From Beyond Our Borders: Providing Health Information to Foreign-Born Populations Lydia N Collins, MLIS Consumer Health Coordinator

Introduction to NLM and NN/LM

Division of the National Institutes of Health (NIH) World’s largest biomedical library Produces free, authoritative electronic health information resources 130+ health information databases (PubMed & MedlinePlus) Not a commercial vendor Government tax dollars at work! U.S. National Library of Medicine URLURL for NIH NLM

National Network of Libraries of Medicine (NN/LM)  NN/LM, formerly Regional Medical Library Program  Established in the Medical Library Assistance Act (1965)  Mission  Provide health professionals and the general public with equal access to biomedical information  Coordinated by the National Library of Medicine  8 Regional Offices  Support Network members to achieve NN/LM mission  5-year contracts URLURL for NN/LM MAR

Refugee and Immigrant Populations Overview

Refugees and Immigrants arrive in the United States from all over the world …

Definitions  Refugee : “a person who is unable or unwilling to return to his or her country of nationality because of persecution or a well-founded fear of persecution on account of race, religion, nationality, membership in a particular social group, or political opinion.” ~Immigration and Nationality Act

Distinctions  Immigrant : chooses “to move in order to improve the future prospects of themselves and their families,” usually for employment or education opportunities. ~United Nations High Commissioner for Refugees (UNHCR) website

How do refugees get to the U.S.? START: The Refugee flees from his/her country of origin. The refugee registers with the UNHCR. This agency ensures that the individual qualifies as a refugee under international law. The UNHCR refers the individual to a U.S. Embassy with a Refugee Processing Post. END : The refugee is met at the airport and resettlement agencies provide services such as case management, assistance learning English, and housing support.

U.S. Refugee Statistics  69,909 refugees in 2013  58,236 refugees in 2012  56,384 refugees in 2011  73,293 refugees in 2010  Top countries: Iraq, Burma (Myanmar), Bhutan, and Somalia. Followed by Cuba, Iran, Democratic Republic of Congo, and Sudan.  Refugee “cap” each year

Refugee Arrivals by State  URL For DHS Publication URL

Map of Emerging Populations  URL for HealthReach Map of Emerging Populations URL

Unique Health Issues

Importance of Cultural Competency  What is culture ?  One definition: Characteristic features, beliefs, social norms, and way of life shared by a racial, religious, or social group, or by people in a specific place or time  It’s not just about the words!  Differences between Western Caucasian and East Asian facial expressions  /  - Western emoticons primarily use the mouth  ^.^/;_; - Eastern emoticons primarily use the eyes

Culture and Patient Health  Beliefs about objects, symbols, food, the body, blood, non- traditional medicine, etc.  Communication styles and norms  Role of relationships  Ways of learning new information  Role of translators and interpreters

Culture and Clinical Practice  Integrating cultural information into clinical practice  Things to watch: styles of speech, eye contact, body language  Industry Collaboration Effort  Better Communication, Better Care: Provider Tools to Care for Diverse Populations  URL for Industry collaboration Effort URL for Industry collaboration Effort  New Joint Commission recommendations for hospitals, policy makers, and researchers  The 4 C’s of Culture: A Mnemonic for Health Care Professionals

Erie County - Country Profiles

Erie County Refugee Populations (2014) IraqBurma (Myanmar)Bhutan/NepalSomaliaDemocratic Republic of Congo

Erie County Refugee Populations (2014) cont… EthiopiaKenyaUgandaSudanUkraine

Languages Spoken in Erie, PA  Arabic, Burmese/Karen, Nepali, Somali, Swahili/Kinyarwanda Based on information from Erie County Demographics Profile August 2013 URL for Languages Spoken in ErieURL

Health Information Resources

DatabasesWeb sitesJournals Other (Blogs, Radio etc…)

More Thoughts on Culture  Tailor messages to intended audience  Avoid stereotypes  Relevant photos/artwork  Appropriate symbols  Realistic recommended behaviors  Back-translate and field test translated material  “…more than a patients’ rights issue…critical to safety and quality of care”*

HealthReach  URL for HealthReach URL

Health Reach - Example A community health worker works extensively with refugees from Bhutan. Where could she find information about flu shots for children?

Flu Shot- English/Somali  URL for HealthReach Flu Info in Swahili URL

HealthReach and Erie County, PA Nepal Resources available covering a range of topics which include but are not limited to: Image from CIA The World Factbook  Healthy Teeth  Active TB Disease  Talking to Children About the Flu  Flu Prevention  Diabetes Nutrition  HIV/AIDS Awareness  MMR Vaccine  Tdap Vaccine

MedlinePlus  URL for MedlinePlus URL

MedlinePlus: Multiple Languages URLURL for Multiple Languages in MedlinePlus  Amharic  Arabic  Bosnian  Chinese  Croatian  French  German  Italian  Korean  Polish  Portuguese  Russian  Spanish  Swahili  Tigrinya  Vietnamese

MedlinePlus- Example  A family physician has been seeing a group of new patients from Kenya and Somalia who appear to be suffering Carbon Monoxide Poisoning. Is there anywhere he could go to locate patient handouts or other materials in Swahili ? Images from CIA The World Factbook

Carbon Monoxide Poisoning  URL for Carbon Monoxide Information in MedlinePlus in Swahili URL

EthnoMed  URL for EthnoMed URL

EthnoMed Example  A physician has been seeing a diabetic patient and believes that he may be non-compliant with his medication regiment. The physician just realized that Ramadan has just begun, and wonders if the patient may be Muslim.

