We conducted a health survey in 2013 and received about 7,500 results! Thank you all for your time and input into this important endeavor. It helped inform us about issues that need to be addressed and we were able to share this with the Peace Corps. One of our co-founders analyzed the data and made recommendations to the Peace Corps, which can be seen below.
Report on the Results from the Health Justice for Peace Corps Volunteers Survey
Health Justice for Peace Corps Volunteers is a group of returned Peace Corps Volunteers (RPCVs) who are working to improve the quality of care that sick and injured Peace Corps volunteers and RPCVs receive. This survey is one step in that process. In it, we attempt to gather information about the difficulties that RPCVs face getting care. The preliminary results of this survey are presented here. The raw data from the survey are included at the end.
Overall, there are many problems brought up by this survey that are beyond the scope of what Health Justice can solve. The increasing reports over the decades by Returned Peace Corps volunteers (RPCVs) of poor health in country, political and financial considerations influencing the quality of their care, decreased expectation of recovery and increases in the amount of debt that RPCVs take on to pay for Peace Corps-related illness is disturbing. These trends have been discussed with the Peace Corps and will be discussed more at length in the near future. Ultimately, solving these problems rests in their hands, and while we can encourage them, we are not medical professionals, so we cannot help.
However, that does not mean that there are no issues about which Health Justice can speak out. The most surprising issue found while reviewing results from this survey is the rate at which RPCVs filed, or rather did not file, for Federal Employees Compensation Act (FECA) coverage. If a RPCV filed a claim, they had a very good chance of having it approved. However, about 63% did not file claims. An even larger percentage never even informed the Peace Corps that they were ill. While the process is difficult, it can be made more manageable with the assistance of the Peace Corps. With assistance, the number of RPCVs who didn't file dropped significantly.
In addition to these problems, there are problems with the Department of Labor, who oversees FECA. Calls are not returned in a timely manner, bills are not paid, and payments can be quite sporadic. For a population that is quite vulnerable, this can make recovery more difficult.
This is not to say that nothing has improved since the founding of the Peace Corps or that all results are bad. The majority of volunteers finish their service. The Peace Corps has gotten better about informing volunteers about FECA and helping them file claims. The majority of RPCVs are able to get health insurance. The Peace Corps has shown that with effort it can improve the health of PCVs and the access of RPCVs to FECA coverage. We hope that by working with them the Peace Corps will continue to improve. Our recommendations can be seen below.
Of the more than 210,000 people who have served in the Peace Corps, over 7400 of them responded to this survey. The survey was written by members of Health Justice for Peace Corps Volunteers (Health Justice for PCVs) and conducted entirely on the internet via a web page form, from when it opened at the end of August 2012 until December 4, 2012. This form presented questions to respondents based on their previous answers, so not all respondents were presented with all questions. The questions that all respondents were presented with were questions 1 through 5, 12, and 18. Those questions that they were not presented with weren't applicable. For example, a respondent who reported no health problems either during service or after returning would not be asked if they filed a FECA claim. At the end of the form, the respondent was able to leave a comment. More than 2,600 comments were received. They are still being processed. The very last element of the form was a request by the National Peace Corps Association (NPCA) for the respondent's contact information. Respondents had the option of not leaving contact information, leaving contact information and not having it sent to the NPCA, or leaving contact information and having it sent to the NPCA. The contact information was stored in a separate table so that contact information could in no way be linked to responses from the survey. The request to fill out the survey was sent mainly by the NPCA through email, although Health Justice also sent out requests to fill out the survey to its membership. It went first to the NPCA's "advocacy" email list, then to the list of all RPCVs (not only members) for whom they had addresses, and finally to all members of Peace Corps Connect, a social networking site for RPCVs run by the NPCA.
There were problems during September which resulted in some comments not being accepted by the survey program. However, because the survey recorded answers after nearly every question, only the comments were lost from these surveys rather than all the data. Also, over the weekend following Thanksgiving, an error caused by the web server made the survey unavailable for two days. As it was a holiday weekend and a notice from the NPCA had already been sent out notifying RPCVs that the results would soon be tallied, most likely few people who wanted to fill out the survey were turned away.
A brief note on the subject of gender: for a very long time, gender had been a simple binary question. Someone was born one gender, and they stayed that gender. However, "they stayed that gender" is no longer true. This is why the question asks for gender at the time of service. There are some people who would prefer not to answer this question, thus the "unspecified" option. There are some people who would like to answer but don't feel that "male" or "female" are the correct options, thus the option where more information could be added in a text box. Some respondents were very angry about the way that gender was handled by this survey. One respondent asked if gender was really relevant. We could not know without asking, which is why we asked. In the raw data and graphs, the "unspecified" and "more information" options are added together to create "Other Gender". This choice of wording is not intended to indicate that there is a single gender called "other" that all these respondents fit into. It only indicates that an option other than "male" or "female" was chosen. In the text of this report, that option is represented by "other gender identification". We apologize to those who are offended. Offense was not intended. Also, when any category had very few respondents, often time those results are not mentioned in the analysis. This happens in the later questions when analyzing by gender the results of those of other gender identification. It is not that their thoughts and experiences do not matter. It is just that one cannot draw conclusions from a sample size that small.
