Refugees and New Americans
Essentials of Cultural Competence in Pharmacy
Practice: Chapter 9 Notes
Chapter Authors: Dr. Cynthia Naughton and
Dr. Norma Kiser-Larson
1. Articulate relevant terminology related to refugees and new
2. Understand the history of immigration legislation in the
3. Describe the overseas visa process.
4. Articulate common medical problems in refugees and new
5. Describe common misconceptions of refugees and new
Some Key Terms
Foreign born: a person born in one country who moves to
Resettlement: immediate need of protection for refugees
Immigrant: someone who comes to live in another country
Legal immigrant: a person who follows the appropriate
immigration procedures and plans to become a long-term
resident or permanent citizen
Illegal immigrant: Someone who enters the country under
false pretenses or breaks other laws to remain in a country
Overseas Medical Examination
Purpose: to identify medical conditions that may create social or economic burdens for the
A person designated with a Class A condition cannot enter the U.S. unless the disease is
treated, a waiver is issued by the U.S. Immigration and Naturalization Service (INS), or both.
Class A Conditions Class B Conditions
Untreated chancroid, gonorrhea, granuloma Tuberculosis, inactive or noninfectious
inguinale, lymphogranuloma venereum, or
Tuberculosis, active and infectious Noninfectious Hansen’s disease
HIV infection Other conditions (in past medical history or
current physical examination) that will
require follow-up care for the well-being of
Hansen’s disease (leprosy)
Any physical or mental disorder associated
with harmful behavior, or history of such
behavior that is likely to renew.
Drug abuse or addiction
Refugee Health Assessment
This may be a refugee’s first interaction with the American health care
system. The refugee is screened for tuberculosis and other
communicable diseases, and a health assessment examination is
Common health problems in refugees and immigrants include:
• Infectious diseases
• Intestinal parasites
• Vitamin D deficiency
• Dental caries
• Incomplete or undocumented immunizations
• STDs, including HIV
• Trauma/Posttraumatic Stress Disorder
• Elevated levels of lead (in children)
Immigrants consume a disproportionate Immigrants consume less health care
amount of health care resources. resources than native-born Americans.
Limited health care access for Areas with relatively high uninsured
immigrants has no effect on the U.S. rates are likely to have greater instances
population. of vaccine-preventable diseases,
communicable diseases and disability.
Illegal immigrants get a “free ride” in the Undocumented workers are paying
U.S. health care system. billions of dollars annually in Social
Security and Medicare taxes they will
never be able to draw on.
Immigrants are an excessive burden to Except for limited emergency services,
our nation’s public health insurance immigrants do not qualify for Medicaid
programs. or the State Children’s Health Insurance
Immigrants come to the U.S. for the Most immigrants come to the U.S. for
primary purpose of receiving health care work opportunities.
1. How will you keep yourself informed of the changing needs
of new Americans?
2. Before reading this chapter, what stereotypes of new
Americans did you hold? Now?
3. What are your own beliefs about immigration policies? How
will this impact your practice?
4. How can you remain open to the vastly different
experiences of refugees and new Americans?
(descriptions listed in Appendix C)
Central American Refugee Center (www.carecen-la.org)
U.S. Committee for Refugees (USCR) www.uscr.org
Global Health Council (www.ncih.org)
World Health Organization (www.who.org)