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Refugee Health Provider Guide

Refugee Health Provider Guide

Table of Contents

  1. Contacts
  2. Definitions
  3. Intake
  4. Typical flow
  5. History and physical
  6. National recommendations
  7. Other resources
  8. Physical health topics
  9. TB
  10. Hepatitis (A, B, C, and E)
  11. Parasites
  12. Malaria
  13. Iron and B12 deficiency
  14. …
  15. Resources
  16. Mental health
  17. Common issues
  18. Screening forms
  19. Resources

Contacts

Public Health Services

SEH Public Health Department Office (DOH)—(505) 841-8928

Linda Hellyer, Nurse Manager ()

Lia Geever, Nurse ()

Christine XXX, Nurse (XXX)

Michelle Esquibel, State Refugee Mental Health Coordinator()

New Mexico Department of Health (NMDOH) Tuberculosis Program

Marcos Burgos, Medical Director ()

Diana Fortune, Nurse Consultant ()—(505) 827-2473

Deborah Isaacks, Nurse Consultant ()-(505) 827-2471

Midtown DOH (location of Dr. Burgos clinic)—(505) 841-4182

New Mexico Department of Health (NMDOH) Refugee Program

Karen Gonzales, Program Manager, ()-(505)476-0376 x562

Clinic Services

UNM Southeast Heights Clinic (505) 272-5885

Brain Isakson, Psychologist ()—(505) 827-2471

Pacifica Interpreters—(800) 272-7442, access code 7411#

Young Children’s Health Center (YCHC)—(505) 272-9242

Volunteer Resettlement Agencies (Volags)

Lutheran Family Services

Tarrie Burnett, Program Director ()—(505) 933-7015

Catholic Charities

XXX, Program Director (XXX)—(505) 724-4670

Definitions

Asylee: A person who flees their country of nationality because of persecution or political opinion and then seeks sanctioned status in another country. When entering the U.S. a person would seek asylum from U.S. Citizenship and Immigration Services (USCIS).

Cuban/Haitian Entrant:Any person from Cuba or Haiti granted parole status.

Immigration and Customs Enforcement(ICE): a component of DHS that enforces immigration laws.

Internally Displaced Persons (IDP):A person who has to leave an area within their country of nationality because of persecution, political opinion, or disaster including natural disasters.

International Organization of Migration (IOM): International organization that works closely with UNHCR and host countries to provide services for refugees including in some circumstances health assessments.

Migrant/Immigrant: A person who leaves their country for another country. The main distinction between a migrant and a refugee is someone who is a migrant could return to their country of nationality and be protected by their government.

Parolee??? (1970’s seventh preference visa additions, but still used now for people inadmissible to the U.S. but here temporarily due to humanitarian crisis?)

Refugee: A person who flees their country of nationality because of persecution or political opinion. Most commonly a person who enters the U.S. as a refugee was an asylee in another country first. The number of refugees admitted to the U.S. is by region of the world and determined annually by the President and Congress.

Special Immigration Visas (SIV): a limited number of SIVs are being issued to Iraq and Afghan nationals who worked for U.S. Armed Forces or Chief of Mission. (more information:

United Nations High Commissioner for Refugees (UNHCR): A component of the United Nations that provides services when people are fleeing persecution and in refugee camps. They identify, interview, and submit information for resettlement on behalf of asylees and refugees to other countries.

U.S. Citizenship and Immigration Services (USCIS):a component of the Department of Homeland Security (DHS) that administers visas, refugee, and asylum applications.

Volunteer Resettlement Agencies (Volags): U.S. organizations that are contracted with U.S. federal government to provide services including housing, employment options, healthcare, and schooling for refugees during the initial resettlement period.

??? Technical medical exams that are part of the asylee/refugee process

U.S. Refugee Arrivals by Region of Nationality, 2001–2015

Note: Data from the Department of State (DOS) Worldwide Refugee Admissions Processing System (WRAPS) on refugee arrivals differ slightly from the Department of Homeland Security’s Yearbook of Immigration Statistics due to a different data counting approach.

Source: MPI analysis of WRAPS data from the DOS Bureau of Population, Refugees, and Migration, access here:

Intake

Typical flow

Refugees, whose status is determined before arrival in the U.S., should receive a pre-departure exam consisting of a physical, and TB and syphilis testing if ≥18 years old. Any Class A conditions (communicable diseases of public health significance—active TB, leprosy, yellow fever, mental health conditions associated with harmful behavior, etc.) have to be treated before coming to the U.S.

