The Old Order Amish Culture Care Connection

Document Sample
The Old Order Amish Culture Care Connection Powered By Docstoc
					Refugee Health In Minnesota




       Carol Berg, RN, MPH
   Public Health Manager, UCare
          cberg@ucare.org
      Presentation Objectives
• Describe refugee and immigrant
  populations in Minnesota.
• Explain the MDH Refugee Health
  Program.
• Cite the health needs assessed among
  new arrivals.
• Identify strategies to enhance culturally-
  specific health care services for new
  arrival populations.
            USCIS Definitions
                              U.S.A.

 U.S. Citizen                                  Non-Citizen



           Immigrant                                 Non-Immigrant

     LPR               authorized
                LTR                       undocumented   student                tourist
                      employment                                   visitor on
                                            individual             business

Persons fleeing from persecution



refugee     asylee              parolee


                                                                                    8/03
  What does it mean to be a refugee?

• Foreign-born resident who:
  • is not a United States citizen
  • cannot return to his or her country of origin because
    of a well-founded fear of persecution due to race,
    religion, nationality, political opinion, or membership
    in a particular social group
• Refugee status is generally given:
  • prior to entering the United States
  • by the Bureau of Citizenship & Immigrant Services
    (USCIS)
  • Eligible for up to 8 months of public assistance.
What does it mean to be an immigrant?
• Foreign-born resident who:
  • is not a United States citizen
  • is defined by U.S. immigration law as a
    person lawfully admitted for permanent
    residence in the United States
  • either arrives in the U.S. with an immigrant
    visa issued abroad, or adjusts their status in
    the U.S. from temporary to permanent
    resident
  • may be subjected to a numerical cap
  What does it mean to be an asylee?

• Foreign-born resident who:
  • is not a United States citizen
  • cannot return to his or her country of origin
    because of a well-founded fear of persecution
  • due to race, religion, nationality, political
    opinion, or membership in a particular social
    group
• Asylee status is generally given:
  • after entering the United States
  • by the State Department or USCIS
  What does it mean to be a parolee?

• Foreign-born resident who:
  • is not a United States citizen
  • has been given special permission to enter
    the United States:
    - under emergency conditions or
    - when that person's entry into the U.S. is
      considered to be in the public's interest
           Migrants to Minnesota
• Primary Migrants to Minnesota
  • Foreign-born persons whose primary state of
    resettlement in the U.S. was Minnesota
  • Arrival notification from CDC

• Secondary Migrants to Minnesota
  • Significant movement of refugees/ immigrants
    from state of primary arrival
  • Health information requested from primary
    arrival state
  • If no information is available, baseline health
    assessment should be done
 Refugee Health Program Goal
• To control communicable disease
  among, and resulting from, the arrival
  of new refugees through:
    • health assessment
    • treatment
    • referral
 Functions of MDH Refugee Health Program
• Coordinate initial    • Collect and
  health assessments,     disseminate health
• Educate providers       screening data,
  regarding screening   • Collaborate with
  protocols,              Volags, MAAs, and
• Administer contacts     other community
  with local health       based organizations,
  departments for       • Provide health
  refugee screening,      resources for foreign-
                          born populations and
                          their health care
                          providers.
             Refugee Health Assessment
                  Information Flow
Quarantine Station/CDC




                                   Local Health Dept.

                                                          Forwards to
                         Screens                         primary provider


                                                                    Primary provider
                                                                        screens

                                           Screening form
                                         completed & returned
   Volags (Volunteer Agencies): Local
       Organizations or Affiliates
• Catholic Charities (CC)
• Lutheran Social Services (LSS)
• Jewish Family Services or Minneapolis
  Jewish Family and Children's Services
  (JFS)
• MN Council of Churches (MCC)
• International Institute of Minnesota (IIM)
• World Relief Minnesota (WRM)
Mutual Assistance Associations (MAAs)*
• Amigos de las Americas            • Islamic Center of MN
• Association for the               • Lao Assistance Center of MN
  Advancement of Hmong              • Lao Family Community
  Women in MN                       • Oromo Community of MN
• Center for Asians and Pacific     • SEA Community Council
  Islanders
                                    • Slavic Community Center
• CLUES
                                    • Somali Family Services
• Confederation of Somali in MN
                                    • United Cambodian Association
• Ethiopian Community in MN           of MN
• Hmong American Mutual             • Vietnamese Social Services
  Assistance Assoc.
                                    • West African Mutual Aide
• Hmong American Partnership          Association
• Intercultural Mutual Assistance          *List not comprehensive
  Association
                            Refugee Arrivals to MN by Region of World
                                           1979-2010
                     8000

