit that contains basic items necessary to prevent and treat illnesses that may occur during service. Kit items can be periodically restocked at the medical office.
 Medical Kit Contents
Acetaminophen (Tylenol) 500 mg tablet
Chlorine water purification tablets
Dental floss (unwaxed)
Emergency First Aid Pocket Guide
Gauze pads (sterile)
Hibiclens antiseptic/germicial liquid soap
Hydrocortisone 1% cream
Ibuprofen (Advil, Motrin) 200 mg tablets
Oral rehydration salts
Pseudoephedrine tablets (Sudafed)
Sepasoothe lozenges (sore throat)
Tempa-Dot thermometer (Farenheit)
Tetrahydrozaline HCL (eyedrops)
 Before You Leave: A Medical Checklist
If there has been any change in your health—physical, mental, or dental—since you submitted your examination reports to the Peace Corps, you must immediately notify the Office of Medical Services. Failure to disclose new illnesses, injuries, allergies, or pregnancy can endanger your health and may jeopardize your eligibility to serve.
If your dental exam was done more than a year ago, or if your physical exam is more than two years old, contact the Office of Medical Services to find out whether you need to update your records. If your dentist or Peace Corps dental consultant has recommended that you undergo dental treatment or repair, you must complete that work and make sure your dentist sends requested confirmation reports or X-rays to the Office of Medical Services.
If you wish to avoid having duplicate vaccinations, contact your physician’s office to obtain a copy of your immunization record and bring it with you to Nicaragua. 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 Nicaragua. You do not need to begin taking malaria medication prior to departure.
Bring a three-month supply of any prescription or over-thecounter medication you use on a regular basis, including birth control pills. Although the Peace Corps cannot reimburse you for this three-month supply, it will order refills during your service. While awaiting shipment—which can take several months—you will be dependent on your own supply. The Peace Corps will not provide or 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. 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; in addition, the amount of dust in the air can irritate. 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 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 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).
- Location: Most crimes occurred when Volunteers were in public areas (e.g., street, park, beach, public buildings). Specifically, 47 percent of assaults took place when Volunteers were away from their sites.
- Time of day: Assaults usually took place on the weekend during the late evening between 10:00 p.m. and 3:00 a.m.— most often occurring around 1:00 a.m.
- Absence of others: More than 75 percent of crime incidents occurred when a Volunteer was unaccompanied.
- Relationship to assailant: In most assaults, the Volunteer did not know the assailant.
- Consumption of alcohol: Almost a third 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; 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 Nicaragua as compared to all other Inter-America and Pacific (IAP) 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 Nicaragua
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. You can reduce your risk by developing a security strategy that takes appropriate precautions, avoids uncomfortable situations, and takes you out of harms way. Crime at the village or town level is less frequent than in the large cities, especially Managua. People know each other and generally will not steal from their neighbors. Bus terminals, large public gatherings, and tourist attractions in large towns, for instance, are favorite sites for pickpockets. The following are safety concerns in Nicaragua you should be aware of:
Volunteers have reported being robbed of their purse, watch, wallet, or other personal possessions while riding on a crowded bus or walking in an urban area at night. Most petty thieves want only your belongings, and Volunteers are always encouraged to give up personal items should they encounter a thief. The Peace Corps encourages you not bring to Nicaragua any item that you are not willing to lose or to carry items you would not be willing to give up.
Some Volunteers report having their houses broken into and personal items stolen. This typically happens when Volunteers leave their sites. Part of the Volunteer settling-in allowance is dedicated to home security items such as good locks and bars for doors and windows. A Peace Corps staff member will visit your home to inspect your housing conditions and make recommendations to maximize home security. You will receive more information on how to prevent petty theft and burglary during training, and you will receive routine visits to your site from the safety and security coordinator.
Alcohol abuse occurs at a higher rate in Nicaragua than in the United States, so you should avoid areas where there is heavy drinking, especially at night. As a professional, you are expected to adhere to high standards of behavior at all times. If you choose to drink, you must drink responsibly. Alcohol use by Volunteers is a common factor in incidents involving their safety. During training, you will learn how to recognize alcohol abuse and hear some of the real consequences for Volunteers who drank too much alcohol. Irresponsible behavior related to alcohol use is grounds for administrative separation from the Peace Corps.
Statistically speaking, the risk of sexual assault in Nicaragua isn’t substantially higher than in the U.S. Most sexual assaults in Nicaragua occur as a result of domestic violence.
Fortunately, very few Peace Corps Volunteers have been sexually assaulted. Women serving in Nicaragua should know that some men may see them as sexual objects, that friendships with men are not culturally the norm, and that they need to maintain a constant awareness of the threat of sexual assaults. “Come-ons” made by men to women as they walk by are common and can be especially offensive to American women. You will receive information during training on how to minimize your risks of sexual assault and harassment 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, develop a security strategy, use sound judgement, ensure that your house is secure, and develop relations in your community that will make you an unlikely victim of crime. In coming to Nicaragua, 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 Nicaragua will 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 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. Keep your money out of sight by using an under-garment money pouch, the kind that hangs around your neck and stays hidden under your shirt or inside your pants. Do not keep your money in outside pockets of backpacks, in shirt pockets, or in fanny packs. In general walking around Managua is not safe or convenient; all Volunteers are required to use taxis at all hours of the day or night when in Managua. At your site, you should always consider walking with a companion.
Volunteers and trainees should bring only such personal property and cash with them as is necessary to maintain the modest standard of living expected of Volunteers. Given the substantial risk of theft and difficulty in safeguarding property overseas, do not bring excess cash or expensive or valuable items. A safe is available in the Peace Corps office to store valuable items you may choose to bring, such as your personal passport, credit cards, cash, etc.
Preparing for the Unexpected: Safety Training and Volunteer
 Support in Nicaragua
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. Nicaragua’s in-country safety program is outlined below.
The Peace Corps/Nicaragua 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 and safety and security coordinator. Yearly safety and security meetings for Volunteers are held in all departmental capitals to share regional experiences and receive relevant updates. 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 Nicaragua. This training will prepare you to develop a security strategy that involves adopting a culturally appropriate lifestyle and exercising 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.
Strict site selection criteria are used to determine and approve Volunteers’ work sites. Each site is inspected before the Volunteer’s arrival to ensure it meets the Peace Corps/Nicaragua’s site approval criteria related to adequate work options, housing, communications, basic infrastructure (availablility of basic foodstuffs and water), transportation options, and other support needs. 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.
You will also learn about Nicaragua’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 detailed site locator form with your address, contact information, and a map to your house. If there is a security threat, Volunteers in Nicaragua will gather 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 a Peace Corps staff member. 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.