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PubMed2003

Social support and the significance of shared experience in refugee migration and resettlement.

This article examines the role of social support as a determinant of refugee well-being and migration patterns during early resettlement. Analysis is based on qualitative in-depth interviews with 47 government-assisted refugees in Canada and 38 key informants (settlement service providers and immigration officials) in Canada and overseas. The study describes refugees' decision making during stages of migration and resettlement, from whom they seek social support in particular situations, what sources are appraised as most important, and what is significant about the support. The authors suggest that a goal of refugees support-seeking strategies is affirmation through shared experience.

Acculturation↗
PubMed2003

Bosnian and Soviet refugees' experiences with health care.

Studies of refugees in the United States rarely address health the first few years following resettlement in part because the refugees become subsumed under the foreign-born or immigrant category. A national study reaffirmed the so-called healthy immigrant effect, but fewer sick days and less physician use may actually reflect access problems, economic concerns, and health beliefs or practices that clash with American health care. Because statistics may mask differences in health and why people seek professional care, it is important to combine qualitative and quantitative approaches. This study examined health, illness, and health care use patterns of refugees in Northern California using a database analysis, a medical record review, and an ethnographic study of the Bosnian and former Soviet Union refugee communities. This article describes some ethnographic findings from participant observation, semistructured interviews, and focus groups, with an emphasis on people's experiences with health care, health risk behaviors, and self-care.

Acculturation↗
PubMed2001

Great suffering, great compassion: a transcultural opportunity for school nurses caring for Cambodian refugee children.

The cultural ways of Cambodian refugee families, combined with the physical and psychological health problems inherent in their refugee experience, present opportunities for nurses to engage in transcultural nursing. The purpose of this descriptive study was to understand the nature and meaning of a school district cross-cultural team's experiences of providing health care for children of Cambodian refugee families. Focus group interviews with school nurses and Cambodian liaisons were conducted utilizing S. M. Dobson's conceptual framework of transcultural health visiting as a guiding theoretical perspective. Transcultural and intracultural reciprocity as experienced with Cambodian families are explored and described. Concrete suggestions for fostering transcultural reciprocity with Cambodian refugee families are provided.

Adolescent↗
PubMed2005

'The ghost pushes you down': sleep paralysis-type panic attacks in a Khmer refugee population.

Among a psychiatric population of Cambodian refugees (N = 100), 42% had current--i.e. at least once in the last year--sleep paralysis (SP). Of those experiencing SP, 91% (38/42) had visual hallucinations of an approaching being, and 100% (42/42) had panic attacks. Among patients with post-traumatic stress disorder (PTSD; n = 45), 67% (30/45) had SP, whereas among those without PTSD, only 22.4% (11/45) had SP (chi2 = 20.4, p < .001). Of the patients with PTSD, 60% (27/45) had monthly episodes of SP. The Cambodian panic response to SP seems to be greatly heightened by elaborate cultural ideas--with SP generating concerns about physical status, 'good luck' status, 'bad luck' status, sorcery assault, and ghost assault--and by trauma associations to the figure seen in SP. Case vignettes illustrate cultural beliefs about, and trauma resonances of, SP. A model to explain the high rate of SP in this population is presented. SP is a core aspect of the Cambodian refugees response to trauma; when assessing Cambodian refugees, and traumatized refugees in general, clinicians should assess for its presence.

Cambodia↗
PubMed2006

Longitudinal research to promote effective refugee resettlement.

Canada's relative generosity in admitting refugees and fairness in considering refugee claims has earned this country an enviable reputation. However, having opened its doors to those selected, Canada's resettlement policies and programs fail to provide for their needs, and to promote their optimal adaptation. Based on a decade-long investigation of the resettlement of more than 1300 Southeast Asian refugee--'Boat People'--the current report examines how research concerning (a) the impact of pre-migration trauma; (b) the mental health impact of social resources such as the like-ethnic community, refugee sponsorship programs, and language training; and (c) individual coping strategies such as suppressing the past, can contribute both to theory and to improving policy and practice. The presentation acknowledges the contributions of Dr. Alexander H. Leighton by demonstrating the importance of his insistence on the need for a longitudinal perspective both for conducting research and for planning programs and services.