Diabetes during Ramadan  URL for Diabetes During Ramadan URL

HIT  URL for Health Information Translations URL

HIT-Arabic  URL for Arabic Health Information Translations URL

Diversity Rx  URL for DiversityRx URL

LINCS-Diversity and Literacy  URL for LINCS URL

PHPartners  URL for Partners in Information Access URL

Resources - Journals  BMC Public Health  Bulletin of the World Health Organization  CDC Morbidity Mortality Weekly Report  Journal of Immigrant and Minority Health  Journal of Refugee Studies  Journal of Transcultural Nursing

Emergency Preparedness for Culturally Diverse Communities  Perspective of a “disaster” culture  “Disaster culture” in many countries  “Everything is from Allah”  Spiritual leaders are preferred source of information  Limited economic resources are barrier

Drexel-Diversity Preparedness National Resource Center on Advancing Emergency Preparedness for Culturally Diverse Communities URLURL for Diversity Preparedness

NLM SIS Multi-Cultural Resources  URL for Multi-Cultural Resources for Health Information from SIS URL

Website Evaluation Guidelines  Accuracy  Authority  Bias  Currency  Coverage  Culturally appropriate URLURL for MedlinePlus Evaluating Health Information Topic Page

Organizations

Refugees PA URLURL for Refugees in PA

UNHCR: Office of the United Nations High Commissioner for Refugees  Established December 14, 1950 by the United Nations General Assembly  Coordinates international action to protect refugees and resolve problems worldwide

U.S. Committee for Refugees and Immigrants (USCRI)  Mission: “To address the needs and rights of persons in forced or voluntary migration worldwide by advancing fair and humane public policy, facilitating and providing direct professional services, and promoting the full participation of migrants in community life.” 

Bridging Refugee Youth & Children’s Services (BRYCS)  National level technical assistance to organizations which serve refugees and immigrants  Particular focus on issues relevant to youth and children  Toll-free and expert consultation 

Staying Healthy For Beginners 

Information Rx.org

NN/LM MAR Membership 

 PubMed.gov comprises more than 21million citations for biomedical literature from MEDLINE, life science journals, and online books. PubMed is a free resource that is developed and maintained by the National Center for Biotechnology Information (NCBI), at the U.S. National Library of Medicine (NLM), located at the National Institute of Health (NIH).  PubMed provides links to PubMed Central (PMC) a free full-text archive of biomedical and life sciences journal literature at the U.S. NIH/NLM.  PubMed Tutorials are useful for those learning to use the resource.  URL for PubMed URL  URL for PubMed Tutorials URL  URL for PubMed Central URL PubMed

PMC, launched in February 2000, is designed to provide permanent and free access to biomedical and life sciences journal literature at NIH/NLM. PMC is the digital counterpart to NLM’s extensive print journal collection. URLURL for PubMed Central PubMed Central (PMC)

PubMed Health specializes in reviews of clinical effectiveness research, with easy-to-read summaries for consumers as well as full technical reports. Clinical effectiveness research finds answers to the question “What works?” in medical and health care. Includes Behind the Headlines section (from England's National Health Service).  URL for PubMed Health URL PubMed Health

 URL for PubMed Health Clinical Effectiveness URL Clinical Effectiveness

NNLM OERC  URL for Evaluation Guides from the NNLM OERC URL

U.S. Department of Justice  URL for Department of Justice Information for Asylees and Refugees URL

Promote Upcoming NLM Focus on resources – HealthReach  HealthReach (formerly RHIN) (Focus on NLM Resources)  Presenter : Laura Bartlett, Outreach and Special Populations Branch, National Library of Medicine  Date / Time : Thursday, May 7, 2015 / Noon – 1 pm (ET)  Where :  Online / No Registration Required  Description : HealthReach ( is a resource of quality multilingual, multicultural public health information for those working with or providing care to individuals with limited English proficiency. Resources include:  Health education materials in various languages and formats (brochures, fact sheets, videos)  Provider tools (including best practices, cultural information, and effective use of interpreters)  Special collections on Emergency and Disaster, Women’s Health and Mental Health  During the presentation the site will briefly be demonstrated, and new initiates such as the funding and acquisition of new materials will be discussed.

Thank you! Lydia N Collins Consumer Health Coordinator National Network of Libraries of Medicine, Middle Atlantic Region URLURL for NN/LM MAR Developed by NN/LM staff. This project has been funded in whole or in part with Federal funds from the National Library of Medicine, National Institutes of Health, Department of Health and Human Services, under Contract No. HHS-N C with the University of Pittsburgh-Health Sciences Library System.