1. Caring For Refugee Children in Louisville
What can we all do to make a difference

2. Objectives Participants will be able to:
Define process for refugee immigration to U.S. and KY
Identify common illness/findings associated in new pediatric refugees
Identify unique needs of pediatric refugee clients in the healthcare setting and tips to enhance the interaction

3. What is a Refugee
A person who has been forced to flee his or her country because of persecution, war or violence. He or she is unable to return to their country, owing to a well- founded fear of being persecuted for reasons of race, religion, nationality, political opinion or membership in a particular social group.
Refugees have legal status upon their entry to the U.S. and are eligible for citizenship after five years.

4. Who is a Refugee Men, women and children. Children make up approx 51%
They were doctors, nurses, scientists, farmers, laborers, contractors, machinists etc…..

6. Where are they going Top refugee hosting countries
1. Jordan (2.7 million+)
2. Turkey (2.5 million+)
3. Pakistan (1.6 million) 
4. Lebanon (1.5 million+)

7. Top Refugee Hosting Countries
5. Iran (979,400)
6. Ethiopia (736,100) 
7. Kenya (553,900) 
8. Uganda (477,200)
9. Democratic Republic of Congo (383,100)
10. Chad (369,500)

8. U.S. History and Refugees
Pilgrims (fleeing religious persecution)
1948 – first legislation regarding refugees enacted by Congress (> 250,000 displaced Europeans after WWII)
Later laws assisted refugees fleeing Communism (China, Hungary, Korea, Poland and Yugoslavia)
1960’s Cubans fleeing Fidel Castro’s regime
1975 Vietnamese refugees after the fall of Saigon

9. Refugee Act of 1980
Standardized resettlement services and federally supported Defined “refugee” Provided for admission of all refugee nationalities Provided legal basis for Office of Refugee Resettlement (ORR) which is at the Department of Health and Human Services

10. *Since 1975 over 3 million refugees have resettled in U.S.
*Annual admissions range - >200K in 1980 to 27K year post 2001
*70K refugees admitted in 2013, 2014, 2015
Have you heard of these refugees: Albert Einstein and former Sec of State Henry Kissinger and Madeleine Albright
US Dept of State Fact Sheet. Bureau of Population, Refugees, and Migration. June 19, 2015
Einstein and Kissinger from Germany, Albright was from Czechoslovakia and All fled Nazi persecution

11. Refugee Resettlement Process
Average processing time from referral to admission is 18-24months.
Each year a presidential determination sets a limit of refugee admissions to the US refugee ceiling 85K ceiling was 100K (new administration may change number)
Department of State’s Bureau of Population, Refugees and Migration (PRM) works with national voluntary organizations to facilitate resettlement. Every refugee is assigned to a resettlement agency.

12. Example of brochure from Africa
The U.S. selects refugees for admission based on their humanitarian protection need, not religion or nationality

13. Security Security clearance includes:
*Interviews by officers of the Dept Homeland Security
*Fingerprints and personal histories checked against consular watch lists and databases in the Intelligence Agencies and National Counterterrorism Center, Homeland Security, FBI and Defense Dept.
*Syrian refugees must also be passed through fraud detection unit of Department of Homeland Security

14. Process for Kentucky
Kentucky Office for Refugees (KOR) is the Kentucky State Refugee Coordinator’s office and administers federal funding (from ORR) for post-resettlement services.
KOR contracts with agencies in Louisville, Lexington, Bowling Green, Owensboro and couple new sites in Northern KY to work with refugees in:
*securing employment, learning English, pursuing educational opportunities and addressing medical needs all to become self-sufficient

15. Our State
Has resettled over 25,000 refugees in last 10 years 2,048 refugees arrived in FY 2015

16. Countries of Nationality of Arriving Refugees

18. Countries of Origin
Approx 500 children were seen in KY from Jan – June 2016

19. Languages

20. Agencies in Louisville
KRM – Kentucky Refugee
Ministries
MRS - Migration and Refugee Services (Catholic Charities)

21. Programs & Services Employment Services English Language Training
Refugee Cash Assistance
Case Management
Elder and Youth Services
Career Development
Citizenship Preparation
Refugee Health Assessments **
Goal is self-sufficiency!

