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Health Care and Immigrant Populations in the U.S. James A. Litch MD, DTMH Centers for Disease Control and Prevention; WA Department of Health, Epidemiology Office; University of Washington School of Medicine. Presentation Overview. Health issues facing new immigrant populations in the U.S. - PowerPoint PPT Presentation
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Health Care and Immigrant Populations in the U.S.
James A. Litch MD, DTMH
Centers for Disease Control and Prevention;
WA Department of Health, Epidemiology Office;
University of Washington School of Medicine
Presentation Overview
• Health issues facing new immigrant populations in the U.S.
• One Example: The Tibetan Refugee Resettlement Project
• Lessons learned: steps for providers interested in delivering health care to immigrant populations
High Degree of Vulnerability
• Disease/Illness • Mental illness
• Isolation• Crime• Violence (domestic and community)• Underemployment• Poverty
Health Issues: Immediate
• Tuberculosis
• Chronic viral hepatitis infection
• Intestinal parasites
• Nutritional deficiencies
• Lack of immunization
• Depression and other psychiatric illness
Health Issues: Urgent
• Establish primary care and emergency services
• Identify chronic medical conditions and treatment alternatives
• Language barriers may be persistent
Health Issues: Ongoing
New behavioral limits may require rapid change:– Old practices may be
dangerous or illegal– The new environment
has different risk factors
– Awareness of specific cultural practices yields returns
Delivering Health Care
• Health conditions may not be the dominant problem patients face
• Health care services alone are unlikely to be sufficient
• This leads to many challenges that require creative linking of resources
Tibetan Refugee Resettlement Project
• Between 1992 and 1993, the first group of Tibetan refugees entered the US
• 1000 visas were issued for immigration, but a unique stipulation was made that prevented the use of federal resources for support
• This mobilized a nationwide effort in 21 cities
Tibetan Refugee Resettlement Project
• Refugees from India, Tibet and Nepal• Came as individuals, with family
members to follow in 3-6 years• Seattle received 36 individuals,
followed by 150 family members• Tibetan community advocates
identified and empowered early after arrival
Tibetan Refugee Resettlement Project• Immigrants were not eligible for public
assistance for 1 year• Arrived with a prearranged job offer and
household sponsor waiting• Medical screening and care at a Seattle
family medicine residency clinic• Structured language, safety/health
education, legal support, and acculturation classes
• Weekly peer support group
• Key outcome indicator: First group to transition into leadership roles
• The program was re-incorporated as a new non-profit organization in 1996 to settle the next larger wave of immigrants
TibetanCommunity Program
Tibetan Resettlement Project
Lessons Learned for Health Care Providers
• Specialty or focused clinics for a particular immigrant group are lacking
• Travel effort to receive care needs to be appreciated
• Language interpreters are NOT optional• Screening is straightforward, but just a
starting point
Lessons Learned for Health Care Providers: Cont’d
Recognize the need for critical referrals:– English as a second language (ESL)– Counseling/Psychiatric care– Housing – Employment– Establishing residence– Peer support
Steps for Health Care Providers
• Commitment is needed from clinic staff, not just the care provider
• Training:– Family practice residency training– Diploma in Tropical Medicine and
Hygiene– Short-term overseas clinical work– Rotate at a regional international clinics
• Get connected in your local community
Conclusion
• Mainstream, don’t marginalize
• Treat the individual, and the patient
• Identify and act to employ outside resources for critical needs