The first question we have to ask is "how accurate is this information?". The distribution mainly by the NPCA implies that the RPCVs who were informed of the survey were in contact in some way with the NPCA, so volunteers who were very disenchanted with the Peace Corps might not have received the message. On the other hand, some responders commented that those who had some kind of illness because of their service would be more likely to respond. Or, one could guess that volunteers who felt a great deal of loyalty to the Peace Corps would be more likely to answer because they wanted to defend the Peace Corps' honor. Regardless of guesswork about the motivations of those who responded, the percentage of men and women who filled out the survey are very close to the percentages that the Peace Corps gives for the genders of currently serving volunteers. Also, the average age of the survey responder when serving (if one uses 25 years old as the average age of someone who served in their 20s and likewise for the other ages) is very close to the Peace Corps' reported average age. This seems to indicate that the results are fairly representative of the RPCV community.
Reports of illness in country - question 5 - increase by decade, are higher with women than men, and are highest among volunteers who serve multiple times followed by volunteers in their 20s and 30s. While it could be guessed that volunteers who served in the 1960s don't remember all the little illnesses that they had in country, the results go up fairly smoothly over time, so it seems more likely that memory lapse is not the reason for the increase in health issues. Also, the Peace Corps budget (when adjusted for inflation) on a per volunteer basis went down steadly since the Peace Corps founding in 1962. The only decade that saw an increase was the 1990s, and the reports in the survey of illnesses in country stayed the same in the 1990s as in the previous decade, rather than increasing. It should be noted that in the 1960s volunteers had doctors from the United States caring for them in country. In 1991, a General Accounting Office (GAO) study1 was highly critical of the care that Peace Corps volunteers received. According to the study, the Peace Corps had already begun making reforms at that time, which might account for the rates of reported illness staying constant from the 1980s through the 1990s.
Volunteers in general were very good about seeking help for their medical problems, as shown in question 6, even making a slight improvement over help seeking rates from the 1960s and 1970s. While the majority of volunteers go to Peace Corps medical staff or a local practitioner for help (although less so to local practitioners in recent decades), volunteers are also seeking help from Peace Corps staff in non-medical positions. This appears to be especially true for those who have other gender identification.
Questions 8 and 9 deal with factors influencing the quality of care during Peace Corps service. Question 8 covers gender and other personal considerations influencing the quality of care. While this did increase over the decades, it still only reaches a height of 13% in 2010s. Males report the lowest incidence, while those with other gender identification report the highest. The results differ least by age, although those who served at multiple ages reported it more often. When the question is political and financial considerations and how they influence the quality of volunteer care, the increase in reports of these issues is much more pronounced, growing steadily since the 1960s. One can note that the incidence of these reports increases the least between the 1980s and 1990s, which may be related to the increase in the Peace Corps budget on a per volunteer basis (when adjusted for inflation) during the 1990s. As mentioned previously, efforts by the Peace Corps to improve care and the 1991 GAO study might also be factors in this small change between the 1980s and 1990s. After the 1990s, however, reports of political and financial considerations influencing care have increased significantly. As with question 8 about gender and personal considerations, question 9 also shows males reporting the fewest positive responses, while those with other gender identification report the highest. Differences in the number of positive responses increased only slightly over those in question 8.
Question 10 asks if the health problems reported in question 5 were entirely resolved by the Peace Corps in the country of service. In the 1960s, 69% left country healthy. By the 2010s, that number had steadily decreased over the decades until it reached only 37%. It was lowest for PCVs serving in multiple decades. Both gender and age responses were close to 50%, with men reporting 60% of the time that they recovered in country, women reporting 52% recovery in country, and those with other gender identification reporting only 38%. It is hard to know how representative the other gender identification responses are, though, as there were so few respondents in that category. As for age, the results were fairly closely grouped, with volunteers in their 20s (at the time of service) reporting the highest recovery rate at 53% and those who served in the 40s reporting the lowest at 42%.
Question 11 dealt with whether the respondent was able to complete their service. While the number of early terminations and medical separations has risen since the 1960s, most volunteers were still able to complete their service. Those with other gender identification reported a much lower rate of completing service than other genders, but again the sample size is very small for this group, so the results might not be accurate. Those who served in their 60s were less likely to complete their service, while those who served at multiple ages were more likely to be medically separated and very unlikely to terminate their service early.
