Trail of Medical Missteps in a Peace Corps Death

The death of Nick Castle, a 23-year-old volunteer in China, raises serious questions about Peace Corps medical care.

Comments: 217

  1. Another real story. A young lady volunteered in AFrica with Peace Corps and got very sick. She did not die but got very sick from local disease. Years passed by. After they left Peace Corps, they were not supported by Peace Insurance. They were out of luck.

    In this post Cold War era, we hope Peace Corps is what represents US. We should not treat out best like this.

  2. May his memory always be a blessing.

  3. Indeed. My heart goes out to the family. No matter what comes of this review, he cannot be replaced.

  4. Thank you for this story. I was friends with So-Youn, and served with her in Morocco, and it's good to see that the world and the US still care about her and about Peace Corps.

    I know the agency, and especially our team in Morocco in 2009, were devastated at the news of her death (I was at her memorial service in Morocco), and they did everything they could to fix the systemic problems in the Morocco medical office. Based on conversations with volunteers near her, I do think there was more Peace Corps could have done in So-Youn's case, and I know a number of other volunteers, including myself, who felt that (a) we couldn't trust our Peace Corps Medical Officer and (b) our illnesses and issues would be fixed faster if we took matters into our own hands - as PCVs are wont to do. I don't know what it's like there now, but I heard after I left that things were getting better, and I can only hope that this rumor is true.

    Just to add, despite our experience with death in the Peace Corps, I would still highly recommend this life-changing experience to anyone and everyone who wants to make a small difference in the world.

  5. I agree about the value of the Peace Corps experience. My mother, Anne Reese, joined the Peace Corps when I was in college and worked in Morocco, where she had three extraordinary years that inspired her to work in other places, including Burkina Faso and, more recently, Islamabad.

  6. A sad story, and a sad end for an honorable young American doing service for his country and humanity.

  7. This saddens me. I love to travel and have been fortunate to not have had any serious medical diseases or conditions throughout my travels. I may not have traveled to places as remote as the peace corps volunteers, but I have always made it a priority that in the event that I think my health is in danger, I am better off flying back to the U.S. ASAP unless I'm in an area in which I have confidence in, in terms of adequate medical care. I don't know of that's reasonable, but I'd rather ensure that I continue to live than risk an unfortunate demise in some small town half way across the world.

  8. My heart goes out to the Castles for the loss of their lovely son.

  9. This is such a tragedy. However, the article seems to conflate things that are the Peace Corps's responsibility with things that are simply risks of volunteering in a poor area. For example, the ambulance got lost, delaying his treatment. That fact is mentioned more than once.

  10. Yes, Heather. This is a very sad story. But third-world people face risks like this every day. Although the Peace Corps should provide extra support for our volunteers, the nature of volunteering in such circumstances requires a willingness to take risks above and beyond those that one would expect here in the US. Thank you, Nick.

  11. Anyone going to a Third World country should realize that they may be risking life and limb.

    This is, no doubt, one of the major reasons that most Peace Corps volunteers are young, in that they have no experience of very bad things happening to them and have an optimistic view of human nature.

  12. Lucia and Nigel:

    China is an advanced developing country, not "third world."

    As a former PC volunteer and resident of Kunming, China, I found nothing in this story showing malpractice or failure of the system.

  13. One wonders, in view of this catastrophic failure, whether the Peace Corps would even now have the guts to look at itself if not one parent would ever again let a child volunteer. This was no mere "tragedy"; it was a perfect storm of medical incompetence and flagrantly cavalier administration. Nick's father got it right: "Everybody's sorry, but no one's responsible."

  14. Volunteers are adults - many well into their adult years. Parents to not "let" their children volunteer with Peace Corps.

  15. Agree. I was a volunteer at age 21, just out of university in 1963. My parents didn't "let" me go and more than they would have let me go to grad school, let me take a job as a teacher or let me get married.

  16. I am so very sorry for their loss. Nick sounds like he was an amazing man who used his strengths and passions to better the world.

    I would like to note for all of those individuals that are not familiar with the Peace Corps that this is a rare case. I served as a volunteer in Paraguay (2011 - 2013), and the Peace Corps medical staff was always bending over backwards for me and my fellow volunteers. I felt safe with them, and I felt well taken care of. When someone close to me contracted tuberculosis, the Peace Corps had me tested three times, sent me to a specialist and continued to monitor my health. That is one of many examples of how the Peace Corps Paraguay doctors looked after me. It is unfortunate that this was not the case with the doctor with Peace Corps China. The Peace Corps is an amazing organization that changed my life and allowed me to give back to the world. Que viva el Cuerpo de Paz!

  17. This is a terrible series of events. I would never advise any young adult to serve in the Peace Corps. They want young adults to give them their lives for a couple of years but don't have structures in place to protect those lives. I don't believe for a second that his death was inevitable regardless of treatment.

  18. This isn't true at all. This is a very sad case, but I served in the Peace Corps in Paraguay, and our doctors were amazing individuals who did everything that they could for us. I knew volunteers that had surgeries, saw specialists and some who were even flown back to the U.S. to see a doctor. The Peace Corps in general takes care of its volunteers. In this case, one doctor made a series of bad decisions. If you want to blame someone, blame the doctor. You can't generalize all Peace Corps service experiences and the Peace Corps off of one case.

    People have bad experiences with the military too. Will you encourage all young people to stay away from the military as well?

  19. I think what was meant was that appropriate treatment SO LATE as when Nick was FINALLY hospitalized would not have saved him. However, he had been sick for qite some time, during which the PC doctor repeatedly failed to initiate treatment which COULD have changed the outcome.

  20. This seems to have taken place in a city, not in the countryside. It seems that Mr. Castle should have been taken to the equivalent of the ER?? To what degree the lack of fluids was a contributing factor is unclear from this. Who is the Agency's country director ? -- a statement from this person might be of interest. I hope the staff now feels empowered to ask for this vehicle in the case of emergency but why could not another one be used?

    More questions than answers here. Terribly unfortunate and my condolences to all involved.

  21. Such a selfless young man. My heart aches deeply for his dear parents, all of his family members, and friends. Nick is a rare twenty-three year old, such dedication and compassion. To his parents, David and Sue, please know how complete his purpose here on earth had to have been. As I read of his love for Kurt Vonnegut and the Beatles, I could imagine how interesting and fun it would have been to come across a kid like this, and have an illuminating conversation, perhaps in an airport, or at a wedding, or
    maybe waiting in line somewhere. Nick, your goodwill and compassionate service to others will live on in the spirits of those you impacted in your lifetime. I am now one of them. Thank you.

  22. As a RPCV from Kyrgyzstan 1993-1995, this article does not surprise me at all. We were given a book from Doctors Without Borders and encourage to read it when sick. If one were sick, one had to travel to the capital to seek treatment. In some cases, a volunteer would have to drive up to 10 hours, for others, they would have to take a plance.
    Peace Corps has a LONG way to go to provide appropriate medical care for its volunteers. This article exposes what any former volunteer already knows.

  23. This is beyond sad. We have people in Congress who, for some reason, do not believe we all deserve affordable healthcare. And now we hear about these incidents, where we send young people on missions around the world to help others, but we can't help them? Broken systems all around us! There have been times when I told lour oldest boy to think about joining this organization if he wants to make a difference, but these stories have convinced him he shouldn't. Once again those in charge are letting things slide. Truly sad.

  24. What is the first thing they tell you, be careful and don't drink the water.

  25. Since Peace Corps volunteers usually work in places with poor access to healthcare that meets Western standards, there need to be better use of technology so that volunteers have direct contact with medical personnel in the US. Working through the local medical community depends on less qualified practitioners to know what they don't know, which does not always happen.Telemedicine and internet video should allow volunteers to complement the advice of local practitioners with expertise from US based physicians.

  26. When going into the Peace Corps you are trained to adapt to the local people and culture.

    You are expected to live as your counterpart professional workers live.

    You accept the risk that you are remote from "Western" medical care.

    Being deprived is part of the experience, and the adventure.

  27. He was in _China_. They treat dehydration in China with intravenous fluids. I know: I was treated for dehydration in September of 2013 in Tibet.

  28. "...during its 53-year history, 296 volunteers, or less than two-tenths of 1 percent of the total.."

    No wonder they say it like that. 5 or 6 a year sounds like an awful lot to me. This is not okay.

  29. While tragic, some of the deaths they mention are things that could happen anywhere, in the Peace Corps or not: car crashes, rock-climbing accident, heart attacks. The article says 18 deaths in five years, which is 3-4, and there is a wide range of ages in the Peace Corps. Which is not to say that they don't have to have good safeguards and procedures in place.

  30. Worse than VA controversy. Thought of volunteering before, but not now. Too much CYA and not enough common sense and compassion.

  31. We live in the growing culture of cowardice where nobody responsible accepts responsibility and everybody rushes for the nearest window curtain for the safest possible CYA treatment.

    The Peace Corps -- that American bastion of ostensible integrity -- indeed seems to have net Nick and the Castle family down. In the process it has lowered its own reputation to that of costume jewelery in the crown of American service.

    www.endthemadnessnow.org

  32. My heart goes out to Nick Castle's parents and family. They help to make the system better by sharing and giving voice to Nick's tragic experience. I was a Peace Corps Volunteer in the then still developing country of South Korea. I have no doubt that the thousands of Peace Corps volunteers who served there from the late 60's to early 80's helped South Korea build a better, more democratic country. As other PC volunteers mentioned, joining the Peace Corps at 22 totally changed the arc of my life--for the better. Just last month I journeyed to North Korea and saw first-hand a totally different model--one that is a poster-child for state failure. I am happy to have helped South Koreans choose a different and better path.

  33. Truth be told, you and other PC volunteers served in South Korea during a time of U.S.-backed military dictatorships. During that period, many South Korean labor organizers and students fought for democracy, and many suffered the costs of red-baiting, as a result--even, in some instances, paying for their activism with their own lives. South Korea's Truth and Reconciliation Commission covered the dark crimes of this difficult era--and the crimes that were sponsored by South Korea--in their investigation. Although you claim "to have helped South Koreans choose a different and better path," this is a whitewash of America's historic role in South Korea. Democracy in South Korea--although the ostensible purpose of U.S. intervention--came about, in large part, because of the courageous work of South Koreans who fought for democracy, and this struggle for democracy often pitted them against the United States.

  34. Yes, but not against Peace Corps Volunteers, who are not government employees and who are under no compulsion to represent U.S. foreign policy in any way, shape, or form.

  35. Two facts to remember:
    1- Half of all doctors finish in the bottom half of their medical school class
    2- Blessed are the Peacemakers for they shall be called children of God.
    Each of these lived up to their truth. May he rest in the peace of Christ.

  36. That 50% of all medical students finish in the bottom half of their medical school classes is true, but does not tell the story. Medical school admissions are highly competitive, and it's fair to say that they are generally comprised of students in the top 10% of their baccalaureate rankings. Thus, even the bottom half of the medical class is populated by students who were in the top tenth of their college classes.

  37. This is not only a problem with the Peace Corp. It's also a problem with STATE, USAID, NGO's and other agencies that rely on Dr's to take appropriate action when they themselves are restricted by the regulations at Headquarters. Nick was too proud to call for help outside of his organization. Surely his parents would have jumped if they knew. You have here a volunteer inept organization created by the cold war and lived beyond it's use. It's foundation can not retain institutional memory by statue, and those appointed at Headquarters are too interested in building their comfort zone in Washington, D.C instead of supporting folks in the filed. I suggest the reporter may want to look across the Federal Government that deploy folks into the filed. As for the Peace Corp, my recommendation is to close it down.

  38. There are American physicians (Regional Medical Officers) who are with the Foreign Service and handle limited territories. In addition, US Embassy and some consulates have American nurses who are federal employees and are also part of the Foreign Service. Peace Corps volunteers who are posted close to an Embassy or consulate are not precluded from using the services of these American professionals, but many are so remotely posted that they have to rely on the people affiliated with their own agency. Any parent who sends their kid off on a Peace Corps experience in a developing country should be acutely aware that American standard medical care will not be available and that the kid will need to aggressively advocate for decent health care. This is the third world we're talking about.

  39. And shut down the State Department, USAID, and all NGOs? Anyone who lives or travels in medically primitive areas must be prepared to manage their own health care, and to know in advance where to turn for help. And even the best help available may not be adequate.

  40. SW and Susan:

    China (Chedngdu) is neither "third world" or "primitive".

  41. I was a PCV in the former Soviet Union 20 years ago and I can tell you that access to medical care was something we were always concerned about. Many volunteers lived hundreds of miles from the head office and and in the event anything happened, we had to rely on local medical care.

  42. Considering the age, good health, and education of the folks in the Peace Corps, a fatality rate of .2% over a couple of years seems pretty high...

  43. Most of those deaths are car accidents. And anyone who has driven in a developing country can attest as to why that is the case.

