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PubMed1982

Guidelines for providing medical care to Southeast Asian refugees.

Almost 500,000 Southeast Asian refugees have arrived in the United States since 1975. While these refugees have not presented substantial public health problems, they have important personal health problems frequently requiring medical attention. Medical care providers in this country need to be aware of disease patterns and prevalence among these refugees. As well, they need to be aware of the cultural and religious backgrounds and previous medical practices of this refugee population, particularly as these practice influence the refugees' ability to obtain and maintain medical services provided in this country. Historical, cultural, religious, ethical, and medical information is provided to help US health care facilities develop culturally appropriate medical care services for Southeast Asian refugees.

Acculturation↗
PubMed1995

Prevalence of viral markers among refugees from southern Albania: increased incidence of infection with hepatitis A, B and D viruses.

BACKGROUND: Since 1991, thousands of refugees from southern Albania have entered north-western Greece, an area with low-to-moderate endemicity for infection with hepatitis viruses. We examined the prevalence of several markers of viral infection in this population in order to ascertain the likely impact of its presence on the epidemiology of hepatitis infections in north-western Greece. DESIGN: Consecutive unselected serum samples were obtained from refugees resident in three different reception camps. SETTING: A university hospital. STUDY POPULATION: One thousand and twenty-five refugees (662 males and 363 females, age range 0-81 years) and 1984 healthy controls (1293 males and 691 females, age range 0-80 years). INTERVENTIONS: None. RESULTS: We found a significantly greater prevalence of markers of infection with hepatitis A virus (prevalence of antibodies to hepatitis A virus 98.2%), hepatitis B virus (HBV; prevalence of HBV s antigen 22.2%, prevalence of HBV c antibody 70.6%, prevalence of HBV s antibody 40.5%, prevalence of HBV e antigen 21.1%, prevalence of HBV e antibody 46.2%), hepatitis C virus (prevalence of antibodies to hepatis C virus 1.75%) and hepatitis D virus (prevalence of antibodies to hepatis D virus 12.7%) among refugees from southern Albania than in healthy Greek controls. These markers were found with significantly greater frequency among younger refugees (< 30 years of age) than in older members of the same population. CONCLUSIONS: We conclude that refugees from southern Albania are a new immigrant population characterized by a high incidence of infection with hepatitis A, B and D viruses. This finding may reflect the low socioeconomic status of the immigrant population and the poor hygienic conditions experienced by its members. The high incidence of HBV and HDV infections in the population from Albania will probably increase the prevalence of infection with these viruses in Ioannina and subsequently in the whole of the Epirus region. We therefore believe that rigorous adherence to general precautions and the initiation of hepatitis B vaccination programmes will be necessary in future, both in our area and in Albania.

Adolescent↗
PubMedDate not supplied

Prevalence of hepatitis B markers and measles, mumps, and rubella antibodies among Jewish refugees from the former Soviet Union.

OBJECTIVE: To assess the prevalence of hepatitis B virus (HBV) infection and immunity to measles, mumps, and rubella among refugees from the former Soviet Union (FSU). DESIGN: Descriptive study. SETTING: Soviet Immigrant Health Care Program, Sinai Samaritan Hospital, Milwaukee, Wis. PATIENTS: Consecutive sample of 496 Jewish refugees from the FSU presenting for new arrival screening from December 1, 1990, through January 11, 1993. OUTCOME MEASURES: Hepatitis B surface antigen (HBsAg), hepatitis B core antibody, hepatitis B surface antibody, and measles, mumps, and rubella antibodies. RESULTS: At least one hepatitis B marker was detected in 22% of the refugees, and HBsAg was detected in 0.4%. The rate of HBV infection (any marker present) increased with increasing age, ranging from 4% among those aged 0 through 19 years to 31% among those aged 50 through 59 years (chi 2 test for trend, 13.5; P < .001). Among those aged 0 through 19 years, 19% lacked antibody to measles, 8% lacked antibody to mumps, and 13% lacked antibody to rubella. Refugees who were less than 30 years of age were more than twice as likely to lack antibodies to measles, mumps, or rubella compared with those who were 30 years of age or older (relative risk, 2.8; 95% confidence interval, 1.8 to 4.2; P < .001). CONCLUSIONS: In our sample of Jewish refugees from the FSU (primarily Ukraine, Russia, and Belorussia), the rate of HBsAg positivity was low, suggesting that routine screening for HBV infection is not needed. Seronegativity to measles, mumps, and rubella was relatively common among those less than 30 years old. Those refugees who were born after 1957 should be given combined measles, mumps, and rubella vaccine unless their written documentation indicates previous receipt of these antigens according to the immunization schedule recommended in the United States.

