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Domestic Refugee Health Trends & Cultural Considerations
“He who has health, has hope. And he who has hope, has everything.”
~ Arabian Proverb
Refugees flee their country not for economic gain but to escape
persecution, the threat of imprisonment and even threats to their lives. They
need a safe haven where they can recover from mental and physical trauma
and rebuild their hopes for a better future.
Refugee Countries of Origin
Map obtained from WorldMapper utilizing data from United Nations Development Program, 2004, World Development Report.
http://www.worldmapper.org/display.php?selected=14
HIV/AIDS Global Disease Burden
Map obtained from WorldMapper utilizing data from United Nations Development Program, 2004, World Development Report. http://www.worldmapper.org/display.php?selected=227
Diabetes Global Disease Burden
Map obtained from WorldMapper utilizing data from the World Bank’s 2005 World Development Indicators.
http://www.worldmapper.org/display.php?selected=239
Tuberculosis Global Disease Burden
Map obtained from WorldMapper utilizing data from the World Health Organization’s 2004, Human Resources for Health. http://www.worldmapper.org/display.php?selected=228
Malaria Global Disease Burden
Map obtained from WorldMapper utilizing data from the World Health Organization’s 2004, Human Resources for Health.
http://www.worldmapper.org/display.php?selected=229
Undernourishment Global Disease Burden
Map obtained from WorldMapper utilizing data from the United Nations Development Program’s 2004 Human Development Report. http://www.worldmapper.org/display.php?selected=178
National Resettlement Statistics
0
10,000
20,000
30,000
40,000
50,000
60,000
Florida California Texas New York Michigan
Number of Arrivals Eligible for Refugee Benefits by State FYY 2010 & 2011
Data Source: FY2012 Social Services Allocations Report by State
Refugee Arrivals by County, FFY 2013 HOLMES
PINE
LLAS
ORANGE
MADISON
TAYLOR
HAMILTON
SUWANNEE
DIXIE GILCHRIST
LEVY
UNION
ALACHUA PUTNAM
MARION
LAKE CITRUS
BAKER
NASSAU
DUVAL
CLAY ST. JOHNS
FLAGLER
VOLUSIA
SEMINOLE
BREVARD
OSCEOLA HILLSBOROUGH
POLK
MANATEE HARDEE
INDIAN RIVER
OKEECHOBEE ST. LUCIE
MARTIN
PALM BEACH
BROWARD
MIAMI- DADE
COLLIER
HENDRY LEE
CHARLOTTE GLADES
DESOTO SARASOTA
ESCAMBIA SANTA ROSA
OKALOOSA WALTON
JACKSON WASHINGTON
CALHOUN
BAY
GULF
GADSDEN
FRANKLIN
LEON
WAKULLA LIBERTY
PASCO
HIGHLANDS
HERNANDO
MONROE
No Arrivals
20,000+
1,000 – 2,000
700 - 999
400 - 699
100 - 399
1 - 99
Data Source: FL DOH Refugee Domestic Health Assessment System
Data Source: FL DOH Refugee Domestic Health Assessment System
Refugee Health Services Provided
Services offered by County Health Departments include:
Medical history review Physical assessment Communicable disease screening Chronic disease screening Hepatitis screening Parasitic infection screening Malaria & Lead screening Health education Immunizations
Refugee Children from Select Countries of Origin Testing Positive for the Presence of Lead, FFY 2012
0.0%
0.5%
1.0%
1.5%
2.0%
2.5%
3.0%
3.5%
4.0%
HAITI CUBA IRAQ
Data Source: FL DOH Refugee Domestic Health Assessment System
Percent of Positive TB Results from Select Countries of Origin, FFY 2012
0%
10%
20%
30%
40%
50%
60%
70%
BURMA HAITI ETHIOPIA BHUTAN IRAQ VENEZUELA
QuantiferonTB SpotTST
Data Source: FL DOH Refugee Domestic Health Assessment System
Percent of Abnormal Ova and Parasites Results from Select Countries of Origin, FFY 2012
Data Source: FL DOH Refugee Domestic Health Assessment System
0%5%
10%15%20%25%30%35%40%45%
HAITI
ETHIOPIACUBA
COLOMBIA
VENEZUELA
Cuba • Health Concerns
– Diabetes – Hypertension – Communicable disease
exposure in transit – Mental health concerns
• Cultural Considerations – Strong sense of
community & family values
– Well-versed in medical care and preventive medicine
– Integration challenges related to adjustment to U.S. values & benefits (particularly youth)
Sources: FL DOH Refugee Domestic Health Assessment System Robson, Barbara (2006). Cubans, Their History & Culture. Refugee Fact Sheet Series No. 12. Washington D.C.