                     7000

                     6000
Number of arrivals




                     5000

                     4000

                     3000

                     2000

                     1000

                        0
                             1979
                                    1980
                                           1981
                                                  1982
                                                         1983
                                                                1984
                                                                       1985
                                                                              1986
                                                                                     1987
                                                                                            1988
                                                                                                   1989
                                                                                                           1990
                                                                                                                  1991
                                                                                                                         1992
                                                                                                                                1993
                                                                                                                                       1994
                                                                                                                                              1995
                                                                                                                                                     1996
                                                                                                                                                            1997
                                                                                                                                                                   1998
                                                                                                                                                                          1999
                                                                                                                                                                                 2000
                                                                                                                                                                                        2001
                                                                                                                                                                                               2002
                                                                                                                                                                                                      2003
                                                                                                                                                                                                             2004
                                                                                                                                                                                                                    2005
                                                                                                                                                                                                                           2006
                                                                                                                                                                                                                                  2007
                                                                                                                                                                                                                                         2008
                                                                                                                                                                                                                                                2009
                                                                                                                                                                                                                                                       2010
                             Southeast Asia                                                               Sub-Saharan Africa                                                       Eastern Europe
                             FSU                                                                          Middle East/North Africa                                                 Other


Refugee Health Program, Minnesota Department of Health
Kittson                Roseau
                                                             Lake
                                                                                                                  2010 Primary Refugee Arrival
                                                             of the
                                                             Woods


                                                                                  Koochiching
                                                                                                                    To Minnesota (N=2,320)
Marshall

                                                 Beltrami                                                                         St. Louis

Polk                 Pennington                                                                                                                                                 Cook

                     Red Lake                Clear
                                             Water                                                                                                                 Lake
                                                                                    Itasca




          Norman               Mahnomen
                                                             Hubbard       Cass



       Clay                  Becker

                                                                                                         Aitkin


                                                            Wadena                    Crow Wing
                         Ottertail
                                                                                                                                   Carlton
                                                                                                                                                                                Number of Refugees Arrival By
           Wilkin
                                                                                                                                                                                Initial County Of Resettlement
                                                                                                                                   Pine
                                                             Todd
                                                                                                       Mille
                                                                                                       Lacs         Kanabec
                         Grant            Douglas
                                                                          Morrison                                                                                                     0
                                                                                           Benton
           Traverse      Stevens          Pope               Stearns                                               Isanti                                                              1- 20
          Big Stone
                                                                                              Sherburne

                             Swift
                                                                                                                                  Chisago                                              21 - 50
                                                        Kandiyohi
                                                                                                                    Anoka
                                                                                                                   71
                                                                       Meeker          Wright                                    Wash-
                                                                                                                                 ing-                                                  51 - 100
                                     Chippewa                                                            Hennepin
                                                                                                         Hennepin           Ram- ton
                                                                                                                            sey
                    Lac Qui Parle
                                                                                 McLeod         Carver
                                                                                                                                                                                       101 - 300
                                                  Renville
                    Yellow Medicine                                                                         Scott

                                                                           Sibley
                                                                                                                         Dakota
                                                                                                                                                                                       301 – 1,000
                Lincoln        Lyon          Redwood                                                              Rice
                                                                                Nicollet            Le
                                                                                                    Sueur
                                                                                                                                   Goodhue
                                                                                                                                                  Wabasha
                                                                                                                                                                                       1,001 – 2,000
                                                             Brown

                Pipestone        Murray                              Watonwan        Blue Earth        Waseca        Steele        Dodge      Olmsted        Winona
                                                  Cottonwood


                Rock             Nobles          Jackson               Martin              Faribault           Freeborn               Mower             Fillmore      Houston
            Primary Refugee Arrivals, Minnesota
                          2010
                                              FSU        Eritrea Congo (DR)
                        Laos/Hmong                         2%
                                               2%                   1% Haiti
                           2%
                     Ethiopia                                               1%
                      4%                                                           Other
                   Bhutan                                                            5%
                      8%

                     Iraq
                     10%
                                                                                     Burma
                                                                                       36%


                            Somalia
                              29%                                                         N=2,320

“Other” includes Afghanistan, Cambodia, Cameroon, China (incl. Tibet), Colombia, Cuba, Guinea, Kenya, Liberia,
Mali, Mexico, Nigeria, Rwanda, Saudi Arabia, Sierra Leone, Sudan and Togo
*“FSU” includes Armenia, Belarus, Kyrgyzstan, Moldova, Ukraine and Uzbekistan

Refugee Health Program, Minnesota Department of Health
             African Refugee Family
             Reunification Suspended
    The State Department announced that the U.S. family-
    reunification program for African refugees has been
    suspended after DNA testing of applicants revealed
    widespread fraud. The suspension affects family
    members seeking to join East Africans, and some
    Liberians, already in the United States.