Continuing to progress from the end of Peace Corps service, question 12 asks if the respondent developed any physical or mental health problems as a result of their service that did not come up in country. Most of the results are grouped together for this question, with two thirds saying that no problems developed with the rest of the respondents being split between answering "yes" and not being sure. The exceptions to this were those who served in multiple decades, those who served in the 2010s, those with other gender identification and those who served at multiple ages. They were significantly more likely to be unsure. Volunteers with health problems that are difficult to diagnose or who have only recently returned from their service may be unsure if their health problems are a result of their service.
Those who had a problem that came up after their service that was related to their Peace Corps service were asked how long after the end of their service they contacted the Peace Corps. Most RPCVs contacted the Peace Corps about the problem within the first 6 months after the end of their service or not at all. While the number of volunteers who did not contact the Peace Corps has come down from its high in the 1970s of 81%, the lowest it gets is 61% with those who served in multiple decades. The results by gender are pretty closely grouped, as are those by age. The one exception is that those who served in their 40s or 50s responded "did not contact" much more often than volunteers who served at other ages.
If an RPCV had a health problem that had not been resolved in country or that arose after they finished their service that was a result of their service and they informed the Peace Corps, then they were asked if their health issue was resolved by Peace Corps Headquarters. Some, presumably those whose health issues were not resolved in country, did not inform Peace Corps Washington of their ongoing problems. As seen previously, the percentage of those who did not report their problem to the Peace Corps has been declining. Of the rest, from the 1960s through the 1990s, they were divided almost evenly between those whose problem was resolved and those whose problem was not. However, the reporting of recovery decreased in the 2000s and decreased even more sharply the following decade. Those who served multiple decades saw rates of recovery similar to those who served in the 2010s. By age, respondents who served in their 20s were the least likely to contact the Peace Corps about their health problems, and volunteers who served in their 40s and 50s were the least likely to recover. Generally, the rest of the results by age, and all of those by gender were fairly closely grouped.
"The biggest issue I've had with the PC PCU is them losing paperwork that I've sent. It's happened at least 4 times. When things are urgent and I have to call and find out where I am at in my paperwork being accepted and I find out they have lost the paperwork and never called to tell me, its beyond aggravating." - Survey Comment
Question 15 asks if calls to the Peace Corps were returned in a timely manner. Timely responses times peaked in the 1980s and 1990s, falling in recent decades. Volunteers who served in multiple decades reported even worse response times, falling almost to 50% answering "yes" and 50% answering "no". RPCVs with other gender identification report 100% that calls were not returned in a timely manner. However, the number of these volunteers is so low that it is doubtful that this is a representative sample. Volunteers who served in their 20s, 30s and 40s reported slightly more often that calls were returned in a timely manner. When asked if returned calls were helpful and polite, generally respondents said they were, with volunteers with other gender identification and volunteers who served in their 40s and 50s reporting the most problems.
Respondents are asked in question 17 if the Peace Corps ever contacted them to find out if they had made progress in their recovery after they officially left the Peace Corps. While slightly more responded "yes" who served in the 1970s and 1980s and who served at multiple ages, the vast majority responded "no".
"While CorpsCare/AfterCorps was helpful at the most basic level (i.e. having it to rely on when if I was sick), I had awful experiences with the way Peace Corps handled the transition to/from the service providers and the quality of coverage offered to RPCVs at the price paid. The premium rate change and the elimination of premium options in 2011 occurred with nearly NO communication to volunteers. It was an appalling and inexcusable behavior towards those who've served this country and represented its face overseas. When I inquired about the 2011 service change in July 2011, I was initially ignored and then stonewalled by Peace Corps' health desk. I never felt that my concerns were ever addressed let alone followed up with. As a result, this has solidified much of my opinion for the organization at the senior level. I fear this survey will prove to be a waste of time. I've taken the time to voice my opinion again, with little faith that it will ever be addressed." - Survey Comment
Question 18 asks if the respondent was informed that private, post-Peace Corps health insurance (AfterCorps/CorpsCare) was available. While the majority of those who served before the 1990s either did not have this option or were not aware of it, in the 2000s and 2010s, reports of having been informed increased dramatically, with only a small percentage in 2010s reporting that they were not informed. In response to question 19 as to whether the respondent signed up for this insurance, understandably positive responses were very rare before the 1990s. The 2000s and 2010s show rates of about 60% signing up for this insurance. Women were more likely than men to sign up for it, and those of other gender identification even more likely than women. By age, those who served in their 40s and 50s were more likely to sign up for this insurance than other ages. When asked about the insurance's usefulness, clearly those who served before the 1990s generally didn't use it. Of those who did use the insurance, they were fairly evenly divided between those who found it helpful and those who did not. Respondents who served most recently found it slightly less useful than those from previous decades who used it, as did those of other gender identification. Volunteers who served in their 50s and 60s found it more useful than those of other ages.
