Effective Cross-National Respectful Partnerships: A Case Study of Peace Corps' Volunteer Covid-19 Volunteer Evacuation.

Strong, trusted partnerships within a social capital framework are core to Peace Corps' successful international, national, and community interactions and outcomes. The Peace Corps' integrated three level model has thrived since its beginning in 1961. During this time, about 250 000 two-year Volunteers have lived and worked in 142 countries. In March 2020, the Peace Corps had to evacuate all 7 000 currently serving Volunteers because of the world-wide Covid-19 pandemic, a task organized and completed in nine days. The evacuation's success depended on the resiliency of these honored long-term partnerships, and specifically: a partnership model with three intertwining layers of collaboration between national and host country staff and Volunteers;years of respectful integration of Volunteers in local communities building mutual trust;in-country and cross-nation preparedness for health, safety, and security emergencies;transparent communication during the evacuation among all involved parties in every nation with Volunteers; andin-country and host country staff support across countries during the evacuation. This case study illustrates elements of effective and sustainable partnerships that ensure their effectiveness during a crisis and survival beyond the crisis. I write this at the anniversary of one year from my stepping down as the twentieth Director of the Peace Corps. During my tenure, I brought home all 7 000 currently serving Volunteers in nine days as the Covid-19 pandemic spread across countries. This massive - and successful - undertaking was possible because of long-standing and trusted partnerships between the Peace Corps and the communities and countries hosting Peace Corps Volunteers. This is my personal reflection and a reminder to build, honor, and tend relationships with international partners who are collaborators in learning, service, and research in good times and our friends, protectors, and allies in times of crisis.

A descriptive analysis of dengue in Peace Corps Volunteers, 2000-2019.

BACKGROUND: Peace Corps Volunteers (PCVs) are a unique expatriate population at risk for dengue. Previous studies examined travelers or lacked demographic information about expatriates. We examined dengue incidence among PCVs before and after deployment of an electronic medical record (EMR) to assess temporal and demographic factors. METHODS: Dengue cases within Peace Corps' Epidemiologic Surveillance System from 2000 to 2019 were identified using a standard case definition, and two timeframes were compared: pre-EMR 2000-2015 and post-EMR 2016-2019. RESULTS: Annual infections occurred in a roughly 3-year cyclic pattern from 2007 to 2019. Incidence rate decreased from 1.35 cases per 100 dengue Volunteer-years (95% CI 1.28-1.41) in 2000-2015 to 1.25 cases (95% CI 1.10-1.41) in 2016-2019. Among PCVs who served from 2016 to 2019, the majority of infections occurred in females and 20-29 year olds, and 7% were medically evacuated. Among PCVs who served from 2015 to 2019, 21% were hospitalized in-country. CONCLUSIONS: Among PCVs, a non-significant decrease in dengue incidence occurred from 2000-2015 to 2016-2019. Annual infection rates peaked every three years, offering opportunities for targeted prevention efforts. Dengue infection in PCVs appears to mimic the overall demographic of Peace Corps. Expatriates like PCVs are at an increased risk for dengue infection compared to short-term travelers.

Dengue Virus Infections among Peace Corps Volunteers in Timor-Leste, 2018-2019.

Dengue is an ongoing health risk for Peace Corps Volunteers (PCVs) working in the tropics. On May 2019, the Peace Corps Office of Health Services notified the Centers for Disease Control and Prevention (CDC) of a dengue outbreak among PCVs in Timor-Leste. The purpose of this investigation was to identify the clinical, demographic, and epidemiological characteristics of PCVs with dengue and recommend dengue preventive measures. To identify PCVs with dengue and describe disease severity, the medical records of PCVs reporting fever during September 2018-June 2019 were reviewed. To identify factors associated with dengue virus (DENV) infection, we administered a questionnaire on demographics, travel history, and mosquito avoidance behaviors and collected blood specimens to detect the anti-DENV IgM antibody to diagnose recent infection. Of 35 PCVs in-country, 11 (31%) tested positive for dengue (NS1, IgM, PCR), eight requiring hospitalization and medical evacuation. Among 27 (77%) PCVs who participated in the investigation, all reported having been recently bitten by mosquitoes and 56% reported being bitten most often at home; only 16 (59%) reported having screens on bedroom windows. Nearly all (93%) PCVs reported using a bed net every night; fewer (70%) reported using mosquito repellent at least once a day. No behaviors were significantly associated with DENV infection. Raising awareness of dengue risk among PCVs and continuing to encourage mosquito avoidance behavior to prevent dengue is critical. Access to and use of measures to avoid mosquito bites should be improved or implemented. Peace Corps medical officers should continue to receive an annual refresher training on dengue clinical management.

