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Refugee 101 for Healthcare Providers Refugees from Rwanda arrive in Tanzania. Photo by UNHCR/ P. Moumtzis.

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Presentation on theme: "Refugee 101 for Healthcare Providers Refugees from Rwanda arrive in Tanzania. Photo by UNHCR/ P. Moumtzis."— Presentation transcript:

1 Refugee 101 for Healthcare Providers Refugees from Rwanda arrive in Tanzania. Photo by UNHCR/ P. Moumtzis

2 Overview Who is a refugee Refugee resettlement in Tucson – Predominant groups and background – Resettlement process and agency roles Refugee health – Health screenings – Common health issues and resources Language interpretation services Community resources

3 What does it mean to be a refugee?  What would you do right now if bombs were falling around you?  What would you do if people of your faith or ethnic group were being singled out, tortured, and slaughtered?

4 What does it mean to be a refugee? If you had 15 minutes to evacuate your home… what would you take ?

5 What does it mean to be a refugee? Where would you go? Who would help you? If you could not return home - would you hope that someone would help you?

6 Who is a Refugee? A refugee is 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…" Article 1, The 1951 Convention Relating to the Status of Refugees Pictures: Courtesy of and

7 Who is a Refugee? This definition of a refugee does not include: Economic migrants Asylum seekers Persons displaced by natural disasters Internally displaced persons (IDPs)

8 Refugees in the World ~ 11 million Women/Children~80% In the Refugee Camps~70% Time in Camps> 10 years Resettled in the 3 rd countries (incl. USA) < 1%

9 Refugees in USA

10 Refugee in Tucson

11 Iraq About the size of CA Baghdad (Capital ~5.7 million (2004)). Nationality: Iraqi(s). Population (07/09): 28,945,657. Ethnic groups: Arab 75%-80%, Kurd 15%-20%, others ~ 5%. Religions: Muslim 97%, Christian and others ~ 3%. Languages: Arabic/Kurdish

12 Iraqi Refugees

13 Bhutan Location: Southern Asia, between China and India Population: `710,000 Constitutional Monarchy Languages: Dzongkha (official), Tibetan dialects, Nepalese dialects (among Nepalese) Ethnicity/race: Bhote 50%, ethnic Nepalese 35%, indigenous or migrant tribes 15% Religions: Lamaistic Buddhist 75%, Indian- and Nepalese- influenced Hinduism 25%

14 Bhutanese Refugees


16 Somalia Population (2010 est.): 10,112,453 (growth rate: 2.8%); infant mortality rate: 107.4/1000; life expectancy: 50 Capital: Mogadishu (~ 1,208,800) Languages: Somali (official), Arabic, English, Italian Ethnicity/race: Somali 85%, Bantu and others 15% (including Arabs 30,000) Religion: Islam (Sunni)

17 Somali/Somali-Bantu Refugees

18 Democratic Republic of Congo Population: 67 million (2010) Capital: Kinshasa Languages: French, Lingala, Kiswahili, Kikongo, Tshiluba Major religions: Christianity, Islam Life expectancy: 47 years (men), 50 years (women) (UN)

19 Refugees from Congo

20 Eritrea Population: 5.2 million (UN, 2010) Capital: Asmara Languages: Tigrinya (official), Arabic (official), English (official), Tigre, Kunama, Afar, others Major religions: Muslim, Coptic Christian, Roman Catholic, Protestant Life expectancy: 59 years (men), 64 years (women) (UN) Infant Mortality Rate: 41.3/1,000

21 Eritrean Refugees

22 How Do Refugees Reach the US? -Application for resettlement in a third country - Rigorous screening (medical and security) - Interviews - Cultural orientations Waiting time: several months to many years Picture:

23 Refugees in the US Once approved, refugees are assigned to various sponsoring voluntary agencies in the United States 12 Nationwide Refugee Resettlement Agencies 4 in Phoenix 3 in Tucson (see handouts)

24 PRE-ARRIVAL: Locate & Furnish Apartment Connect utilities ARRIVAL: Pick up at Airport Home Safety Orientation WEEK 1: DES Interview (Food Stamps/AHCCCS) Social Security Card RMAP card FIRST 30 DAYS: CORE SERVICES Ongoing cultural/home orientations Financial/MG orientations Health Screening (including TB screening and Immunizations) Begin initial doctor visits Register adults for ESL at Pima Bus passes School Enrolment Employment Assistance 6 MONTHS: Start paying on IOM Travel Loan 1 YEAR: Apply for Permanent Residency (Green Card) 5 YEARS: Apply for Citizenship Resettlement in Tucson

25 Insufficient financial assistance for the first 90 days ($900 per person) Shortage of Staff Caseload Challenges of Resettlement

26  Common challenges for new arrivals: Living in poverty Securing employment Learning the language Getting around Tucson Navigating the healthcare system and other government services Adapting to American culture (time, individualism, the status of women, etc.) Resettlement in Tucson

