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PubMed2006

[General practitioners' experiences with refugee patients].

BACKGROUND: Refugees are likely to suffer from complex medical conditions due to persecution and exile. The symptoms may persist several years after the individual has fled his or her homeland. Knowledge of refugees' health condition in their receptive countries is insufficient. MATERIAL AND METHOD: Qualitative interviews with 12 general practitioners (GPs) in and around Oslo. A narrative approach was chosen for the analysis. RESULTS: The GPs' consultations with refugee patients seem to be characterised by uncertainty on the relevance of their refugee experience to their health condition. The GPs were reluctant to invite the patient to talk about traumatic experiences connected to their homelands, the escape and the exile. Rather, they express that unfamiliar culture and foreign language act as barriers to good communication between doctor and patient. Specialised health services seem neither to be accessible to the patients nor to be providers of clinical supervision for the GPs. INTERPRETATION: Cultural status seems to cover up experiences related to escape and exile. A lack of specialised health services seems to place the GP as a single actor in the medical service to refugee patients. The interviews revealed a need for instruction material adapted to the GPs' situation.

Clinical Competence↗
PubMedDate not supplied

Health profile of applicants for refugee status (admitted into Quebec between August 1985 and April 1986).

Refugees requesting asylum when in Canada are termed "Applicants for Refugee Status". The present epidemiological study of a large series of these refugees by the Community Health Department of St-Luke's Hospital in Montreal provides a picture of their social and health profiles. The refugees came from developing countries with serious internal conflicts. On the whole, their state of health was satisfactory. However, in some cases specific diseases were detected which were often connected with their geographical origin. These diseases, which included treponematosis, intestinal parasitosis and nutritional deficiency should in future give rise to health care programs specially adapted to the sub-populations concerned. As regards the problem of torture, both its underestimation and inadequate psychological follow-up among refugees are of great concern and call for special training in treating the effects of torture on its victims.

Adolescent↗
PubMed1989

Parasitic infections in Asian refugees in Fort Worth.

This report describes parasitic infections recorded from April 1984 to December 1987 in refugees using services of the Fort Worth-Tarrant County Public Health Department. Infections with 1,601 parasitic infections were documented in 824 laboratory specimens obtained from refugees. Ascariasis and giardiasis were more prevalent than other parasitic infections. The highest attack rates occurred in refugees from Cambodia (70.0%), Laos (69.7%), and Vietnam (54.3%). Information from this study supports published data on high attack rates and endemicity of infections in refugees from Southeast Asia. Continued surveillance and treatment of these refugees should improve their health conditions and prevent the development of endemic foci in the United States.

Asia↗
PubMed1985

Nutrition studies of Ugandan refugees in Sudan and Rwanda. A report on surveys using the mid-upper arm circumference method.

Nutritional surveys were undertaken in refugee camps in southern Sudan and Rwanda. Nutrition status was assessed using the mid-upper arm circumference method. A high level of malnutrition was found in the main transit camp for refugees from Uganda into southern Sudan. Nutrition status in refugee settlements was adequate in the Rwanda camps, where refugees had only been displaced for a short period of time; there was only a limited degree of malnutrition. The findings correlate with the time period of displacement of the refugees.

Arm↗
PubMed1977

Psychosocial first aid for refugees (an essay in social psychiatry).

Post-war refugee resettlement schemes offer an opportunity for the study of contemporary social phenomena of compulsory mass migration. The process, set in motion by man-made disasters of war, oppression and persecution, deeply affects not only the victims but also the social institutions as they mobilize resources to accommodate the stateless and homeless new populations. The traditional focus on 'culture-change' is inadequate for the development of principles of aid to the refugees. In this paper, an operational definition of the structure and natural history of the social situation of resettlement is outlined, with reference to the working hypotheses of (1) the Social Displacement Syndrome and (2) the Psychosocial First Aid for Refugees Project. This has been derived from clinical and field studies of four successive refugee groups in Canada over the past 27 years, with specific focus on the social dynamics of the situation from immediately upon resettlement to one year after. In this early phase, the coexistence of personal and social disequilibrium in the refugees and among those who represent the institutions responsible for their management creates specific conditions, of which some enhance the disposition for recovery or 'repair' and some might reinforce the disposition for lasting 'social breakdown'. Some generalizations concerning practical and theoretical work in social psychiatry are made.

