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Lily Fowler

Some Peace Corps Volunteers Face Injury Overseas, Indifference at Home

News of safety, health and corporate conduct

Former Peace Corps volunteer Christie-Anne Edie in Colorado Springs, Colo., in September.

In June 2011, nine months into her assignment as a Peace Corps paramedic in the Central Asian republic of Turkmenistan, Caitlyn Hogan was run over by a car while crossing a gravel road near her apartment.

Her ankle was crushed but, as she tells it, her ordeal had just begun. Instead of receiving help from federal agencies because of being hurt while on duty overseas, Hogan said she got caught in a bureaucratic maze that has haunted her life ever since. Her requests for disability payments were ignored. On top of that, she is fearful that she will be stuck with many of her unpaid medical expenses, which so far total $17,000. Meanwhile, the collection agency calls keep coming.

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“It’s kind of devastating really. Peace Corps was something I wanted to do forever, and I get this chance to go,” Hogan, 27, said in a recent interview with FairWarning. “I can’t even feel positive about the stuff I got accomplished because it’s so overshadowed just by the lack of care by Peace Corps and their disinterest in helping.”

Caitlyn Hogan, who served in Turkmenistan.

Hogan’s feelings of abandonment by the Peace Corps are hardly unique. Volunteers who serve in impoverished, dangerous countries all too often endure sexual and other assaults, psychological trauma and physical injuries, as well as exotic diseases. Yet former volunteers-turned-activists say the government workers’ compensation program that is supposed to provide medical care and disability payments for the injured is rife with troubles. Even Peace Corps officials, while declining to comment on any specific cases, acknowledge some of the problems.

The program’s flawed management was underscored by a Government Accountability Office report issued in November. The assessment was required by the Kate Puzey Peace Corps Volunteer Protection Act of 2011, named after a volunteer who was murdered while working in the West African nation of Benin.

The narrowly focused report faulted both the Peace Corps and the U.S. Labor Department, which administers the workers’ compensation program known as FECA, after the Federal Employees’ Compensation Act. “The agencies generally do not work together to use available information to monitor the accessibility and quality of FECA benefits for volunteers,” according to the assessment.

The report, which noted that FECA serves about 1,400 Peace Corps volunteers a year and spent $36 million in benefits on them from 2009 through 2011, did not examine actual examples of the hardships resulting from the program’s flaws. Nor did the Government Accountability Office note that it found similar problems when it examined FECA 21 years ago.

No Mental Health Specialists

But the report gave a clue of how difficult it may be for returning volunteers to get proper treatment. Using the government’s online search tool to look for doctors registered with the program, the report’s authors did not find any mental health specialists in California, New York, Texas or any of the other 10 states with the most Peace Corps veterans.

As the cautious language of the report put it, “volunteers may face some challenges accessing registered providers.” Beyond that, the report noted the possibility that there may be volunteers who are assaulted but are too ashamed or fearful to report the incidents while overseas and, as a result, may lack the documentation to file FECA claims later on.

Interviews by FairWarning with more than a dozen former Peace Corps personnel – about half of them members of Health Justice for Peace Corps Volunteers, an advocacy group – highlighted the struggles of harmed volunteers. Many failed to gain government-paid medical care when they returned to the U.S. because they couldn’t find doctors registered with FECA. What’s more, they say, claims for medical insurance reimbursements often bog down or are rejected because of bureaucratic bottlenecks and the lack of information provided to volunteers.

Volunteer Jessica Gregg, for example, said she was drugged and sexually assaulted in October, 2007 by a young man she met at a restaurant in Mozambique, where she had served for 13 months as an English teacher. Afterward, Gregg returned home to Tucson, Ariz., to recover. But after Gregg had several psychological counseling sessions, the labor department denied her health care claim, and she went without further therapy or medication for six months, until she obtained private insurance through a new job.

“There was never a person I could talk to specifically about workers’ compensation that seemed competent,” Gregg said. She explained that her claim was denied because she found out too late that the labor department required a doctor, not a psychologist, to perform her initial medical examination.

