Peace Corps Chronicles - Part Four

About: “(We) Either explode in silence or perish in silence,” famously said by one household name in Chinese literature, Lu Xun (Chinese: 魯迅, 1881 – 1936).

This is another way to say that our words hold power. Expressing an idea is a flash of thought, a release of emotion, and a spark that aims to illuminate both our inner space and others. Those who adhere to rigid rules and suppress feelings by swallowing their tears will be snubbed and vanish in silence.

Part 4 of My Unfulfilled Peace Corps Journey:

The Peace Corps Medical Process vs. What It Should Be

How long does it take to gauge somebody’s well-being? Or in how many words? Would the Peace Corps medical staff ever care about our overall health, lifestyle, physical fitness, mental acuity, emotional stability…?

Over the past six months, I compiled all the messages exchanged with my assigned Peace Corps nurse on the medical portal into a Word document that spans over 30 pages and totals more than 7,000 words (excluding the required tasks I completed!). Yet, throughout this period, she did not ask a single question about my physical or emotional well-being or my lifestyle. I know my conditions are far from what they used to be in many ways, and I would need several fundamental adjustments if I were in Mongolia to fulfill my Peace Corps duty. How was the nurse expected to gauge that, and better yet, provide me with support in achieving it? Or are they not in the business of supporting us but merely going through the formality—a very long, complex, and absurd one?

I may be living in an Arcadian world, but I like to imagine a situation where Peace Corps medical personnel could play a positive role in a volunteer’s experience. By getting to know us first, they could provide the necessary consultations before departure and throughout our journey, ensuring we can successfully carry out our mission in an unfamiliar, far less developed country with the highest spirits. Does this seem more effective than checking off copious boxes to go through the motions?

However, many of the tasks generated for me involved repeated requests for ‘office notes’ from my physicians: my orthopedist regarding my shoulder, my cardiologist regarding my heart examination, and my family physician regarding various test results. I saw the orthopedist only once to get a cortisone shot for my tennis-induced shoulder pain. I felt fine afterward, playing tennis about five times a week again, with no follow-up visits required. How would the orthopedist know how I felt more than six months later? But my words meant nothing after I raised that question. After I repeatedly requested an office note to get through it, my orthopedist’s assistant wrote a generic one that “my shoulder should be fine now,” with his signature either as a means of supporting my Peace Corps mission or simply to get it over with.

The office note from the cardiologist was even more baffling. I submitted all the echocardiogram testing results, along with the cardiologist’s remarks. There were no medication or treatment suggestions, just a follow-up in three years for reassessment. That wasn’t sufficient for the approval process. My assigned nurse kept asking for a “Formal Office Note.” Is there such a thing?

After several rounds of messages between the cardiologist's office and me because the Peace Corps nurse did not budge, the NR finally asked me, “What does the Peace Corps want? Or please send a form so the cardiologist can verify and sign it.” This task was eventually considered complete because the Peace Corps nurse was unsure of what she was looking for, and no “Formal Office Note” form was ever provided or even existed.

After my eye exams, I was repeatedly asked for the frame size of my reading glasses—to replace them in case I lost them while serving for the Peace Corps, I was told. I have worn reading glasses for over a decade and keep them everywhere in my house (I could bring five pairs if required), but I never need to know the frame sizes. Usually, I pick the frame on the wall of the optometrist's office, and it’s made for me according to the prescription. It took me three more trips back to the optometrist's office to explain why I needed the form to be filled out and signed. They were either too busy for me, or the doctor was not there to sign it.

The dental process also involved quite a few back-and-forths, and my dental task is still shown as “not completed,” despite four fillings and more than ten x-rays taken on three trips. My dentist has refused to see me anymore because, he said, he has done all he could for me.

I could go on, but I’m sure you now see the pattern and how convoluted this medical clearance process is for volunteers like me and all my healthcare providers trying to meet their exorbitant requirements, as if the entire world should revolve around the Peace Corps. Given that my case should be relatively simple—I have no existing conditions and have never been infected with COVID during the pandemic years—it's even more concerning. Many Peace volunteers have shared their far more sobering experiences below and in my previous parts of this story.

After investing significant time, energy, and thousands of dollars with various health providers, we ultimately achieved nothing except for shattering a dream of serving the Peace Corps mission.

One PC volunteer messaged me that he spent more than 12 months, until the very last week before his departure, to obtain the necessary medical clearance. And in his own words: “It’s very, very cruel!”