For those volunteers who were ill after their service, either because they did not recover in country and did not recover with the help of Peace Corps headquarters or because they became ill after their service, question 21 asked if the Peace Corps informed them that they could file a Federal Employees' Compensation Act (FECA) US Department of Labor Workers' Compensation claim. Note that only those who were sure that their illness was related to their service and only those who had notified the Peace Corps of their illness were asked this question, which ended up being about 10% of respondents. Very few from the 1960s were informed of this option, and from there responses of those who were informed increase to more than 75% in the 2010s. Men were informed less often than women, while the small number with other gender identification who responded were all informed. Those who served in their 60s and those who served at multiple ages were informed more often than others.
This number of 10% for those who were ill as a result of their service and who had notified the Peace Corps corresponds well with numbers presented in the 1991 GAO study1. The study showed that from 10 to 30 percent of former volunteers had medical problems related to their Peace Corps service, and of these, about half had not filed a FECA claim. In this Health Justice study and as noted earlier, 10% of respondents were still ill after their service and had informed Peace Corps of their illnesses. 31% was the percentage of total responders who were still ill after their service, including those who had not notified the Peace Corps. This report will discuss who filed and who didn't in a few paragraphs.
"I need help to navigate how to file a claim for a condition that happened after returning from service. I need to file the federal papers but it is unclear what paperwork to file or how to fill it out. I need help!" - Survey Comment
Question 22 asks if anyone from the Peace Corps helped the respondent file a claim. The number who responded positively, while low, is increasing. The number who did not file has been decreasing, as well. Men and those of other gender identification were less likely to file, while those who served in their 50s and 60s were more likely than average to file. Those who served in their 50s were the least likely to receive assistance filing, while those who were in their 60s were the most likely to receive assistance.
The following question, 23, asked if the respondent was informed that if they were too disabled to work that they could file for lost income. There was a steady increase over the decades of those who were informed, peaking in the 2010s at 19%. The results for men and women were very close, while when sorting by age, those who served in their 40s and at multiple ages were the least likely to be informed.
When asked if the Peace Corps helped them file for lost income, most responses were fairly closely grouped. The exceptions by decade are the those who served in the 2000s were less likely to file for lost income, while those who served in multiple decades more often got help. By gender, the results were fairly close. However, by age, those who served in their 50s were less likely to get help, but much more likely to file a claim.
Respondents were asked in question 25 if they had been informed by Peace Corps that they might be eligible for vocational rehabilitation through the Department of Labor. Almost universally, the answer was no. Only 2% of respondents reported being told.
Question 26 asks if the respondent's FECA claim was accepted. Only respondents who had reported that they had an illness because of their service were asked this question. Almost twice as many respondents reported that their claims were accepted versus those who reported that their claim was not. However, about two thirds of all respondents to this question reported not filing for FECA. Those who served in the 1960s and 1970s were the least likely to file, and filing rates have steadily improved since then. Also, volunteers who served in recent decades were more likely to have their claims accepted. Interestingly, volunteers who served during multiple decades and those who served in the 1970s were the only groups who had more claims rejected than accepted. By gender, the responses were pretty close, with men being only slightly less likely to file a claim. By age, those who served in their 40s were the least likely to file a claim, while those who served in their 60s were both the most likely to file and the most likely to have their claim accepted. Those who served at multiple ages were the most likely to have their claims rejected. This could be because they were more likely to file multiple claims, and therefore had a greater chance of being rejected.
When looking at statistics related to FECA claims, the percentage of total responders whose FECA claims were accepted was two percent, while three percent of all responders filed FECA claims. As previously noted, 31 percent of all respondents were ill as a result of their service. Of all who were eligible to file claims, those who early terminated (quit their service early) were the least likely to have a claim accepted at only 19 percent. Those who were medically separated were almost twice as likely to have a claim accepted. Respondents who received assistance from the Peace Corps when filing were dramatically more likely to have a claim accepted: 73% had their claims accepted. In general, these numbers are low because most volunteers don't file for FECA. When looking at the percentages of those who did not file out of those who were eligible to file for FECA, it was those who completed their service who were least likely to file at 68 percent. Repondents who were medically separated were the most likely to file: 51% did not file. However, the most interesting number here is the number of those who were helped by the Peace Corps who did not file - only 11 percent. Once RPCVs filed claims, their chances of having their FECA claims accepted was fairly high. Of those who early terminated and filed a claim, fifty percent had their claims accepted. This number rises to 75% for those who were medically separated. When a respondent received assistance from the Peace Corps, 82 percent of the time their claim was accepted versus 59 percent for those who did not receive assistance. When looking at who received assistance, those who were medically separated were more likely than other groups, with 19 percent as compared with eleven percent for those who early terminated and those who completed their service. For an injured or sick volunteer, assistance from the Peace Corps filing a FECA claim can clearly increase their chances of having their claim accepted. This survey did not ask why volunteers did not file claims. Honestly, this was in part because we did not know beforehand that so many ill RPCVs did not file for FECA. If the Peace Corps chooses to look into this matter further, they may wish to try to discover why RPCVs don't file. Another question that could have been asked is if respondents would have filed for FECA if they had more than three years to do so.