Adaptation, Psychological↗
PubMed1994

Mental health among immigrant and refugee children of divorced parents.

The mental status of 27 children in divorced immigrant families and 17 children in divorced refugee families was examined, and compared to that of 113 children in divorced Swedish families. Differences in divorce-pattern between these families and Swedish divorced families were analysed. Viewed together, the immigrant and refugee children displayed a significantly higher symptom load compared to Swedish children from both divorced and intact homes. When examined separately, the refugee children but not the immigrant children were more troubled than Swedish children from divorced families. The shorter time the children had spent in Sweden, the higher was their symptom load. In comparison to Swedish divorced couples, the immigrant and refugee couples had been married for a shorter time, had been unhappy for a longer time prior to divorce, and joint custody was less common. Most of the marriages had been unhappy before the arrival in Sweden, but a dissolution had not been seen as feasible earlier. As among the Swedish couples, it was the woman who had initiated the divorce in most cases, and it was also the mother who became the residential parent in most cases.

Adolescent↗
PubMed1991

Public health aspects of a refugee camp.

The explosion in the number of refugees throughout the world has led to the development of a new medical speciality; Migration Medicine. Such a speciality has a strong public health dimension. Addressing the public health needs of refugees especially in developing countries is one of the few challenges of practising public medicine which gives measurable results in weeks rather than years. Whilst I was a trainee in Public Health Medicine in Glasgow, UK, I was seconded to Medecins Sans Frontières ('doctors without borders') to act as Medical Co-ordinator of a relief operation for refugees from Sudan. This paper discusses some of the lessons that the experience taught me which have application to many refugee situations throughout the world.

Alcoholism↗
PubMed2006

Experiences and expectations of refugee doctors: Qualitative study.

BACKGROUND: Refugee doctors constitute a potentially valuable resource for reducing the recruitment crisis in psychiatry. However, various hurdles make their route into the National Health Service (NHS) difficult. AIMS: To explore the perceptions and experiences of refugee doctors trying to practise psychiatry in the UK. METHOD: Thirty-one refugee doctors participated in qualitative interviews designed to elicit their experiences in trying to practise as doctors in the UK. Twenty were re-interviewed about 6 months later. RESULTS: Doctors identified a range of practical problems that made it difficult for them to take the required steps towards practising in the UK. These included lack of appropriate information, lack of a clear route through the system and feelings of isolation. The English language examination was seen as a particular bottleneck, as were finding clinical attachments. The psychological impact of the experience was profound. CONCLUSIONS: These findings have important implications for how refugee doctors are introduced to the practice of psychiatry in the NHS.

Adult↗
PubMed1998

Travelling with "excess baggage": health problems of refugee women in Western Australia.

Refugee women face problems during resettlement in host countries that are often worse than those faced by voluntary migrants. Although these problems are generally thought to be related to previous traumatic experiences, this may not always be the case; there are many refugee women who may not have personally experienced torture or trauma but who nonetheless express needs that suggest a perception of profound marginalisation from the mainstream society. This paper summarises the health problems identified in a needs assessment of refugee women from Latin America resident in Perth, Western Australia and discusses some of the issues that create "excess baggage" for refugee women.

Adaptation, Psychological↗
PubMed2003

HIV/AIDS and the African Refugee Education Program in New Zealand.

In the past decade, the resettlement of African HIV-positive refugees in New Zealand has meant dramatically changing patterns of new HIV infection. This increase in heterosexually acquired HIV has been met by mounting disquiet on the part of the public, politicians, and health officials. The voices of the refugees themselves have been lost in this debate. This article discusses the experiences of African refugees with HIV, being in New Zealand, and the establishment of the National HIV/AIDS Refugee Health Education Program, designed to meet the needs of African communities in New Zealand.

Adult↗
PubMed2007

Problem drinking among Cambodian refugees in the United States: how big of a problem is it?

