Peace Corps Costa Rica Health Manual
March 2016
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EMERGENCY CONTACT INFORMATION Peace Corps Office
2231-4122 (land line) Doña Betty’s extension
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Dra. Ana Lucía Mayorga MD Work cellular phone Home land line phone
125 8592-3166 2273-8722
Doña Jennifer’s extension Work cellular phone Home land line phone
116 8869-2571 2272-1816
Dra. Erika Canessa extension 131 Personal cellular phone 8577-8838
Peace Corps Duty Officer (Administrative)
8913-2400
Medical Officer on duty (cellular phone)
8913 2627
Med Office Fax
2296-5287
For after-hours emergencies, on holidays, or weekends, contact the Peace Corps Medical Officer (PCMO) by the emergency cellular phone number. If the PCMO cannot be contacted by cell phone, call the PCMOs landline home phone number or any of the phone numbers on your Emergency Contact Card for assistance from other Peace Corps staff.
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INTRODUCTION The medical team welcomes Peace Corps Volunteers that elected to serve in Costa Rica. Our goal is to support each person to maintain a reasonably functional health status in order to perform the service intended to. Occasionally, Volunteer may require further medical assistance in which case, this health manual is designed to help you in maintaining good health. It is a reference handbook for use throughout Peace Corps service. It contains five sections that we encourage Volunteers to refer to, as necessary. In section I, contains the rules, regulations and pertinent policies. Section II has out in-country medical information guide, in section III has the medical kit content, medications names, indications and uses. In section IV has the medical treatment guide and finally, in section V, Volunteer will find the Personal Health Plan form, which must be complete by the end of training.
Volunteer Health The Peace Corps Health program focuses on the idea of prevention of illness and injury and explicit responsibility for personal health care. We hope you will set good examples of healthy living and preventive health care practices in Costa Rica. The basic belief that PREVENTION of illness is a better approach to health than curing of illness is our principle. Preventing illness makes our lives easier and the individual mission of Peace Corps more successful. If however, in spite of adhering to the best preventive practices, illness strikes, the PCMO’s are here to provide treatment and support, with a great deal of help on the part of the volunteer.
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HEALTH UNIT TEAM Full-time Peace Corps Medical officer: Dr. Ana Lucia Mayorga Alvarez Medical Doctor/General Practitioner Our PCMO was born in Guatemala. She graduated from the University of Costa Rica and has vast experience in primary care. In addition, Dr. Ana Mayorga enjoys designing and delivering health talks as well. We are fortunate to have her. Full time Peace Corps Medical Officer: Dr. Erika Canessa. Medical Doctor/General Practitioner She was born in Costa Rica. She did her elementary and high school studies in Oregon, USA. Her medical degree is from Universidad Iberoamericana (UNIBE) in San Jose, Costa Rica. E-mail best option is medical@cr.peacecorps.gov, and ecanessa@peacecorps.gov Peace Corps Medical Officer (PCMO) Jennifer Clarke RN/MS Jennifer is a nurse, graduated from University of Costa Rica. In addition, she studied a Diploma program in Health Management at the University of the West Indies in Jamaica, did Occupational Health course at Centro de Estudios Latinoamericamos in Israel, a Master’s degree in Human Anatomy from Universidad de Ciencias Médicas UCIMED, and is currently finishing a second Master’s degree in OB/GYN. E-mail best option is medical@cr.peacecorps.gov, and jclarke@peacecorps.gov Administrative Assistant for the Medical Office– Betty Rowe Doña Betty holds a bachelor degree in Political Science from the University of Costa Rica and at present, she is working on her thesis. She serves as initial contact in the Medical Office for all PCV. Her responsibilities include coordinating appointments; she handles medlink (refills and supplies) system, prepares the purchase orders and prepares the encomiendas to send to PCVs, among others responsibilities. E-mail best option is medical@peacecorps.gov, and browe@peacecorps.gov For absences and special activities, Health Unit has two medical doctors that provide occasional substitution, Dr. Maria Laura Ortega MD; and Dr Sonsire Coward MD. They are present on scheduled days 4
Table of content Emergency contact information Introduction Health Unit team
Section I Medical office policies Medical care outside the capital Post service health benefits
Section II Health resources Medical evacuation Alcohol policy
Section III The medical kit
Section IV Medical treatment guide General medicine Allergic reaction Fainting Eye and ear problems Canker sore Sinus infection Throat infection Flu Bronchitis Asthma Abdominal problems Muscle/bone problems Sprain and strains Burns and sunburns Animal bites/insect stings/vector-borne disease Dengue virus Chagas Zika virus Chikungunya Snakes bites Skin infections, rashes and infestations Women's health Men's health
Section V Personal health plan (insert)
Page number 2 3 4 6 6 13 14 19 19 22 24 25 25 30 30 30 31 32 33 37 39 40 41 42 43 44 48 49 52 53 56 57 58 60 62 63 67 69
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SECTION I MEDICAL OFFICE POLICIES
Peace Corps Volunteers Rights and Responsibilities PCVS RIGHTS
To receive all necessary medical care in the event of an illness or injury including medical evacuation if needed To be treated with respect, consideration and dignity regardless of your race, color, religion, sex, national origin, age, disability, sexual orientation, gender identity, gender expression, genetic information, marital status, parental status, political affiliation or your participation in any authorized complaint procedure. To privacy, security, and medical confidentiality for your health information and records To privacy during the physical exam. You will be offered a chaperone and a gown or drape for all exams that require exposing all or part of your body. To be informed about the diagnosis, treatment, and prognosis of an illness or injury. To be informed about the credentials and qualifications of your health care providers. To be informed about the scope and availability of healthcare services in your country. To receive individual health information regarding personal wellness and illness. To receive health education/training on the prevention of illness and injury specific to your country. To receive immunizations and malaria prophylaxis according to Peace Corps protocols. To refuse all or part of your care subject to the conditions imposed by law and Peace Corps policy. To be informed about your post-service benefits, including the Federal Employees' Compensation Act (FECA) program and post-service health insurance. To bring a complaint or concern regarding your health care services to the attention of the appropriate Peace Corps officials
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RESPONSIBILITIES You must accept a large amount of personal responsibility for your general health, well-being, safety, and security. Proper precautions, if taken, will reduce the risk of contracting serious illness and sustaining serious injury. The old adage "an ounce of prevention is worth a pound of cure" is extremely important in areas where medical diagnostic and treatment facilities are not up to United States standards. Your responsibilities include: Treat all staff with respect, dignity and consideration. Reporting all significant health problems to the PCMO. Providing complete information to the PCMO about your past medical history and current health problems to allow proper evaluation and treatment. Except in an emergency, obtaining PCMO authorization prior to receiving any medical or dental care. Complying with all medical policies and practices of the Volunteer Health Program. For example, you must: -Take disease prevention medications as prescribed; -Follow all prescribed therapies and other medical recommendations carefully; -Not wear contact lenses; -Engage in responsible and safe sex if you choose to be sexually active; -Keep up to date on your immunizations; -Drink alcohol only moderately, if at all, and do not use illegal drugs; -Sleep under a mosquito net in places known to have mosquitoes; -Drink safe water, buy and prepare food carefully; if conditions allow -Swim only in places that are unquestionably safe. Peace Corps expects that each individual will be doing everything possible to assure your own well-being and safety. For example, you must: -Write a detailed Health Plan; submit to PCMO and follow, -Wear a seat belt, if available, when riding in a vehicle; -Wear a helmet when on a bicycle; -Avoid all dangerous areas, especially at dusk and at night.
Failure to meet your responsibilities may lead to situations that may not only be unhealthy but could lead to further administrative actions. 7
PCMO's Responsibilities
COMPLETE HEALTH CARE The PCMO is charged with all your health care needs during your Peace Corps service. The primary role of the PCMO is to establish and maintain a health care system that responds to the needs of Peace Corps Trainees and Volunteers in the field in as safe, efficient, and timely a manner as possible considering the circumstances in Costa Rica. This includes immunizations, primary health care or coordinating medical care in the regional hospitals or clinics, managing all medevacs and referrals to specialists, and maintaining health records according to US standards. The PCMO will restock medical kits as needed, maintain a pharmacy with drugs necessary for treatment of many routine conditions, and complete an annual inventory of medical supplies and equipment. Additional duties include site visits to insure that the health, safety, and security of each Volunteer is being addressed, along with other staff members. The PCMO is integrally involved in the overseeing of all aspects of the service of Trainees and Volunteers. Lastly, the PCMO provides health and safety training during Pre-service training (PST), In-service training (IST), and at the Close of Service (COS) Conference.
Routine medical check-ups There are two mandated check-ups during service. The mid-service assessment done after a year in country to update, review unresolved health concerns and take care of new medical conditions should there be any. Dental cleaning and prophylaxis is schedule too. Women undergo a routine breast examination, and men may undergo a routine testicular exam as well. The other required evaluation is the Close of Service (COS) examination. This assessment is divided into two phases. The first phase is completed within 90 days of the COS date and includes a dental evaluation and a complete physical exam with lab testing. The second part is completed within the last week prior to your COS date. At that time, final post-service paperwork along with other checkout details will be finalized. Notification of Next of Kin If you are hospitalized or seriously injured, Peace Corps in Washington is notified. According to PCVs wishes, Peace Corps, if authorized, will notify your parents or the next of kin. If the health condition of the Volunteer is critical, notification will be done. 8
Medical Confidentiality Medical confidentiality is viewed as an essential part of the Peace Corps Health program. It ensures that Volunteers can be completely open in discussing their physical and mental health concerns with the PCMO. To be covered by medical confidentiality, information must be of a medical nature about an individual Volunteer and must have been given to a medical provider. Medical information that you discuss with members of the Peace Corps Staff who are not health care professionals is not considered medically confidential. The same holds true with medical information discussed with other Volunteers or anyone else. Hopefully these individuals treat such information with discretion. Medical confidentiality may be extended to non-medical personnel in any of the following circumstances. Persons with whom confidential information is shared are required to protect that information in the same way as the medical staff. The Volunteer has authorized in writing the release of some or all of his/her medical information. If, in the opinion of the PCMO, failure to release information would pose a significant threat to the life or physical safety of the Volunteer or others, or the Peace Corps program, the PCMO should extend medical confidentiality to appropriate staff members. The Country Director is responsible for the overall health and safety of each Peace Corps Volunteer. Under special circumstances, the CD could or could not be notified in cases of sexually assault. Detailed explanation is provided during PreService Training (PST); in the Sexual Assault class. Medical Confidential information that is properly shared with the CD is treated and is bound by the rules of confidentiality and privacy.
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HEALTH CARE CONCERNS
Peace Corps supports a culture that embraces quality, Volunteer safety, and service satisfaction. In order to ensure that we continue to provide quality care, we encourage you to express concerns or dissatisfaction with the care received. If comfortable, talk to the PCMO about the dissatisfaction with the care received; or discuss the concerns with the Country Director if you do not obtain satisfactory resolution in the discussion with the PCMO or do not feel comfortable discussing the problem with the PCMO. If neither of these avenues for resolution addresses the concerns sufficiently, you can also file an email concern with the Quality Improvement (QI) Department at headquarters:
QualityNurse@peacecorps.gov In the email you must include your name, your location, PCMO (or other health care provider) involved, and a detailed description of the health care related concern. You can expect a response from Headquarters within five (5) business days. Your medically confidential information will be shared only with Peace Corps staff members that have a specific need to know it to address the situation appropriately. To the extent possible consistent with appropriate handling of the concern, your identity will be kept confidential. Keep in mind that email is not a secure method of communication. If you choose to communicate via email, Peace Corps will ask you to sign a waiver acknowledging the risk of communicating via email. Peace Corps staff may not retaliate against a Volunteer for reporting a concern. This forum (email) is open to Volunteers only.
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Contraception All Volunteers should be aware that contraceptive information, advice, and most contraceptive methods are available from the Health Unit. Unwanted pregnancy can change or curtail your Peace Corps experience. If you are using a particular type of contraceptive, inform the PCMO in order to appropriately prepare to refill them. The Medical Office may not stock brand-name pills, but will have a similar generic formulation. For those Volunteers not in a long-term, mutually monogamous relationship, condoms should always be used. Condoms provide a barrier to help decrease the risk of contracting a sexually transmitted infection, but condoms are not 100% effective. Pregnancy If you think you may be pregnant, call or come to the Medical Office. A urine or blood test can be performed for confirmation. Pregnancy will be treated as any other medical condition. Since medical facilities in the Volunteers sites in Costa Rica cannot provide the US standard of prenatal care and delivery, there is a very high possibility that you could be separated. Counseling regarding pregnancy options including termination or adoption will be provided. If you choose to terminate the pregnancy, Peace Corps will refer you to a qualified practitioner. The payment of the procedure will be discussed at the time, as this topic is being reviewed. Peace Corps will provide round trip airfare with per diem, psychological counseling and offer a method of birth control for future use. If the Volunteer desires to start a family and continue with the pregnancy, a medically separation could be considered given the resources and conditions most Volunteers live. Post-service prenatal care costs are covered under FECA but normal pediatric expenses or care for congenital defects are not. Paternity In the event of a non-volunteer pregnancy (whether a spouse or an unmarried partner,) the Country Director must be informed. A Volunteer who fathers a child by a woman to whom he is not married may be administratively separated. The Country Director determines if the Volunteer's actions have impaired his ability to complete his assignment, has jeopardized the credibility of the Peace Corps program, or has violated host country laws or customs. Should the volunteer be authorized to remain in service, the Medical Office will pay for the prenatal, delivery and postpartum costs incurred by a non-Volunteer partner only if the Volunteer has taken action to acknowledge paternity. Costa Rican paternity legislation states that DNA testing is mandatory if a woman claims that the volunteer is the father of her child. If the test result is positive, the volunteer may be required to provide child support. In the case of non-compliance; the volunteer may be detained and face with travel restrictions.
