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PubMed1995

Making the biopolitical subject: Cambodian immigrants, refugee medicine and cultural citizenship in California.

Linking the health profession to the normalization of citizenship, scholars influenced by Michel Foucault claim that while biomedicine attends to the health of bodies, it is also constitutive of the social and bureaucratic practices that socialize subjects of the modern welfare state. Yet, we seldom learn about how patients themselves draw the medical gaze, nor how their resistances to biomedical intervention both invite and deflect control. I try to show this by means of clinicians' and Khmer refugees' interpretations of their encounters. This study illustrates that refugee medicine is a mix of good intentions, desire to control diseased and deviant populations, and the exigencies of limited resources which often favor medicalization. Californian clinicians, many of them Asian-Americans, display a deep faith in the efficacy of modern medicine for third world patients so that they can function in the new country. Khmer refugees, in contrast, seek rather specific resources while wishing to elude control over the body and mind that goes with medical care. I argue that the biomedical gaze is not such a diffused hegemonic power but is itself generated by the complex contestation of refugee subjects pursuing their own goals. Clinicians and refugees are equally caught up in webs of power involving control and subterfuge, appropriation and resistance, negotiation and learning that constitute biopolitical lessons of what becoming American may entail for an underprivileged Asian group.

Acculturation↗
PubMedDate not supplied

Complicated grief in Bosnian refugees: associations with posttraumatic stress disorder and depression.

Complicated grief is likely to be common among refugee populations exposed to war trauma. However, there have been few studies investigating the traumatic antecedents and correlates of complicated grief in refugees, and the relationship of that symptom pattern with other common disorders such as posttraumatic stress disorder (PTSD) and depression. We studied Bosnian refugees recruited from a community center in Sydney, Australia, with the sample being supplemented by a snowball method (N = 126; response rate, 86%). Measures included a trauma inventory, the Clinician Administered PTSD Scale (CAPS), the depression module of the Structured Clinical Interview (SCID), and the Core Bereavement Items (CBI). A dimension of traumatic loss derived from the trauma inventory was a specific predictor of complicated grief, with exposure to human rights violations being associated with images of the traumatic events surrounding the lost person. There was no link between PTSD and grief other than for a low-order association with the PTSD intrusion dimension. In contrast, depression was strongly associated with grief and its subscales. Only the subgroup with comorbid grief and depression reported higher levels of traumatic loss. The results suggest that complicated grief in refugees can become persistent and associated with depression. While PTSD and grief share common symptoms of intrusion, the two symptom domains are sufficiently distinct to warrant independent assessment of grief in refugee populations.

Adolescent↗
PubMed2004

Comparison of varicella history with presence of varicella antibody in refugees.

OBJECTIVE: To compare history of varicella with presence of varicella antibody in refugees and to determine the number of unnecessary doses of varicella vaccine administered to refugee children > or =7 years of age. METHODS: Cross-sectional study of refugees > or =7 years of age evaluated between July 2000 and October 2002 by the Refugee Health Assessment Program at Boston Medical Center. We recorded age, sex, region of origin, varicella history, and results of serologic testing for presence of varicella antibodies. RESULTS: Eighty-eight percent of individuals with a positive history of clinical varicella had varicella antibody; 65% of those with negative history had varicella antibody. The positive predictive value of a history of clinical varicella was 88%. The negative predictive value of a negative history was 39%. CONCLUSION: History of varicella was not a reliable predictor of presence or absence of varicella antibody in refugees. Strategies to protect individuals with negative histories of clinical varicella include immediate immunization or serotesting followed by immunization of susceptible individuals. Relying on positive histories of clinical varicella may leave some individuals susceptible to varicella and impede efforts to eliminate varicella in the US.

Adolescent↗
PubMed2001

The behavioral and emotional problems of former unaccompanied refugee children 3-4 years after their return to Vietnam.

