Health care and safety in the Eastern Caribbean
From Peace Corps Wiki
|Health care and safety in the Eastern Caribbean|
|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/Eastern Caribbean maintains its own in-country health unit with three full-time medical officers. One, based on St. Lucia, is responsible for the medical needs of Peace Corps Volunteers on Dominica and St. Lucia. Another, based in St. Vincent and the Grenadines looks after Volunteers on St. Vincent and the Grenadines, as well as Grenada. The third, based on St. Kitts, takes care of Volunteers on Antigua and Barbuda and St. Kitts and Nevis. The medical officers travel regularly to the island nations in their care. Consultant medical services are also available throughout the Eastern Caribbean. In addition, the Peace Corps has a well-organized system for moving seriously ill Volunteers to the continental United States or another appropriate site when necessary.
The Peace Corps medical program emphasizes the preventive approach to disease rather than the curative mode. As a rule of thumb, good healthcare comes from good health maintenance. Health conditions in the Caribbean are good by international standards, but certain immunizations are required 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. If you have any concern about the type and quantity of innoculations you will receive during your service, please consult with the Peace Corps Office of Medical Services in Washington, D.C. Refusal to get shots or take prescribed medication will be grounds for removal from service. All trainees will receive extensive medical orientation during training.
 Health Issues in the Eastern Caribbean
It is critical to your health that you promptly report to the medical office or other designated facility for scheduled immunizations, and that you let your medical officer know immediately of significant illness and injuries. Many diseases that afflict Volunteers worldwide are entirely preventable, but only if proper care and precautions are taken. Food and water can pose a challenge to healthy living in the Eastern Caribbean. The most common diseases include food poisoning, environmental allergies, conjunctivitis (or pink eye), heat rash, swimmer’s ear, viral infections, diarrhea, urinary tract infections, and dengue fever. Your medical officer will discuss specific standards for water and food preparation during pre-service training. Other diseases prevalent in the Eastern Caribbean include STDs, especially HIV/AIDS, alcohol and drug abuse, diabetes, and hypertension.
A recent increase in hurricanes passing through the region has significantly increased Volunteer stress levels. The need to consolidate in preparation for a storm disrupts Volunteer activities and may take Volunteers away from their sites for a number of days, even weeks. In addition, if a storm does impact a Volunteer’s island, dealing with the trauma and devastation can pose particular issues to mental health and well-being. Peace Corps staff are trained to assist Volunteers in dealing with issues associated with hurricanes.
 Helping You Stay Healthy
Peace Corps/Eastern Caribbean provides personalized healthcare service to trainees and Volunteers. You will receive all the necessary inoculations, medications, and information to stay healthy. Upon your arrival in the Eastern Caribbean you will receive a medical handbook. At the beginning of training, you will receive a health kit with supplies to take care of mild illnesses and first-aid needs.
During training, you will have access to basic first-aid supplies through the medical officer. However, during this time, you will be responsible for your own supply of prescription drugs and any other specific medical supplies you require, as we will not order these items during training. Please bring at least a three-month supply of any prescription drugs or special medical supplies that you use, since they may not be available in-country and it may take several months for new shipments to arrive.
We will provide you with well-tested and proven generic medications to suit your needs. We cannot gurantee that we will provide you with the U.S. brand-name medications you currently use .You may want to consult with your physician now and switch from brand-name to generic medications before you come. In particular, women using oral contraceptives of a particular brand and composition may find that we will replace what they are used to with generics with the exact same composition of hormones and other components.
You will have physicals at mid-service and at the end of your service. If you develop a serious medical problem during your service, the medical officer in charge of your island of assignment will consult with the Office of Medical Services in Washington, D.C. If it is determined that your condition cannot be treated on island, you may be sent out of the country for further evaluation and care.
 Maintaining Your Health
As a Volunteer, you must accept significant responsibility for your own health. Proper precautions will significantly reduce your risk of serious illness or injury. The old adage “An ounce of prevention …” becomes extremely important in areas where medical diagnostic and treatment facilities lack appropriate technology and resources. The most important of your responsibilities in the Eastern Caribbean includes taking preventive measures for the following:
Dengue fever is a common health problem in all of the islands, so you should take all the necessary precautions against mosquito bites. The Ades egypti mosquito is the carrier of this disease. Avoid mosquito bites by wearing appropriate clothing, ensure that your landlord provides screens on your windows, and use Peace Corps-provided mosquito netting and insect repellent.
