Health Care for Foreign Born
Students
DISCLOSURE
• I have no conflicts of interest in this
presentation.
• There will be no discussion of medication
off‐label use.
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Susan Hammerton, MSN
SESSION NAME: HEALTH CARE FOR FOREIGN BORN STUDENTS
CASBHC conference May 2nd, 2013.
OBJECTIVES
• Provide a checklist of screening tests for
students who were born outside of the US.
• Provide an overview of mental health
needs.
• Open dialogue and explore how to
improve our health care services to this
population of students.
• Refugee – a person who flees to a foreign
country to escape danger and persecution via
the United Nations High Commissioner of
Refugees.
• Asylum Seekers – protection from arrest or
deportation given to political refugees. Often
come into the USA without documents and then
seek asylum status from the embassy.
• Immigrant with papers – A person who comes
into the country to take up permanent residence
• Immigrant without papers – Came across the
border without permission to seek work.
Where do refugees come from?
Recent arrivals --• Myanmar (Burma)
• Iraq
• Ethiopia
• Afghanistan
• Somalia
• Iran
• Eritrea
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One can look up what is happening in the individual countries on a website
called UNHCR - www.unhcr.org
on the home page in the upper right hand corner is a search called browse
by country which brings up the current profile and situation of that country.
USA accepts 70,000 refugees per year.
About 2,500 get to Denver, CO. each year.
Immigrants
• Number of children 0-17 years old in
Colorado per 2000 census: 1,053,066
• 16.1% in immigrant families
• 72% are fluent in English
• 39% are fluent in English yet speak
another language at home
Where are immigrants from in
Colorado
• 57%
• 12.5%
• 10%
• 5.5%
• 4%
• 3%
• 2.5%
• 2%
• 2.5%
• 1%
Mexico
Europe
East Asia
Indochina
West Asia
Central America
South America
USSR
Africa
Caribbean
Health Services
• Need a health exam prior to being accepted as a
refugee.
• Some come with a clear status
• If have an A status; usually refused entry into the
USA unless have an anchor relative and are
seen for health care within 7 days (active TB,
leprosy, HIV)
• Others with B1,B2, B3 – have a problem and
need to seek health care within one month.
• Upon getting to the U.S. some of the health care
is repeated just to use U.S. labs.
• ARRIVAL
in the U.S.
Linguistic Competency
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Language – how to talk to these folks?
Denver Health has a language line
Must have a speaker phone.
I try to be concise in what I have
translated. Anticipate what the discharge
instructions are. I have the extreme
advantage of being in the school and
being able to get kids back in when
needed.
The First Encounter
• PPD done stateside
• HIV if over 13 years old
• O&P stool sample
• Physical exam
(including hearing and vision)
• Hematocrit
• Review of Immunizations
Physical Findings
• Perforated TMs
• Dental Caries
• Anemia
• PPD positive – mostly Latent TB
• Amebas
• Underweight
(draw CBC, Chem 20, TSH, sed rate and
do a UA)
Classifications of Tuberculosis
• TB class A – active – needs direct observed treatment
(DOTS)
CXR positive with one positive AFB sputum smear
• Class B1 – clinically active non infectious
CXR positive and 3 negative AFB smears
• Class B2 – not clinically active.
CXR positive for other lung condition
• Call B3 – CXR abnormal compatible with old or healed
TB.
• Latent TB –
PPD 10 mm or greater and CXR negative
Other examples of Class B
health conditions
• Pregnancy
• High blood pressure
• Diabetes
• Tell me your
story
• Ask them if
they have
seen bad
things
happen.
TRAUMA SCREEN
Have you ever been ……….
• in a Natural disaster – fire, earthquake, flood
• in a bad accident
• in place with war going on around
• physically abused
• threatened with physical harm or separated from home
• a witness to violence between your parents
• a witness other family members fighting or being hurt at home
• beaten up, shot at, or threatened to be hurt badly
• a witness to someone being beaten up, shot or killed
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seen a dead body other than at a funeral
• sexually molested or abused or raped
• a witness to someone being sexually abused or molested
• experienced the loss of someone very important
• experienced painful or scary medical treatment
• kidnapped
• neglected, left alone or severely ignored
• experienced anything else you would consider to be traumatic.
S & S of PTSD
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Re-experiences the trauma – dreams, flashbacks thought
Avoids any reminders of the trauma
Diminished interest or participation in activities
Detachment or estrangement
Restricted affect
Increased arousal
Guilt
Difficulty concentrating
Increased arousal – hyper vigilance = increased resting pulse
Guilt
Irritability overactivity
Dissociation spaciness
Difficulty sleeping nightmares
Hopelessness foreshortened future
Worry separation anxiety
Somatization.
• Assimilation – the process of receiving new facts
or of responding to new situations in conformity
with what is already available to consciousness
• Acculturation – cultural modification of an
individual,group or people by adapting to or
borrowing traits from another culture.
• The students rate of assimilation versus their
parents.
• Boxing for Cuba by Guillermo Vincente Vidal.
Gave a great example of not speaking spanish
so as not to have an accent and gain the most
possible from living in the US.
Undocumented versus documented
immigrants
• Plyer versus Doe 1982 decided that all
kids no matter what their legal status have
the right to an education in the US through
high school
• Yet if a student can never become a
citizen or resident and get a SS# - they
often have no motivation to finish school
• Just Like Us by Helen Thorpe is a
nonfiction account of 4 mexican girls.
KNOW your OWN cultural stuff!
• One can never know everything there is to
know about other cultures.
• The whole hot and cold thing……
• In refugee camps they are told to wait in
their tent until told what to do versus
initiating everything for yourself and family
in the U.S.
• A South High Student explained – open
your ears and listen.
8 dimensions of US culture
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Time and its Control
Task versus Relationship
Comfort with Change
Self Sufficiency
Personal Control over Destiny
Status – addressing someone formally is not
important to us usually.
• Language – we are direct and that is okay
• Individualism
REFERENCES
• Dimensions of Culture Newsletter/ January
2010 by Marcia Carteret
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