Charlotte Crawford & Neil Boyer (Ethiopia 1962–64) in Egypt
Ethiopian PCVs on Vacation
where returned Volunteers share their expertise and experiences
Charlotte Crawford & Neil Boyer (Ethiopia 1962–64) in Egypt
Ethiopian PCVs on Vacation
Staying safe, preventing malaria
BY PEACE CORPS ON AUGUST 9, 2013
By Barry G. Simon, M.D., Peace Corps Medical Director, Office of Medical Services
Last week, the U.S. Food and Drug Administration updated its warning label on the anti-malarial drug mefloquine hydrochloride, and there has been a surge in news coverage lately about the side effects of medications used to prevent malaria.
The Peace Corps takes these warnings very seriously and has taken proactive steps to ensure that Volunteers have all of the information they need to make an informed decision about the anti-malaria medication that is right for them, in collaboration with their Peace Corps Medical Officer.
Before beginning any kind of anti-malaria regimen, every Volunteer has an individual, one-on-one consultation with their Medical Officer to discuss the pros and cons of each medication and all possible risks and side effects. Volunteers can revisit their choice of medication at any time during their service, and while mefloquine continues to be an FDA-approved medication for malaria prevention, Volunteers who wish to request a change in medication can do so simply by talking with their Peace Corps Medical Officer. This policy is in place at every Peace Corps post worldwide, and the Peace Corps is working hard to make sure each and every Volunteer is familiar with the options available to them.
The Peace Corps uses a multi-pronged approach to combat malaria among Volunteers, which includes training on prevention, provision of insecticide-treated bed nets, screening for windows in all Volunteers’ homes, and a choice of one of four types of medication, each of which has proven extremely effective in suppressing malaria. With the proper use of bed nets, protective clothing, insect repellents and anti-malarial medication, the chances of developing active malaria are significantly reduced.
The Peace Corps’ Office of Health Services continually updates its policy on malaria suppressive medications based on the best medical information available and is working closely with the Centers for Disease Control and Prevention to monitor any further developments. Currently serving Volunteers who have questions about their health care can contact the Peace Corps’ Quality Improvement Unit at email@example.com. Returned Peace Corps Volunteers with concerns about their health care can contact the Peace Corps’ Post Service Unit at firstname.lastname@example.org.
Dr. Barry Simon is board certified in internal medicine and pulmonary diseases and practiced in a private practice setting for 29 years prior to joining Peace Corps. He previously served as the Chief of Clinical Programs at Peace Corps, beginning in 2008, and for 20 years prior to joining Peace Corps he served as a consultant in pulmonary diseases for the Office of Medical Services. Dr. Simon received his medical degree from Boston University and completed five years of training in internal medicine and pulmonary diseases at Georgetown University Hospital in Washington, D.C.
These are comments off of the Peace Corps Website: http://passport.peacecorps.gov/2013/08/09/staying-safe-preventing-malaria/
10 replies »
August 10, 2013 at 9:50 pm
I am a currently serving volunteer. I had my consultation with my PCMO and they did offer me options, they did seem to lean towards Mefloquine as the best option unless I started to experience side effects, at which point they would happily switch me to another drug. I have yet to experience any side effects but I may have another serious discussion with my PCMO about the full extent of potential side effects of each drug and then decide whether or not I will continue to remain on Mefloquine or switch to one of the other two options. I know that my PCMO has been very willing to work with volunteers who choose to use the other options. My only hope is that now that there is more recognition of the side effects, that the discussions the PCMOs have with their volunteers include a more detailed description of the side effects as well as follow up interviews with volunteers who choose to use Mefloquine.
August 10, 2013 at 1:23 am
“Before beginning any kind of anti-malaria regimen, every Volunteer has an individual, one-on-one consultation with their Medical Officer to discuss the pros and cons of each medication and all possible risks and side effects.”
When does that happen? It’s not happening in Malawi and I doubt that’s standard operating procedure. In order to be taken off of mefloquine, volunteers have to make a convincing case to the PCMO. There’s little education about the side effects of mef and they’re severely diminished. I was fortunate enough to be on Doxy for my service but many of my fellow volunteers still experience symptoms after having returned more than a year ago.