Questions 27 through 36 were asked only of those who responded that their FECA claim was accepted. This makes, unfortunately, for a much smaller sample size of only about 150 respondents. This means that some groups will not be well represented. However, Health Justice feels that many ill RPCVs suffer under a very difficult system with the Department of Labor (DoL), which is the agency that administrates FECA. We wanted to know if our impression was correct, and these questions explore that issue.
When asked, in question 27, approximately how much time elapsed between when the respondent officially left the Peace Corps and when their benefits from the DoL began, respondents were almost evenly split between less than 6 months and more than 6 months. Those who served in the 1970s, 1980s and in multiple decades reported much longer waits for benefits than those who served other decades. Also, reports of wait times over six months have decreased in recent decades. Men report slightly longer wait times, while those who served in their 40s and at multiple ages reported more often a delay of more than 6 months before benefits began.
Question 28 asks if respondents were under more financial stress during this time due to lack of benefits. The responses from the 1960s and 1970s are nearly opposite, which makes for some confusion. However, beginning in the 1980s, reports of increased financial stress increase steadily by decade. Men and women have very similar responses, with a little less than two thirds indicating increased financial stress while without FECA benefits. By age, those who served in their 40s, 50s, and 60s indicated more financial stress than those who served when they were younger or at multiple ages.
Next, respondents were asked if the DoL provided any assistance for them in finding a doctor or filling out forms (for example, with an occupational nurse). In general, few respondents received assistance from the Department of Labor. A small number from each group reported being helped, but because the numbers for most groups are small, it is hard to tell which numbers are representative. It may be that slightly more assistance has been given in recent years, but the results are not especially clear.
In question 30, the survey asks if respondents are currently receiving or received income for lost wages. In general, the answer is no, with 78% giving this response. The remaining responses are divided almost evenly between those who receive or received income for lost wages and those who did but not reliably, either because the wages ended before the respondent recovered or because the payments were inconsistent. While it is difficult to pick out any trends, one can safely say that unreliable lost wage payments trouble almost every demographic group.
"I found Peace Corps very helpful, and my FECA claim was quickly accepted, but my doctor had a terrible time actually trying to get paid, and I eventually had to shell out several thousand dollars myself. It was very embarrassing, as I had a longstanding relationship with my doctor and every charge was absolutely legitimate, but the DOL was incredibly unresponsive and kept making excuses not to pay. I thought if the claim was accepted that meant they would pay. I was wrong. If I had it to do over I would not have bothered filing a claim. If the problem had been worse and the amount of money I lost had been larger I would have considered suing. It was all extremely disappointing." - Survey Comment
When asked, "Does or did the USDOL pay for your medical and prescription bills?", because of the low number of respondents for some categories, the results are somewhat chaotic. However, when first looking at the overall results, 36% reported that the Department of Labor paid medical and prescription bills. The same number reported that the DoL was supposed to pay but did so inconsistently. If we set aside the categories with few respondents, we see that those who served in the 1990s more often responded that DoL paid their medical and prescription bills. Those who served in the 1980s, 2000s and 2010s all reported results that were fairly similar to those in the overall results. Those who served in the 2010s report more inconsistent payments than those who served in the 1980s through the 2000s. Men reported a lower rate of medical and prescription payments than women. The results by age are somewhat problematic, as most categories have few respondents.
Question 32 asks if respondents had difficulty getting bills covered by the Department of Labor. With the exception of those who served in the 1960s and multiple decades (totaling only 6 respondents), around 70% of respondents reported this difficulty. Only 59% of those who served in the 1990s had this difficulty. This corresponds to the responses for the 1990s in the previous question. By gender, men showed slightly more difficulty getting bills covered by the DoL than women. The results by age generally correspond to the overall percentage of 73% reporting difficulties. While the total number of respondents is small, those who served in their 60s and at multiple ages reported an equal number of repondents who had no difficulty as those who did have difficulty getting their bills covered by the DoL.
When asked if calls to the Department of Labor were returned in a timely manner, the results are fairly closely grouped around the overall average of 70% who did not have calls returned in a timely manner versus 30% who did. Interestingly, while most volunteers who served in the 1960s reported that they did not have trouble getting their bills covered by the Department of Labor in the previous question, 100% of respondents reported that their calls were not returned in a timely manner. Those who served in the 2000s, a much larger number of repondents than those who served in the 1960s, reported the second worst numbers, with only 26% saying that their calls were returned in a timely manner. Men reported having calls returned in a timely manner less frequently than women. This seems to correspond to their responses in previous questions of more difficulty getting bills paid and fewer saying that the Department of Labor was paying their medical and prescription bills. By age, the percentage of respondents who had calls returned in a timely manner is between 20 and 35% for most age groups. The exceptions were those who served in their 50s and at multiple ages, who reported that about 50% of the time their calls were returned in a timely manner.
