Health care and safety in Samoa
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Revision as of 00:20, 23 November 2008
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 Samoa maintains a clinic with a full-time and a backup medical officer, who together take care of Volunteers’ primary healthcare needs. Additional medical services, such as testing and basic treatment, are also available in Samoa at two local hospitals (one private, one public).
During your service, if you become seriously ill or in-country medical services cannot provide further medical treatment that you may urgently require, the medical officer in Samoa will consult with the Office of Medical Services in Washington, D.C. If it is determined that your condition cannot be treated in Samoa, you may be sent out of the country for further evaluation and care.
Health Issues in Samoa
The main health issues in Samoa for Peace Corps Volunteers are diarrhea, skin infections, and infections and discomfort related to the upper respiratory system. Sexually transmitted diseases (STDs) have also been on the increase in Samoa, thus HIV/AIDS awareness and STD prevention are emphasized.
Helping You Stay Healthy
The Peace Corps will provide you with all the necessary immunizations, medications, and information to stay healthy.
Upon your arrival in Samoa, you will receive a medical handbook. At the end of pre-service 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, 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 new shipments to arrive.
Volunteers are required to have a health evaluation at mid-service (one year into service) and a medical examination at the end of service. You are also entitled to a dental examination at mid-service and at close of service. (As dental facilities are limited in Samoa, Volunteers may, with prior approval of the medical officer, have this checkup while in the U.S. or other country if traveling off island on vacation leave.)
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 medical diagnostic and treatment facilities are not up to the standards of the United States. The most important of your responsibilities in Samoa include taking preventive measures for skin fungus, heat rash, cumulative exhaustion, diarrhea, and gastrointestinal illnesses.
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 worldwide 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 for Samoa during pre-service training.
Abstinence is the only absolute preventive measure of HIV/ AIDS 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 a health condition that is treated in the same manner as other Volunteer health conditions requiring medical attention, but may 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 can be met. The majority of Volunteers who become pregnant are medically separated. Feminine hygiene products are available at local markets, but if you require a specific feminine hygiene product, please bring your own 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 might occur during service. Kit items can be periodically restocked at your Peace Corps medical office.
Medical Kit Contents
American Red Cross First Aid & Safety Handbook
Antibiotic ointment (Bacitracin/Neomycin/Polymycin B)
Antiseptic antimicrobial skin cleaner (Hibiclens)
Chlorine tablets (for water purification)
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)
Sterile gauze pads
Tetrahydrozaline eyedrops (Visine)
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 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 Samoa. If you had 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 Samoa.
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 anti-oxidant supplements.
You are encouraged to bring copies of medical prescriptions signed by your physician. This is not a requirement, although it might come in handy if you are questioned in transit about your on-hand three-month supply of prescription drugs.
If you wear eyeglasses, bring two pair with you so you have a spare. If a pair breaks, the Peace Corps will replace one pair only, using the information your doctor in the United States provided on the eyeglasses form during your examination. To reduce the 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. You will probably spend a lot of time outdoors so also pack a good pair of ultraviolet sunglasses. It is well-known that prolonged exposure to the sun and ultraviolet rays increase the risk of eye disease.
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. If you have any doubts or questions about what is covered or not, however, please consult with the Peace Corps Office of Medical Services, especially if you have a pre-existing health condition. 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 re-enrolling in your current plan when you return home.
Safety and Security—Our Partnership
Serving as a Volunteer overseas entails certain safety and security risks. Living and traveling in an unfamiliar environment, a limited understanding of the local language and culture, and the perception of being a wealthy American are some of the factors that can put a Volunteer at risk. Property thefts and burglaries are not uncommon. Incidents of physical and sexual assault do occur, although almost all Volunteers complete their two years of service without serious personal safety problems. In addition, more than 84 percent of Volunteers surveyed in the 2004 Peace Corps Volunteer Survey say they would join the Peace Corps again.
The Peace Corps approaches safety and security as a partnership with you. This Welcome Book contains sections on: Living Conditions and Volunteer Lifestyle; Peace Corps Training; and Your Health Care and Safety. All of these sections include important safety and security information.
The Peace Corps makes every effort to give Volunteers the tools they need to function in the safest and most secure way possible, because working to maximize the safety and security of Volunteers is our highest priority. Not only do we provide you with training and tools to prepare for the unexpected, but we teach you to identify and manage the risks you may encounter.
Factors that Contribute to Volunteer Risk
There are several factors that can heighten a Volunteer’s risk, many of which are within the Volunteer’s control.
Based on information gathered from incident reports worldwide in 2004, the following factors stand out as risk characteristics for assaults. Assaults consist of personal crimes committed against Volunteers, and do not include property crimes (such as vandalism or theft).
- Location: Most crimes occurred when Volunteers were in public areas (e.g., street, park, beach, public buildings). Specifically, 43 percent of assaults took place when Volunteers were away from their sites.
- Time of day: Assaults usually took place on the weekend during the evening between 5:00 p.m. and 2:00 a.m.— with most assaults occurring around 1:00 a.m.