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Medical Travel and Per Diem
All Volunteers must receive approval from the PCMO before coming to San José for medical or dental problems. If authorized, the Medical Office reimburses the costs related to bus transportation (where available), lodging and meals according to the realities of each individual. The Volunteer is responsible for the arrangement of his or her lodging –according to the authorized locations, meals, other ground transportation and logistics. Other costs related to medical care needs; require pre-authorization and coordination for favorable and best results. Emergencies, urgent and lifethreatening situations are treated as such. Peace Corps is responsible for providing all medical care, prescriptions and supplies necessary for reasonable maintenance of each person’s health care. The home-base medical care for Volunteers is at the Peace Corps Medical Office in the capital, San José, rendered by PCMOs. For initial evaluation or emergency, it could be necessary to obtain medical care nearer to Volunteers’ sites (see list attached). For this reason, Peace Corps has made services and credit agreements with some medical facilities outside the capital, private providers, laboratories and pharmacies to provide these services for Volunteers with prior authorization from the Medical Office.
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Medical care resources outside the capital In order to provide timely medical care, the Medical Office has identified the following facilities in order to receive, -prior authorization to do so, initial evaluation. Appointments are coordinated via Do単a Betty to complete the administrative part of the visit (appropriation of funds, etc.) There are other medical services contacts in each region, including laboratories, pharmacies, physical therapist or individual private practices which could become a good resource. Zona Norte Hospital Cooperativo. They are open daily up to 10:00 PM. Address: Downtown Ciudad Quesada, opposite Hospital de Ciudad Quesada CCSS. Phone: 2460-1080. Guanacaste Liberia: 1-Hospital Clinica Biblica, address is Dentro del centro comercial Do-It center, entrada al Golfo de Papagayo. Phone 2667-0891. 2-Hospital Clinica San Rafael Arcangel, de la escuela Asuncion Esquivel, 100 metros este y 25 metros sur. Phone 2666-1717. We do have credit agreement that requires a written document (or mail or fax or verbal authorization) prior providing service. Puntarenas Clinica Lostalo: They are open 24 hours daily. Address, in Barranca 250 meters East from Acueductos y Alcantarrillado. Phone is 2663-5858. Zona Sur Ciudad Neilly: 1-Centro Medico, 75 meters east of the Tribunales de Justicia, phone 2783-5330/2783-5054, they are open mostly in the afternoon during the work-week. 2-San Vito: San Vito Centro Medico, altos de la Farmacia Assisi. Phone 2773-5580, they are open during office hours on workweek days. 3-Buenos Aires: Centro Medico, de la entrada de los Bomberos 50 metros al norte, they are open during office hours on workweek days. 4-Perez Zeledon: Cllnica de Urgencias Medical, del hotel Los Crestones (o del Estadio Municipal de futbol) 200 metros al Sur, phone 2772-6060. Caribbean Limon: Medica Wolter & Chavarria, Del restaurant Black-Star-Line 325 meters East. Phone 2758-0033/2758-7569.
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POST SERVICE HEALTH BENEFITS Federal Employees' Compensation Act An important reason to keep your health record updated is eligibility for benefits for service-related health problems under the Federal Employees Compensation Act (FECA) after the end of service. The health record is the most important document referred to when making decisions about benefits to be awarded to a Volunteer. FECA provides medical and disability compensation to Volunteers after service for injuries or illnesses that occurred during service. The Office of Workers’ Compensation Programs (OWCP), US Department of Labor, administers FECA. This office is solely responsible for adjudicating all claims. In general, any injury or illness that is incurred during PC service is considered to be service-related. However, FECA does not cover:
Pre-existing conditions, unless they are aggravated by service. Volunteers in the US on special leave, annual leave, or on medevac. Injuries caused by willful misconduct, attempted suicide, or drug or alcohol intoxication.
For any injury or illness for which compensation may be claimed, there must an entry in the Health Record that mentions the condition. If it is not documented in the Health Record, discuss the medical condition with the PCMO. AfterCorps Health Insurance All Peace Corps and Crisis Corps Volunteers and Trainees are eligible for AfterCorps, the Agency's post-service health insurance program for Volunteers, regardless of length of service. All Volunteers are automatically enrolled for their first month after service, have the opportunity to extend their AfterCorps coverage for up to 3 months, and may elect to enroll qualified dependents. Detailed, updated information on post-services health benefits is available from the Medical Office. AfterCorps is a private, comprehensive health insurance policy specifically designed to complement the PC127C vouchers and FECA benefits to which returned Volunteers are already entitled. This policy has no restrictions for pre-existing conditions, covers medical expenses not related to overseas service, and provides low cost health insurance for returning Volunteers. 14
Payment of the insurance Peace Corps will automatically pay the first month's AfterCorps premium for all Volunteers and Trainees who COS, regardless of the reasons for their close of service or their length of service. For the purpose of the AfterCorps program "COS" includes completion of tour and all forms of early termination. Prior to COS, Volunteers will be given an opportunity to extend their individual AfterCorps policy for up to 3 months. At that time, they may also enroll and extend coverage for qualified dependents. To insure ongoing coverage for themselves and their qualified dependents, Volunteers must follow the instructions outlined in the AfterCorps brochure/extension form. Because AfterCorps covers all non-service related conditions, returned Volunteers will be covered after COS for injuries or illnesses that developed in the US while on vacation, home leave, emergency leave, or on medevac but not directly engaged in Peace Corps activities.
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Health Benefits Card To receive health care while in service, when in the US on vacation, home leave, emergency leave, medevac, and after close of service, Volunteers need to have a Health Benefits Program Identification Card. This card is provided to each individual upon arrival to country. After close of service, the card is primarily used with the PC-127C form, a voucher for authorization for evaluation, provided by the PCMO. When the card is given, you will be provided with information on proper use and how to access medical providers who accept the authorizations and receive payment for services from the program. Early Termination If you decide that you do not want to leave Costa Rica prior to your COS date, you will not be pressured to change your mind. Take the time you need to have discussions with the significant people in your life, in order to assure it is the right decision for you. Do not feel embarrassed or lose self-respect for changing your mind. Decisions are part of everyday life. We will respect it. If you are concerned of the implications for work and other aspects, discuss them with appropriate staff including the PCMO. There is final paperwork to complete before your departure. Processing will usually take three days to complete. In the Medical Office, this includes appropriate physical assessments depending on the timing relative to your last evaluation. If you have outstanding medical issues, the PCMO will issue a PC127C form for assessment in the US along with instructions on using it. PC127C forms expire after 180 days. Information will also be provided regarding the Federal Employees Compensation Act (FECA) and the Office of Workers Compensation Policy (OWCP) with whom any post-service claims must be discussed. Replacement of Eyeglasses Volunteers who wear eyeglasses should have brought at least two (2) pairs of eyeglasses. If your glasses are lost, stolen, or broken, Peace Corps will replace up to two pair of eyeglasses during your service for up to US$199 each (the equivalent in local currency). Sunglasses or photo gray lenses will not be provided. If the eyeglasses are broken, efforts will be made to repair them. Any amount above this must be paid by the PCV. Contact lenses are the sole responsibility of the Volunteer and its maintenance. Peace Corps strongly encourages not using contact lenses while in Peace Corps. Peace Corps will not provide replacement contacts or solutions necessary for using contact lenses.
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DENTAL CARE The aim of the dental program is to reduce the incidence of dental problems to an absolute minimum. To achieve this, Volunteers must pay more attention than usual to preventive techniques and, possibly, change some lifelong habits. An annual check-up with cleaning and prophylaxis is authorized for each Volunteer which is routinely schedule around the mid-service training and within 90 days of COS. Should a dental emergency occur, immediate evaluation may be required for which, PCVs must contact the PCMO. More extensive dental work (root canal, bridge, plates, etc.) requires prior approval from the Office of Medical Services at Peace Corps in Washington. IMMUNIZATIONS
Crucial to the effectiveness of a program of preventive medicine is the maintenance of immunizations. All Trainee health records are reviewed at the beginning of service to ascertain if the required immunizations are up-to-date or prior series were completed correctly. All immunizations are given by the PCMO. Most vaccines have some type of usually minor or mild side effects. While not everyone receiving a vaccination will have side effects, the most common ones are: Redness or tenderness at the site of the injection Mild body aches Low grade fever For most injections, these side effects will last for a few days. As with any drug or vaccine, there is the rare possibility that you may have an allergic reaction or a more serious reaction than those described above. Some indicators of a more serious reaction include: Difficulty breathing (coughing, tightness in the chest) Skin rash or hives Increased heart rate Convulsions (seizures) If you think you are having a serious reaction to an immunization, voice that concern to the PCMO immediately.
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Immunization during Peace Corps service The following are the vaccines Volunteers will be receiving
Hepatitis A
First dose is administered during PST (the second dose is after six months). This type of viral hepatitis is spread through fecal/oral route and is preventable by good general hygiene habits and frequent hand washing.
Hepatitis B
First two doses are administered during PST (the third is after six months). It provides immunization for life. This form of hepatitis, also viral, is spread via blood and sexual secretions primarily. Using condoms greatly reduces transmission.
Typhoid (Typhim Vi)
One injection is administered during PST. It is valid for two years. This bacterial infection is transmitted via contaminated water.
Rabies
It is not routinely administered. Only for animal bites specifically bats. If bitten by bats, there is a series of vaccines doses to complete basic immunization protocol.
Tdap (Diphtheria and Tetanus)
The first basic series are administered during chilhood. Booster doses are given to adults. If there is no documented booster within the last five years, then one dose is provided. It is valid for 5 to 10 years.
Influenza (Flu) vaccine
Every year influenza vaccine is administered from July and up to May of the following year. Usually, vaccination must be completed within the same year.
TB Skin Test
A skin test for tuberculosis (called a PPD) is routinely applied at COS. While skin tests do not prevent disease, a positive test suggests prior exposure and, therefore, the possibility that an infectious process may be at an early stage. A positive skin test does not mean a person has tuberculosis. It indicates exposure and requires further investigation to determine whether or not the disease is actually present.
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SECTION II HEALTH RESOURCES The Peace Corps Health Unit The Peace Corps Medical Office is located on the 1st floor of the Peace Corps office and provides medical services to Volunteers in Costa Rica. The Peace Corps Medical Officer’s (PCMOs) primary role is to establish and maintain a health care system that responds to the needs of Peace Corps Volunteers in the field in as safe, efficient, and timely a manner as possible within the particular country environment. The PCMO is a member of the country team with the Country Director providing direction and supervision, concerning administrative matters. In all professional medical matters, the PCMO receives guidance, direction, and support from the Office of Health Services at Peace Corps headquarters in Washington, DC. A set of comprehensive Medical Technical Guidelines directs the in-country PCMO's actions. The Medical Office schedule:
Monday through Friday From 7:30 AM to 4:00 PM The office is closed on all American and Costa Rican holidays
There is a PCMOs on-call 24 hours a day, 7 days a week. For after-hours emergencies, Volunteers should call the medical emergency cellular phone. Do not send text messages. Volunteers must seek prior approval from PCMOs before receiving medical care from an outside medical provider or traveling to the capital for medical or dental treatment. Reimbursements for medical care costs are subject to revision and verification. Violations of these policies could be grounds for further administrative actions. In life threatening situations, Volunteers are go to the nearest medical facility for prompt medical attention, and contact the PCMO as soon as possible, preferable as soon as the condition appears in order to coordinate the best course of actions. Health Record Health Unit recently began using electronic health records. As it is a work in progress, we are still finalizing details to include PCVs access. Health Unit will maintain PCVs updated.
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Contacting the PCMO Go ahead to contact the Medical Office if you need medical care beyond first attempts of self-care. If you are sick or have an unresolved, continuing medical problem, Volunteers are to call/visit the medical office for assistance. Many issues can be resolved over the telephone, in person or other means. Before you call or visit, organize what you want to discuss with the PCMO, it will be helpful if you write a list in order not to miss anything and bear in mind that medical staff will be needing time to attend each person in a professional manner, avoid visiting or calling for medical conditions when you have commitments in “five minutes” but need medical care in “two minutes”. PCMOs usually will have further questioning and perhaps may request that Volunteer collaborate with some degree of selfexamination (pulse). Other medical resources The medical care system delivery, include a medical kit that contains over-thecounter medications which Volunteers may use as needed for self-treatment for minor, common health problems. Use the appropriate section of this health manual to help you determine when and what medication to use. Do not self-medicate otherwise. Outside of San José, medical care can be obtained from local clinics or hospitals for acute conditions. It is advisable that you become acquainted with the medical capabilities and the staff at these institutions before medical care is needed.
Important logistics information when using outside facilities On certain occasions, Volunteers require immediate initial assessment; have logistical transportation problems, medical emergencies or have a special condition that impedes/delay Volunteers to receive medical care at the Peace Corps Office in the capital. For these reasons, we have made agreements with outside medical provider, facilities, laboratories, pharmacies and others. EXCEPT IN THE CASE OF A LIFE- THREATENING EMERGENCY, VOLUNTEERS ARE ASKED TO CONTACT THE PCMO BEFORE SEEKING OUTSIDE MEDICAL CARE . P LEASE KEEP IN MIND THAT IF EMERGENCY TREATMENT IS INITIATED , CONTACT THE PCMO RIGHT AWAY TO INVOLVE US IN THE TREATMENT PROCESS AS EARLY AS POSSIBLE .