  44. Re the .2% death rate, in the U.S. in 1995 there were 192 deaths per 100,000 people ages 25-44. In 1996, the death rate per 100,000 was 175. In 1997, the death rate was 161 per 100,000.
    [Data published by the US Census Bureau, see http://www.allcountries.org/uscensus/129_death_and_death_rates_by_age.html .]
    Given that the Peace Corps volunteers often live in remote areas in 3rd world countries with dodgy local water supplies, malaria carrying mosquitoes, and long drive times to receive medical care, the doctors at the end of that drive could work for Mayo Clinic and the death rate wouldn't necessarily be much lower.

  45. Contrary to what the NY Times asserts, two tenths of one percent is an enormous number. That is one in 500 Peace Corp volunteers!. This is particularly bad since the vast majority are in their twenties and thirties and in likely better health than the average young person. (After all, if you are really sick, you are not likely to volunteer in rural China).

  46. 296 of ALL the PCVs who have ever served have died. Since 215,000 PCVs have served, that's one in every 726. And since PCVs serve for two years, that means that in any given year, the chance is 1 in 1,452 that a PCV will die. That's about the stateside risk for a 25 year old or so (it's actually lower than the male rate, higher than the female rate).

  47. Not to diminish the tragedy of what has happened here, but as you raise the point of statistics, the Peace Corps Volunteer estimated mortality rate of 0.20% has to be compared with a similar number for the USA. A Johns Hopkins study from 2003 shows a mortality rate in the USA for males age 20 -24 of 0.14%. Simple math shows that this mortality rate applied to the PCV population works out to 10 deaths per year while a mortality rate of 0.20% works out to 14. Sounds cold, but the point is that compared to the comparable mortality rate in the USA-- the country with the greatest healthcare in the world, a higher rate for Volunteers placed in some of the most danergous and least accessable points on the globe could be expected -- from a statistical point of view.

  48. Robert, while we have superb healthcare AVAILABLE, I would not say that we have the greatest healthcare because many Americans cannot access it due to lack of money/ health insurance. In fact, if you look at longevity, mortality rate (esp. at birth), we are not in the top 10. France often comes up near the top.

  49. "...concluded that despite medical missteps by a Peace Corps doctor who missed signs of serious illness, Mr. Castle’s death could not have been prevented."

    So, the PC doctor was INCOMPETENT, and the young man's death could have been prevented.

    Tragic. Condolences to his family.

  50. This is truly a sad story and I feel for the family. However, in my experience as a Peace Corps Volunteer in Kenya, 97-99, The medical staff was unbelievably competent and would go to any extremes they had to for us. Peace Corps, by its very nature, your service is usually in areas inadequately served by medical centers. Sanitation, and water supply are usually lacking. Please don't think poorly of the organization as a whole. There are currently 7,000 volunteers serving in 65 countries with a total budget equal to that of the Army Marching Band. Peace Corps experience brings out the best in all of us who served.

  51. I served in Jamaica from 1979 to 1981 and am hard pressed to find anything critical to say about the Peace Corps. My expectation was that the Peace Corps would get me there and take me home but the success or failure of my experience was up to me. Volunteering is a risky undertaking and I feel very sorry for Mr. Castle's family and know that I would be devastated if that were my child but I would also be proud of what they did. Sometimes bad things happen to good people and finding someone to blame is not a productive use of time and energy.

  52. Dear Craig,
    My son works in Nairobi for MicroenergyCredits. My husband and I were going to visit him in August, but I am concerned about the fact that the PC has pulled out all its volunteers. Of course, there is a state department warning.
    I was wondering whether you are in touch with people on the ground there. Do you think it is safe to visit Nairobi?
    Thank you for any information. I was in JVC (Jesuit Volunteer Corps) in '79-80.
    Mary at [email protected]

  53. What a sad story. Your son was a hero. Hopefully more care will be taken to protect the volunteers.

  54. As a Returned Peace Corps Volunteer in Uzbekistan (almost 14 years ago) this story reminds me of a fellow volunteer who died in service from a rare acute form of lukemia during my stint. It was our host country medical staff that actually caught the illness and initiated the medivac out of country. During my time as a volunteer (about 16 months) we had a volunteer fall out of a 3-story window, one in a serious scooter accident on vacation and several other minor health/mental health related evacuations. PC medical staff in-country was trained to administer vaccinations and treat minor gastrointestinal infections, not deal with serious emergency health needs. My heart goes out to Nick's family, unfortunately he is not the first person the Peace Corps has let down.

  55. What a horrifying story. I am so sad for the Castles and their loss. Peace Corps needs to own up and take responsibility for this atrocious mistake.

  56. It is heartbreaking that this man didn't receive help earlier. As a former volunteer, I think that broad generalizations built off of one story are misleading at best. There is a hotel full of volunteers getting medical help in Virginia right now. I was medically evacuated myself for two weeks, which is more the norm in cases where health is at risk. Volunteers are adults. Not children. It is up to volunteers to advocate for themselves as much as the Peace Corps needs to offer competent medical services.

    To people responding as to not "letting" a "child" go. It is not up to parents to "let" a child go overseas with the Peace Corps, after the age of 18, it is that adult's choice.
    Medical incompetence happens in the US as much as it does overseas within the Peace Corps structure. This could have happened here too outside of any government bureaucracy. Not to minimize the loss, but this story feels sensationalistic by the writer.

  57. " Volunteers are adults. Not children. It is up to volunteers to advocate for themselves ..."

    Adults who are sick frequently need people to advocate for them. Hospitals have patient advocates for adults who don't have family members to perform that function. You don't expect a man who is sick enough to die to do much more than alert his doctor, which this man did. Yes, the Peace Corps let him down.

  58. It's not necessarily how likely that medical incompetence would occur there versus the U.S. but the fact that the incompetence in question cost this young man's life. Given the lack of qualified doctors in that part of China, he really had no choice for alternative treatment other than to be Medivaced to a major city, which obviously didn't happen. In the U.S. you could switch hospitals or go elsewhere for medical treatment.

    The Peace Corps absolutely has a responsibility to make sure their volunteers (unpaid employees) have access to decent medical care. There should be a doctor on-site or a detailed action plan for emergencies. This is pathetic.

  59. Strongly agree with your final paragraph.

    "Medical incompetence happens in the US as much as it does overseas within the Peace Corps structure. This could have happened here too outside of any government bureaucracy. Not to minimize the loss, but this story feels sensationalistic by the writer."

    It seems depressing and negative and insensitive to say this.
    However- it is the absolute truth for anyone who has been a caregiver , and goes home after their shift,thinking "I hope to God this doesn't ever,never, happens to me,my family,and those I love.

  60. Nick Castle's death is a tragedy that touches not only his family and friends, but all of us who embrace the mission and ideals of the Peace Corps. I suffered pneumonia and other illnesses while serving years ago as a volunteer in Nepal. Inevitably, health risks are greater in less developed parts of the world, where Peace Corps operates. The agency's new director, Carrie Hessler-Radelet, who was confirmed in her office only last month, has already had success in several areas, such as overhauling an outdated recruitment process. Let's hope she can make a similar impact with the challenges highlighted in this story, honoring Nick's memory.

  61. I find it hard to comment on this story knowing that the parents of this bright, idealistic, compassionate, kind young man may read this, but I just want to know why we are sending Peace Corps volunteers to China. While China's GNP is not quite that of the U.S., it's going to be close to double the United States by mid-century. Why should we subsidize a country that has enough money to spend on infrastructure that they have built a railroad to go to a place that that they subjugated for decades but can't put equal money into public health programs or public hospitals?

    And while I understand that people in need do not choose their country of birth, it seems insufferable that there would be any immigration issues that would hinder people seeking to render medical care for someone trying to improve the quality of life for the people of China.

  62. China is continuing with the fiction that it is a poor country, and this gets it advantages. It is time, past time, to consider it as such. It is a very rich country, although some persons there are poor. Enough of giving China advantages! They don't have to meet the same standards the US does in pollution, etc.

  63. The mission of the Peace Corps is to promote world peace and friendship by providing qualified volunteers to interested countries in need of trained manpower, by fostering a better understanding of Americans on the part of the people served and by fostering a better understanding of other people on the part of Americans.

  64. Not to be disrespectful to the PC, but realistically I don't think the value of the program is measured by the impact on the host country, but rather on the volunteers themselves, who return back to the US with valuable language, cross cultural and personal skills that will serve them (and the US) well in their future careers and lives. So rural China would be an excellent experience.

    Tragic story - seems like a good solution would be to have the PC program piggy back on the existing infrastructure and support for State Department workers, as others have pointed out.

  65. So sorry for Mr. Castle & his family. Having suffered miserably from gastroenteritis (I too became dangerously thin & weak), it baffles me that the doctors gave him Cipro. My doctor did the same & it made me so much worse! On my own, I researched symptoms & found that a steroid (Entocort) was a much better medication for inflammation. I practically had to beg my doctor for it. And 5 days later (after months of suffering), I was like new!

    Please doctors - stop with the antibiotics already! Please start listening to us & give us the steroids we really need (which actually treat the inflammation) - before you cause any more suffering.

  66. Truly sad story and my condolence to the volunteer's parents.

    Unfortunately, medical doctors are not perfect. I got a very strange care right here, in California (Loma Linda) in 2011. Fortunately, it was only on the periphery of my body (oral cavity) and far from fatal.

    The further one goes from this country (and most EU countries), the probability of serious health problem and inadequate medical care increases.

    Nick Castle could have actually be better off with Marines in Afghanistan. As long as he was not involved in direct confrontation with the 'locals', he would have received an excellent medical there. Of course, he could have also be killed by a 'friendly fire'.

  67. I am very sorry for the loss the Castle family has suffered, but the idea the Peace Corps is somehow immune from all threats to a volunteer's health, including medical negligence, is simply naive. This could have happened anywhere in America. As a Peace Corps Volunteer who served in Uganda from 2003-2005, I received excellent and attentive medical care under a strong and responsible Country Director. However, I also knew (and was told) that my health was primarily my responsibility and took that very seriously - just as I do now that I'm home.

  68. I'm very sorry for this young and tragic death. What strikes me as strange is that Mr. Castle's crisis was not in some remote location, but in China's 4th largest city, and the West China Hospital has an English language web site that lists an emergency hotline, open 24 hours, 365 days with Chinese and English speakers.
    I make it a point when going abroad to check the Blue Cross web site, which lists medical providers worldwide (including West China Hospital) should the need arise. I've found my way to emergency rooms in London (broken arm) and Lombok (serious ear infection). Can't the Peace Corp give its volunteers some latitude to use their judgment and seek local care in an emergency?

  69. In the early years of the Peace Corps, each "Peace Corps country" had at least one "Peace Corps Physician" who was a full staff member of the country team. These physicians, most of them young and coming directly out of internship or residency training, or only a few years later, were assigned to the Peace Corps as Commissioned Officers in the US Public Health Service. Specific training was excellent; Washington-based support and supervision was direct and effective; quality was supeb, and morale and committment to the Peace Corps was sky-high. Many of those young doctors went on to careers in public service, many in community medicine and public health, and many in international work. Many of us still hold that memory in life-long friendships that we made with our medical peers.
    My guess is that the same spark still exists in young American physicians and also in nurse practitioners and physician assistants. The Peace Corps could do well by looking at that former experience, and finding a way to bring it into a contemporary context.
    Stephen C. Joseph, MD
    Peace Corps Physician, Nepal, 1964-66

  70. And would Congress please approve a Peace Corps budget that allows that. Year after year, I join other returned Peace Corps Volunteers in begging Congress not to cut the Peace Corps budget. All my friends say Peace Corps is great; few, if any, will call their two Senators.

    PCV Colombia 1963 -64
    US Diplomat, retired in 2006

  71. As a Peace Corps volunteer in Nigeria from 1967-1969, I can attest to the high quality of medical care in those early days. The PC doctor made rounds of thousands of miles to check on all of us and responded to requests for help as quickly as was possible over rough dirt roads. We did use the local hospital and local doctors for most ordinary illnesses, but the PC doctor kept track of what was happening. On two occasions he sent me to Europe for tests and treatment that neither he nor the local medical people could provide.

    I am distressed by the implications of this story and wish that the early system, as described by Dr. Joseph could be reinstated. I agree with him that many young American medical professionals would welcome the opportunity to serve as Peace Corps medical officers.

  72. Thank you for recognizing that PAs and NPs could be part of a Peace Corps medical team.

  73. Several years ago, my husband and I were "accepted" into the Peace Corps. At the time, we were 62 and 65, and had much to offer.

    However, we declined after we were told that we would have to, at our financial expense, to "prove" that we had no existing conditions, and I had to sign a document stating that I would NOT have a mammogram for the next three years...He had a "cured" condition, but he still needed to "prove" that it wouldn't recur. I wasn't comfortable with no preventive care for 3 years. It's too bad; we could have offered a lot.