August 10, 2013 at 3:38 pm
We did not have this in the Dominican Republic either. When asked about side effects the doctors basically brushed the concerns aside as unimportant. I fortunately was not in a high risk area so quit taking the malaria med shortly after going to my site. Of course I took other precautions. During my COS physical I told my doctor that I had taken myself off the meds and she seemed to understand why. She did say that if I contracted malaria I would be subject to ET and all of the consequences that go along with it. I think the PC needs to reanalyze some of the areas that are required to take malaria meds and possibly only require the meds in specific hot spots within certain countries, and they certainly need to do a more thorough job of answering questions about the safety of the drugs available. I do not agree with the “comply or your out” rule concerning this either.
August 10, 2013 at 4:46 pm
That’s what I was made to feel - take this pill, it’s our only option - until I flat out refused to take it anymore and told my PCMO I *will* be taking Doxy. The option for Malarone wasn’t even on the table because of the cost and I don’t even know what this mysterious fourth option they’re talking about is. Most areas with PCVs that are endemic are also chloroquine resistant, so I hope it’s not that.
August 11, 2013 at 2:40 pm
I didn’t get a consultation. I was just told: here’s a paper of the possible side effects of mefloquine, and you have to sign it.
When I started taking mefloquine, I couldn’t sleep at all for four days straight. I told my PCMO about the side effects, and was told to take a Benadryl and see if that helped me sleep. When that didn’t work, they told me to break the pill in half and take half a dose twice a week.
Eventually they gave me Doxy.
6 Peace Corps
August 13, 2013 at 3:05 pm
In early 2013, the Peace Corps Office of Medical Services updated its policy on malaria suppressive medications. This policy now includes a one-on-one conversation between Volunteers and their Peace Corps Medical Officers, and the choice of one of four types of medications proven to suppress malaria, depending on Volunteers’ location. As mentioned above, the Peace Corps continually updates its policy on malaria prevention based on the best medical information available, and the process outlined here reflects the most recent updates.
If you are an RPCV and have concerns about your health, we strongly encourage you to contact the Peace Corps’ Post Service Unit email@example.com, so we can directly address your specific case. If you are a current Volunteer, don’t hesitate to reach out to your PCMO to discuss any questions or concerns.
Your health, safety and security are our top priorities, and we greatly appreciate your feedback to help us better support the Peace Corps community.
7 Irene Brammertz
August 9, 2013 at 10:10 pm
What are the four choices? I recently served in Malawi as a Response Volunteer and was given two choices: Mefloquine or Doxy. I asked for Chloroquine since that had worked really will during my initial service in the DRC but was told it was not an option. When I developed nightmares the Medical officer told me to split the dosage in half and takes it twice a week instead of once. They said Chloroquine was not effective something disputed by other expats who said since nobody has been taking that there is not really resistance against it.
8 Dr. Remington Nevin
August 9, 2013 at 10:26 pm
Regarding the myth of “choice”, the Peace Corps seems reluctant to acknowledge the verifiable fact that in prior fiscal years, it did not adequately budget to provide the safer daily drug Malarone to all PCVs who might request it. In the particular case of travel to Malawi, as any experienced travel physician who consults the primary literature will know, the country has been virtually devoid of chloroquine-resistant malaria for years.
9 Dr. Remington Nevin
August 9, 2013 at 8:57 pm
Since the drug was licensed in 1989, the mefloquine package insert has very clearly warned that should certain neuropsychiatric symptoms develop while taking the drug, these should be considered prodromal to a “more serious event”, and the drug immediately discontinued. Yet Dr. Hans Lobel, writing in the Summer 1996 Peace Corps “Healthwise” newsletter, seemed to dismiss these symptoms as “anecdotal”. He wrote “What could explain the many anecdotes about adverse effects of mefloquine in the face of the many investigations indicating that the drug is well tolerated when used for prophylaxis? The anecdotal stories focus on neuropsychological events; insomnia, dizziness, strange dreams (some PCVs reported liking them), anxiety and headache. Such subjective events can occur as a result of stress.”
Today it is clear that each of these symptoms is a potential indication of a developing toxicity that warrants careful evaluation. According to today’s product labeling, these symptoms mandate the immediate discontinuation of the drug, in order to minimize the risk of “permanent” neurological injury and psychiatric symptoms potentially lasting “years” after use.
Yet in light of Dr. Lobel’s dismissive commentary, which trivialized the significance of anxiety, it is not clear whether PCVs received even proper counseling consistent with earlier product labeling. It seems probable that many PCVs may have been erroneously instructed to continue use of the drug despite the development of contraindicating symptoms, including anxiety, depression, restlessness, or confusion. Today, we recognize that these and other contraindicating neuropsychiatric symptoms develop in a sizeable minority of prophylactic users, if not a majority.
