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Infectious diseases in a Nicaraguan refugee camp in Costa Rica.

Some Nicaraguans living in Costa Rica are in refugee camps. The types and rates of infectious diseases in the Pueblo Nuevo refugee camp were measured by examining medical records for 1985 and performing stool and blood testing. The incidence of infections was 320 episodes per 1000 persons per year. Respiratory infections represented 63% of all illnesses and pulmonary tuberculosis was high. Malaria was not found in blood samples and no childhood illnesses preventable by immunizations were recorded in the records. Intestinal parasites were found in 56% of the persons examined, considerably higher than the 15% prevalence noted in surveys of Costa Rica as a whole. Trichuris trichiura was found in 40% of the positive stool samples. The deficient hygienic conditions and overcrowding in the camp are responsible for the high rates of infections and the continued presence of infections many of which probably were acquired in Nicaragua. Improvement of hygienic conditions can be accomplished by involving the refugees in education, cleaning and identifying problem areas. Adequate sanitation and improved water supply, and reducing overcrowding are also recommended.

Adult↗

Vietnamese refugees and blocked mobility.

"This paper examines data from published sources and ethnographic studies conducted by the authors in Oakland, California and Philadelphia [Pennsylvania] to assess the economic situation of Vietnamese refugees in the United States. Evidence suggests that in strong contrast to being a 'success story,' the economic status of many recently arrived Vietnamese refugees is characterized by unstable, minimum-wage employment, welfare dependency and participation in the informal economy. The paper suggests that the group's economic opportunities have been limited by the configuration of circumstances that have surrounded their entry and settlement into the United States as refugees, as well as by the demographic structure of the group."

Americas↗

Refugee experiences and Southeast Asian women's mental health.

The wars in Southeast Asia displaced thousands of families from Cambodia, Laos, and Vietnam. The upheavals led to a number of waves of immigration to the United States. Current research supports hypotheses of post-traumatic stress disorder diagnoses in refugees from the wars in Vietnam but omits pertinent cultural factors. This phenomenological study of 19 women from Southeast Asia examines the meanings of their refugee experiences. Open-ended interviews with these women reveal themes of survival, despair, and isolation. Health care providers may notice cultural bereavement as opposed to post-traumatic stress disorder, reflecting a psychological resilience not extensively explored previously. Developing empathetic interactions and including important ethnic identity factors in caring for refugee women appear essential in providing appropriate health care.

Adult↗

Afghan refugee issues in the U.S. social environment.

Since Afghan refugees began coming to the United States in the early 1980s, the Afghan community of the San Francisco Bay Area has become the largest in the United States. This population copes with a number of stressors that negatively affect their health and psychological well-being. Based on an ethnographic study, we focus on the social context in which Afghan refugees find themselves, describing Afghans' perceptions of their interactions with mainstream American citizens and health and social service providers. The theme running through all such interactions is information--its scarcity, character, and cultural differences in type, purposes, and means of transmission. Quotes from interviews illustrate four types of problems: economic and occupational problems, health-care access, family and children's issues, and immigration issues/ethnic bias. Policy and program recommendations are applicable to other recent refugee populations that experience similar information problems with regard to the dominant society.

Adult↗

Testimonial psychotherapy for adolescent refugees: a case series.

Adolescent refugees are a traumatized, vulnerable group of arrivals to America who lack experience with or interest in psychiatric care. Testimonial psychotherapy's unique focus on transcribing personal, traumatic events for the altruistic purpose of education and advocacy make it an acceptable interaction by which to bridge the cultural gap that prevents young refugees from seeking psychiatric care. The theoretical basis for testimony is discussed. Testimonial psychotherapy has been used with adult refugees, but not with adolescents. This article describes the testimonial process with three Sudanese adolescents (the so-called 'Lost Boys'), which appeared feasible and safe. An efficacy study is underway.

Adolescent↗

War-wounded refugees. Quality of life after 2-3 years in Sweden.

The Medical Center for Refugees in Linköping, Sweden, includes a medical ward for refugees and asylum applicants. It was started in January, 1986 and is financed by the Swedish Immigration Board. Sixty percent of the patients are war-wounded and 40% have diagnoses non-related to war. This article describes a group of 19 refugees who were the war-wounded patients at this ward in June, 1986. In most of them the main medical impairment was amputation. They were followed up in 1988 by interview and self-ratings. The aim was to illuminate their quality of life after 2-3 years in Sweden. Most of them were satisfied with their external living conditions. Their psychological well-being, however, was not so good and they were very occupied by thoughts of their native countries. Their physical handicaps seemed to be of secondary importance.