“My PTSD symptoms and depression were crippling,” Gregg testified in an affidavit submitted in February, 2011 to the House Committee on Foreign Affairs, which looked into cases of volunteers who were raped or otherwise assaulted after ABC News reported on the issue. “I went without psychological care for an extended amount of time simply because I could not afford treatment or even navigate the system on my own.”

Although the Peace Corps covers medical costs for volunteers while they are on duty, once they return home, volunteers are expected to turn to the agency’s “Post-Service Unit” to receive medical examinations. After that, the Post-Service Unit largely steps aside, and its only continuing involvement is providing assistance in filing a FECA claim with the labor department.

Like federal employees, Peace Corps volunteers with job-related injuries can file claims to cover medical bills and, if they can’t return to work, to secure disability payments. Since volunteers are considered to be on the job around the clock when they are on foreign soil, any injury they suffer while on assignment is eligible for coverage.

But Peace Corps officials admit the system is flawed. “Unfortunately, this system has failed” returned volunteers, “and that is truly disheartening,” Peace Corps acting director Carrie Hessler-Radelet wrote in a recent blog post.

An Incentive to Deny Claims

To improve the situation, Peace Corps officials told the Government Accountability Office that they are adding staff and giving case managers authority to provide “care coordination for some catastrophic illnesses or injuries.”

Jessica Gregg (center) with other former Peace Corps volunteers in Mozambique in 2006.

But the agency says it has limited authority to make reforms, and points the finger at the labor department for the way it runs the workers’ compensation program.

Still, labor department figures show that the Peace Corps sometimes falls down in handling its part of the job. For instance, the Peace Corps delivered its paperwork for wage-loss claims on time in only 42 percent of the cases in the 2012 fiscal year.

And critics doubt that the Peace Corps pushes the labor department very hard to approve more claims because the Peace Corps, like any other federal agency, would wind up having to foot the bill. “Peace Corps has a financial incentive to get the Department of Labor to deny claims,” said Kevin Clark, a former volunteer from Canaan, N.H. who was one of the founding members of Health Justice for Peace Corps Volunteers.

Another former volunteer, Chuck Ludlam of Washington, D.C., said, “the transition between the Peace Corps medical system and the Department of Labor medical system is of no interest to the Peace Corps. As long as you get the volunteers off the books, they’re happy.”

Geoffrey Shapiro, a workers’ compensation lawyer in Warrensville Heights, Ohio, who has represented injured Peace Corps volunteers, said the labor department – which declined to comment for this story — also is to blame. He said it wants to protect federal agencies by holding down workers’ compensation costs, “so they blame the injured workers” and deny many of their claims for benefits.

Calls Ignored

In September 2008, Peace Corps volunteer Christie-Anne Edie started teaching women and adolescents about family planning, sexually transmitted diseases and sanitation. But by spring of the following year, while she was in the West African nation of Burkina Faso, Edie says she contracted a mysterious gastrointestinal infection. It was so severe that by December 2009 the Peace Corps sent her back home to Fort Collins, Colo.

When the Post-Service Unit turned her case over to the labor department, she said it felt as though the Peace Corps was saying, “We wash our hands of you. There is nothing we can do.”

Since then, according to records Edie provided FairWarning, the labor department has rejected her more than $25,000 in medical bills. “They always come up with some sort of excuse not to pay,” Edie said.

Getting help from either the Peace Corps or the labor department, she said, has proved futile. In addition to sending several letters, Edie said she has left 16 voicemail messages with the labor department that have never been returned.

Christie-Anne Edie in Burkina Faso in June 2009.

The shortcomings of the Peace Corps’ Post-Service Unit have been a concern for more than two decades. In 1991, the Government Accountability Office (then known as the General Accounting Office) said the unit’s officers often were unable to answer volunteers’ questions about FECA. Many returned volunteers weren’t even told they were entitled to health care benefits.

