Health care and safety in Turkmenistan

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Health care and safety in [[{{#explode:Health care and safety in Turkmenistan| |5}} {{#explode:Health care and safety in Turkmenistan| |6}} {{#explode:Health care and safety in Turkmenistan| |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 health and safety of every Volunteer. Peace Corps medical programs emphasize the preventive, rather than the curative, approach to disease. The Peace Corps in Turkmenistan maintains a joint medical unit with a full-time medical officer, who takes care of Volunteers’ primary healthcare needs as well as those of the U.S. embassy staff. Additional medical services, such as testing and basic treatment, are also available in Turkmenistan at local, American-standard hospitals. If you become seriously ill, you will be transported either to a medical facility in the region or to the United States.

Health Issues in Turkmenistan

Major health problems among Volunteers in Turkmenistan are rare and are often the result of a Volunteer’s not taking preventive measures to stay healthy. The most common health problems encountered by Volunteers include colds, diarrhea, sinus infections, headaches, dental problems, minor injuries, STDs, adjustment disorders, and alcohol abuse. These problems may occur more frequently or be compounded by life in Turkmenistan because environmental factors in the country raise the risk of or exacerbate the severity of certain illnesses and injuries.

The most common major health concerns in the country are tuberculosis, dysentery, hepatitis, and giardiasis. You will be vaccinated against hepatitis A and B; meningitis; tetanus/ diphtheria; typhoid; rabies; measles, mumps, and rubella; and polio. Skin tests (PPD) for tuberculosis will also be given.

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 Turkmenistan, you will receive a medical handbook, a water filter, a mosquito net, and a medical kit with supplies to take care of mild illnesses and first-aid needs. The contents of the kit, which will be replenished at the end of training, are listed later in this chapter.

During pre-service training, you will have access to medical supplies not included in the medical kit through the medical officer. However, you will be responsible for your own supply of prescription drugs (such as allergy medication) 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 from worldwide suppliers to arrive (if your insurance allows it, a six-month supply is even better).

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 Turkmenistan will consult with the Office of Medical Services in Washington, D.C. If it is determined that your condition cannot be treated in Turkmenistan, you may be sent out of the country for further evaluation and care.

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 …” 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 Turkmenistan is to take preventive measures for the following:

Many illnesses that afflict Volunteers worldwide are entirely preventable if proper food and water precautions are taken. These illnesses include food poisoning, parasitic infections, hepatitis A, dysentery, pinworms, and typhoid fever. Your medical officer will discuss specific standards for water and food preparation in Turkmenistan during pre-service training.

Tuberculosis is present in the country, so it is important to stay away from people who are constantly coughing and have signs of tuberculosis infection and to regularly ventilate your room and your office. You will be given the PPD skin test upon your arrival in-country, at mid-service, and at the end of your service.

Rabies is prevalent throughout the country, so you will receive a series of immunizations against it when you arrive in Turkmenistan. Be wary of all unknown animals, and if you are exposed to an animal that is known to have or suspected of having rabies, inform the medical officer at once so that you can receive post-exposure booster shots.

Abstinence is the only certain choice for prevention of 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 an unplanned pregnancy. Your medical officer can help you decide on the most appropriate method to suit your individual needs. Contraceptive methods are available without charge from the medical officer.

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

Women’s Health Information

Pregnancy is treated in the same manner as other Volunteer health conditions requiring medical attention, but also has 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.

(Note that pregnancy is also a men’s health issue. Male Volunteers who father children have specific rules and guidelines to which they must adhere. Male Volunteers who father children must discuss the issue with the country director to determine the appropriate course of action regarding continuing their service. More information about this is contained in the Peace Corps Manual.)

If feminine hygiene products are not available for you to purchase on the local market, the Peace Corps medical officer in Turkmenistan 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 kit that contains basic items necessary to prevent and treat illnesses that may occur during service. Kit items can be periodically restocked at the medical office.

Medical Kit Contents

Ace bandages
Acetaminophen 325 mg (Tylenol)
Adhesive tape
American Red Cross First Aid & Safety Handbook
Antacid tablets (Tums)
Antibiotic cream (Bacitracin/Neomycin/Polymycin B)
Antifungal cream (Tinactin)
Antiseptic antimicrobial skin cleaner (Hibiclens)
Aspirin
Band-Aids
Butterfly closures
Calamine lotion
Cepacol lozenges
Condoms
Dental floss
Diphenhydramine HCL 25 mg (Benadryl)
Ibuprofen 400 mg (Advil)
Insect repellent stick (Cutter’s)
Iodine tablets (for water purification)
Lip balm (Chapstick)
Multivitamins
Oral rehydration salts
Oral thermometer (Fahrenheit)
Pepto-Bismol tablets
Pseudoephedrine HCL 30 mg (Sudafed)
Robitussin-DM lozenges (for cough)
Scissors
Sterile gauze pads
Tetrahydrozaline eyedrops (Visine)
Tweezers