What will Peace Corps do to identify, diagnose, and treat those RPCVs who have been injured by the toxic effects of this drug, partially as a result of the poor medical advice provided to them by earlier Peace Corps officials?
August 9, 2013 at 9:21 pm
I wholeheartedly concur. I began my PC service on Mefloquine and had almost immediate negative psychological effects. I had violent, disturbing dreams, night terrors, began sleep walking and had what I am guessing we’re anxiety attacks. I would “wake up” and, eyes open, see intruders in my room, see people sitting at the foot of my bed. I would see a recurring hallucination of three yellow birds (during daylight hours). When I reported it to the PCMO, I was regarded with an attitude of “suck it up, it’s just stress from moving to a new country, you’re paranoid now from other PCV horror stories.” I had to stay in it almost five months before, after having suicidal dream, I told the PCMO I was refusing to take it any longer and she could go from there. I was switched to Doxycycline and was on it about four months and contracted malaria. I was switched back to Mef, had many of the same symptoms, though to a lesser degree, and basically kept quiet about it because of the two strikes policy in regards to contracting malaria. I was on Mef for another two and a half years through my extension. I took my pill on Tuesday, felt like the world was ending on Wednesday & Thursday, couldn’t get any sleep on Friday, Saturday & Sunday, then mellowed out on Monday just in time to take my pill again. I’ve been off it for about four months now and am taking Doxy while continuing to work overseas, but I still see people in my house, I still sleepwalk and I still have sudden bouts of panic. Articles like the one in the NYT make my issues feel justified, but they’re also scary because it’s not something I want to continue to live with. That being said, if I had to choose between the side effects and the malaria that almost killed me, I’ll take the pills every time.
‘If you want to see a bit more about the earthquake in Nepal go to these sites:
After the earthquake, the Peace Corps and Embassy evacuated all PCVs from Nepal. The Embassy and the Peace Corps did not give the PCVs the option to stay and help in the relief efforts, and provide them some subsistence to do so. The PCVs, with their fluency in Nepali, could have been assigned to work with international relief organizations, to assist in the effort, especially in the more remote communities near the epicenter. But, to simply route them out of the country - done! - doesn’t seem very much in tune with the Peace Corps ethic.
I am sure that Peace Corps/Kathmandu had their reasons. Maybe the Staff wanted to go home.
Nobel Prize laureate, Wole Soyinka, LandRover that Tom inherited when he became the University of Ibadan
Theater’s business manager and directed the College’s 1964 Shakespeare national tour.
Those were the days my friend
We thought they’d never end
A lot gets lost over time and 50+ years of history is a long time for an agency. Reading this past weekend the long, and deadly prose written report: The Peace Corps A Comprehensive Agency Assessment– published in June 2010 by the agency–I realized how much of the original spirit of the Peace Corps has evaporated in five decades of service.
This report written by six people, with lots of advisory committees, attempts to evaluate the agency, and make recommendations for the future. It was done at the suggestion of Peace Corps Director Aaron Williams (2009-12) who said during his Senate Foreign Relations Committee Hearings that his intention, once confirmed as director, was to “carry out an agency-wide assessment of the Peace Corps as a means of strengthening, reforming, and growing the agency.” Aaron said that “the agency-wide assessment would serve as a valuable tool for the agency to better articulate a strategic vision for the Peace Corps for the next ten years.”
Why anyone would read this report is beyond me. It reads like a bad novel, and having written a few bad novels, I know what that prose is like. Here’s an example of an impossible sentences: “The Peace Corps at fifty is ready for a strong new beginning-rooted in the vibrant past of those early days, yet ready to harness twenty-first century American intellectual power, innovation and commitment to result.” What bullshit!
Then, they say (and this is only on page 5!) “Excitement, engagement, and effectiveness are the terms that should characterize the Peace Corps as it moves into the future. As the agency prepares to turn fifty, the agency needs to position itself to be one that looks less in the rear-view mirror at its rich history, but rather, looks forward firmly believing its best days are yet to come.” (Where’s the video of the PCV cheerleaders rallying around this rah-rah quote to carry us all to victory?)
There are some 200 plus pages of such dribble and as I work my way through the document, and the many, many vague recommendations the writers make, I’ll have more to say on other blog entries. But for the moment all this ‘assessment’ language reminds me of what was said and done in the early days of the Peace Corps.
I suggest that the current administration might be wise to look themselves into the ‘rear-view mirror’ and see what Shriver and the other senior staff 50 years ago, how they did it, why it worked, and use those days as the way forward.
Here are a few examples of what I mean.
