Health care and safety in Macedonia

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Health care and safety in Macedonia
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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.

Flag of Macedonia.svg

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 Macedonia maintains a clinic with one full-time Peace Corps medical officer (PCMO) and one part-time medical officer, who take care of Volunteers’ primary healthcare needs.

Additional medical services, such as testing and some treatment, are also available in Macedonia at local hospitals. If a Volunteer becomes seriously ill, he or she will be transported to either a more advanced medical facility in the region or to the United States.

Contents

[edit] Health Issues in Macedonia

Major health problems among Volunteers in Macedonia are rare and are often the result of a Volunteer’s not taking preventive measures to stay healthy. The most common health problems are ones that also exist in the United States, that is, colds, diarrhea, hemorrhoids, constipation, sinus infections, skin infections, headaches, dental problems, minor injuries, sexually transmitted diseases (STDs), adjustment disorders, emotional problems, and alcohol abuse. These problems may be more frequent or compounded by life in Macedonia because environmental factors here raise the risk of or exacerbate the severity of certain illness and injuries.

[edit] Helping You Stay Healthy

The Peace Corps will provide you with all the necessary inoculations, medications, and information you need to stay healthy. Upon your arrival in Macedonia, you will receive a medical handbook. You will also receive a medical kit with supplies to take care of minor 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 medical supplies through the medical office. However, you will be responsible for your own supply of any prescription drugs you currently use (including birth control pills) for the first three months of service, and any other specific medical supplies you require, as we will not order these items during training. Please bring a three-month supply of these prescription drugs with you to Macedonia, since they may not be available here and it may take several months for new shipments to arrive.

You will have physicals at midservice and at the end of your service. If you develop a serious medical problem during your service, the medical officer in Macedonia will consult with the Office of Medical Services in Washington, D.C. If it is determined that your condition cannot be cared for in Macedonia, you may be sent out of the country for further evaluation and care.

[edit] 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. It is critical to your health that you promptly report to the medical office or other designated facility for scheduled immunizations, and that you let your medical officer know immediately of significant illness and injuries.

Many diseases that afflict Volunteers in Macedonia are entirely preventable if proper food and water precautions are taken. These diseases include food poisoning, amebiasis, giardiasis, hepatitis A, dysentery, and typhoid fever. Your medical officer will discuss specific standards for water and food preparation in Macedonia 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.

[edit] Women’s Health Information

Pregnancy is treated in the same manner as other Volunteer health conditions that require medical attention. 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 Macedonia, the Peace Corps’ medical standards for continued service during pregnancy cannot be met. Volunteers who become pregnant and wish to continue their pregnancies will be medically separated.

Feminine hygiene products are available for you to purchase on the local market. The Peace Corps medical office in Macedonia will not provide them. If you require a specific feminine hygiene product, please bring a supply with you.

[edit] 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.

[edit] 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
Calamine lotion
Cepacol lozenges
Condoms
Dental floss
Diphenhydramine HCL 25 mg (Benadryl)
Insect repellent stick (Cutter’s)
Lip balm (Chapstick)
Oral rehydration salts and Gatorade
Oral thermometer (Fahrenheit)
Pseudoephedrine HCL 30 mg (Sudafed)
Robitussin-DM lozenges (for cough)
Scissors
Sterile gauze pads
Tetrahydrozaline eyedrops (Visine)
Tinactin (antifungal cream)
Tweezers

[edit] 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 with you to Macedonia. 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 shortly after you arrive in Macedonia.

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 one 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 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.

[edit] 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.

[edit] 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).

[edit] 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:

Strategies to reduce the risk/impact of assault:

[edit] 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 Macedonia as compared to all other Europe, Mediterranean, and Asia (EMA) 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.

[edit] 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]

[edit] Security Issues in Macedonia

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.

Macedonia is a relatively safe place to live from the standpoint of personal security. However, like anywhere in the world, it is not without petty crimes and assaults. 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. But because you are a foreigner and will probably be considered rich, your home may be more prone to break-ins than those of your neighbors. Tourist attractions and public transport, especially in large towns, are favorite work sites for pickpockets. Fortunately, violent crime is relatively rare. If you follow a few simple guidelines, you will reduce most risks.

Macedonia is a collectivistic society where people exist in a socio-cultural environment characterized by strong family relationships and a strong idea of being part of the group. Adjust to the culture, make local friends, and become part of the socio-cultural collective and you will reduce safety risks. Once you are accepted by the locals and you have local friends, you will no longer be perceived as a lone stranger that is an easy target in the eyes of criminals.

