Refugee Health Presentation

Zaw Win Aung Special Medical Case Manager

1125 Brookside Ave. Suite C9 Indianapolis IN 46202

317-921-0836 www.exodusrefugee.org

Presentation Title | Page 3 Exodus Refugee The Life Ahead

Exodus Refugee Immigration works with refugees—worldwide victims of persecution, injustice and war— to establish

self-sufficient lives in freedom and sanctuary for themselves and their families in Indiana.

Mission Statement


“a person who "owing to a well-founded fear of being persecuted for reasons of race, religion, nationality, membership of a particular social

group, or political opinion, is outside the country of his nationality, and is unable to or, owing to

such fear, is unwilling to avail himself of the protection of that country."

A REFUGEE IS…


Resettlement

• Airport Pick-Up & Welcome • Orientations -Life in America, culture, apartment, safety budget, employment, resettlement plan

• Services - Welfare (within 7 days) - Social security (10 days) - Employment referral & English classes (10 days) - School enrollment (30 days) - Health screening & referral for treatment (30 days)

• Goals employment by 90 days, self-sufficiency by 180


Why Indiana? • Welcoming Community • Resources services, transportation • Employment • Cost of living • Safety • A future

Welcome to the

Hoosier State Refugee Communities • Experienced traumatic circumstances • Loss of homeland, familiar • Strong sense of community, ethnic and national pride • Courageous, full of hope • Strong sense of community • Ethnic and national pride


Refugee Contributions • Food, art, ritual • Diversity • Language, religion • Strong family values • Community service • Civic pride • Consumers • Industrious workforce • Professionals in a variety of fields • Generations of passionate, committed citizens


Ethnicities Resettled 2013

Iraq, 22

Congo, 15 Bhutan, 14

Eritrea, 8

China, 7

Somalia, 3 Ethiopia, 2

Chin, 523

Karen, 71

Karenni, 16

Burmese, 14 Kachin, 11 Arkanese, 5 Mon, 4 Arakan, 1

90% from Burma, 73% Chin 71 of 716

individuals from other countries


Burma (Myanmar)


The People of Burma

States • Chin State • Kachin State • Kayin (Karen) State • Kayah (Karenni)

State • Mon State • Rakhine (Arakan)

State • Shan State

http://upload.wikimedia.org/wikipedia/commons/b/bc/Burma_en.png


Many Languages • More than 100 dialects spoken in Burma

• Today, Burmese is the Official Language, English is secondary • Burmese taught in schools in the major cities; Military Regime prohibits

education in ethnic dialects

• Usage of minority languages is discouraged

• Other major languages spoken: Shan3,200,000 Karen dialects2,600,000 Kachin900,000 Chin dialects780,000 Mon750,000 Rakhine730,000 Karenni/Kayah


History of Burma • 1948 Independence from British rule Democracy • 1962 Military Rule • 1962-1977 Student Protests • 1988 Uprising-Security forces massacred 1000s of students and protestors


Why People are Fleeing Burma • Forced labor • Economic oppression • Political suppression • Racial discrimination

• Ethnic Fighting • Religious persecutions • Silencing those speaking out against military rule

Chin State Flag Karen State Flag

http://upload.wikimedia.org/wikipedia/commons/6/61/Chinstateflag.png


Fleeing Their Homeland • Lives Threatened

• Forced to leave without warning

• Not able to bring much, sometimes just family and clothes on their backs

• Families may be separated

In danger along the way:

• Fleeing in the jungle

• Malaria

• Starvation



Thailand Refugee Camps Refugees in Malaysia



Life in a Refugee Camp

You are living outside of space and of time, you have no roots, you have no past, you don’t know whether you have a future. You have no rights, you have no voice, you have nothing to participate in, you are not a citizen, you have no papers, sometimes you haven’t even got your name. You have to pinch yourself to reassure yourself that, yes, I am alive, I am me, I am a human being. I am a person.

• Strict rules

• Basic Health Care

• Basic Education

• Crime

• No citizenship

• Overcrowded & Under-supplied

• Exposed to disease

• Disabling – cooking, working

-Vaira Vike-Freiberga, Latvian president and former refugee



Nel Plah’s Karen Story



Overseas Medical Screening

U.S. State Department Each person is rigorously screened before released to come to the U.S. Not cleared to travel until not a threat to others Classified as: “A” immediate follow up required upon arrival to the US “B” may require follow up



Health Screening Part 2: Indianapolis

• Marion County Refugee Clinic

• TB (skin test), Immunizations, Parasites, Hepatitis A,B,C, Lead, Sickle Cell, Gen exam… etc.

• TB Suspects referred to TARC

• All referred to Primary Care



Challenges: Navigating the U.S. Healthcare System

• Language 100s of dialects

• Miscommunication • Say “yes” when they do not understand • Say what they think you want to hear out of respect & politeness

• Showing emotion may not be culturally appropriate

• Misunderstanding of medical advice

• Open-ended questions helpful

• System/ Insurance/ Transportation



Cultural Differences

• Female/Male doctor & patient relationships

• Changes in diet are used to treat illness

• Disease caused by spirit/Nat/ancestor

• Betel Nuts use (seed of Betel Palm- Areca catechu)

• Yellow lotion/make up

• Pregnancy and Delivery Rituals

• Traditional Medicine Used in Burma o Hot/Cold balance o Herbs, Coining o Lead and arsenic in child meds

• Breastfeeding o Publicly o Until child is 2 years old



Health Statistics (WHO) Total population (2012) 52,797,000

GDP per capita (current USD) $1144

Life expectancy at birth m/f (years, 2012) 64/68

Probability of dying under five (per 1 000 live births, 2012)

52

Probability of dying between 15 and 60 years m/f (per 1 000 population, 2012)

242/184

Total expenditure on health per capita (Intl $, 2012)

25

Total expenditure on health as % of GDP (2012)

1.8 (US- 17.9, Malaysia- 4, India- 4.1)



Hospitals in Burma Total Number of Hospitals 924 Total beds available 41,804 Patients admitted 1,324,979 Highest causes of death: Pregnancy, child birth, puerperium 17.9% Infectious and parasitic diseases 16.7% Injury, poisoning, other externals 16.5% Source: Ministry of Health 2011


Thank you!

Exodus Refugee Immigration 1125 Brookside Ave, Suite C9 Indianapolis, Indiana 46202

317.921.0836

exodusrefugee.org

Government & Nonprofit

Refugee Health Presentation