Adult↗

Somatisation: illness perspectives of asylum seeker and refugee patients from the former country of Yugoslavia.

BACKGROUND: Somatisation is particularly challenging in multicultural contexts where patients and physicians often differ in terms of their illness-related beliefs and practices and health care expectations. This paper reports on a exploratory study aimed at better understanding how asylum seeker and refugee patients from the former country of Yugoslavia who were identified by their physicians as somatising make sense of their suffering. METHODS: We conducted semi-structured interviews with 26 asylum seeker and refugee patients from the former country of Yugoslavia who attended the general medicine outpatient clinic of a Swiss teaching Hospital and were identified as presenting with somatisation. Interviews explored patients' illness perspectives and health care expectations. Interviews were audio taped, transcribed verbatim and analyzed to identify key themes in patients' narratives. RESULTS: Patients attributed the onset of symptoms to past traumatic experiences and tended to attribute their persistence to current living conditions and uncertain legal status. Patients formulated their suffering in both medical and social/legal terms, and sought help from physicians for both types of problems. CONCLUSION: Awareness of how asylum seeker and refugee patients make sense of their suffering can help physicians to better understand patients' expectations of the clinical encounter, and the particular nature and constraints of the patient-provider relationship in the context of asylum.

Adult↗

Health and health care utilisation among asylum seekers and refugees in the Netherlands: design of a study.

BACKGROUND: This article discusses the design of a study on the prevalence of health problems (both physical and mental) and the utilisation of health care services among asylum seekers and refugees in the Netherlands, including factors that may be related to their health and their utilisation of these services. METHODS/DESIGN: The study will include random samples of adult asylum seekers and refugees from Afghanistan, Iran and Somali (total planned sample of 600), as these are among the largest groups within the reception centres and municipalities in the Netherlands. The questionnaire that will be used will include questions on physical health (chronic and acute diseases and somatization), mental health (Hopkins Symptoms Checklist-25 and Harvard Trauma Questionnaire), utilisation of health care services, pre- and post-migratory traumatic experiences, life-style, acculturation, social support and socio-demographic background. The questionnaire has gone through a translation process (translation and back-translation, several checks and a pilot-study) and cross-cultural adaptation. Respondents will be interviewed by bilingual and bicultural interviewers who will be specifically trained for this purpose. This article discusses the selection of the study population, the chosen outcome measures, the translation and cross-cultural adaptation of the measurement instrument, the training of the interviewers and the practical execution of the study. The information provided may be useful for other researchers in this relatively new field of epidemiological research among various groups of asylum seekers and refugees.

Acculturation↗

Health-related quality of life in diabetic patients and controls without diabetes in refugee camps in the Gaza strip: a cross-sectional study.

BACKGROUND: Prevalence of diabetes mellitus is increasing in developed and developing countries. Diabetes is known to strongly affect the health-related quality of life (HRQOL). HRQOL is also influenced by living conditions. We analysed the effects of having diabetes on HRQOL under the living conditions in refugee camps in the Gaza strip. METHODS: We studied a sample of 197 diabetic patients who were recruited from three refugee camps in the Gaza strip and 197 age- and sex-matched controls living in the same camps. To assess HRQOL, we used the World Health Organization Quality of Life questionnaire (WHOQOL-BREF) including four domains (physical health, psychological, social relations and environment). Domain scores were compared for cases (diabetic patients) and controls (persons without diabetes) and the impact of socio-economic factors was evaluated in both groups. RESULTS: All domains were strongly reduced in diabetic patients as compared to controls, with stronger effects in physical health (36.7 vs. 75.9 points of the 0-100 score) and psychological domains (34.8 vs. 70.0) and weaker effects in social relationships (52.4 vs. 71.4) and environment domains (23.4 vs. 36.2). The impact of diabetes on HRQOL was especially severe among females and older subjects (above 50 years). Low socioeconomic status had a strong negative impact on HRQOL in the younger age group (<50 years). CONCLUSION: HRQOL is strongly reduced in diabetic patients living in refugee camps in the Gaza strip. Women and older patients are especially affected.

