Well, at this point in time I had hoped to be in Peru, completing orientation and headed for Tarapoto to serve again as a water and sanitation specialist volunteer. But, I'm not.
The good news is that 3 of the 6 PCRVs in my group departed last week, despite the government shutdown. Their travel had to be arranged by overseas staff, since the DC office is pretty much shut down. Two of us are still waiting for medical clearance and one awaits security clearance. All of which is on hold, due to the government shutdown.
Just before the ridiculous government shutdown started, I was informed that Office of Medical Services declined to clear me (details below). My appeal to the Board of Review (originally scheduled for Jan 18th) is now on hold, Peace Corps websites are not being maintained and I have no way of communicating with the few staff left on duty.
Overseas staff have not been furloughed, but can do little to help. They have indicated that they will try and get the 3 of us to Peru as soon as clearances come through. But, we may have to wait until August 3rd, when the next Response group to Peru is scheduled. So, I'm in Shutdown Limbo. My solace is that the weather here in Fort Myers, FL is heavenly and I get to spend more time with son Alden and 5 of my beautiful grandchildren. My heart goes out to the PC staff who are either furloughed or working without pay, as well as the millions of others suffering from the shutdown.
Details of my Medical Appeal follow for those interested in the details:
Washington, D.C.
Dear Board of
Review members:
I respectfully
request that you re-consider medical clearance in support of my invitation to
serve as a Peace Corps Response Volunteer (PCRV) in Tarapoto, Peru. As you know from PC records, my involvement
with Peace Corps dates from September 2011 and a two-year service as a WASH
PCV, followed by a year as PCVC for Renewable Energy in the Lima office. Since then, I have completed 3 PCRV
assignments in Panama. I have always complied
with PCMO medical recommendations, as can easily be verified by the PCMOs who
know me very well in both countries. Indeed,
I have endeavored to get fellow Volunteers, all far younger than myself, who
expose themselves to risk in various ways, to comply with PCMO advice because
it is in the interests of Peace Corps as an Agency. PC post staff who know me, including Country
Directors, know of my enthusiastic Peace Corps service, which has been a
privilege, responsibility, and opportunity I have not taken lightly. I was visited by former Director Carrie
Hessler at one point and post staff will assert that my contributions to
further the Peace Corps mission have been
substantial and significant, including a published blog of my Peace Corps
activities followed by 250+ subscribers and numerous manuals and educational
materials used by volunteers.
In this context, I
was very disappointed and surprised by the sudden negative finding on my current
medical clearance. This is what I was
told by OMS:
“We have reviewed your medical information you provided. We regret to inform
you that we are unable to medically clear you for service with Peace Corps at
this time. Please know that this decision was not made lightly.
We are unable to
clear you due to your coronary artery disease with a quadruple coronary artery
bypass surgery in 2014. Your coronary artery disease has not been treated for
the past four years, and you have only started a statin this month. Your BMI is 30, you have had at least one
elevated blood pressure to 170/100 and had a recent elevated fasting blood
sugar of 105. This places you at an
increased risk of a myocardial infarction and for developing diabetes. You will need close monitoring of your
coronary artery disease, blood pressure, weight, blood sugar and kidney
function. We are concerned that we cannot reasonably accommodate appropriate
close monitoring and follow-up of your medical conditions without unreasonable
disruption to service.”
While I truly do appreciate the mission of the OMS to ensure
the well-being of volunteers in the field, I feel that in this instance, the
decision may not be fully informed and possibly over-cautious. I wish to add
that this also comes after OMS required many extra and expensive tests, all of
which I paid for out of pocket and passed well, with positive letters of health
and fitness from my primary care physician and my cardiologist. While I am
aware that conditions may change, this is all the more puzzling because I have
been medically cleared with exactly the same medical conditions three times
since 2015 and I completed all my recent Response services in tropical Panama
without incident. Therefore, I wish to address the reasons for this denial of
medical clearance in a full appeal, with all due respect, by clarifying and
providing more information to you.
OMS: “We are unable to clear you due to
your coronary artery disease with a quadruple coronary artery bypass surgery in
2014.” – This has been my condition since 2015 and I have been medically
cleared 3 times since then and completed 3 Response services in rural Panama
without monitoring or incident, in conditions nearly identical to Tarapoto,
Peru.
OMS: “Your coronary
artery disease has not been treated for the past four years, and you have only
started a statin this month.” – No treatment has been prescribed because it was
not deemed imperative, neither by my PCP, nor my cardiologist nor by PCMO and
OMS who have overseen my health for much of the time over these past 4 years.
Lipid panels have all been within normal ranges. A statin and aspirin were only
recently prescribed in response to the PCMO suggestion as a prophylactic
measure, not out of medical necessity, and of course I am complying with this
recommendation. Besides treatment, I
have always led a healthy lifestyle, full of exercise and healthy eating.
OMS:
“Your BMI is 30”
– My weight fluctuates between 205 and 215 pounds, giving me a BMI of 29 to 30.
I have a large frame and am athletic , so the BMI is not a good indicator of a
weight issue. Moreover, a recent Harvard Medical article outlines why BMI is
NOT a good indicator of health or risk for adverse cardio events. (
https://www.nature.com/articles/ijo201617)
I exercise daily, eat wisely and monitor my BP with a home cuff frequently. I
do not smoke or drink alcohol. Moreover, neither my PCP nor cardiologist view
this as a serious health risk, and advise control with diet and exercise,
monitored in annual check-ups.
OMS: “You have had at
least one elevated blood pressure to 170/100” – In 2016, nearly 3 years ago, I had a single high BP reading as
indicated. I had just changed a flat tire and was concerned about low air in
the spare, so was under stress at the time. I was also smoking at the time.
