Mushrooms, ESL, and Rock n Roll with Refugees in Minnesota

Transcription

1 Mushrooms, ESL, and Rock n Roll with Refugees in Minnesota Refugee Health Program- Minnesota Department of Health Sara Chute, MPP Refugee Health Consultant, MN Department of Health 2007 Refugee & Immigrant Conference Chicago, IL -- October 23, 2007

2 Overview Refugees in MN & the world Model for Successful Health Education My work a work in progress Challenges/Rewards Next Steps

3 Objectives/Outcomes Hopefully you will be able to: Think about refugee groups in a new way View challenges as opportunities Become aware of blind spots Identify avenues for outreach and education Tap into existing resources Create partnerships

4 Ann O Fallon Susan Dicker Sara Chute Blain Mamo

5 Worldwide Statistics Total # of refugees and asylum seekers 13.9 million Total # of internally displaced persons* 24.5 million New refugee and asylum seekers, million Refugees warehoused 10 years or more 8.8 million Total # resettled 69.4 thousand World Refugee Survey 2007, US Committee for Refugees *The Internal Displacement Monitoring Centre, Dec 2006 (Global IDP Project)

6 Principal Sources of Refugees Afghanistan 3,260, Palestine 3,036, Iraq 1,687, Burma (Myanmar) 693, Sudan 648, Colombia 453, Congo-Kinshasa 413, Somalia 410, Burundi 438, Vietnam 308,000 World Refugee Survey 2007, US Committee for Refugees

7 Main Countries of Refugee Resettlement United States 41, Australia 12, Canada 10, Sweden 1, Norway Denmark New Zealand Finland UK Netherlands 312 World Refugee Survey 2007, US Committee for Refugees

8 Refugee Admissions Ceilings for FY2007 Unallocated 29% Africa 31% Near East/ South Asia 8% Latin America/ Caribbean 7% Europe & Central Asia 9% East Asia 16% N=70, 000 Africa East Asia Europe & Central Asia Latin America/Caribbean Near East/South Asia Unallocated Source: US Department of State

9 Who is coming to MN?

10 Refugee Arrivals to MN by Region of World Number of arrivals Southeast Asia Sub-Saharan Africa Eastern Europe FSU Other Refugee Health Program, Minnesota Department of Health

11 Primary Refugee Arrivals Minnesota, 2007* Liberia 11% Ethiopia 13% FSU 6% Other 5% Somalia Burma Ethiopia Liberia FSU Other Burma 23% Somalia 42% N= 2,391 *01/01/07-09/30/07 Other includes Afghanistan, Cameroon, Chad, China (also Tibet), DR Congo, Cuba, Eritrea, France, Indonesia, Kenya, Laos (Hmong), Nigeria, Sierra Leone, Sudan, Togo, Uganda and Vietnam.

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13 Age Distribution of Refugee Arrivals, 2007* Percentage 60% 55% 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% < >65 Somalia Burma Ethiopia Liberia FSU Refugee Health Program, Minnesota Department of Health Age Categories *01/01/07-09/30/07

14 Kittson Marshall Roseau Lake of the Woods Koochiching 2006 Primary Refugee Arrival To Minnesota (N=5,354) Beltrami St. Louis Polk Pennington Cook Red Lake Clear Water Itasca Lake Norman Mahnomen Hubbard Cass Clay Becker Aitkin Wilkin Ottertail Grant Douglas Wadena Todd Morrison Crow Wing Mille Lacs Kanabec Carlton Pine Number of Refugees Arrival By Initial County Of Resettlement 0 Traverse Big Stone Chippewa Lac Qui Parle Yellow Medicine Lincoln Pipestone Stevens Swift Lyon Murray Pope Renville Redwood Cottonwood Stearns Kandiyohi Brown Meeker Sibley Watonwan McLeod Nicollet Benton Wright Blue Earth Sherburne Carver Le Sueur Waseca Rice Dakota Goodhue Olmsted Winona Rock Nobles Jackson Martin Faribault Freeborn Mower Fillmore Houston Scott Isanti Anoka 71 Hennepin Ram sey Steele Chisago Washington Dodge Wabasha