Food poisoning is another common ailment that can be avoided by following proper food and water safety precautions. You will be cautioned about the quality of potable water and given instructions on how to keep your drinking water potable.
It is important to emphasize that HIV/AIDS is a sexually transmitted disease and concerns all sexually active individuals, both homosexual and heterosexual. The keys to reducing the risk of exposure to HIV/AIDS are knowledge and prevention. The Peace Corps has adopted medical policies and practices worldwide to help protect its Volunteers and staff from transmission of the disease; however, only you can avoid the risk of infection. While you will receive more information from your medical officer about this important issue, you must be aware of the following basic facts:
- Worldwide, 5 million to 10 million people may be infected with the virus that causes AIDS.
- The incidence of HIV/AIDS in the Caribbean is second only to sub-Saharan Africa.
- HIV/AIDS is fatal and currently cannot be cured.
- The AIDS virus is spread by sexual intercourse, by contaminated blood, and by contaminated hypodermic needles.
- A person can look and feel healthy and still be able to spread the virus.
- An infected woman can pass AIDS to her child during pregnancy or during birth.
- HIV/AIDS has not been shown to be spread by casual contact, such as living in the same house or sharing eating utensils, etc.
- HIV/AIDS has not been shown to be transmitted by biting insects.
- Celibacy or a stable, monogamous relationship with another uninfected person is the safest way to avoid infection. In any case, reducing the number of sexual partners reduces the chances of getting HIV/AIDS.
- Use of condoms reduces the exchange of body fluids and may reduce the risk of HIV/AIDS infection during sexual contact.
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 time you have sex. Whether your partner is a host country citizen, a fellow Volunteer, or anyone else, do not assume they are free of HIV/AIDS or other STDs.
Your Peace Corps medical officer will provide you with more specific in-country information and will keep you informed of measures you can take to reduce your risk of exposure.
 Women’s Health Information
Volunteers are expected to adhere to an effective means of birth control to prevent unplanned pregnancies. Your medical officer can help you decide on the most appropriate method to suit your individual needs. Contraceptive methods are available without charge from the medical officer. Pregnancy is a health condition that is treated in the same manner as other Volunteer health conditions requiring medical attention, but may also have programmatic ramifications. The Peace Corps is responsible for determining the medical risk and the availability of appropriate medical care if a pregnant Volunteer remains in-country. Given the circumstances under which Volunteers live and work in Peace Corps countries, it is rare that the Peace Corps medical and programmatic standards for continued service could be met. The majority of Volunteers who become pregnant are medically separated.
Feminine hygiene products are readily available in all the Eastern Caribbean island nations. 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 health kit that contains basic items necessary to prevent and treat illnesses that might occur during service. Kit items can be periodically restocked at your Peace Corps medical office.
 Medical Kit Contents
Ace bandage 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 the time you submitted your examination reports to the Peace Corps, you must immediately notify the Office of Medical Services. Failure to disclose new illnesses, injuries, allergies, or pregnancy can endanger your health and may jeopardize your eligibility to serve.
If your dental exam was done more than a year ago, or if your physical exam is more than 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, you should 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 Eastern Caribbean.
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. You may want to switch to generics before you come as we may not be able to provide you with U.S. brand-name medications.
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 non-prescribed medications, such as St. John’s Wort, glucosamine, Selenium, or anti-oxidant supplements.
You are encouraged to bring copies of medical prescriptions signed by your physician. This is not a requirement, although it might come in handy if you are questioned in transit about your on-hand three-month supply of prescription drugs.
If you wear eyeglasses, bring two pairs with you—a pair and a spare. If a pair breaks, the Peace Corps will replace it, using the information your doctor in the United States provided on the eyeglasses form during your examination. Many Volunteers in the Eastern Caribban use contacts without problems, but Peace Corps will not supply or replace contact lenses or associated solutions unless an ophthalmologist has recommended it for a specific medical condition and the Peace Corps’ Office of Medical Services has given approval. However, please keep in mind the appropriate water and sanitation to support eye care with the use of contact lenses may not be available in all sites.
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 and/or preexisting conditions might prevent you from re-enrolling in your current plan when you return home.