Shriver was asked early on about creating a long-term budget estimate, to which he replied by laughing and saying, “That’s a legitimate question, but how the hell do I know where we’re going to be in five years?” Shriver would top that off by returning the Peace Corps appropriations to the Treasury. He gave back $1.9 million for fiscal year 1962, and $3.9 million for 1963. It was an unprecedented move by a government agency. When is the last time the Peace Corps (or any other agency) returned money not spent at the end of the fiscal year?
Then there is Warren Wiggins. He would write his staff in the first years, “We do not rely upon the rule-book. We operate fast and stay legal, but if something goes wrong, just operate fast.”
Shriver had no time for timid proposal or the bureaucratically inhibited response. He demanded boldness and intellectual daring. “There will be little tolerate of a ‘tomorrow’ philosophy, or ‘it can’t be done because it hasn’t been done before’ attitude,” he told those early employees of the Peace Corps. At the Director he also demanded total commitment from employees. Weekends work and early-morning phone calls to one’s home became standard. And Shriver wanted his Washington staff out in the field, working as Reps with the Volunteers. Harris Wofford went to Ethiopia as CD; Tom Quimby to Liberia; Frank Mankiewicz to Peru. Shriver himself, by 1963, had visited thirty-six of the forty-four countries in which the Peace Corps had program.
Shriver did not want a Peace Corps where the desk-bound bureaucrats made plans, unaware of the actual conditions under which Volunteers work. To make sure that didn’t happen, in 1962, he set up the Evaluation Division, the first of its kind in the federal government.
In recent years, the Peace Corps senior staff never went anywhere. Jodi Olsen, the Deputy Director under Gaddi, wasn’t even allowed to travel by Gaddi, and she was the only senior official at the agency who had served as a PCV.
Instead of traveling, the Peace Corps has now gone wild setting up ways and means to ‘evaluate’ the agency’s goals from ‘afar’.
This is not new. Maureen Carroll (Philippines 1961-63) tells that when she was the CD in Botswana in the early 1990s she’d come to work on Monday morning and her office floor would be littered with paper that had been faxed out from PC/Washington over night, all of PC/Washington wanted to know something. The faxes covered the floor, like so much mice droppings.
Now, in this new decade of the Internet and iphones, starting in 2007, the Office of Strategic Information, Research and Planning (OSIRP) was created and “charged with enhancing the agency’s strategic planning and reporting, evaluation and measurement, and date governance efforts.”
It appears that the agency has pulled together several ‘offices’ in PC/HQ under one giant umbrella. The office does four basic surveys. The first is the Volunteer Reporting Tool, an electronic data management system started in 2009. This ‘tool’ allows posts to “periodically collect detailed qualitative and quantitative data from all Volunteers on activities that relate to the three goals of the Peace Corps.”
The office (OSIRP) second monitoring tool is the Project Status Report which measures the progress of projects toward meeting their goals.
Then there is the “Annual Volunteer Survey to “asses Volunteers’ impressions of their service.”
The last ‘tool’ is the Results Based Field Evaluation. (Don’t you love these names?) This study, began in 2008, ‘collect information from host country counterparts, beneficiaries, host families and stakeholders to help inform Peace Corps on the impact of the Peace Corps’ work primarily focusing on goal one and goal two activities.”
Wouldn’t you think that with all these ‘tools’ the Peace Corps would get it right?
And this is just the beginning of the Peace Corps ‘tools’ for self-evaluation.
There is something called the “Administrative Management Control Survey” as well as reports from the Inspector General Office, also the report adds, “The Peace Corps benefits from the countless number of Ph.D. dissertations, M.A. theses, and academic studies on various aspects of the Peace Corps’ work.”
I’d like anyone of today’s Senior Staff to quote to me anything that they learned from reading what academics or for that matter what RPCVs had to say on their academic research of the Peace Corps.
Since the 1990s, I have been giving lists of Peace Corps books to Peace Corps Directors and other ‘new’ (mostly Political Schedule Cs appointments) the names of books that tell the story of the agency and not once has any of these people come back to me and commented on what they read. The majority of the senior staff come into the agency totally ignorant of the history or the books written by RPCVs. It is all “On the Job Training” for them.
All of this brings to mind a story of a Peace Corps Director that I heard about in the late Sixties. This was during the days when CDs really ran their own countries. A Peace Corps HQ official went out to Brazil to see why the Latin America Regional Office wasn’t getting any reports from this post. (The Peace Corps went to Brazil in 1962 and left in 1980.)