OBJECTIVE: The objective of this study was to examine the behavioral and emotional problems of former unaccompanied refugee children who had repatriated to Vietnam from refugee centers in Hong Kong and South East Asia. The children were compared with a matched sample of children who had never left Vietnam. METHOD: The participants consisted of 455 Vietnamese children aged between 10 and 22 years; 238 of the children had formerly resided in refugee camps without their parents. Data were collected using the Achenbach Youth Self-Report, the Cowen Perceived Self-Efficacy scale, a Social Support scale as well as an Exposure to Trauma scale. RESULTS: No significant difference was found between the two groups of children on the YSR Total Score. The former refugee children had significantly lower Externalizing scores and failed marginally to report significantly higher Internalizing scores than the local children. The study showed that the perceived self-efficacy, number of social supports and experience of social support did not differ between the two groups of children. Further analysis showed that a significant interaction between the immigration status of the children and the children's subjective perception of their current standard of living explained the differences in the YSR. CONCLUSION: The results suggest that the experience of living without parents in a refugee camp does not lead to increased behavioral and emotional problems in the immediate years after repatriation.

Adolescent↗
PubMed2002

Tuberculosis among Tibetan refugees in India.

Tuberculosis (TB) is a major public health problem among Tibetan refugees in India. To determine the incidence of and risk factors for TB among Tibetan refugees in India, data on TB were included in the demographic and health surveillance project carried out by the Tibetan government-in-exile in Dharamsala from 1994 to 1996. Risk factor and morbidity data were determined by baseline and monthly follow-up home visits, and reported TB was confirmed by clinic records. The surveillance covered approximately 90% of the refugees in civilian settlements and approximately 70% of the monks in monasteries. In the settlement population, TB incidence was extraordinarily high in the settlement population, 10.9/ 1,000 in 1994. but decreased to 7.7/1,000 in 1996. Incidence rates varied between regions, age groups, and occupational groups, being highest in the Doon Valley (14.8/1,000). in sweater sellers (16.7/1,000), and in the unemployed (23/1,000). Among monastery monks, incidence rates were even higher than in the settlements, averaging 17.2/1,000 over the 3-year period. The proportion of patients without sputum results and variation in the proportion of smear positive cases indicated inadequate use and poor quality of laboratory services. India's Revised National Tuberculosis Control Program, based on WHO-recommendations, has been highly successful in pilot districts and is being extended to the whole country. This program should be adopted promptly by the health care system serving Tibetan refugees and vigorously implemented among the refugee population.

Adolescent↗
PubMedDate not supplied

Parasitic screening of a refugee population in Illinois.

In a one year period in Illinois, 4,695 stool specimens from refugees for parasitologic screening and 733 diarrheal specimens from non-refugees were tested by routine ova and parasite examination- concentration and permanent stained smear. Patients infected with pathogens were as follows: African group (48.9%), Middle Eastern group (56.5%), Southeast Asian group (48.9%), Eastern European group (46.6%), Hispanic group (38.0%) and non-refugee group (20.7%). The study showed differences between the various groups of refugees and the non-refugee group. The need for routine screening of this population was clearly shown.

Feces↗
PubMed2004

Fat, rich and beautiful: changing socio-cultural paradigms associated with obesity risk, nutritional status and refugee children from sub-Saharan Africa.

There has been an increase in Australia's intake of refugees and migrants from sub-Saharan Africa over the last two decades. These refugees have been exposed to nutritional risks prior to migration, which, together with changes associated with acculturation, impact on their health and nutritional status post-migration. However, there is a paucity of data in Australia that has examined the health and nutritional status of this ethnic minority in Australia. Despite basic research assessing the nutritional status of children, none have specifically concentrated on the health and nutritional situation of sub-Saharan refugee children. In the absence of such studies, this paper explores issues relating to obesity in sub-Saharan African refugee children within a cultural and public health framework. We begin by outlining the history of obesity and its cultural meaning. We then move to a consideration of predisposing factors for obesity and how these factors translate into obesity risk contexts of sub-Saharan refugees post-migration. We argue there are a number of key challenges related to culture and the relationship between socio-economic factors post-migration that require addressing by health professionals, dieticians and health educators to ensure the delivery of successful health outcomes.

