A few months ago I mentioned some unhappy medical news (first paragraph), and not for the first time. You remember back in community entry when I had malaria? Turns out that was just the opening act of “Hannah’s Wild and Exotic African Disease Safari!” As you speak, I am recovering from my body’s most recent attraction: schistosomiasis. This is an exciting development, bodily speaking, because it brings my total number of exotic diseases to two (you can bet your latest skin disease this will show up on my next “Let’s Do the Numbers” post!). Fear not, this is a completely curable disease that I happened to catch and show symptoms for early in my service. I blame my fish ponds. Or possibly Lake Malawi. Either way, the treatment is a simple one-time dose and all volunteers receive it at the end of their service whether they show symptoms or not. My fiesta of maladies aside, this recent bout of illness brings us to an interesting topic about Peace Corps life:
What happens when you get sick in Peace Corps?
When new trainees come to country, some of their first staff visits are with the medical staff, commonly called Peace Corps Medical Office (PCMO). They provide you with the quick-and-dirty details of staying healthy in country (for us: don’t drink the water straight; wash your hands; poop is literally everywhere) and get you started on all the necessary medications (for us: birth control, malaria prophylaxis, vaccinations). PCMO also comes to trainings in all countries to teach you about all the indigenous disease and health threats that, apparently, lurk in just about every nook and cranny imaginable (or maybe that’s just Zambia).
Most PCMO posts are made up of several host country national staff (HCNs – the term for locals) and occasionally an American staffer, too. In our case, we have two HCN staff (one that operates as, essentially, a nurse practitioner and one that is an American and European trained MD) and another NP level staffer from Ghana. These staff work regular work hours and alternate carrying a 24-hour emergency phone. All volunteers are given the number for this phone and we can call at any time of day or night to report serious symptoms. For less-than-emergency illnesses, we are supposed to wait until business hours to call in.
If When you get sick in Peace Corps, most of the help you receive will likely be over the phone (or, at least it is for us since most of us are so far from Lusaka where PCMO is based). Our PCMO officers specialize in “distance diagnostics”. Volunteers will describe (and sometimes send pictures) of our various maladies, and PCMO will go through a flowchart trying to figure out which disease or infection or whatnot is bothering us. Sometimes if our symptoms sound serious enough PCMO will order us to take medical days at our provincial house or in Lusaka, either for rest, waiting for drugs to be delivered to cure us of our woes, or for further testing. Occasionally, there’s no “right” answer to our symptoms and sometimes we have to experiment with various antibiotics or wait it out. For me, the most frustrating thing about being sick in Peace Corps is when there aren’t any answers; when the tests are inconclusive but I still feel like I’ve been hit by a number of poorly maintained buses. In Zambia, it’s difficult to not freak out just a little bit. Do I have some horrible brain eating worm from Hell, or is this just a cold? Is this malaria, or am I dehydrated? It’s tough to not worry about yourself, and then you feel ridiculous for worrying so much about yourself.
The important thing to know about getting sick in the Peace Corps is that your health is a top priority for PCMO. While sometimes they may not seem worried, any volunteer has a right to assert their access to higher levels of health care, and PCMO will generally oblige. Health volunteers are productive volunteers, and I’ve been impressed at the lengths PCMO has been willing to go to figure out an illness and return volunteers to the field, health restored. The other important thing to know about PCMO is sometimes they make mistakes, or don’t realize the severity of symptoms. It is really important that PCVs are their own best advocate when they are ill. We know ourselves and our bodies best, and sometimes we have to push when we feel like our health needs aren’t being met. That being said, it’s tough to treat 200+ volunteers (like we have in Zambia) over the phone, sight unseen, through symptoms described by non-medical professionals. It’s hard to know what’s really being said when volunteers call and say, “I’ve been feeling off.” That’s why it’s important for volunteers and PCMO to work together and communicate closely when things are amiss.
So, what happens when you get sick in Peace Corps? You talk to PCMO. They try to diagnose you. Sometimes they bring you closer for better treatment, and sometimes they send medication to you. In the event of a serious, life-threatening emergency, they have your site information on file to send a helicopter or car out to get you (very, very rare). The rest of the time, they send you refills on common medications (ibrofen, tums, etc.) and visit with you during your mid-term conference for an annual physical and dental exam, and then again at your close of service.
Do you have questions about what to expect from PCMO? Feel free to contact me for a volunteer perspective.