  74. It's true that it can cost older applicants thousands of dollars to get the medical examinations necessary to be cleared for service. This undoubtedly prevents some very good people from serving. Peace Corps could benefit by having a higher ratio of experienced, older volunteers. (In the meantime, I believe that, currently, waiving annual mammograms is an option but not a requirement.)

  75. As an older volunteer, I went through the same process of having to get a doctor's opinion that a knee problem and herniated disc for which I had operations many years ago would not recur. It took a little effort but was doable. My doctor got the hospitable records, which were usually kept for only 7 years but hadn't been discarded, and based on reviewing those records and examining my physical mobility, was willing to say that the conditions were not likely to recur. And in 4 years of service, they didn't recur. The point is to follow through to see what happens with the medical examination before deciding to give up.

  76. IMO slight overreaction on your part to not having a mammogram for three??? years? (Thought PC service was two years.) Many women I know found their own tumors (after an inconclusive mammogram... and in one case the mammogram was totally useless and the treatment too late.

  77. I am not a friend of the Peace Corps, but to the best of my knowledge most volunteers are fully aware that they are going to very remote and isolated places and go there to live in very primitive conditions.

    I think that to expect top medical care under these conditions is a bit naive.

    The daughter of some friends of ours went first to an isolated region in Africa that became threatened by insurgents and was therefore sent home in a rush. In her second attempt, in South America, she became ill, and was again sent home to recover. In her third and final attempt she became the object of some unwanted attention by one of the locals and was again sent home with no possibility to return.

    In her case, I feel the Peace Corps did the best they could in difficult circumstances.

    As the father of two kids in their twenties, I feel deeply for Mr. Castle's family.

    I do not know that I would blame the Peace Corps for the misguided expectation of safety, given the sort of places that the volunteers are sent to.

  78. Expectations of safety are one thing, medical malpractice is another. Medical care in China can be as good as any found in a smaller city in the US. The major hospitals in their larger cities are on a par with ours.

    A posting near Chengdu is not equivalent to a posting in Africa or South America. Although little know to most in the US, it is a sizable city (10 Starbucks locations the last time I was there). There was no reason for the poor care provided to Nick Castle.

  79. This is so tragic. And there is no way that setting up an electronic medical records system for such a small group should take two years. Or at least an emergency medical messaging site for all current volunteers. That should take about one week especially if you contacted the Bill and Melinda Gates Foundation.

  80. The original policy of the Peace Corps was to provide American doctors hired in the United States and whose full time job was providing health services to the volunteers in the countries in which they served. These doctors were an essential member of my staff in the 10 years I served from 1961 to 1971 as an overseas Country Director and Regional Director for Africa . When and why this policy changed I do not know but I suspect it was budgetary.

  81. It still seemed to be the policy when I served in Sierra Leone in 1981-1983. I received excellent care from the American Peace Corps doctors, one of whom was Mae Jemison (who went on to become an astronaut), who worked full-time on behalf of the PC Volunteers. Once or twice a month they went to visit PCVs in the provincial capitals; although if I were sick at other times, I had to get myself to Freetown from my village, which wasn't always easy.

    One thing I'd like to point out is that the PC Volunteers looked out for each other. Once, when my neck was very swollen, I went to the nearest town and was persuaded by other PCVs to go see the PC Doctor in Freetown. Although he didn't know what specifically the problem was--and he had taken courses in tropical medicine to prepare for his job in West Africa--he gave me penicillin and that cleared it up. He also let me stay at his very comfortable house while I was recuperating, which was his habit for any Volunteer who was more than just slightly unwell.

    I am very sorry for Nick's parents for their loss. Having worked in China for a few years, I am shocked at the apparent lack of care their son received, since there definitely are quality medical establishments used to treating foreigners; at least when I was there in the 1990s, there were. The fact that a gynecologist was serving as a primary care physician for Peace Corps Volunteers astounds me.

  82. I was in Peace Corps in Kenya in the late 1970's and got sick with amoebic dysentery. In my delirium I traveled from the coast overnight to headquarters in Nairobi and lay on the sidewalk in front of the office till someone came. The American Peace Corp doctor came and put me in a local hotel/hospital drinking saline solution till I got better and took tests but could find no amoeba. After a few days I was better but couldn't eat without strong stomach cramps so for the month basically had soup and lost 38 lbs. Whatever the Dr. did didn't work. When I returned to the coast I went to an English doctor who also ran tests but couldn't find an amoeba but said he was going to prescribe medicine as thought he had found it. A week later the dysentery was gone and I got better. Didn't think so highly of Peace Corp doctor after that. At that time I considered being sick as part of the Peace Corps adventure which in my case also included malaria. I don't know how safe you can make Peace Corps. Each country has its own dangers and getting help may not be so quick. I went for the adventure and was foolish with my health but being young I didn't worry about it. However I also knew that unlike fellow Kenyans I could always go to the Peace Corps and in worse case get flown out of the country. As a 59 year old now. this article helps me appreciate what were probably some of my parents worst fears and I am sad for his parents.

  83. Nonesense. I am a returned Peace Corps volunteer, now a physician. Peace corps is a branch of the US State Department. Are diplomats in Africa and Asia dying of viral gastroenteritis? Of course not. Diplomatic Corps receive care from US-trained physicians that are employees off the State Department. Peace Corps volunteers? Apparently not worthy of such high quality care. Their care is regulated to doctors who could never receive a medical license opinion the US. Shame on the Peace Corps for saving money by denying volunteers the same level of care their State Department brethren receive.

  84. Dan, A thoughtful and compassionate comment. I was a Peace Corps volunter in India in 1966 to 1968; I also became sick with with amoebic dysentery and later malaria. At that time, the Peace Corps forbade us to see local doctors; we were required to travel to see Peace Corps doctors in cities far from our locations. When I came down with malaria, I was taken by local friends to a Seventh Day Adventurist hospital nearby my local site, and treated well; in the condition I was then, I could not have made the trip to Bombay to see the PC doctor. I am grateful for the care they provided. Yes, being a volunteer creates risks; a part of the experience. Several of my Peace Corps friends returned home with serious medical issues that required long term hospitalization. I was lucky; now 70 years old, I, probably like you, treasure my Peace Corps experience. Still, I appreciate this article holding the Peace Corps to a higher standard of providing medical care for volunteers, and most of all, my heart goes out to Nick's parents. You entrusted your son to an agency that did not provide the proper care; your loss cannot be measured. The loss to the strife torn world of today of a person like Nick cannot be measured either.

  85. I lived and worked in Kenya, also in the late 1970s, as a pilot on the Coast and had a lot of PC friends. I flew around the Game Parks, and also did a sked run from Malindi to Lamu, in a C-402, so Dan we may have met?

    We always said if someone/friend of ours got really sick or injured, we would immediately put them in one of our planes and fly them up to Nairobi for medical care.
    I was sick with severe dysentery myself once while staying in Nairobi. As my condition got worse, and I couldn't hold down food, a pilot friend took me to a hospital, where I was given a shot of I-don't-know-what in the butt. A few days later I was much better. But occasional mild diarrhea was pretty common. Drinking more Tusker beer seemed to help.

  86. It is sad to read of this. Every parent should inform their child that they should go to the hospital and not rely on the peace Corp doctors for anything other than the most routine care. If the peace Corp were to change their hiring practice I would suggest that they hire emergency room doctors rather than general practitioners and gynocologists. Parents should purchase insurance for their children so that they don't hesitate to go to a hospital.

  87. Dr. Gao and Dr. Christian are both well-trained, wonderful people (I should know, I've been seen by both of them). There is a reason why you are not allowed to go into a hospital without informing Peace Corps staff (I volunteered at a university in China with an affiliated hospital, and I promise you, I would not set foot into that hospital unless I had to). If Peace Corps Volunteers decide to break the rules and go to the hospitals available, they are going to get sick/hurt more, not less, often. I find so much of what people are writing without having been a PCV really curious. Any other Peace Corps China volunteer would groan along with me about how overly cautious the medical staff were and are. My heart goes out to the Castle family, but I loved my experience and would volunteer in China again.

  88. To Kimberley,
    I am interested in your response. Why do you feel the peace corps forbids a volunteer from going to a hospital w/o telling staff first? And why would breaking that rule result in volunteers getting sick or hurt more often?

  89. "A Chinese-trained gynecologist"? I don't understand this at all. Chengdu has western medical clinics with western doctors available. One is Parkside Health, which we used when we lived in Shanghai. This is inexcusable. Why would the Peace Corps hire a gynecologist as a general-duty doctor? Who was looking out for this young man? Not the Peace Corps, evidently.

  90. I was searching the comments to find one like yours!

    Thank you for saying it has to do with incompetence on the part of the Peace Corp.

    It sounds to me like one massive cover-up.These young brave individuals are being "USED" .There are other more formidable ways to live overseas and get decent healthcare.A rural hospital in China with 14,000 people coming and going daily and a GYN in charge of medical care for the volunteers, is NOT one of them!

  91. Well, when more than half of the volunteers are women, why NOT have a doctor with experience in women's health?

  92. If someone had lost 9% of his body weight in a month, I'd want to know why, not just let it pass because he still had a tenth of a point to lose before some chart deemed him underweight.

  93. That is such a sad story for such a promising young man.

  94. Reading this over, I don't see how things would have happened differently at our PC post in the same situation. Lots of volunteers lose weight at site, because of GI issues and limited food. Lots of volunteers get ill due to food-borne pathogens, are proscribed Cipro, and eventually get better.
    My own experience with Peace Corps medical was positive; I was sick during training, and PC doctors (host-country nationals with excellent English) brought me to headquarters and gave me an IV & good follow up. Peace Corps gave volunteers flu shots and equipped volunteer Wardens with prescription meds that could be given immediately to nearby volunteers after a phone-consult with medical. A lot of our care at site was essentially tele-medicine: call up medical, describe the problem, get pills from the Warden. Prescription meds, both personal and for the Warden kit, were sent out via mail by medical regularly.

    I heard from volunteers at other posts that they had language barriers with their medical staff, & would self-diagnose problems via the internet. Treating volunteers in the field is logistically challenging because PC sites are often in extremely remote areas of already underdeveloped countries, hours from any large cities. And then, some volunteers developed a very stoic attitude towards health issues, since we got sick so much more often than at home, and a lot of people didn't want to have to go home due to a medical problem.

  95. But Nick was in Chengdu a city of 30 million people, not out in the bush, or the Himalayas or other far flung place, many hours away from medical care-I find it incomprehensible, that a doctor does not recognize dehydration when s/he sees it

  96. Thank you NYTimes for looking into this.
    My heart aches for Nick, his parents, and all who knew him.
    Horrific situation, unspeakable loss. Same for Ms Kim.
    But don't think these things don't happen here also. Misdiagnosis, delays in getting care or lack of adequate care & outright mistakes happen every day in major hospitals.
    Regardless, Peace Corps owes it to these bright wonderful kids who volunteer to do the best by them. I hope this is a wake up call, along the lines of the VA mess. They must do better in serving the best of our youth in far flung places.

  97. This is an outrage...there anything else else else to say about this? no altruism left i the world...

  98. This 3,500 word story would be more accurate and have greater integrity with an inverted focus: The death of "less than two-tenths of one percent" of volunteers in a 53 year old program.

    There is tragedy in this young man's story. But there is also tragedy in using his story to suggest systematic medical incompetence by Peace Corps professionals.

  99. 2/10 of 1 percent death rate for a program that uses mostly young, healthy people is HUGE!!!!!

  100. This is a very large death rate in healthy 25-35 year olds!!!

  101. Not all these people died of medical incompetence: quite a few were killed in accidents that could have happened in the US.

  102. My condolences to the Castle family on their loss. I served in Mali in the early aughts and I received a book called "Where There Is No Doctor" (no joke) in case I had to self-diagnose an illness. Our in-country doctor did not impress, but our regional medical officer was dynamite. She was very responsive to volunteers' concerns, and we often went over the head of our in-country doctor to get medical approval on things.

    We all wish that Nick Castle's situation could have turned out differently and that he could have finished his service. It is tragic that he could not. But those in his community who were fortunate enough to have met him, and the students who were fortunate enough to have learned from him have had their lives changed for the better. I am sure of it.

  103. This story sounds sadly familiar. One of the earliest deaths in the Peace Corps involved David Mulholland, who joined the Peace Corps in the Philippines in 1961 and died shortly thereafter. I believe the Peace Corps doctor was a pediatrician with little experience in tropical medicine.

  104. What I fail to understand is why is the Peace Corp in China? They are one of the wealthiest countries in the world. I have the same question why missionaries find it necessary to go there. There are many country's that need help more than China including parts of the United States. China has not requested these people and in many cases place restrictions on what they teach. Missionaries often go there claiming to be teachers in order to spread the gospel. If these resources are to be expended go where we are wanted and put some effort into portions of this country.