Question 34 asks if the respondent is currently receiving any type of coverage or compensation under the Federal Employees' Compensation Act (FECA). 70% reported that they were not receiving any type of coverage or compensation, with 30% of those who had their claims accepted reporting that they were currently receiving coverage or compensation. This is 0.6% of all respondents. Only respondents who served in the 1970s had no member who is currently receiving compensation. All other respondents by decade had at least one, with those serving in the 2010s and multiple decades each having about 50% who were currently receiving compensation of some kind. Men and women both reported percentages very close to the overall percentage. By age, only those who served in their 50s and at multiple ages deviated noticably from the overall percentage, with those serving in their 50s reporting that 60% were receiving some form of compensation.
When asked about the Department of Labor's vocational rehabilitation program in question 35, the majority, 86% overall, had not received any training through the Department of Labor. Of all respondents, only 5 received this training. The majority served in the 1990s and were in their 20s. All were female. Of those who have not yet returned to work, they served almost entirely after the 1990s, more were female, and most were in their 20s, although the last two are more likely because the majority of volunteers are female and in their 20s.
Question 36 asks if the respondent's wages were supplemented by the Department of Labor while they worked part time. As with the previous question, few reported receiving wage supplementation. The same number reported that their wages were supplemented as reported that they received supplemental wages but were dropped before they recovered. The reports of receiving supplemental wages are fairly evenly divided across decade of service and by gender. All those who had their wages supplemented were in their 20s when they served. All who had their supplemental wages dropped before they recovered were female, and most served in their 20s with one who served in her 30s. This question is the last that is specific to those who had FECA claims approved.
Question 37 was asked of all respondents who were ill because of their service. This question asks "If you were sick or injured as a result of your service, have you been able to obtain health insurance?". The majority of respondents - 82% overall - were able to obtain health insurance. In much smaller numbers, volunteers were able to obtain insurance through family (7%) and the government (4%). Only 7% overall were unable to obtain health insurance. The results are grouped fairly closely by decade, until the 2000s, when the rate at which respondents were able to obtain insurance began to drop slightly. In the 2010s, respondents relied much more often (17%) on family and were much less able to obtain medical insurance, only 66%. Those who served multiple decades were far more likely to receive medical insurance through the goverment than other groups. Men and women had responses that were very close to the overall percentages. By age, those who served in their 20s were more likely than any other group to get medical insurance. Those who served in their 50s were the least likely, only 61%. Those who served at multiple ages and those who served in their 50s and 60s were very likely to get their insurance through the government. Going back to questions 19 and 20, those who served in their 50s were the most likely to sign up for health insurance through the Peace Corps, the most likely to use it and the most likely to find it useful. It would appear that for a time, at least, the health insurance offered through the Peace Corps helped some respondents who were in the group with the most difficulty getting insurance.
When asked in question 38 if their health issues lasted more than a year after they ended their service, 45% said no, and 55% said yes overall. There was a slightly better rate of recovery in the 1960s. Also, those who served in the 2010s also reported better rates, although because most have not been back for more than a year, it is hard to know how accurate this is. In general, though, by decade and gender, the results were fairly close to the overall results. By age, the percentage who reported that their health issues lasted more than a year increased with age, to 65% for those in their 50s and 60s.
Question 39 asks if the respondent expects to ever be as well as they were prior to serving in the Peace Corps. Overall, 63% said yes. By decade, those who served in the 1970s were most likely to expect to be as well as before they served at 72%, with the percentages decreasing steadily from there until the 2010s, when the percentage was 57%. Those who served over multiple decades were the only group whose responses were more negative than positive, with only 44% expecting to be as well as they were prior to serving. The percentages for men and women were exactly the same. Respondents who served in their 20s, 30s and 40s reported results very close to the overall percentages. Those who served in their 60s and at multiple ages were evenly split between those who expected to be as well as they were before their service and those who didn't. Those who served in their 50s were the least positive about their prospects, with only 47% expecting to be as well as before their service.
When asked in question 40 if the respondent had lost time from work due to health issues, 73% responded that they had not. The results by decade were closely group, with only those who served in the 1980s and during multiple decades more often reporting time lost from work, 36% and 35% respectively. By gender, the results were very close to the overall percentages. By age, most were again very close to the overall percentages. Those who served in their 60s were less likely to report time lost from work, perhaps because they entered the Peace Corps after retirement. Those who served in their 40s reported slightly more often than the other age groups that they had lost time from work due to health issues, 33%.
