Health care and safety in Zambia
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===Women’s Health Information ===
===Women’s Health Information ===
===Your Peace Corps Medical Kit ===
===Your Peace Corps Medical Kit ===
Latest revision as of 23:07, 1 February 2010
|Health care and safety in Zambia|
|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.
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 Zambia maintains a clinic with two full-time medical officers who take care of Volunteers’ primary health-care needs. Additional medical services, such as testing and basic treatment, are also available in Zambia at local hospitals. If a Volunteer becomes seriously ill, that person will be transported to either South Africa, the designated regional medical evacuation center, or to the United States.
The Peace Corps medical officers and health unit support your health needs in-country. The Volunteer health program emphasizes prevention and self-responsibility. Although medical care overseas differs significantly from the health care you may be familiar with in the U.S., your medical care during Peace Corps service is designed to meet your basic needs. It is important that you share your health concerns with a medical officer, including any discomfort you might have about your diagnosis and treatment.
Trainees and Volunteers with medical problems beyond the expertise of the medical officers or host country medical community are sent to a location with more advanced medical care, either within the Africa region or to Washington, D.C. Peace Corps/Zambia medical officers are supported by an area medical officer, who is a U.S. board-certified physician. Medical officers also receive ongoing guidance and support from the Office of Medical Services at Peace Corps headquarters in Washington, D.C.
 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 Zambia, you will receive a medical handbook. You will receive a first-aid kit with supplies to take care of mild illnesses and first-aid needs and the contents of the kit are listed later on in this section.
During your first 8 to 10 weeks in Zambia, you will have access to basic first-aid 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.
You will have physicals during mid-service and at the end of your service. If you develop a serious medical problem during your service, the medical officer in Zambia will consult with the Office of Medical Services in Washington, D.C. If it is determined that your condition cannot be cared for in Zambia, 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 medical diagnostic and treatment facilities are not up to the standards of the United States.
Zambia is a very healthy country to live in provided you use your common sense and pay particular attention to situations that could easily be prevented. Commonly encountered health problems here are colds, coughs, flu, strep throat, diarrhea, and fevers. Depending your immunization history, you will receive immunizations against rabies, hepatitis A and B, meningococcal meningitis, and typhoid.
Many illnesses that afflict Volunteers worldwide are entirely preventable if proper food and water precautions are taken. These illnesses include food poisoning, amebiasis, giardiasis, hepatitis A, dysentery, Guinea worms, tapeworms, and typhoid fever. We will discuss specific standards for water and food preparation during your pre-service training.
One significant illness you could be exposed to is Plasmodium falciparum malaria. During pre-service training, you will be fully informed about its life cycle, the steps you need to take to prevent getting it, how to diagnose it, what to do for self-treatment, and when you should contact the medical officer. Malaria can be a fatal disease, so we take it very seriously. Taking malaria prophylaxis is not a negotiable issue; Volunteers are expected to take it as prescribed, and failure to do this could result in administrative separation. Mefloquine is the main anti-malarial taken by Volunteers. For those who do not tolerate it, doxycycline (taken daily) is an alternative. The Peace Corps, in conjunction with the Centers for Disease Control and Prevention, has determined that mefloquine is the preferred malaria prophylaxis in chloroquine-resistant areas; and given data collected from the many Volunteers who have taken it for two years or more, it has been deemed very safe.
Nutrition is the cornerstone not only to a healthy body, but also to a healthy service. It is therefore imperative that you eat nutritionally. Throughout pre-service training, you will learn how to maintain a well-balanced diet. Once you get to your site, you will need to allow yourself the time for “hunting and gathering.” Changing your mind-set from a fast food culture to one in which significant time and energy must be expended can be challenging. However, this can be done in ways that will allow you to also develop and secure your status as a respected and valued member of your community and village.
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.
Zambia currently has one of the highest incidences of HIV/AIDS in Africa. In a country with a population of 10 million, the Zambia Ministry of Health reports that an estimated 950,000 adults and 70,000 children are currently infected with the HIV virus. Approximately 20 percent of men and women between the ages of 15 and 49 are HIV positive. More than 75 percent of Zambian AIDS cases come from sexually active young adults and children under five who were infected by their mothers at birth. The country is experiencing an alarming rise in the number of children left orphaned because of AIDS. The effect of HIV/AIDS on Zambia is widespread, affecting not only the family structure, but also the country’s economy and education system. The disease will continue to adversely affect the country’s already low life expectancy.
Abstinence is the only certain choice for prevention of HIV and other sexually transmitted diseases (STDs). You are taking risks if you choose to be sexually active. To lessen the 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.
During pre-service training, 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 office.
Your health in Zambia should not be an issue if you make sensible, healthy choices.
 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. 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 from the medical office. If you require a specific feminine hygiene product please bring a three-month supply with you.
 Your Peace Corps Medical Kit
The Peace Corps medical officer provides Volunteers with a first-aid 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 or at provincial Volunteer leader houses.
