1. Essentials of Cultural Competence in Pharmacy Practice: Chapter 9 Notes Chapter Authors: Dr. Cynthia Naughton and Dr. Norma Kiser-Larson Refugees and New Americans

2. Learning Objectives 1. Articulate relevant terminology related to refugees and new Americans 2. Understand the history of immigration legislation in the U.S. 3. Describe the overseas visa process. 4. Articulate common medical problems in refugees and new Americans. 5. Describe common misconceptions of refugees and new Americans.

3. Some Key Terms Foreign born: a person born in one country who moves to 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

4. 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 ConditionsClass B Conditions Untreated chancroid, gonorrhea, granuloma inguinale, lymphogranuloma venereum, or syphillis Tuberculosis, inactive or noninfectious Tuberculosis, active and infectiousNoninfectious Hansen’s disease HIV infectionOther 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

5. 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: Infectious diseases Intestinal parasites Malnutrition Vitamin D deficiency Dental caries Incomplete or undocumented immunizations STDs, including HIV Depression Trauma/Posttraumatic Stress Disorder Elevated levels of lead (in children)

6. Common Misconceptions Myth Immigrants consume a disproportionate amount of health care resources. Limited health care access for immigrants has no effect on the U.S. population. Illegal immigrants get a “free ride” in the U.S. health care system. Immigrants are an excessive burden to our nation’s public health insurance programs. Immigrants come to the U.S. for the primary purpose of receiving health care services. Fact Immigrants consume less health care 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.

7. 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?

8. Additional Resources (descriptions listed in Appendix C) Central American Refugee Center (www.carecen-la.org)www.carecen-la.org U.S. Committee for Refugees (USCR) www.uscr.orgwww.uscr.org Global Health Council (www.ncih.org)www.ncih.org World Health Organization (www.who.org)www.who.org