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Slide1: 

Minnesota Department of Health Blain Mamo Refugee Update September 13, 2005 Metro Refugee Health Task Force Refugee Health Program, Minnesota Department of Health

What does it mean to be a refugee?: 

What does it mean to be a refugee? Foreign-born resident who: is not a United States citizen cannot return to his or her country of origin because of a well-founded fear of persecution due to race, religion, nationality, political opinion, or membership in a particular social group Refugee status is generally given: prior to entering the United States by the State Department or Immigration and Naturalization Services (INS) Refugee Health Program, Minnesota Department of Health

Refugee Admissions Ceilings for FY2005: 

Refugee Admissions Ceilings for FY2005 Source: US Department of State

Primary* Refugee Arrivals to MN by Region of World 1979-2004 : 

Primary* Refugee Arrivals to MN by Region of World 1979-2004 Refugee Health Program, Minnesota Department of Health *First resettled in Minnesota

Country of Origin by County of Resettlement, 2004: 

Country of Origin by County of Resettlement, 2004 N=3506 N=2724 N=346 N=158 Refugee Health Program, Minnesota Department of Health

Planning for Hmong Arrivals : 

Planning for Hmong Arrivals Increase capacity of current LPH screening clinics Potential for mass screening clinics Need for volunteers Request for assistance from private community clinics Foundation support Refugee Health Program, Minnesota Department of Health

External Inadequacy: 

External Inadequacy Hennepin County Health Assessment and Promotion Clinic (HAP) 60% of non-Hmong arrivals 20% of Hmong arrivals Need: 76-124/week Capacity: 100/week Refugee Health Program, Minnesota Department of Health

External Inadequacy: 

External Inadequacy St Paul-Ramsey County Department of Public Health (SPRCDPH) 20% of non-Hmong arrivals 60% of Hmong arrivals Need: 77-173/week Capacity: 40/week Refugee Health Program, Minnesota Department of Health

External Inadequacy Addressed : 

External Inadequacy Addressed Request for assistance from private community clinics Determine who serves the Hmong Letters requesting help sent Mass screening (HealthPartners Regions Hospital) Refugee Health Program, Minnesota Department of Health

Clinic Partnerships: 

Clinic Partnerships Large numbers required us to increase capacity beyond county clinics In May and June 2004, MDH offered training to ~ 25 clinics 16 clinics in Ramsey; 9 clinics in Henn Hmong Physicians have performed the bulk of screening in St. Paul Benefits = continuity of care, cross-cultural competence, linguistic access Refugee Health Program, Minnesota Department of Health

Internal Inadequacy: 

Internal Inadequacy Support staff needs Data entry New arrivals Screening results Xerox and mail to counties Filing paperwork Professional staff needs Current involvement in other projects Develop appropriate resources (no Hmong arrivals in many years) Refugee Health Program, Minnesota Department of Health

Internal Inadequacy Addressed: 

Internal Inadequacy Addressed Request funding from ORR Request funding from State Refugee Coordinator Data entry needs Blue Cross Foundation offer Bilingual staff person Community Empowerment model Refugee Health Program, Minnesota Department of Health

Internal Inadequacy Addressed: 

Internal Inadequacy Addressed New databases needed Who goes to which clinic Overseas immunizations into MIIC Refugee Health Program, Minnesota Department of Health

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Refugee Health Program, Minnesota Department of Health

Slide17: 

Refugee Health Program, Minnesota Department of Health

Monthly Primary Refugee Arrivals by Country of Origin, Minnesota, 2004: 

Monthly Primary Refugee Arrivals by Country of Origin, Minnesota, 2004 Refugee Health Program, Minnesota Department of Health

Primary Refugee Screenings By Initial County of settlement, 2004: 

Primary Refugee Screenings By Initial County of settlement, 2004 Hennepin County Total screened 3147 (97%) HAP/Red Door/HCMC 69% Private Clinics/ Other Counties 31% Ramsey County Total screened 2645 (99%) St. Paul-Ramsey Co PH 35% Private Clinics/Other Counties 65% Refugee Health Program, Minnesota Department of Health

Health Status of New Refugees, Minnesota, 2004: 

Health Status of New Refugees, Minnesota, 2004 Health status upon arrival No (%) of refugees No(%) with infection screened among screened TB infection* 6656 (98%) 2252 (34%) Hep B infection** 6518 (96%) 607 (9%) Parasitic Infection*** 6283 (93%) 1084 (17%) Sexually Transmitted 4352 (64%) 82 (2%) Infections(STIs)**** Malaria Infection 388 (6%) 4 (1%) Lead 807 (82%) 17 (2%) Immunizations 91% started or continued with recommended series Refugee Health Program, Minnesota Department of Health Total screened: N=6771 (97% of the 7005 eligible refugees) * Persons with >= 10mm induration from Tuberculin Skin Test ** Positive for Hepatitis B surface antigen (HBsAG) *** Positive for at least one intestinal parasite infection **** Positive for at least one STI

Timeline of Overseas Screening and U.S. Resettlement, Hmong Refugees, 2004-2005: 

Movement to US, CDC Enhanced TB Screening Rec #1 Standard overseas TB screening started Timeline of Overseas Screening and U.S. Resettlement, Hmong Refugees, 2004-2005 Overseas & U.S.-based investigations CDC Enhanced TB Screening Rec #2 June 2004-January 2005 4 MDR-TB cases overseas; 6 active TB cases in US (2 MDR-TB) Additional overseas data: 17 MDR-TB Movement halted Adapted from CDC TB at the WAT, 2 week travel moratorium