Adolescent↗
PubMed1993

Attitudes and knowledge about preventive dental care in Chilean refugees in Sweden.

The aim of this study was to evaluate the effects of a simplified oral health programme on attitudes to and knowledge of preventive dentistry. The subjects were Chilean refugees and the programme was delivered at one or two sessions in the form of group information/discussion. Because of increasing immigration, Sweden has become a multicultural society. The number of non-Nordic immigrants has doubled in the past decade. The major refugee groups have come from Iran, Chile and Poland. The subjects comprised 193 Chilean refugees: 106 in a single-visit group and 87 in a two-visit group. The oral health programme was completed by 94 and 65 subjects respectively and was evaluated after 6 months. Positive effects were discernible in attitudes to and knowledge of preventive dentistry, particularly with respect to oral hygiene. A key to success may have been group discussion in which the refugees could relate oral health problems to their own ethnic group. This could have an important function in bridging cultural, linguistic and situational barriers. Different forms of outreach programmes for oral health via groups, organisations or authorities in close contact with refugees shortly after arrival in Sweden are proposed. This approach may be particularly effective in a multicultural society and also in the context of the turbulent conditions the newly-arrived refugee experiences.

Attitude to Health↗
PubMedDate not supplied

[Psychological status of Croatian refugees in Hungary].

This presentation addresses the capability of Croatian refugees from Baranja to acclimatize themselves in the Republic of Hungary. The authors assessed the mental health of 100 refugees through a psychiatric interview using a questionnaire, specifically designed for the purpose of this research. Their ages ranged from 10 to 82 years, average age 38 years. The assessment of mental health of the refugees was conducted 6 weeks following their placement in a camp (social institution) of a small town (Maria Jüd) in Hungary. The authors found that refugees fled their homes and homeland in front of barbarous combined forces of local Serbs whom they identified as terrorists and Yugoslav Federal Army. Leaving homes and country was sudden and unexpected, but by their own will. The departure was accompanied by fear, anxiety, disbelief, despair, anger and rarely by panic behaviour. Fear for children's safety was on the first place, than fear from exposure to violent injury--torture and crippling, while threat for ones own life and life of relatives as well as loss of property were of milder intensity. Among the most dominant feelings refugees manifested during an interview were: home--and homeland sickness and uncertainty about the future. In 61% of the examinees, these feelings prevailed. Forty-two per cent of the subjects experienced emotional and psychosomatic disorders, primarily Beard's "neurasthenic syndrome". Only 5% of the refugees needed psychiatric help, mainly those who had psychic problems before they fled their homes. The authors conclude that Croats from Baranja who took refuge in Hungary had acclimatizational problems even 6 weeks after displacement, which were manifested as emotional and psychosomatic reactions.(ABSTRACT TRUNCATED AT 250 WORDS)

Adaptation, Psychological↗
PubMed1996

Morbidity and mortality surveillance in Rwandan refugees--Burundi and Zaire, 1994.

In April 1994, resumption of a longstanding conflict between the Hutus and Tutsis--the two major ethnic groups in the central African countries of Burundi and Zaire--resulted in civil war and mass genocide in Rwanda. An estimated 63,000 (primarily Tutsi) refugees subsequently moved from Rwanda into northern Burundi, and 500,000 refugees fled to Tanzania (Figure 1). In early July 1994, as armed strife subsided, many Tutsis returned home to Rwanda, and an estimated 1 million Rwandan Hutus fled to Zaire, and 170,000 fled to Burundi. To monitor the health status of the refugees, the Office of the United Nations High Commissioner for Refugees (UNHCR) and nongovernmental organizations (NGOs) working in refugee camps in both countries established systems for rapid surveillance of morbidity and mortality. This report presents the findings of these systems during May-September 1994 (the period of the most intensive population migration) and indicates that mortality was high among refugees in camps in both countries.

Burundi↗
PubMed1996

Refugees: do not forget the basics.