OBJECTIVE: The present study assesses current drinking behavior in a representative sample of Cambodian refugees. Earlier estimates of alcohol use in this population suggest that Cambodian refugees are at elevated risk for alcohol-use problems, but these studies have relied on convenience samples and may not reflect current consumption patterns. METHOD: A cross-sectional, face-to-face interview was conducted in Khmer on a household probability sample of Cambodian refugees residing in the largest such community in the United States. The overall response rate was 87% and yielded 490 respondents in the current analyses. RESULTS: Rates of consumption and alcohol-use problems were low in this population. Few participants (26%) reported any alcohol consumption in the 30 days preceding the interview, and only 2% reported any heavy drinking in the last 30 days. Multivariate analyses indicated that younger participants and men were more likely to report any recent drinking, and men were more likely to report any heavy drinking. Notably, recent consumption was not related to degree of trauma exposure or extent of psychiatric distress when controlling for age and gender. CONCLUSIONS: These data contrast dramatically with the widespread belief that Cambodian refugees are at elevated risk for problem drinking. Findings highlight the pitfalls of drawing population-based conclusions from data based on nonrepresentative samples or from nonstandard measures of alcohol consumption.

Adult↗
PubMed2006

Rates and correlates of seeking mental health services among Cambodian refugees.

OBJECTIVES: We assessed the rates and correlates of seeking mental health services among a probability sample of Cambodian refugees who needed such services. METHODS: Interviewers conducted face-to-face interviews with a representative sample drawn from the largest US community of Cambodian refugees. The analytic sample included 339 persons who met past 12-month criteria for posttraumatic stress disorder, major depression disorder, or alcohol use disorder. Respondents described contact with service providers for psychological problems during the preceding 12 months. We examined bivariate and multivariate predictors of seeking services. RESULTS: Respondents reported high rates of contact with both medical care providers (70%) and mental health care providers (46%). Seeking services from both types of providers was associated with lack of English-speaking proficiency, unemployment, 3 or fewer years of preimmigration education, and being retired or disabled. Women, individuals with health insurance, and persons receiving government assistance also were more likely to seek services. CONCLUSIONS: Cambodian refugees with mental health problems had high rates of seeking service for psychological problems during the preceding 12 months. Research is needed to examine the effectiveness of services received by Cambodian refugees.

Adult↗
PubMed1983

Caring for Southeast Asian refugee patients in the USA.

This paper concerns care of refugees from Southeast Asia who speak little English and are relatively unfamiliar with the formal health care system in the United States. It aims to demystify the behaviors of refugee patients and to support health practitioners who are attempting to care for them. Western medicine is discussed in terms of the expectations that refugees tend to hold of it, and of the conflicts with Southeast Asian beliefs and practices which it presents. Despite language differences, health care agents can increase the effectiveness of their communication with persons from Southeast Asia, primarily by allowing for their viewpoints. Topics discussed are: the first encounter with a refugee patient; use of interpreters; obtaining informed consent; "the passive obedient" patient; the "non-compliant" patient; body image; sources of social support for healing; use of medications; traditional self-care practices; and death and depression.

Asia, Southeastern↗
PubMed1987

Sudden death in sleep of Laotian-Hmong refugees in Thailand: a case-control study.

A syndrome of sudden and unexpected death during sleep occurs among adult Southeast Asian refugees in the United States. Surveillance for sudden deaths was conducted among Laotian-Hmong refugees in the Ban Vinai refugee camp in northeastern Thailand to determine if a similar cause of death occurs there. Sixteen sudden and unexpected deaths associated with sleep were found that were similar to the sudden deaths noted among Southeast Asian refugees in the United States. A case-control study in Ban Vinai revealed associations between sudden death in sleep and membership in the Green-Hmong subgroup, a family history of sudden death, and previous non-fatal sleep disturbances. Sudden and unexpected death during sleep of young adults is a regional phenomenon within Asia and occurs in populations that are culturally and genetically distinct. Migrants from affected populations in Asia carry with them the susceptibility to sudden death in sleep.

