The Medical Application and Appeals Process

Note: This post was originally written after receiving final medical clearance in early July, but due to my unfamiliarity with using Blogger, I accidentally saved the post instead of publishing it. So, the publish date will appear as being much later than the post was actually written. At least I'll be more prepared for the next post now!

So I decided to wait until receiving final medical clearance to write my first post, just to play it safe. But the good news is, I received word last week that I am officially medically cleared to serve! This means that, unless I do something stupid like jump off a 60-foot rope swing and crack my sternum again (a great story for another time), I should be all set to leave with the rest of my staging class on September 2 to head to Yaoundé! I really couldn't be more excited. So, in honor of this great news, I've decided to try my hand at writing my first ever blog post. Now I've never done one of these before, and I am embarrassingly technologically challenged for someone of my generation, so this may not turn out the way I want it to. But, you never know until you try, so here goes nothing!

Because receiving medical clearance was probably the toughest part of this whole process for me personally, I've decided I'll write my first post about why the process can be so tricky, and include some tips for hopeful future volunteers so that they can be fully prepared to face it head-on.

I'd first like to start off by saying the medical clearance process is obviously very extensive for a reason. It is so important to recognize that in most of the posts that PCVs (Peace Corps Volunteers) serve in, there will not always be immediate and easy access to westernized healthcare. This means that if you have a health condition that requires consistent visits to the doctor or intensive monitoring, finding a site that will fit your needs might be pretty tricky. Now, that's not to say if you have any health condition that you should just forget about even applying--through research I've learned that people with all types of health conditions have served successfully. However, if you do have a health condition and are considering applying, I would definitely recommend taking some time to determine if you will be able to deal with this condition and remain healthy in regions where you might not have access to the kind of care you're used to.

Going off of that, I would like to point out that the medical appeal process is also in place for a reason. The individuals who make the decision to medically clear or deny you are only able to get a small picture of you and any health conditions you might have based on the information you provide in very structured forms. Their professional determination of your health status is based solely on the forms you fill out, personal statements, and the correspondence between you and your nurse advocate on the MAP (Medical Applicant Portal). This means they don't have the opportunity to get to know the real you in person--they don't get to see the certainty in your eyes that you are fully ready and able to serve regardless of your past health conditions, nor do they get to hear the determination and passion in your voice when you tell them you are ready to serve. When relying solely on written communication, miscommunications and misunderstandings can occur--for example, one of your forms might make it appear as though a health condition is more serious and debilitating than it actually is, simply because there is not room on the form to detail the lack of severity of your condition. So, naturally, these individuals may not be able to get the full picture of who you truly are, and what your true health status is. Therefore, if you feel that this has happened to you, I urge you to consider appealing, as long as you know that your health condition really won't cause you any more problems than the average volunteer would experience. Even if the appeal doesn't end up going through, you'll know that you tried everything you could to make things work.

Based on my experience with the medical application and appeals process, I would like to offer some advice to future applicants, in the hopes that your process will go more smoothly than mine:

1. Keep a detailed account of all health conditions, symptoms, medications, interventions, etc. that you have experienced in the past 5 years. In order to get the full health profile of the applicant, the Peace Corps medical team asks about any health conditions you have experienced and/or treated within the past 5 years. For someone who can barely remember what she ate for breakfast yesterday, this task proved incredibly challenging. I couldn't even remember the locations of some of the doctors I had been to, and therefore had no idea how to obtain my medical records with them to fill out related forms for the Peace Corps. So, to prevent yourself from the grueling task of checking emails and voicemails from 2009, I would recommend keeping a sort of medical/health journal, in which you record any current and past medical conditions, symptoms, and treatments in as much detail as possible. This will make filling out your health summary and any related forms much easier!

2. Request relevant medical records as early in advance as possible. Though the Peace Corps rarely asks for the direct submission of medical records (except for vaccination records), having access to all of your old medical records--especially those from the past 5 years--is incredibly helpful throughout the medical application process. This prevents you from accidentally misdiagnosing yourself or forgetting to mention certain medications and conditions. The last thing I can stress with this is the importance of obtaining accurate and up-to-date vaccination records--this includes vaccinations you received as a baby!