  105. One of the wealthiest countries in the world?? 68% of its vast population live on less than $5 a day. Nearly a third live on less than $2 a day. Not that Peace Corps is even in the business of providing material assistance. It's about cultural exchange and projecting a positive image of America. You really need to educate yourself about both China and the goals of Peace Corps.

  106. By definition, if we are in China- it is because the Chinese government asked us to be there.

  107. It is not simple altruism - it is as much benefit to the Volunteer and to the U.S. that we are there. Understanding the Chinese way of life. Returned Peace Corps Volunteer Peter Hessler, widely read author and correspondent, is just one of the more prominent examples. Peace Corps is a win-win --- it is the "servant", if you will, who is enriched. I admire Nick's love for China too. May he rest in peace.

  108. I fail to see differences between this tragedy and others unfolding across America this very moment. It's the inevitable consequence of an internecine ideological political climate that will sacrifice lives in order to garner votes around wedge-issued scarcity dramas. Powerful politicians who work only for their own limited and selfish interests are responsible for inadequate funding support for all American public institutions today. Reagan was intentionally prophetic, government has become the problem.

    PC volunteer, Panama, 1966-1968. My heart goes out to Castles.

  109. "I fail to see differences between this tragedy and others unfolding across America this very moment."
    Well said. No one in my PC group in India escaped dysentary and other more serious maladies. No one blamed Peace Corps nor the inadequate medical care from the Public Health doctors who were spread too thin. At least we had some care which is more than the poor with out insurance get in this country today.
    The experience was transformative and changed my life. I am sorry for the Castle's loss.
    RPCV India 1965-1967

  110. As an American who has worked (for medical companies) and traveled in Asia, I have greatly enjoyed the cultural experiences but have also been warned by local doctors that "the bugs here see you Anglo's coming," and to be wary of any medical conditions that persist more than a few days.
    I have found myself very ill on two occasions, one in China, where a plane ticket to more advanced health care (Singapore) and strong antibiotics (including in one case injection) were key to my recovery. I would caution any foreign travelers to have a backup plan and not to let things go too far before seeking high level care, as some infections can move quickly. When things go bad, they can go bad in a hurry.
    My heart goes out to the family of this gifted young man.

  111. I am deeply sorry for the Castles' loss, and the series of missteps that led to Nick's death. However, it is not true that all Peace Corps Volunteers receive sub-par or inadequate medical care. I served in Mongolia 2010-2013. Four months into my service, I tore my achilles tendon and received excellent care and attention from the Peace Corps-Mongolia medical staff. I was med-evac'ed from my site to the capital city where I was taken for an MRI. Then I was med-evac'ed to Bangkok, Thailand where I had surgery (only 7 days after I was injured) in an excellent hospital and received physical therapy daily until I was able to return to Mongolia 4 weeks later. The Peace Corps medical officer (PCMO) in Mongolia advocated for me with PC HQ to return to Mongolia to complete my service, which I desperately wanted to do. Continuing rehabilitation therapy on my own, the PCMO checked on me weekly and monitored my progress. Peace Corps even flew me back to Bangkok for a check up with my surgeon. I have no complaints about the care I received. I even signed up for a 3rd year of service. It is simply not true that the whole system is broken.

  112. I'm glad you're ok, but your anecdote doesn't change the fact that Nick is dead, and it's mainly because the Peace Corp physician couldn't tell a sick person from a well person. That's incompetence, straight-up.

  113. I'm just glad that you had a good experience and you made it back alive. Also I am sorry but you can not compare a torn Achilles tendon and the level of medical care that was provided to you to what happened to Nick.

  114. What percent of doctors in the US can't tell a sick person from a well person? More than you may think

  115. It is o ften not until something serious occurs that a volunteer learns that s/he might not be able to depend on the Peace Corps for their health, safety and well-being. Essentially, the PCV is alone with whatever situation they find themselves in. Program officials will say that certain things cannot be done without causing a diplomatic crisis. In that situation, the relationship of the US to the host country is valued more than helping the PCV.

  116. A sad and tragic story. Rest in peace.

    In a way it is uplifting to read that there are still so many people that volunteer their time to go into remote areas to help improve the lives of strangers. My heart and thoughts are with the Castle family. Through their sorrow they should be very proud.

  117. While the Peace Corps comes off as a caring, helpful, people oriented organization it is all a front. During my time in Panama as a Peace Corps Volunteer I was faced with two very stressful situations which left me with post tramatic stress disorder. After being medically evacuated I was told by several Peace Corps officials both in Panama and in DC that I would never return to Panama though the resoning behind their decision was never explained. I was then cut off from their insurance without any warning, forced to close of service, return all my hard earned grant money, and compeately cut off from the organization. Two monnths later I have still not recieved a dime to pay for medications, doctor visits or for my time of service. What started out as a great adventure has turned in to a nightmare. It is hard to be optimistic about my time with the organization when they clearly don't care about the people involved. I am so sorry for all volunteers who are in the same boat or worse. It is one of the hardest things I have ever been through in my life.

  118. Chengdu has a population of 30 million people. Although the care might not be up to expectations for California or Canada (similar population) it isn't Nepal and certainly not a rural hardship post.
    The Peace Corps has some soul searching to do.

  119. RPCV, China 2010-2012

    Andy, they train in Chengdu and then go to their post. And yes, there are some volunteers living and volunteering in the city of Chendgu, but mostly spread out into 4 provinces.

  120. I was a PCV in Nepal in 89-91. We were given a blue med kit and you were supposed to guess the disease. We called it "Antibiotic Roulette." When it got to the IV stage you were supposed to be medivaced to Kathmandu. You were definitely not supposed to leave your life in the hands of local treatment.

    The first time I fell sick with Amoeba I was so ill I could not stand. I had so tille strength I could not leave the outhouse. When i sent a sample my mail to Kathmandu it came back via telegraph after everyone in the village handled it. It read "PC/NP" which did not stand for "Peace Corps Nepal" but rather "Pus Cells, no Parasites." By then I was doing well on antibiotic and went off them as suggested and completely relapsed.

    I lost a lot of weight, ignored the rules and got better. But that system could easily have killed me.

  121. A quick look at on line actuary tables shows the average death rate for males 25 years old is about 1 in 750 per year. Thus having 1 in 500 die during a two year period, would suggest that being in the Peace Corp does not increase your chance of dying despite the hardships associated with living in some quite primitive areas far from medical assistance. Of course, the people in the Peace Corps are necessarily selected to be healthier than average and thus a lower death rate would be expected, but accidents are a major cause of death of the young mitigating this bias somewhat.

  122. The loss of one of our best and brightest, who was in the process of serving humanity and bringing honor to his family and nation, due to what should have been an easily treatable illness.

    Did Dr. Gao perform a blood test at any point? Is it not logical to assume that a foreign person might not have the immunities that a native would have, and thus would be more susceptible to a simple bacterial infection?

    “Diarrhea and respiratory infections are the most common complaints and just require patience and over-the-counter medications.” Not so! My husband, born in the Philippines, returned from a visit there in 1983 with a gastrointestinal infection and was prescribed oral antiobiotics, to which he did not respond. He was subsequently hospitalized and diagnosed with typhoid, requiring a resection of his large intestine. We eventually won a jury decision in a malpractice suit against the doctor.

    Is it not also true that perhaps the major cause of illness and death in the entire world is dysentery, which is, in effect, prolonged diarrhea?

    Such a profound loss, and so completely preventable. As a public health nurse advised me to do in 1983, Mr. Castle's family should consider a lawsuit, if only to prevent this from happening to another Peace Corps volunteer. Perhaps any award could be used to fund a scholarship in infectious diseases.

  123. So what exactly was the cause of death?

    The article doesn't give enough information to figure out whether getting him to the hospital earlier would have helped and whether the earlier illnesses are relevant. It almost raises more questions than it answers

  124. Toward the beginning of this article it states "Three months before he died, Mr. Castle suffered gastrointestinal problems and complained to his Peace Corps doctor of worrisome weight loss, but he received scant follow-up care."
    I think a good dose of common sense is needed here. We have a young person in a strange country and culture. Sudden weight loss sounds like a reason to get on the next plane home. There are times to be noble and times to be wise. There should be training up front. If you get sick, time to pack it up and go home. Try again later.

  125. Don't blame the victim. Hindsight is 20/20. Idealism and altruism is what gets a person involved in the Peace Corps. His sense of responsibility to his commitment and his not knowing the deficiencies of another country's medical practitioner's expertise is neither his fault nor deserves blame. Compassion.

  126. Weight loss is common overseas. That's common sense.

  127. From US to less medical advanced area, I often see people overlook the immune adjustment ability. The younger you are the better your body can adapt to environment with strange pathogens. I had experience of bring kids back to Asia for summer vacations. My 3 years old girl back then was bitten by mosquitos in Japan, both upper eyelid and cheek under the same eye swollen up, immediately her one eye could not see - with half face puffed. Fortunately we were in a relative's clinic. A shot relieved her puffing up face. I took them for many time of trips over the summers as thinking it would be building up the immune system for them. When I saw people had not thought about this and opt to travel to a strange place or even stay a period of time, I worry about them. If you are not a local, you would not be able to figure out the traffic and else. I had experience riding taxi across a big city in China. It took 4 hours. No wonder my friend had suggested me to get one taxi at 3 pm for a 7 pm dinner. Many things could be critically important when one needs immediate medical care for acute illness. So this story may help to raise awareness on this issue.

  128. My Peace Corps doctor in Moldova was a bit of a hypochondriac when it came to the big G ( Giarda ) and any sort of diarrhea type symptoms. But she was under constant monitoring by Peace Corps DC. Maybe it was because we had so many 50+ volunteers - but I felt pretty secure. Though she did miss one friend's diagnosis- it was a rare disease that took American doctors another year in the U.S to figure it out.

    What I find is so interesting and alarming at times is the difference in quality between countries. I just don't understand how Peace Corps swings so wildly from amazing to dysfunctional.

  129. "I just don't understand how Peace Corps swings so wildly from amazing to dysfunctional."

    Like everything in t our health care system-you are fortunate if someone who "cares and listens" handles your care. There are a lot of algorithm physicians out there today. There is also the pressure on them to do things cheaply,and in accordance with various bureaucratic guidelines.

    The essential, single word of note is the "care" part of healthcare. Without that you're just another Kafka-esque lost soul in line at the DMV,trying to log in to Healthcare.gov. or arguing a claim denial with Blue Cross/Blue shield.

    There is no "global solution" to the problem. We need to treat each stranger as we would treat family and friends-not as irritant or problem in the days work-flow.

    I have tried to urge my students to ask themselves "How inconvenienced,bothered and caught up in a web of others indifference will I be if I get involved? My suggestion is that the more reluctant you are to get involved is the signpost on the correct and ethical path.

  130. At least the Peace Corps gets attention from national media such as the Times. Other organizations which send young Americans overseas receive far less scrutiny while sending poorly-prepared recent graduates into dangerous situations with little support. Those too deserve investigation.

  131. RPCV Kenya '04-'06

    Like so much of our government PC is a bureaucracy; however, in contrast to the balance of our government’s effort, PC requires a pioneering spirit that in some ways leads to an irreconcilable conflict.

    I am grateful every day for my service and the person it made me. I am also grateful to the PC/Kenya team who consistently went above and beyond.

    Nevertheless, the version of American foreign policy that slices the world up into neat little pieces with clean lines and predictable responses is not one well-suited to PC. Despite the best efforts, this centralized and layered approach will inevitably lead to tragedies borne out of an urgency and volatility that favors more nimble architecture.

  132. My sympathies to the Castle family. My heart breaks for you. We honor your fine son, his generous heart, his service to humanity. Shame on the Peace Corps for their dereliction of duty.

  133. When I taught English in Quito at the Fulbright Commission in the late 90's, a Cambridge University-trained doctor treated my dysentery, and I paid for it with my own insurance. I'm glad my bosses told me that I would have to find my own health care services, instead of sending me to a quack! It seems to me that the Peace Corps has failed on two horrendous levels: 1) not providing the quality of care to its volunteers that it should and 2) putting them at yet further risk by lying about the poor quality of its services. That's reprehensible. Castle should have been warned that he was getting an oxygen-mask doctor. What else is the Peace Corps not telling its volunteers?

  134. Why are we doing anything in China? Send the Peace Corps to the needy in the US, not overseas to a brutal regime.

  135. In fact there is a US-version of the Peace Corps - VISTA or Americorps but they are less "glamorous" than going abroad. I agree with your sentiment somewhat as I changed my focus from international health issues to domestic ones after learning about problems in the US.

    http://www.nationalservice.gov/programs/americorps/americorps-vista

  136. Yes...I would love to see the Peace Corps sent to our inner cities to teach English for heaven's sake.

  137. We have it in the US. It's called Americorps and receives even less funding and prestige.

  138. He was dangerously underweight and complained of being cold; his system was shutting down.

    And the doctor thought it wasn't serious because she looked at some insurance chart and could place his weight at low normal.

