Health care and safety in Dominican Republic
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 the Dominican Republic maintains a clinic with two full-time medical officers, who take care of Volunteers’ primary healthcare needs. Additional medical services, such as testing and basic treatment, are also available in the Dominican Republic at local, American-standard hospitals. If you become seriously ill, you will be transported either to an American-standard medical facility in the region or to the United States.
- 1 Health Issues in the Dominican Republic
- 1.1 Helping You Stay Healthy
- 1.2 Maintaining Your Health
- 1.3 Women’s Health Information
- 1.4 Your Peace Corps Medical Kit
- 1.5 Before You Leave: A Medical Checklist
- 1.6 Safety and Security—Our Partnership
- 1.7 Factors that Contribute to Volunteer Risk
- 1.8 Summary Strategies to Reduce Risk
- 1.9 Support from Staff
- 1.10 What If You Become a Victim of a Violent Crime?
- 1.11 Security Issues in the Dominican Republic
- 1.12 Staying Safe: Don’t Be a Target for Crime
- 1.13 Preparing for the Unexpected: Safety Training and Volunteer Support in the Dominican Republic
Health Issues in the Dominican Republic
Major health problems among Volunteers in the Dominican Republic are rare and are often the result of a Volunteer’s not taking preventive measures to stay healthy. The most common health problems in the country are minor ones that are also found in the United States, such as colds, diarrhea, sinus infections, skin infections, headaches, dental problems, STIs, adjustment disorders, and alcohol abuse. These problems may be more frequent or compounded by life in the Dominican Republic because certain environmental factors here raise the risk or exacerbate the severity of illnesses and injuries.
The most common major health problems are malaria, amoebic dysentery, dengue fever, and HIV/AIDS. Because malaria is endemic in the Dominican Republic, taking antimalarial pills is required. You will receive vaccinations against the following: hepatitis A, hepatitis B, meningococcal meningitis, rabies, typhoid, MMR (measles, mumps, and rubella), and TD (tetanus and diphtheria). If you have already received any of these vaccinations, please bring written documentation of the dates they were administered.
Amoebic dysentery can be avoided by thoroughly washing fruits and vegetables and either boiling drinking water or using the water purification tablets provided in your Peace Corps-issued medical kit.
Helping You Stay Healthy
The Peace Corps will provide you with all the necessary inoculations, medications, and information to stay healthy. Upon your arrival in the Dominican Republic, you will receive a medical handbook. During training, you will receive a medical kit with supplies to take care of mild illnesses and first-aid needs. The contents of the kit are listed later in this chapter.
During pre-service training, you will have access to basic medical supplies through the medical officer. However, you will be responsible for your own supply of prescription drugs and any other specific medical supplies you require, as we will not order these items during training. Please bring a three-month supply of any prescription drugs you use as they may not be available here and it may take several weeks for shipments to arrive.
You will have a medical evaluation at mid-service and a physical examination at the end of your service. If you develop a serious medical problem during your service, the medical officer in the Dominican Republic will consult with the Office of Medical Services in Washington, D.C. If it is determined that your condition cannot be treated in the Dominican Republic, 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 most important step in preventing malaria and dengue is to avoid being bitten by mosquitoes. The best ways to avoid insect bites are to sleep under a mosquito net, wear long sleeves and pants whenever possible, use insect repellent, and keep screens on your windows and doors. The mosquitoes that transmit malaria bite primarily between dusk and dawn; the mosquitoes that transmit dengue are day feeders. The Peace Corps requires all Volunteers serving in the Dominican Republic to take the antimalarial drug Aralen (chloroquine). Aralen, however, can exacerbate dermatological conditions such as psoriasis. If you have a history of psoriasis, contact the medical office in Washington, D.C., before you leave for staging. You may be able to take an alternative antimalarial medication.
Rabies is endemic throughout the region. You will receive a series of three vaccinations to protect you against rabies once you arrive in the Dominican Republic. If you are bitten by any animal, inform your medical officer immediately so appropriate action may be taken.
Many diseases that afflict Volunteers worldwide are entirely preventable if proper food and water preparation is followed. These illnesses include food poisoning, parasitic infections, hepatitis A, dysentery, parasitic infections and typhoid fever. Your medical officer will discuss specific standards for water and food preparation in the Dominican Republic during pre-service training.
Abstinence is the only way to prevent the transmission of HIV and other STIs. You are taking risks if you choose to be sexually active. To lessen these risks, 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 this person is free of HIV/AIDS or other STIs. The Dominican Republic has a high infection rate of STIs and HIV/AIDS. You will receive more information from your medical officer about this important issue.
Sexually active Volunteers are expected to adhere to an effective means of birth control to prevent an unplanned pregnancy. Oral contraceptives and condoms are available in the health unit.
It is critical to your health that you promptly report to the medical office 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.
There are many feminine hygiene productsm available on the local market; therefore, Peace Corps/Dominican Republic will not provide these products. If you prefer a specific product, you should bring a supply with you.