The Peace Corps Medical Office provides or arranges health services for Peace Corps Volunteers. Only the PCMO can refer Volunteers to private practitioners and specialist. Remember the PCMO needs the cooperation of local health care providers to render services in circumstances that PCMOs cannot be present, are far away or other conditions that we need them. In order to retain qualified health professionals for the benefit of present and future Volunteers, we ask that Volunteers keep the fine art of being courteous and respectful without compromising self-respect and esteem, as well as personal safety. Remember that not all health professionals are educated or trained equally and even may not be up to US standards, nevertheless they should be respected as professionals. 20
Being patient could help us; help Volunteers through the perilous of the local health care system which is different from that of the U.S. Feedback and outside consultant survey The Peace Corps Office of Health Services (OHS) in Washington, D.C. and the Costa Rica medical office strive to provide a medical culture that embraces quality health care and patient service satisfaction. As part of that effort, we are pleased to offer you the new Health Care Consultant On-Line Satisfaction Survey. This survey provides an avenue through which you can give non-urgent feedback to your PCMO or the Office of Health Services (OHS) regarding the health care you received from an outside consultant and or facility (e.g. laboratory, hospital, etc.). We strongly recommend that Volunteers provide feedback to update the resources we offer by giving your comments at HTTPS ://WWW.SURVEYMONKEY .COM/S /SURVEYONHEALTHPROVIDERS
Please note that if you need to report a more urgent situation regarding a health care provider, please discuss with your PCMO directly or contact the quality nurse line at QualityNurse@peacecorps.gov Peace Corps wants to know your thoughts (positive and negative) about the health care providers you visit. This feedback will assist us in assessing the quality of care given by the health providers to Volunteers. The Survey tool is available online only to ensure that we capture the data in a secure manner that can be easily stored and collated for posts by the OHS Quality Improvement Unit in Washington, D.C. On page 13, is the local list of medical resources used outside the capital. This list is updated periodically. What to do in an emergency It is preferable to notify the PCMO or CD before any action is taken unless this delay would impede necessary emergency treatment. In the case of a life-threatening emergency, you should go (or be taken) to the nearest hospital or other medical facility where evaluation can be initiated. Upon arrival or once you have been evaluated, notify the PCMO or, if that is not possible, the Peace Corps office RIGHT AWAY OR AS SOON AS POSSIBLE.
The purpose of medical care in any regional hospital is to provide emergency care and to stabilize the patient's condition. It is NOT to provide major surgical or medical intervention once the Volunteer has been stabilized.
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Medical evacuation
FROM VOLUNTEER SITE TO SAN JOSÉ You are responsible for coordinating routine medical transportation from your site to San José by bus or private vehicle, which is why it is critically important that you develop a plan for transportation under urgent situations soon after arriving at your site. Often, another Volunteer can accompany a sick or injured PCV but a Costa Rican friend or supervisor may also be an escort. When coming to San José for evaluation of a potentially serious health problem or injury be sure to bring your personal and PC passports, all important personal items and valuables with you or bring them to the Peace Corps office for safekeeping.
FROM COSTA RICA TO SOMEWHERE ELSE
Some situations require medical evacuation from Costa Rica to somewhere with more sophisticated medical facilities. This may be in Panama, Washington, D.C or Home of Record. The final decision to evacuate a Volunteer is made by the Office of Health Services in Washington. PCMO and in country consultants will provide as much information possible and make recommendations according to the case. Medical evacuation (medevac) must be sought on cases due to serious illnesses/injuries, for further testing/diagnosis methods which are not available in country; the medical care required is beyond country resources, or exhaustion of in-country capabilities. Guidelines for evacuation include the following situations:
Elective surgery or severe illness of any consequence Difficult diagnostic problems, especially if prolonged Pregnancy counseling Moderate or severe emotional problems Alcohol & Drug abuse counseling (outside the protocol)
At the time of a medevac, an appropriate medevac packet of instructions and detailed information will be provided. Your return to Costa Rica to continue service depends on how the evaluation and treatment proceed. Peace Corps policy requires that a Volunteer on medical
hold must terminate service after 45 days if full medical clearance has not been achieved. In other words, if the problem has not resolved in 45 days,
the Volunteer will be medically separated. After termination, Volunteers could opt to get reinstated or go ahead to re-enroll (Concepts are explained in PC Manual).
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Safe Water PROPER WATER TREATMENT
Drinking fluids, especially water, is important in maintaining proper hydration and good general health. Enough water must be consumed so that you urinate at least four (4) times a day which is roughly three liters of fluids per day. Much of the municipal water is potable but could be contaminated due to different reasons (flooding, pie corrosion, astray pets in the wild, human contamination among other reasons). Water for drinking could be considered “potable” therefore “safe”. To be certain, treating one’s own drinking water could be an excellent idea, especially in areas that the potability of water is unknown. Following one of these simple treatment procedures will ensure personal safe drinking water.
BOILING
Boiling is an effective method and relatively simple. A rapid or rolling boil for three minute kills everything -- bacteria, viruses, worms, and parasites. If you boil your water in the morning, it will cool off during the day and be ready for use couple hours later. It should always be kept in a covered, clean container.
OTHERS Chlorine also can be used. If you are not able to boil your water, add chlorine bleach. Use four (4) drops of 3-5% bleach to one (1) liter of water and let it stand for 30 minutes before drinking. Iodine tablets are recommended also, but as a last resort. This method is for short-term use only to avoid possible thyroid problems -use no longer than 3 weeks out of every 6 months. Add one Iodine tablet to a liter of water and let it stand for 60 minutes. Use this method when traveling and other options are not available. Other options include water filters, which are not too popular in this country. Health Unit has few water filters available for PCVs use.
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ALCOHOL POLICY The policy is outlined in the Peace Corps Costa Rica Volunteer Handbook. Following, is the directive from our Regional Director, issued in February 2015. It reads: The Regional Director, of the Inter-America and the Pacific Region, issued in February 2015, a new alcohol policy which reads: As the Peace Corps Regional Director of the Inter-America and the Pacific Region, I want to clarify to all Trainees, Volunteers and staff how I intend to support Country Directors in taking disciplinary action relating to conduct involving alcohol use. While some alcohol use is socially acceptable in most of our posts, excessive use of alcohol compromises the capacity of Trainees and Volunteers to serve safely and productively, and risks negatively affecting the reputation of the Peace Corps and Volunteers. Volunteers may be administratively separated for unsatisfactory conduct or performance, violation of Peace Corps policies or for conduct that diminishes their effectiveness or the effectiveness of the Peace Corps program. This Administrative Notice serves as notice to Trainees and Volunteers of the intent to enforce the alcohol and conduct policies of the agency and posts. Hence forth, disciplinary action -- including Administrative Separation -- may be taken for any Trainee or Volunteer found to have engaged in any of the following behaviors:
Public intoxication Excessive alcohol use while at a work-related event or any Peace Corpssponsored event Failure to appear for work or training due to intoxication or hangovers Verbal or physical aggressiveness while under the influence of alcohol Destruction of public or private property while under the influence of alcohol Intoxication to the point of belligerence, incapacitation, blacking out, inability to respond in an emergency situation or failure to make sound judgments Drinking in a manner that is culturally inappropriate or damaging to the reputation or mission of the Volunteer or the Peace Corps. Alcohol use that compromises a Volunteer’s or Trainee’s safety and security.
Credible reports, including those obtained from individuals who choose to remain anonymous, may serve to support disciplinary action.
THIS NOTICE DOES NOT IN ANY WAY AMEND OR OVERRIDE EXISTING PEACE CORPS POLICIES AND PROCEDURES . ANY VOLUNTEER OR TRAINEE WHO IS CONCERNED ABOUT HIS OR HER LEVEL OF ALCOHOL USE IS ENCOURAGED TO REACH OUT TO A PEACE CORPS MEDICAL OFFICER If PCVs perceive themselves as needing clinical medical support, the Health Unit will provide it with the guidance of the Office of Health Services in Washington.
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SECTION III THE MEDICAL KIT The Peace Corps Medical Kit is intended to provide the items necessary to prevent illness and treat minor illnesses that might occur during Peace Corps service. Replacement supplies are available through the MEDLINK system. The items in this kit are intended for your personal use ONLY. Dispensing medications to other PCVs or Costa Ricans must not be done. Costa Rica has pharmaceuticals and medications available that have not been approved by the Food and Drug Administration for use in the US; and many drugs that require prescription in the USA can be purchased "over-the-counter". In addition, some medications that are used for life-threatening infections in the US could be used for minor infections in developing countries due to cost factors. For these and other reasons, Volunteers home-base medical care is at the Peace Corps Medical Office in the capital, PCMOs oversee the care received outside of the office and must be informed and consulted for new treatments being prescribed.
As a general caution, Volunteers must check with the PCMO before taking any medication prescribed by anyone other than the PCMO. Exceptions are treated as such!
Medical Kit Contents
Diphenhydramine HCl 25 or 50 mg. Capsules (Benadryl)
For treatment of allergic reactions such as hives; swellings due to bee, wasp, insect stings and bites; and contact dermatitis (poison ivy, poison oak, etc.). It can also be used as a sleeping aid. Dosage: One capsule every 4 hours as needed. For severe allergic reaction, two capsules may be taken every 4 to 6 hours but contact the PCMO for further recommendations. Precautions: May cause drowsiness and dizziness.
Phenylephrine HCl 5 mg
For the treatment of nasal and sinus congestion, common cold or allergy (hay fever). Dosage: One 5-mg. tablet every 6 hours as needed. Do not exceed 4 tablets in a 24-hour period, not more than 3 days. Precautions: Should not be taken by persons with history of high blood pressure. It may cause insomnia or palpitations in some people.
Antacid Tablets
For the relief of minor indigestion and "heartburn.� Dosage: Chew 2 to 4 tablets, 3 times per day. It should be taken after meals and at bedtime, or as needed. Followed with 1/2 glass water. Do not exceed more than 12 tablets a day. Precautions: Report any significant or persistent abdominal pain to the PCMO. Prolonged use of antacids is not recommended due to increased susceptibility to certain intestinal infections. 25
Anti-fungal Cream (Clotrimazole/Tinastin/Tolnaftate)
For treatment of fungal skin infections like jock itch, athlete's foot, and ring worm. Dosage: Apply sparingly to affected areas 2 to 3 times per day. Precautions: it should be discontinue if condition worsens and must be reported to the PCMO.
Triple Antibiotic Ointment
A broad-spectrum antibiotic ointment for the treatment of minor skin wounds, cuts, scrapes, abrasions, scratches, and minor burns. Dosage: Apply sparingly to affected area 2 to 3 times per day. May cover wound with sterile bandage or dressing. Precautions: Any significant burns should be reported to the PCMO as well as infected skin wounds (pus-like discharge, fever, redness, "streaks,� enlarged lymph nodes, or a wound that does not heal. Discontinue use of ointment if skin irritation or blistering occurs. Do not use on a deep laceration or significant burn.
Caladryl Cream and Hydrocortisone Cream 1% Use for soothing relief of minor irritations such as mosquito bites , minor itching and skin irritations. Dosage: Apply sparingly to affected areas 2 to 3 times per day Precautions: Discontinue use if increased irritation of skin occurs. Do not apply to blistered, raw or oozing areas.
Antiseptic Skin Cleaner (chlorhexidine)
An antiseptic, anti-microbial skin cleaner for minor skin wounds. Dosage: Lather with water; rinse thoroughly after use. Precautions: Discontinue use if irritation of the skin develops.
Saline Eye Drops
For symptomatic relief of dry eyes Dosage: Use as indicated on the bottle. Precautions: Seek medical attention for any pain or evidence of infection in the eye (pus discharge or continued redness). Discontinue use of this preparation if increased irritation of the eye occurs. Do not touch dropper to eyes. Anti-diarrheal caplets (Loperamide 2 mg) Dosage: Take two caplets if more than three watery stools in one day if no bloody
diarrhea or fever are present. May take one caplet or 2 mg with each additional watery stool; not to exceed 8 mg daily. Water Purification Tablets (Iodine Tablets) Use occasionally as directed for purification of contaminated drinking water.
Sore Throat Lozenges (Cetylpyridium)
For the relief of minor discomfort due to sore throat. Dosage: Suck on one lozenge every one to two hours as needed. Precautions: Contact the PCMO if soreness persists more than two-three days. 26
Dextromethorphan cough lozenges
For the relief of cough. Dosage: Suck on one lozenge every one to two hours as needed. Contact the PCMO if there is also shortness of breath, wheezing, chest tightness, or if the cough wakes you from sleep.
Bismuth Subsalicylate Tablets
For temporary relief of minor upset stomach, nausea, and diarrhea. Adult Dosage: Chew two tablets every ½ to 1 hour as needed (max. 8 doses in 24 hours). Precautions: Tongue or stool may turn black. Contact the PCMO if symptoms persist.
Acetaminophen Tablets 325. (Tylenol)
For relief of minor aches and pains and reduction of fever. Dosage: Two to three tablets every four hours as needed (max. 12 tablets/day). Precautions: Avoid if there is a history of liver disease or known allergy.
Ibuprofen 200/400 mg. Tablets
For relief of minor aches and pains and reduction of fever. Dosage: Two tablets every four to six hours as needed (do not exceed 2400mg/day). Take it with food. Precautions: Do not use if there is a history of stomach ulcers, bleeding or blood clotting problems, or known aspirin allergy. Lip Balm with SFP 15 Use as needed for moisturizing dry, chapped lips. Do not share with other people.
Insect Repellent (containing 30% DEET -- diethyltoluamide)
Apply to exposed areas as needed. Discontinue use if skin irritation develops.