Adult↗

Organised violence and the stress of exile. Predictors of mental health in a community cohort of Vietnamese refugees three years after resettlement.

BACKGROUND: The prevalence and course of mental disorders among Vietnamese refugees were studied, using a model including variables from different research traditions. METHOD: A consecutive community cohort of 145 Vietnamese boat refugees aged 15 and above were personally interviewed on their arrival in Norway and three years later. RESULTS: Three years later, there was, unexpectedly, no decline in self-rated psychological distress (SCL-90-R), almost one in four suffered from psychiatric disorder and the prevalence of depression was 17.7% (Present State Examination). Female gender, extreme traumatic stress in Vietnam, negative life events in Norway, lack of a close confidant and chronic family separation were identified as predictors of psychopathology. CONCLUSIONS: The effects of war and persecution were long-lasting, and compounded by adversity factors in exile. A uniform course of improvement in mental health after resettlement cannot be expected in all contexts. The affected refugees need systematic rehabilitation.

Acculturation↗

Psychological sequelae of torture and organised violence suffered by refugees from Iraq. Trauma-related factors compared with social factors in exile.

BACKGROUND: Refugees who have suffered traumatic events present complex therapeutic challenges to health professionals. There is little research into post-exile factors that may be amenable to change, and therefore reduce morbidity. We examined the importance of social factors in exile and of trauma factors in producing the different elements of psychological sequelae of severe trauma. METHOD: Eighty-four male Iraqi refugees were interviewed. Adverse events and level of social support were measured. Various measures of psychological morbidity were applied, all of which have been used in previous trauma research. RESULTS: Social factors in exile, particularly the level of "affective" social support, proved important in determining the severity of both post-traumatic stress disorder and depressive reactions, particularly when combined with a severe level of trauma/torture. Poor social support is a stronger predictor of depressive morbidity than trauma factors. CONCLUSIONS: Some of the most important factors in producing psychological morbidity in refugees may be alleviated by planned, integrated rehabilitation programmes and attention to social support and family reunion.

Adolescent↗

Impact of immigration detention and temporary protection on the mental health of refugees.

BACKGROUND: Over the past decade, developed Western countries have supplied increasingly stringent measures to discourage those seeking asylum. AIMS: To investigate the longer-term mental health effects of mandatory detention and subsequent temporary protection on refugees. METHOD: Lists of names provided by community leaders were supplemented by snowball sampling to recruit 241 Arabic-speaking Mandaean refugees in Sydney (60% of the total adult Mandaean population). Interviews assessed post-traumatic stress disorder (PTSD), major depressive episodes, and indices of stress related to past trauma, detention and temporary protection. RESULTS: A multilevel model which included age, gender, family clustering, pre-migration trauma and length of residency revealed that past immigration detention and ongoing temporary protection each contributed independently to risk of ongoing PTSD, depression and mental health-related disability. Longer detention was associated with more severe mental disturbance, an effect that persisted for an average of 3 years after release. CONCLUSIONS: Policies of detention and temporary protection appear to be detrimental to the longer-term mental health of refugees.

Adult↗

Screening of immigrants and refugees for pulmonary tuberculosis in San Diego County, California.

STUDY OBJECTIVES: To evaluate the outcomes of a tuberculosis (TB) screening program for recent immigrants to San Diego County, CA, and to compare the demographic and clinical characteristics of pulmonary TB cases occurring in recently arrived foreign-born persons detected through this screening with those of similar cases found through routine surveillance. DESIGN: Retrospective review of computer databases and medical records. SETTING: Local public health department. PATIENTS: Recent immigrants and refugees classified as TB suspects in their country of departure and foreign-born patients with active TB detected through routine surveillance. RESULTS: Five hundred seventy-one of 658 immigrants and refugees (87%) of completed screening. Thirty-nine subjects (7%) were found to have active TB, and 433 subjects (76%) were found to have latent TB. A diagnosis of active TB was associated with age of 25 to 44 years (odds ratio, 3.6; 95% confidence interval, 1.1 to 11.6) and A (odds ratio, 25.7; 95% confidence interval, 1.3 to 512.2) or B1 classifications (odds ratio, 4.3; 95% confidence interval, 1.5 to 12.5). Cases detected through screening comprised 12% of all reported foreign-born persons with active TB. Compared to other recently arrived foreign-born persons with active TB, those detected through immigrant screening were more likely to be Asian and born in the Philippines and less likely to have advanced disease. CONCLUSIONS: Most immigrants and refugees classified as TB suspects by foreign screening completed the US screening process, which had a high yield for detecting active and latent TB. Only a minority of foreign-born persons (12%) with active TB were discovered through this program, however, and additional measures are needed to facilitate early case finding in other foreign-born populations.