Iraq • Health Concerns
– Diabetes – Hypertension – Mental health concerns
(anxiety, trauma from war, & survivors of torture)
– Dental needs – Advanced medical needs
including cancer, kidney disease/failure, heart disease
• Cultural Considerations – Mostly well-educated &
come from wealthy families or backgrounds
– Privacy of family matters/male and female dynamics
– Strong religious beliefs – Family is center of life – Victims of trauma &
torture Sources: FL DOH Refugee Domestic Health Assessment System Ghareeb, E., Ranard, D., Tutunji, J. (2008). The Iraqis: Their History, Cultures & Background Experiences. COR Center Enhance Refugee Backgrounder. Washington D.C.
Burma/Myanmar • Health Concerns
– Nutrient deficiencies – Parasitic infections – TB exposure – HIV/AIDS – Hepatitis B – Mental health – Alcoholism & Substance
Abuse
• Cultural Considerations – Coining & Cupping are
common practices – Alcoholism & substance
use – Domestic violence – Mental health views – Medicinal beliefs
• Balance of hot and cold • Food linkage to health
issues • Blood letting
Sources: FL DOH Refugee Domestic Health Assessment System Ranard, D., et. al (2012). Refugees from Burma: Considerations for Healthcare Providers. Refugee Health Technical Assistance Center & Center for Applied Linguistics.
Democratic Republic of Congo • Health Concerns
– Tuberculosis exposure – HIV – Parasitic Infections – Malnourishment – Hypertension – Vision – Mental Health (trauma &
torture) – Sexual & gender-based violence
• Cultural Considerations – Loose family structures – Limited English proficiency & ability
to read/write – Religious & strong belief in power
of prayer – Western medicine is generally
accepted & usually complements traditional practices
– Little understanding of mental health practices & diagnoses
– Spousal abuse & physical discipline of children is common
Sources: FL DOH Refugee Domestic Health Assessment System Ranard, D., et al (2013). Refugees from the Democratic Republic of the Congo. Center for Applied Linguistics.
Haiti • Health Concerns
– Tuberculosis exposure – HIV – Mental health (especially
after the earthquake) – Parasitic infections – Malnutrition
• Cultural Considerations – Acceptance of western
medicine although many practice traditional medicine due to lack of medical care in Haiti
– Don’t always access U.S. health care
– Strong religious beliefs & voodoo practices
– Strong family ties Sources: FL DOH Refugee Domestic Health Assessment System Ranard, D., et al (1994). Haitians: Their History & Culture. Refugee Fact Sheet Series No. 10. Center for Applied Linguistics.
Title VI & Refugees • Requires Federal agencies to examine the services they provide,
identify any need for services to those with limited English proficiency (LEP), and develop and implement a system to provide those services so LEP persons can have meaningful access to them.
• Agency plans should provide for such meaningful access consistent with, and without unduly burdening, the fundamental mission of the agency.
• Requires that the Federal agencies work to ensure that recipients of Federal financial assistance provide meaningful access to their LEP applicants and beneficiaries.
• Know where to access LEP documents & ensure your agency has access to on-site or telephonic interpreters to provide informed care and treatment.
Displays of Cultural Competence • Ensure your clinic appears inviting to a diverse population (posters, materials available
in multiple languages, etc.) • Post miniature flags of countries served or have a map where clients can mark their
country of birth/origin • Post information about language access and right to an interpreter • Greet clients in their native language • Hire bilingual staff, if possible • Take your time with the patient and begin with a pleasant neutral conversation • Read about the cultural beliefs and history of your clients to better understand their
background and how they may perceive western medicine (but don’t assume the background applies to all from that culture)
• Understand how medical decisions are made in the family structure – in some cases one family member may make medical decisions for the family
• Be sensitive when providing services to clients who may have experienced sexual violence
Helpful Resources Educational Materials • Refugee Health Information Network • USCRI Food and Nutrition Handouts • Ethnomed • Health Information Translations • Medline Plus • National Resource Center on Advancing Emergency Preparedness for Culturally Diverse
Communities
Cultural Backgrounders • Cultural Orientation Resource Center/Center for Applied Linguistics • Florida Center for Survivors of Trauma and Torture
Contact: Julie Framingham Refugee Health Program Analyst 850-245-4444 x 2306 [email protected]
Questions?