Refugees to U.S. get head-to-toes health check-ups in California clinics

Refugees to U.S. get head-to-toes health check-ups in California clinics

But immigrants — including illegal immigrants — are on their own for entry health exams and health care

For years, both California and the nation have been helping refugees settle in America. This includes a free head-to-toe medical exam performed in county medical clinics around the state, as well as free medical care for a number of months.

This same help is not provided to either legal or illegal immigrants.

The refugee program is not limited to medical care; frequently refugees are met at the boat or plane by charitable agencies (such as Catholic charities) who help the refugees find housing, channel them to language classes, help get them jobs and provide free medical care for a period of time.

The Refugee Health Program began in the late 1970s primarily to assist the Vietnamese arriving by boats from Southeast Asia; it was opened up to all federally recognized refugees in July 1981. A refugee has a distinct legal status in the U.S. and that designation pertains to those seeking or taking refuge, especially from war or persecution, by going to a foreign country. Funded jointly by the Department of Health and Human Services/Office of Refugee Resettlement, the State Office of Family Planning and the states'' Departments of Social Services, the program saw more than 50,000 refugees enter the U.S. the first 10 years.

The program is still thriving, although who enters the country changes frequently as groups of refugees come to the U.S. from different parts of the world each year.

For example, in California in the 1990s there were many refugees from former Yugoslavia (Bosnia and Croatia), Russia, Afghanistan and Iran. In early 2000, there was an upswing of refugees from Africa — Somalia, Ethiopia, Eritrea, Sudan and other countries. In recent years, there have been refugee groups from Burma and asylee groups from China. An asylee, similar to a refugee, is an alien in the United States or at a port of entry who is found to be unable or unwilling to return to his or her country of nationality, or to seek the protection of that country because of persecution or a well-founded fear of persecution.

Refugee clinics can be found in most counties, including Alameda, Contra Costa, Sacramento, San Francisco, Santa Clara, Monterey and Stanislaus counties.

In Santa Clara County, the refugees are medically screened at the Tuberculosis and Refugee Health Assessment Clinic at Santa Clara Valley Health and Hospital System''s Ambulatory Care Unit, according to Andrea Polesky, M.D., who is in charge of the program.

The clinic is notified by government officials of the entering refugees, and usually within 30 days new arrivals come to the clinic for an exam. Before leaving for America, the U.S. requires a medical exam be given in the exiting country. "All adult refugees and legal immigrants are screened for syphilis, HIV and active tuberculosis prior to immigration. Very few come in with communicable diseases," Polesky said.

"During the past two years we saw 1,039 of 1,230 arrivals from 33 different countries of birth. Some of the 191 we did not see were because patients move when they get to the U.S. or won’t come in, or get a physician through family contacts," she said.

Most of the patients examined are healthy, Polesky said, but the most common diagnoses in Santa Clara County have been:

• Positive tuberculin skin test (39 percent)
• Eosinophilia (12 percent)
• Dental caries (10 percent)
• Obesity (8 percent)
• Hypertension (6 percent)
• Smoking (5 percent)
• Chronic hepatitis B infection (4 percent)
• Parasitic diseases about (3 percent)

Approximately 0.5 percent of patients had active tuberculosis and 0.1 percent were infectious, she said.

"In our clinic, refugees are screened for the above plus parasites and viral hepatitis. They have a full history and physical with additional screening for post-traumatic stress disorder. Adult vaccines are updated in the clinic and pediatric vaccines in the neighboring immunization clinic," Polesky said.

Parasitic diseases and chronic hepatitis B were more common in Asian and African refugees; hypertension and obesity were more common in refugees from the Middle East and Eastern European countries.

"Translation services are very important and most of our employees are certified to interpret in one to three different languages," she added.

The past two years, the refugees entering Santa Clara County have come from Iran (419); Vietnam (310), many from refugee camps in the Philippines; Somalia (117); Burma (85); Philippines (39); Ethiopia (37); Iraq (13), during the past two weeks several more families have come; other African countries (122); other Asian countries (29), plus a few others (Russia, Georgia, Cuba).

San Francisco County gets many refugees from Russia and Slovakia.
From Oct. 1, 2006 through Sept. 30, 2007, some 7,067 refugees and asylees entered California. Last year Santa Clara County had 1,230 refugees and asylees.

"The public health portion of the refugee health exam is designed to screen new refugees for communicable diseases. However, promoting good overall health, vaccination and treatment and prevention of chronic diseases is also part of the mission of the California Department of Public Health Refugee Health section. The exam is part of a larger resettlement process," Polesky said.

"The refugees are, in general, not a health danger," Polesky said. This medical screening is all part of a welcome to America. And the refugees get good medical care once they are here."

In Santa Clara County, tuberculosis among immigrants has been a problem, Polesky said.

Entering immigrants — even if they are legal — are not provided the same screening, although legal immigrants from higher risk countries are screened for TB before entry. Nor are the immigrants met at the boat or plane by charitable agencies. They get no medical insurance or access to medical care. Legal immigrants are screened for syphilis and HIV before coming to the U.S., but not the illegal immigrants.

The public health portion of the refugee health exam is designed to screen new refugees for communicable diseases. However, promoting good overall health, vaccination and treatment and prevention of chronic diseases is also part of the mission of the California Department of Public Health Refugee Health section. The exam is part of a larger resettlement process, Polesky said.

—By Diana Diamond

Diana Diamond is the editor of the Healthcare Journal. You can reach her at diana@healthjournalnorcal.com.