Oral Rehydration Salts
To be used as supplemental rehydration aid in the event of vomiting. Mix with treated water according to package instructions.
Condoms
Condoms are provided free of charge to PCVs for the prevention of sexually transmitted infections including HIV/AIDS. Condoms should not be considered a reliable source of birth control.
Red Cross First Aid and Personal Safety Manual Other Contents
Latex gloves, Scissors, Tweezers, Medical Tape, Band-Aids, Ace Bandage, Gauze Pads, Dental Floss.
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Disposable thermometers (Fahrenheit)
Follow directions for use: Protect from extreme temperatures and sunlight. Re-supply Requests (Refills) We are pleased to announce a streamlined process for you to order supplies and refills from your Medical Office, called PC Medlink. This is a tool that allows you to order supplies via the web or text messaging and see your requests in a single web portal. This will make it easier for you to order supplies and will allow your PCMO to track your requests more effectively. Here is how PC Medlink will work:
You can order your supplies and refills via Internet at any time, during the month You will receive an automated confirmation that your order has been received. Health Unit will inform the guide number required to retrieve the package from the encomienda office. (Encomienda is the equivalent to USPS in the US). PCMOs will fill the order during the first week of the following month. If, Volunteers need supplies and refills for a Peace Corps event (trainings, conferences, etc.), the order must be place via Medlink and specify it. Occasionally, Volunteers need a specific item that is not listed. You should click on any item from the list, and then, a special instruction box will appear and volunteers can write the name of the item needed. Emergencies are treated as such, PCVs must inform the Health Unit.
In summary, Volunteers can request supplies and refills during any given time of the month and will receive them during the first week of the following month.
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To activate account
To get started, please visit the link below to sign up and consent to use the application. You will receive an email from PC Medlink that gives you a link to activate your account. Once you receive it, if possible, activate your account sooner rather than later since the link expires. If any problems arise, questions, concerns, and feedback to improve the tool, send it to support@pcmedlink.org After you complete the authorization, you will receive a “Welcome letter” to your email that will allow you to set up a password and access the application. Once your order is processed by the Medical Office, you will receive a response via text e-mail with the details of the “Encomienda” guide number to pick-up your approved items. Occasionally, Health Unit may send a form for the PCV signature (not all refills requires the PCV signature), please do so and send it back to the Health Unit.
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Section IV Medical Treatment Guide General Medicine *Fever Fevers can occur by themselves but very often occur with other symptoms that may indicate a particular illness such as respiratory tract infection, gastrointestinal infection, urinary tract infection, etc. Please see the designated section of this guide if you have other symptoms along with the fever. If you feel feverish, check your temperature with your thermometer. Symptoms: Mild: Feeling very hot or feeling chilled Body aches Temperature 99.4F (37.4 C) – 101.5F (38.5 C) Fatigue Severe o Shaking chills o Temperature >101.5 (38.5C) Treatment Acetaminophen 325mg, 1-2 tablets every 6 hours or Ibuprofen 200 or 400mg, 1-2 tablets every 8 hours Do not exceed 2400 mg o Ok to alternate the two medicines Drink lots of clear fluids, at least 8oz (240ml)/hour Rest When to call the PCMO: Call immediately for any severe symptoms if fever >101.5 (38.5C) If mild symptoms persist for more than 24 hours
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*Allergic Reactions Allergic reactions can occur in response to stings, drugs, plants or foods. Symptoms: Mild
Generalized itching may be an early sign Runny/stuffy nose, sneezing, and itching around the eyes Various skin reactions ranging from a small, red, raised eruptions to giant hives that look like large areas of raised skin Serious/Life threatening: o Breathing difficulty;
o Swelling of the tongue, throat, or face o Weakness; o Loss of consciousness or a seizure.
Treatment
Mild:
Take Diphenhydramine (antihistamine Benadryl) 25/50 mg, 1-2 capsules every 8 hours by mouth for 3 days Apply cool compresses and/or calamine lotion to rash For serious/Life threatening situations: o If you have an epinephrine pen, use it. o If any sensation of difficulty breathing go immediately to closest hospital, while going, contact PCMO
Call the PCMO For any serious or life threatening symptoms while getting to the hospital For any new allergic reaction resulting in severe hives and itching
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*Fainting or Near-Fainting You may feel like fainting if you are dehydrated or if you have been standing in one place with your knees locked. Some people faint when they have medical procedures like getting blood drawn. Symptoms: Mild (near-fainting): Feeling “giddy”, “dizzy”, “woozy”, or light-headed Seeing tunnel vision, or seeing blackness in peripheral vision Feeling nauseated Severe (faint): Going completely unconscious and falling to the floor
Treatment: As soon as symptoms start sit down and put your head between your knees Drink some cool-clear fluids If not nauseated, have something to eat Have someone open windows or doors for coolness or cross breeze Don’t try to stand up again unless you have someone with you If you see someone else faint elevate their legs, turn their head to the side in case they throw up, and call for help.
Call the PCMO
For any actual fainting episode, if near fainting happens one or more times without any good reason (like dehydration or standing too long).
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EYE AND EAR PROBLEMS CONJUNCTIVITIS - "PINK EYE"
Conjunctivitis is a common, highly contagious eye infection Symptoms One or both eyes look red or "blood shot,” Eye itching and irritation o May have a foreign body sensation Eye discharge o Clear, white or yellowish Possible swelling of the eyelids Vision usually not affected unless it is cloudy from the discharge Treatment Cool or warm, moist compresses to the eye/s three times daily Antibiotic eye drops may be needed o Antibiotic eye drops must be obtained from PCMO o Apply 1-2 drops to affected eye/s every 2 hours while awake for 2 days then every 4 hours while awake for 5 more days If you are a contact lenses user, take them out and do not use until treatment finished o Throw out current contacts Careful and frequent hand washing No sharing of towels or other personal items Consider staying home from school/work Throw out current eye makeup
Call PCMO For all suspected eye infections
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Sty (Hordeolum) Symptoms Red, swollen, tender bump on the upper or lower eyelid.
Treatment Warm, moist compress to the eye/s 4-6 times daily Don’t pick, squeeze or scratch Wash eye area with baby shampoo twice daily
Call PCMO If not resolve in 2-3 days treatment, becomes larger or more painful, blurry or vision change and if eye becomes swollen or red.
Eye Trauma Eye trauma can occur from a direct injury to the eye in sports or from assault. It may also occur from getting a foreign body (dust, wood chip, etc.) or caustic liquid (bleach, ammonia, etc.) in the eye. Symptoms You may have: Pain Foreign body sensation Redness Bleeding or the appearance of blood in the white (sclera) of the eye Vision change Blurry vision Partial or complete vision loss Treatment For foreign body attempt to flush out with clean water or gently dab out with clean cotton swab For chemical splash flush the eye with clean water continuously for 15 minutes For any active bleeding cover the eye with clean gauze If you wear contacts, take the contact out
Call PCMO Call the PCMO immediately for any eye trauma 34
EAR WAX (CERUMEN) IMPACTION For some inexplicable reason, few Volunteers may develop excessive earwax during their time in Costa Rica. Symptoms Hearing loss Pain or tenderness in the ear canal Treatment Earwax softener drops: apply 5-10 drops into each affected ear twice daily for four days. Rest with affected ear faced up for 10-15 minutes after application to ensure medication stays in ear canal. Earwax softening drops need to be obtained from the Medical Office Call PCMO If pain or hearing loss worsens, if there is no resolution after use of earwax softener, if you have bloody or pus-like drainage from the ear and if you develop fever.
EXTERNAL EAR INFECTION (OTITIS EXTERNA) External ear infections are infections of the ear canal. Symptoms Itchy ear canal Pain in the ear canal o Worse if the ear is pulled Discharge o Yellow, brown or clear. Hearing loss in affected ear Treatment Antibiotic/steroid eardrops: 4 drops to affected ear twice daily for seven days, prior contact with the PCMO For pain Acetaminophen (Tylenol) 325mg, 1-2 tablets every 6 hours as needed or Ibuprofen 200/400mg, 1-2 tablets every 8 hours as needed, do not exceed 2400 mg.
Call PCMO Contact the PCMO if there is suspicion of external ear infection and to discuss need for antibiotics. Also, if pain or hearing loss worsens, no resolution after use of antibiotic/steroid eardrops, if you have bloody or pus-like drainage from the ear, and if develop fever. 35
MIDDLE EAR INFECTIONS (OTITIS MEDIA) Middle ear infections are infections of the ear drum Symptoms Ear pain Fever Decreased hearing Treatment Antibiotic treatment for 7-10 days, as per the PCMO indications Warm moist compresses to the ear three times daily For pain Acetaminophen (Tylenol) 325mg, 1-2 tablets every 6 hours as needed or Ibuprofen 200/400mg, 1-2 tablets every 8 hours as needed. Phenylephrine decongestant 10mg, 1 tablet every 4-6 hours as needed
Call PCMO For any suspected middle ear infection, pain or hearing loss worsens, if no resolution after treatment, blood, pus, fever or if doesn’t resolved.
Dental/Oral Problems Dental Pain Dental pain can be cause by a tooth with a cavity, lost filling or lost crown. It can also be caused by gum infections. Dental trauma can cause lost or broken teeth. Symptoms Painful tooth/teeth , Sensitivity of a tooth to cold, sweets or heat Gum swelling or receding, Pus from the gums Facial swelling, Fever Treatment Ice or heat pack to the face over the affected tooth, for 20 minutes 3-4 times per day Enhance good dental hygiene and brush teeth after each meals Floss teeth daily (preferably before bedtime) Consider using sensitive teeth toothpaste (Sensodyne) if available
Medication Acetaminophen (Tylenol) 325mg, 1-2 tablets every 6 hours as needed for pain Ibuprofen 200/400 mg, 1-2 tablets every 6-8 hours as needed for pain, do not exceed 2400 mg. Call PCMO For dental pain that worsens or does not get better with treatment, pus around the gums, if fever or facial swelling, or if Volunteer had dental trauma. 36
Aphthous Ulcer (Canker Sore) Aphthous ulcers are very common. It is often difficult to determine why people develop mouth ulcers because their cause remains uncertain. Mouth ulcers tend to occur after infection or when the person is stressed or “run down.” The ulcers could last 7 to 10 days. Symptoms Small painful ulcers found on the gums or inside the mouth.
Treatment Good dental hygiene Brush teeth after meals For pain relief: o Wash out the mouth with warm salt water after meals Acetaminophen (Tylenol) 325mg, 1-2 tablets every 6 hours as needed for pain Ibuprofen 200/400 mg, 1-2 tablets every 6-8 hours as needed for pain. Topical solution provided by PCMO to apply on affected area Call PCMO For symptoms that worsen or don’t improve after 10 days
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UPPER RESPIRATORY PROBLEMS The “common cold” or upper respiratory infection (URI) The common cold or URI results from a viral infection URIs usually last 10 to 14 days but can last considerably longer. Symptoms
Runny nose, clear, yellow or greenish nasal discharge, stuffy nose, ear pressure, mucus in the throat/post nasal drip, scratchy or sore throat, fatigue and weakness Cough o Dry, without mucous, clear, yellow or greenish mucous Fever below 101ºF, muscle and body aches, mild headache Treatment General self-care Hydrate o Drink at least eight ounces of non-caffeinated, nonalcoholic fluids every two hours, drink more if a fever is present. Rest o Stay home from work/school, cancel social obligations and stay at home Avoid smoke, don’t drink alcohol Humidification o A hot shower (if you are so lucky), put a pot of water to boil, use towel over head to inhale the vapors (be careful not to burn face due to direct exposure) Hot or warm liquids to soothe throat irritation and prevent coughing o Warm water or tea with honey and lemon Salt water gargles (do not underestimate) o One teaspoon of salt in a glass of warm water, gargle and spit 3-4 times daily Medication For pain Acetaminophen (Tylenol) 325mg, 1-2 tablets every 6-8 hours as needed or Ibuprofen 200/400 mg, 1-2 tablets every 8 hours as needed. Phenylephrine decongestant 10mg, 1 tablet every 4-6 hours as needed for stuffy/runny nose or sinus congestion Sore throat and/or cough lozenges as needed Saline nasal spray 1-2 sprays each nostril as often as needed to moisten mucous membranes and loosen secretions (through PCMO) Expectorant (Guaifenisen)/Robitussin syrup 1 tsp every 6 hours to loosen secretions (through PCMO) Call PCMO If symptoms worsen or persist for more than 10 to 14 days after trying the self-care measures listed above, Fever greater than 101ºF for more than two days, pain in the ears, face, or chest that is not relieved with Tylenol or Ibuprofen, difficulty breathing or shortness of breath, skin rash, severe sore throat, particularly if unable to swallow or open the mouth, headache and/or stiff neck.
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Sinus Infection Sinus infections can be caused by both viruses and bacteria
Symptoms Facial pain and pressure o Under, around, or above the eyes Nasal congestion Yellow or green nasal discharge Fever Tooth pain Increased pain/pressure when bending forward
Treatment For pain Acetaminophen (Tylenol) 325mg, 1-2 tablets every 6-8 hours as needed or Ibuprofen 200/400 mg, 1-2 tablets every 6-8 hours as needed, do not exceed 2400 mg a day. Phenylephrine decongestant 10mg, 1 tablet every 4-6 hours as needed Humidification A hot shower (if you are so lucky) Put a pot of water and inhale the vapors. Saline nasal spray: 1-2 sprays each nostril as often as needed to moisten mucous membranes and loosen secretions (through PCMO)
Call PCMO If symptoms worsen or persist for more than 7-10 days or fever greater than 101ºF.