Africa South of the Sahara↗
PubMed2000

Management of an outbreak of meningococcal meningitis in a Sudanese refugee camp in Northern Uganda.

We describe an outbreak of meningitis at a Sudanese refugee camp in Northern Uganda that lasted over a year from February 1994. Some 291 cases occurred in a refugee population of 96860 (averaged over the year), an attack rate of 0.30%. The case fatality rate was 13.3%. From a small number of samples taken for culture N. meningitidis serogroup A, serotype 21:P1.9, clone III-1 was identified as the causative organism. The outbreak started in the camp's reception centre which had the highest attack rate. Spread from the reception centre was rapid and the epidemic reached its peak within 3 weeks. All of the cases amongst residents of the reception centre reported having had meningococcal vaccine before arriving at the camp and so were not immunized on arrival as would normally have been the case. Some 37 547 doses of meningococcal vaccine were used in a mass immunization campaign in February and March 1994. Following this the outbreak was declared over in August 1994 when no cases were registered for 2 consecutive weeks. However, following a massive and sudden influx of refugees a new epidemic peak occurred during February 1995. Many of these new refugees were also not immunized on arrival due to pressures of numbers. A follow-up immunization campaign then brought an end to the outbreak. Our experience confirms the effectiveness of timely and high-coverage immunization campaigns in controlling group A meningitis outbreaks amongst refugees in Africa.

Adolescent↗
PubMed2004

Beyond the frontstage: trust, access, and the relational context in research with refugee communities.

This paper examines the role of trust and the concept of access as they affect the relational context in which community research, and research with refugee communities in particular, is conducted. Sociologist Irving Goffman's metaphor of frontstage and backstage behavior is used to illustrate the complexity and importance of developing of relations of trust, and thereby gaining "backstage" access, in communities that are generally closed to outsiders. It is argued that gaining authentic ("backstage") access to refugee communities, as well as other communities that have developed a self-protective insularity, is essential if we are to gather data that accurately reflect the actual beliefs, feelings, and experiences of community members. The paper then examines the puzzling lack of discussion regarding issues of trust, access, and the relational context in the literature on refugee mental health. Explanations for this apparent inattention are sought in the influence of the prevailing scientific paradigm that guides most research with refugees, and that shapes the values of the field's "gatekeepers," the editors and reviewers of scholarly journals. Throughout the paper, key points are illustrated with examples drawn from the author's research with refugees from Guatemala, Bosnia, and Afghanistan.

Developing Countries↗
PubMed2000

Mental health status in refugees: an integrative review of current research.

The purpose of this integrative review was to assess the results of current published quantitative research about refugees and their mental health status. An extensive literature review using several approaches was performed. A group of 12 articles met inclusion criteria for this study sample (N = 12). All 12 studies showed negative mental health status in the refugees sampled. Mental health outcomes included posttraumatic stress disorder, depression, anxiety, psychosis, and dissociation. This review revealed a lack of culturally sensitive understandings and diagnostic measures in the majority of current published quantitative research on refugees. The scope of this research for health professionals is broad, as the number of refugees continues to rise. Recommendations for clinicians include an expanded range of practice to incorporate refugee-specific assessment and treatment.

Health Status↗
PubMedDate not supplied

Correlates of drug use and abuse among Indochinese refugees: mental health implications.

The results of this study suggest that problems with alcohol and other drugs, including tobacco, will become an increasingly important issue for the Indochinese refugee community. Although the problem is relatively small in comparison to the magnitude of the problem among other disadvantaged populations, the refugees still view this issue as troublesome for their community, especially for the younger generation. A significant number of refugees use alcohol and other drugs, including tobacco, as coping mechanisms to deal with their problems, and find their own behavior troublesome. This warrants further study in order to find the conditions under which substance abuse can be decreased and prevented. The present study suggests that adjustment and mental health problems, with the lack of social and institutional support, may be one of the major reasons refugees turn to psychoactive substances to alleviate their stresses and to forget their problems. Substance abuse among refugees creates enormous health risks for a population that is already at greater risk than the general American population. Preventive measures should be implemented at this critical moment in time so that this small problem will not grow into a larger one.