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
American Red Cross First Aid & Safety Handbook
Antiseptic antimicrobial skin cleaner
Diphenhydramine HCL 25 mg (Benadryl)
Iodine tablets (for water purification)
Oral rehydration salts
Pseudoephedrine HCL 30 mg (Sudafed)
Sterile gauze pads
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, you must complete that work and make sure your dentist sends the required reports or X-rays to the Office of Medical Services.
If you wish to avoid having duplicate vaccinations, obtain a copy of your immunization record and bring it with you. 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 once you arrive in-country. You do not need to begin taking malaria medication prior to arrival.
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 weeks—you will be dependent on your own medication supply. The Peace Corps will not pay for herbal or nonprescribed medications, such as St. John’s Wort, glucosamine, selenium, or antioxidant supplements.
You are encouraged to bring copies of medical prescriptions signed by your physician. This is not a requirement, but they might come in handy if you are questioned in transit about carrying a three-month supply of prescription medications.
If you wear eyeglasses, bring two pairs with you—a pair and a spare. Peace Corps will replace one pair of glasses during your two-year term of service. We discourage 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).
- 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 Dominican Republic as compared to all other Inter-America and Pacific (IAP) 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 firstname.lastname@example.org.
Security Issues in the Dominican Republic
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 the Dominican Republic. 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 the Dominican Republic you should be aware of:
Motor vehicle accidents. These are the single greatest risk to your safety in the Dominican Republic. You are strongly encouraged to wear seat belts whenever available and to avoid riding in overcrowded public buses or vans. Volunteers are not allowed to drive motorized vehicles and are prohibited from traveling long distances in cars or buses at night. When you travel for official business, the Peace Corps will reimburse your expenses for bus or airline tickets.
Robbery/burglary. Some Volunteers’ homes have been robbed in the past, so you need to exercise the same precautions that you would in the United States. The Peace Corps will provide information on proper home safety during training and requires landlords to install deadbolt locks on all Volunteer housing. In addition, many Americans and Dominicans have been the victims of muggings, especially in Santo Domingo.
A common strategy of muggers is for a man to walk up behind a person and grab his or her cellphone, bag, or purse, making a getaway on a motorcycle driven by a partner. It is therefore important to travel on well-lit streets at night with other people around you.
Border conflicts. Dominicans and Haitians have had border conflicts in the past. At times, the disputes have resulted in gunfire and the involvement of the military. For safety reasons, you must get approval from Peace Corps staff before traveling to Haiti.
Harassment. Volunteers have reported varying levels of harassment, such as sexual comments and being called derogatory names, though this rarely happens at Volunteers’ sites, where they are known. Strategies for dealing and coping with harassment will be discussed during pre-service training.
Alcohol abuse. The Dominican Republic has a higher rate of alcoholism than the United States. Volunteers have reported being approached by drunken men asking for money and alcohol. It is best to avoid frequenting non-hotel bars, particularly at night. Alcohol use impairs judgment and must be consumed responsibly. The Peace Corps does not tolerate public drunkenness by Volunteers, which can lead to termination of their service.
Sexual assault. Volunteers have been targets of sexual assault in the Dominican Republic. Alcohol consumption and cross-cultural differences in gender relations often are associated with sexual assaults. In addition, the assailant often is an acquaintance of the Volunteer. Volunteers who take seriously the training provided by the Peace Corps regarding sexual assaults will minimize their risk. Volunteers are urged to report all assaults and threats of assault to the Peace Corps medical officer so that staff can respond with appropriate support. (Note that sex outside of marriage is not looked upon favorably in the Dominican Republic and that promiscuous behavior on your part may jeopardize your safety or your ability to develop mutually respectful relationships in your community and your job.)
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 home is secure, and develop relations in your community that will make you an unlikely victim of crime. In coming to the Dominican Republic, do what you would do if you moved to a large city in the United States:
Be cautious, check things out, ask questions, learn about your neighborhood, know where the more risky locations are, use common sense, and be aware. You can reduce your vulnerability to crime by integrating into your community, learning the local language, acting responsibly, and abiding by Peace Corps policies and procedures. Serving safely and effectively in the Dominican Republic 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 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 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 do not carry beepers or cellphones in visible places, as they are common targets of robbers. Always walk with a companion at night.
Preparing for the Unexpected: Safety Training and Volunteer Support in the Dominican Republic
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 reporting and responding to safety and security incidents. The Dominican Republic’s in-country safety program is outlined below.
The Peace Corps/Dominican Republic office will keep Volunteers informed of any issues that may impact Volunteer safety through information sharing. Regular updates will be provided in Volunteer newsletters and in memorandums from the country director. In the event of a critical situation or emergency, Volunteers will be contacted through the emergency communication network.
Volunteer training will include sessions on specific safety and security issues in the Dominican Republic. 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; different housing options and living arrangements; and other Volunteer support needs.
You will also learn about Peace Corps/Dominican Republic’s detailed emergency action plan, which is implemented in the event of civil or political unrest or a natural disaster. When you arrive at your site, you will complete and submit a site locator form with your address, contact information, and a map to your house. If there is a security threat, Volunteers in the Dominican Republic 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 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.