 Medical Kit Contents
American Red Cross First Aid & Personal Safety Manual
Antacid Tablets (Tums)
Antiseptic Antimicrobial Skin Cleaner (Hibiclens)
Bacitracin/Neomycin/Polymycin B Ointment
Diphenhydramine HCL (Benadryl): 25 mg tablets
Insect Repellant Stick (Cutter’s)
Iodine Tablets (Water Purification Tablets)
Lip Balm (Chapstick)
Oral Rehydration Salts and Gatorade
Oral Thermometer (Fahrenheit)
Pseudephedrine HCL (Sudafed): 30 mg tablets
Robitussin-DM Lozenges (Cough Calmers)
Sterile Gauze Pads
Tetrahydrozaline Eye Drops (Visine)
Tinactin Cream (Tolnaftate)
 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 taking 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, either at your predeparture orientation or shortly after you arrive in Zambia. You do not need to begin taking malaria medication prior to departure.
Bring a three-month supply of any prescription or over-thecounter medication you use on a regular basis, including birth-control pills. Although the Peace Corps cannot reimburse you for this three-month supply, we will order refills during your service.
While awaiting shipment—which can take several months— you will be dependent on your own medication supply. The Peace Corps will not pay for herbal or non-prescribed medications, such as St. John’s wort, glucosamine, selenium, or antioxidant supplements.
You are encouraged to bring copies of medical prescriptions signed by your physician. This is not a requirement, although it 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 U.S. 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 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, over 50 years of age, or have a health condition that may restrict your future participation in health-care plans, you may wish to consult an insurance specialist about unique coverage needs before your departure. The Peace Corps will provide all necessary health care 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 health-care benefits described in the Peace Corps Volunteer Handbook. You may wish to consider keeping an existing health plan in effect during your service if you think age and/or preexisting conditions might prevent you from reenrolling in your current plan when you return home.
 Safety and Security—Our Partnership
Serving as a Volunteer overseas entails certain safety and security risks. Living and traveling in an unfamiliar environment, a limited understanding of the local language and culture, and the perception of being a wealthy American are some of the factors that can put a Volunteer at risk. Petty 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 83 percent of Volunteers surveyed 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 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 in the Volunteer’s control. Based on information gathered from incident reports worldwide in 2003, 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, 47 percent of assaults took place when Volunteers were away from their sites.
- Time of day: Assaults usually took place on the weekend during the late evening between 10:00 p.m. and 3:00 a.m.— most often occurring around 1:00 a.m.
- Absence of others: More than 75 percent of crime incidents occurred when a Volunteer was unaccompanied.
- Relationship to assailant: In most assaults, the Volunteer did not know the assailant.
- Consumption of alcohol: Almost a third 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; and Emergency Preparedness, Plans, Training, and Exercise. The safety and security team also tracks crime statistics, identifies trends in criminal activity, and highlights potential safety risks to Volunteers.
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 following country-specific data chart shows the incidence rates and the average number of incidents of the major types of safety incidents reported by Peace Corps Volunteers/trainees in Zambia as compared to all other Africa region programs as a whole, from 1999–2003. 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 the eight most commonly occurring assault types. 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.
 Security Issues in Zambia
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 Zambia. You can reduce your risk of becoming a target for crime 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, especially in large towns, are the favorite work sites for pickpockets. To deter pickpockets, make sure your backpack has well-secured pouches and do not keep anything of value in them. To prevent theft, don’t carry large amounts of cash on your person or leave large amounts of cash or items of value in a hotel room or in your house. Do not keep your money in outside pockets of backpacks, in coat pockets, or in fanny packs. Keep money out of sight by using an undergarment money pouch, such as the kind that hangs around your neck and stays hidden under your shirt or inside your coat. Although assaults are very rare, don’t walk anywhere alone at night. Use of alcohol is a factor in most safety incidents, so you must be cautious when drinking alcohol. Your ability to make safe decisions is impaired, your sense of a safe environment becomes blurred, and you become an easy target for any unsafe situation.
 Staying Safe
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 Zambia, do what you would do if you moved to a large city in the States: Be cautious, check things out, ask lots of 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 Zambia may require that you accept some restrictions to your current lifestyle.
Volunteers attract a lot of attention in large cities and their sites alike, but receive far more negative attention in highly populated centers where they are anonymous than 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 don’t respond to such negative and unwanted attention.
 Preparing for the Unexpected
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 responding to safety and security incidents. Zambia’s in-country safety program is outlined below.
The Peace Corps/Zambia 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 memoranda from the Country Director. 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 Zambia. 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.
Specific site selection criteria are used to determine safe housing for Volunteers before their arrival. Peace Corps staff works 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.
You will also learn about the country’s detailed emergency action plan, pertaining to events 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 Zambia will gather with other Volunteers at a pre-determined location 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 medical officer and safety and security coordinator. 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.