Acculturation↗
PubMed1982

Cross-cultural problems for Southeast Asian refugee minors.

The process of assimilation is both painful and rewarding to the refugee and the people of the host country. Throughout the history of the United States, people have found creative ways to deal with cross-cultural differences. As illustrated in the composite case illustration, the resolutions involve overt adoption of the host culture's customs, acceptance of the refugee's cultural customs, compromise by both cultures, and peaceful coexistence of the two cultures. The broad issue is how a society responsibly assimilates groups of people with different cultures and customs in a way that does no condemn any culture and allows the refugees to become self-sufficient members of society. The struggles touched upon in this article do not stop after the first year of the refugee's resettlement. The process of assimilation of a group of people into mainstream society generally takes about three generations. For the refugees, it is a life-long struggle between the "old ways" and the "new ways" in their own lives, as well as in the lives of their children.

Acculturation↗
PubMed1995

[Psychosocial preventive work among war refugees. A task for primary health care?].

During the two first years of the war in Bosnia (1992-93) refugees came both to Norway and to other European countries. Bosnian "war refugees" are released prisoners from Serbian concentration camps, and their close families. Most of the former prisoners and their families had experienced extreme traumas, qualifying them for help from expert psychotherapists. No such help was available. The aim of the present project was to find out whether useful psychosocial preventive work can be done within the primary health services. Our intervention, which was carried out during a six month period in 1993-94, included two semi-structured interviews with each refugee family in the centre, and follow-up contacts with persons who indicated major psychological problems. All the refugees reported that they experienced deep sorrow, and the majority had difficulty in sleeping and concentrating. A pessimistic view of their future was common. Most of the refugees were positive towards participating in the interviews. Several of them have reported that the interviews were of direct help. In the majority of cases we have experienced that the ordinary health contacts later have been meaningful.

Adult↗
PubMed1996

[A study of post-traumatic stress reactions among war refugees based on medical records. A standard model may support the treatment].

A special project designed to aid Bosnian refugees in Stockholm County was initiated and funded by the County Council in February 1994. The present study, a joint endeavour involving the Bosnian Project, the Centre for Trauma and Torture Diagnostics, and the Red Cross Centre for torture victims, was designed to fulfil the following aims: To characterise the patient population in terms of social situation, trauma history, symptoms and treatment; To review accumulated experience at the three centres; To outline and discuss the treatment; and To suggest new avenues for further research concerning refugees and trauma. To obtain comparable material for this retrospective review of case records at the three centres, a special case chart format was adopted, covering pre-war and pre-treatment information on general background, social situation, health status and medication, as well as trauma history, symptoms and treatment. Most patients reported good pre-war health, but at the time of the study exhibited manifest effects of trauma history; 95 per cent reported mental problems, and 39 per cent medical disease or physical disorders. These refugees were thus characterised by manifest post-traumatic stress symptoms and need of treatment. Despite their relatively short time in Sweden, almost all had permanent residence permits and fixed addresses. The absence of a comparable control group precluded comparison with other refugee or normal populations. The findings suggest the need of co-ordination and co-operation between the special facilities available to refugees, and of a standardised format for case records.

Adult↗
PubMed1998

Tuberculosis control in refugee populations: a challenge to both relief agencies and national programs.