Adolescent↗
PubMed2001

Growth status and related medical conditions among refugee children in Massachusetts, 1995-1998.

OBJECTIVES: This study analyzed growth and identified related medical conditions among refugee children in Massachusetts. METHODS: Between July 1995 and June 1998, 1825 refugee children were screened. Variables included positive tuberculin (purified protein derivative; PPD) test; dental abnormalities; pathogenic parasites; weight-for-age, height-for-age, and weight-for-height z scores; and body mass index greater than the 84th percentile. RESULTS: Of all the children, 21% had parasites, 62% had caries, and 25% had a positive PPD reaction. Twelve percent overall and 28% younger than 2 years had anemia. Eight percent had height-for-age z scores less than -2, and 6% had weight-for-age z scores greater than +2. Of those aged 1 to 9 years, 7% had weight-for-height z scores greater than +2. Weight-for-height z scores less than -2 were concentrated among Africans and East Asians (both 8%). Height-for-age z scores less than -2 were seen among African (13%), Near Eastern (19%), and East Asian (30%) children. Weight-for-height z scores greater than +2 and body mass index greater than the 84th percentile were concentrated among children from the former Yugoslavia (8% and 15%) and the former Soviet Union (8% and 14%). CONCLUSIONS: Recently arrived refugee children have significant growth abnormalities. European refugees were overweight; those from developing countries had growth retardation.

Adolescent↗
PubMed2003

Evidence in support of foster care during acute refugee crises.

OBJECTIVES: The United Nations High Commissioner on Refugees (UNHCR) and United Nations Children's Fund (UNICEF) policy encourages foster care during refugee emergencies. We examined evidence to support this policy using data from the 1994 Rwandan refugee crisis. METHODS: The association of weight gain and acute illness with family status (foster children vs children living with their biological families) was examined using latent growth curve and repeated measures logistic regression analysis. RESULTS: Weight gain for all children averaged 0.40 kg/month and was associated with child's age but not with family status, child's or caregiver's sex, caregiver's marital status, possession of blankets or plastic sheeting, severe malnutrition, month of enrollment, or acute illness. Illness was not more common among foster children than among children living with their biological families. CONCLUSIONS: This analysis supports the UNHCR/UNICEF recommendation of fostering for unaccompanied children during an acute refugee crisis.

Acute Disease↗
PubMed2002

Sociodemographic correlates of assimilation of refugees from Kurdistan.

Successful assimilation of refugees in their host country is an important prerequisite of psychological well-being. Refugees' satisfaction in the new country is one of key indicators of their assimilation. The satisfaction with their host country was assessed for 54 Kurdish refugees of mean age of 35.8 yr. (SD= 10.9) via an 8-item rating scale partly based on Cernovsky's Assimilation Scale. The 36 men and 18 women had resided in the host country for a mean of 4.5 yr. (SD=4.0). An overall score was calculated from ratings of satisfaction with personal safety, health, employment, food, financial security, social life, and entertainment. This overall score was unrelated to age, sex, and employment status. Those who emigrated at a younger age (r = -.28, p = .03) and those with lower education reported more satisfaction with their host country (r = -.28, p = .03) perhaps because they could more easily and rapidly re-establish social status comparable to what they had in their homeland than could older refugees from Kurdistan's higher educational strata.

Acculturation↗
PubMed1984

Incidence of middle ear disease in Indochinese refugee schoolchildren.

186 Indochinese refugee schoolchildren were screened for middle ear disease using pure-tone audiometry and an acoustic impedance battery. A control group consisting of 186 American schoolchildren was also screened. The purpose of the investigation was to determine the incidence of ear disease in the Indochinese refugee school population as compared to American classmates. A secondary objective was to establish an effective screening criterion for the refugee population. Results indicated that the incidence of ear pathology in the Indochinese population exceeded that found in the American classmates and in most other studies reported on high-risk populations. Medical evaluation confirmed that low compliance (less than 0.25 cm3) is a sensitive predictor of probable middle ear pathology in Indochinese refugee children.

Acoustic Impedance Tests↗