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PubMed1995

Migration and health. A study of Latin American refugees, their exile in Sweden and repatriation.

OBJECTIVE: To analyse and elucidate the migration process in order to identify psycho-social themes which might act as stressors with influence on health. DESIGN: Qualitative in-depth interviews with eleven strategically selected Latin American refugees. SETTING: Latin American refugees living in Lund, a university town, and those who were repatriated to Santiago, Chile. PARTICIPANTS: 11 Latin Americans of whom 4 were repatriated to Chile. RESULTS: The migration process was divided into four courses of events: cultural background and everyday life; organized violence; the exile; the repatriation. "Themes" such as cultural and working identity and high control were extracted from the dialogues as central buffering factors against microbiological or physicochemical disease agents harboured by the individual. CONCLUSIONS: During the exile the cultural barrier, social degradation, guilt, social passivity, and ideological alienation cause a changed identity and low control which increase the vulnerability to psychological distress and physical disease.

Adaptation, Psychological↗
PubMed1997

Drug problems among immigrants and refugees in The Netherlands and the Dutch health care and treatment system.

Immigration from former colonies and the influx of refugees whose disadvantaged situation in society often leads to drug problems is described. The Dutch Government provides for a wide variety of services for drug users which include programs for minorities like the Surinamese, Moluccan, Moroccan, and Turkish communities. However, they are either executed poorly or are based too much on "White" methods. An account of a survey about the current situation of Black Surinamese women in the Netherlands is given, and the situation of refugees in the Netherlands as it relates to drug use is described.

Adult↗
PubMed1990

The Refugee Act of 1980: what have we learned?

"This article discusses the objectives of legislation enacted in 1980 that incorporated into U.S. law the international definition of a refugee. It examines the political climate that existed when the legislation was debated and how sudden, unforseen events affected the implementation of the new law. Particular attention is directed at understanding the difficulty the U.S. has experienced in achieving a nationality-neutral refugee program and in establishing a political asylum system that is fair but resistant to abuse." (SUMMARY IN FRE AND SPA)

Americas↗
PubMed1989

Western voodoo: providing mental health care to Haitian refugees.

This article described certain aspects of Haitian life, voodoo and its role in Haitian society, the quality and quantity of psychiatric and mental health care for Haitians in Haiti, and suggestions for providing appropriate mental health care to Haitian refugees in the United States. Conway and Buchanan (1985) described what has helped Haitian refugees adapt in the transition to life in the United States: the strengths from their cultural heritage, such as fortitude; perseverance in the most arduous circumstances; deep religious faith; high self-respect; reliance on the extended family; and the tradition of sharing. Building on these assets may assist Western mental health-care providers in offering culturally sensitive mental health care to Haitians.

Attitude to Health↗
PubMedDate not supplied

Epidemic of gynecomastia among haitian refugees: exposure to an environmental antiandrogen.

OBJECTIVE: To investigate an observed epidemic of gynecomastia among Haitian refugees in US detention centers in 1981 and 1982. METHODS: All identifiable environmental exposures were investigated for estrogenic and antiandrogenic activity. RESULTS: A high incidence of gynecomastia was observed among Haitian refugees in five detention centers in the United States. Of 284 men screened, 20 (from 18 to 53 years old) demonstrated new-onset gynecomastia (Tanner stages 2 to 5) in June 1982. The mean onset of gynecomastia was 130 +/- 12 days after arrival in the United States. Other symptoms included loss of libido (in all 20 patients) and decreased beard growth (in 10). Plasma concentrations of luteinizing hormone, follicle-stimulating hormone, prolactin, testosterone, and estradiol were not significantly different from those in 20 age-matched control subjects. Environmental substances, including tap water and the delousing agents Kwell shampoo and R&C Spray (applied to bedding and clothing), were tested for estrogenicity and androgenicity. None of these substances bound to cytosol estrogen receptors. The delousing agents were assayed for androgen binding by using genital skin fibroblasts. R&C Spray competed equally with testosterone for androgen-binding sites. Phenothrin, the "multi-cide" component of R&C Spray, reproduced this competitive binding result. When tested for antiandrogenic effects on prostate growth by using immature male rats treated with testosterone-filled Silastic capsules, phenothrin antagonized androgen action, as demonstrated by decreased prostate weights. CONCLUSION: The antiandrogenic activity of phenothrin may explain this unusual epidemic of gynecomastia.

Adolescent↗
PubMed1982

Prevalence of schistosomiasis and other parasitic diseases among Cambodian refugees residing in Bang-Kaeng holding center, Prachinburi Province, Thailand.

