Health care and safety in Cape Verde

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Health care and safety in [[{{#explode:Health care and safety in Cape Verde| |5}} {{#explode:Health care and safety in Cape Verde| |6}} {{#explode:Health care and safety in Cape Verde| |7}}]]
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.

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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 trainee and Volunteer. Peace Corps medical programs emphasize the preventive, rather than the curative approach to illness and disease. The Peace Corps in Cape Verde maintains a clinic with a full-time medical contractor (an American nurse practitioner), who takes care of trainees’/Volunteers’ primary healthcare needs. Some additional medical services, such as testing and basic treatment, are also available in Cape Verde at a local hospitals and health clinics. If a trainee or Volunteer becomes seriously ill and cannot be treated here, he or she will be transported to higher quality medical facility in the region and/or to the United States.

Health Issues in Cape Verde

Cape Verde is a country in which it is relatively easy to stay healthy. The typical tropical diseases experienced on the continent of Africa, such as schistosomiasis and fi liariasis, do not occur here. There are occasional isolated outbreaks of malaria during the rainy season on the island of Santiago; consequently, Volunteers on Santiago are required to take malaria prophylaxis for part of the year.

There are health issues in Cape Verde, however, that you may not encounter in the United States. You may acquire intestinal parasites, which cause diarrhea and discomfort, but this is usually easily diagnosed and treated, as is diarrheal illness caused by food poisoning. In addition, fair-skinned people must be very cautious about the sun—sunburn, permanent sun damage, and the development of pterygium (a callous-like growth on the eyeball from the sun exposure) can be cause for concern. Sun-related health problems are easily remedied by wearing a hat, sunscreen, and good-quality sunglasses. The Peace Corps does not supply sunglasses, regular or prescription. You must bring or ship your own sunglasses.

A surprise to most Americans is that the vast majority of health concerns in Cape Verde are the same as in the United States. Colds, minor injuries, and mild bacterial infections make up the majority of the Volunteer’s health problems.

There are two larger hospitals in Cape Verde: one in Praia and one in Mindelo. Both hospitals have basic capabilities. The remainder of the healthcare system is divided into small regional hospitals and out-patient dispensaries, but the care is of variable quality and limited in scope. Of particular concern is the inappropriate use of antibiotics, especially those given by injection. Therefore, you should check with the medical officer before taking any locally purchased or prescribed drug. Because of the limited capacity of emergency medical care in Cape Verde, the risk of trauma is of great concern. To reduce the risk of accidents, the Peace Corps has strict guidelines about vehicle, motorcycle, and bicycle use.

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 Cape Verde, you will receive a medical handbook, as well as a first-aid 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 pre-service training, you will have access to basic fi rstaid supplies in the medical kit. 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 a three-month supply of any prescription drugs you use, since they may not be available here and it may take several months for new shipments to arrive.

You will have physicals at the midpoint and at the end of your service. If you develop a serious medical problem during your service, the medical contractor in Cape Verde will consult with the Office of Medical Services at Peace Corps headquarters in Washington, D.C.

The health unit for Peace Corps/Cape Verde is maintained at its offices in Praia. The facility is similar to that of a small family practice clinic in the United States, and it also contains a small pharmacy. The health unit is a combined facility, used by both the Peace Corps and U.S. embassy staff. The unit is staffed by a Peace Corps medical contractor or offi cer (also referred to as a PCMO), who is a nurse practitioner. A Cape Verdean medical secretary and a registered nurse provide coverage on alternate weekends and when the PCMO is not available. The PCMO’s primary responsibilities are to provide medical care, immunizations, and health training to trainees/ Volunteers; and to assist Peace Corps staff in programming, counseling, and other support functions. The health unit is open five days a week during normal working hours. It is closed on weekends and holidays, but the PCMO, or her backup, is on call at all other times for emergencies via cellphone.

Maintaining Your Health

As a trainee or Volunteer, you must accept a certain amount of responsibility for maintaining 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 are not up to the standards of the United States. Your most important responsibility in Cape Verde includes taking preventive measures.

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 contractor know immediately of significant illness and injuries.

