12/9/9 Perceptions of PCMO

Yesterday, I met with a group of people from Peace Corps Washington. Apparently, it's Peace Corps policy to send people to - not investigate, they said repeatedly, but inquire - as to the circumstances surrounding any tragedy.

I'm a member of the organizing committee for Morocco's Volunteer Support Network. In that capacity, PC staff asked me - asked us - to come to headquarters and meet with "The Washingtonians", to give them our sense of how the Volunteer community is reacting to soyoun's passing.

[Sorry, it's still hard to talk about. But I'm working on it.]

Most of the response I've heard centers around the role of the Peace Corps Medical Officers (PCMO). PCMO has a hard task - maintaining the health of 215 people scattered across a country the size of California, not all of whom have access to clean water, let alone phone service. That said, they've made their share of misdiagnoses and faulty prescriptions, which PCVs tend to complain to each other about. PCMO's reputation has steadily eroded, and in the wake of a friend's - a sister's - death from illness, people have been looking for someone to blame, and most of the anger has settled on PCMO.

Knowing that, I wanted to investigate why. What are these mistakes that have compounded into such a deep distrust that PCMO has become the scapegoat of choice? So I surveyed the PCVs in my stage, called the ones who seemed to want to tell their stories, and collected information.

Of course, the plural of anecdote is not data, but it was the best approach I could come up with.

So I collected stories. Sad stories. Stories of my friends - my Peace Corps family - feeling neglected, mistreated, and abandoned by the people they had trusted their health care to.

One PCV came back from a medical evacuation, still in recovery, and never got a phone call from PCMO for followup care. After getting in touch with PCMO and asking for some followup, and PCMO promised a forthcoming call...which never came.

A PCV was assaulted and battered, went to PCMO for care, and was told, "You're over-reacting. It happened, it's done, go home." Fears about returning to the scene of the crime were dismissed and even derided.

A PCV felt symptoms of a progressive disease that led to debilitation. PCMO said that the symptoms were "normal". PCV lobbying led to a lab test, whose results were positive - marginally positive - and PCMO continued to say that nothing serious was wrong.

A PCV took a hard fall and came to PCMO - it happened within 100 yards of a Peace Corps facility - asking for painkillers. The doctor failed to notice that the Volunteers' pupils were different sizes, a straightforward indication of a concussion. Another PCV did notice this, and arranged care.

A PCV had symptoms of a serious parasitic infection and repeatedly called PCMO. Each call was answered by a different medical officer - we have 2 doctors and 1 nurse, all of whom rotate phone duties - and not until the 8th call did anyone realize that this was an ongoing problem, not a new one.

Speaking of a failure to look at medical records...

A PCV requested a MRI to evaluate long-lasting pain in a joint. PCMO thought it was too expensive, and arranged an x-ray - but since nothing was broken, doctor and patient agreed that an x-ray wouldn't show anything. Just as the PCV was heading out for the exam, a cast-off comment indicated that this was a long-standing problem, of many years' duration. PCMO said, "Oh, that changes everything," and arranged for different tests - but still not an MRI. The Volunteer was startled to realize that the well-documented medical history had never once been checked by the doctor.

A Volunteer had trouble breathing. It was dismissed by PCMO...until the PCV insisted on lab tests that revealed life-threatening blood clots in the lungs.

..and there are so many others. So many stories - some serious, many minor - of PCVs enduring pain, sometimes for days, sometimes for months. And we endure. We carry on, knowing that Peace Corps isn't supposed to be easy...but with an ever-diminishing faith in the power of PCMO to keep us whole and healthy.

One of the emerging themes of these stories was the need felt by PCVs to "lobby for treatment." The idea that, without fighting for care, symptoms and struggles are diminished or dismissed by PCMO. Running a fever? Keep taking ibuprofen every two hours, then call back in 48 hours. Diarrhea? Limit your food to the BRATT diet - bananas, rice, apples, tea, & toast - for the next 48 hours. As was said in one of today's meetings, "If I had a nickel for every time I heard 'Wait 48 hours and then call back,' I could afford to call my parents."

The idea that we're not hypochondriac idiots - that we know how to manage minor problems, and that maybe we've already waited 48 or 72 hours before calling PCMO - doesn't seem to penetrate.

And when a medical tragedy arises - even one that isn't PCMO's fault, as the recent inquiry has determined - we're all too willing to turn our lost faith into targeted anger.

Anger is one of the stages of grief. It's human nature to look for someone to blame for something as horrific as the death of a wonderful young woman. And given this history - given that nearly every Volunteer has at least one story, and usually several, of PCMO missteps, large or small - we find an outlet for our anger.