Isolated cases of schistosomiasis were discovered on stool examination among Cambodian refugees residing in Thailand. Further epidemiologic investigations were conducted on a sample of 5,085 Cambodian refugees in the Ban-Kaeng holding center, using the intradermal skin test as a screening device to determine the prevalence of this disease. A positive diagnosis of Schistosoma mekongi was confirmed in 17 of those examined by recovery of eggs in the stool. The prevalence of schistomiasis in the Bang-Kaeng camp was 3.3 cases/1,000 population. All positive cases came from geographic areas in cambodia where schistosomiasis has not been previously reported, indicating that schistosomiasis in Cambodia is currently more widespread than generally believed.

Adolescent↗
PubMed1995

Serologic evidence of respiratory and rickettsial infections among Somali refugees.

Somali refugees living in a camp located in Djibouti were studied in October 1991 and May 1992. The refugees had been living at the camp for about two years. The median age of volunteers was 25 years, of whom 69% were female. Paired sera obtained seven months apart were evaluated by complement fixation, microimmunofluorescence, indirect fluorescent antibody, streptococcal antibody, and enzyme-linked immunosorbent assay techniques for evidence of pathogen infection. Fifty-two percent, 31.3%, 8.0%, 5.9%, and 25.4% of the volunteers had serologic evidence for pre-enrollment infection with Chlamydia pneumoniae, Mycoplasma pneumoniae, Rickettsia typhi, R. conorii, and Coxiella burnetti, respectively. Similarly, 43.5%, 5.2%, 6.1%, 10.7%, 15.8%, and 11.9% of the volunteers studied had serologic evidence for new infection with Streptococcus pyogenes, C. pneumoniae, M. pneumoniae, R. typhi, R. conorii, and Cox. burnetii, respectively. These data suggest that the studied pathogens may be endemic in displaced populations living in the Horn of Africa.

Adolescent↗
PubMedDate not supplied

Use of cultural themes in promoting health among Southeast Asian refugees.

PURPOSE: Vietnamese, Cambodian, and Hmong refugee populations in the United States face serious physical and psychosocial health issues. Literature on these populations is largely descriptive of illnesses and of cultural beliefs or behavior patterns related to illness. There is minimal literature linking beliefs and behaviors to the underlying cultural themes. The purpose of this paper was to search the literature for cultural themes from which culturally relevant health promotion strategies could be designed. SEARCH METHODS: Literature was reviewed from the fields of health, social, and political science, history, and Southeast Asian folklore. Search methods included review of 147 writings from library and MEDLINE search and 123 interviews with refugees and key professionals in the field. This manuscript includes 106 selections as well as content from 93 interviews. FINDINGS AND CONCLUSIONS: From the literature emerged two cultural themes common to these population, kinship solidarity and the search for equilibrium. The use of these cultural themes as carriers of health messages is suggested. Examples of ways to link the message with the cultural theme are presented, including the use of folklore, recognition of cultural illnesses, and use of cultural knowledge in addressing new situations such as inner city urban survival. Cultural themes are a means of conveying health messages addressing such issues as transition in family structure, depression, and substance abuse.

Asian↗
PubMed1980

Leprosy in Indo-Chinese refugees.

Five cases of leprosy, four borderline tuberculoid and one indeterminate, which were recently diagnosed in Indo-Chinese refugees in Adelaide are reported. This diagnosis should be kept in mind when dealing with skin lesions in Indo-Chinese refugees.

Adult↗
PubMed1988

Rehabilitation of refugee victims of torture and trauma: principles and service provision in New South Wales.

A number of recently-arrived refugees who are suffering from psychological disturbances and physical injuries that have resulted from torture or severe trauma has come to the attention of welfare workers and health personnel in New South Wales. A tentative estimate of more than 2000 refugees in New South Wales who are so affected, and clear evidence of extensive human rights abuses in the countries from which they came, indicate an urgent need for specialized care for the victims. Organized violence, including detention, torture and severe deprivation, is a tool of governments in many countries of the world. The varied forms of torture are all designed to destroy the trust, personality and self-esteem of the victims and to foster dependency, debility and dread, both in the victims and in the societies in which they live. Those persons who survive torture and detention often are affected severely in body, mind and spirit. Many victims exhibit acute and chronic symptoms that are described commonly by the diagnostic categories "post-traumatic stress disorder" and "torture syndrome". Their kin, especially spouses and children, also suffer psychological and familial disturbances frequently, as a result of the arrest, detention and torture of the victim. Their suffering is compounded by the distress of fleeing their home country and the stresses of adjusting to a new country and way of life. In Europe and North America, services have been established to treat and to rehabilitate sufferers of these disorders. Treatment programmes differ in structure and size, but include commonly psychotherapy, physiotherapy, specialized medical care and parallel assistance with resettlement and social adjustment for both the patients and their families. This article cites illustrative case material from New South Wales and summarizes the recommendations for a community-based rehabilitation service for victims both of torture and of other forms of organized violence, such as detention in "re-education" camps or the genocide in Kampuchea.

