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
Slide16: 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
Slide29: 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