15 Refugee Health Screening in MN Exam w/in the first 90 days of arrival Public health clinics and private providers Goal:...to control communicable disease among, and resulting from, the arrival of new refugees through: health assessment treatment referral

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17 Health Status of New Refugees Upon Arrival to MN, 2007* Screening Rate 93% (1,201) of all Eligible refugees were screened Immunizations (Overseas / Domestic Screening) 62% with overseas vaccines / 88% started/continued vaccinations Tuberculosis Infection ( Diagnosis of LTBI or Suspect/Active TB disease) All refugees 46% Sub-Saharan Africans 51% S/SE Asians 25% East Europeans 30% Hepatitis B Infection (HBsAG positive) All refugees 8% Sub-Saharan Africans 8% S/SE Asians 7% East Europeans 1% Refugee Health Program, Minnesota Department of Health *01/01/07-06/30/07

18 Health Status of New Refugees Upon Arrival to MN, 2007* Parasitic Infection (at least one type of pathogenic parasite)** All refugees 15% (Giardia, Trichuris, Schistosoma) Sub-Saharan Africans 15% (Giardia, Trichuris, Schistosoma, Hymenolepis) S/SE Asians 17% (Giardia) East Europeans 3% Lead Level (>=10 ug/dl, <6 years of age) All refugees 0% Hemoglobin (<12 gm/dl) All refugees 13% Sub-Saharan Africans 13% S/SE Asians 16% East Europeans 15% Most Common Referrals Dental (56%), Primary Care, Family Practice or General Medicine (71%) Refugee Health Program, Minnesota Department of Health *01/01/07-06/30/07

19 Health Status of New Refugees, Minnesota, 2007* Health status upon arrival No (%) of refugees screened No (%) with infection among screened TB infection* 1,157 (96%) 527 (46%) Hep B infection** 1,176 (98%) 90 (8%) Parasitic Infection*** 1,114 (93%) 169 (15%) Sexually Transmitted 980 (82%) 19 (2%) Infections(STIs)**** Malaria Infection 16 (1%) 1 (6%) Lead***** 71 (90%) 0 (0%) Total screened: N=1,201 (93% of the 1,298 eligible refugees) * Persons with Latent TB infection or suspect/active TB disease diagnosis ** Positive for Hepatitis B surface antigen (HBsAG) *** Positive for at least one intestinal parasite infection **** Positive for at least one STI *01/01/07-06/30/07 *****Children <6 year old (N=79) Refugee Health Program, Minnesota Department of Health

20 Creating a model for successful health education

21 Known: Basis for Model Many health, economic and social disparities exist for refugees groups Model seeks to address: How do refugees learn about health issues? How to break thru barriers like language/culture? What are creative ways to deliver health messages to refugee groups?

22 Model Step 1: Program Assessment Step 2: Test your Cultural Competence Step 3: Get to know your refugee groups Step 4: Local Experts Step 5: Community Partners Step 6: Strategic Plan

23 Step 1: Program Assessment Do you have a person who serves as a link between your agency and refugees in your area? Funding for my position: how it came about and why it matters

24 Step 2: Test your Cultural Competence If this work were easy, it would already be done -Sweet Honey and the Rock [Bernise Johnson Reagan] Gearing up: Are you ready for this challenge? Where are you coming from?

25 Stand up if Values Exercise

26 Cultural Competence Ongoing process Requires: Knowledge Base Awareness /Attitudes Skills Desire Meeting each other halfway It s always personal

27 The Role Culture Plays A person s culture influences his or her beliefs in direct and indirect ways Each culture holds certain beliefs about how illness is defined about how certain illnesses are caused about the substances or behaviors that will help or cure certain problems Because of differences between cultures, refugee communities may have beliefs different from one s own

28 Step 3: Get to know your refugee communities

29 QUIZ

30 How do you say Hello in Somali? A. Nabad B. Iskawaaran C. Nabadeey D. Wanaagsan Extra Credit: how do you wish a Somali person Happy Ramadan?

31 What US states have resettled the most refugees in FY 2007? How many has the top state resettled [as of August 30, 2007)?

32 What famous refugee was Secretary of State under the Clinton administration? What country was he/she from?

33 As a woman, what would your married name be if you were: A. Hmong? B. Somali? Extra credit: what would your child s name be?

