Health Care for Foreign Born
• I have no conflicts of interest in this
• There will be no discussion of medication
off‐label use.
Susan Hammerton, MSN
CASBHC conference May 2nd, 2013.
• Provide a checklist of screening tests for
students who were born outside of the US.
• Provide an overview of mental health
• 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
• 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
One can look up what is happening in the individual countries on a website
called UNHCR -
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.
• 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
• 57%
• 12.5%
• 10%
• 5.5%
• 4%
• 3%
• 2.5%
• 2%
• 2.5%
• 1%
East Asia
West Asia
Central America
South America
Health Services
• Need a health exam prior to being accepted as a
• 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.
in the U.S.
Linguistic Competency
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
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
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
• 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
• Ask them if
they have
seen bad
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
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
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
Difficulty concentrating
Increased arousal – hyper vigilance = increased resting pulse
Irritability overactivity
Dissociation spaciness
Difficulty sleeping nightmares
Hopelessness foreshortened future
Worry separation anxiety
• 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
• 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
• 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
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
• Dimensions of Culture Newsletter/ January
2010 by Marcia Carteret

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