Health care and safety in Kiribati
From Peace Corps Wiki
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 Kiribati maintains a clinic with a full-time medical officer, who takes care of Volunteers’ primary healthcare needs. Additional limited medical services, such as evaluation and treatments, are also available in Kiribati at Tungaru Central Hospital. If you become seriously ill, you will be transported to an American-standard medical facility in the region, to Australia, or to the United States.
Health Issues in Kiribati
Among the health issues of the I-Kiribati people are smoking, HIV/AIDS and other STDs, alcohol abuse, diabetes and heart disease, malnutrition, dehydration, and infections from cuts, sores, and insect bites. You will work on some of these issues if you are a health Volunteer, and you will need to know about others in order to maintain your own health. Past Kiribati Volunteers have required medical evacuation as a result of seemingly minor cuts that were not kept clean and properly managed. There is also a risk of injury in traffic accidents in South Tarawa and in mishaps on the coral reef.
The prevalence of smoking is declining in developed countries, but increasing in developing countries. Eighty-five percent of I-Kiribati smoke. Many host country nationals will undoubtedly view you as an authority and role model in the healthcare field and may see smoking as a benefit or a sign of being more modern and acceptable. Smoking not only significantly increases the likelihood of premature death and disability, but engenders an image that contradicts the goals of the Peace Corps’ health programs. By choosing not to smoke, you may help others decide not to smoke. If you are currently a smoker, but want to stop, the Peace Corps will help you quit. Smoking is not allowed inside any Peace Corps building or vehicle worldwide.
The Peace Corps has adopted medical policies and practices worldwide to help protect Volunteers and staff from infection with HIV, but the behavior of each Volunteer will have the greatest impact on preventing infection. It is important to emphasize that while AIDS in the United States has occurred primarily in certain high-risk groups, in parts of the developing world the disease affects men and women equally, regardless of sexual preference.
The keys to reducing the risk of exposure to AIDS are knowledge and prevention. Your Peace Corps medical officer will provide you with more specific information about Kiribati and will keep you informed of measures you can take to reduce your risk of exposure. Measures include abstinence, monogamous relationships, consistent and correct use of condoms; avoiding any injections not provided by the Peace Corps medical officer; avoiding blood transfusions except under the supervision of the medical officer; not sharing toothbrushes and razors (which may be contaminated with blood); and avoiding any penetration of skin surfaces (such as acupuncture, ear piercing, tattooing, or incisions of the skin during traditional ceremonial or healing practices).
Alcoholism and drunkenness are major health and social issues for I-Kiribati. People who are friendly and kind when sober may become dangerous and reckless menaces to themselves and others when drunk. Intoxicated bus drivers have caused serious accidents on the main road through South Tarawa. Spousal abuse is not uncommon when alcohol is involved. Volunteers have a dual responsibility to be role models themselves by not abusing alcohol and to avoid people who are drinking too much. Volunteers should not go out alone at night or get on any bus if the driver seems impaired. Volunteers might also consider working in alcohol and smoking awareness campaigns as secondary (or primary) projects. Volunteers should avoid drinking irresponsibly. A Volunteer who is unable to control compulsive drinking habits needs to see the medical officer. If the alcohol abuse persists, the Volunteer may need to be administratively separated from the Peace Corps.
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 Kiribati, you will receive a medical handbook. At the end of 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, since they will not be available here and it takes several months for new shipments to arrive.
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 Kiribati will consult with the Office of Medical Services in Washington, D.C. If it is determined that your condition cannot be treated in Kiribati, you may be sent out of the country for further evaluation and care. The decision to medically evacuate a Volunteer or trainee to Washington, D.C., is made by the Office of Medical Services at Peace Corps headquarters.
Maintaining Your Health
As a Volunteer, you must accept a certain amount of responsibility for your own health. Proper precautions will significantly reduce your risk of serious illness or injury. The old adage “An ounce of prevention Is worth a pound of cure” becomes extremely important in areas where diagnostic and treatment facilities are not up to the standards of the United States and transport from island to island and to the Peace Corps office for medical evaluation and treatment may be difficult and time consuming.
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 illnesses and injuries, including any possible exposure to rabies while traveling (there is no rabies in Kiribati).
Volunteers are prohibited from driving or riding on motorcycles. All Volunteers riding bicycles are required to wear bike helmets, and the Peace Corps will provide these. Failure to comply may result in administrative separation.
Many illnesses that afflict Volunteers worldwide are entirely preventable if proper food and water precautions are taken. These diseases include food poisoning; parasitic infections; hepatitis A, B, and C; dysentery; Guinea worms; tapeworms;
and typhoid fever. Your medical officer will discuss specific standards for water and food preparation in Kiribati during pre-service training.