Former volunteers for years pressed, unsuccessfully, for Congress and the Peace Corps to set up an ombudsman office where the injured could turn to for help.

By 2008, Christopher Dodd, then a U.S. senator from Connecticut and chairman of the Subcommittee on Western Hemisphere, Peace Corps and Narcotics Affairs, was spurred to write to the Peace Corps director at the time, Ronald A. Tschetter. Dodd said he had been contacted by a “significant number of Returned Peace Corps volunteers who have expressed deep concerns with the performance of Office of Workers’ Compensation Program.”

Dodd suggested that the Peace Corps establish an “information center” that could track the handling of workers’ compensation claims. But that request, too, failed.

“Billing Process Is a Nightmare”

When it comes to getting medical care back in the U.S., injured volunteers often have few options. Dr. John Ellis, an Oklahoma City, Okla., physician who specializes in treating injured workers, said federal employees from all over the country travel to see him because they can’t find anyone else who will treat them. “It just blows my mind that no one will see these people,” Ellis said.

Toby Rubenstein, who for more than 20 years was a claims handler and supervisor for the labor department’s workers’ compensation program, said physicians lack a financial incentive to treat Peace Corp volunteers or federal workers.

The program is “not paying very much and yet the billing process is a nightmare, so that’s why the doctors don’t want to see them,” Rubenstein said.

Jack Saul, a psychologist based in New York City and an assistant professor at Columbia University’s Mailman School of Public Health, said he has treated two or three volunteers for free. “My experience has been that the process was so complicated that I eventually just gave up in trying to be compensated for work that I had done with some people who had been in the Peace Corps,” he said.

When it comes to getting paid, “It’s literally a word game,” said Howard L. Graham, an attorney in Tacoma, Wash., and author of the “Federal Employees’ Compensation Act Practice Guide.” “They require the perfect medical report.”

No one has struggled more, however, than injured volunteers like Hogan, whose ankle was crushed while on duty in Turkmenistan. After being treated at a hospital in the capital city of Ashgabat, Hogan said she spent six weeks sleeping on the floor of the local Peace Corps office trying to recuperate. Then, suddenly, she was shipped home to the Pittsburgh, Pa., area, when a doctor back in the U.S. saw an MRI of her injury and realized she wasn’t recovering properly.

Hogan continues to suffer from traumatic arthritis. Because her leg gives out on her at least once a day, she often uses a cane. Her bad ankle has led to other injuries, like a recent fall that hurt her back and neck. She also is being treated with electroshock therapy for anxiety issues. And she carries on the battle to get her medical bills paid by the labor department.

“I guess I’m kinda stuck with being 27 and being crippled for life,” she said.

Myron Levin contributed to this story.

Posted in , , Mother Jones

John Coyne Babbles Peace Corps Worldwide

Founding of Health Justice for Peace Corps Volunteers



Advocacy:  September Featured Advocate – Nancy Tongue

By Jonathan Pearson on Tuesday, September 11th, 2012

Cultural anthropologist Nancy Tongue says for those who know her, it’s almost as if they know one of two people. “There are those who know the ‘healthier’ me, and those who know the ‘sick’ me. There are few who know both.”

For nearly thirty years, Nancy has been engaged in a sometimes lonely, always difficult struggle to receive support and compensation for Returned Peace Corps Volunteers whose post-Peace Corps lives are seriously impacted by debilitating illness or injury. Over that time, she has been in contact with several hundred other RPCVs (including recently returned volunteers) facing similar challenges.

There is positive dialogue and action currently underway with the Peace Corps’ soon-to-be Acting Director Carrie Hessler-Radelet on how to address these issues. A Government Accountability Office (GAO) study on the roles and responsiveness of the agency and the US Department of Labor (USDOL) is also in the works. Nancy says unfortunately, there are volunteers who continue to return home seriously sick and injured who still face issues of being unable to get the care they need, obtain general health insurance, or struggle to live on the disability income that the Peace Corps “pay scale” qualifies them for.

