Health Care and Immigrant Populations in the U.S.

James A. Litch MD, DTMH

Centers for Disease Control and Prevention;

WA Department of Health, Epidemiology Office;

University of Washington School of Medicine

Presentation Overview

• Health issues facing new immigrant populations in the U.S.

• One Example: The Tibetan Refugee Resettlement Project

• Lessons learned: steps for providers interested in delivering health care to immigrant populations

High Degree of Vulnerability

• Disease/Illness • Mental illness

• Isolation• Crime• Violence (domestic and community)• Underemployment• Poverty

Health Issues: Immediate

• Tuberculosis

• Chronic viral hepatitis infection

• Intestinal parasites

• Nutritional deficiencies

• Lack of immunization

• Depression and other psychiatric illness

Health Issues: Urgent

• Establish primary care and emergency services

• Identify chronic medical conditions and treatment alternatives

• Language barriers may be persistent

Health Issues: Ongoing

New behavioral limits may require rapid change:– Old practices may be

dangerous or illegal– The new environment

has different risk factors

– Awareness of specific cultural practices yields returns

Delivering Health Care

• Health conditions may not be the dominant problem patients face

• Health care services alone are unlikely to be sufficient

• This leads to many challenges that require creative linking of resources

Tibetan Refugee Resettlement Project

• Between 1992 and 1993, the first group of Tibetan refugees entered the US

• 1000 visas were issued for immigration, but a unique stipulation was made that prevented the use of federal resources for support

• This mobilized a nationwide effort in 21 cities

Tibetan Refugee Resettlement Project

• Refugees from India, Tibet and Nepal• Came as individuals, with family

members to follow in 3-6 years• Seattle received 36 individuals,

followed by 150 family members• Tibetan community advocates

identified and empowered early after arrival

Tibetan Refugee Resettlement Project• Immigrants were not eligible for public

assistance for 1 year• Arrived with a prearranged job offer and

household sponsor waiting• Medical screening and care at a Seattle

family medicine residency clinic• Structured language, safety/health

education, legal support, and acculturation classes

• Weekly peer support group

• Key outcome indicator: First group to transition into leadership roles

• The program was re-incorporated as a new non-profit organization in 1996 to settle the next larger wave of immigrants

TibetanCommunity Program

Tibetan Resettlement Project

Lessons Learned for Health Care Providers

• Specialty or focused clinics for a particular immigrant group are lacking

• Travel effort to receive care needs to be appreciated

• Language interpreters are NOT optional• Screening is straightforward, but just a

starting point

Lessons Learned for Health Care Providers: Cont’d

Recognize the need for critical referrals:– English as a second language (ESL)– Counseling/Psychiatric care– Housing – Employment– Establishing residence– Peer support

Steps for Health Care Providers

• Commitment is needed from clinic staff, not just the care provider

• Training:– Family practice residency training– Diploma in Tropical Medicine and

Hygiene– Short-term overseas clinical work– Rotate at a regional international clinics

• Get connected in your local community

Conclusion

• Mainstream, don’t marginalize

• Treat the individual, and the patient

• Identify and act to employ outside resources for critical needs