27 Before going to USA: Medical assessment by International Organization of Migration/IOM: TB-screening, Chest X-ray, RPR tests, and general physical exam; Upon arrival to USA: TB-screening within first 30 days Initial medical screening within 30 days after arrival unless stated differently; Initial dental screening within first 30 days REFUGEE HEALTH CARE REQUIREMENTS

28 Health Insurance RMAP Federally-funded temporary public benefits program for new refugees Covers medical costs during first 8 months not covered by AHCCCS Also covers immunizations and dental and eye exams for refugees including over 21 years AHCCCS Arizona/Federal Medicaid health insurance program for qualified low-income residents Coverage for medically necessary care with limitations Broader coverage for children under 21 years and ALTCS members

29 Mandatory for all refugees within 30-60 days after arrival Funded through RMAP Screening for communicable diseases, mental health, undiagnosed chronic conditions Screening tests including TB, Hepatitis B, HIV, Syphilis, GC/Chl, and Pregnancy test Vaccinations for children and adults Follow-up immunizations for adults to fulfill I-693 requirements Immediate referrals to Center for Well-Being, OB Intake at FMC, Infectious Diseases Providers at UMC Preventive Health Screening

30 Pain Headache Neck pain Back Pain Abdominal Pain Female Pelvic Pain Mental Health PTSD Depression Anxiety Adjustment Disorder Social Isolation Chronic Conditions Anemia Asthma Diabetes Dyslipidemia COPD Hypertension Vitamin D def Vitamin B12 def (Bhutanese) Common Refugee Health Issues

31 Vaccine Requirements for Green Card

32  Language barrier  Differences in health beliefs  Differing beliefs regarding causes of health and ill health (e.g. viruses, organ systems)  Concept of chronic (vs acute) disease  Concept of preventive care (e.g. CA screenings tests)  Difficulty navigating health care system  Understanding medication refills  Keeping set appointment times  Following up with referrals to specialists  Healthy Living: Nutrition, hygiene, sanitation Patient and Provider Challenges

33 Pre-migration: exposure to infectious & parasitic diseases, physical & psychic trauma During flight & refugee camps: malnutrition, exposure to the elements, exposure to infectious & parasitic diseases, physical & psychic trauma Post-migration/Resettlement: increasing susceptibility to chronic diseases, problems & stressors of resettlement (unemployment, language, etc.) Source: Link between Migration & Resettlement Health Burden

34 Mental Health Considerations

35 Triple Trauma Paradigm Pre-Flight –Disruption, secrecy, fear, traumatic events Flight –Food insecurity, separation, lack of trust Resettlement –Cultural isolation, loss of status, limited social support

36 Pre-flight Kidnappings Rapes Threats of harm Family members tortured and killed Tortured by militia or government officials Witnessing and experiencing shootings and bombings Long term discrimination and oppression

37 Flight Limited resources Lack of status Discrimination Family still in home country or no knowledge of their whereabouts

38 Post-flight New town Foreign Country New language New Culture Unemployed New Apartment New neighbors New school Crowded locations Heavy traffic Financial difficulties No friends No extended family Unable to communicate Role reversal Changing Gender Roles Impact of Torture

39 Services at Center for Well-Being Clinical Services: Individual, Family and groups counseling for depression, anxiety, and severe trauma

40 Refugee Well-Being Project: In-home wellness promotion and informational sharing

41 Survivors of Torture Program: Intensive case management services for those who fit the definition of a survivor of torture

42 Language and Communication Tucson Refugees Speak: Acholi, Amharic, Anywak, Arabic (several dialects), Bosnian (Serbian/Croatian), Dari, Dinka, English, Farsi, French, Karen, Kinyarwanda, Kirundi, Krahn, Kurdish, Lingala, Mandingo, Maay-Maay, Nepali, Mende, Ndogo, Oromo, Pushtu, Russian, Turkish, Somali, Spanish, Swahili, Tigrinya, Uzbek, Vietnamese…

43 Telephone Interpretation Cyracom Language Line

44 Telephone Interpretation Services: Typical Process Call the specific health plan’s Member Services number Request interpretation services and specify language Be prepared to provide the patient’s: –Name –AHCCCS ID# –DOB –Address Also be prepared to provide the doctor’s: –Name –Location –NPI #

45 Telephone Interpretation Tips Specific process and required information for each health plan varies See handouts Contact the applicable health plan’s Customer Service for any questions or problems

46 What To Expect When Working With Refugees: Refugees who speak limited English Refugees who speak excellent English A family that is less educated A family that is highly skilled and educated People that seem very conservative or foreign People that seem very liberal or westernized Slides from The IRC

47 A Few Tips: Release your expectations Develop Self-Awareness –Be aware of your worldview, values, and behaviors –Be aware of your prejudices Develop Awareness of Different Cultures –Listen & Learn & Appreciate –Address Misconceptions Keep trying and don’t be afraid of mistakes Slides from The IRC

48 Contact Information International Rescue Committee (IRC): 319-2128 Lutheran Social Services: 721-4444 Catholic Social Services: 623-0344 See handout form for referrals to IRC’s Wellbeing and Survivors of Torture Programs See handout on community resources

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