Abstinence is the only certain choice for preventing infection with HIV and other STDs. You are taking risks if you choose to be sexually active. To lessen risk, use a condom every time you have sex. 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 your medical officer about this important issue.
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.
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. Due to the increased medical risk to the fetus and mother and the lack of appropriate obstetric and perinatal care at post Volunteers wishing to continue their pregnancy will be medically separated.
If feminine hygiene products are not available for you to purchase on the local market, the Peace Corps medical officer in Kiribati will provide them. If you require a specific product, please bring a six-month supply with you.
Your Peace Corps Medical Kit
The Peace Corps medical officer provides Volunteers with a medical 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
Adhesive tape (Durapore)
American Red Cross First Aid & Safety Handbook
Antacid tablets (Tums)
Antibiotic ointment (Bacitracin/Neomycin/Polymycin B)
Antiseptic antimicrobial skin cleaner (Hibiclens)
Benzoyl peroxide (for acne)
Cotton balls and swabs (Q-Tips)
Diphenhydramine HCL 25 mg (Benadryl)
Insect repellent stick (Cutter’s)
Iodine tablets (for water purification)
Lip balm (Chapstick)
Motion sickness medication
Multivitamins, including calcium and vitamin C
Mycelex (for vaginal yeast infections)
Oral rehydration salts and Gatorade
Oral thermometer (Fahrenheit)
Pseudoephedrine HCL 30 mg (Sudafed)
Sterile gauze pads
Tetrahydrozaline eyedrops (Visine)
Tinactin (antifungal cream)
Treatment for body and head lice
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 Kiribati. 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 non-prescribed 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. To reduce your risk of developing a serious infection or other eye disease, we discourage you from using contact lenses during your Peace Corps service. 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 their use has been recommended by an ophthalmologist 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 and/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). Spe-cifically, 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 usually occurred when the Volunteer was unaccompanied. In 82 percent of the sexual assaults the Volunteer was unaccompanied 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 inappro-priate 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 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 Kiribati as compared to all other Inter-America and Pacific (IAP) region programs as a whole, from 2002–2006. 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-aday, 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 Kiribati
Unfortunately, as elsewhere, crime does exist in Kiribati. Because you are a foreigner and probably considered “rich,” your new home may be more prone to break-ins than those of your neighbors. Normal precautions will usually reduce most risks. Crime at the village or town level is much less frequent than in cities, but risks increase in proportion to population size. Living with a host family also significantly reduces risks.
Make sure you have a lock on your door and that you keep it locked when you are away and after dark. Fortunately violent street crime is not a major threat. Although Kiribati is considered safe, women should always be escorted at night or travel in groups. The main reasons for this are that it is culturally mandated, and some people drink too much at night and get out of control. To avoid trouble, do not talk with men who have been drinking excessively and make sure you have co-workers, another Volunteer, or neighbors close by. Peace Corps staff members visit every site before a Volunteer is assigned there to identify a host family and to make certain that housing and other circumstances meet the agency’s safety standards. If the circumstances change later on, it is up to the Volunteer to take appropriate action, such as moving or staying with neighbors, and then contacting the Peace Corps office in Tarawa to schedule a new safety and security visit.
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 victim of crime. In coming to Kiribati, 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 host family and community, learning the Kiribati language, acting responsibly, and abiding by Peace Corps policies and procedures. Serving safely and effectively in Kiribati may require that you accept some restrictions on your current lifestyle.
Volunteers attract a lot of attention in South Tarawa and on outer islands. While traveling in Kiribati or other countries of the Pacific region, you can reduce unwanted attention if you dress conservatively, avoid eye contact, and do not respond to people you don’t want to talk to. Keep your money out of sight. 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. For women, it may be helpful to wear an engagement ring or wedding band.
It is generally recommended that women not travel alone, even during the daytime, between communities on the outer islands. Try to find a friend, a counterpart, or a host family member to accompany you.
Preparing for the Unexpected: Safety Training and Volunteer Support in Kiribati
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. Kiribati’s in-country safety program is outlined below.
The Peace Corps office in Kiribati will keep Volunteers informed of any issues that may impact Volunteer safety through information sharing. Regular updates will be provided in Volunteer newsletters and in memorandums from the country director and staff. In the event of a critical situation or emergency, Volunteers will be contacted through the emergency communication network. At least one Volunteer from each island is required to contact the Peace Corps Office every Wednesday and this is a good opportunity to share any important news in either direction.
Volunteer training will include sessions to prepare you for specific safety and security issues in Kiribati. 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, 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 criteria are based in part on relevant site history; access to medical, postal, and other essential services; availability of communications, transportation, and markets; identification of a responsible host family; and other support needs.
You will also learn about the country’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 with your address, contact information, and a map to your house. If there is a security threat, Volunteers in Kiribati will gather at predetermined locations until the situation resolves itself 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.