Health Services↗
PubMed1994

Cerebral sparganosis in an East Timorese refugee.

OBJECTIVE: To report the first case of cerebral sparganosis diagnosed in Australia. CLINICAL FEATURES: A 23-year-old East Timorese refugee, whose diet before migration included raw snakes and frogs, presented with a generalised tonic-clonic seizure and a nine-month history of episodic left hemianaesthesia. Computerised axial tomography of the brain showed a right frontal lesion, which was excised, and histological examination demonstrated changes typical of sparganosis. INTERVENTION AND OUTCOME: Excision of the lesion resulted in cure. Postoperative eosinophilia and a subcutaneous nodule presumed to be due to disseminated sparganosis resolved following a course of praziquantel. CONCLUSION: Clinicians should consider the possibility of unusual parasitic infections in refugees who present with intracranial space-occupying lesions, especially those from developing countries. A dietary history may aid the diagnosis.

Adult↗
PubMed2006

A comparison of the mental health of refugees with temporary versus permanent protection visas.

OBJECTIVES: To determine the impact of the Australian provisions for temporary rather than permanent protection for asylum seekers found to be genuine refugees. DESIGN AND SETTING: A comparison of the mental health of Persian-speaking refugees with temporary (n = 49) versus permanent (n = 67) protection visas attending an early intervention program in Sydney, New South Wales, 2002-03. MEASURES: Standard measures were used to assess past trauma, detention experiences, postmigration stresses, symptoms of post-traumatic stress disorder (PTSD), anxiety, depression and functional impairment. RESULTS: The two groups had experienced similar levels of past trauma and persecution. Nevertheless, holders of temporary protection visas (TPVs) returned higher scores on three psychiatric symptom measures (P < 0.001). Multivariate analyses showed that TPV status was the strongest predictor of anxiety, depression and particularly PTSD. Further analyses suggested that, for TPV holders, experience of past stresses in detention in Australia and ongoing living difficulties after release contributed to adverse psychiatric outcomes. CONCLUSIONS: The sequence of postmigration stresses experienced by TPV holders appears to impact adversely on their mental health.

Adolescent↗
PubMed1995

Innovations in refugee health care.

As the face of immigration in the US changes, so must health care programs for these new Americans change. Two refugee programs in Maryland prove that adapting to the medical needs of the refugee community can benefit not only these immigrants but the US health care system as well.

Cultural Diversity↗
PubMed1999

[Access to health services: difficulties encountered by refugees residing on Ile-de-France. Charity and full-coverage health care: two divergent concepts?].

Theoretically, since 1992, 100% of socially underprivileged persons residing in France have unlimited access to health care. However, before they become fully integrated into the society, many refugees in various legal situations do not have access to health care. The mechanisms behind this exclusion unmask the difficulties the health care system has in managing the underprivileged population. This work was conducted at the Comede health care facility specially designed to care for refugees. According to the current French legislation, health care protection and medical insurance coverage is a right of all persons living in France. Although the establishment of a large number of centers specifically designated for the underprivileged population has improved access to health care, repeat visits and uninterrupted care cannot be assured unless the patient has been awarded 100% free health care status. There are several obstacles to acquiring this status: complexity of the legal procedures, recipients unaware of their rights and the procedures of the health care system, information limited to specialized journals, restrictive or illegal action by the health protection services. All of these obstacles can be overcome if the patients are given precise information, notably by their physician. Instead of effectively applying the procedures concerning patients rights to health care, the system has developed free health care facilities which do not necessarily provide uninterrupted care. To provide the universal health care coverage promised by the legislators, the only criteria for access to care must be residence in France. Acquiring this status should be considerably simplified and requires the active participation of the entire health care community.

Health Services Accessibility↗
PubMed1999

Vaccination campaign for Kosovar Albanian refugee children--former Yugoslav Republic of Macedonia, April-May, 1999.