Adolescent↗

Intentional isoniazid overdosage in young Southeast Asian refugee women.

During a two-year period, from January 1984 through December 1985, six cases of intentional overdosage with isoniazid were reported in young Southeast Asian refugee women. The patients were aged 14 to 23 years, had all immigrated within one year and were receiving isoniazid preventive therapy for tuberculosis infection without disease. Clinically, all patients experienced generalized seizures, and three sustained moderate metabolic acidosis. All recovered uneventfully. Psychiatric evaluations revealed that two patients had major depression; two, adjustment disorders with depressed mood; and two, no psychiatric illness. The latter two patients and two others ingested an excessive amount of isoniazid immediately following an argument with a family member. Because tuberculosis infection is prevalent in refugees immigrating from Southeast Asia, isoniazid, given for six months to one year as preventive therapy, is one of the most frequently prescribed drugs during the early resettlement period. There may be an increased risk of intentional isoniazid overdosage during preventive therapy of young refugee women.

Adolescent↗

Assessment of nutritional status, cognitive development, and mother-child interaction in Central American refugee children.

A cross-sectional study was conducted between July and December 1992 to assess the nutritional status, cognitive development, and mother-child interactions in a group of 153 Nicaraguan refugee children living in Costa Rica. Nutritional status was assessed using anthropometric indices. Cognitive development was assessed with the Bayley Scale of Mental Development. Mother-child interaction was assessed with the Nursing Child Assessment Teaching Scale and Caldwell's Home Observation and Measurement of the Environment Inventory. Correlational analysis was performed to examine the relationship between child cognitive development scores and mother-child interaction measures and also between anthropometric measures and child cognitive development scores. Multiple regression analysis was performed to evaluate the relationship between the mother-child interaction measures and cognitive development scores, after adjusting by anthropometric measures. Thirty-three percent of the children were below the 10th percentile for height-for-age. There was no significant correlation between the total amount of mother-child interaction and child cognitive development. However, certain aspects of the home environment correlated with cognitive development, specifically the manner in which the mother responded emotionally and verbally to her child, and the organization of the child's physical and temporal environment. Multiple regression analysis revealed that the manner in which the mother responded and the child's weight-for-height were important in predicting child cognitive development. The child's weight-for-height and certain aspects of the home environment played an important role in the cognitive development of this refugee population. The findings indicate the importance of assessing nutritional status in this refugee population.

Adult↗

A private-sector preferred provider network model for public health screening of newly resettled refugees.

US law and regulations stipulate a process for the health screening of refugees. The responsibility of caring for refugees resettled in the United States rests, in part, with public health or welfare departments. Massachusetts has met its screening responsibilities through the innovative creation of a network of private preferred providers. We explore the Massachusetts model of public-private collaboration within the context of federal refugee health priorities and current state fiscal restraints affecting public health programs, and demonstrate the model's accomplishments.

Community Health Centers↗

Health problems among Indochinese refugees.

The results of medical evaluations of 194 recent indochinese refugees are reported. In addition to confirming findings of other studies of these refugees, we found a significant prevalence of abnormalities, i.e., hematological (37 per cent), dermatological (26 per cent), psychiatric (10 per cent of adults), and thyroid (5 per cent). Guidelines and recommendations of physicians providing medical care for indochinese refugees are presented.

Adolescent↗

Nutritional status of Southeast Asian refugee children.

Since 1975 nearly 300,000 Indochinese refugees have been relocated in the United States. The Nutrition Division, Centers for Disease Control. Atlanta, surveyed the medical records of four west coast clinics to obtain nutrition-related data on 821 Southeast Asian refugee children under six years of age, arriving between July 1979 and June 1989. Hemoglobin, hematocrit, and anthropometric data were compared to those of a comparison group of Southeast Asian children screened prior to 1979 and to a National Health Examination Survey reference population. The newly-arrived refugee group was found to be highly anemic and stunted relative to the comparison group. Although stunted, the study group did not appear greatly wasted.

Anemia↗