Meeting up with the CD on the top floor of the Peace Corps Office in Brazil, the Washington guy had official mail for the Country Director and while they stood together making small talk in front of an open window, the CD casually fingered through the mail, tossing out through the open window mail he didn’t want.
Slowly, the visiting HQ official began to realized the CD was throwing away (unread) all the ‘official’ mail he had brought with him from D.C. When he glanced out the window, several floors below in the interior courtyard of the building, were hundreds of such official letters from Peace Corps/Washington, tossed away unread by this Country Director.
So much for what Peace Corps/Washington wanted to know what was happening in Brazil. This CD was running his own operation and not listening to Peace Corps/Washington.
As Warren Wiggins told his staff years ago, “We do not rely upon the rule-book. We operate fast and stay legal, but if something goes wrong, just operate fast.”
Those were the days!
Next what the Peace Corps is doing right. Two new and wonderful changes in the agency.
While observing the Kazakh elections, 2005, Ken Hill is being observed.
Dr. Remington Lee Nevin is a consulting physician epidemiologist board certified in Public Health and General Preventive Medicine by the American Board of Preventive Medicine. Dr. Nevin specializes in the evaluation of adverse reactions to antimalarial medications, particularly the neurotoxic quinoline derivative mefloquine (previously marketed in the United States as Lariam®).
The above is from his website: http://www.remingtonnevin.com/site/home.html
Dr. Nevin has written a letter to the Peace Corps Director urging that the policy regarding the use of mefloquine be changed to protect Volunteers from the medication’s adverse effects. His letter is signed by RPCVs who support the change. Many of whom have suffered severe and potentially permanent damage from the drug.
RPCV advocates, including members of “Health Justice for Volunteers, are urging RPCVs to write to Peace Corps Director Carrie Radelet-Hessler in support of Dr. Nevin’s recommendations, and also to contact their Congressional delegation with the same request. Here is the link to download a PDF version of Dr. Nevin’s letter: http://www.remingtonnevin.com/rpcv20150305.pdf
To find and contact your Congressional Representative, go to this website:
To find and contact your US Senators, go to this website:
There are four RPCVs currently serving in the US House of Representatives. They created the Peace Corps Caucus last year. Representatives usually reserve their website email contacts for their constituents.
The best way to contact these RPCVs might be to call their offices.
RPCV John Garamendi 202.225.1880
RPCV Mike Honda 202.225.2631
RPCV Sam Farr 202.225.2861
RPCV Joseph P. Kennedy III 202.225.5931
There was a Catholic secondary school for women a mile and a half or so from the Government teacher training college where Fanselow was teaching in 1962. Young Catholic women taught at the secondary school not as Peace Corps Volunteers, but as volunteers for a Catholic organization.
John and the women would often get together on weekends after mass at the secondary school and sometimes went on walks later in the day.
One afternoon they came upon the large pot used to cook stew for events in the village. John and the women teachers had food with them as well as forks, knives and spoons for their picnic, and they thought it would be a good joke to give forks, etc. to the people in the village and hop into the pot. (John had remembered seeing an old Abbot and Costello movie with a similar scene.)
Of course as soon as he saw the slides of the photos he realized how insulting and insensitive their joke was.
The villagers, however, had thought it was a funny thing what John had done, but they had not seen any Abbot and Costello movies, and had no experience of putting people in pots.
The photo was taken in 1962 after Fanselow had been in Uyo, the town where both institutions were located, for only a few months.
Rather than destroy the outrageous photo John, throughout his long teaching career, has used the photo when discussing how we often do things without thinking of what we supposedly have learned. That is one reason, John says today, “why trying to teach cross cultural understanding is so tough.”
The Peace Corps would give thousands of young Americans a chance to see at first hand the conditions in remote areas of the world.
The Peace Corps is guilty of enthusiasm and a crusading spirit. But we’re not apologetic about it.
Any idealist who tries to join the Peace Corps must realize he is not going to change the world overnight.
In the Peace Corps, the volunteer must be a fully developed, mature person. He must not join to run abroad or escape problems.
Morris Baker’s white mule (that he named “LandRover”, because it was so sure footed) was one of several mules that he used to visit small villages in Gojjam Province while serving as a Leprosy Control PCV with the Ethiopian Ministry of Health. This was his second year assignment in Ethiopia. The man holding the reins is a leprosy patient.
Morris Baker (Ethiopia 1966-68)
John Coyne Babbles is a collection of comments, opinions, musings, and outrages from this RPCV who served with the first group (1962-64) in Ethiopia.