This article describes the main challenges faced by relief workers in meeting the needs of refugees in terms of their health and nutritional status. The main causes of refugee deaths in "emergencies" have been documented and identified. This has allowed the definition of technical principles for health interventions in refugee settings: a multi-sectoral approach; involving the refugees; meeting specific needs of refugee children and women; instituting a simple and reliable health information system; and ensuring proper management and coordination among all partners. Two examples selected from UNHCR field operations illustrate how important it is to adhere to the basic technical principles. Finally, the article also emphasizes that health assistance in refugee situations takes place in a context which is complex and comprises many variables. In addition to their qualifications and experience, health professionals must also be aware of the global dynamics of a conflict situation. Their leading principle should be that all human beings have the right to appropriate health care.

Africa↗
PubMed1997

[Control of tuberculosis in refugees and displaced].

As a result of national and international conflicts, the number of refugees and displaced persons in various countries of the world is increasing. The complex and protracted nature of these conflicts often forces refugees to remain away from their countries for long periods, living in refugee camps. Many refugees come from countries where tuberculosis is endemic and, once the immediate problems of establishing a camp are overcome, this disease becomes the principal problem affecting refugee camps. In order to advise the persons in charge of refugee camps on how to set up tuberculosis control programs, this document details the general requirements and specific recommendations of WHO for the implementation of such programs, as well as guidelines for their evaluation and monitoring, including criteria that would justify camp closure.

Humans↗
PubMed1988

Refugee screening policy, 15 June 1988.

On 16 June 1988, the Government of Hong Kong introduced a new refugee screening policy. Under the policy, all refugees will be treated as illegal immigrants and detained and interviewed to determine whether they qualify as refugees. If they do qualify by showing that they left their country of origin because of a "well-founded fear of prosecution," they are to be moved to refugee camps where they can apply for resettlement. If they do not qualify, they are to be held in closed detention centers for repatriation to their country of origin. The purpose of the policy is to deny refugee status to persons who are leaving their homeland for largely economic reasons.

Asia↗
PubMed1985

Tuberculin conversions in Indochinese refugees. An assessment of boosting and anergy.

Indochinese refugees entering the United States have a high rate of tuberculosis and tuberculin reactivity. In addition, several investigators have noted that a large number of refugees with initial tuberculin tests that are "not significant" change to "significant" reactions when retested within 8 wk. This "conversion" phenomenon has been reported in 21 to 43% of refugees and has been unexplained by antigen, testing, demographic, or exposure risk factors. A prospective evaluation of 218 refugees, conducted to assess the role of anergy and boosting, confirmed earlier findings, with 52% of 118 persons with initial tuberculin reactions that were "not significant" developing "significant" reactions on subsequent testing. Anergy, as measured by nonreactivity to mumps and candida skin tests, was not found to be a contributing factor, as few refugees were anergic and as rates of anergy did not differ significantly among refugees with different responses to tuberculin. Boosting, however, played a major role in explaining the "conversions," as 59% of persons who changed to "significant" tuberculin tests did so when retested with tuberculin at 1 to 3 wk. "Delayed" boosting rather than incubating disease or anergy appeared to be the most likely explanation for the remaining "conversions" that occurred on a third PPD test conducted at approximately 8 wk. If the "conversion" phenomenon is due to boosting, it remains to be seen whether the boosting is a result of previous exposure to Mycobacterium tuberculosis or to other, nontuberculous mycobacteria.

Adult↗
PubMed1999

Mass vaccination with a two-dose oral cholera vaccine in a refugee camp.

In refugee settings, the use of cholera vaccines is controversial since a mass vaccination campaign might disrupt other priority interventions. We therefore conducted a study to assess the feasibility of such a campaign using a two-dose oral cholera vaccine in a refugee camp. The campaign, using killed whole-cell/recombinant B-subunit cholera vaccine, was carried out in October 1997 among 44,000 south Sudanese refugees in Uganda. Outcome variables included the number of doses administered, the drop-out rate between the two rounds, the proportion of vaccine wasted, the speed of administration, the cost of the campaign, and the vaccine coverage. Overall, 63,220 doses of vaccine were administered. At best, 200 vaccine doses were administered per vaccination site and per hour. The direct cost of the campaign amounted to US$ 14,655, not including the vaccine itself. Vaccine coverage, based on vaccination cards, was 83.0% and 75.9% for the first and second rounds, respectively. Mass vaccination of a large refugee population with an oral cholera vaccine therefore proved to be feasible. A pre-emptive vaccination strategy could be considered in stable refugee settings and in urban slums in high-risk areas. However, the potential cost of the vaccine and the absence of quickly accessible stockpiles are major drawbacks for its large-scale use.