    Just awful medical inattention.

  139. My wife and I served in the Peace Corps for two years, returning from Macedonia in 2010. We both encountered serious health issues while serving. The Peace Corps medical staff did an outstanding job of providing care for us while we were there. That being said, we were living in Macedonia - we knew that there was some danger in doing what we were doing and had we needed the local medical services for anything really serious we would have been in trouble. The Peace Corps organization as a whole from what we witnessed was competent beyond words, truly remarkable, I too would hope that this story not paint the entire program with the same brush.

  140. I cried reading this article. Nick's death was preventable. My heart goes out to his parents, family and friends.

    From the perspective of avoiding deaths like these in future, I'd like to add a third point to two good points that have already been made in these comments. It has already been expressed that 1) Peace Corps medical care can be fantastic or lacking, depending on the place, time and people involved, and 2) Volunteers need to advocate for themselves, just as people have to in the medical system at home.

    Point #3 is that it can be very difficult or even impossible for a volunteer to fight Peace Corps bureaucracy quickly and successfully while ill. Volunteers are told to respect a whole host of rules (and defer to PC authority) and we don't have financial resources (monthly stipend of $150) to take our care into our own hands. A friend of mine had an infection that went septic, she risked amputation of her leg because no one could get in touch with the single medical officer authorized to request medevac. If you know you need to be medevaced but the country medical officer is out of cell phone range, you cannot medevac yourself.

    Two suggestions, PC country med offices need to delegate authority and have more than one person qualified to make decisions. And Peace Corps HQ should establish a direct emergency line to regional or Washington assistance for volunteers who feel like their conditions/illnesses/assaults are falling through the cracks.

  141. I am a Peace Corps volunteer now - there IS a direct emergency line to the Washington medical office for the reason you suggest (if we feel that care from the local PCMO is inadequate.) I started serving later in 2013, so I don't know if this hotline is a response to Nick Castle's death or if it was available earlier.

  142. I cannot speak to this particular case, but I was the local contact for US university interns placed in Chinese companies and schools a decade ago. We had a serious accident with one of our students. The school she was in panicked because the school administrators believed the school might be liable for very expensive (foreign) medical care. The school therefore proceeded to all but kidnap the student (isolating her from other US students and taking her phone) and sent her to a local hospital with VERY substandard care (to put it politely). She could easily have died had I not finally been made aware of the situation by another student.

    I wonder whether it might make more sense to have a US doctor in country (or borrow one from the embassy), rather than relying on people who could potentially come under pressure from local organizations.

  143. I was a Peace Corps volunteer in the early 1990's, dropped off in Northern Nigeria with a duffel bag full of spices and high brow fiction (the wisdom of this placement is a story for another time). Luckily, I was premed and had received some basic medical training, and I lived near a compound of UN volunteer doctors from Cuba and the Netherlands. I turned to them when I came down with horrible fevers (diagnosis-malaria; immediate treatment- life saving.). I relied on my friends in the UN compound to treat my ills and keep me alive.

    Now, as a physician, I am so angered to hear of Nicholas Castle's death. He died of gastroenteritis??? Shockingly. The Peace Corps is cutting corners to save money, and this is costing volunteers their lives. Each country should have a medical team comprised of US-trained physicians, PA's and RN's. That is what the state department folks get. Why are Peace Corps volunteers denied the high quality care that others with the state department receive? Another travesty for Peace Corps!

  144. Cause of death was not presented in this article.

    As a PC vol you accept the risk of going to places in the world where there isn't a Starbucks down the road.

  145. In Togo and in Nepal, the embassy doctor served Peace Corps volunteers, USAID and foreign service officers, along with US government contractors.

  146. Excellent comment.

  147. What a horrible tragedy. And just why did the Peace Corps ever discontinue the practice of having full-fledged members of the U.S. Public Health Service accompany the volunteers? Stories like this make you wonder whether this country's powers that be really care anything at all about the welfare of those who go many an extra mile in their willingness to serve others in need. Then again, right here in the good old USA many of us are wondering the same thing about this country's commitment to its very own citizens in need. And, please, don't anyone preach to me about 'self-reliance' and 'tough love'. I just had my lunch.

  148. This is tragic to lose a young man to medical negligence and indifference. A Westerner in China who goes down from 130 to 119 lbs is a pretty good sign of something seriously wrong. The Peace Corp participants are not run of the mill people, and Peace Corp should take the responsibility for providing outstanding care for them, as they give up substantial comforts and take on risks by going to these whole in the wall places that their country sends them.

  149. The United States should do more to support its domestic volunteer corps, as well. I am an AmeriCorps VISTA alum, and while I walked away with many of the same personal revelations and insight that many PCV's did, I also shared many of their frustrations.

    As an AmeriCorps VISTA, my stipend of $920/month pre-tax was not enough to support my shared housing costs, service existing debt, and eat without going into further debt (I had SNAP.)

    My pre-ACA 'healthcare coverage,' provided through a private cooperative system, did (and still does not) not cover pre-existing health conditions, and the $5,550 Eli Segal education award (and forbearance interest payment) for completing service was counted as taxable income.

    National Service volunteers struggle with what seems like confused leadership because of our lack of support at the congressional level. Not only are priority service areas changed constantly, but during budget negotiations, we are often hostage. AmeriCorps VISTAs were not furloughed during the government shut-down, but we were instructed to continue serving despite no promise of receiving our meager living allowance. We are prohibited from taking outside employment; being instructed to continue meant we could not seek other income during the shutdown. There is no sign of Congress changing this prohibition, either.

    Armed services: $438 B, 1,369,532 active, 850,880 reserve
    AmeriCorps: $1.05 B, ~80k members
    PC: $379 M, ~7,209 volunteers

  150. I understand the parents grief,and the feeling that their son was let down by the Peace Corp,as his health deteriorated. He was a brave young man, filled with idealism-so missing in this country where colored ribbons,5km fundraiser walks, and bumper stickers constitute the response of "socially aware and compassionate" youth.

    On the other hand- this young mans death by medical incompetence could just as well occurred in the US. I've worked in the healthcare field since 1978. In busy hospitals,especially in poverty pocket "count-hospitals" as well as rural ,isolated community hospitals of 25 beds facilities . I have seen so many cases where "failure to appreciate" the urgency of dehydration, electrolyte imbalances, and peripheral circulatory collapse have led to preventable deaths or limb loss.

    Often the chief culprit in medical misadventures, is the hubris of the provider (MD usually). On many occasions I have seen clinical care givers (RN's and others) risk their jobs by refusing to defer to the physician-often for a stranger-due to their alert compassion and sense of duty, and actual time spent with the patient.

    This is of no consolation to Mr. Castles family. But it does occur in some of the "best" US hospitals. The immediate response by the facility is always "damage control", not change in practice. I imagine that the Peace Core, with its continually threatened and reduced budget, is in an even weaker position.

  151. I was a volunteer in Senegal, West Africa in 1995. I agree that the Peace Corps' medical care is sub-par. When I had gastrointestinal distress, I lay in my hut for over 24 hours, delirious and with a fever of 103-104 F degrees. Local villagers would walk into my hut, look at me, offer no assistance & walk out. Once I could walk, it took flirtatious pleading & begging with local male police officers to get a half-day ride to a larger town, where a Peace Corps medical box was located with antibiotics.

    I think a key to this story is this line: "But the Peace Corps vehicle was in use by the agency’s country director, an internal inquiry later found, and none of the medical staff members 'felt empowered enough' to ask her to give it up 'even during an emergency.' "

    I remember feeling that out country director was an overpaid bureaucrat who really didn't know what was happening with his volunteers in the field. He lived in a gorgeous house in the capital, which was attended to by local maids, cooks & groundskeepers. He hosted parties for other government officials. His son surfed and smoked weed on the roof of their house.

    Why were the medical professionals so afraid to ask the director to give up her car for this medical emergency? If they could have used her car, this young man's life might have been saved. Let's get rid of hierarchy-loving government bureaucrats and hire former Peace Corps volunteers as country directors. The Peace Corps needs an overhaul on many levels.

  152. My daughter was in the Peace Corps. As she relayed to me there are really two branches of employees in country. The Peace Corps: people really in the field living with the local populace. And, the Posh Corps: the people living an upper class live in a big city.

  153. Maybe that director was a former volunteer. What makes you think he wasn't?

  154. Here's hoping that the NYT will follow up on the charge about the country director's lifestyle.

    It does seem inevitable that every well-intentioned program ends up run by a hidebound bureaucracy staffed by self-serving functionaries.

  155. I am shaking as I write this.

    My daughter was a Peace Corp volunteer with Nick Castle in China. She left the PC early for a variety of reasons (the PC has a significant drop out rate around 40% they never tell you about) and came back to the US for Christmas where it was quickly discovered she had some serious medical issues. Once she was back on my health insurance (thank you, President Obama) she received first class medical treatment and surgery at a suburban Philadelphia hospital. She's absolutely fine today and has entered the teaching profession.

    Had she stayed in China her medical issues would have been the same Russian Roulette Nick faced. I am heartbroken for his parents, family and friends.

    We live in a troubled world and the political discourse between us is coarse. The kids (and most of them are just that) who enter the Peace Corp are among our best and brightest. They've simply decided to measure success not by how much money they ultimately make but by a desire to make the world a little bit better.

    There are many Nick Castles among us, in the PC and military and elsewhere, doing the best for their country. This article is a reminder of their sacrifice. God Bless them and their families.

  156. Mookie,

    I share your concern and reaction. Nick's death is so tragic and unnecessary. I served in Peace Corps China 05-07, when Dr. Gao had just begun to work with the PCMO. I taught in Chengdu and visited the medical and Peace Corps office on a number of ocassions. I was impressed with the quality of care that I received from Dr. Joanne Polka, the PCMO. Joanne was the key to a successful and fully professional health care program for Peace Corps vols in China. Dr. Gao was always at her side, almost seeming to be an apprentice to both common medical diagnoses (using English, as Dr. Gao was very well trained though in gynecology) and working with American volunteers who were young people. I really feel for Dr. Gao here, and though the piece highlights the timeline that lead to this tragedy, it shows to me how ESSENTIAL it is for a very experienced medical professional - who is an American - to serve as PCMO. I don't know if Dr. Gao had "anchoring bias", but certainly needed to work together with an American PCMO and program that is sensitive to EVERY potential symptom, not just assuming common colds or stomach bugs (that most vols like me had). I loved and cherish my time in Peace Corps China. And it is out of affection that I appreciate the New York Times and especially the Castles' for revealing some HUGE needs for improvement.

  157. A very similar situation happened to my cousin back in the early 1980s when he was in Morocco as an RPCV. He came back home to receive treatment for a serious gastrointestinal problem that was not being dealt with effectively by the local doctors or the Peace Corps. It took him months to get better, but he always felt like he had failed the Peace Corps in some way. It amazes me that the Peace Corps has made so little strides in securing proper medical treatment for its volunteers since then. Sadly, I also remember learning of a brilliant student from Hamilton College, NY named Jennifer Lynn Rubin of Oneonta, NY, who served as an RPCV in the country of Togo in West Africa and was murdered there in 1983 as a result of a retaliation for reporting a theft. In my view, she had not been effectively briefed on the customs and culture of the this particular village and did not know enough to weigh the risks involved in reporting the incident to family.

  158. Thanks for this thoughtful post. Our youngest daughter was I the Peace Corp stationed in Kazakhstan.
    We were informed she was "missing" and the totally inept person from our embassy informing us of this situation told us to "...be optimistic because no bodies have been found".
    Fortunately, she was found healthy and well. However, the memory of this incident lingers on.
    ,

  159. I am very sorry for the Castle family's loss. I think every volunteer worries about somehow dying while abroad and how much harder that would make it for their family. I know that I did.
    The Peace Corps (PC) is dangerous. It has to be. If it wasn't dangerous it would be the Foreign Service or USAID. The volunteers would go everywhere in a white Landrover with tinted windows. Every other face of Americans helping abroad already looks like this, unless they are proselytizing.
    PC allows volunteers to interact with locals on a level like no other organization. This is what makes it effective. All other development organizations are based in the capitals. They speak the local language through an interpreter. They don't have neighbors. They don't make friends.
    PC errs on the side of caution. It is quick to send volunteers home and it is quick to ban things. In my country of service, riding a horse for example, was not permitted. And when volunteers decided they had had enough they were often en route to the US by the end of the day.
    It's always easier to say ''make it safer,'' but in US Gov. this often translated to ''impose stricter regluations and isolate volunteers from their community.''