Question 41 asks, if the respondent lost time from work due to these health issues, how much time was lost? The results differ quite a bit by decade and age. Overall, respondents reported most often that they lost only days (38%). Whether 1-4 weeks or 1-12 months was more common differs by decade and doesn't seem to follow any specific pattern. In general, those who returned recently reported less time lost, as many have not been back 10 years yet. If looking only at the 1960s through the 1990s, the percentage of those who had lost more than 10 years from work was between 6 and 9%. This is especially interesting when looking at those who served in the 1960s, as they reported the highest percentage (9%). Generally, those who served in the 1960s report the best health and fewest problems. By gender, men reported answers that peaked with "1-7 days" (33%) and decreased steadily to their lowest at "more than 10 years" (8%). Women, as with the overall results, have high points at "1-7 days" and "1-12 months". Men report noticeably higher numbers of longer term time loss. By age, the most noticeable point is that 67% of those who served in their 60s lost 1-12 months from work. On the other hand, there are only 9 people in this group, so perhaps these data points are skewed. Also, those who served in their 40s and 50s reported longer term injuries much more often than those who served at younger ages, with 32% of those who served in their 50s being ill for more than 10 years.
Results when respondents were asked in question 42 if they had had out of pocket expenses for their medical issues were most often positive, with 59% reporting "yes". However, when broken down by decade, the results swing from 52% reporting "no" for those who served in the 1960s to only 28% reporting "no" for those who served in the 2010s. Those who served multiple decades reported only 26% "no". The percentages of "no" responses decrease steadily from the 1960s through the 2010s. By gender, the results are fairly closely grouped and very near to the overall results. By age, those who served in their 20s reported the least percentage of out of pocket medical expenses with 58%. Those who served in their 40s reported the highest percentage with 75%.
When asked how much they had spent on out of pocket medical expenses, the majority of respondents overall, by decade, and by gender all reported $101 to $1,000 (49% overall). Those who served in more recent decades generally had spent less than those who served earlier, probably because they have not been back that long. Those who served in the 1980s reported most often that they had spent $5,000 to $10,000 and more than $10,000 on out of pocket medical expenses for their Peace Corps related health issue. Results differed very little by gender. By age, the two most obvious outliers were those who served in their 50s, as their reported expenses were more often $1,001 to $5,000 (52%), and those who served at multiple ages, as they reported very strongly results of $101 to $1,000 (75%). With regards to those who served in their 50s, they were the least likely to have health insurance, so perhaps this is part of the reason.
When asked in question 44, "Have you gone into debt to pay for treatment for your Peace Corps-related health problems?", the majority of respondents (92%) reported that they had not. However, the number who had gone into debt grew from only 2% for those who served in the 1960s to 10% for those who served in the 2010s. The increase is very steady by decade, despite those who served in the 2000s and 2010s reporting less out of pocket medical costs than those who served in other decades. One reason for this could be because of the poor economy in recent years. By gender, the results were nearly identical and close to the overall results. By age, only those who served in their 50s showed any deviation from the overall results, with 14% reporting that they had gone into debt, as opposed to the overall number of 8%.
When asked in the last question, question 45, if the respondent needed immediate help, those who served in the 2010s and multiple decades were more likely to answer "yes", 18% and 12% respectively. By gender, men were more likely to need help. By age, those who served in their 50s, 60s and at multiple ages, were more likely to need help, while those who served in their 40s were the least likely.
The survey had an option to leave a comment at the end. The survey received a total of 2,875 comments. Some were angry about everything from the way the respondent was treated by the Peace Corps to the way the survey was constructed to the financial cost to the Peace Corps imposed by ill volunteers. Some were comments about changes that needed to be made to the survey. Some thanked Health Justice for their work. Some asked for help. By far, though, the majority were the stories of RPCVs about their health. Not all were negative, and many had suggestions on how to improve the system.
The survey had problems processing some of the punctuation marks in the comments, which led to some comments being lost. While the programmer tried to avoid this problem and beta testing indicated that the survey was working correctly, there were still problems. Health Justice apologizes for any inconvenience this caused. However, due to the way the survey was written, only the comment was lost. The rest of the data for the survey remained in the database.
There were common themes regarding volunteer health in many of the comments. Here is a brief summary:
The final page of the survey offered the respondent the option of leaving their contact information to be passed on to the NPCA, which is trying to gather contact information for all RPCVs. A box asked if the information could be passed on, so to avoid the confusion of implied consent. This information was stored in a table that contained no information that would link the survey responses to the contact information. While Health Justice has seen no interest by the Peace Corps in reprisals against RPCVs for negative comments, we felt that the responsibility of protecting the medical privacy of respondents was not a burden we wished to take on.
Health Justice would like to thank all those who participated in the survey. We understand that its imperfections caused frustration, and we greatly appreciate those who chose to help us anyway. It is our hope that the information we have gathered can be used to help not only those who are ill but can also be used to improve the Peace Corps itself.