 Safety and Security—Our Partnership
Serving as a Volunteer overseas entails certain safety and security risks. Living and traveling in an unfamiliar environment, a limited understanding of the local language and culture, and the perception of being a wealthy American are some of the factors that can put a Volunteer at risk. Property thefts and burglaries are not uncommon. Incidents of physical and sexual assault do occur, although almost all Volunteers complete their two years of service without serious personal safety problems. In addition, more than 84 percent of Volunteers surveyed in the 2004 Peace Corps Volunteer Survey say they would join the Peace Corps again.
The Peace Corps approaches safety and security as a partnership with you. This Welcome Book contains sections on: Living Conditions and Volunteer Lifestyle; Peace Corps Training; and Your Health Care and Safety. All of these sections include important safety and security information.
The Peace Corps makes every effort to give Volunteers the tools they need to function in the safest and most secure way possible, because working to maximize the safety and security of Volunteers is our highest priority. Not only do we provide you with training and tools to prepare for the unexpected, but we teach you to identify and manage the risks you may encounter.
 Factors that Contribute to Volunteer Risk
There are several factors that can heighten a Volunteer’s risk, many of which are within the Volunteer’s control. Based on information gathered from incident reports worldwide in 2004, the following factors stand out as risk characteristics for assaults. Assaults consist of personal crimes committed against Volunteers, and do not include property crimes (such as vandalism or theft).
- Location: Most crimes occurred when Volunteers were in public areas (e.g., street, park, beach, public buildings). Specifically, 43 percent of assaults took place when Volunteers were away from their sites.
- Time of day: Assaults usually took place on the weekend during the evening between 5:00 p.m. and 2:00 a.m.— with most assaults occurring around 1:00 a.m.
- Absence of others: Assaults ususally occurred when the Volunteer was unaccompanied. In 82 percent of the sexual assaults the Volunteer was 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 the Eastern Caribbean as compared to all other Inter-America and Pacific region programs as a whole, from 2001–2005. It is presented to you in a somewhat technical manner for statistical accuracy.
To fully appreciate the collected data below, an explanation of the graph is provided as follows:
The incidence rate for each type of crime is the number of crime events relative to the Volunteer/trainee population. It is expressed on the chart as a ratio of crime to Volunteer and trainee years (or V/T years, which is a measure of 12 full months of V/T service) to allow for a statistically valid way to compare crime data across countries. An “incident” is a specific offense, per Peace Corps’ classification of offenses, and may involve one or more Volunteer/trainee victims. For example, if two Volunteers are robbed at the same time and place, this is classified as one robbery incident.
The chart is separated into eight crime categories. These include vandalism (malicious defacement or damage of property); theft (taking without force or illegal entry); burglary (forcible entry of a residence); robbery (taking something by force); minor physical assault (attacking without a weapon with minor injuries); minor sexual assault (fondling, groping, etc.); aggravated assault (attacking with a weapon, and/or without a weapon when serious injury results); and rape (sexual intercourse without consent).
When anticipating Peace Corps Volunteer service, you should review all of the safety and security information provided to you, including the strategies to reduce risk. Throughout your training and Volunteer service, you will be expected to successfully complete all training competencies in a variety of areas including safety and security. Once in-country, use the tools and information shared with you to remain as safe and secure as possible.
 What If You Become a Victim of a Violent Crime?
Few Peace Corps Volunteers are victims of violent crimes. The Peace Corps will give you information and training in how to be safe. But, just as in the U.S., crime happens, and Volunteers can become victims. When this happens, the investigative team of the Office of Inspector General (OIG) is charged with helping pursue prosecution of those who perpetrate a violent crime against a Volunteer. If you become a victim of a violent crime, the decision to prosecute or not to prosecute is entirely yours, and one of the tasks of the OIG is to make sure that you are fully informed of your options and help you through the process and procedures involved in going forward with prosecution should you wish to do so. If you decide to prosecute, we are here to assist you in every way we can.
Crimes that occur overseas, of course, are investigated and prosecuted by local authorities in local courts. Our role is to coordinate the investigation and evidence collection with the regional security officers (RSOs) at the U.S. embassy, local police, and local prosecutors and others to ensure that your rights are protected to the fullest extent possible under the laws of the country. OIG investigative staff has extensive experience in criminal investigation, in working sensitively with victims, and as advocates for victims. We also, may, in certain limited circumstances, arrange for the retention of a local lawyer to assist the local public prosecutor in making the case against the individual who perpetrated the violent crime.