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Throat infection (tonsillitis/pharyngitis) Throat infections can be caused by viruses, bacteria or others. They can occur without other cold symptoms. Symptoms Sore throat with difficulty swallowing Swollen, red tonsils May have a white or light-colored, pus-like coating Swollen lymph nodes in the neck Fever Headache and body aches Body rash
Treatment For pain Acetaminophen (Tylenol) 325mg, 1-2 tablets every 6-8 hours as needed or Ibuprofen 200/400 mg, 1-2 tablets every 6-8 hours as needed, do not exceed 2400 mg a day. Rest and hydrate Don’t smoke Hot or warm liquids to soothe throat irritation. Warm water or tea with honey and/or lemon Salt water gargles every 8 hours (1 tsp of salt in a glass of warm water) Call PCMO For all severe sore throats without other cold symptoms, fever greater than 101ºF, swollen throat, and difficulty breathing or swallowing. Also if there is white thrust or pus.
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THE “FLU” – INFLUENZA Influenza or “the flu” is a seasonal viral infection. Symptoms of the flu usually have a sudden onset. Symptoms High fever May have shaking chills alternating with sweats Muscle and body aches Sensitivity to light, sounds and touch Fatigue Headache Sore throat and runny or stuffy nose Cough (dry or with phlegm) Nausea, vomiting, or diarrhea.
Treatment For pain Acetaminophen (Tylenol) 325mg, 1-2 tablets every 6-8 hours as needed or Ibuprofen 200/400 mg, 1-2 tablets every 6-8 hours as needed, do not exceed 2400 mg a day. Rest, stay away from work/school Hydrate Drink at least eight ounces of no caffeinated, non-alcoholic fluids every two hours Call PCMO For fever greater than 101ºF, headache with stiff neck, body rash, and if you have difficulty breathing or shortness of breath.
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Bronchitis Bronchitis is a viral infection that occurs frequently with other URI’s and can last for 5-21 days, average just over one week. Symptoms Cough (may be dry and hacking, productive w/clear, yellow or green phlegm) Fatigue Chest wall soreness Treatment Expectorant (Guaifenisen) / Robitussin Syrup 1 tbsp. every 6 hours as needed for loosening secretions and calming cough (through PCMO) Cough drops as needed For pain Acetaminophen (Tylenol) 325mg, 1-2 tablets every 6-8 hours as needed or Ibuprofen and chest pain 200/400 mg, 1-2 tablets every 6-8 hours as needed, do not exceed 2400 mg a day. Rest and hydrate Don’t smoke.
Call PCMO For shortness of breath, difficulty breathing, chest tightness or wheezing, cough causing gagging or vomiting, pain inside the chest with deep breathing and cough. Also for fever greater than 101.0 F, coughing up blood, and cough that lasts greater than 2 weeks
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Asthma or Reactive airways
(this is a medical emergency)
Asthma is a condition of the bronchial tubes characterized by wheezing, coughing, chest tightness, and/or shortness of breath. It is sometimes associated with exercise. Symptoms Chest tightness and/or wheezing May occur when exercising, exposed to very cold air, or polluted air Coughing that wakes you at night Treatment Albuterol inhaler 2 puffs every 6 hours as needed for cough and chest tightness Must be examine by PCMO or medical doctor at nearest health facility For any symptoms that seem like asthma
Seasonal Allergies (Hay Fever) Some volunteers, who have never experienced seasonal allergies in the past, may become symptomatic in Costa Rica. Symptoms o Itchy, watery eyes o Swelling around eyes o Runny and/or stuffy nose o Post-nasal drip o Sneezing o Mild cough o Ear and/or sinus congestion o Difficulty sleeping Treatment Antihistamines as needed for relief of most symptoms: o Claritin (Loratidine) 10mg, 1 tablet by mouth daily as needed o Zyrtec (Cetirizine) 10mg, 1 tablet by mouth daily as needed o Benadryl (Diphenhydramine) 25mg, 1-2 capsules at bedtime as needed Allergy eyes drops for eye symptoms not relieved with oral antihistamines o Patanol (Olopatadine) 0.1% 1-2 drops each eye twice daily as needed (through PCMO) Flonase (Fluticasone) nasal spray for nasal symptoms not relieved with oral antihistamines (through PCMO)
Call PCMO For symptoms that are causing lack of sleep, inability to work and other generalized discomfort. 43
ABDOMINAL PROBLEMS Diarrhea (Enteritis) About 95% of diarrhea cases are caused by viruses and resolve spontaneously. It can also be caused by travel, stress, or any of a number of intestinal organisms from improperly prepared food or water. Symptoms Four or more loose or watery stools per 24 hours May also occur fever Abdominal bloating and/or cramping Nausea Belching and/or flatus Treatment Oral Rehydration salts (ORS) o Mix as directed usually 1 packet per liter of treated water o Diluted fruit juices o Chicken or beef broth, o Gatorade or other non-caffeine sports drink Drink at least 250ml (about 8 oz.) of fluid every 2 hours while awake Home-made oral rehydration drink: o 1 liter of treated water o 1/2 teaspoon salt o 8 level tbsp. of honey or sugar o 1/2 teaspoon baking soda (if available) o Adding orange, apple, grapefruit juice improves taste; pureed banana adds potassium. Taste first to be sure it is no saltier than tears. Diet: BRAT diet (bananas, applesauce, rice and toast –liquid and simple starchy meals) o Avoid heavy, greasy meals, red meats o Avoid milk and dairy products, irritants foods and drinks (spicy and carbonated drinks) Avoid alcohol, caffeine beverages, cakes, cookies, sweats and chocolates. Medications Bismuth chewable tablets (Diamode, Peptobismol) 2 tablets every hour as need for diarrhea and stomach upset not to exceed 8 tablets in a 24 hour period Immodium (loperamide) 2mg: Take 2 tablets after the first loose stool and one tablet after each subsequent loose stool. Not to exceed 8 tablets in a 24 hour period
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Call PCMO
For fever greater than 101° F, blood or mucus in stools, severe abdominal cramps, vomiting, diarrheal episodes more than 4-5, weakness, dizziness and/or lightheadedness and for diarrhea lasting more than 3 days.
Vomiting Nausea and vomiting can be caused by viral illness, food poisoning, water contamination, excessive alcohol, and pregnancy. Symptoms Throwing up
o Partially digested food o Stomach juices or nothing (dry heaves) Nausea (not always) Diarrhea Fever Abdominal pain and cramping Belching and/or flatus Headache
Treatment
Clear liquids only for first 24 hours and as long as vomiting lasts Oral rehydration salts (as directed above) Other clear liquids: potable water, flat non-caffeinated soda, Gatorade, diluted fruit juices, weak herbal tea, beef or chicken broth Start with small sips every few minutes with a goal of 250 ml (about 8 oz.) or more every 2 hours After 24 hours if vomiting has stopped, advance to bland diet BRAT diet (as mentioned previously) or other plain starches such as noodles, saltine crackers, hot cereal. Avoid irritant foods and drinks Alcohol, caffeinated beverages, greasy food, spicy food. Medications
Dramamine 50 mg, 1 tablet by mouth every 8 hours as needed for nausea and/or vomiting. Wait 30 minutes after taking medication to drink or eat. Call PCMO
If unable to keep down any clear fluids, two or more episodes of vomiting, fever greater than 101° F, bloody vomit, severe abdominal cramps/pain, persistent weakness, dizziness, and/or lightheadedness.
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Indigestion/Heartburn (Dyspepsia) Symptoms
o Burning sensation in mid-upper abdomen or mid-chest Usually after eating o May be worse after heavy or spicy meals o May be worse after going to bed o May have nausea
Treatment o Avoid foods that cause symptoms o Don’t eat within three hours of going to bed o Calcium Carbonate (Tums): Chew 1-2 tablets twice daily as needed Call PCMO
For dyspepsia present more than 1-2 days/week, pain not relieved with treatment and medications, chest/abdominal pain that is accompanied by nausea and vomiting, difficulty breathing or shortness of breath.
Constipation
Most people have a bowel movement (BM) daily or every other day. For some people it is normal to have a BM every 3-4 days. Constipation is present when BMs occur less than normal and cause discomfort. Symptoms o Inability to have a BM even when the urge is there o Incomplete BMs o Stool that is too hard or too small o Minor bleeding at the anus due to hard stool or straining o Abdominal discomfort and/or bloating Treatment
o Hydrate. Drink at least 2 liters of water per day o A hot beverage in the morning can stimulate a BM o Increase fiber intake with whatever is available at site Vegetables, dried fruit, whole grains, oat meal, papaya, etc. o Daily aerobic exercise for 20 minutes or more.
Medications
o Fiber supplements or Metamucil powder as directed by PCMO
Call PCMO
For absence of BM 5 or more days, persistent rectal pain/bleeding, nausea and/or vomiting and abdominal pain 46
Hemorrhoids Hemorrhoids are dilated veins in the region of the rectum. They are worsened by straining and hard stools. Symptoms
o o o o o
Rectal pain with bowel movements (BM) Small amounts of bright red bleeding during or after BMs Lump that can be felt outside of the anus May be painful or tender Usually soft but may feel firm
Treatment
o Keep stool soft by staying hydrated and eating plenty of fiber o Drink at least 2 liters of water per day o Vegetables, dried fruit, whole grains and keeping diet as mentioned above
Medications
o Fiber supplements or Metamucil powder as directed by PCMO o Proctoglyvenol suppository: One suppository rectally 2-3 times daily as needed (through PCMO)
Call PCMO
Persistent rectal bleeding and pain not relieved with treatment and medications
Intestinal Worms Intestinal worms are usually acquired by ingesting contaminated food or water. Symptoms
o o o o o o
May have no symptoms at all Itching around the anus, especially at night Visible worms outside the anus Diarrhea, nausea, vomiting, abdominal pain/cramping Blood in stool Difficulty breathing or shortness of breath
Treatment

Need PCMO evaluation or local medical attention as authorized by PCMO Call PCMO
o If you suspect that you have intestinal worms
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MUSCLE/BONE PROBLEMS Back Pain Most acute back pain is the result of trauma or strain to the lower back. Symptoms
o o o o
Muscle aches or stabbing pain in lower back Pain may radiate into buttocks and down the legs Limited flexibility or range of motion Difficulty standing straight and other musculoskeletal problems
Treatment
o Stop activities that aggravate pain (jog/run, hike, lifting objects, etc.) Activities that involve lifting, twisting, bending, and climbing o Avoid bed rest and continue normal daily activities as much as possible o Ice/cold compresses to apply on affected area (alternate 5 min. 3-4 times daily) o Hot/warm compresses on back (alternate 5 min. 3-4 times daily) o Gentle stretching and strengthening exercises as tolerated Medication
For pain Acetaminophen (Tylenol) 325mg, 1-2 tablets every 6-8 hours as needed or Ibuprofen 200/400 mg, 1-2 tablets every 6-8 hours as needed, do not exceed 2400 mg a day. Muscle relaxer tablets (through PCMO) Call PCMO
For severe pain not relieved with medication or treatment, frequent, painful, bloody urination, numbness, tingling, weakness in the legs/feet, pain not reduced after 72 hours with self-care and fever associated with back pain.
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Sprains and Strains Sprains and strains result from trauma to a joint. Sports injuries and falls are common causes. Symptoms
Pain in the affected joint Swelling in and around the affected joint May have bruising around or below the joint Decreased range of motion Decreased ability to bear weight
Treatment
RICE: o Rest the extremity (arm or leg) o Elevate the extremity to the level of the heart or above o Compression: wrap the joint snuggly but not tightly with an ace wrap o Cold/ice compress, apply on joint (alternate 5 min. 3-4 times daily) Gentle stretching and strengthening exercises After pain and swelling has subsided, usually 7-10 days Specific exercises can be obtained from the PCMO Medication
For pain Acetaminophen (Tylenol) 325mg, 1-2 tablets every 6-8 hours as needed or Ibuprofen 200/400 mg, 1-2 tablets every 6-8 hours as needed, do not exceed 2400 mg a day. Call PCMO
Inability to bear weight (if hip, knee or ankle injury), loss of movement/range of motion, deformity of the joint, moderate to severe pain not relieved with medication or treatment, frequent, painful, or bloody urination, numbness, tingling, or weakness in the affected extremity.
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Leg cramps Leg cramps can be caused by dehydration, over-exercise or stretching that is too vigorous. Symptoms Pain and/or spasm in one or both legs, commonly in calf area, at night
Tends to occur suddenly but may come on gradually
Treatment
Stand up and walk around for a few minutes to stretch the muscle Massage 2-3 times daily Sit down, prop the cramped leg up, pull your toes toward you with one hand, and gently rub down (not across) the calf muscle from knee to heel Increase your consumption of water Medication
For pain Acetaminophen (Tylenol) 325mg, 1-2 tablets every 6-8 hours as needed or Ibuprofen 200/400 mg, 1-2 tablets every 6-8 hours as needed, do not exceed 2400 mg a day.