Another one wrote: “Cheng, sorry about your frustrating experience with PC medical clearance. You are not alone. I, and many others, have been through the same thing. As I prepared for my 3rd PC assignment, I was denied medical clearance only a couple of weeks before departure. After a stressful appeal that included a letter from my physician, I was cleared to leave 2 weeks after the rest of my cohort. As I tried to extend my service for an additional year, I again had to be medically cleared. I was denied again. I appealed again, with a letter of support from my US provider, but was denied again. My heart was broken 💔 I know I could have continued to serve without any problems but this decision was final. I wish you luck if you are still able to appeal the decision 🙏”

One highly successful social media influencer wrote: “Cheng, I'm so sorry about your Peace Corps medical denial! It's unfortunate that these barriers exist. But just know - you did NOT fail. The only true failure is not trying. That is why I hope people will not just focus on the outcomes but also the benefits of the process.”

Many comments expressed a common sentiment: Cheng, you have a beautiful way of communicating your thoughts, and I thoroughly enjoyed the posts you shared. May you find what you are looking for.

I also realized that many people have far more extensive and somber experiences—and possess stronger, more resilient spirits—than I do. This insight reaffirms my decision to share my emotions and encourage others to do the same. The truth is, even a ‘failed’ journey can be more rewarding than it initially appears—if we choose not to keep it to ourselves. At the same time, I can't help but wonder what the Peace Corps management thinks about how we volunteers feel regarding their bizarre Medical Clearance Process. Don’t they even care?

In Contrast, Here is Another Approach

I signed up for new medical insurance this year, and they offered an option to assess my overall health by sending a nurse practitioner to my home through a “House Call” program, which I willingly accepted.

The nurse practitioner came to my home exactly at the scheduled time to review my health history and medications (which I don’t use). She inquired about my everyday work, pastimes, social activities, sleeping habits, diet, exercise, and stress levels. She checked my toes, knees, and shoulders, screened my heart condition, and administered a cognitive test.

The RN then suggested that I drink more water than any other beverage before, during, and after playing tennis, and avoid alcoholic ones. Additionally, she recommended reading and writing less late in the evening to improve my sleep quality. She further advised me that taking a nice, long walk after supper can help calm the nervous system and reduce tension built up during the day, thereby improving sleep further. Those are precisely what I should be doing.

This session, which lasted only an hour and a half, allowed the health company and me to better understand my overall health conditions and the necessary steps I should take to improve them. The RN told me she would return next year to see how I’ve been doing if I like the program. I told her this is the most effective preventive health program I have ever known. It’s free for me, and I even received a $50.00 gift card as a courtesy for my participation.

Could government agencies learn something from private organizations like this one? In theory, the government should aim to set an example, given that its funding and authority derive from the general public—the ultimate source of its legitimacy. This idea is, in fact, neither new nor original. During the 1930s, the U.S. government efficiently led the world in many large-scale public construction efforts as part of the New Deal programs, which aimed to address the Great Depression. Where has this “can-do” spirit gone now?

Perhaps I’m just talking to a wall right now. However, what are the chances of creating a better future that the world desperately craves? My ideas are limited to my experience, described here and in Parts 1 – 3 of my Unfulfilled Peace Corps Journey. I’m interested to hear more about what others have gone through. What is your vision for what the Peace Corps medical team should aspire to become?

 “(We) Either explode in silence or perish in silence,” famously said by one household name in Chinese literature, Lu Xun (Chinese: 魯迅, 1881 – 1936).

This is another way to say that words hold tremendous power. Expressing an idea is a flash of thought, a release of emotion, and a spark that aims to illuminate both our own inner space and others. Those who adhere to rigid rules or suppress feelings by swallowing their tears will be snubbed and eventually vanish in silence.

To truly thrive—individually and collectively—we must embrace independent thinking and express our thoughts while adapting to the inevitable changes around us. By doing so, we can align our personal journeys with the progress of the cultural movement. This is a timeless call from Lu Xun and a vital reminder for everyone determined to rise above challenges rather than perish in them.

PS. This part does not signify the end of my story; rather, it likely marks the beginning of new journeys as my life path ventures into the unknown—as it always has.

We all evolve as individuals, but I can’t do it alone—no one can! After I posted Part 1 of this story, I could continue writing only because I had gained the strength of an ally in all of you, which made me realize that you were truly on my side. This emotional and factual alliance we’ve built together is necessary (if not sufficient) for making this world a better place.

Therefore, please share your stories, support one another, and amplify our messages as we carry the weight of humanity together, just as the Peace Corps was meant to do. Together, we can help humanity evolve.

Edit: Add your comments to the discussion in the Comments section below, then check out Article Part 4 of My Unfulfilled Peace Corps Journey: How one private healthcare company managed my health—by getting to know me first.