Since then, I’ve had no less than eight documented clinical BP readings in the
normal range.
To wit:
12/02/16 170/100 PCP exam (under stress from
changing tire and smoking)
01/11/17 130/95 Cardio
exam Daytona Heart
08/12/18 134/80 Peace Corps COS exam
08/20/18 110/64 PCP Annual Exam Dr Johnson
10/12/18 124/78 PCP referral exam Dr Johnson
11/21/18 128/70 PCP referral exam (Lee Health –
Dr Islam)
12/06/18 130/86 Cardio exam (Lee Health Dr
Brownstein)
12/10/18 130/75 PCP consult (Lee Health Dr
Islam)
12/14/18 128/70 PCP consult (Lee Health Dr
Islam)
Again, I have been medically
cleared by OMS/PCMO 3 times since that aberrant high BP reading. My PCP and
cardiologist have both specifically stated that I do not have hypertension, nor
do I require monitoring for BP, other than my usual self-monitoring.
OMS: “(You) had
a recent elevated fasting blood sugar of 105” – This is only slightly elevated.
Other blood sugar readings since 2015 have been normal. There are no other
indications or diagnosis of diabetes. The reading is stable per the most recent
labs and is well controlled and does not indicate “close monitoring” nor
serious medical concern, per my physician.
OMS: “You will
need close monitoring of your coronary artery disease, blood pressure, weight,
blood sugar and kidney function” – Both my PCP and cardiologist have stated
that my health risks are minimal. I already monitor my health and daily
exercise and healthy eating is second nature to me. My PCP and cardiologist
both feel the continuation of my healthy lifestyle and an annual check-up is
all that is required. Without wishing
to be repetitive, I have in fact been medically cleared 3 times with exactly
the same physical conditions as presented here and I have served without
incident or concern in those assignments in tropical climates very similar to
this assignment in Tarapoto, Peru. This
includes making strenuous jungle hikes.
However, I am more than willing to adjust any activities in-country
based on PCMO recommendation and my own regular self-monitoring.
OMS: “We are
concerned that we cannot reasonably accommodate appropriate close monitoring
and follow-up of your medical conditions without unreasonable disruption to
service.” – While I am not sure of the appropriate close monitoring yo feel is
needed, I am not opposed to that and I am committed to following PCMO
recommendations. I have recently (2016. 2017 and 2018) served as a PCRV in
rural Panama while being 12 hours from the capital city. In Tarapoto, which is
a mid-sized city, I would have access to excellent medical facilities and be
just 1.5 hours by plane from Lima, with 5 flights available daily, in the
unlikely event I needed higher level medical attention. This assignment is not
publicized with any special medical risks and access to specialist care in
Tarapoto, unlike many rural PC sites, is readily available. Should PCMO decide
that I do need more regular check-ups as part of monitoring, then that can be
easily done in Tarapoto, where I will be living, with minimal or no
interruption to my service. Again, I
will gladly comply with all PCMO recommendations, including anything specific
related to monitoring. Chief PCMO Peru, Dr Jorge Bazan is a good and trusted
friend and I would be happy to work with him.
In summary, I have no other conclusion at this point except
to think that OMS is expressing undue concern for my health, giving too much
weight to risk factors and risk for hypertension, kidney problems and diabetes,
in contradiction of what my physicians
and OMS/PCMO have indicated over the last four years, per my medical data. I
have been medically cleared 3 times since 2015 with identical indicators and
have served Peace Corps well and without extra monitoring or incident in a
strenuous tropical climate identical to Tarapoto, Peru. Local medical care in
the city of Tarapoto is plentiful and exceeds that available in my recent rural
Panama assignments and this would appear to be sufficient medical
accommodation. Again, I will comply with any and all recommendations by
PCMO. I am a robust and healthy individual
with excellent strength and stamina. Few individuals my age have my physical
health and habits, which is important to PC in recruiting in my age
bracket. I exercise daily, eat well, do
not smoke or drink and monitor my BP frequently. I am, and have always been a
committed, dedicated and compliant Peace Corps Volunteer, and very proud of my
outstanding Peace Corps service.
I hope you will take the time to review all this clarification,
new information and the attachments I am enclosing. I am committed to this appeal and to
complying with PCMO recommendations.
I do hereby respectfully request medical clearance to serve
with Peace Corps once again.
Attachments:
Letter from PCP Dr Islam; Letter from Cardiologist Dr Brownstein; Site and
Mission Specific Considerations; Data from 2 recent office visits; Lab results
from 12/13/18; Letter from former PC Country Director Sanjay Mather
Site and Mission Specific Considerations
Tarapoto, Peru, where I would be living, is the 20th
largest city in Peru. With a population of about 170,000, it is the largest
city in the San Martin Region and a major commercial and tourist hub. It is
comparable in size to Providence, RI or Chattanooga, TN. There are 8 major
hospitals within the city limits, including the teaching hospital at the
National University. There are 5 flights daily to and from Lima, with a travel
time of about 1 hr 30 min.
The PC Response assignment in Tarapoto involves working with
the Ministry of Health to develop educational programs and teaching tools for
water conservation, home disinfection, and water committee functions. It does
not entail water system inspections, as did my last Response assignment in
Panama, which required strenuous hikes in steep tropical terrain, which I
completed earlier this year (2018) without incident.
Robert “Goyo” Plimpton is a
67 year old retired attorney, general contractor and inventor and the
grandfather of 5. He has served with the Peace Corps as a Water &
Sanitation Volunteer since 2011 in Panama and Peru, where he was honored with
the Volunteer Excellence Award and was invited to serve a third year as PCVC.