Extensive ethnic conflict within the Kosovo region of the Federal Republic of Yugoslavia and an organized bombing campaign by the North Atlantic Treaty Organization led to mass population displacement in 1998 and early 1999. In April 1999, approximately 500,000 Kosovar Albanians fled into the Yugoslavian Republic of Montenegro and the neighboring countries of Albania, Bosnia-Herzegovina, and the Former Yugoslav Republic of Macedonia (FYROM). Of the estimated 130,000 refugees who fled to FYROM, approximately 65,000 were housed in seven refugee camps. A major public health concern in these camps was the prevention of vaccine-preventable diseases, particularly measles. In response, the FYROM Ministry of Health (MOH) in collaboration with the United Nations Children's Fund (UNICEF) and International Medical Corps, a nongovernmental organization, planned and implemented a mass vaccination campaign. This report describes the first campaign (April 26-May 10, 1999), its results, and follow-up activities.

Albania↗
PubMed2000

Referral times of Vietnamese refugees with tuberculosis in camps in Hong Kong.

SETTING: Two closed camps in Hong Kong for Vietnamese refugees. OBJECTIVE: To determine the referral times by clinicians (doctor's delay) of cases of tuberculosis (TB) from refugee camp clinics to the hospital/chest clinic. DESIGN: Retrospective case-note study of 97 Vietnamese patients receiving treatment for tuberculosis. RESULTS: The sites of TB were pulmonary (n = 61), glandular (n = 15), pleural effusion (n = 15), and other (n = 6). The median referral time was 18 days (range 0-417). Median consultations numbered three (range 1-16). Fifty-three (54.6%) patients were prescribed antibiotics. Thirty-nine (40%) patients were referred within 10 days; of these, 18 were referred the same day. These 39 patients were less likely to have received antibiotics (9/39 [23.1%] vs 44/58 [75.9%], relative risk [RR] 0.3 95% confidence interval [CI] 0.17-0.55), but were equally likely to have been physically examined (RR 0.66, 95%CI 0.39-1.1). Sixteen (16.5%) patients were referred after 90 days. They attended the clinic more often (median attendances 6.5 vs 3, P = 0.0002), and were prescribed more antibiotic courses (mean antibiotic prescriptions 1.6 vs 0.7, P = 0.03). CONCLUSION: Referral times by these clinicians varied widely, with long delays for approximately 60% of patients. Guidelines pertinent to primary care clinicians are needed to heighten their awareness of tuberculosis to prevent referral delays and subsequent TB treatment.

Adolescent↗
PubMed2001

[Reactions to torture and persecution. Traumatized refugees in the Danish health service].

The Danish health services encounter a growing number of refugees who suffer from the effects of persecution and torture. To be a traumatised refugee in a foreign culture often causes psychological reactions and biological changes, and, at the same time, adaptation to a new culture is a demanding existential challenge. The condition is rather poorly described by the diagnoses "post-traumatic stress disorder" and "enduring personality change after catastrophic experience". These conditions can cause difficulties both diagnostically and treatment-wise, as the trauma story can awaken violent reactions in the doctor, and because the symptoms can be so culturally framed they are difficult to interpret. The prognosis depends on a number of issues pertaining to the patient, the trauma, and the patient's overall state after the trauma. At best, the prognosis is relatively good, but in a number of cases the patient's state becomes chronic and disabling. At present, the recommended treatment is a combination of psychotherapy, psychopharmacological treatment, physiotherapy, and social initiatives. There is still uncertainty as to the optimal treatment, and the organisational situation regarding treatment in Denmark is unclear.

Comorbidity↗
PubMed2001

Obstetric profiles and pregnancy outcomes of immigrant women with refugee status.

This paper describes the obstetric profiles and pregnancy outcome of immigrant women with refugee status. A retrospective analysis of two hundred and seventy one immigrant women with confirmed refugee status who delivered in our hospital between June 1999 and May 2000 was performed. The average gestational age at booking was 33 weeks. The majority (63%) were multiparous, had low rates of epidural analgesia, instrumental delivery and episiotomies. There were no differences in the gestational age at delivery, incidence of caesarean section and birth weights from the hospital population. In this small study group there were four perinatal deaths giving a corrected perinatal mortality of 14.8 compared to 5.6 in the hospital population. Seven patients (3%) tested positive for Human Immunodeficiency Virus (HIV). Two patients (0.8%) were diagnosed with active tuberculosis. The majority of patients (80%) were living in emergency accommodation. In conclusion, this population has specific obstetric, medical and social problems.

Adult↗