These concerns led her to form Health Justice for Peace Corps Volunteers in March 2012, a growing group of advocates whose stated mission is “to ensure that Peace Corps Volunteers who become sick and injured due to their overseas service obtain the support and benefits to which they are legally entitled.” It also provides a built-in support group for one another. The group is now launching a survey which all RPCVs are encouraged to take, in an effort to better assess the depth and scope of the problems.

Nancy’s Story

A Rural Health Educator in Chile in the early 1980’s, Nancy says Peace Corps was one of the greatest experiences of her life. But the aftermath has been just the opposite. Upon returning to the U.S, Nancy began the process of readjustment, settling into New York City and securing a position of Director of the local Ronald McDonald House.

But soon, she started to feel ill.

Subtle and intermittent at first, by 1984 her condition worsened to the point where she became bedridden, needed to leave her job and move back home with her parents. Her parents took her from one medical center to another in an attempt to diagnose and alleviate her symptoms. It was at this point where Nancy says she faced numerous administrative and bureaucratic obstacles. “Once sick, the Peace Corps assumes that volunteers will file for a Federal Workers’ Compensation claim through the USDOL but does not help them do so. Without a clear diagnosis one cannot obtain a claim and without insurance, one cannot get appropriate medical treatment. Additionally, most medical specialists will not accept USDOL claimants because reimbursement can take months.”

Eventually, Nancy was diagnosed with extra-pulmonary tuberculosis, a condition that stemmed from her service which affected her immune and neurological systems. The symptoms of her illness continue to wax and wane all these years later, as they do for many with post-Peace Corps illnesses or injuries. Nancy says that predicament poses other problems. “The (federal support) system is not set up to accommodate people who are well enough to work episodically or sporadically because of their health, or even volunteer part-time, without having their disability coverage or workers’ compensation claim jeopardized.” Nancy did return to her career at various times and each time was inadvertently dropped out of the system entirely. Nancy says Peace Corps did little to help, and from her personal experience through contact with other RPCVs, understanding and working through the system to secure and maintain disability assistance can be overwhelming and time consuming, causing many deserving individuals to give up.

How You Can Help

And what about the broader Peace Corps community. How can they help Health Justice for Peace Corps Volunteers? “First, they need to believe us and recognize that systems are fallible,” says Nancy. Listening and empathizing are also important. “Earlier gatherings with the Peace Corps community were challenging. Anything I said was viewed as a betrayal of the Peace Corps. But we are the ones who feel betrayed because we have suffered physical, mental and financial anguish with little support.”

Along with the new survey and strategies to address policy changes, Nancy and her colleagues are also considering other steps and activities to raise awareness and build the level of acceptance and support for those volunteers facing serious injury or debilitating illness.  Follow this link to stay connected.

All RPCVs are encouraged to take the brief survey.  Please forward the survey to other RPCVs you know. And be on the lookout for future updates.

  • Comments (2)
  1. Maurice e. Edwards said 1 day ago

    I was unable to complete the survey. At the end I was telling my experience that included the subsequent development of urinary bladder cancer after contracting Bilharzia (schistosomiasis) in Nigeria. I was treated by in-country physician Harry Lutrin.
    I may have filled the allocated space and the system locked down. All I could do was exit the survey without it being forwarded. What I wanted to relate was that staff I contacted in PC Washington said my PC records were lost. Whether they meant only medical records or all evidence there of my ever being a PCV, I do not know.

  2. Meghan said 22 hours ago

    Nancy is doing an outstanding job and is an unbelievable gift and spokeswoman for the world of RPCVs who returned with illnesses or injuries and are still battling to survive every day. I cannot stand the thought of anyone being put into a situation where medical care becomes such a battle, where collection agencies are calling, when you spend your only waking hours and strength on the phone dealing with red tape and getting no where. We went to work in countries where this was happening, but perhaps what we failed to realize is that it happens here in the United States to the marginalized, many of us who are well-educated, want to work, have a lot to contribute to society, and want nothing more than to continue serving humanity should only their own organization (in this case the Peace Corps), their own country (the USA) help them with compromised health issues due to active duty working for it. How developed are we as an American society that this is happening? I have been dealing with this for over four years, have watched my youth slip away in bed while sick, am voracious to get well and continue serving, but this is not possible with the way the system is currently set up. There needs to be a change. We have been doing our most to make that change, but we need help.