Before You Leave: A Medical Checklist

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

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

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

Bring a three-month supply of any prescription and six-month supply of over-the-counter 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. We discourage you from using contact lenses during your service to reduce your risk of developing a serious infection or other eye disease. Most Peace Corps countries do not have appropriate water and sanitation to support eye care with the use of contact lenses. The Peace Corps will not supply or replace contact lenses or associated solutions unless an ophthalmologist has recommended their use for a specific medical condition and the Peace Corps’ Office of Medical Services has given approval.

If you are eligible for Medicare, are over 50 years of age, or have a health condition that may restrict your future participation in healthcare plans, you may wish to consult an insurance specialist about unique coverage needs before your departure. The Peace Corps will provide all necessary healthcare from the time you leave for your pre-departure orientation until you complete your service. When you finish, you will be entitled to the post-service healthcare benefits described in the Peace Corps Volunteer Handbook. You may wish to consider keeping an existing health plan in effect during your service if you think age or pre-existing 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). 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 Turkmenistan 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.

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 violentcrimehotline@peacecorps.gov.

Security Issues in Turkmenistan

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. Most Volunteers feel safer from crime in Turkmenistan than in the United States but, as with anywhere in the world, crime does exist in Turkmenistan. You can reduce your risk by avoiding situations that make you feel uncomfortable and by taking precautions. Tourist attractions, especially in large towns, are favorite work sites for pickpockets. Petty theft is also prevalent in villages because of decreased economic opportunity and rising drug use, especially among young men.

The following are safety concerns in Turkmenistan:

Volunteers have occasionally reported instances of harassment, such as being called derogatory names, receiving overt sexual comments, and having children throw small rocks at them. Strategies for dealing with harassment are discussed during pre-service training.

Volunteers have also been targets of sexual assault in Turkmenistan. Alcohol consumption and cross-cultural differences in gender relations are often associated with sexual assaults, and the assailant is often an acquaintance of the Volunteer. Volunteers who take seriously Peace Corps/Turkmenistan’s training regarding sexual assaults will minimize their risk. Volunteers are urged to report all assaults and threats of assault to the Peace Corps medical officer so that staff can respond with appropriate support. Note that sex outside of marriage is not looked upon favorably in Turkmenistan and may jeopardize both your safety and your ability to develop mutually respectful relationships in your community and at your job.

Homosexual behavior is technically illegal in Turkmenistan, and the rights of gays and lesbians are not protected under the Turkmenistan Constitution, so gay and lesbian Volunteers have to practice discretion. The Peace Corps is committed to providing support for all Volunteers regardless of sexual orientation.

Turkmenistan has a very hospitable culture, and making house visits is highly encouraged. When you are at somebody’s home, the host will often offer you an alcoholic drink, usually vodka. Alcohol use impairs judgment and must be consumed responsibly. Many incidents of harassment and assault among Volunteers are related in some way to use of alcohol.

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

Volunteers attract a lot of attention in large cities, but receive far more negative attention in highly populated centers, where they are anonymous, than in smaller towns, where “family,” friends, and colleagues look out for them. While whistles and exclamations are fairly common on the street, this behavior can be reduced if you dress conservatively, avoid eye contact, and do not respond to unwanted attention. Keep your money out of sight by using an undergarment money pouch, the kind that hangs around your neck and stays hidden under your shirt or inside your coat. Do not keep your money in outside pockets of backpacks, in coat pockets, or in fanny packs, and always walk with a companion at night.

Preparing for the Unexpected: Safety Training and Volunteer Support in Turkmenistan

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

The Peace Corps/Turkmenistan office will keep you informed of any issues that may impact Volunteer safety through information sharing. Regular updates will be provided in Volunteer newsletters and in memorandums from the country director. In the event of a critical situation or emergency, you will be contacted through the emergency communication network.

Volunteer training will include sessions to prepare you for specific safety and security issues in Turkmenistan. 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 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; housing options and living arrangements; and other support needs.

You will also learn about Peace Corps/Turkmenistan’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, you will gather with other Volunteers in Turkmenistan at predetermined locations until the situation is resolved or the Peace Corps decides to evacuate.

Finally, in order for the Peace Corps to be fully responsive to the needs of Volunteers, it is imperative that Volunteers immediately report any security incident to the Peace Corps safety and security coordinator or 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 current and future Volunteers.