Administration, Oral↗
PubMed1988

Zatu No. AN V 28 FP-PRES setting forth the Refugees Regulations, 3 August 1988.

This legislation provides that a National Refugees Commission is to make all decisions relating to granting of refugee status and the loss of such status. A representative of the UN High Commissioner for Refugees is to be present as a consultant at all meetings in which such decisions are made. These decisions can be revised in cases in which new information appears. Persons receiving refugee status can be expelled from Burkina Faso only for reasons of national security, if they engage in activities that threaten public order, or if they are sentenced to loss of liberty for a crime or offense of a certain level of seriousness. Except for overriding reasons of national security, they may not be expelled before being allowed to present their defense to the National Commission, which must give its opinion. Nor may they be expelled until a reasonable period has passed in which they are permitted to look for another country that will admit them. Refugees seeking employment are to be treated in the same manner as foreigners from the country that has concluded with Burkina Faso an agreement that is the most favorable with respect to the desired activity. They are to receive the same treatment as nationals with respect to access to education and the amount of enrollment fees.

Africa↗
PubMed1982

Leprosy. Our Southeast Asian refugee experience.

In the past two years, we have diagnosed four cases of leprosy at the St Paul-Ramsey Hospital Dermatology Clinic. This is a markedly increased incidence for the state of Minnesota. All of these cases have been found among recently arrived Southeast Asian refugees not noted to have their disease by previous screening examinations. The purpose of this study is to report these four cases (two tuberculoid, one lepromatous, and one borderline leprosy) and to review the Southeast Asian Refugee Resettlement Program, focusing on medical screening programs. We recommend refugee health education, health personnel training, and refugee medical screening centers as ways to detect leprosy among refugees entering the United States.

Adult↗
PubMed1998

Tuberculosis among immigrants and refugees.

BACKGROUND: Overseas screening of immigrants and refugees applying for a visa to the United States identifies foreign-born individuals who are at high risk for tuberculosis (TB) or who have active TB. The system's effectiveness relies on further medical evaluation and follow-up of foreign-born individuals after their arrival in the United States. METHODS: Retrospective cohort study of 893 immigrants and refugees who arrived in the United States from July 1, 1992, through December 31, 1993, with a destination of San Francisco, Calif, and a referral for further medical evaluation. MAIN OUTCOME MEASURES: Time to report to the local health department after arrival and the yield of active and preventable cases of TB from follow-up medical evaluations. RESULTS: Median time from arrival in the United States to seeking care in San Francisco was 9 days (range, 1-920 days). Of 745 immigrants and refugees (83.4%) who sought further medical evaluation, 51 (6.9%) had active TB and 296 (39.7%) were candidates for preventive therapy. Being a refugee was an independent predictor of failure to seek further medical evaluation in the United States. Class B-1 disease status based on overseas TB screening (odds ratio, 3.5; 95% confidence interval, 2.0-6.2) and being from mainland China (odds ratio, 4.4; 95% confidence interval, 1.9-9.9) were independent predictors of TB diagnosed in San Francisco. CONCLUSIONS: Timely, adequate medical evaluation and follow-up care of immigrants and refugees has a relatively high yield and should be a high priority for TB prevention and control programs.

Emigration and Immigration↗
PubMed2005

The "lost boys of Sudan": functional and behavioral health of unaccompanied refugee minors re-settled in the United States.

OBJECTIVE: To assess the functional and behavioral health of unaccompanied Sudanese refugee minors approximately 1 year after resettlement in the United States. DESIGN: A descriptive survey. SETTING: Local refugee foster care programs affiliated with the US Unaccompanied Refugee Minors Program. PARTICIPANTS: A total of 304 Sudanese refugee minors enrolled in the US Unaccompanied Refugee Minors Program. MAIN OUTCOME MEASURES: Health outcomes were assessed using the Harvard Trauma Questionnaire and the Child Health Questionnaire. Outcomes included the diagnosis of posttraumatic stress disorder and scores on all Child Health Questionnaire subscales and global single-item assessments. RESULTS: Twenty percent of the minors had a diagnosis of posttraumatic stress disorder and were more likely to have lower (worse) scores on all the Child Health Questionnaire subscales. Low functional and behavioral health scores were seen mainly in functioning in the home and in subjective health ratings. Social isolation and history of personal injury were associated with posttraumatic stress disorder. CONCLUSIONS: Unaccompanied Sudanese minors have done well in general. The minors function well in school and in activities; however, behavioral and emotional problems manifest in their home lives and emotional states. The subset of children with traumatic symptoms had characteristics that may distinguish them from their peers and that may inform future resettlement services for unaccompanied minors in the United States.