Many diseases that afflict Volunteers worldwide are entirely preventable if proper food and water precautions are taken. These diseases include food poisoning, amebiasis, giardiasis, hepatitis A, dysentery, guinea worm, tapeworms, and typhoid fever. The medical contractor will discuss specifi c standards for water and food preparation for Cape Verde during pre-service training.

Abstinence is the only certain choice for prevention of HIV/ AIDS and other sexually transmitted diseases (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 Cape Verdean, a fellow trainee or 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 unit about this important issue.

Trainees and Volunteers are expected to adhere to an effective means of birth control to prevent unplanned pregnancies. The Peace Corps medical officer can help you decide on the most appropriate method to suit your individual needs. Contraceptives are available without charge from the Peace Corps medical offi cer.

Dental care, fillings, crowns, root canals, and yearly cleanings are provided in Cape Verde. Volunteers are expected to practice good oral hygiene habits that protect their teeth during their two years of service. Toothbrushes and fl uoride toothpaste are available at local markets and dental fl oss is provided by the medical unit. There are several Cape Verdean dentists who provide U.S.-standard dental care to Volunteers.

If you wear eyeglasses, bring two durable pairs. The Peace Corps will purchase a new pair of eyeglasses from a government vendor if yours become damaged beyond repair, lost, or stolen. However, because the process takes two to three months and the frame choices are limited, it is worthwhile to have a good backup pair.

The Peace Corps in Cape Verde strongly discourages the use of contact lenses. Volunteers who use contact lenses have developed serious eye infections from poor sanitation and the dusty conditions that prevail here during much of the year. If you choose to wear contact lenses in Cape Verde, all expenses for the lenses and materials are your responsibility. Plan to ship or bring all contact lens supplies. The Peace Corps will not supply or replace contact lenses or associated solutions unless their use has been recommended by an ophthalmologist for a specific medical condition and the Peace Corps Office of Medical Services has given approval.

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 ramifi cations. 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. The majority of Volunteers who become pregnant are medically separated, terminating their Peace Corps service.

Regarding feminine hygiene products, only tampons are available in the health unit and are limited to regular size OB tampons. Sanitary pads are available on the local market and are not provided by the health unit. If you require another brand of tampon other than OB regular, please bring a supply with you. Alternatively, you may want to look into a device called the Keeper, which many Volunteers use successfully (for more information about this product go to: www.

Your Peace Corps Medical Kit

The Peace Corps medical officer provides Volunteers with a first-aid kit that contains basic items necessary to prevent and treat illnesses that might occur during service. Kit items can be periodically restocked at the Peace Corps medical offi ce.

Medical Kit Contents

Diphenhydramine HCL (Benadryl): 25 mg tablets
Pseudephedrine HCL (Sudafed): 30 mg tablets
Antacid tablets (Tums)
Antiseptic antimicrobial skin cleaner (Hibiclens)
Tinactin cream (Tolnaftate)
Bacitracin/Neomycin/Polymycin B ointment
Tetrahydrozaline eye drops (Visine)
Cepacol lozenges
Robitussin-DM lozenges (Cough calmers)
Iodine tablets (Water purifi cation tablets)
Lip balm (Chapstick)
Insect repellant stick (Cutter’s)
Oral thermometer (Fahrenheit)
Oral rehydration salts and Gatorade
Adhesive tape
Butterfl y closures
Ace bandage
Sterile gauze pads
Dental floss
Red Cross First Aid and Personal Safety Manual

Before You Leave: A Medical Checklist

If there has been any change in your health since the time you submitted your examination reports to the Peace Corps— physical, mental, or dental—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 Offi ce 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 Peace Corps Office of Medical Services.

If you wish to avoid taking duplicate vaccinations, you should contact your physician’s office, obtain a copy of your immunization record, and bring it with you to your predeparture orientation (also called staging). 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 Cape Verde.

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 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 are eligible for Medicare, 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 benefi ts 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 pre-existing 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 Cape Verde as compared to all other Africa region programs as a whole, from 2000–2004. It is presented to you in a somewhat technical manner for statistical accuracy.