3. Fill out every form and personal statement in as much detail and specificity as possible. As some of you reading this might know, I was originally declared medically ineligible to serve because I forgot to emphasize a specific treatment I was receiving was optional and not medically necessary. After the deaths of 6 students at Tulane within a single semester, I elected to pursue optional talk therapy to discuss my personal experiences and feelings associated with death and grief. Though immensely helpful, this therapy was not at all medically necessary, and was not intended to be used as a treatment or intervention for any specific health condition. However, in my personal statement regarding attending talk therapy, I neglected to mention this, likely creating the impression that this was a medically necessary intervention. During the medical appeals process, I simply highlighted this error, emphasizing attending therapy had been a personal choice in response to tragedy, rather than something required or even recommended by a doctor for a condition. I guess that was all of the information that was missing, because I heard back within less than two weeks that my appeal had gone through! So, based on my experience, I would recommend that you provide as much detail and specificity as you can on all forms and personal statements you submit to the Peace Corps medical team. If you go to acupuncture once a month simply because it relaxes you, be sure to emphasize that--though every case and condition is obviously different, including as many details as possible in the beginning will likely save you a lot of headaches later on.

4. Develop a good relationship with your nurse advocate. The nurse that you will be communicating with on the MAP is there as your advocate--meaning they hold your best interests in mind in all situations. Though the messages and seemingly never-ending tasks they send to you may seem overwhelming, I promise everything they do is done in order to help you succeed. So, be sure to be polite, kind, and grateful for all of their time and hard work. These nurses are truly willing to go out of their way to help you through the process, and it is amazing to see how invested they become in your success. So make sure to thank them every once in awhile!

5. KEEP AN ITEMIZED BILL FROM EVERY APPOINTMENT/MEDICAL INTERVENTION YOU MAKE DURING THE MEDICAL PROCESS. The Peace Corps reimburses for certain treatments and appointments, but only if you send an itemized bill along with your request for reimbursement. If you're like me and lose things, keep these all together in a place where they cannot get lost--because if they do, there's not much that can be done to reimburse your expenses.

6. Address any minor medical concerns--no matter how small--as soon as possible. Though it may seem frustrating to visit a doctor for a simple cough, in this case, it is much better to be safe than sorry. You never know if a condition could be more serious, and therefore more difficult to address at the last minute or in time for clearance.

7. Establish good relationships with your doctors. This one is super important, because you will often have to call their offices multiple times to remind them to send records, fill out forms, see you for a follow-up appointment, etc. If you have good relationships with these doctors, you likely won't feel as guilty after leaving that sixth voicemail in a row.

8. Be an active participant in the entire process. Remember that although this process may involve multiple providers, multiple nurse advocates, and multiple professional Peace Corps medical staff members, at the end of the day, it is your responsibility to ensure all forms and tasks are submitted correctly and on time. If you submit a task late because your doctor didn't email you back in time, you are still the one who submitted the task late--not your doctor. Therefore, it is incredibly important to keep track of what forms and tasks are outstanding, and to take responsibility to ensure they are completed on time. Sometimes this may involve emailing certain doctors multiple times, requesting second opinions, or even seeking out new providers. You must be active and engaged in the process, otherwise it is so easy for you to get behind or forget things!

Though there are probably so many more tips I could provide, this should be a good starting place for any future applicants to prepare themselves for the process. However, if you have any further questions, please feel free to contact me, and I'll do my best to answer them. In conclusion, though the medical process can often be difficult and time-consuming, it is so incredibly worth it. Before sending you off to work in a foreign country for two years, the Peace Corps wants to be absolutely sure that you are as healthy and physically prepared as possible. They have your best interests in mind, which is why the process is so thorough. Wouldn't you hate to get all the way over to your new home, only to find a certain health condition makes it impossible for you to stay? The medical process is designed to prevent this from happening, so just be sure to be as honest, thorough, and detailed as possible. That way, if you receive final medical clearance, you will likely experience a huge sense of relief that you are truly, finally ready.