  160. When I was younger, I considered the PC and I suppose I still can since they accept older volunteers and I have a medical background. But I'm not sure you can say that PC is necessarily effective. I remember reading about a young man, a PC volunteer, with no agricultural background sent to Africa to teach farmers about farming. His view, rightly so, was what could he realistically teach these people who had been farming for decades. Even with a farming background, his experience would have been in the US, a place with different soil/ climate/ etc. characteristics. I also question how much impact people expect to have in 2 yrs.; what happens after they leave? Are the natives able to sustain any changes? PC should not merely be an experience for Americans to learn about other countries; other countries need to genuinely benefit.

    Don't be so arrogant about other orgs. I have friends who've volunteered with other groups for a much longer period than 2 yrs. in another country and some are very effective.

  161. I had two sons (and a husband) serve in the Peace Corps. I think of myself as a reluctant Peace Corps enabler.
    I have always had mixed feelings about the Peace Corps. I think, generally, it is a adventurous experience for the participant.
    It is, from my vantage point, as a parent, a very tense experience for the parent. While one of my sons would comfort me that he had the best health care in the world because he could be medivaced out of his location b/c the Peace Corp had his coordinates. I knew, as a parent what he did not know as a 23 year old: that a lot of things had to line up just right to get that circumstance to work---the doctor needed to be accessed, and then, the doctor needed to be on point. The medivac needed to be available and convinced it was needed, and on and on....

    Needless to say this concept did not help me many nights lay my head on the pillow. Like many things in this world, it is a bit of a crapshoot---the country you are sent to, the doctors that surround you, how your immune system adapts to the health ecology of the location.

    I gotta say, I was glad he had had his appendix out before he left. I felt such a diagnosis might challenge some local docs in Africa and is one of those diagnoses you are time limited to get right or suffer major consequence.

    Peace Corps is not for the faint of heart, either as a volunteer or a loved one.

  162. Life is not for the faint of heart.
    Chance is always there.
    Hope for the best; prepare for the worst so far as possible.

  163. I won't pretend to know the grief and emptiness the Castles must still be feeling after the loss of their son. I do know that for myself, as one who has considered volunteerism a way of life, Nick was living the highest form of life possible-giving selflessly and thoroughly in the service of both his country and humanity at large. How many of us can, at the end of our lives, honestly make this claim. To have lived without regrets and with the passion of knowing they were changing the world for the better as a result of their actions, however small and insubstantial it may have seemed in retrospect. Too often, our lives, I think, are about personal gain, guaranteed security and endless material acquisition. Nick Castle can be a role model for all of us as a testament that there is so much more available out there than self-aggrandizement and the road all too well-traveled.

  164. From 1967 - 1970 we served, far out in the bush, in Cameroon as public health volunteers. We were issued a basic medical/first aid kit, had some training, and expected to use our judgment and common sense to maintain health, in quite primitive conditions. If we could make it the 75 miles to the capital, we knew our own Peace Corps doctor would take care of us. Yes, Peace Corps suffers from endemic federal-agency bureaucratic illness; but it still offers matchless opportunities for service and for learning. I would do it again, and maybe will!

  165. I am very sorry for this young man and his parents. I commend him for wanting to serve our country and people in need.

    Why in the world is the Peace Corps in China, an industrial powerhouse? Maybe, China needs to found its own version of VISTA or AmeriCorps?

  166. As a parent of an RPCV I deeply sympathize with the Castle family's tragic loss. We were constantly concerned for our daughter's safety while she was abroad and felt very fortunate that she only suffered only minor illnesses during her service. The risks, to health and otherwise, were always apparent. It must be an almost unbearable tragedy to lose a son or daughter whose displays the enterprise. heart and promise characteristic of those who volunteer. Hopefully, corrections will be made. In my experience. the Peace Corps, as an organization, is upfront in taking its responsibility for the welfare of its volunteers very seriously.

  167. My wife and I spent 6 months teaching in China in 1985. I went from about 180 to 160 pounds. My wife similarly lost a great deal of weight due to various gastrointestinal disorders.

    I don't know exactly what happened to poor young man who died and certainly one can only feel great sympathy for his parents and siblings but the truth is when you spend time in a third world country you're taking a bit of a gamble. You may very well be exposed to various diseases and you have a pretty good chance of not getting the kind of medical help you might receive in the states.

    We always seem to demand accountability, someone has to be responsible for the tragedy. But maybe that's not the case in this instance, maybe Nick Castle just had the terrible misfortune to have gotten ill in a place that wasn't suited to care for him.

  168. No, he became gravely ill and the organisation that was supposed to be looking out for him failed him. Failed him utterly. There are no excuses for the incompetent "care" he was "provided".

    I might add that China has changed significantly since your visit in 1985, and there are now a variety of high-quality western-style hospitals available, that is, if your physician is capable of recognising that you're sick enough to need to go to one. In this case, the physician was incompetent, and a young man is dead.

  169. As a former volunteer who went through a similar ordeal, the Peace Corps actively lies and covers up it's medical negligence. The problem is both the medical incompetence and downright negligence AND their history of covering it up by lying. So yes, they should be held accountable.

  170. The historic laissez-faire attitude of the federal government towards the health of its Peace Corps volunteers no longer cuts the mustard in a nation which has now dedicated itself to the good health of every American. Plainly the federal government has the resources to assure the good health of Americans no matter where they are stationed. The question is whether or not it has the will to do so for Peace Corps volunteers, whose numbers currently include my son. If it doesn't, then perhaps the Peace Corps' time has passed.

  171. I am Nick's mom. I am very happy for all who have served in the Peace Corps and came home healthy and safe. Nick was NOT treated properly by the PCMO's and we have experts outside of the Peace Corps supporting our concerns. I naively believed the Peace Corps would be doing the right thing in investigating Nick's death and treatment. In reality they misled to believe that an investigation was ongoing and that changes would be made. That did not happen until the Times made an inquiry to the IG's office back in April of 2014. It is now over 17 months since Nick's death and we still don't have a report from the IG's office. The Peace Corps seems to sweep issues under the rug and deal with them only when they get out of control.They are a bureaucracy like any other government organization.It has taken many years for the victims of sexual assault to get any type of help from the Peace Corps. There are many other RPCV's who come home disabled or with life long illnesses and it is very difficult for them to get any type of treatment. Anyone who had a positive experience-great.It doesn't take away from what happened to my son. My son loved the Peace Corps. He also died. His death could have been prevented with very simple treatment.
    Our family wants the Peace Corps to be better-for all the volunteers.

  172. No less than military servicemen and women, your son swore and oath and died serving the interests of our country.
    Thank you for his service.
    This wealthy and powerful nation does not provide adequate medical care to either military or PC volunteers.
    Why?

  173. Sue,

    I am so saddened for your loss. I can see from the NYT piece that Nick truly loved Peace Corps and was a dedicated volunteer.

    I served in Peace Corps China (05-07) when Dr. Gao was beginning to work in the medical office in Chengdu. As a volunteer in Chengdu, I visited the office regularly and was shown nothing but the most professional of health care. In reflection on this piece, I remember that there was a PCMO, Dr. Joanne Polka, who was an American trained and experienced medical professional. She spent a lot of time working and orienting Dr. Gao. I don't know the experience of the American currently working alongside Dr. Gao, but that person needs to be vigilant and train EVERYONE in the office to treat every symptom as a potentially serious illness. Dr. Gao is well trained, but the PC needs an American staff at each outpost who will make assertive medical decisions with a professional sense of urgency when emergencies arise. Again, I am so sorry for your loss and cannot commend you and your husband enough for allowing your tragedy to expose some flaws in what is a fantastic ideal that Nick, and I, as volunteers loved.

  174. My condolences to you and your family. The world has lost a shining light.

  175. Speak to PCVs from any number of different countries and you will get back an equal number of different opinions on the administration of the programs. Some country programs are orderly run while others are at the other end of the scale. My program was mostly like the wild west. However for health care, my Medical Officer was great, had a protocol and monitored us closely -- until some shadow in a cubicle in DC got involved.

    I was three fourths of the way through my two and some years of service when I got hit with appendicitis. I was also fortunate to have been at a conference away from the field in the capital where my Medical Officer was also present. Another PC Medical Officer from the neighboring country brushed me off with gastritis. To my Medical Officer's credit, she took my immediately to the hospital and I had emergency surgery. Despite the frightening retrograde Soviet look to all of the medical facilities, the care I received overseas from "host nationals" was far better in quality than any I have experienced here in the US.

    Yet, for the wonderful person my MO was, she did also put me on antidepressants (I had complaints about insomnia) upon orders of Washington. I never saw a psychologist, psychiatrist or even a doctor of any kind. This led to a dependence which took me over 10 years to break. My mind had been altered. All because someone whom I never met or spoke to said I should take the medication.

    Mr. Castle's death shouldn't have happened.

  176. The article says that "deaths in the Peace Corps are rare," but it then states that 0.2% of Peace Corp volunteers have died. Statistically speaking, that’s a very high date rate, when compared to the fatality rate for occupations in the U.S.

    First, it should be noted that the 0.2% figure mentioned by the article is not expressed on an annual basis. But that conversion is easy enough. According to the Peace Corps website, volunteers serve an average of two years. Therefore, over the course of its history, the Peace Corps on average has experienced an annual death rate of 0.1%. That may sound low, but it’s actually very high for an occupational death rate.

    The U.S. Government’s Bureau of Labor Statics (BLS) released a list of the ten deadliest occupations in 2012. See http://www.bls.gov/news.release/pdf/cfoi.pdf (p. 5 of PDF). Statistically, the deadliest is logging worker with a date rate of 0.1278%. Second is fishing workers with a death rate of 0.117%. For the third profession on the list, the death rate drops sharply to 0.053%, which is only about half of the Peace Corps volunteer 0.1% death rate. Thus, if Peace Corps volunteer was a U.S. occupation tracked by the BLS, it would have the third highest death rate of any occupation in America!

  177. Also, as cited in the article the PC volunteer membership is disproportionately young. The occupational data you cite most likely spans all ages and represents populations that are composed of larger percentages of people older than the PC membership.

  178. David Mulholland, my roommate at Tufts University in 1961, was the first person to die in the Peace Corps. He was located in Occidental Negros province of the Philippines when he died [see New York Times obituary for more information]. His symptoms, I am told, were almost exactly the same as those of Nick Castle. Of course, in those days, I guess they didn't have the comprehensive care they have now: Plus ça change, plus c'est la même chose.

  179. After reading this story, I would never agree that my young adult child serve in the Peace Corps. Heart-breaking.

  180. Surely part of the problem is that Republicans ahem starved the Peace Corps of needed funding.

    Another part may be that the Peace Corps is a tool of public relations more than an organization that helps people.

    It's also very hard to find Pepto-Bismol in China.

    I hope the parents sue the US government.

  181. It depends on where you are. If you are in a major city like Shanghai, Peking, or Hong Kong (now that it's part of the PRC), you can find Pepto-Bismol or other meds, especially in districts with lots of foreigners or wealthy Chinese natives who have been abroad and desire Western products.

  182. I have mixed reactions from reading this article. The Peace Corps as a government agency should face public scrutiny, especially in light tragic incidents such as the death of Mr. Castle. However, I wonder if the laser-like focus on this particular case actually provides a balanced and useful perspective of how the Peace Corps manages the medical affairs of volunteers in the field.

    I was a volunteer English teacher in Kazakhstan from 2006-2008. I drank the local water, and late in my two-year service I contracted giardia. After numerous phone consultations with our medical officer (who was a US military-trained doctor from the Ukraine), I was flown to the Peace Corps office in Almaty, where I was examined and given medication. The symptoms eventually cleared up, and I resumed my service as normal. In my opinion, this is the typical story of how medical treatment in the Peace Corps works. Stories such as Mr. Castle's, although unfortunate, are exceptions to the rule.

  183. Also an RPCV from the Philippine/Mindanao in 1983-84. My sympathies and prayers for the Castle family.
    While in the Peace Corp I experienced an obstructed inferior vena cava and pulmonary emboli. Prior to the PC I was a long distance runner and had bicycled across the USA. Started having low. (low) back pain/chest pain with exertion. The PC physician in Manila told me it was in my head. Gradually had lower extremity edema that increased to pitting edema. After 2 months of this was hospitalized in Makati Medial Center. 10 days later was tranferred to Clark AFB hospital as IV antibiotics did nothing. 28 days in Clark and no diagnosis. Flew to DC and sent, after a week, to a filiarsis researcher at NIH. He diagnosed obstructed IVC (not lymphatic edema) and directly admitted me to GW hospital. A venogram confirmed the diagnosis.
    The experience changed my life. I went on to medical school as I was frustrated by the lack of diagnosis. I was lucky to live. But the resulting venous insufficiency left me without the ability to run and chronic venous stasis problems.
    There is a attitude, or at least was, of the PCV not seeking care. PCVs try to tough it out and self diagnose. A fellow PCV looked at my legs and called the PC nurse himself. I wasn't going on my own. The PC nurse saved my life. In addition diagnosis are difficult. This is especially true in a 3rd world environment. A GYN physician should not be the medical manager.