Call PCMO
For any swelling in the legs and for pain not relieved with self-treatment
Dislocations and Fractures
Dislocations and fractures are the result of trauma involving significant force. Car crashes, falls, and high impact sports are common causes. Symptoms
o Pain, swelling and/or deformity o Bruising and/or bleeding, bone may be exposed through broken skin o Inability to bear weight
Treatment
Rest and gently elevate the area of injury, immobilize or splint the area of injury Cover any open wounds with dry, sterile gauze or at least a clean cloth Leave the fractured bone in the position it was found and splint it in that position. Do NOT push the bone back through skin. Apply a cold pack to a closed fracture, but not to an open fracture. For pain Acetaminophen (Tylenol) 325mg, 1-2 tablets every 6-8 hours as needed or Ibuprofen 200/400 mg, 1-2 tablets every 6-8 hours as needed, do not exceed 2400 mg a day. Get to the closest health care facility immediately. Communicate with PCMO Call PCMO
Right away for any suspected fracture or dislocation 50
SKIN AND NAIL PROBLEMS
MINOR SKIN WOUNDS AND ABRASIONS Symptoms
Any break in the skin. Small cuts, scrapes or scratches Might or might not bleed May be the result of a wound or from dry skin that cracks
Treatment:
Wash the skin well with soap and clean water. Scrub or irrigate out any ground in dirt or debris. Make sure the skin is dried off then apply antibiotic ointment and clean dry Band-Aid or larger dressing as needed. Call the PCMO
For redness, warmth, swelling around the wound, pus in or around the wound, stiffness of the limb or swollen, tender lymph nodes or red streaks leading up from the wound.
BLEEDING LACERATIONS AND PUNCTURE WOUNDS SYMPTOMS Lacerations are large or deep cuts such as those from knives or axes. These cuts may go through the full thickness of the skin exposing underlying tissue, muscle or bone. Puncture wounds are small but go deep, such as those caused by stepping on a nail. Treatment Treatment should be focused on cleaning the wound and stopping the bleeding. If there is heavy or pulsatile bleeding, stop the bleeding first! Put pressure over the wound If the bleeding doesn’t stop see if you can locate the exact site of bleeding, get your fingers directly over it and then press hard. Get immediate help; go to the nearest medical facility. Call the PCMO Immediately if bleeding is persistent, if you think you may need stitches. If you see any signs of infection such as redness, swelling, increasing pain, or pus from the wound.
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BURNS AND SUNBURN Burns can be caused by flame, hot liquids or metal, chemical, or an electrical source. Prolonged sun exposure, especially without sunscreen, can cause significant burns to the skin also. Symptoms: Pain Redness Mottled appearance with blisters Charred or white areas (non-painful) Mild swelling Large area is involved Treatment
Hold the burned area under cool running water or plunge into cool water (not ice water). It draws the heat from the injury thereby lessening the burn. Cover the wound with antibiotic ointment and a dry dressing. Bandage loosely. For pain Acetaminophen (Tylenol) 325mg, 1-2 tablets every 6-8 hours as needed or Ibuprofen 200/400 mg, 1-2 tablets every 6-8 hours as needed, do not exceed 2400 mg a day. Call the PCMO For any burns that cause blisters, white skin or charred skin, burns to face, hands or genitals, electrical burns, if pain persists or has infection signs.
INGROWN TOENAIL
An ingrown nail results from cutting the nail too short or rounding the edges. Symptoms Pain, redness, and swelling around the edge of the nail. Treatment Soak the affected toe/foot in very warm water for 15 minutes 3 to 4 times daily Use a wood stick (or something that will not traumatize tissues) to lift the nail edge; and pushing a piece of cotton twice the thickness of a candlewick between the skin and the ingrown nail tip. For pain Acetaminophen (Tylenol) 325mg, 1-2 tablets every 6-8 hours as needed or Ibuprofen 200/400 mg, 1-2 tablets every 6-8 hours as needed, do not exceed 2400 mg a day. Call the PCMO: If the toe does not get better with self-treatment 52
ANIMAL BITES/ INSECT STINGS AND VECTOR BORNE DISEASES Dog and Animal bites Symptoms Any break in the skin caused by the bite of a dog, cat, or other animal Puncture wound from single tooth Shallow abrasion causing bleeding Superficial or deep laceration Treatment o Clean the wound immediately o Control bleeding o Apply clean, dry dressing o For pain Acetaminophen (Tylenol) 325mg, 1-2 tablets every 6-8 hours as needed or Ibuprofen 200/400 mg, 1-2 tablets every 6-8 hours as needed, do not exceed 2400 mg a day. Call PCMO Call the PCMO for ALL dog or animal bites that break the skin!!
Insect bites and stings Symptoms Sensation of pain, burning or stinging after contact with insect One or more red bumps that are usually itchy and sometimes painful. Often there is a small hole in the middle of the site, occasionally with the end of the stinger sticking out. Treatment
For mild reactions
Get away from the stinging insects Wash the site with soap and water Apply cold compresses to reduce pain and swelling Don’t scratch Take Diphenhydramine (Benadryl) 25mg 1-2 capsules every six hours as needed if itching. Apply Hydrocortisone cream or calamine lotion. For pain Acetaminophen (Tylenol) 325mg, 1-2 tablets every 6-8 hours as needed or Ibuprofen 200/400 mg, 1-2 tablets every 6-8 hours as needed, do not exceed 2400 mg a day. 53
Symptoms of severe allergic reaction
Anaphylaxis (which is life-threatening with full-body reaction) o difficulty breathing or swallowing o tightness in the throat o severe hives and itching o facial swelling, especially around the mouth or eyes o pain in the stomach area o fast heartbeat If you have an epinephrine pen – Use it Ask for help and get to the closest hospital. Call the PCMO after getting help.
Call PCMO During or after getting immediate help.
Scorpion Stings In Costa Rica, the sting of the scorpion is rarely fatal in adults, except for person that are allergic or susceptible. Symptoms
Mild: Tingling, burning, or pain at the site of the sting Severe: sweating and chills dizziness nausea and vomiting Slurring of speech or feeling of a thick tongue throat and generalized muscle spasms abdominal cramps, or restlessness Treatment
Apply cold compresses to help relieve numbness and pain Acetaminophen (Tylenol) 325mg, 1-2 tablets every 4-6 hours as needed for pain relief Diphenhydramine (Benadryl) 25mg, 1-2 capsules every 6 hours for itching or more severe symptoms Call PCMO For any severe reactions or fever.
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Bed Bugs
Bedbugs are nocturnal parasites and feed at night or in surroundings where lighting is dark or subdued. Symptoms
Red wheals (bumps) or blisters with an intense itch Bites tend to occur in lines or clusters Symptoms may persist for up to two weeks Treatment Apply Hydrocortisone cream or calamine lotion to the bites Diphenhydramine 25mg, 1-2 capsules every 6 hours as needed for itching Spray the walls, floors, furniture, and mattresses with commercial insecticide Wash bed linen and clothing in hot water and then iron
Call PCMO For bites that become more painful, swollen, or reddened over time, fever
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DENGUE FEVER Dengue is a disease caused by any one of four closely related dengue viruses (DENV 1, DENV 2, DENV 3, or DENV 4). The viruses are transmitted to humans by the bite of an infected mosquito the Aedes aegypti Symptoms
High fever and at least two of the following: Severe headache Severe eye pain (behind eyes) Joint pain Muscle and/or bone pain Rash Low white cell count
Warning signs include o o o o o o o o
Severe abdominal pain or persistent vomiting Red spots or patches on the skin Bleeding from nose or gums Vomiting blood Black, tarry stools (feces, excrement) Drowsiness or irritability Pale, cold, or clammy skin Difficulty breathing
Treatment General self-care Hydrate o Drink at least eight ounces of noncaffeinated, nonalcoholic fluids every two hours Rest o Stay home from work/school For pain or fever Acetaminophen (Tylenol) 325mg, 1-2 tablets every 6 hours as needed DO NOT take Ibuprofen or aspirin type medications. Call PCMO Suspicion of having dengue, fever greater than 101ºF or for warning signs. 56
Chagas disease Chagas disease is an infection caused by a protozoan parasite (Trypanosoma cruzi) that can result in acute inflammatory skin changes and may eventually cause infection and inflammation of many other body tissues, especially those of the heart and intestinal tract Symptoms
Acute-phase: Swelling and/or redness on the skin infection site rash, swollen lymph nodes, fever, head and body aches, fatigue, nausea, vomiting and/or diarrhea, liver and/or spleen enlargement, Romaña sign = severe swelling of one eye
Treatment
Medical evaluation is required Call PCMO
Presence of Romaña sign
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Zika virus infection What is Zika? — Zika is a type of virus. Infection with Zika can cause fever, rash, joint pain, and red eyes. Zika virus is spread mainly through mosquito bites. But spread is also possible from a pregnant mother to her unborn baby, and through sex. If you have Zika while you are pregnant, it can cause problems for your baby. If you are not pregnant or planning to get pregnant, Zika is not likely to make you very sick or cause serious problems. Where is Zika found? — Since May of 2015, there has been an outbreak happening in Central and South America, Mexico, and the Caribbean. The virus has also been found in Puerto Rico and the US Virgin Islands. There have been cases of Zika in the United States, too. So far, this has mostly happened to people who have traveled to countries where the virus is found. What are the symptoms of Zika? — Many people infected with Zika have no symptoms, or only mild symptoms. If there are symptoms, they usually happen 2 to 14 days after being bitten by a mosquito that has the virus. Symptoms might include: ●Fever ●Rash ●Pain in the joints, especially in the hands and feet ●Red eyes ●Headache In some areas where there is Zika virus, there have also been more cases of a disease called "Guillain-Barré syndrome." This is a condition that causes muscle weakness. Experts suspect it is related to Zika. What if I am pregnant? — If you get infected with Zika while you are pregnant, you could pass the infection on to your baby. If you are pregnant or trying to get pregnant, experts say you should avoid traveling to countries where there is Zika virus. If you do visit these countries, it's especially important to try to avoid mosquito bites. During the Zika outbreak in Brazil, there have been many reports of problems in pregnant women with the infection. These problems have included babies being born with a head that is smaller than normal, and in some cases miscarriage (when a pregnancy ends on its own). The babies who are affected often have problems with their development, too. Experts are studying the effects of Zika on pregnant women and their babies. Is there a test for Zika? — Yes. How is Zika treated? — There is no specific treatment for Zika virus infection. If your symptoms bother you, you should rest and drink plenty of fluids. You can also take acetaminophen (sample brand name: Tylenol) to relieve fever and aches.
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Can Zika be prevented? — Yes. The best way to prevent Zika virus infection is to avoid the mosquitoes that carry it. Not all countries where Zika is common control mosquitoes well. But you can lower your chances of getting the infection if you live or travel there. You can: ●Stay inside when the mosquitoes that carry Zika are most active. They bite during the daytime, in the very early morning, and in the few hours before sunset. Buildings with screens and air conditioning are safest. ●Wear shoes, long-sleeved shirts, and long pants when you go outside. ●Wear bug spray or cream that contains DEET or a chemical called picaridin. Check the label to make sure. Do not use DEET on babies younger than 2 months. ●On your clothes and gear, use bug repellants that have a chemical called permethrin. ●Drain any standing water if possible, such as wading pools and buckets. Mosquitoes breed in standing water. It's also important to try to avoid mosquito bites if you have already gotten Zika. That's because during the first week of having it, the virus can be found in your blood. If a mosquito bites you, and then bites another person, that person could then get Zika too. Although Zika is spread mainly through mosquito bites, there are other possible ways to get it: ●Sex – There have been a few reports of people getting Zika through sex. This is probably not a common way to get the infection. But if you have been to a country where there is Zika virus, it's a good idea to use a condom.
There is no vaccine for Zika virus infection.
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Chikungunya fever This topic last updated: Feb 25, 2016. INTRODUCTION — Chikungunya is an arthropod-borne virus (arbovirus) endemic to West Africa that causes acute febrile polyarthralgia and arthritis. The name chikungunya is derived from a local language of Tanzania meaning "that which bends up" or "stooped walk" because of the incapacitating arthralgia caused by the disease. Spread and resurgence — Chikungunya virus spreads by means of travel of infected individuals between regions where competent mosquitoes exist for perpetuation of local transmission. Americas — In December 2013, chikungunya fever was reported in the Caribbean Island of Saint Martin. Since then, local transmission has been confirmed in more countries and territories in the Caribbean, North America, Central America, and South America. The majority of cases reported in the continental United States have been imported cases. Mosquito vectors — The major chikungunya virus mosquito vectors are Aedes aegypti and Aedes albopictus. These vectors are also capable of transmitting dengue and Zika viruses, which are increasing in geographic range and intensity of transmission. Aedes aegypti — Ae. aegypti is well adapted to urban settings and is widely distributed in urban areas of the tropics and subtropics worldwide. It prefers the human host as a source of blood meals and breeds readily in flowerpots and in trash, such as discarded plastic cups. A single Ae. aegypti mosquito may be able to infect more than one human, since this species feeds on another host if its blood meal is interrupted. It is also the vector for dengue and Zika viruses. CLINICAL MANIFESTATIONS Acute infection — Clinical signs and symptoms begin abruptly with fever and malaise following an incubation period of two to four days (range 1 to 14). Fever may be high grade (40ºC); the usual duration of fever is three to five days (range 1 to 10 days). Polyarthralgia begins two to five days after onset of fever and commonly involves multiple joints (often 10 or more joint groups). Joints affected include hands, wrists, and ankles. Arthralgia is symmetrical in 64 to 73 percent and involves distal joints more than proximal joints. Involvement of the axial skeleton was noted in 34 to 52 percent of cases. Pain may be intense and disabling, leading to immobilization. The most common skin manifestation is macular or maculopapular rash (usually appearing three days or later after onset of illness and lasting three to seven days). The rash often starts on the limbs and trunk, can involve the face, and may be patchy or diffuse. Islands of normal skin may be seen along with the diffuse rash. Pruritus has been reported. Bullous skin lesions have also been described. Additional manifestations may include headache, myalgia, and gastrointestinal symptoms. DIAGNOSIS — Diagnostic techniques for identification of chikungunya virus include serology, viral culture, and molecular techniques. Serology is the primary tool for diagnosis in the clinical setting. Immunoglobulin M (IgM) anti-chikungunya virus antibodies (detected by direct enzyme-linked immunosorbent assay [ELISA]) are present starting about five days (range 1 to 12 days) following onset of symptoms and persist for several weeks to three months.
