Health care and safety in Costa Rica

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Health care and safety in [[{{#explode:Health care and safety in Costa Rica| |5}} {{#explode:Health care and safety in Costa Rica| |6}} {{#explode:Health care and safety in Costa Rica| |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 Volunteer. Peace Corps medical programs emphasize the preventive, rather than the curative, approach to disease. The Peace Corps in Costa Rica maintains a health unit with a full-time medical officer, who takes care of Volunteers’ primary healthcare needs. Medical services may include hospitalization at authorized facilities that are located in the capital city. If you become seriously ill or the resources in-country are insufficient, the Office of Medical Services at Peace Corps headquarters may decide to medically evacuate you to the United States for further care or treatment.

Health Issues in Costa Rica

Health conditions in Costa Rica are typical of those found in tropical countries. Most illnesses can be avoided by using common sense and following basic preventive measures.

Because you will be serving in an area where malaria, a mosquito-borne disease, is prevalent, you will be given and required to take an approved antimalarial drug while you are in-country for your entire service. Humidity and heat promote the growth of skin infections, which you can help prevent by keeping your body clean and dry. Environmental pollution, mold, and pollen found throughout the country year-round can aggravate existing environmental allergies. (Because it is very difficult, even in the United States, to identify the causing allergen, the Peace Corps does not provide allergy testing.) Other illnesses that exist in Costa Rica are dengue fever, rabies, tuberculosis, intestinal parasites, hepatitis A and B, and infection with STDs, including HIV/AIDS.

Helping You Stay Healthy

The Peace Corps will provide you with all the necessary inoculations, medications, and information to stay healthy. 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 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, since they may not be available here and it may take several months for shipments to arrive.

You will have a basic nurse assessment at midservice and a physical examination for clearance at the end of your service. If you develop a serious medical problem during your service, the medical officer in Costa Rica will consult with the Office of Medical Services in Washington, D.C. If it is determined that your condition cannot be treated in Costa Rica, 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 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 of your responsibilities in Costa Rica is to take preventive measures for the following:

Many illnesses that afflict Volunteers worldwide are entirely preventable if proper precautions are taken, such as boiling drinking water and washing fruits and vegetables with soap and water. These illnesses include food poisoning, parasitic infections, hepatitis A, dysentery, tapeworms, and typhoid fever. Your medical officer will discuss specific standards for water and food preparation in Costa Rica during pre-service training.

Abstinence is the only certain choice for preventing infection with HIV and other sexually transmitted diseases. 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 this person is free of HIV/AIDS or other STDs. You will receive more information from the medical officer about this important issue.

Volunteers are expected to adhere to an effective means of birth control to prevent an unplanned pregnancy. Your medical officer can help you decide on the most appropriate method to suit your individual needs. Contraceptive methods are available without charge from the medical officer.

A male Peace Corps Volunteer who fathers a child out of wedlock may be administratively separated if the country director determines that the Volunteer’s action has impaired his ability to perform his assignment or has violated local laws or customs. Absent administrative action, the Peace Corps will pay the prenatal, delivery, and postpartum costs for a non-Volunteer spouse or unmarried partner only if the Volunteer has taken action to acknowledge paternity of the child and only for costs incurred while the trainee or Volunteer is in service. Paternity legislation in Costa Rica states that DNA testing is mandatory when a woman claims a man is the father of her child. If the test establishes paternity, the father automatically must pay child support; if he does not comply, he can be jailed.

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.

Feminine hygiene products are available for you to purchase on the local market. 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 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

Ace bandages
Adhesive tape
American Red Cross First Aid & Safety Handbook
Antacid tablets (Tums)
Antibiotic ointment (Bacitracin/Neomycin/Polymycin B)
Antiseptic antimicrobial skin cleaner (Hibiclens)
Band-Aids
Butterfly closures
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
Pseudoephedrine HCL 30 mg (Sudafed)
Robitussin-DM lozenges (for cough)
Scissors
Sterile gauze pads
Tetrahydrozaline eyedrops (Visine)
Tinactin (antifungal cream)
Tweezers

Before You Leave: A Medical Checklist

If there has been any change in your health—physical, mental, or dental—since you submitted your examination reports to the Peace Corps, you must immediately notify the Office of Medical Services. Failure to disclose new illnesses, injuries, allergies, or pregnancy can endanger your health and may jeopardize your eligibility to serve.

If your dental exam was done more than a year ago, or if your physical exam is more than two years old, contact the Office of Medical Services to find out whether you need to update your records. If your dentist or Peace Corps dental consultant has recommended that you undergo dental treatment or repair, you must complete that work and make sure your dentist sends requested confirmation reports or X-rays to the Office of Medical Services.

If you wish to avoid having duplicate vaccinations, contact your physician’s office, obtain a copy of your immunization record, and bring it to your pre-departure orientation. If you have any immunizations prior to Peace Corps service, the Peace Corps cannot reimburse you for the cost. The Peace Corps will provide all the immunizations necessary for your overseas assignment, either at your pre-departure orientation or shortly after you arrive in Costa Rica. 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, 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 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. 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. 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 Costa Rica as compared to all other Inter-America and Pacific 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 Costa Rica

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 Costa Rica. 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 most common safety risks to Volunteers in Costa Rica are petty crimes like pickpocketing, theft, robbery, and simple assault. Aggravated assault, sexual assault, and rape also occur, as in any other place in the world, so Volunteers must avoid unsafe environments and situations.

Staying Safe: Don’t Be a Target for Crime

You must be prepared to take on a large degree of responsibility for your own safety. Only you can make yourself less of a target, ensure that your house is secure, and develop relations in your community that will make you an unlikely victim of crime. In coming to Costa Rica, 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 Costa Rica may require that you accept some restrictions on your current lifestyle.

Volunteers attract a lot of attention in large cities and at their sites, but they are likely to receive far 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. You should always walk with a companion at night.

Preparing for the Unexpected: Safety Training and Volunteer Support in Costa Rica

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. Costa Rica’s in-country safety program is outlined below.

The Peace Corps/Costa Rica 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 to prepare you for specific safety and security issues in Costa Rica. 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. 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/Costa Rica’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 will receive instructions from the Peace Corps about the appropriate action to take. This might include gathering with other Volunteers at a predetermined location 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 medical officer. 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.