  184. Most of the statistics cited in this article concern those who completed 2 years of service. But an investigation into any Peace Corps practice should also take into account those who did not finish the program. I believe many of the latter drop out for reasons connected with the management of the program and the lack of responsiveness to concerns about safety and health (both mental and physical). The experiences of those willing and competent volunteers who didn't make it all the way should be included in this discussion.

  185. My daughter was a PCV in Morocco and I lived in China for 5 years on a professional assignment. While our health care system has it's problems, we in the west are very lucky to have ready access to health care, particularly in emergency situations. When I was living in Dalian, I had what was suspected to be a heart problem and was quickly moved from the clinic that served our expat team to the Chinese health care system. My day was one to remember, driving around trying to find the correct hospital, suffering from chest pains with no medication available, and being taken to places where I was literally afraid to spend an hour, let alone a night. This young man's story is terrible, but I'm afraid not uncommon. A toxic mix of American bureaucracy and Third World medicine. A shame that it couldn't be avoided.

  186. Thank you, David and Sue, for sharing your heart-wrenching story. As the mother of a 22-year-old who leaves in a few months for his own Peace Corps assignment, I feel I know better than most how truly special Nick must have been.

    I hope that your story - and the stories of so many volunteers who commented here - can drive needed improvements within an organization that still holds so much promise for so many.

  187. I served in Albania in the early 90s and like virtually all of my fellow volunteers, suffered from gastrointestinal illness, which resulted in diarrhea, vomiting and dramatic weight loss. The Peace Corps had an excellent medical officer in Tirana. She treated us with diligence and would evacuate volunteers for treatment if their condition warranted.

    In the early spring of 1993, I traveled to Krakow to participate in a conference. My route to Poland took me through Skopje, Sofia, Belgrade and Budapest. In Sofia, I started feeling ill. What seemed like a sinus infection soon became a persistent cough, and then a constant, often violent cough. When I arrived in Budapest, I went to the Peace Corps Country office and met with the medical officer. The medical officer gave me Tylenol and sent me on my way. Approximately 5 days later, I returned to Albania and went immediately to the medical officer in Tirana. She diagnosed pneumonia and gave me an injection of penicillin and ordered bed rest for one week. She was upset, however, about the lack of care I received in Budapest. [The facilities in Budapest appeared to be of Western standards; the Albanian facilities were definitely not.]

    I think I was lucky for a couple of reasons, namely, Albania is small and there were less than 20 volunteers in the country at the time; and perhaps the budget climate was different then.

    I hope Nick Castle's family can find peace. I hope the Peace Corps can change.

  188. First, to Sue and David Castle, thank you, the impact of your courage and determination will resonate forever.
    That a so-called "Peace Corps." inducts extremely well intentioned, young people, and subsequently looks askance, is utterly shameful.
    When the Times reporter cited how the Peace Corps. devised a news release addressing Nick's tragic passing, the Peace Corps sense of grandiosity and entitlement went out of bounds.
    The news was not about the Peace Corps., it was about Nick. Nick expressed concerns about his health multiple times. He was a heroic young man, who in all likelihood, thought that most people he encountered were as well meaning as he.
    Under these circumstances, that a government agency, the Peace Corps, was singularly concerned about how they appear in the media--is absolutely sickening.

  189. All those hyperventilating at the idea of 2/10ths of 1% of people who approximately between age 20 and 39 dying, need to get a grip. That is 20/100ths of 1%

    The mortality rate in the US for that age group averages 21/100ths of 1%.

    There is NO difference in the mortality rate for that age group whether they be a Peace Corp volunteer or staying home in the US

    ANd car accidents or injuries while doing sports (climbing etc) while a Peace Corp volunteer are hardly the fault of the Peace Corp.

  190. I don't think that was the point of the article. The PCV's should have decent medical care. Our government whuich sends them to other countries, where they volunteer, has an obligation to their citizens. If not, the recruitment brochure should state that they go at their own risk. Also troubling is the lack of a clear explanation after this young man' death. My deepest sympathy to the Castle family.

  191. Thank you for this story. It, along with the stories from previous volunteers, who emphasizes once again that the Peace Corps, despite its ambitious mission statement and the thousands of positive experiences it has created for volunteers and the communities served by volunteers, is an agency in flux.

    While the article brings up a very valid point about placing some degree of responsibility on the Peace Corps medical staff, it does leave out one critical component - the program staff. We were the professionals (ideally acting professionally) who made the decision of where to place a volunteer and we were the ones visiting volunteers on a regular basis. On more than one occasion I had to "remove" a volunteer because I observed during a meal he/she was not eating, because the community commented they were not leaving his/her room and any number of clear signals of potential psychological or physical concern.

    Sadly after my 2-years working in the Peace Corps (and never being a PCV) I concluded that the agency had yet to fully professionalize and define what it wanted to be and how it could get there. It just seemed strange that after more than 40 years, volunteers were still debating if PC was about having a "life experience" or truly providing "development assistance" I believe it is these ideological struggles that overshadow much of the agency's crisis and mishaps.

  192. My wife and I were Peace Corps volunteers in Turkmenistan from 1994-1996. During our in-country training, Turkmen PCVs were given a crash course in Turkmenistan-specific medical self-help and a copy of "Where There Is No Doctor." We were stationed in a village several hours from the capital, and to communicate with the medical officer, we needed to walk into town and wait in line to use the phone at the village post office. I had several high fevers (104+), a couple forms of dysentery, and other illnesses during my service. I lost about 40 pounds over two years, mostly due to hyper-inflation, sickness, and a lack of food in the village marketplace.

    But I thought our PCMOs were great. The only problem was that they were far away and communication and transportation was a problem. That's the nature of the Peace Corp -- you live in remote places and you live at the level of the people you serve. During our service, many of our Turkmen friends had struggles with illness and I remember thinking that I wished they could see *our* physicians to get advice and medicine.

    What happened to Mr. Castle is a tragedy and I can't imagine what his parents are going through. Many things about the Peace Corps, and many specific country program, could be improved. It sounds like some terrible mistakes were made in this case. I don't think it's entirely possible, though, to eliminate the health risks that come with Peace Corps service.

  193. I don't think anyone here is advocating that the Peace Corps eliminate risks. That's just silly. Rather, many of us would prefer that the people who run the Peace Corps simply start acting responsibly, which was certainly not what they did with Mr. Castle and many others (myself included).

  194. I don't think anyone here is opposed to Peace Corps acting responsibly. In all organizations, in every country, some people will make mistakes and some bureaucratic units will function better than others. And all organizations can be improved. But this article point out that when mistakes and organizational failures happen in the Peace Corps, the consequences can be much more serious than mistakes here in the U.S., given that volunteers must rely for expert medical advice on one person who usually is located hours or days away, and is often hard to contact.
    What I'm saying is really just what many other RPCVs have noted in the comments: living among and at the level of the people you serve is what make the Peace Corps different that other U.S. organizations. Peace Corps volunteers are often assigned to remote locations where they may be the only American their hosts and friends have ever seen.
    I'm sorry that you had a bad experience in your country in the 80's and I agree that there are probably many ways that specific country programs today could be improved. From the article, it sounds like mistakes were made with regard to Mr. Castle, with tragic consequences.

  195. First, my heart goes out to the parents and friends of Mr. Castle. Having experienced the loss of a child myself, I know how difficult the path before them is.
    My wife and I were PCVs in Mali, 1988-1990. We had what one commonly gets in rural West Africa: dysentery, malaria, worms, skin infections, etc. and we did the best we could to treat ourselves and to get care from the Peace Corps Medical Office when necessary. They were quite competent and caring, but generally overworked. We all understood that we weren't going to get the care we expected in the US, but that's just a reality one accepts when one signs up.

    Later, I served as Country Director in a Balkan country for five years and got a chance to see how the agency allocates money, care, and people to the volunteers who serve. I was genuinely impressed with the competence of our American and local medical officers, not to mention the high level of effort they routinely put in. There were times when we felt financially stressed, but this is more a reflection of our country's budget priorities than the agency's willingness to fund care.
    When I was a PCV the commonly told joke was that PC funded the work of 10000 volunteers in 70 countries for less than the cost of the US military marching bands. Twenty five years later, the tight budgets remain while the volunteers and staff continue to bring all of the energy, resourcefulness, and love that it takes to make a difference in the communities that they serve.

  196. What a terrible thing to have happen!! Volunteers need much better care than this.

    I was part of Malaysia XIV and taught in a local school with the Peace Corps in northwestern Borneo in the Malaysian state of Sarawak in 1967-68. We had our own Peace Corps doctor. The doctor left. I never heard a reason. It would be interesting to know why we could have our own doctor several years after Peace Corps started but that now volunteers can get horribly sick and not get decent care.

    Peace Corps left Malaysia years ago. I heard that the reason was the the host country was asking for volunteers with higher degrees than could be provided.

  197. I think there is a risk in sending out young people on their missions. Aside from any problem with the country's medical care or the medical supervision of Peace Corps volunteers in the field, there is simply the fact that young people who have almost never been really sick, don't know how to monitor themselves. I'm not saying this was true in the case of Nick Castle, but it is something to think about. They don't know when serious is serious to a great extent. Nor do the other volunteers. I know of a case of a death, by a fairly rare virus, in the case of a college student acquaintance. He was just quiet in his bed and a day or so later he died. I'm saying this without knowing the facts of Peace Corps life, whether or not they do give the volunteers a check sheet on symptoms and problems they, the volunteers, should be very vocal about.

  198. Thank you for reporting on this. As a former volunteer in the Dominican Republic I absolutely believe they were negligent because it happened to me. I was hospitalized with pneumonia for four days because the Peace Corps nurse badly misdiagnosed me (American and American trained). She insisted I had bronchitis, gave me cough syrup, said it would take up to 6 weeks to go away, and told me to go back to my site- 6 hours away from medical care. I stayed in the area though over night and by that evening I could not breathe and was rushed to the ER. Had I gone back I would have died.

    While that was bad, the worst part was the way the Peace Corp. covered it up- then and even now. The nurse prevented me from having visitors by not posting my admittance in the Peace Corps lounge, which was customary then (to keep me from talking apparently). No other volunteers even knew I was there until I was released (we did not have cell phones back then). The Director insisted I stay with her for a week after my release (something never done). And when the Peace Corp denied my 1 year extension request because of “anxiety” other volunteers agreed they knew they messed up- badly- and wanted me out of there.

    Last year I requested my Peace Corps. medical records for something unrelated and amazingly- there was absolutely no record of my hospitalization. If that happened to me now I would speak to lawyer immediately. I hope Mr. and Mrs. Castle get the justice they deserve.

  199. I was in the Peace Corps in China over a decade ago. To this day, I often say that I got some of the best medical attention I have ever received while I was there. I was treated for things I did not complain about but that the medical staff decided preemptively that I needed. For instance, after a certain incident involving my housing situation, the medical staff (mainly Candace who is mentioned here in the article) decided that I should come into Chengdu and take a few mental health days to remove myself from my apartment. I was not even upset by what had happened and resisted at first, but looking back, it was a good thing to do. I also had a slight case of asthma that they watched like a hawk and always got me any medication I needed before I needed it. Furthermore, I had quite a few friends who were medically evacuated to Washington DC to have all sorts of ailments looked after.
    I feel terribly for the parents and family of this young man, along with anyone who was involved in this case. It is a tragedy.

  200. “Diarrhea and respiratory infections are the most common complaints and just require patience and over-the-counter medications.”

    Except when they kill you.

    "But the Peace Corps vehicle was in use by the agency’s country director, an internal inquiry later found, and none of the medical staff members “felt empowered enough” to ask her to give it up “even during an emergency.”

    Another hierarchy gone bad.

    R.I.P, Nick. People like you are rare and much needed.

  201. I was a volunteer in Ecuador with WorldTeach. There was also a PC presence there and the PC nurse came to talk to us. We thought she was going to tell us what to do if we got sick, how to recognize the signs of a serious illness, etc... All she did was to continually tell us to not get sick. She did not offer one piece of helpful information and when she left we were all stunned at how incompetent she was. Until the PC medical care gets better, the smartest route is to find a doctor in the country who specializes in treating Westerners.

  202. I am the mother a healthy, slender 19 year old son. I am neither a doctor nor a nurse, but if he were vomiting and lost 10 plus pounds within a month, I would know something was drastically wrong! The Peace Corps doctor in China did not care enough about this young man. A mother chaperone would have had him to the hospital during the onset of the first bout of vomiting. He should have lived, no question about it. I feel so sorry for the family.