Looking at the survey results, it is clear that help through FECA can be difficult to obtain, and that dealing with the Department of Labor can be frustrating at best. The best solution to this problem would be for the Peace Corps to reverse the trend shown in the study of increasingly poor volunteer health. While there is no sure solution to this problem without more research, which is beyond the scope of both this survey and Health Justice's capabilities, based on the survey responses, the survey comments, and our experience as Peace Corps volunteers, we have the following recommendations:
While the best solution would be for fewer RPCVs to have lingering illnesses or other health problems, there will always be former volunteers in the FECA system. Often, their problems will not fit easily into the insurance diagnosis-code-based system that the Department of Labor's Office of Workers' Compensation uses. This comment speaks to this issue, "I suffered injuries from accident while serving in Guatemala (08-10). All in-country care was excellent, including flight evacuation and emergency surgery. Medical leave in the states and medical care there was equally good. However, as a result of the accident I have had continuing health issues related to the accident. I had the care approved, but the reimbursement process with Peace Corps Washington and DOL has been a big headache. Reimbursement is still pending, phone calls are not retuned, and contact person never answers phone. A streamlined process of reimbursement for an RPCV, with case managers attentive to needs of the patient would be a huge step forward." Our recommendations are:
The percentage of RPCVs who have illnesses that last decades, who are unable to get medical insurance, who spend thousands on medical care for their Peace Corps illnesses, and who receive compensation from FECA because of time lost from work is fairly small. However, these are RPCVs for whom the illnesses aquired during their service can make the rest of their lives significantly more difficult. Health Justice will continue to work with the Peace Corps to find ways to improve their chances of getting the help they need. One group that has lasting problems, often tinnitus or mental health issues, is those who took Lariam/Mefloquine during their service. Since the Peace Corps is one of the largest users of Lariam in the world, perhaps it would be in their interest to gather information on effective and ineffective Lariam treatment and to disseminate this information to affected volunteers.
Lastly, for volunteers who have been ill and on FECA for an extended period of time, the normal procedure is to return to work at the federal agency that they left, perhaps on a part time basis to see if they are ready to return to full time work. This is not currently an option for Peace Corps volunteers, or if it is, no one is informed of it. The problem with returning to part time work outside of the Peace Corps is that when someone on FECA receives income it often triggers them getting dropped from the FECA system, meaning that they no longer have access to medical care or lost income compensation. If it turns out that they are unable to work, they may have to fight for years to get reinstated into the program. This provides a strong disincentive to returning to work. If the Peace Corps provided options for these RPCVs who wanted to return to work, like a way of completing their service, serving with Peace Corps Response, or working in some other way with Peace Corps, it could give the recovering RPCV a chance to work, potentially complete their service, and test their readiness to return to full time work. Also, the closure provided by working for the Peace Corps may help show future employers that the RPCV has fully recovered.
Average age of volunteer at the time of service: 28
Percentage who had some health problem (however minor) during or as a result of their service: 73%
Percentage of RPCVs who took the survey: 3.6%
The margin of error is about 1.13%
Peace Corps Budget vs. Number of Volunteers (in inflation adjusted dollars)
Please note that the numbers through 1972 will be somewhat high due to the only partial data available on serving volunteers during that time.
1960s: $89,232 per volunteer
1970s: $63,575 per volunteer
1980s: $52,972 per volunteer
1990s: $55,779 per volunteer
2000s: $47,275 per volunteer
2010s: $46,196 per volunteer
Statistics Relating To FECA Claims
(For an explanation of common abbreviations and terms, see the footnotes.)
Percentage of total responders whose FECA claims were accepted: 2%
Percentage of total responders who filed FECA claims: 3%
Percentage of total responders who were still ill after their service and had informed Peace Corps of their illnesses: 10%
Percentage of total responders who were still ill after their service: 31%
Percentage from category who had claims accepted out of the total from that category who were eligible to file claims:
Early Termination: 19%
Medically Separated: 37%
Completed Service: 21%
Received Assistance From Peace Corps When Filing: 73%
Did Not Receive Assistance From Peace Corps When Filing: 27%
Percentage from category who had claims accepted out of those from that category who filed claims:
Early Termination: 50%
Medically Separated: 75%
Completed Service: 65%
Received Assistance From Peace Corps When Filing: 82%
Did Not Receive Assistance From Peace Corps When Filing: 59%
Percentage from category who did not file out of total from that category who were eligible to file:
Early Termination: 63%
Medically Separated: 51%
Received Assistance From Peace Corps When Filing: 11%
Percentage from category who received assistance from the Peace Corps when filing out of total from that category who were eligible to file:
Early Termination: 11%
Medically Separated: 19%
Individual questions and answers can be found here: Questions and Totals
Inflation adjustment was done using this calculator: http://www.westegg.com/inflation/
Peace Corps budget and volunteer numbers are from this report: http://files.peacecorps.gov/manuals/cbj/2012.pdf
1991 GAO Report on Peace Corps Volunteer health: http://www.gao.gov/assets/160/150730.pdf
PCV: Peace Corps Volunteer
ET: Early Termination. Volunteer chooses to end their Peace Corps service early.
FECA: Federal Employees Compensation Act
Med Sep: Medically Separated. Removed from Peace Corps service by the Peace Corps for medical reasons
NPCA: National Peace Corps Association