Washington Post: After their return, some Peace Corps volunteers find byzantine health system neglects them

After their return, some Peace Corps volunteers find byzantine health system neglects them

By Lisa Rein
Washington Post, December 23 at 11:08 AM

Returned Peace Corps Volunteer William Harless with his students in Thailand.
(Courtesy William Harless)

The Peace Corps says its top priorities are the health, safety and the security of its volunteers. But a new internal report acknowledges that some Volunteers who come home sick or injured have been waiting years – even decades – for adequate medical care and have fallen deeply through the cracks of a federal insurance bureaucracy.

The report, by a task force set up by the agency in March, is a particularly candid assessment by top Peace Corps officials of government failure to provide top-notch health-care access to thousands of young people who serve in far-flung developing countries.

“A wide variety” of returned volunteers “shared their experiences not only about the health issues that impact the quality of their lives but the feeling of abandonment after giving months and years of service to their country,” says the report, completed late last month and posted on the Peace Corps’ website.

The task force of senior agency officials interviewed returned volunteers and found a pattern of frustration. Many have “tried to get their health service issues resolved for decades and believe there is a lack of understanding from Peace Corps and the Peace Corps Community,” the report found.

They describe “anger and frustration” at a bureaucracy that does not understand what they did as volunteers and does not understand their injuries and illnesses, it said. “They sometimes suffer the humiliation of having to endlessly repeat their medical histories.”

The task force was prompted by increasing complaints and visibility of returned volunteers who are coming forward in frustration over how their medical issues are handled. Many say they’ve struggled to navigate an insurance system with limited benefits, with little support from the Peace Corps.

Watchdog groups have estimated that anywhere from 10 to 30 percent of Peace Corps volunteers develop health issues from their service overseas, whether physical or mental, starting during service or after.

When they get home after serving a little over two years on average, they’re responsible for filing a worker’s compensation claim with the Department of Labor, with the burden of proof of a service-connected illness being on the volunteer. Returned volunteers complain of a lack of payments from the Labor Department, a lack of access to specialists who will cover them for treatment, limited coverage and limited follow-up by the Peace Corps when they need it.

The report cites an almost non-existent coverage of mental health issues.

” … With mental health or long-lasting issues, [Labor] has suggested that the [volunteer] should not even bother trying to submit claims because of the cumbersome, bureaucratic process or due to the statute of limitations,” it says, describing a lack of sensitivity and support of these issues.

The public focus on health care comes as the Peace Corps received a record level of funding in the budget deal Congress approved last week – at $410 million, the largest in its 54-year history. The agency saw a 40-year high in application numbers this year.

The task force made numerous recommendations for reform, including higher compensation for returned volunteers who go on disability; better coordination between the Peace Corps and Labor Department; better outreach and support to volunteers from the Peace Corps; and more robust and longer insurance coverage. Some changes would need legislation from Congress.

William Harless, who served in a remote area of Thailand in 2009, said a Thai doctor contracted by the Peace Corps  dismissed his complaints of excruciating pelvic pain as anxiety.

But he turned out to have contracted a food-borne infection that eventually caused nerve damage down his hip and left leg and in his digestive system, he said. The infection appears to have triggered an autoimmune reaction that has lingered and gotten worse in the past year.

Harless was in and out of hospitals in Bangkok with little relief. When he finally came home, he said, his worker’s compensation claim for medical care was approved. But none of the specialists he needed to see would cover his care.

Claims examiners at the Labor Department have been unresponsive, he said, as has the Peace Corps, which only informed him three years after his return that he qualified for disability payments that he has lived on off and on.

Harless has been active with Health Justice for Peace Corps Volunteers, a group of returned volunteers who have faced service-related illnesses and injuries and came together to seek better benefits and access to care. Much of the impetus for change has come from them.

He said Peace Corps director Carrie Hessler-Radelet “has apologized to me profusely and tells me what’s happening to me is wrong.” She  has hired new staff in the post-service unit to help injured returned volunteers, he said. But it is not enough.

“We thought we were doing a good thing for our country when the Peace Corps recruited us,” said Harless, who lives in San Francisco. “Our country keeps sending 7,000 volunteers abroad annually with full awareness that the protections for their health care are inadequate or non-existent. When they were recruited, they were promised excellent health care, but they ended up with the opposite and are having to watch their lives fall apart.”

In a critical report in 2012, the Government Accountability Office found fault with both the Peace Corps and the Department of Labor for not tracking the accessibility and quality of care for returned volunteers. Auditors found that health claims by returned volunteers were growing steadily.

The Peace Corps says it is implementing significant reforms.

“Over the past five years, the Peace Corps has undertaken the most extensive reform efforts in the agency’s history and implemented significant steps to improve the quality of health care and the provision of compassionate support for both current and returned Volunteers,” spokeswoman Erin Durney said in a statement.

She said the agency is reviewing the recommendations of the task force “and is committed to a rigorous plan of action to improve outcomes for returned Volunteers with medical conditions however it can within the restraints of current law.”

Lisa Rein covers the federal workforce and issues that concern the management of government.