The creation of a postcolonial subject: The Chicago and Ateneo de Manila schools and the Peace Corps in the Philippines, 1960-1970.

In the 1950s and 1960s scholars from the University of Chicago and the Ateneo de Manila created social scientific knowledge that helped establish the Peace Corps as a Cold War institution in the Philippines. Central were the social scientists at the University of Chicago and the Ateneo de Manila University who established a knowable postcolonial subject: "the Filipino," which resulted from their research on Philippine values. In this context, the Ateneo/Chicago social scientists developed the "SIR," the "smooth interpersonal relation" model that entails the notion that Filipinos and Filipinas particularly valued this nonconfrontational skill set among people. The SIR model was taught by social science experts to early Peace Corps volunteers as they prepared for their assignments in the Philippines. The article shows how the SIR model could cause distress and confusion as it was applied by Peace Corps volunteers in the Philippines.

Long term health outcomes among Returned Peace Corps Volunteers after malaria prophylaxis, 1995-2014.

BACKGROUND: A primary reason for non-adherence to malaria chemoprophylaxis is fear of latent side effects. We examined latent effects of malaria chemoprophylaxis among Returned Peace Corps Volunteers (RPCVs). METHODS: During July 18-September 16, 2016, RPCVs who served during 1995-2014 with an e-mail address in Peace Corps' RPCV database were invited to take an internet-based survey on malaria prophylaxis and medical diagnoses. "Good adherence" meant taking prophylaxis "as prescribed" or "most of the time." Prevalence of diseases diagnosed after Peace Corps service was compared between users and nonusers of each antimalarial using log-binomial regression. RESULTS: Of 8931 participants (11% response rate), 5055 (57%) took chemoprophylaxis. Initial chemoprophylaxis was mefloquine 59%, chloroquine 13%, doxycycline 16%, atovaquone-proguanil 4%, and "other" 8%. Sixty percent reported good adherence. Mefloquine users had the best adherence (67% good adherence). Prevalences of most diseases were similar between exposed and unexposed groups. Certain psychiatric diagnoses were slightly more likely among mefloquine users (PR 1.14, 95% CI [1.04-1.25], P = 0.0048). When excluding those with prior psychiatric illness, there were no differences in psychiatric diagnosis rates. CONCLUSION: Malaria chemoprophylaxis use by Peace Corps Volunteers is safe. Avoiding mefloquine use in those with prior psychiatric illness can reduce psychiatric side effects.

Road traffic injuries in Peace Corps Volunteers, 1996-2014.

INTRODUCTION: Road traffic injuries are a leading cause of mortality and morbidity worldwide. Travellers are at risk given unfamiliarity with local road conditions and traffic rules. Peace Corps Volunteers are a unique population of long-term travellers who live and work in-country, often in remote settings, over a period of 27 months and use a range of transportation modes. METHODS: Data from Peace Corps' Epidemiologic Surveillance System (ESS) and Death In-Service (DIS) database were analysed in 2015 for non-fatal and fatal road traffic injuries among in-service Volunteers from 1996 to 2014. Volunteer-months were used to calculate incidence rates, and rates were compared among countries and regions. RESULTS: A total of 5047 non-fatal and 15 fatal road crash injuries were reported during 1 616 252 Volunteer-months for an overall rate of 3.12 non-fatal injuries and 0.01 fatalities per 1000 Volunteer-months. The total combined rate of nonfatal road traffic injuries among Volunteers generally declined from 4.01 per 1000 Volunteer-months in 1996 to 2.84 in 2014. Pedestrian and bicycle injuries emerged as the most frequent mechanisms of injury during this timeframe. Differences in rates of observed road traffic-related fatalities among Volunteers compared with expected age-matched cohort rates in the US were not statistically significant. CONCLUSIONS: Peace Corps transportation policies and training, and changes to road environments worldwide, may have led to a decrease in the rate of road traffic injuries among Peace Corps Volunteers. Pedestrians and bicyclists remain at risk of road traffic injuries.