    Minnesota only accepted through the family
    reunification program (P-3) until June 2008.


Source: Voice of America, August 20, 2008
“Free Cases” or “Families without U.S. Ties”

Def.-: Refugees who do not have family ties or
 anchors residing in the U.S. or the resettlement
 state

With the change in resettlement policy, Minnesota
 started accepting “Free Cases” in July 2008:
  – From July 2008 – Present: 849 (27%) of 3,166 arrivals
    came as “Free Cases”
     • 2008: 44 (4%)
     • 2009: 178 (14%)
     • 2010: 959 (41%)

  – Top Countries: Somalia, Burma and Iraq
      Primary Refugees without U.S. Ties (Free Cases)
                     Minnesota, 2010

                                               Eritrea   Ethiopia
                          Congo (DR)             3%        2% Other
                             3%
                                                               1%

                      Bhutan
                       10%                                            Somalia
                      Iraq                                              43%
                      12%




                             Burma                                    N=959
                              26%



     ‘Other’ includes Cuba and Sudan
Refugee Health Program, Minnesota Department of Health
“New” Refugee Populations

      2008 to Present
Burma (Myanmar)


              1948 - 1974




              1974 - 2010




                  2010 -
                                      Background

  • Over 140, 000 refugees along Thai-
    Burmese border since 1984
    (Temporary Protection)
        o Students with claims of political          Fiscal Year   US Arrivals
          persecution versus Ethnic Minorities
                                                     2006          1,612
                                                     2007          13,986
        – U.S.A: Expected to resettle                2008          18,139
           in the US during 10 yrs starting FY2006
                                                     2009          18,275
                                                     2010          16,693
        – Minnesota: Burmese started arriving in
            2003; the KaRen/Burmese starting 2006    2011 (Jul)    14,089
               To date: 3,372 arrivals




Source: Human rights watch and US State Department
Bhutan
                                      Background
   • Over 106, 000 Nepali speaking
     Bhutanese (Lothsampas) refugees
     expelled from Southern Bhutan in the
     early 1990s; currently refugees are living
     in 7 camps in Nepal

   • Cultural, linguistic expressions denied;
     Bhutan has denied their right to return to
     their country                                   Fiscal Year   US Arrivals
                                                     2008          5,320
   • U.S.A: At least 60,00 are expected to           2009          13,317
       resettle in the US - special humanitarian
       concern                                       2010          12,363
                                                     2011 (Jul)    10,816
   • Minnesota: Bhutanese refugees started
       arriving in May 2008
           To date: 456 arrivals

Source: Human Rights Watch and US State Department
                    IRAQ




1963-1991   1991-2004   2004-2008   2008
                                  Background



    • Iraqi refugees (2.2 Million)
          Syria (~500,000)                           Fiscal Year   US Arrivals
          Jordan (~1.4 million)                      2006          202
          Other (~360,000)
                                                     2007          1,608
    • U.S.A: 30,000 referred                         2008          13,822
                                                     2009          18,838
    • Minnesota: Iraqi refugees started
      arriving in April 2008                         2010          18,016
          To date: 445 arrivals                      2011 (Jul)    7,544




Source: Human Rights First and US State Department
      Refugee Admissions Ceilings for FY2011

                                       Unallocated        Africa
                                                0%          15%



               Near East/
              South Asia                                               East Asia
                     49%                                                    26%




                                                                   Europe/
                                                               Central Asia
                                         Latin America/                 3%
                                             Caribbean
                                                    7%
                                                                        N=80,000
     Africa                      East Asia                  Europe/Central Asia
     Latin America/Caribbean     Near East/South Asia       Unallocated
Source: US Department of State
             Types of Medical Exams

 Overseas       Visa Medical Examination
     U.S.   Public Health Service

 Domestic      Refugee Health Assessment
     Minnesota   Department of Health

   Adjustment of Status Medical Examination
     From temporary to permanent resident
     Needed to obtain a green card
     US Citizenship and Immigration Service
      Adjustment of Status Exam
          (Green Card Exam)

 Immigrants:  exam done by Civil
  Surgeon required
 Refugees: immunizations only (unless
  arrived with Class A condition); local
  Public Health can act as Civil Surgeon
 Forms are found at www.uscis.gov
 Call MDH for more guidance
 Health Status of New Refugees, Minnesota, 2010‡
Health status upon arrival                          No of refugees             No(%) with infection
                                                    screened                   among screened
TB infection*                                       2,086 (95%)                  570 (27%)
Hepatitis B infection**                              2,160 (98%)                     112 (5%)