To fully appreciate the collected data below, an explanation of the graph is provided as follows

The incidence rate for each type of crime is the number of crime events relative to the Volunteer/trainee population. It is expressed on the chart as a ratio of crime to Volunteer and trainee years (or V/T years, which is a measure of 12 full months of V/T service) to allow for a statistically valid way to compare crime data across countries. An “incident” is a specific offense, per Peace Corps’ classification of offenses, and may involve one or more Volunteer/trainee victims. For example, if two Volunteers are robbed at the same time and place, this is classified as one robbery incident.

The chart is separated into eight crime categories. These include vandalism (malicious defacement or damage of property); theft (taking without force or illegal entry); burglary (forcible entry of a residence); robbery (taking something by force); minor physical assault (attacking without a weapon with minor injuries); minor sexual assault (fondling, groping, etc.); aggravated assault (attacking with a weapon, and/or without a weapon when serious injury results); and rape (sexual intercourse without consent).

When anticipating Peace Corps Volunteer service, you should review all of the safety and security information provided to you, including the strategies to reduce risk. Throughout your training and Volunteer service, you will be expected to successfully complete all training competencies in a variety of areas including safety and security. Once in-country, use the tools and information shared with you to remain as safe and secure as possible.

Security Issues in Cape Verde

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 Cape Verde. You can reduce your risk of becoming a target for crime by avoiding situations that make you feel uncomfortable and by taking advance 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, markets and beaches (especially in large towns), are the favorite places for pickpockets to ply their trade. While Cape Verde is known as a peaceful country, Peace Corps trainees and Volunteers may suffer from being easily identified targets for petty thieves. Petty theft is increasingly on the rise and the most common security risk. Purse snatchings are common in particular areas of Praia, and a lackadaisical attitude towards household security (securely locking doors and windows) has resulted in loss of personal property like MP3 players, and CD collections. Paying attention to your personal and home security will be essential toward making your service incident free. Peace Corps/Cape Verde advises Volunteers to limit their travel to Praia. Integration into your community through CAREFUL selection of friendships can be one of the most effective ways of securing your personal safety.

We caution Volunteers to take their time getting into relationships. In Cape Verdean culture a woman essentially becomes the property of a man, whether you remain together or not.

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 the victim of crime. In coming to Cape Verde, do what you would do if you changed residence in the United States: be cautious, check things out, ask a lot of questions, learn about your neighborhood, know about where the more risky locations and which neighborhoods to avoid, 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 which are in place for your protection. Serving safely and effectively in Cape Verde may require that you accept some restrictions to your current lifestyle. Volunteers attract a lot of attention in large cities and at their sites. However, they receive far more negative attention in highly populated centers where they are anonymous; in smaller towns, “family,” friends, and colleagues will tend to 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 don’t respond to such negative and unwanted attention. Some precautions a Volunteer should take include keeping money, jewelry, watches and other items that others my consider of value out of sight; and using an undergarment money pouch that stays hidden under clothing. Volunteers should not keep money or other valuables in outside pockets of backpacks, coat pockets, or in fanny packs. Finally, walking at night is not advised. It is best to take a cab and never walk alone.

Preparing for the Unexpected: Safety Training and Volunteer Support in Cape Verde

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 Cape Verde in-country safety program is outlined below.

The Peace Corps/Cape Verde office will keep Volunteers informed of any issues that may impact Volunteer safety through information sharing. Regular updates will be provided in newsletters and in memoranda from the Country Director. In the event of a critical situation or emergency, Volunteers are contacted through the emergency communication network, which is part of the emergency action plan.

Volunteer training will include sessions to prepare you for specific safety and security issues in Cape Verde. 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, or other training components.

Site selection criteria are used to determine safe housing for Volunteers before their arrival in-country. Peace Corps staff works 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 an appropriate, safe, and secure housing and work environment. Site selection criteria 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 support needs.

You will also learn about Peace Corps/Cape Verde’s detailed Emergency Action Plan, 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 that will include your address, main/alternate 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, to be fully responsive to the needs of Volunteers, it is imperative that Volunteers immediately report any security incident (big or small) to the Peace Corps staff. The Peace Corps has established protocols for addressing safety and security incidents in a timely and appropriate manner. The Peace Corps also collects and evaluates safety and security data to track trends and develop strategies to minimize risks to future Volunteers.