TB in Wat Camp March 2004- February 2005 (as of June 2005) : 

TB in Wat Camp March 2004- February 2005 (as of June 2005) 424 TB Class Conditions 264 began treatment for TB disease 4 (2%) were < age 15 years 1 (0.4%) HIV-infected 17 MDR-TB Only 3 had previous treatment for TB 10 reported weekly contact with another MDR-TB case 7 linked by social network to smear+ MDR-TB case TB Program, Minnesota Department of Health

TB Among Newly Arrived Hmong Refugees: United States* : 

TB Among Newly Arrived Hmong Refugees: United States* 37 confirmed cases of active TB in persons who arrived before January 21, 2005 CA (25), WI (6), MN (4), Other (2) 4 (11%) MDR-TB (all in CA) 8 (22%) had TB class condition identified overseas Age < 5 years: 7 (19%) 5-14 years: 8 (22%) 15 and older: 22 (59%) *As of June 16, 2005 TB Program, Minnesota Department of Health

MN Response to Wat TB: 

MN Response to Wat TB Clinical training for medical community Focus on TB diagnosis, treatment TB 101 for Volag caseworkers Focused talking points Community Forum for Hmong Conducted in Hmong TB education Chance to air concerns Refugee Health Program, Minnesota Department of Health

Primary Refugee Arrivals: 

Primary Refugee Arrivals 2005* *1/1/2005 – 9/10/2005

Primary Refugee Arrival by Month, Minnesota, 2001-2005*: 

Primary Refugee Arrival by Month, Minnesota, 2001-2005* Refugee Health Program, Minnesota Department of Health

Primary Refugee Arrivals, Minnesota 1/1/2005 - 9/10/2005: 

Primary Refugee Arrivals, Minnesota 1/1/2005 - 9/10/2005 N=3403 “Other” includes Burundi, Cambodia, Cameroon, China (also Tibet), DR Congo, Cuba, Eritrea, Guatemala, Guinea, Iran, Iraq, Kenya, Rwanda, Sierra Leone, Sudan, Togo, Vietnam, Yemen and Zimbabwe Refugee Health Program, Minnesota Department of Health

Monthly Refugee Arrivals by Country of Origin, Minnesota, 1/1/2005 – 9/10/2005: 

Monthly Refugee Arrivals by Country of Origin, Minnesota, 1/1/2005 – 9/10/2005 Refugee Health Program, Minnesota Department of Health

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Suburban metro: Carver, Scott, Washington Refugee Health Program, Minnesota Department of Health Refugee Arrivals by County, Minnesota, 2001-2005* *01/01/05-09/10/05: N=3403

Health Stat us of New Refugees, Minnesota, 2005‡: 

Health Stat us of New Refugees, Minnesota, 2005‡ Health status upon arrival No of refugees No(%) with infection screened among screened TB infection* 1104 458 (41%) Hep B infection** 1094 106 (10%) Parasitic Infection*** 1071 124 (14%) Sexually Transmitted 814 20 (2%) Infections(STIs)**** Malaria Infection 23 3 (13%) Lead 90 5 (5%) Refugee Health Program, Minnesota Department of Health ‡ 2005 results dates between 1/1/05 and 6/30/05 Total screened: N=1529 (74% of the 2061 eligible refugees) * Persons with >= 10mm induration from Tuberculin Skin Test ** Positive for Hepatitis B surface antigen (HBsAG) *** Positive for at least one intestinal parasite infection **** Positive for at least one STI

Burma (Myanmar): 

Burma (Myanmar)

Background: 

Background Over 100, 000 refugees along Thai-Burmese border since 1984 (Temporary Protection) Students with claims of political persecution versus Ethnic Minorities UNHCR only active in Bangkok Minnesota: Burmese refugees started arriving in 2003 Over 140, 000 are expected to resettle in the US during the next 10 years Source: Human rights watch and US State Department

Primary Refugees from Burma by County of Resettlement, MN, 2003-present: 

Primary Refugees from Burma by County of Resettlement, MN, 2003-present Refugee Health Program, Minnesota Department of Health N=311

Demographics of Burmese Refugees Minnesota, 2003- present: 

Demographics of Burmese Refugees Minnesota, 2003- present Gender Female 164 (53%) Male 147 (47%) Age Distribution <5 33 (11%) 5-14 87 (28%) 15-24* 60 (19%) 25-44 108 (35%) 45-64 20 (6%) 65+ 3 (1%) Refugee Health Program, Minnesota Department of Health * Gender not evenly distributed: 60% female

Slide35: 

Screening rate: 87% Tuberculosis: 39% positive for TST Hepatitis B: 11% positive for HBsAG Intestinal Parasites:12% positive for at least one type of parasite (Giardia Lambia) Immunizations: 90% had documentation of overseas vaccinations; 91% started or continued series Common Referrals: Primary Care (60%), Dental (37%) Health Status of Burmese refugees in MN 2003 to Present Refugee Health Program, Minnesota Department of Health

Minnesota Refugee Health Program: 

Minnesota Refugee Health Program Phone: 612-676-5414 or 1-800-657-5414 Web site: www.health.state.mn.us/refugee Address: Minnesota Department of Health Refugee Health Program 717 Delaware St. SE PO Box 9441 Minneapolis, MN 55440-9441 7/18/00 Refugee Health Program, Minnesota Department of Health