Peru Update

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:

Peace Corps Office of Medical Services (OMS) Board of Review

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 20^th 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.