If you do become a victim of a violent crime, first, make sure you are in a safe place and with people you trust and second, contact the country director or the Peace Corps medical officer. Immediate reporting is important to the preservation of evidence and the chances of apprehending the suspect. Country directors and medical officers are required to report all violent crimes to the Inspector General and the RSO. This information is protected from unauthorized further disclosure by the Privacy Act. Reporting the crime also helps prevent your further victimization and protects your fellow Volunteers.
In conjunction with the RSO, the OIG does a preliminary investigation of all violent crimes against Volunteers regardless of whether the crime has been reported to local authorities or of the decision you may ultimately make to prosecute. If you are a victim of a crime, our staff will work with you through final disposition of the case. OIG staff is available 24 hours-a-day, 7 days-a-week. We may be contacted through our 24-hour violent crime hotline via telephone at 202.692.2911, or by e-mail at [email protected]
 Security Issues in the Eastern Caribbean
When it comes to your safety and security as a Peace Corps Volunteer, you will have 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 all of the Caribbean islands. You can reduce your risk of becoming a target for crime by avoiding situations that make you feel uncomfortable and by taking precautions such as keeping away from high risk areas; not walking in deserted places alone (especially at night); avoiding angry, aggressive people; and keeping out of arguments and quarrels. Crime at the village or town level is less frequent than in the 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. Safety concerns in the Eastern Caribbean you should be aware of are: Break-ins, petty thefts, robberies, drug abuse, alcohol abuse, drug-related crimes, gang feuds, rape, harassment, and vehicular accidents.
 Staying Safe: Don’t Be a Target for Crime
As has been stressed, you must be prepared to take responsibility for your own safety. Basic and personal things like not making yourself a target, ensuring that your house is secure, and developing relations in your community that will make you an unlikely victim of crime are things that you alone can do. In coming to the Eastern Caribbean, do what you would do if you moved to a large city in the United States: Be cautious, check things out, ask a lot of questions, learn about your neighborhood, know where the more risky locations are, use common sense, and always be aware. You can reduce your vulnerability to crime by integrating into your community, acting responsibly, and abiding by Peace Corps policies and procedures. Serving safely and effectively in the Eastern Caribbean may require that you accept some restrictions on your current lifestyle.
Volunteers receive more negative attention in populated centers, where they are anonymous or thought of as tourists. In smaller towns, “family,” friends, and colleagues will look out for them. While whistles and exclamations are fairly common on the street, this behavior can be reduced if you dress conservatively, avoid eye contact, and do not respond to such negative and unwanted attention. Keep your money out of sight. Do not keep your money in outside pockets of backpacks, in coat pockets, or in fanny packs. If you need to be out at night, do so in a group or at least have a companion.
Preparing for the Unexpected: Safety Training and Volunteer
 Support in the Eastern Caribbean
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.
The Peace Corps office will keep Volunteers informed of any issues that may affect their safety through information sharing. Regular updates will be provided in Volunteer newsletters and in memoranda from the country director or safety and security coordinator. In the event of a critical situation or emergency, Volunteers will be contacted through the emergency communication network using a “phone tree.”
Volunteer training will include sessions to prepare you for specific safety and security issues on your island of assignment. 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 cross-cultural, health, and other components of training.
Certain site selection criteria are used to determine safe housing for Volunteers before their arrival. Peace Corps staff work closely with host communities and counterpart agencies to help prepare them for the Volunteer’s arrival and to establish expectations of their respective role in supporting the Volunteer. Each site is inspected before the Volunteer’s arrival to ensure placement in appropriate, safe, and secure housing and work sites. Site selection criteria are based in part on any relevant site history; access to medical, banking, postal, and other essential services; availability of communications, transportation, and markets; different housing options and living arrangements and other support needs.
You will also learn about the Eastern Caribbean’s detailed emergency action plan in the event of civil or political unrest or a natural disaster. A booklet covering the emergency action plan will be given to each Volunteer. 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 will gather at pre-determined locations until the situation resolves itself or the Peace Corps decides to evacuate.
Finally, in order to be fully responsive to the needs of Volunteers, it is imperative that Volunteers immediately report any security incident to Peace Corps staff. The Peace Corps has established protocols for addressing safety and security incidents in a timely and appropriate manner. In addition to responding to the needs of the Volunteer, the Peace Corps collects and evaluates safety and security data to track trends and develop strategies to minimize risks to future Volunteers.