Parasitic Infection***                               2,106 (96%)                     471 (22%)
Sexually Transmitted                                 1,765 (80%)                      28 (2%)
Infections (STIs)****
Malaria Infection                                      234 (11%)                        0 (0%)

Lead*****                                              833 (87%)                      16 (2%)

Hemoglobin                                           2,151 (98%)                     437 (20%)
‡ 2010 Preliminary results for arrivals between 01/01/2010 and 12/31/2010
Total screened: N=2,193 (98% of 2,242 eligible refugees)
* Persons with LTBI (>= 10mm induration or IGRA+, normal CXR) or suspect/active TB disease
** Positive for Hepatitis B surface antigen (HBsAG)
*** Positive for at least one intestinal parasite infection
**** Positive for at least one STI
*****Children <17 years old (N=954 RHAs)                    Refugee Health Program, Minnesota Department of Health
           Health Status of New Refugees, Minnesota
                Immunization Status, 2002-2010


                          100
                           90
                           80                                                                   Overseas
                           70                                                                   Domestic
                Percent




                           60
                           50
                           40
                           30
                           20
                           10
                            0
                                2002

                                       2003

                                              2004

                                                     2005

                                                             2006

                                                                    2007

                                                                           2008

                                                                                  2009

                                                                                         2010
                                                            Year


Refugee Health Program, Minnesota Department of Health
       Health Status of New Refugees
         Upon Arrival to MN, 2010*
 Screening     rate                   98% (2,193/2,242)
 Immunizations                        91% (2,003/2,193)
 started or continued age-appropriate vaccinations after
 health screening

 Tuberculosis                         27% (570/2,086)
 Latent TB infection or suspect/active TB case

         B
 Hepatitis                               5% (112/2,160)
 HBsAg positive
                                  *Preliminary Results
       Health Status of New Refugees Upon
            Arrival to MN, 2010*, cont’d
   Parasitic infection             22% (471/2,106)
    Tested positive for at least one intestinal parasite
    (common: Strongyloides, Giardia, Schistosoma, Trichuris, E.
    histolytica)

   Lead level (<17 y.o.)             2% (16/833)

   Hemoglobin                      20% (437/2,151)
    less than 12gm/dL

   Referrals
    Primary Care (51%), Pediatrics (43% of <18 yrs),
    Dental (37%), Public Health Nurse (13%), Vision
    (8%)
                                   *Preliminary results
              Tuberculosis Infection* Among Refugees
               By Region Of Origin, Minnesota, 2010
                                                           N=2,086 screened


     Overall TB Infection
                                          27%                       570/2,086


      Sub-Saharan Africa                                          40%           320/803


              SE/East Asia
                                         20%        201/1,004


Latin Ame rica/Caribbean                         4/25
                                    16%

North Africa /Middle East
                                      14%     32/221


                    Europe                                            39%       13/33


                            0%                 10%                 20%           30%           40%               50%
*Diagnosis of Latent TB infection (N=568) or Suspect/Active TB disease (N=2)              *Preliminary results
Refugee Health Program, Minnesota Department of Health
                      Hepatitis B infection Among Refugees
                      by Region of Origin, Minnesota, 2010

                                                    N=2,160 screened


        Overall Hepatitis B
                                      5%                 112/2,160
          Infection Rate


       Sub-Saharan Africa          4%             37/834


               SE/East Asia                 7%               74/1,039


  Latin America/Caribbean        4%        1/28


  North Africa/Middle East       0% 0/227


                     Europe      0% 0/32

                            0%               2%               4%        6%           8%             10%


Refugee Health Program, Minnesota Department of Health                       *Preliminary results
               Intestinal Parasitic Infection* Among Refugees
                    by Region of Origin, Minnesota, 2010

                                                             N=2,106 screened


         Overall Parasitic
                                           22%             471/2,106
          Infection Rate

     Sub-Saharan Africa                   18%            149/812


              SE/East Asia                         26%             271/1,025

           Latin
                                                                               47%   15/32
     America/Caribbean

North Africa/Middle East                16%        33/204


                      Europe           9%     3/33


                                0%        5%       10% 15% 20% 25% 30% 35% 40% 45% 50%
  *At least one type of pathogenic intestinal parasite
                                                                                       *Preliminary results
* At least one Program, Minnesota Department of nonpathogenic)
Refugee Health stool parasite found (including Health
       Health Concerns: Immediate