Today's worldwide tuberculosis epidemic and the movement of a growing number of refugees overlap geographically and have made tuberculosis control in refugee populations an issue of increasing importance. However, in developing countries, where both of these problems are concentrated, tuberculosis control in refugee populations remains a largely unmet need. Experience shows that despite difficult field conditions, tuberculosis control programs can be managed successfully in this setting. The range of outcome results reported for treatment completion and defaulting is, however, wide. Analyzing possible determinants for observed variation in treatment outcome results, this paper outlines prerequisites for establishing a tuberculosis control program in a refugee setting. An attempt is made to formulate a general strategy for the main policies which, if applied consistently, will reduce morbidity, mortality and transmission of tuberculosis among refugee populations living in camps. Criteria for the evaluation and monitoring of such a program are discussed.

Communicable Disease Control↗
PubMed1998

Somali refugee health screening in Hennepin County.

Somalis are one of the newest refugee groups to settle in Minnesota, first arriving in 1993. The largest number of Somali refugees in Minnesota live in Hennepin County, which received 85% of the state's Somali refugees in 1996. In this population, tuberculosis, parasitic diseases, and malaria are of particular concern. In 1996 Somalis accounted for 27% of the foreign-born cases of tuberculosis in Minnesota. Before entering the United States, all refugees are given an overseas health assessment, which focuses on identifying conditions that might be contagious. The examination is limited and is valid for one year. Domestic refugee health assessment is very important, since it provides a comprehensive medical evaluation and treatment plan for health conditions that may interfere with successful resettlement.

Communicable Disease Control↗
PubMed1998

[Refugee or immigrant children in hospital].

The aim of the study was to gain knowledge of the diagnosis, length of hospital stay, and ethnic background of refugee and immigrant children admitted to the Paediatric Ward at Aker University Hospital in Oslo, and to find out how well the staff and families of the children communicated. 347 children, admitted from ten districts in the immediate vicinity of the hospital, were included in the study. 133 (38%) children had parents who were both born in a non-western country. 44 of the children came from a refugee background and 89 from an immigrant background. The median stay on the Paediatric Ward was three days for the immigrant children and two days for the refugee children and children from Western countries. None of the groups was admitted more frequently than the others. Refugee and immigrant children were most often admitted because of respiratory diseases or obscure symptoms. Communication between the staff and more than 40% of the families with refugee or immigrant backgrounds was not satisfactory. Three out of four mothers and one out of two fathers were unable to communicate well in Norwegian. One third of the mothers had less than six years of school education and one quarter of the immigrant mothers had never attended school.

Child↗
PubMed1998

Emergency contraception among refugees and the displaced.

In 1994, the international relief community began to recognize and address the reproductive health needs of refugees and displaced populations. A minimum initial service package of reproductive health services for refugees and the displaced, which includes emergency contraception (EC), was developed and recommended for use in refugee settings. This paper describes the experience of one international relief organization, the International Rescue Committee (IRC), in introducing EC into its worldwide reproductive health program. A recent IRC survey found that EC is available in 4 out of 14 settings where it provides reproductive health services. A case study from Tanzania demonstrates the modes of delivery, the demand for EC by women who have experienced sexual violence, and the community responses to this method of contraception. More information, education, and communication directed at refugee communities; more donor support for supplies; and institutional commitment to train staff are needed to expand refugee access to EC.

Contraceptives, Postcoital↗
PubMed2004

Murug, Waali, and Gini: Expressions of Distress in Refugees From Somalia.

OBJECTIVE: To study how mental illness is understood, expressed, and treated among Somali refugees and how these factors influence use of health services for mental problems. METHOD: Seventeen adult Somali refugees (9 women, 8 men) were recruited by mail or by word-of-mouth to participate in the study. The study setting was an urban community health center in Rochester, N.Y., that provides family practice patient care to local Somali refugees. A qualitative design was used that incorporated a combination of methods, chiefly semistructured interviews. Interviews focused on the ways in which sadness, depression, and anxiety are expressed and on the participants' understanding of the origins of and treatment strategies for these problems. Interview transcripts were analyzed to identify recurrent themes. RESULTS: Nearly all participants felt that mental illness was a new problem for their community that did not exist to the same extent in prewar Somalia. Themes that emerged to explain the causes of mental illness included the shock and devastation of war; dead, missing, or separated family members; and spirit possession or a curse. Three major types of mental problems were identified that were associated with specific behaviors and treatment strategies: murug (sadness or suffering), gini (craziness due to spirit possession), and waali (craziness due to severe trauma). Rather than seek help from a clinician, participants preferred to first use family support, prayer, or traditional therapies for most situations. CONCLUSION: Somali refugees have distinct ways of conceptualizing, expressing, and treating commonly understood mental problems. Participants differed in their opinions about whether they would consult a doctor to discuss feelings of sadness or craziness. Effective mental health care of refugees should address culture-specific belief systems in diagnosis and treatment.

