Health care and safety in Niger

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Health care and safety in [[{{#explode:Health care and safety in Niger| |5}} {{#explode:Health care and safety in Niger| |6}} {{#explode:Health care and safety in Niger| |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. Peace Corps in Niger maintains a clinic with two full-time medical officers, who take care of Volunteers’ primary healthcare needs. Additional medical services, such as radiology and dentistry, are also available in Niger at local clinics. If you become seriously ill, you will be transported either to a city in the region where more services are available or to the United States.

Health Issues in Niger[edit]

With careful adherence to the preventive measures you will be taught during pre-service training, it is possible to remain healthy throughout your service in Niger. However, sickness is more common, and standards of hygiene and food handling are lower, than in the United States. Although there is a great deal you can do to minimize risks, Volunteers do suffer gastrointestinal disorders, upper respiratory infections, and other medical problems from time to time.

Helping You Stay Healthy[edit]

The Peace Corps will provide you with all the necessary inoculations, medications (including malaria prophylaxis), and information to stay healthy. Upon your arrival in Niger, 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.

During pre-service training, you will have access to basic medical supplies through the medical office. However, during this time, you will be responsible for your own supply of prescription drugs and any other specific medical supplies you require, as we will not order these items during training. Please bring a three-month supply of any prescription drugs you use, since they may not be available here and it may take several months for 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 officers in Niger will consult with the Office of Medical Services in Washington, D.C. If it is determined that your condition cannot be cared for in Niger, you may be sent out of the country for further evaluation and care.

Maintaining Your Health[edit]

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 …” 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 Niger is to take preventive measures against disease.

Malaria, which is endemic in Niger, requires strict adherence to the prophylactic regime of mefloquine or doxycycline as well as the use of barrier methods such as mosquito nets and insect repellent to prevent mosquito bites. Failure to adhere strictly to the recommended malaria prophylaxis may result in administrative separation. Overexposure to the sun is also a risk, so it is important to wear sunscreen, a hat, and sunglasses. One must treat all minor wounds promptly to prevent them from becoming infected.

Many illnesses that afflict Volunteers worldwide are entirely preventable if proper food and water precautions are taken. These illnesses include gastrointestinal disorders such as food poisoning, parasitic infections, hepatitis A, dysentery, and typhoid. Your medical officers will discuss specific standards for water and food preparation for Niger 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 or other STDs. You will receive more information from the medical officers about this important issue.

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

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

Women’s Health Information[edit]

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 for the Volunteer. Given the circumstances under which Volunteers live and work in Peace Corps countries, it is rare that Peace Corps medical and programmatic standards for continued service during pregnancy can be met.

Feminine hygiene products can be purchased in local markets, but they are expensive. The Peace Corps medical office in Niger supplies Volunteers with a limited selection of feminine hygiene products. You should bring a three-month supply of any products you will require during training. If you require a specific product for the rest of your stay, please bring a two-year supply with you or arrange to have supplies sent from home.

Your Peace Corps Medical Kit[edit]

The Peace Corps medical office 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[edit]

Ace bandages
Acetaminophen 325 mg (Tylenol)
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
Chlorine dropper bottle
Clomtimazole 1% antifungal cream
Condoms
Cough lozenges
Dental floss
DiGel tablets
Diphenhydramine HCL 25 mg (Benadryl)
Hydrocortisone cream 1%
Ibuprofen 400 mg
Insect repellent
Lip balm
Malaria kit
Stool sample kit
Oral rehydration salts
Oral thermometer (Fahrenheit)
Pseudoephedrine HCL (Sudafed)
Scissors
Sterile gauze pads
Tetrahydrozaline eyedrops (Visine)
Tweezers
White petroleum jelly
Zinc oxide


Before You Leave: A Medical Checklist[edit]

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, you should contact your physician’s office, obtain a copy of your immunization record, and take 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, both at your predeparture orientation and after you arrive in Niger. You will be given malaria prophylaxis tablets to take 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 as long as these medications are documented in your overseas health records.

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 will be given multivitamin and calcium tablets to supplement your diet.

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 the risk of developing a serious infection or other eye disease. Niger does not have appropriate water and sanitation to support eye care with the use of contact lenses. Moreover, Niger has frequent dust storms that can pose problems for contact lens wearers. The Peace Corps will not supply or replace contact lenses or associated solutions, or replace or repair sunglasses, 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[edit]

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[edit]

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[edit]

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[edit]

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 Niger as compared to all other Africa region programs as a whole, from 2000–2004. It is presented to you in a somewhat technical manner for statistical accuracy.

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

The incidence rate for each type of crime is the number of crime events relative to the Volunteer/trainee population.

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

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

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

What If You Become a Victim of a Violent Crime?[edit]

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 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 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. The Office of Inspector General 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 regional security officers. 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 regional security officer, the Office of Inspector General 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. The Office of Inspector General 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 violentcrimehotline@peacecorps.gov.

Security Issues in Niger[edit]

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 Niger. 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 Niger.

Motor vehicle accidents. “Bush taxis,” the most common mode of motorized transportation in rural areas, are often overloaded, poorly maintained, and unsafe. They should be avoided to the extent possible. Volunteers should not travel on roads and highways at night because of the high risk of accidents.

Robbery/burglary. In urban markets, bus stations, and other areas where crowds are present, purse snatching and pickpocketing are common. Money and other valuables should be kept secure. While unusual, theft can occur even in rural villages. Houses should be kept locked and valuables should be kept in a locked trunk when you leave your village.

Violent crime. Though this is very rare in rural villages, it is a growing concern in larger cities, particularly in Niamey, the capital. There are certain high-crime areas (which will be pointed out to you) that must be avoided. In cities, Volunteers should travel in groups of two or more at night.

Staying Safe: Don’t Be a Target for Crime[edit]

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 Niger, 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 Niger may require that you accept some restrictions on your current lifestyle.

Volunteers attract a lot of attention whereever they are in Niger, 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. 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 Niger

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

Peace Corps/Niger office will keep Volunteers informed of any issues that may impact Volunteer safety through information sharing. Regular updates will be offered in the newsletter 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. Thus, it is imperative that Volunteers keep the Peace Corps/Niger office informed of their whereabouts so that they can be contacted in the event of an emergency. If a Volunteer seems to be missing, even for a short period of time, we must assume something is wrong and initiate extensive search procedures.

Volunteer training will include sessions on specific safety and security issues in Niger. 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 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/Niger’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 Niger will gather at predetermined locations until the situation is resolved or the Peace Corps decides to evacuate.

Finally, Volunteers must immediately report any security incident to the Peace Corps office. 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.