Transcript Cultural Guidelines - American Pharmacists Association

Refugees and New Americans
Essentials of Cultural Competence in Pharmacy
Practice: Chapter 9 Notes
Chapter Authors: Dr. Cynthia Naughton and
Dr. Norma Kiser-Larson
Learning Objectives
1. Articulate relevant terminology related to refugees and new
2.
3.
4.
5.
Americans
Understand the history of immigration legislation in the
U.S.
Describe the overseas visa process.
Articulate common medical problems in refugees and new
Americans.
Describe common misconceptions of refugees and new
Americans.
Some Key Terms
 Foreign born: a person born in one country who moves to
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another country
Resettlement: immediate need of protection for refugees
Immigrant: someone who comes to live in another country
voluntarily
Legal immigrant: a person who follows the appropriate
immigration procedures and plans to become a long-term
resident or permanent citizen
Illegal immigrant: Someone who enters the country under
false pretenses or breaks other laws to remain in a country
Overseas Medical Examination
 Purpose: to identify medical conditions that may create social or economic burdens for the
United States.
 A person designated with a Class A condition cannot enter the U.S. unless the disease is
treated, a waiver is issued by the U.S. Immigration and Naturalization Service (INS), or both.
Class A Conditions
Class B Conditions
Untreated chancroid, gonorrhea, granuloma
inguinale, lymphogranuloma venereum, or
syphillis
Tuberculosis, inactive or noninfectious
Tuberculosis, active and infectious
Noninfectious Hansen’s disease
HIV infection
Other conditions (in past medical history or
current physical examination) that will
require follow-up care for the well-being of
the individual.
Hansen’s disease (leprosy)
Any physical or mental disorder associated
with harmful behavior, or history of such
behavior that is likely to renew.
Drug abuse or addiction
Refugee Health Assessment
This may be a refugee’s first interaction with the American health care
system. The refugee is screened for tuberculosis and other
communicable diseases, and a health assessment examination is
performed.
Common health problems in refugees and immigrants include:
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Infectious diseases
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Intestinal parasites
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Malnutrition
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Vitamin D deficiency
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Dental caries
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Incomplete or undocumented immunizations
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STDs, including HIV
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Depression
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Trauma/Posttraumatic Stress Disorder
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Elevated levels of lead (in children)
Common Misconceptions
Myth
Fact
 Immigrants consume a disproportionate
 Immigrants consume less health care
amount of health care resources.
 Limited health care access for
immigrants has no effect on the U.S.
population.
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 Illegal immigrants get a “free ride” in the
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 Immigrants are an excessive burden to
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 Immigrants come to the U.S. for the
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U.S. health care system.
our nation’s public health insurance
programs.
primary purpose of receiving health care
services.
resources than native-born Americans.
Areas with relatively high uninsured
rates are likely to have greater instances
of vaccine-preventable diseases,
communicable diseases and disability.
Undocumented workers are paying
billions of dollars annually in Social
Security and Medicare taxes they will
never be able to draw on.
Except for limited emergency services,
immigrants do not qualify for Medicaid
or the State Children’s Health Insurance
Program.
Most immigrants come to the U.S. for
work opportunities.
Reflection Questions
1. How will you keep yourself informed of the changing needs
of new Americans?
2. Before reading this chapter, what stereotypes of new
Americans did you hold? Now?
3. What are your own beliefs about immigration policies? How
will this impact your practice?
4. How can you remain open to the vastly different
experiences of refugees and new Americans?
Additional Resources
(descriptions listed in Appendix C)
 Central American Refugee Center (www.carecen-la.org)
 U.S. Committee for Refugees (USCR) www.uscr.org
 Global Health Council (www.ncih.org)
 World Health Organization (www.who.org)