Adaptation, Psychological↗
PubMed2002

Health problems among UN refugees at a family medical centre in Ankara, Turkey.

OBJECTIVES: Political lability in the Near East has brought about the migration of refugees from adjacent countries to Turkey in recent years. To provide an effective health service for refugees, a needs assessment has to be done. UN refugees referring to a family medical centre located in Ankara, Turkey, were therefore investigated for health problems. DESIGN: Medical records were studied retrospectively for age distribution, gender, origin, diagnoses, type of treatment and referral to a secondary health care setting. SUBJECTS: 212 refugees of different countries (mostly from Iraq, Iran and Palestine). RESULTS: Infectious disease was the most often diagnosed condition. Post-traumatic stress disorders could be observed in 12% of refugees. CONCLUSION: The family physician must be careful not to misdiagnose these disorders during medical examination. Most disease can be diagnosed and treated in family practice. Special care must be taken in the case of mental disorders.

Adult↗
PubMedDate not supplied

A needs assessment in a refugee mental health project in north-east London: extending the counselling model to community support.

In the United Kingdom, as elsewhere, mental health services are becoming increasingly aware that existing services may not meet the needs of different minority groups. This paper outlines the model used to set up a project focusing specifically on refugee mental health needs in Waltham Forest, in north-east London. Funding was available for one sole mental health worker and careful consideration was therefore given as to how her time should be used. A thorough needs assessment of refugees living in Waltham Forest determined that the provision of therapy or counselling alone would not be the most appropriate means of addressing refugees' needs. The intervention model developed therefore included awareness raising and community mobilization, in addition to one-to-one clinical sessions. The empowerment, training and support of refugee community groups became a central part of the work, which helped to establish and then consolidate links between mainstream services and individual refugees.

Community Mental Health Services↗
PubMed2005

Diagnostic evaluation of newly arrived asymptomatic refugees with eosinophilia.

BACKGROUND: Refugees may arrive for resettlement with asymptomatic parasitic infections, and eosinophilia may be the only clue to the presence of infection. Our aim was to determine the prevalence of eosinophilia and develop a standardized approach to the evaluation of asymptomatic refugees with eosinophilia. METHODS: We reviewed the medical records of refugees seen from October 1998 through May 2002 at Boston Medical Center. Data examined included age, country of origin, absolute eosinophil count, results of stool ova and parasite testing, and results of serological testing for Strongyloides stercoralis, Schistosoma species, and filaria. RESULTS: Eosinophilia--defined as an absolute eosinophil count of >or=450 cells/microL--was present in 266 (12%) of 2224 refugees. Patients with eosinophilia ranged in age from 2 months to 81 years and had arrived from Africa, Eastern Europe, Southeast Asia, South America, the Caribbean, and the Middle East. Absolute eosinophil counts ranged from 450 to 3224 cells/microL. Pathogens were identified in stool samples of 76 (29%) of 265 patients. Serological testing for S. stercoralis, Schistosoma species, and/or filaria was done for 120 (45%) of 266 patients. Results of serological testing were positive for S. stercoralis in 45 (39%) of 115 patients, for Schistosoma species in 15 (22%) of 67 patients, and for filaria in 18 (51%) of 35 patients. Serological evidence of parasitic infection was seen at all levels of eosinophilia and in patients with and without pathogens identified in their stool samples. CONCLUSIONS: Systematic evaluation for parasites in asymptomatic, newly arrived refugees with eosinophilia should include stool ova and parasite examination, serological examination for S. stercoralis for all patients, and serological examination for Schistosoma species and filaria in patients from regions where these organisms are endemic.

Adolescent↗
PubMed2003

Iron deficiency is unacceptably high in refugee children from Burma.