Carry valuables close to your body or under your clothing. Undergarment money pouches, the kind that hang around your neck and stay hidden under your shirt or inside your coat, are highly recommended. Do not keep money in outside pockets of backpacks, in coat pockets, or in fanny packs. Never keep your backpack on your back while on public transportation; place your arm across the zippers of your backpack and hold it in front of you. Hold small bags tightly under your arm. While in restaurants, place your pack or bag in your lap or next to you, not on the floor.

Be wary of overly friendly strangers, particularly near bus and train stations, and curious groups of kids near banks or ATM machines. Do not accept food or drink from persons you do not know. If you choose to accept an offer to share refreshments, go with the person to purchase the food and drink. This will prevent someone from attempting to drug you and rob you and avoid the danger of an adverse drug reaction.

Avoid dangerous places. Make inquiries before you wander off somewhere alone. Develop local friends and contacts; they are the best source of this kind of information. Try to stay out of underpasses, and do not linger in train stations. Do not carry any valuables or important documents in your backpack. Always secure your valuables while you are away from home: lock your apartment and bicycle if you have one. Use safety deposit boxes in hotels, and consider purchasing personal property insurance so you can replace valuable items if a theft does occur.

Women should not walk alone after dark. Suggestive comments made to women from men in the streets are common. While annoying, this is unfortunately part of Macedonian culture. You may have to adjust some recreational activities to daytime hours.

[edit] 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 Macedonia, 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, build a friendly relationship with your neighbors, 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 Macedonia 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 receive far more negative attention in highly populated centers than they do in smaller towns, where “family,” friends, and colleagues will look out for them. While whistles and exclamations are fairly common on the street, this behavior can be reduced if you dress conservatively, avoid eye contact, and do not respond to such negative and unwanted attention.

Politics is something that Macedonians often discuss over everyday conversations. Volunteers should try to avoid any political conversations and political gatherings. If you feel you need to participate in a discussion on politics, please remember to express that this is your personal opinion and that you are not representing the official policy of the U.S. government or the Peace Corps.

Macedonia experienced an armed conflict in 2001. The Macedonian government and international community have made efforts in clearing the country of landmines, and from 2003-2006 there haven’t been any incidents reported related to landmines. There is still a considerable amount of illegal weapons left over from the conflict in 2001, particularly in the northwest area of the country. The Macedonian government continues its efforts to collect these illegal weapons by carrying out national collection campaigns.

Peace Corps/Macedonia also has an out-of-site policy that is strictly enforced. The Volunteer commitment is for 24-hours a day and seven days a week and Volunteer service requires a commitment to the community served. Thus, Volunteers are strongly encouraged to spend as much time at their sites as possible to enable them to meet the three goals of Peace Corps service. This includes working on community-based projects during school breaks, especially during the summer. Volunteers who are frequently away from site quickly lose the confidence of counterparts and community members. Also, excessive absenteeism from site has an adverse impact on the Volunteer’s effectiveness and job satisfaction.

Second, occasional trips from site are encouraged so that Volunteers can learn more about Macedonia, visit friends and colleagues, conduct business and participate in the projects of other Volunteers.

Third, Peace Corps is charged with the serious responsibility of ensuring Volunteer safety at all times. Thus, it is imperative that Peace Corps be able to reach every Volunteer in a timely manner for a variety of reasons such as:

In order to be able to reach every Volunteer in a timely manner, the following general policy is in effect:

Anytime a Volunteer is away from site overnight, the Volunteer must notify the duty officer or program manager of specific travel plans, including contact information. Failure to do so may result in administrative separation.

[edit] Preparing for the Unexpected: Safety Training and Volunteer Safety Support in Macedonia

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. Macedonia’s in-country safety program is outlined below.

The Peace Corps/Macedonia 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 memoranda from the country director. In the event of a critical situation or emergency, Volunteers will be contacted through the emergency communication network. Therefore, it is crucial that the personal contact information of every Volunteer be up to date at any given moment.

Volunteer training will include sessions to prepare you for specific safety and security issues in Macedonia. 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 any relevant site history; access to medical, banking, postal, and other essential services; availability of communications, transportation, and markets; different housing options and living arrangements; and other support needs.

You will also learn about the 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 Macedonia 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.

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