Journal Article↗
PubMed1983

Refugee resettlement: models in action.

"A model of refugee resettlement containing two axes is proposed: volume of refugee intake and emphasis on economic or cultural adaptation." The refugee resettlement practices of Canada, France, and the United States are then described. The author notes that France and Canada favor a moderate intake of refugees with emphasis on economic adaptation, although the emphasis in Quebec is on cultural adaptation. In contrast, the United States accepts a large volume of refugees, with a similar emphasis on economic adaptation.

Americas↗
PubMedDate not supplied

Vancouver AIDS conference: special report. Rwandan refugee camps: NGOs get rough treatment from both sides.

NGOs attempting to grapple with the thankless task of helping the Rwandan refugee camps have come in for some rough treatment from two directions over their HIV/AIDS efforts. At the policy level, an AMREF paper presented to the Vancouver conference charges bluntly that "There is no policy regarding HIV/STDs in refugee camps among international organizations specializing in refugee crises; thus there is absence of STD drugs and protocols, no privacy in open (tent) clinics, no means of protection (no condoms), and no information regarding STDs/HIV." AMREF bases its comments upon its experience among 700,000 Rwandan refugees in camps in West and North-West Tanzania, an area where (AMREF remarks pointedly) there was previously a low prevalence of HIV by Tanzanian standards, at 2-5%. At the operational level, CARE International, in a conference paper, reported rough treatment at the hands of the Rwandans themselves. It has been working under contract from AIDSCAP among the 400,000 Rwandans who fled to the Ngara district of Tanzania. Not surprisingly, it found that women and girls in the camps faced a higher risk than men. But more surprisingly at first sight, it found that after its HIV educational efforts "negative attitudes about condom use increased from 22% to 78%," which was possibly explained by "political ideology." "Young Hutu men in the camps boasted of their efforts to impregnate as many women and girls as possible to help replenish the population."

Africa↗
PubMed1992

Famine-affected, refugee, and displaced populations: recommendations for public health issues.

During the past three decades, the most common emergencies affecting the health of large populations in developing countries have involved famine and forced migrations. The public health consequences of mass population displacement have been extensively documented. On some occasions, these migrations have resulted in extremely high rates of mortality, morbidity, and malnutrition. The most severe consequences of population displacement have occurred during the acute emergency phase, when relief efforts are in the early stage. During this phase, deaths--in some cases--were 60 times the crude mortality rate (CMR) among non-refugee populations in the country of origin (1). Although the quality of international disaster response efforts has steadily improved, the human cost of forced migration remains high. Since the early 1960s, most emergencies involving refugees and displaced persons have taken place in less developed countries where local resources have been insufficient for providing prompt and adequate assistance. The international community's response to the health needs of these populations has been at times inappropriate, relying on teams of foreign medical personnel with little or no training. Hospitals, clinics, and feeding centers have been set up without assessment of preliminary needs, and essential prevention programs have been neglected. More recent relief programs, however, emphasize a primary health care (PHC) approach, focusing on preventive programs such as immunization and oral rehydration therapy (ORT), promoting involvement by the refugee community in the provision of health services, and stressing more effective coordination and information gathering. The PHC approach offers long-term advantages, not only for the directly affected population, but also for the country hosting the refugees. A PHC strategy is sustainable and strengthens the national health development program.

Aged↗
PubMed1995

Health status of pediatric refugees in Buffalo, NY.