34 What are major health concerns for refugees? A. Diabetes B. Cancer C. Heart Disease D. Obesity E. Depression F. HIV G. All of the above

35 What are the largest refugee groups coming to the US (FY 2007)? i.e. Which countries are they coming from?

36 Which of the following groups are NOT predominantly Christian? A. Karen [from Burma] B. Russian C. Hmong D. Somali E. Ethiopian

37 About how many Karen refugees are living on the Thai - Burmese border? A. 75,000 B. 140,000 C. 2 million

38 What are some ways of reaching the refugee groups in your community? How do refugees learn about chlamydia, hepatitis, tuberculosis, diabetes, etc.? Where do your refugee groups go to learn, read the paper, drink coffee, listen to the radio, etc.?

39 Opportunities for outreach Soccer games - sports Events (Holidays, health & resource fairs) ESL centers Churches, mosques, synagogues Community radio/tv/press Healthcare institutions (clinics, hospitals) Schools

40 Step 4: Get to know your local experts Who can help you deliver your message/s? Mainstream experts Community experts Community leaders Examples: MDH folks, Poison Control folks, HealthEast docs, LPH nurses, Hellen, Elizabeth, Dr. Osman, Ama, Mao, EhTaw

41 Step 5: Who are your community partners? Who can help make your initiatives a success? Look for: Established agencies Places where health ed fits with mission Paid employees Examples: Barb, Diane, Amano, Editors, Radio Hosts, Wilfred, Tzianeng, Mona

42 Step 6: Develop strategic plan (bring all these steps together) Set reasonable goals Defining your limits - parameters Be flexible with your expectations Track your successes and be proud of them!

43 Ongoing Activities I ve created a monster! -Frankenstein

44 TB ESL Classes

45 HIV Nutrition Mental Health Health Access

46 Health articles in ethnic press TB Hepatitis B IZ Cancer HIV/AIDS Preventive Care

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48 Radio Shows Mental Health Cancer Poisonous Mushrooms

49 Metro Refugee Health Task Force CHWs Asylees Health materials Karen refugees Cultural Competence Refugee Health Screening African Born and HIV-AIDS And many more

50 Committee Member

51 Community Events Hmong Resource Fair

52 African World AIDS Day

53 Collaboration Relationships

54 Noteworthy events Mass vaccination of +600 Somali refugee families Poisonous Mushrooms Forum [Hmong] Forum for KaRen refugees from Burma Somali Health DVDs Pan Flu Workshops for LEP populations World Refugee Day

55 Poisonous Mushrooms Forum

56 Health forum for Karen refugees

57 Somali Health DVDs

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59 Pan Flu Workshops Mankato Minneapolis Moorhead St Paul Rochester St Cloud

60 World Refugee Day 2007

61 Upcoming Projects

62 Hep B ECHO TV and DVDs TB

63 Health Classes for Somalis

64 Challenges

65 Challenges Language [being an outsider] Culture How to make health a priority Western medical model Concept of Time Partners job/s volunteer vs. paid time Being a resource, not a burden Limiting our role Many refugee communities to cover Not enough hours in the day! Refugee Health Program, Minnesota Department of Health

66 The Outsider

67 Language

68 Culture Western Medical Model

69 How to make your issue a priority?

70 Concept of Time

71 Challenges continued Partners job/s volunteer vs. paid time Being a resource, not a burden Limiting our role Many refugee communities to cover Not enough hours in the day!

72 Things that can reinforce prejudice Examples 9/11 Gangs and violent crime Tuberculosis in Hmong community Vietnam Veteran and Hmong Hunter Stereotypes about: Literacy levels Diseases, health concerns Religion [imams, shamans, etc.]

73 My and phone messages are in other languages half the time! Rewards The government is not so bad Builds relationships between mainstream and refugee communities Allows experts to see needs first-hand Allows community to access experts

74 Americans are not so bad

75 Connects community to mainstream

76 Allows experts to see needs first-hand

77 Next steps: What can your agency do? Get out of the office!! Have coffee with your community partners and local experts Get to know your refugee groups Talk with your community partners to develop programs to respond to perceived needs What color is your Sara Chute?

78 Questions? Minnesota Department of Health Refugee Health Program (651)