REFUGEES- THE REAL STORY

Transcription

1 REFUGEES- THE REAL STORY WPHA-WALHDAB Annual Conference May 26, 2016 Radisson Paper Valley Hotel, Appleton WI Kathy Schultz, Health Navigator, World Relief Fox Valley Sonja Jensen, RN BSN, Appleton Public Health Department Jayne Tebon, RN BSN, Winnebago County Public Health Department

2 Who is a Refugee? United Nations High Commission on Refugees (UNHCR) defines a refugee as any person forced to flee their country because of persecution, war or violence. A Refugee has a well-founded fear of persecution because of his: Race Religion Nationality Political Opinion Social Affiliation

3 UNHCR Video: A World in Crisis

4 REFUGEE FACTS: UNHCR determines Refugee status Migrant = Refugee Must cross an international border Fleeing to preserve life no options

5 The Numbers: ~25 million Refugees worldwide 10.5 million in camps <1% resettled annually 85,000 resettled in U.S. in 2016, President requesting 100,000 for 2017

6 Where are the Refugees in Wisconsin coming from? Burma (Myanmar) Somalia Iraq and Syria Democratic Republic of the Congo (DRC) Cuba Pakistan and Afghanistan

7 Pathway to Resettlement UNHCR US State Dept/Homeland Security Voluntary Resettlement Agency (VOLAG) Determines Refugee status, provides aid overseas Security Checks and Clearances Responsible for assisting Refugee and establishing self-sufficiency

8 Multi-level Security Process Referral to US State Dept DHS approval Medical screening Resettlement Support Center DHS in-person interview Match with VOLAG, cultural orientation 1 st Security level Photographs, fingerprints Final interagency security check

9 What assistance does a Refugee receive from the government when he resettles in the US? One-time gift of $925 8 months of Medicaid coverage Foodshare and Cash Assistance (same rules as citizens)

10 VOLAG Responsibilities World Relief Fox Valley, Catholic Charities, Lutheran Social Services, International Institute of WI, Pan-African Community Association Airport Reception Housing/utilities Basic household necessities Food Clothing Home orientation Community/cultural orientations Social Security Registration Public Assistance and Medicaid Registration School/ESL registration Employment assistance Initial Refugee Health Screening Establishing with Primary Care Health orientation Initiate Travel loan repayment

11 IMPORTANCE OF HEALTHCARE A key factor for a successful resettlement is good healthcare Proper Diagnosis Correct treatment feels better Improved employment/ education opportunities

12 Language Barriers Common to all Refugees Culture Traumatic History Medical Philosophy

13 Translation Body Language LANGUAGE Verify patient understands translator - Dialects important Use simple terminology Eye contact, bowing head - respect Nodding, shaking head - every culture different. Talk to translator if you sense confusion, unease Ask client to repeat important information back to you

14 Gender/Family Husbands present with wives Uncomfortable with stranger touch Medical decisions made by entire family CULTURE Relationship with Physician Patient won't ask questions Patient assumes provider knows all Patient will not volunteer unsolicited information Stoicism Patients consider problems normal Patients minimize problems in comparison with family/friends

15 Physical injurysometimes improperly/never treated Internalization of physical and emotional trauma TRAUMATIC HISTORY Sexual assault (women, men, children)-not immediately obvious or declared Everyone they know has similar experience - reluctance to discuss/re-live Witness to violence/death of family and friends

16 DIFFERENCES IN MEDICAL PHILOSOPHY Preventive Health Immunizations Preventive Health Screening Hygiene, Nutrition and Exercise education Medications Western Medicine concepts OTC vs Prescription Medications Pharmacy Education Mental Health Cultural Taboos History of Trauma Stigma

17 What is the role of Public Health? To ensure timely health screening services are provided to refugees. Timely health screenings will identify health conditions and behaviors that need to be addressed, and help prevent the spread of communicable disease.

18 What information does Public Health receive prior to the arrival of the refugee? Name, DOB, Date of arrival Biographical data form Language Known medical conditions TB screening results Current medications Treatment for parasites

19 How do we prepare before the first meeting with the refugee? Review overseas medical records Set up initial PCP appointment Coordinate with VOLAG

20 What happens at the Public Health Initial Refugee Appointment? Gathering information: Interpreter Medical history Medications New complaints Oral screening Teaching the client: PCP education Laboratory testing education Immunization education

21 Communicating with the PCP Before the 1 st appointment: Screenings recommended Urgent issues After the 1 st appointment: Medications Lab results Referrals to specialists

22 What happens at the 2 nd Public Health appointment for a refugee? Lab results Medication education Immunization teaching Referrals to specialists, other PH programs Follow up for PH concerns like latent TB

23 REMEMBER These clients are your Patient first, and a Refugee second. Be patient with your Patients. Imagine yourself in their situation.

24 UNHCR Video: Refugee Stories: Scisa Rumenge, DRC

25 On-line Resources Cultural Orientation Resource Exchange coresourceexchange.org Center for Applied Linguistics culturalorientation.net UNHCR unhcr.org IOM iom.net US Department of State, Bureau of Population, Refugees and Migration (PRM) state.gov/j/prm WI Department of Children and Families dcf.wisconsin.gov/refugee