OBJECTIVE: To characterize the health status of recent pediatric refugees. RESEARCH DESIGN: Medical records of 107 pediatric refugees who underwent screening during a recent 24-month period were reviewed. SETTING: A county hospital pediatric clinic in a metropolitan area with a population of 1,189,000. The majority of pediatric refugees who come to the Buffalo, NY, area receive a health screening in this clinic. RESULTS: Most of the children were from Vietnam (67%), the Soviet Republics (19%), or Africa (14%). The median age was 8 years 2 months (range, 1 to 18 years). Only 39% of the children had evidence of adequate immunizations for age (39 of the children from Vietnam, two children from Africa, and one from the Soviet Republics). In 30%, physical examinations exposed conditions that required follow-up or referral to a medical or surgical specialist. Forty-two percent of the children required dental referral. Seven children were anemic; three had microcytic anemia. Of 81 children who underwent screening for hepatitis B, six (7%) were carriers, 35 (43%) were positive for hepatitis B surface antibody, and only four (5%) related a history of hepatitis exposure. Stool specimens were examined for ova and parasites in 87 children; 19 had pathogenic parasites with multiple organisms in two. Thirteen (24%) of 55 children who were tested from Vietnam, five (36%) of 14 children who were tested from Africa, and one (5%) of 18 children who were tested from the Soviet Republics had pathogenic parasites. Parasites included Ascaris lumbricoides (n = 8), Necator americanus or Ancylostoma duodenale (n = 5), Giardia lamblia (n = 3), Trichuris trichiura (n = 2), Dientamoeba fragilis (n = 2), and Entamoeba histolytica (n = 1). Skin testing for tuberculosis with purified protein derivative (tuberculin) was completed in 83 children, and 17 (20%) had reactive tests (21% [12/58] from Vietnam, 11% [1/9] from Africa, and 25% [4/16] from the Soviet Republics). CONCLUSIONS: Refugee children who come to the United States frequently have conditions that put them at risk of future morbidity and may require utilization of substantial health care resources. Some of these conditions represent public health concerns.

Adolescent↗
PubMed2000

An evaluation of poor pregnancy outcomes among Burundian refugees in Tanzania.

CONTEXT: Little is known about pregnancy outcomes among the approximately 11 million refugees worldwide, 25% of whom are women of reproductive age. OBJECTIVE: To estimate incidence of and determine risk factors for poor pregnancy outcomes and to calculate the contribution of mortality from neonatal and maternal deaths to overall mortality in a refugee camp. DESIGN: Cross-sectional review of records and survey, conducted in February and March 1998. SETTING: Mtendeli refugee camp, Tanzania. PARTICIPANTS: For the overall assessment, 664 Burundi women who had a pregnancy outcome during a recent 5-month period (September 1, 1997-January 31, 1998) and their 679 infants; 538 women (81%) completed the survey. MAIN OUTCOME MEASURES: Incidence of fetal death (fetus born > or =500 g or > or =22 weeks' gestation with no signs of life), low birth weight (<2500 g), neonatal death (death <28 days of life), and maternal death (deaths during or within 42 days of pregnancy from any cause related to or aggravated by the pregnancy or its management). RESULTS: The fetal death rate was 45.6 per 1000 births, the neonatal mortality rate was 29.3 per 1000 live births, and 22.4% of all live births were low birth weight. Compared with women without poor pregnancy outcome, those with poor pregnancy outcome were more likely to report prior high socioeconomic status (adjusted odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.4), having a first or second pregnancy (OR, 2.2; 95% CI, 1.4-3.4), and having 3 or more episodes of malaria during pregnancy (OR, 2.0; 95% CI, 1.4-3.1). Neonatal and maternal deaths accounted for 16% of all deaths during the period studied. CONCLUSIONS: Poor pregnancy outcomes were common in this refugee setting, and neonatal and maternal deaths, 2 important components of reproductive health-related deaths, contributed substantially to overall mortality.

Adult↗