Iron-deficiency anemia (IDA) in refugees is reported to be among the major medical problems worldwide. Because food rations are typically inadequate in iron, long-term reliance is a key predictor of anemia among displaced people. Comprehensive nutritional assessments of refugee children from Burma have not previously been completed. Refugee children aged 6-59 mo were studied to determine 1) the prevalences of anemia, iron deficiency (ID) and IDA and 2) the factors associated with anemia and ID. Cluster sampling in three camps and convenience sampling in two additional camps were used. Hemoglobin (Hb) levels were measured and micro mol zinc protoporphyrin/mol heme were determined in 975 children. Logistic regression analyses (95% CI) determined predictors of anemia and ID. The prevalences of IDA, anemia and ID in these refugee children were 64.9, 72.0 and 85.4%, respectively. Predictors of anemia included young age (P < 0.001), food ration lasting <1 mo (P = 0.001), daily consumption of dietary iron inhibitors (P < 0.05), weight-for-height Z-score of <-2 (P < 0.05), male gender (P < 0.05) and uneducated father (P < 0.001). Predictors of ID were young age (P < 0.001) and recently reported illness (P < 0.05). Laboratory tests confirmed that anemia and ID are major health problems among these refugee children and that ID is the leading cause of anemia. A comprehensive nutrition and public health-focused approach to combating anemia and ID is essential. Following the presentation of results to policy makers, the improvement of the micronutrient content of rations has been initiated.

Age Distribution↗
PubMedDate not supplied

A comprehensive refugee health screening program.

Nationally and internationally, there is a struggle to provide adequate health screening and assessment programs for refugees. The Department of Family Medicine at the University of Colorado Health Sciences Center in partnership with the Colorado Refugee Services Program has developed a comprehensive refugee health screening and assessment program. The program was designed to ensure access to screening and to provide better care for this vulnerable population. Key features of the program include a single point of access for all family members, full availability of appropriate interpreting services, comprehensive health assessments that include a thorough mental health screening, data collection and evaluation, and education of health care providers to deliver culturally responsive care. During the first 30 months of this program, comprehensive assessments were provided for more than 1600 refugees. Future directions include improving the efficiency of daily systems, seeking alternative sources of funding, improving follow-up and vaccination rates, expanding mental health services, and tracking health outcomes and refugees' utilization of health care services through longitudinal research.

Colorado↗
PubMed1995

Identifying and responding to the needs of refugees: a global nursing concern.

Worldwide catastrophic events such as civil war have forced 1 in every 130 people in the world to flee her or his home and become a refugee or displaced person. The article draws upon contemporary refugee experiences from Afghanistan, the Sudan, and the former Yugoslavia to introduce the role of nursing during the refugee journey from flight to asylum seeking. It is hoped that the article will provide nurses with a beginning awareness of the nurse's role in the care and comfort of refugees and displaced people. Central to this role is the gathering of humanitarian, sociocultural, and personal information to enable extensive networking and relationship building with refugees for ongoing empowerment and increased problem-solving capabilities.

Data Collection↗
PubMed1996

The effects of welfare status on psychological distress among Southeast Asian refugees.

It has been established in the general population that there is a relationship between welfare status and psychological well-being. There are few studies, however, which investigate the effects of welfare dependency on Southeast Asian refugees, a population that is highly dependent on welfare. This study examined the relationship between welfare status and psychological well-being among Vietnamese, Cambodian, Laotian, and Hmong refugees. The study compared three welfare groups: those who have never been on welfare, those who were once dependent on welfare and are no longer on welfare, and those who are still welfare-dependent. The results supported three hypotheses: a) a high percentage of all four refugee groups were still dependent on welfare even after being in the United States for an average of 5 to 6 years, b) a significant relationship was found between welfare dependency and psychological distress, and c) dependence on welfare had long-term effects for all four groups. An interesting finding that emerged for the Vietnamese, Cambodians, and Laotians was that individuals who were once on welfare but who are no longer receiving welfare benefits are at similar risk as their counterparts who are currently on welfare of developing psychological distress. The findings therefore showed that for this population, if individuals had been touched by welfare at any period in their lives, they were at risk of developing psychological distress. There was an unexpected different finding for the Hmong; individuals who were no longer on welfare were more at risk than those who continued to receive or never had received welfare. Reasons for the intergroup differences and why refugees tended to stay on welfare longer than the general population were explored, along with a discussion about the implications of the findings for refugee policy.

Adolescent↗