  203. As an RPCV who worked in both Peru (2007-2009) and Honduras (2010-2011), I am struck by the human tendency to express outrage at the death of one of our own fellow citizens, while failing to recognize the implications for the underprivileged Chinese citizens this young man was sent to assist. I find fault with the suggestion implicit in this article that the health care provided by the Peace Corps is negligent and in need of a major overall, when in fact the care most Peace Corps volunteers receive far surpasses the care received by host-country nationals in the countries where they serve. In my experience, the health care I received clearly exceeded the care received by the Peruvians and Hondurans I lived and worked with. In some cases the care even exceeded care I would have received in the U.S. While I empathize with the Castle family, I’m left wondering what entitles U.S. citizens to such high quality care, and not the people they are sent to serve.

  204. For Mr. Castle's case, while the medical care can vary in China, it is not uniformly poor. Doctors in Shanghai and Peking can be top-notch, equivalent or better even than those in the states, and have access to technology. Of course they might be more expensive than the average Chinese citizen can afford.

    Chengdu is a major city in Central China (friends did a medical exchange trip there) and has Western-oriented medical schools/ clinics/ hospitals. I personally have worked with MDs in Xi'an, which is another major city in Central China and had a colleague who became sick during our time there. That colleague was treated similarly by Chinese MDs as he would have been in the States. Mr. Castle's care was below the standard than what he could have received in China even if it was not the top-of-the-line care of Shanghai/ Peking.

  205. First, let me state that Karen's point is well-taken about the huge disparity of care globally. But, the grievous inadequacy of care for those in many parts of the world does not remove the obligation to provide adequate care to PCVs, while acknowledging those they serve should receive similar care.

    Too, Karen, it is useful to bear in mind that Honduras is quite close to the US and it would have been easier to evacuate a You to the US, if necessary. Nevertheless, it us not unrealistic to expect the care in Chengdu to have been decent or to have options for PCVs to be evacuated to areas such as Shanghai or other cities.

    I have a relative in a very low-paying job in the Shanghai area. He received questionable care for one ailment but actually received good care for another once I insisted he go to a facility affiliated with a med school. He returned to the US for follow-up and is back in China.

    Sure, there has to be a balance but care in many parts of the world may have improved in the years since the early PCVs commenting on this thread served and technology has improved also. Nick was keeping a blog, after all. He was not in the "bush." Doctors make mistakes all of the time. But, questioning the care Nick got is not necessarily indicting a whole organization or the program's intent. It is trying to uncover what went wrong, improving it for others and forcing truth-telling if that has not occurred.

  206. My condolences go out to the family. I served in Peace Corps Thailand 2011 to 2013 and this sounds disturbingly similar to my experiences. During training, I suffered from back to back bacterial infections from which I was unable to recover. My gastrointestinal problems lasted for over a month, and I lost 15 pounds on my originally 145 pound, six foot frame. I repeatedly reported my condition and weight loss to Peace Corps staff, but I – I assume because I only sounded ‘mildly distressed’ – was not hospitalized until one day I began vomiting and could not stop without medical intervention over three hours later (this took several calls to Peace Corps staff). I served with my wife and without her insistence and multiple phone calls I do not know if I would have been hospitalized even at this point. I was stayed at the hospital in Bangkok for five days but neither our country director nor the medical director in Thailand, who were both located in Bangkok, visited me during this time (the country director has changed multiple time since this time).

    Peace Corps underwent ‘top-to-bottom’ reform with respect to its’ response to sexual assault. If the reforms worked, perhaps a similar set of reforms are needed for Peace Corps’ response to serious illness.

  207. I didn't serve in Peace Corps, but did spend about 2.5 years in East Africa, much of it in the company of PCVs. Despite its best intentions, I don't think Peace Corps can actually provide better health care than what is available to other expats with good insurance and a couple of credit cards. In urgent situations, Peace Corps turns to the same patchwork network of under-resourced public hospitals and private clinics, with the same provisions for medical evacuation as available to those with good insurance.

    The best description I can offer of the medical care available in country is idiosyncratic. It really depends on who you know; your friends are your best line of defense and most important advocates. Much like Nick's roommate raised the alarm about his illness, I have twice been in situations were friends were instrumental in overcoming shortfalls in the local medical system, especially as they pertain to diagnostic efforts and urgency of treatment. Even with all of the financial resources one can muster, the line between the expected maladies of travel and critically ill is very thin in places with poor medical infrastructure. The margin for error is much smaller when abroad, and the consequences can be tragic. Nick's story saddens me but doesn't surprise me, and I think that in some ways, the greatest failing of the Peace Corps is in leading volunteers and their families to believe that it can provide western-standard care on site.

  208. As a 34 year old returned Peace Corps Volunteer (Mongolia 2011-2013) I have to say that my medical treatment during service was excellent and probably better than any medical care I will ever have again. We had around 130 volunteers in the country at any one time and two Peace Corps Medical Officers (both Americans) who were nurse practitioners. That's a pretty good ratio. One of them was on call 24/7. they also consulted with the Physician at the US Embassy in Ulaan Baatar and the regional Peace Corps Doctor in Thailand. The PCMOs were extremely considerate of our well being and treatment and sensitive to our needs. Anything we needed was supplied in the mail quickly and Volunteers were flown or driven into the capitol whenever needed. During my second year of service I experienced bloody stool and also dislocated my shoulder shortly thereafter. The PCMOs promptly sent me to Thailand to make sure that I received proper treatment. The Hospital in Thailand was a medical tourism hospital and easily the finest hospital I have ever seenl. I met with the American Peace Corps Doctor there and together we consulted with two Thai doctors, one of whom was also the doctor for the Thai Olympic team. I was found to have a polyp in my colon which was removed and it was decided that my shoulder needed no further treatment except physical therapy. which i received. In one week's time I was back at my site teaching English and coaching soccer. I was cared for very well.

  209. I went to med school in Brookly 1991-95. Many of the residents were foreign medical grads FMGs), and many were from China. I found the doctors from China to be incredibly bright, knowledgeable, and hard working. Don't know about those unable to leave the country for better opportunities.
    But this is malpractice- period. The excuse of the location being rural is a non-sequitur. In rural areas lacking the latest medical diagnostic toys, one would expect the doctors to be superior in relying on old standbys- basic physical exam, knowledge of local infectious disease agents, and plain old vital signs. (this country has myriads of health care professionals hopelessly dependent on technology and testing to help them arrive at a diagnosis, who couldn't think for themselves if your life depended on it. seen plenty of those who passed their boards but are absolutely clueless when it comes to identifying patients in distress who need immediate life or death treatment.)
    low blood pressure? they call them vital signs for a reason. skin cold to touch? one of the oldest signs of dire straits, described in classical literature since the earliest days of writing about death and illness.
    this Chinese doctor should be forbidden from contracting with any agency trying to procure health care for foreigners. I hope the family can sue the Peace Corps somehow for employing a quack. I wonder how many female patients she's killed in her gyn practice.
    Nick Castle and his family deserve better. RIP.

  210. 1) Perhaps this was done but just not reported for confidentiality reasons but was there an autopsy? Reading this story, the first red flag to me is the amount of weight loss he had back in October. While that can occur with severe infectious diarrhea, I would worry if a patient did not recover their weight relatively quickly after that. I would be concerned about cancer. I've seen a young man die quickly in the ER from undiagnosed cancer; in that case, he ignored his early symptoms due to no insurance.

    2) I've worked with some fine physicians in the US educated/ trained in other countries but even they note the quality of medical education/ regulation can vary depending on the country. I'm surprised his care was handled by a gynecologist; hopefully, she had training beyond this field in order to serve as a general practitioner. As a latter, I would not consider myself an expert in gynecology. Also, the standards of care can vary and non-US MDs for cultural reasons may be less likely to challenge authority.

    3) Given the spread of the Internet today, even in once remote regions, Peace Corps should consider having some type of system where local doctors or PC volunteers on the ground can call/ e-mail driectly if they have a concern. As a start, they should consider examining EVERY medical situation reported for say the past and next 3 months to see where the weaknesses in the current system might be.

    All but especially preventable deaths in the PC are a tragedy.

  211. I am deeply saddened by the Castle family's loss. I was a Peace Corps volunteer in Nigeria from 1966-1968. There were American doctors in each of the four regional capitals. I was stationed in the Northern Region, but was more than 250 miles away from the PC doctor in Kaduna.

    I was lucky to be healthy almost all my two years. Only once did I get a terrible headache, lack of appetite, and intense fatigue. I knew it wasn't malaria. My roommate went to the local hospital and came back with malaria tablets given to him by the local doctor. I didn't take the tablets and decided to wait. I was slightly better the next day. I told myself if I wasn't feeling better the third day, I would find someone to drive me to Kaduna. I woke up feeling almost normal and still don't know what I had.

    There was less volunteer support in the 1960s, and we were certainly much more isolated in our bush stations. We were told not to delay going to the PC doctor in any medical emergency. We were even given three rabies shots to give us extra time to get to the PC doctor after a dog bite. Perhaps PC needs to go back to using US physicians.

    I don't hesitate to recommend to young people to join the Peace Corps. It was a formative experience for me. It's a tragedy when a volunteer dies, and an even a bigger tragedy when it's a medical death. My condolences to the Castle family.

  212. I finished a lengthy application process for the Peace Corps in May. The outcome was that my application was declined. The reason for denial was, "we are looking for someone more in line" than you are. I was fairly shocked by this outcome. I had intentions to serve for 2 years after finishing 20 years of teaching EFL in Japan. Of course there is more to my story than this on both sides. However I was completely open and honest about my strengths and weaknesses and the Peace Corps was, shall we say, opaque, in their desire to protect themselves. I think any true American would be attracted to the ideals represented on the Peace Corps marketing web page. However there is a difference between the large bureaucratic organization always seeking image and money and influence, and putting their ideals into practice in an efficient and effective way. It seems from reading the stories of the volunteers, it is their determination to make a pearl out of their situation rather than the effective support of the Peace Corps. And this is possibly the reason for the denial of my application. The two people who reviewed my application were more concerned with protecting their positions rather than serving the principles they themselves were initially attracted to when they first joined. However, it is possible that the bureaucratic culture changed them.

  213. If you are a medical official for the Peace Corps then you know that what is being described here is not the result of a medical anomaly or fluke but rather is a reflection of a system problem with the medical care that is offered to Peace Corps volunteers.
    The care that is being offered to Peace Corps volunteers may have been considered acceptable 50 or 40 or even 10 years ago - it is no longer acceptable now. 50 years ago we sent our soldiers to Vietnam to fight a war with semi-automatic weapons and no body armor apart from the largely useless helmet.
    Today, the federal government equips its soldiers with body armor, automatic weaponry and all manner of safety equipment to such an extent that a war which would normally have killed 20,000 soldiers instead killed about 5,000. This is a reflection of the federal government's new and higher regard for the lives and the safety of its soldiers.
    Somehow, that new attitude has failed to filter into the attitude of the Peace Corps in the way it manages the health of its volunteers. We are in an era in which the Affordable Healthcare Act has mandated that every American have health insurance, making it possible for them to receive treatments necessary to maintain good health and protect them from avoidable illnesses. The Peace Corps purports to be protecting the health of its volunteers but the description in this article of what it considers to be protection is hideously inadequate.

  214. Check the budgets of both. What you imply is not realistic given the resources that are allocated to Peace Corps. Those who support the Peace Corps and its Mission should be mindful of the limited resources provided by Congress to address that Mission and involved themselves in seeking what may be needed given an agreed upon Mission for present day. Peace Corps global budget is truly petty cash for the military, could be considered a rounding error in the Department of Defense.

  215. But, Marn, while what you state us accurate, is it the correct budget priority? It may be true that in many cases the PC is doing the best with what it has, but maybe part if the problem is that it should have more and we commenters should at least voice our concern at a mistaken priority.

  216. When I was in a West African country, I went in to the Peace Corps medical office for a vaccination. The nurse gave me the vaccination. Later that day, I went swimming, and found after dangling my legs in the pool, that I could not stand up and my legs would not support my body. I managed to make it home, with my wife and two children, and laid around until that evening, when my strength came back. I went into the Peace Corps medical office the next day and asked to see the vial. The nurse blanched. She looked at the vial and saw that she had given me ten times the vaccine dosage – she had failed to see the decimal point before the number. The Peace Corps doctor wished me well, then joked, “At least you won’t get [name of disease]!” which I found to be extremely funny … because I had recovered. The Peace Corps nurse was later let go.

  217. How can the Peace Corp's "outside expert", Dr. Jeffrey P. Smith conclude that “any suggested changes in the care that was delivered on January 28th would not affect the unfortunate outcome” if he doesn't even know what killed this boy? Changes in care could have resulted in an early diagnoses or at least hydration and stabilization, buying more time to diagnose and treat.

    I want to hear from the Castle's expert. Undoubtedly, the Peace Corps did not select an outside expert with the Castle's input.