See above for group member's story about Larium use (medication used against malaria). 

Peace Corps no longer requires the use of Larium for prophylaxis for malaria. 

Committed to Support Sick or Injured Returned Peace Corps Volunteers

By Jonathan Pearson of National Peace Corps Association on Tuesday, October 2nd, 2012

Carrie Hessler-Radelet (above, speaking at a 2010 50th Anniversary event at the University of Michigan) was recently appointed Acting Director of the Peace Corps

In September, the National Peace Corps Association spot lighted Nancy Tongue (Chile) a Returned Peace Corps Volunteer (RPCV) who has dealt with post-service health issues, as our featured advocate of the month. In response, Acting Peace Corps Director Carrie Hessler-Radelet (Western Samoa 81-83) issued the following statement on matters pertaining to individuals who face serious injury or illness in the aftermath of their Peace Corps service:

“One of my favorite Peace Corps recruitment campaigns is anchored by the tagline ‘The Toughest Job You’ll Ever Love.’ As an RPCV, I love it because it truly speaks to the entire Peace Corps experience. Being a Peace Corps volunteer can be rewarding, but it is no easy task. It’s this reason that motivates me to ensure that our volunteers are supported as much as possible throughout their entire lifecycle as a volunteer – all the way from invitee to RPCV. That’s why I am troubled by the frustrations some of our returned volunteers have encountered when dealing with post-service medical claims through the Federal Employee’s Compensation Act (FECA), which covers federal employees and volunteers who become sick or injured on the job.

“During their service, volunteers receive their medical care directly from Peace Corps. Once they leave Peace Corps service, however, RPCVs have to work through the FECA system. That system is administered by the Department of Labor (DOL), and the Peace Corps’ role in this process is limited by law. Only DOL has the authority to review and accept claims, and to authorize payments. However, the Peace Corps’s Post-Service Unit does help RPCVs to file their claims, collect the relevant Peace Corps health records and submit the necessary paperwork to DOL. We also make efforts to facilitate communication between RPCVs and DOL staff.

“Unfortunately, this system has failed some RPCVs, and that is truly disheartening. That’s why I’m committed to working with our Post-Service Unit and DOL to try to improve the FECA process for returned volunteers.

“Recognizing the difficulties that some RPCVs face when they apply to the Department of Labor for FECA benefits, the Peace Corps has been negotiating with DOL for several years about changes we believe would improve the system. We are also working with the Government Accountability Office to explore ways to improve the FECA process for returned volunteers.

“In addition, the Peace Corps is creating two positions in the Peace Corps Post-Service Unit to try to address problems from the Peace Corps end. We have also expanded the Case Manager position in the Post-Service Unit to include care coordination for some catastrophic illnesses or injuries.

“I am also working with the founding members of Health Justice for Peace Corps Volunteers, including Nancy Tongue and others, as we take steps to try to improve the process for returned volunteers seeking FECA benefits.

“The Peace Corps takes the health and well-being of those who serve very seriously. I am committed to ensuring that our sick or injured RPCVs receive the help and support they deserve.”

The group Health Justice for Peace Corps Volunteers is currently circulating a survey to collect information and experiences from all within the Peace Corps community about these issues.