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TREATMENT AND PREVENTION — Treatment of chikungunya infection consists of supportive care including antiinflammatory agents that relieve symptoms in many patients and analgesic agents. No antiviral agents have been shown to be effective in human infection Thus far, there is no licensed vaccine for prevention of chikungunya infection; active research is under way to develop a vaccine using variety of approaches. Prevention consists of minimizing mosquito exposure. Patients receiving care in an area inhabited by mosquitoes competent to transmit chikungunya virus should be treated in screened, mosquitofree areas or under a bednet to avoid spread.
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Snake Bites This is a medical emergency. Call immediately, get help and take yourself to the closest medical facility. Symptoms Immediate local pain, tenderness Swelling extending up the limb Usually appears within 2-4 hours Most extensive on 2nd or 3rd day Pain in the lymph nodes near the area of the bite Serious Signs of Envenomation
Nausea and vomiting Lightheadedness, fainting, confusion Rapid spread of local swelling involving more than half the bitten limb Evidence of muscular weakness, blurred vision Feeling heaviness in eyelids. Spontaneous bleeding
Treatment
This is a medical emergency, go to nearest hospital and contact PCMO Immobilize the limb and keep it at or below heart level Remove any jewelry or clothing on the extremity Acetaminophen (Tylenol) 325mg, 1-2 tablets every 4-6 hours for pain. DO NOT GIVE ASPIRIN OR IBUPROFEN because they can promote bleeding.
Call PCMO For ALL snake bites, contact the PCMOs immediately.
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SKIN INFECTIONS, RASHES, AND INFESTATIONS
Boils and Carbuncles A boil is commonly the result of an infection in a hair follicle, usually with bacteria from your own skin. Carbuncles occur when the infection spreads and more than one hair follicle is involved. Boils do not usually need antibiotic treatment but carbuncles might because the infection can spread further if not stopped. Symptoms
Hard, raised, reddened, painful area May have soft, white, pimple-appearing center Treatment
Apply hot washcloth compresses to the area for twenty minutes, at least three to four times daily. Wash/dry the area Cover any open wounds Never squeeze a boil. A boil will look like a volcano before it bursts and drains. Most boils will drain on their own after warm compresses. Squeezing can turn a boil into a carbuncle Call PCMO For boils that do not respond to treatment, fever, if it gets larger and spread and if red streaks leading upwards from the boil
Tinea Pedis (Athlete's Foot)
Athlete's foot is a fungal infection of the skin of the feet, especially between the toes. Symptoms Intense itching of one or both feet (not always present) Rash on feet, especially between toes with scaling and thickening of the skin Blisters, oozing, and scaling of the skin Treatment
Wash feet at least daily Dry feet thoroughly, especially between the toes Wear clean, dry, cotton socks Use antifungal cream and powder Change footwear daily, allow to dry in the sun 63
Medication Clotrimazole cream, apply to clean dry foot/feet 2-3 times daily for 2-4 weeks o Can be obtained from the medical unit Call PCMO If symptoms spread and worsen
Tinea Corporis (Ringworm)
Ringworm is a superficial fungal infection. Symptoms
Round, oval, or semicircular skin colored, tan, or red scaly patches on the trunk, limbs, face and/or neck Patches usually flat in the center with a raised border May or may not itch Treatment
Bathe daily and keep skin dry Apply antifungal cream to the patches 3 times daily for 2 weeks Call PCMO If the rash does not get better with treatment
Scabies Scabies is a very itchy skin complaint caused by tiny mites that burrow under the skin and cause intense irritation. It is transmitted by close physical contact with an infected person. It can also be caught from direct contact with infested surfaces such as clothing, towels, or bed linen. It can be sexually transmitted. Symptoms
Intense itching, particularly during the night Dark, wavy marks in areas of infestation o Between the fingers, on the wrists or elbows, around the navel and on the breast or buttocks Occasionally, the genitals are infested. Treatment
Wash all bedding and clothing in boiling, hot water, including personal items Put mattress and pillow out into the sun for several hours to kill any mites Close family members and/or your sexual partner should also be treated Call PCMO: For any suspected case of scabies 64
Lice
Lice (pediculosis) is an infestation of the body with one of three species—head, body, or pubic lice. Pubic lice (crabs) are the most common type found on young adults. Transmission is usually by direct contact with an infected person or object that harbors lice (brushes, combs, clothing, furniture, and bedding). They cannot "jump" from one person to another but are spread by close, direct contact. Symptoms
Itching Visible louse May be seen on the scalp, in armpits, or in genital area Visible nit on hair shaft Treatment
All clothing, bedding, towels, etc., used within two days prior treatment must be washed in hot, soapy water Remove lice with fine comb Wash and leave-in homemade rinse consisting of two ounces of vinegar in two cups of water Avoid intimate contact with any sexual partner(s) until they have been treated Contact PCMO for evaluation Call PCMO For any suspected case of lice
Acne
Acne, although usually a problem for teenagers, can occur at any age because of a change in conditions, stress or diet. Symptoms
Bumps on the face and neck. May also be on the back, chest, or shoulders. Sometimes painful Usually red but may be blackheads or whiteheads Treatment
Wash, gentle antibacterial cleanser daily Use skin and hair products labeled “oil-free,” “non-comedogenic,” Avoid touching the face and never pick or scratch at acne lesions Call PCMO If the acne is not controlled with the above measures talk to the PCMO about topical acne medications 65
Heat Rash "Heat rash" or "prickly heat" is a superficial skin irritation due to environmental heat and humidity. Symptoms
A fine, red raised rash Commonly seen in areas where there is a concentration of sweat glands and where friction o There may be small, pus filled blisters. Itching, stinging or burning sensation Treatment
Keep skin cool and dry Wear loose fitting, cotton clothing Apply calamine lotion after bathing For itching apply Hydrocortisone cream three times a day
Call PCMO If the rash does not get better with treatment
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WOMEN'S HEALTH Menstrual Irregularities and abnormal vaginal bleeding
Due to stress and the changing environment menstrual irregularities are common during Peace Corps service. Symptoms
Missed periods Periods that are heavier or lighter than normal Vaginal spotting or bleeding occurring when period is not due Increased amount of pain and/or cramping with periods
Treatment
Seek counsel with PCMO after 3-4 months irregularities. Keep track/log. Acetaminophen 325mg, or Ibuprofen 200/400 mg 1-2 tablets by mouth every 8 hours as needed for pain, or menstrual cramps. Do not exceed 2400 mg a day. Call PCMO For menstrual irregularities greater than 3-6 months or before if suspect pregnancy
UNPROTECTED SEX OR CONDOM FAILURE
Unprotected intercourse or ejaculation near the vagina can cause unwanted pregnancy. Sexually transmitted infections (STI) can occur from unprotected intercourse, oral sex, or genital to genital contact. Treatment
Emergency contraception, use Plan B as directed Call PCMO Report to PCMO as soon as possible
Urinary Tract Infections (UTI) Symptoms
Pain and/or burning with urination Frequent and urgency to urinate Blood in the urine Low abdominal pain or spasm Pain in lower back on one side Fever
Treatment
Drink at least 250mls of clear fluid every two hours while you are awake Include drinks enriched with vitamin C (cranberry juice, pineapple drink, etc.) Call PCMO: For UTI symptoms that last more than one day. 67
Abnormal Vaginal Discharge A change in vaginal discharge may be a sign of local infection such as yeast infection (candidiasis) or bacterial vaginosis. It can be caused by sexually transmitted infections (STIs) such as trichomoniasis, chlamydia, and gonorrhea. It can also be caused by failure to remove a tampon. Symptoms
Increased or heavy vaginal discharge Change in color and/or consistency of discharge o Thick, white, curd-like, thin, yellow, greenish, brown Mild or severe vagina, itching Burning with urination Swelling of the labia Increased vaginal mal-odor (foul or fishy) Treatment
Enhance perineal hygiene Wear fresh, dry underwear daily Avoid thong underwear Avoid douche Avoid plastic backed panty liners
Call PCMO Contact PCMO for evaluation and treatment
Genital Lesions
Genital lesions can be caused infections, like an ingrown hair (folliculitis). Sexually transmitted infections such as Human Papilloma Virus (genital warts), herpes, and syphilis also cause them. Any new or growing genital lesion should be cause for concern. Symptoms
New or growing lump or bump anywhere in genital area Swollen lymph nodes in the groin Vaginal discharge Fever and/or pain
Treatment
For ingrown hair warm, moist compresses to the area 3 times daily Call PCMO Contact PCMO for evaluation and treatment
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MEN’S HEALTH Urethritis Inflammation and irritation of the urethra is most commonly caused by sexually transmitted infections or other urinary tract infections. Symptoms
Urethral burning with urination Frequency of urination Tingling or irritated sensation in the urethra Urethral discharge Blood in urine Fever and chills Back pain Nausea and vomiting
Treatment
Contact PCMO for evaluation and treatment Call PCMO Contact PCMO for evaluation and treatment
Testicular pain
Pain in the testicles can be the sign of a serious infection such as epididymitis. It can be caused by anatomical problems such as torsion or hernia. It can be the result of trauma. Symptoms
Pain in one or both testicles o Gradual or suddenly Testicular torsion or trauma Pain in the groin or lower abdomen Redness or swelling of the scrotum A change in the shape or size of a testicle Treatment
Contact PCMO for evaluation and treatment Call PCMO Contact PCMO for evaluation and treatment
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Tinea Cruris (Jock Itch) Jock itch is caused by a fungal infection of the groin Symptoms
Rash to the groin area including the scrotum, penis, thighs, peri-anal area and buttocks Red, scaly patches that may have slightly raised borders Tiny blisters may be present Itching Pain and irritation with sexual or physical activity Treatment
Wash daily with gentle soap and water Dry the groin area well Avoid tight clothing and wear absorbent cotton underwear Apply antifungal cream every 12 hours for 14 days
Call PCMO If condition does not improved in two weeks with treatment
ENVIRONMENTAL ILLNESS
Heat Exhaustion Heat exhaustion occurs when the body’s is unable to cool itself. This can happen with exercise and exertion. It is made worse by high humidity. Symptoms
Fatigue Headache Thirst Nausea and vomiting Muscle cramps Faintness or dizziness Irritability Pale and moist (clammy) skin Rapid pulse rate and elevated body temperature (as high as 104°). Mental function remains intact Rest in a shaded and cool environment
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Drink plenty of clear fluids o Oral rehydration salts (ORS) One packet mixed in a liter of treated water o water, non-caffeinated sports drink, weak herbal iced tea, flat clear carbonated drinks (Sprite, Ginger ale, etc.) o Do not drink alcohol or beverages with caffeine Take a cool shower or bath, or apply cool water to your skin Take off any tight or unnecessary clothing Monitor the body temperature which should return to normal within two hours Rest for two to five days after the episode. Call PCMO If you don’t feel better after 30 minutes of treatment and if chest pain, abdominal pain, or shortness of breath.
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SECTION V
P ERSONAL H EALTH P LAN FOR MY P EACE C ORPS S ERVICE PCV Name: PCMO Name: Date of final completion: Instructions: Your Personal Health Action Plan is to be completed during the Pre-service training (prior to the Swearing In ceremony). Be attentive in PST sessions and ask questions while developing your personal plan. The purpose of this plan is to thoughtfully list concrete and specific strategies to be used during your Peace Corps service. The Health Book is another resource. Utilize your action plan during a bad day or when uncertain whether to call the PCMO. Review the plan periodically and change it if a need arises. The plan will be reviewed by the PCMO during or shortly after PST. Your complete Personal Health Plan (that needs be turned in to the PCMO) is part of the criteria for proceeding in service. Writing Personal Medical Emergency Plan will be done as part of the Medical Policies and Procedures session and on a separate sheet.
All information included in this health plan is strictly confidential to the Health Unit at post. The original Personal Health Plan is placed in your medical records. You will be provided with a copy of it after the plan is reviewed by the PCMO. 1) Physical Health a) What common health issues am I concerned about the most in country? List at least five of them. (E.g. sore throat, dog bite, Athlete’s foot) b) Describe the medication groups that are in the medical kit c) How can I use the Med Kit to help myself? (Medications basic purpose) d) What preventive strategies will I practice to keep myself healthy? d) Using the Health Book, list five important symptoms that I will call the PCMO about immediately. i) ii) iii) iv) v) e) Under what other circumstances should I call the PCMO? 72
Personal Health Plan for my Peace Corps Service ------------------------------------------------------------------------------------------------------PCV Name: PCMO Name: Date of final completion: Instructions: Your Personal Health Action Plan is to be completed during the Pre-service training (prior to the Swearing In ceremony). Be attentive in PST sessions and ask questions while developing your personal plan. The purpose of this plan is to thoughtfully list concrete and specific strategies to be used during your Peace Corps service. The Health Book is another resource. Utilize your action plan during a bad day or when uncertain whether to call the PCMO. Review the plan periodically and change it if a need arises. The plan will be reviewed by the PCMO during or shortly after PST. Your complete Personal Health Plan (that needs be turned in to the PCMO) is part of the criteria for proceeding in service. Writing Personal Medical Emergency Plan will be done as part of the Medical Policies and Procedures session and on a separate sheet.
