The Peace Corps Global Health Service Partnership represents a radical change for Peace Corps and Peace Corps Response for two equally important reasons. The first is that these new “GHSPVS’ will receive generous financial compensation for a year of service, in addition to the allowances and benefits afforded the “traditional” PCV and PCRV. The second reason is that these GHSPVS will treat and provide clinical services, as well as training and teaching.  Let us look first at the “benefits package.”  From the concept paper:

Historically, many health professionals interested in providing service - either domestically or abroad to socially and economically disadvantaged populations - face financial challenges from compounding educational debt and personal commitments. GHSC aims to build on the legacy of domestic federal programs such as the National Health Service Corps to assist with education indebtedness. GHSC will provide loan repayment support to eligible individuals for each year served in the Global Health Service Partnership and health service abroad.In addition, the Global Health Service Corps stipend will be available to help offset other personal financial burden like mortgages. Our goal is to encourage service by the best-qualified individuals, including those who may have financial constraints to service. The GHSC will provide stipends of up to $30,000 (this amount is subject to change) for each year served in the joint GHSP program to individuals with documented educational loans or other personal financial burdens.  Individuals with educational loans less than $30,000 will receive a stipend to cover the full amount of their remaining education loans.The stipend application process for individuals seeking support for expenses other than loans is under development.In addition, the Global Health Service Corps stipend will be available to help offset other personal financial burden like mortgages.Our goal is to encourage service by the best-qualified individuals, including those who may have financial constraints to service. The GHSC will provide stipends of up to $30,000 (this amount is subject to change) for each year served in the joint GHSP program to individuals with documented educational loans or other personal financial burdens. Individuals with educational loans less than $30,000 will receive a stipend to cover the full amount of their remaining education loans. The stipend application process for individuals seeking support for expenses other than loans is under development.

Dr. Victoria Kenny, daughter of Senator Kenny  is the creator of the program.  She directs a global health program at Harvard Medical School and works at Massachusetts General Hospital’s Center for Global Health. Certainly, the need for health professionals in the Developing World is acute and the Doctor will qualified to support such an effort. But, Dr. Kerry was evidently unaware of Peace Corps decades long efforts in this field. and aspects of the new program reflect this apparent ignorance. Dr. Kerry was quoted in a recent NPR interview as stating that “The Peace Corps doesn’t have the technical capacity to do clinical medicine and nursing.”  But, this is not why Peace Corps doesn’t do clinical medicine and nursing.  From  Peace Corps instructions, revised in 2005

Technical Guideline 310 / In-Country Health and Safety Training

Section 2 (“Elements of Health Training”), where the concluding paragraph reads:

“The PCMOs also need to remind the PC staff, Peace Corps Trainees, and Peace Corps Volunteers that V/Ts are not authorized to participate in direct health care activities.  These activities include, but are not limited to, participating in immunization programs, attending or otherwise assisting with childbirths, performing phlebotomy, insertion of intravenous catheters, and other activities that may place them at risk for exposure to blood or body fluids.”

Yet, the concept paper makes no mention of this instruction.  Rather, it apparently assumes that the problem is with liability and licensure.  The paper states:

iii. International license requirements and liability issues

The Peace Corps Act provides for Volunteers to deliver direct medical care and treatment. Peace Corps Volunteers do not currently deliver direct medical care in the communities in which they serve. Peace Corps will need to work with host country governments to ensure in-country partnering medical facilities, schools, and health teaching institutions accept reciprocal licensure to practice and deliver direct medical treatment and care in country. Provision of malpractice insurance or indemnity will be required.

One of the most important lessons from the decades of Peace Corps work in the health field is that in almost all developing countries, there can be a lack of medical infrastructure to support the safe delivery of medical care.  HIV/AIDS made this situation all the more dangerous.  The prohibition against participating in direct health activities, is not a function of the competence of the PCV in a health program, rather it is to protect that Volunteer.

I, for one, believe that Peace Corps Washington, particularly in the early days, was very slow to realize the consequences of the lack of adequate medical infrastructure.  The world was saved from small pox, with dirty needles.  It was not just ignorance of the importance of sterilization of all medical instruments and antiseptic procedures in hospitals and clinics, but the lack of a consistent supply of clean water and energy to support these essential practices. I could find no documents that describe these problems.  But, that is very typical of Peace Corps. I speak only from personal experience and evidence reflected in the oral histories and memoirs of RPCVs.  For many nurses, this represented a very real ethical conflict because they  were assigned to hospitals and clinics where they knew that the situations could be dangerous for patients.  The nurses lacked the authority, as well as the resources, to change the situations. I also believe that if Peace Corps Washington had been more alert to this dangerous situation, in the early days, the persistence of what really were vectors for blood borne diseases, like HIV/AIDS, could have been addressed.

Starting June of 2013, the Peace Corps Global Health Partnership plans to place ten to twelve medical professionals in each of three countries; Uganda, Malawi, and Tanzania.  It will be the responsibility of the Peace Corps staff, in-country, to choose the sites for these medical placements.  The presumption being that safe medical environments can be found for all the GHSPVS and that the Peace Corps staff, that “lacks the technical capacity” to support clinical medicine and nursing will, nonetheless, be able to identify such places.

My information on this program comes from the website of the Global Health; the NPR interview and current responses to FOIAs from Peace Corps.  If any of this information is incorrect or not current, I would welcome corrections.

The Peace Corps official website has information on the program: www.peacecorps.gov/response/globalhealth/?from=hp_spotlight