  1. Social Services through Volag
  • Case manager
  • Housing
  • Medicaid
  • Housing
  • Supplemental Nutritional Assistance Program
  • School enrolment/English classes
  1. Public health screening (SEH PHO)
  • Immunizations: MMR, Varicella, Tdap
  • Possible additional immunizations: influenza, Hep A, HPV
  • School age children should also get: meningitis, IPV, PCV, Hib (if <x years old),
  • PHD does NOT give: Meningitis B
  • Testing:
  • GC, Chlamydia, and Syphilis for ≥15 year olds,
  • HIV,
  • TB (quant gold if ≥5 years, PPD if <5 years old),
  • HepB, HepC (for ≥15 year olds or <15 year olds with a specific risk factor),
  • CHEM7, LFTs,
  • CBC with diff,
  • Lead (for children 6 months to 16 years old),
  • Malaria (for individuals coming from Sub-Saharan Africa),
  • Sickle cell screening (for individuals from Sub-Saharan Africa)
  • PRN birth control
  1. Follow up at public health
  • Lab test results usually returned the week after they are drawn
  • Referral for chest xray given at 1 week follow up if TB screening test positive
  • Second immunization appointment schedule 1 month after the first then given per schedule thereafter
  • TB treatment usually starts 1 month after initial appointment
  • Uncomplicated LTBI cases treated at SEH PHO
  • Complicated LTBI or active TB seen by Dr. Burgos at Midtown PHO
  • Mental health screening using Refugee Health Screener-15 (RHS-15) ( usually done at 1 week or 1 month follow up with SEH PHO. Referrals then made to xxx for follow up.
  1. Establish primary care
  • CDC Checklist for the Domestic Medical Examination for Newly Arriving Refugees
  • TB if there is a question about TB screening or treatment contact SEH PHO nurses to discuss

History and physical

INITIAL REFUGEE VISIT TO FAMILY MEDICINE CLINIC
HPI
Interpreter:
Assigned VOLAG: [ ]CC [ ] LFS
ROS:
Gen: Fever, wt loss, night sweats, fatigue
Pulm:
CV:
GI: appetite, diarrhea, abdominal pain
Skin: jaundice, rash, lesions, nodules, ulcers, pruritus
Neuro: HA, seizures, vision, hearing
Endo: menstrual cycle
Psyc:
Trauma/Violence: Depression (PHQ-9) and PTSD screening
Conflict service?
Past Medical Hx:
Chronic illnesses:
Hospitalization:
Severe illness:
Pregnancy history:
Surgeries:
Injuries:
Blood Transfusion:
Medications:
Traditional remedies:
Allergies:
Supplemental Social History
Country of origin:
Country of exit:
Date of arrival in the U.S.:
Entry point:
Plan to live in:
First Language: Read:Write:
Second Language(s): Read:Write:
Education level:
Years spent in Refugee camp:
Marital status:
Children:
Lives with:
Religion:
Work history[MAM(1]:
Smoking/ETOH/Other drugs:
FHx
General:
FHx of DM, Sickle Cell, HTN, heart disease, TB
Overseas Records
Date:
RPR:
Vision:
CXR:
Albendozol (Middle East, South and Southeast Asia, Africa):
Praziquantel (SSA Refugees):
Ivermectin (Burmese):
Artemether and Lumefantrine (Coartem):
Public Health Department Records
Date:
TB Quant:
Chest x-ray:
RPR:
HIV:
CBC:
CHEM7:
LFTs:
HepB:
HepC:
U/A:
GC/CT:
Stool specimen results:
Sickle Cell screen:
Malaria:[MAM(2]
Objective:
Physical Exam
@VS@
CONSTITUTIONAL: Well-developed *** in no acute distress
HEENT: Normocephalic/atraumatic. EOM intact. Moist mucous membranes, no obvious oral lesions
NECK: Supple, no anterior cervical or supraclavicular lymphadenopathy
CARDIO: Normal rate, regular rhythm, no murmurs/rubs/gallops
PULM: Lungs clear to auscultation bilaterally, normal effort, no signs of respiratory distress
GI: Abdomen is soft, non-tender, non-distended, with normal bowel sounds present
MSK: No clubbing, cyanosis, or edema. No obvious joint deformities
SKIN: Skin is warm and dry. No rash noted.
NEURO: Alert, follows commands, answers questions appropriately, no gross deficits
PSYCH: Pleasant affect
Assessment/Plan:

Other resources

  • UNM Family Medicine Resource Guide:
  • CDC Guidelines:
  • Minnesota Department of Health refugee information:
  1. Physical health topics[MAM(3]
  2. TB
  3. Hepatitis (A, B, C, and E)
  4. Parasites
  5. Malaria
  6. Iron and B12 deficiency
  7. …
  8. Resources
  9. Mental health
  10. Common issues—depression, PTSD, adjustment
  11. Screening forms
  • Depression (PHQ-9):
  • PTSD:
  • Refugee Health Screener-15 (RHS-1) used by SEH PHO

Form:

Explanation:

  1. Resources

[MAM(1]Smart phrase ^refSH

[MAM(2]Smart phrase ^refPHD

[MAM(3]To come primarily from the MNDOH reference