All information included in this health plan is strictly confidential to the Health Unit at post. The original Personal Health Plan is placed in your medical records. You will be provided with a copy of it after the plan is reviewed by the PCMO. 2) Emotional/Mental Health – Adjustment and Stress a) What actions do I normally take to protect my emotional health/well-being? (At least three coping skills I'm most comfortable with)
b) What actions could I try if my normal activities/resources are unavailable or not working?
c) What can I try if I am really feeling down? What coping skill can I use?
d) How can I manage stressful situations?
e) When would I be concerned enough to contact/call someone? Who can I call?
f) What things about my mental health would concern me enough to call the PCMO? i) ii) iii) g) What will I do if I notice a fellow Volunteer with emotional difficulties such as increased irritability, appearing sad, sudden withdraw from social contacts, exhibiting strange behaviors, or drinking excessively? (E.g. “You seem really depressed and I am worried about you…”) January 2015 Page 3
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Personal Health Plan for my Peace Corps Service -------------------------------------------------------------------------------------------------------
PCV Name: PCMO Name: Date of final completion: Instructions: Your Personal Health Action Plan is to be completed during the Pre-service training (prior to the Swearing In ceremony). Be attentive in PST sessions and ask questions while developing your personal plan. The purpose of this plan is to thoughtfully list concrete and specific strategies to be used during your Peace Corps service. The Health Book is another resource. Utilize your action plan during a bad day or when uncertain whether to call the PCMO. Review the plan periodically and change it if a need arises. The plan will be reviewed by the PCMO during or shortly after PST. Your complete Personal Health Plan (that needs be turned in to the PCMO) is part of the criteria for proceeding in service. Writing Personal Medical Emergency Plan will be done as part of the Medical Policies and Procedures session and on a separate sheet.
All information included in this health plan is strictly confidential to the Health Unit at post. The original Personal Health Plan is placed in your medical records. You will be provided with a copy of it after the plan is reviewed by the PCMO.
3) Domestic/Intimate Partner Violence (DV/IPV) situations
a) What are red flags and symptoms of DV/IPV?
b) Am I at risk to experience or witness some type of DV/IPV while in service?
c) What will I do in case I find myself in an abusive relationship?
d) What do I do in case my fellow Volunteer is a victim of DV/IPV?
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Personal Health Plan for my Peace Corps Service ------------------------------------------------------------------------------------------------------PCV Name: PCMO Name: Date of final completion: Instructions: Your Personal Health Action Plan is to be completed during the Pre-service training (prior to the Swearing In ceremony). Be attentive in PST sessions and ask questions while developing your personal plan. The purpose of this plan is to thoughtfully list concrete and specific strategies to be used during your Peace Corps service. The Health Book is another resource. Utilize your action plan during a bad day or when uncertain whether to call the PCMO. Review the plan periodically and change it if a need arises. The plan will be reviewed by the PCMO during or shortly after PST. Your complete Personal Health Plan (that needs be turned in to the PCMO) is part of the criteria for proceeding in service. Writing Personal Medical Emergency Plan will be done as part of the Medical Policies and Procedures session and on a separate sheet.
All information included in this health plan is strictly confidential to the Health Unit at post. The original Personal Health Plan is placed in your medical records. You will be provided with a copy of it after the plan is reviewed by the PCMO. 4) Diarrhea a) Define and recognize causes of acute diarrhea
b) List at least three symptoms of dehydration
c) What signs of dehydration would cause me to contact a PCMO
d) List 3 measures to prevent diarrhea and two self-care measures to treat diarrhea
e) List 3 recommended foods that PCVs can have during a diarrheal episode, immediately after and the prohibited meals for these cases (according to each person reality)
f) Explain how to mix oral rehydration salts packets
g) Describe the homemade preparation for oral rehydration salts 75
Personal Health Plan for my Peace Corps Service ------------------------------------------------------------------------------------------------------PCV Name: PCMO Name: Date of final completion: Instructions: Your Personal Health Action Plan is to be completed during the Pre-service training (prior to the Swearing In ceremony). Be attentive in PST sessions and ask questions while developing your personal plan. The purpose of this plan is to thoughtfully list concrete and specific strategies to be used during your Peace Corps service. The Health Book is another resource. Utilize your action plan during a bad day or when uncertain whether to call the PCMO. Review the plan periodically and change it if a need arises. The plan will be reviewed by the PCMO during or shortly after PST. Your complete Personal Health Plan (that needs be turned in to the PCMO) is part of the criteria for proceeding in service. Writing Personal Medical Emergency Plan will be done as part of the Medical Policies and Procedures session and on a separate sheet.
All information included in this health plan is strictly confidential to the Health Unit at post. The original Personal Health Plan is placed in your medical records. You will be provided with a copy of it after the plan is reviewed by the PCMO. 5) Sexual Health and Sexually Transmitted Infections NOTE: if responding to any of the questions in this section causes you discomfort, omit the question. It is, however, highly recommended to think about your actions with respect to sexual health issues. a) For what reasons is sex acceptable/desirable for me (i.e. casual, intimacy, loneliness, long-term relationships)? b) What do I consider safe sex practice? c) Under what circumstance will I consider sex with condoms? d) Under what circumstance will I consider sex without condoms? e) What are some strategies/techniques I can use to ensure I am able to practice sex in a way that is comfortable for me, matches my beliefs about sex and keeps me safe and healthy?
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Personal Health Plan for my Peace Corps Service -------------------------------------------------------------------------------------------------------
PCV Name: PCMO Name: Date of final completion: Instructions: Your Personal Health Action Plan is to be completed during the Pre-service training (prior to the Swearing In ceremony). Be attentive in PST sessions and ask questions while developing your personal plan. The purpose of this plan is to thoughtfully list concrete and specific strategies to be used during your Peace Corps service. The Health Book is another resource. Utilize your action plan during a bad day or when uncertain whether to call the PCMO. Review the plan periodically and change it if a need arises. The plan will be reviewed by the PCMO during or shortly after PST. Your complete Personal Health Plan (that needs be turned in to the PCMO) is part of the criteria for proceeding in service. Writing Personal Medical Emergency Plan will be done as part of the Medical Policies and Procedures session and on a separate sheet.
All information included in this health plan is strictly confidential to the Health Unit at post. The original Personal Health Plan is placed in your medical records. You will be provided with a copy of it after the plan is reviewed by the PCMO. 6) HIV/AIDS a) How do I intend to stay safe in the light of HIV/AIDS as a disease that is transmitted through bodily fluids? (blood, semen, pre-seminal fluid, vaginal fluid, breast milk) b) What are my ideas about having a romantic or sexual relationship during my Peace Corps service? c) When would I consider having protected sexual intercourse – oral, vaginal, anal, etc.?
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Personal Health Plan for my Peace Corps Service --------------------------------------------------------------------------------------------------PCV Name: PCMO Name: Date of final completion: Instructions: Your Personal Health Action Plan is to be completed during the Pre-service training (prior to the Swearing In ceremony). Be attentive in PST sessions and ask questions while developing your personal plan. The purpose of this plan is to thoughtfully list concrete and specific strategies to be used during your Peace Corps service. The Health Book is another resource. Utilize your action plan during a bad day or when uncertain whether to call the PCMO. Review the plan periodically and change it if a need arises. The plan will be reviewed by the PCMO during or shortly after PST. Your complete Personal Health Plan (that needs be turned in to the PCMO) is part of the criteria for proceeding in service. Writing Personal Medical Emergency Plan will be done as part of the Medical Policies and Procedures session and on a separate sheet.
All information included in this health plan is strictly confidential to the Health Unit at post. The original Personal Health Plan is placed in your medical records. You will be provided with a copy of it after the plan is reviewed by the PCMO.
7) Healthy alcohol drinking a) How will I manage my alcohol use, when I’m with my Volunteer peers, to a level I’m comfortable with? (List at least two strategies to limit the effect of alcohol) b) What are the conditions that I personally need/want to consider in order to drink safely? (e.g. being with a friend I trust, being able to leave the situation if I need to, etc.) c) If I am involved in a cultural activity that includes a lot of alcohol, how will I keep myself safe? (List at least two strategies to limit alcohol consumption)
d) What excuses will I use or how will I say no in situations where I don’t want to drink? Are there any specific language skills I need in order to manage this? (List at least two strategies to refuse drinks) e) How do I intend to approach a situation when a fellow Volunteer may have alcohol related problems? f) How do I talk to Volunteer friends whom I am worried about? (E.g. “You are drinking too much and I am worried about you…”) 78
Personal Health Plan for my Peace Corps Service ------------------------------------------------------------------------------------------------------PCV Name: PCMO Name: Date of final completion: Instructions: Your Personal Health Action Plan is to be completed during the Pre-service training (prior to the Swearing In ceremony). Be attentive in PST sessions and ask questions while developing your personal plan. The purpose of this plan is to thoughtfully list concrete and specific strategies to be used during your Peace Corps service. The Health Book is another resource. Utilize your action plan during a bad day or when uncertain whether to call the PCMO. Review the plan periodically and change it if a need arises. The plan will be reviewed by the PCMO during or shortly after PST. Your complete Personal Health Plan (that needs be turned in to the PCMO) is part of the criteria for proceeding in service. Writing Personal Medical Emergency Plan will be done as part of the Medical Policies and Procedures session and on a separate sheet.
All information included in this health plan is strictly confidential to the Health Unit at post. The original Personal Health Plan is placed in your medical records. You will be provided with a copy of it after the plan is reviewed by the PCMO. 8) Urgent Common Health Issues (wounds, bleedings, fractures and burns) and Emergencies a) When do I apply first aid measures? b) When do I call the PCMO and what information do I need to give the PCMO? c) What are 3 essential steps in managing a medical emergency? i) ii) iii) d) My personal list of what to do during/in emergencies includes: (Consider essentials to know or find out after moving to my site: how to get from site to the Peace Corps office in an emergency, what places do I need to put on my map, what emergency numbers do I need to have in my phone, do I need a card for my pocket, who might I give Peace Corps contact information to in case I am unable to call): i) ii) iii) iv) v) 79
Personal Health Plan for my Peace Corps Service -------------------------------------------------------------------------------------------------------
PCV Name: PCMO Name: Date of final completion: Instructions: Your Personal Health Action Plan is to be completed during the Pre-service training (prior to the Swearing In ceremony). Be attentive in PST sessions and ask questions while developing your personal plan. The purpose of this plan is to thoughtfully list concrete and specific strategies to be used during your Peace Corps service. The Health Book is another resource. Utilize your action plan during a bad day or when uncertain whether to call the PCMO. Review the plan periodically and change it if a need arises. The plan will be reviewed by the PCMO during or shortly after PST. Your complete Personal Health Plan (that needs be turned in to the PCMO) is part of the criteria for proceeding in service. Writing Personal Medical Emergency Plan will be done as part of the Medical Policies and Procedures session and on a separate sheet.
All information included in this health plan is strictly confidential to the Health Unit at post. The original Personal Health Plan is placed in your medical records. You will be provided with a copy of it after the plan is reviewed by the PCMO.
9) Malaria a) How do I intend to prevent active malaria during service? (4 basic strategies) b) What two strategies I can use to remember to take my medication daily or weekly? If these are not working, what should I do? c) If I am having side effects of the medication prescribe for me or having any problems with the medication, what do I do? d) What would be required of a Volunteer in the event s/he suspects any malaria symptoms? e) How do I intend to use the Rapid Diagnostic Tests (RDT) for malaria? f) What steps will I take if I think I have malaria?
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Personal Health Plan for my Peace Corps Service -----------------------------------------------------------------------------------------------------PCV Name: PCMO Name: Date of final completion: Instructions: Your Personal Health Action Plan is to be completed during the Pre-service training (prior to the Swearing In ceremony). Be attentive in PST sessions and ask questions while developing your personal plan. The purpose of this plan is to thoughtfully list concrete and specific strategies to be used during your Peace Corps service. The Health Book is another resource. Utilize your action plan during a bad day or when uncertain whether to call the PCMO. Review the plan periodically and change it if a need arises. The plan will be reviewed by the PCMO during or shortly after PST. Your complete Personal Health Plan (that needs be turned in to the PCMO) is part of the criteria for proceeding in service. Writing Personal Medical Emergency Plan will be done as part of the Medical Policies and Procedures session and on a separate sheet.
All information included in this health plan is strictly confidential to the Health Unit at post. The original Personal Health Plan is placed in your medical records. You will be provided with a copy of it after the plan is reviewed by the PCMO. 10) Common Health Problems
a) What three common problems in the country I am most concerned with? Instructions: describe briefly how they can be handled and prevented
b) Am I familiar with the Medical Kit? And the Health Book content?
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Personal Health Plan for my Peace Corps Service -----------------------------------------------------------------------------------------------------PCV Name: PCMO Name: Date of final completion: Instructions: Your Personal Health Action Plan is to be completed during the Pre-service training (prior to the Swearing In ceremony). Be attentive in PST sessions and ask questions while developing your personal plan. The purpose of this plan is to thoughtfully list concrete and specific strategies to be used during your Peace Corps service. The Health Book is another resource. Utilize your action plan during a bad day or when uncertain whether to call the PCMO. Review the plan periodically and change it if a need arises. The plan will be reviewed by the PCMO during or shortly after PST. Your complete Personal Health Plan (that needs be turned in to the PCMO) is part of the criteria for proceeding in service. Writing Personal Medical Emergency Plan will be done as part of the Medical Policies and Procedures session and on a separate sheet.
All information included in this health plan is strictly confidential to the Health Unit at post. The original Personal Health Plan is placed in your medical records. You will be provided with a copy of it after the plan is reviewed by the PCMO. 11) Food and Water Preparation
• What two methods of making water safe to drink in the local context will I use?
• What five keys/approaches will I utilize to make food safe for me?
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Personal Health Plan for my Peace Corps Service ------------------------------------------------------------------------------------------------------Volunteer name and signature _______________________________________ Date __________________________________ PCMO name and signature ___________________________________________ Date ____________________________________
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