         Infectious Disease – TB, parasites, hep B
         Nutritional Deficits – poverty, disease
         Immunizations – required for school
         Mental Health – loss, fear, adjustment
         Access to care – how, why, when, where
         Interpreters – language/cultural
         Costs –insured, under-insured, no insurance

Source: MDH Refugee Health Program
Health Concerns: Long Term
   Chronic Disease – diabetes, hypertension,
    obesity, work hazards, TB in frail and elderly
   Mental Health – family role and self
    definition adjustment, isolation, lack of
    support
   Access to care – misunderstanding and
    mistrust of system
   Interpreters – language/cultural
   Costs –insured, under-insured, no insurance
 Limitations of Domestic
        Screening
• Elective on parts of both state and
  refugee
• Wide variation in quality and
  comprehensiveness across states
• Funding sources may be limited
• Clinics’ and clinicians’ experience/
  expertise in working with newly arrived
  refugees &/or tropical medicine varies
  state to state
 Areas of Need in Resettlement
• Applying for Social Security number, public
  assistance, photo ID
• Education; English language classes
• Employment services
• Housing, food, furniture, clothing
  (www.211unitedway.org)
• Health care services: physical, mental, spiritual
• Ethnic-specific support services (MAAs or other
  community agencies); www.iimn.org (ethnic
  resource directory)
• Legal Assistance
     Strategies to Enhance Culturally
             Competent Care
• Cultural Assessment (incorporate tool, results in
  medical record)
• Other considerations:
   – interpreter services (Interpreting Stakeholder
     Group)
   – bilingual/bicultural staff
   – appropriate education resources
     (www.health-exchange.net)
• Appoint staff as cultural resources
  (www.culturecareconnection.org)
• PHN and community-based follow-up
      Interpreting Stakeholder Group
ISG works to improve the quality and delivery of spoken language and
interpreter services in Minnesota, and to promote the professionalization of
the interpreting industry as a whole.
                       http://www.isgmidwest.org
     Strategies to Enhance Culturally
             Competent Care
• Cultural Assessment (incorporate tool,
  results in medical record)
• Other considerations:
  – interpreter services (Interpreting Stakeholder
    Group)
  – bilingual/bicultural staff
  – appropriate education resources (www.health-
    exchange.net)
• Appoint staff as cultural resources
• PHN and community-based follow-up
Stratis Health – Culture Care Connection
www.culturecareconnection.org


                                An online learning and
                                resource center aimed
                                at supporting health
                                care providers, staff,
                                and administrators in
                                their ongoing efforts to
                                provide culturally
                                competent care.
Diversity In Minnesota – Information Sheets
http://www.culturecareconnection.org/matters/diversity/somali.html


  Somalis in Minnesota                 Hmong in Minnesota
 Know Your Community: County Profiles
 County profiles detail pertinent demographic, socioeconomic, and health
status data, with information about vulnerable populations. County Profiles
  offer providers and administrators an in-depth view of the communities
 they serve. This information can be used in strategic planning to ensure
  the provision of culturally and linguistically appropriate health services.
  http://www.culturecareconnection.org/navigating/mncountyprofiles.html
Minnesota Health Literacy Partnership
MHLP, a program of the Minnesota Health Literacy Council, was formed to help
coordinate health literacy efforts across the state. The partnership is comprised of
health care organizations, consumers, and literacy groups, as well as the state’s health
and social service agencies, and has worked with a number of local organizations to
develop health literacy training, patient education materials, and toolkits.
                           www.healthliteracymn.org
Community Health Education

•   Radio shows
•   ESL
•   Ethnic press
•   ECHO TV
•   Global Brown bags (for staff)
•   Metro Refugee Health Task Force
•   Community health forums
•   Etc!
                 LEARN

L   Listen with empathy to the client’s perception of the
    problem

E   Explain your perceptions of the problem

A   Acknowledge and discuss the differences and
    similarities

R   Recommend treatment

N   Negotiate agreement
                         Berlin, E. A. and Fowkes, W.C., 1983
     Immigrant Health Task Force
•   Improve access to care
•   Data collection and analysis
•   Equitable payment for immigrant health services
•   Develop clinical guidelines
•   Diversify workforce
•   Use trained interpreters
•   Use CHWs
•   Train providers and educate new immigrants.

        MN Immigrant Health Task Force, MDH, 2004
   Contact Information - 2011
• MDH Refugee Health Staff:
   651-201-5414
• MDH Refugee Health Program:
  www.health.state.mn.us/refugee
• Metro Refugee Health Task Force
  Sara Chute: sara.chute@state.mn.us

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:1
posted:7/25/2012
language:
pages:51