Joining The Peace Corps? Don’t Get Sick, Whatever You Do From Mother Jones Magazine

Posted by John Coyne on Friday, December 14th 2012 
[This article appeared on December 13, 2012 in Mother Jones Magazine. It was originally on www.FairWarning.com. I know that in conversations with the new Acting Director of the Peace Corps that she has been working on solving this problem with the Department of Labor and is dealing with it in ways that previous Peace Corps Directors haven't. Carrie has spent her life in nonprofit organizations working on health issues, and she has taken major steps to resolve these issues that PCVs and RPCVs have. Years ago, I suggested to the NPCA that they make this their central issue to help RPCVs, but ALL the NPCA Presidents and CEO (and whatever other grand titles they call themselves) were only interested in advancing their own positions with overseas trips, congressional appearances, visits to the Peace Corps office, and fund raising to pay their salaries. This issue for the Peace Corps and all RPCVs is a huge one. Finally we are getting some attending paid to it. It is unfortunate that the only time the Peace Corps grabs a headline and anyone's attention is when a PCV is murdered or is dying from a parasite picked up while doing the toughest job you'll ever love. John Coyne]

Here is the Mother Jones article. Read it and complain to Congress!

Christie-Anne Edie (center) was sickened during her second Peace Corps service trip. FairWarning Christie-Anne Edie was sickened during her second Peace Corps service trip. FairWarning

In the spring of 2009, Christie-Anne Edie contracted a nasty parasite in Burkina Faso, where she was teaching family-planning and sexual health for the Peace Corps. Her gastrointestinal infection was so severe that the Peace Corps had her medically evacuated to Washington D.C., and eventually flown back home to Colorado months later in December.

And that’s when her nightmare began.

Incredibly sick and without insurance, Edie was initially assigned a field nurse to file her workers’ compensation claims with the Department of Labor. But when her field nurse was abruptly removed from her case, Edie had to navigate the agency’s labyrinthine bureaucracy on her own. Since 2010, Edie has accumulated more than $25,000 in unpaid medical bills. The labor department has rejected her claims for reasons varying “from incorrect billing codes to procedures…not related to accepted diagnosis codes,” Edie says.

“I just feel like I have been abandoned by Peace Corps,” says one former volunteer.

Meanwhile, Edie says the labor department hasn’t returned any of her calls or letters, and collection agencies are hounding her.

“I have sacrificed not only my time and my energy for Peace Corps service, but I’ve sacrificed my health and my finances and my credit and basically my entire life,” Edie said in an interview. “I just feel like I have been abandoned by Peace Corps.”

Edie’s story is far from unique: According to a new investigation by FairWarning, Peace Corps volunteers like Edie, many of whom face sexual assault, injuries, trauma and exotic diseases in developing countries, often fail to receive appropriate medical care and disability payments from the Federal Employees’ Compensation Act (FECA), the government’s workers’ compensation program.

In interviews with more than a dozen former Peace Corps service members, FairWarning found that many volunteers “failed to gain government-paid medical care when they returned to the U.S. because they couldn’t find doctors registered with FECA. What’s more, they say, claims for medical insurance reimbursements often bog down or are rejected because of bureaucratic bottlenecks and the lack of information provided to volunteers.”

When called for comment, Peace Corps told FairWarning it couldn’t comment on individual cases.

A Government Accountability Office (GAO) report published last month blamed both the Peace Corps and Department of Labor for failing to “work together to use available information to monitor the accessibility and quality of FECA benefits for volunteers.”

Although FairWarning notes that Peace Corps officials have acknowledged flaws in the system, this isn’t the first time the organization has come under fire for failing to support its volunteers at home. According to FairWarning, in 1991, GAO found (PDF) the Peace Corps Post-Service Unit’s officers “often were unable to answer volunteers’ questions about FECA. Many returned volunteers weren’t even told they were entitled to health care benefits.”

Read the full story at FairWarning.org.

Senior Editorial Fellow

dpan80x95Prior to joining Mother Jones, Deanna interned for NPR, Kiplinger’s Personal Finance, the Columbus Dispatch, Cincinnati Magazine and Columbus Monthly, among other media outlets, while completing her English degree at Ohio State University. She’s a public radio fan girl, semi-colon abuser and the world’s best/worst vegan baker depending on your source.



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