Refugee/Immigrant

Care for Refugee and Immigrant Patients

Authors: Colline Wong, Christopher Steele MD MPH

 

Introduction

Historically, the U.S. has been the world’s melting pot. As of 2019, over 40 million U.S. residents were foreign born.1 Immigrants come to the United States for many different reasons and under various different legal titles. There are many factors contributing to health disparities amongst immigrants: legal status, insurance status, language barriers, cultural understanding, trauma history among others. Nationally, 41% of undocumented immigrants are uninsured compared to 9% of U.S. citizens.1 Many undocumented immigrants do not access health care due to fear of being reported to Immigration and Custom’s Enforcement (ICE) and deportation. Exacerbating the health disparity caused by inadequate access to healthcare, the fear of being deported itself can cause poor health outcomes. This fear has been linked to increased “toxic stress” in undocumented immigrants leading to poor physical and mental health in these communities.2 Even for those who live in the U.S. without fear of deportation, there are issues surrounding trauma, fear, and loss that can affect mental health. The goal of this module is to discuss disparities in heath care for immigrants and refugees and ways to mitigate them.

 

Learning Objectives

By the end of the session, learners will be able to:

  1. Define the terms refugees, asylees, and migrants.
  2. List and describe disparities in health care access experienced by refugees and immigrants.
  3. List and describe health issues and factors that impact the health of refugees and immigrants.
  4. Describe how to find clinics and care centers that may help refugee and immigrant patients. 
  5. Identify important aspects of the Visa Medical Exam, Initial Domestic Screening visit, and migration history for new refugees and immigrant patients. 
  6. Apply culturally sensitive care and cross cultural communication to the care of refugee and immigrant patients.

 

Required Assignment

  1. Introduction to Refugee and Immigrant Health: https://youtu.be/BN4D-b6FHH0 
  2. Addressing Health Care Needs for Refugees and Immigrants: https://youtu.be/yHVdiKnJ0_s 
  3. Rodriguez-Hernandez M, Pilato TC, Yerdon KA, Kysel IM, Taki F, Yale-Loehr S, Kaur G, Burke AE, Koscal N. Detained. N Engl J Med. 2021 May 13;384(19):1785-1787. doi: 10.1056/NEJMp2032690. Epub 2021 May 8. PMID: 33983690. https://www-nejm-org.ezproxy.lib.uconn.edu/doi/10.1056/NEJMp2032690 
  4. Healthcare access for Undocumented Folks in the Time of COVID19. United We Dream. https://unitedwedream.org/2020/03/healthcare-access-for-undocumented-folks-in-the-time-of-covid19/ . Published 2021. Accessed July 13, 2021.

 

Optional Assignment

  1. Williams P. #196 LIVE! Refugee Health with Tanuja Devaraj MD. The Curbsiders. https://thecurbsiders.com/podcast/196-refugee . Published 2020. Accessed July 12, 2021.

 

Resources

Information and  guidelines on Refugees and their care:

Care centers and clinics: 

 

Works Cited

  1. Radford, J. (2020, May 30). Key findings about U.S. immigrants. Retrieved July 26, 2020, from https://www.pewresearch.org/fact-tank/2019/06/17/key-findings-about-u-s-immigrants/
  2. Immigration, Health Care and Health. (2019, July 26). Retrieved July 26, 2020, from https://www.rwjf.org/en/library/research/2017/09/immigration-status-and-health.html

 

Application Exercise

The Refugee Act of 1980 established the domestic medical screening program. Refugees must be screened within 90 days of arrival to the U.S, and ideally the domestic medical screening should be initiated within 30 of arrival to the U.S. to ensure that any ongoing and emergent health concerns can be addressed. Clinics conducting the domestic medical screening are reimbursed through one of several mechanisms, including the Office of Refugee Resettlement’s (ORR) Refugee Medical Assistance or Refugee Cash Assistance (part of the U.S. Dept of Health and Human Services) and state Medicaid programs. Funding is dependent on the state and an individual’s immigration status, and as a result, the services and clinics that provide the initial domestic screening vary by state. 

Using the Office of Refugee Resettlement’s Key State Contacts, and Find Resources and Contacts please list the state refugee coordinator, refugee health coordinator, and visit the state website of the state that you are currently in. What are three locations in the state you are currently in where refugees can get initial domestic screening exams? 

In some instances, a refugee is unable or unwilling to receive their domestic medical screening from one of these state administered or state affiliated clinics. Clinicians can contact their state’s RHC for information regarding funding and reimbursement for these domestic screening exams. Imagine that you are a primary care provider who is seeing a new patient that would like you to perform their domestic medical screening. After your initial conversation with Mr. X, you discover that he is a 29 year old male from Syria who recently relocated to the U.S. due to fear of persecution. He has been in the U.S. for 39 days and previously had little exposure to health care. 

Using the CDC’s Refugee Health Profiles and Refugee Health Guidance: Domestic Guidance, please list:

  1. General and Optional Testing for newly arrived refugees
  2. Diseases or conditions that have specific guidance in the CDC’s Domestic Guidance section
  3. Priority Health Conditions for this patient (from the Syrian Refugee Health Profile).