Adolescent↗
PubMed1994

Afghan refugee children and mothers.

OBJECTIVE: Although the more than 6 million Afghan refugees represent the largest single group of refugees worldwide, little information is available about their health status. RESEARCH DESIGN: Case series assessing the health and socioeconomic status of female Afghan refugees and their families and the nutritional and developmental status of their children. SETTING AND PATIENTS: Fifty-one female Afghan refugees and their children accompanying them at a maternal child health clinic in Quetta, Pakistan. RESULTS: All families had suffered serious losses from the war. Thirty-three women (65%) had lost at least one liveborn child, most commonly to gastroenteritis, "hunger," or neonatal tetanus. Thirteen children had been killed by bombardment, mine injuries, or gunshot wounds. The nutritional status of the children was markedly poor: z scores were less than -2 for weight in 67% of children and also less than -2 for head circumference in 50% of children. Serial z scores for weight in 23 children showed marked decline in 15 children (65%). Sixty-nine percent of children were overdue for vaccinations. Developmental milestones were significantly delayed. CONCLUSION: Afghan refugee children and their mothers are extremely needy and vulnerable and may be considered among the hidden casualties of war.

Adolescent↗
PubMed2005

Sleep paralysis among Cambodian refugees: association with PTSD diagnosis and severity.

Among Cambodian refugees attending a psychiatric clinic (n=100), 49% (49/100) had at least one episode of sleep paralysis (SP) in the previous 12 months. The annual and monthly SP prevalences were much higher in posttraumatic stress disorder (PTSD) than in non-PTSD patients. Among the PTSD patients, 65% (30/46) had monthly episodes of SP versus 14.85% (8/54) among non-PTSD patients (chi2[2, n=100]=26.78, P<.001). Moreover, patients with SP in the last month (n=30) versus those without SP had much higher PTSD severity scores. In the entire sample (n=100), the PTSD severity scores correlated significantly with the rate of SP in the last month. During SP, Cambodian refugees usually hallucinated an approaching figure (90%, 44/49). The rate of SP-associated and post-SP panic attacks was high, indicating the great distress caused by the phenomenon. SP seems to be a core aspect of the Cambodian refugee's response to trauma. When treating Cambodian refugees, and traumatized refugees in general, clinicians should assess for its presence.

Adult↗
PubMed2007

Cultural awareness through medical student and refugee patient encounters.

PURPOSE: This paper presents findings from a qualitative investigation of cultural awareness that medical students developed in the context of providing medical care to refugees. Our evaluation question was: What kinds of cultural awareness and communication lessons do medical students derive from clinical encounters with refugee patients? METHODS: Thirty-eight semi-structured interviews were conducted to debrief a sample of 27 medical students. A multidisciplinary research team analyzed the debriefing texts following an interpretive "immersion-crystallization" approach. RESULTS: Three domains in cultural awareness training encompassed 13 key lessons or themes. Students reported enhanced awareness about the use of interpretation services and cross-cultural communication. A second set of lessons reflected awareness of the refugees' cultural background, and a third learning component involved experiences of cultural humility. The refugee plight prompted reflection on the students' own culture, and validated the rationale for empathetic care and patient empowerment. CONCLUSION: As medical school curricula incorporate more cultural diversity training, a patient-based learning approach with selected 'hands-on' experiences will create opportunities for students to increase their cultural sensitivity and competency. This program's experiential model indicates that after refugee medical encounters, these beginning medical students reported greater awareness of communication issues, and sensitivity toward religious values, family patterns, gender roles and ethnomedical treatments. It will be important to test these kinds of preceptor/apprenticeship models of cultural sensitivity training at later stages of medical training; in order to assess long-term effects.

Communication↗