- Absence of others: Assaults 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 inappropriate clothing
- Get to know local officials, police, and neighbors
- Travel with someone whenever possible
- Avoid known high crime areas
- Limit alcohol consumption
Support from Staff
In March 2003, the Peace Corps created the Office of Safety and Security with its mission to “foster improved communication, coordination, oversight, and accountability of all Peace Corps’ safety and security efforts.” The new office is led by an Associate Director for Safety and Security who reports to the Peace Corps Director and includes the following divisions: Volunteer Safety and Overseas Security; Information and Personnel Security; Emergency Preparedness, Plans, Training and Exercise; and Crime Statistics and Analysis.
The major responsibilities of the Volunteer Safety and Overseas Security Division are to coordinate the office’s overseas operations and direct the Peace Corps’ safety and security officers who are located in various regions around the world that have Peace Corps programs. The safety and security officers conduct security assessments; review safety trainings; train trainers and managers; train Volunteer safety wardens, local guards, and staff; develop security incident response procedures; and provide crisis management support.
If a trainee or Volunteer is the victim of a safety incident, Peace Corps staff is prepared to provide support. All Peace Corps posts have procedures in place to respond to incidents of crime committed against Volunteers. The first priority for all posts in the aftermath of an incident is to ensure that the Volunteer is safe and receiving medical treatment as needed. After assuring the safety of the Volunteer, Peace Corps staff 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 Samoa 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 Samoa
You will come to Samoa with all the safety knowledge you have gathered over the years and with all the common sense with which you are blessed. In Samoa, you will be faced with new, barely understood social and cultural boundaries, which can be frustrating and confusing. But remember, personal safety is a learning process. As you learn the culture and meet host country nationals and other Volunteers from groups before yours, you will learn new personal safety skills and how and when to use them. For example, one Volunteer suggests: “Befriend as many people and families as possible. The more friends you have, the less likely someone will mess with you. I’ve found that my Samoan friends are very protective of me. They always watch out for me and are very concerned with my safety.”
Personal safety involves looking at yourself and your lifestyle in a different way; it means seeing yourself as Samoans will see you, and then adjusting your lifestyle to promote your safety in your new community. While Samoa has always been considered one of the safest countries in the world, it would be a mistake to be lulled into a false state of security. Some of these risks can be complicated by misunderstandings and misinterpretations that occur when different cultures interact.
Peace Corps/Samoa has designed and implemented training sessions to raise trainee and Volunteer awareness in several areas of concern. These include housing security; bicycle safety and helmet policy; vehicle policy; alcohol and safe drinking; going out and nightlife; illegal use of drugs and misuse of prescription drugs; verbal, physical, and sexual abuse; physical assault and rape; natural disaster preparedness, especially related to cyclones; water safety; HIV/AIDS and other STDs; gender issues and relationships; and knowledge of important Peace Corps policies as well as aspects of the local legal system and laws that affect Volunteers.
Staying Safe: Don’t Be a Target for Crime
Given all the precautions and all the necessary warnings provided to trainees and Volunteers, this training can only be effective if individuals make themselves aware of safety issues and adopt a safety-conscious lifestyle. Do not let common sense wilt with the tropical sun—it is your most important tool in making the most out of the two years you have here. Be practical as you take measures to make yourself safe, just as you would do in the United States. These measures include ensuring that your house is secure, developing relations in your community that will make you an unlikely victim of crime, learning the local language, acting responsibly, and abiding by Peace Corps’ policies and procedures.
Inevitably, Volunteers can attract a lot of attention, both in and outside their community. The more negative aspects of that attention are likely to occur outside their host community where host family, friends, and colleagues are not always present to look out for them. During these times, Volunteers must rely on themselves and should adopt methods to avoid being a target. For example, while whistles and exclamations are a fairly common experience for female Volunteers, this behavior can be reduced if you dress conservatively, avoid eye contact, and do not respond to such negative and unwanted attention. Other methods include keeping money out of sight—use an undergarment money pouch, such as 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.
The Peace Corps takes a firm stand against excessive alcohol consumption and drug use. Most safety incidents involving Volunteers in bars, nightclubs, or in their homes are alcohol- or drug-related. To avoid such incidents, Volunteers are strongly advised against excessive alcohol consumption. Additionally, the Peace Corps has zero tolerance for drug use. Failure to comply with Peace Corps’ policies can result in administrative separation.
Preparing for the Unexpected: Safety Training and Volunteer Support in Samoa
The Peace Corps’ safety program takes a five-pronged approach to helping you stay safe during your two-year service: information sharing; Volunteer training; site selection criteria; a detailed emergency action plan; and protocols for addressing safety and security incidents. Samoa’s in-country safety program is outlined below.
The Peace Corps/Samoa office will keep Volunteers informed of any issues that may impact Volunteer safety through information sharing. Regular updates will be offered in Volunteer newsletters and in memoranda from the country director or safety and security coordinator. 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 Samoa. 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 technical, 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 work closely with host communities and counterpart agencies to help prepare them for the Volunteer’s arrival and to establish expectations of their respective role 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 Samoa will gather at predetermined locations until the situation resolves itself or the Peace Corps decides to evacuate.
Finally, in order to be fully responsive to the needs of Volunteers, it is imperative that Volunteers immediately report any security incident to the Peace Corps safety and security coordinator or the medical officer. The Peace Corps has established protocols for addressing safety and security incidents in a timely and appropriate manner. In addition to responding to the needs of the Volunteer, the Peace Corps collects and evaluates safety and security data to track trends and develop strategies to minimize risks to future Volunteers.