22. Health Assessments
Contracted to perform initial intake assessments in Louisville:
Family Health Centers – Americana
Open Arms Children’s Health – Home of the
Innocents
550 Clinic – UofL Adult ID

23. Health Screening Clinics in KY

24. Intake Assessments
Intake 1: VS, weight/height, vision/hearing screenings, lab draw (UA, CBC, Hep B panel, Lead, HIV, TST/Tspot, stool for O&P).
Intake 2: VS, weight/height, History and Physical, review all lab results, presumptive parasitic treatment, referrals, more labs, treatment of conditions, teaching

25. Most Common Diagnoses

26. Cases Mother with 9 children from Somalia.
Fled Somalia and lived in Ethiopia until came to US.
Older children witnessed murders in Somalia.
Father still in Africa.
(immunization & follow-up appts., dental, ophthalmology, urology)
Mother with 4 boys from Syria.
Boys witnessed father being shot to death.
One sibling with cancer.
(immunizations, follow-up appts, dental, sub specialists, psychology)

27. Cases Single mother from Cuba (mother- poor hearing).
Daughter with Osteogenesis Imperfecta, poor hearing, cavities into pulp, developmental delays, BMI 0%
Blind, deaf, hydrocephalus, club feet, autism, Downs, broken bones set incorrectly, large body burns, undiagnosed congenital heart defects, malnutrition, cleft lip/palate with severe speech issues, seizures, hemiparesis.

28. Cases Children who have been kidnapped and thrown from moving cars.
Parents whose teenage daughter kidnapped and never found.
Family whose house set on fire by Taliban. Mother burned and lost unborn child, 8yo son can’t sleep without touching someone.
Living in refugee camp with limited food and basic necessities.

30. Why We Do What We Do We care.
High risk populations that many practices would prefer not to see.
Every person deserves the best care that can be offered.

31. Can you imagine
Kakuma refugee camp

32. If you were born in Syria, Somalia, DRC, Iraq....

33. How We Try to Meet Needs
Coordinate as many services at one visit as possible (dental, immunizations, follow up appts, optometry, audiology)
Get needed prescriptions even though insurance not active yet
Getting medications to families
Assess urgent dental needs and treat promptly
Immediate mental health evaluation

34. Use translators
Seek assistance from insurance companies in getting needed items (Pediasure, special beds, wheelchairs)
See several children at a time
Provide clothes/shoes

35. Get immunizations caught up– gave 50 immunizations to 2 families
Communicate with families/understand their culture – Translators
Teach about our culture
Develop tools to enhance understanding
Are we perfect…..not even close. We learn something every day and try to make changes

36. What Can You Do to meet their unique needs
Always use a translator even when your patient (child) speaks English well; even when the child’s parent knows some English.
If things don’t seem right….. Keep questioning. Use demonstrations if possible. Reword, rephrase
Remember…speaking louder doesn’t improve comprehension.

37. What Can You Do
Determine how patients who don’t speak English leave a message at your office.
Ensure that your staff call non-English speaking patients with a translator (don’t leave appt info on voice mail in English) *happens a lot!!
Be creative when it comes to forms. How can they be expected to complete a multiple page questionnaire in English. *I am intimidated by some of the packets!!

38. What Can You Do
If it doesn’t seem like translation is going correctly… get another translator.
Call KRM/MRS for guidance if needed
Use pictures if possible
Patience!

39. RESPECT
“To be culturally effective doesn’t mean you are an authority in the values and beliefs of every culture. What it means is that you hold a deep respect for cultural differences and are eager to learn and willing to accept that there are many ways of viewing the world.” Okokon O. Udo