Refugee Health Quarterly
A Refugee Health update from the Minnesota Department of Health
Vol. 16
Jul. 2015
Greetings from the Refugee Health Program: Legislative Update
The Refugee and International Health Program (RIHP)
collaborated with the Health Occupations Program at
MDH to propose guidelines to the Minnesota Legislature
about health care interpreting. The project aimed
to develop recommendations for legislation about
healthcare interpreting that improves access to health
services and quality health outcomes among limited
English proficient (LEP) Minnesotans.
MDH engaged with many interpreters, interpreter
organizations, LEP individuals, and other stakeholder
groups to develop recommendations. In February,
MDH published Interpreting in Health Care Settings:
Recommendations for a Tiered Registry which was
delivered to the health committees in the Minnesota
Senate and Minnesota House of Representatives.
Bill SF 2177 was created based on the recommendations
and was introduced on the Minnesota Senate floor. Its
companion bill, HF 2345, was introduced in the House
of Representatives. These bills will be discussed in the
committees during next year’s legislative session.
Key components of the bill include:
• Creating a tiered registry for interpreters that classifies
interpreters by their level of training
• Ensuring that all interpreters have knowledge of medical
terminology and interpreter ethics
• Forming an advisory board consisting of interpreters and
other stakeholders
• Establishing a system for complaint submission and review
Next year, it will be important that stakeholders in the
medical interpreting field stay engaged so the legislature
knows the potential impact of this bill as it moves towards a
vote.
June 20: World Refugee Day Recap
The United Nations reports that nearly 60 million people
worldwide have been displaced from their homes by
war, conflict, and persecution, the highest number ever
recorded. One of every 122 people is now a refugee,
asylum-seeker or internally displaced person (someone
forced to flee her home but remaining within her
country’s borders). World Refugee Day brings visibility
to the great needs and challenges faced by displaced
persons, as well as their strengths and the lives they
build when they are able to resettle. The RIHP staffed a
booth at the Twin Cities World Refugee Day Celebration
at Arlington Hills Community Center in St. Paul. Food,
music, dance and the presence of diverse organizations
celebrated the vibrant communities refugees have
created in Minnesota.
Image at right: Print ad run in diverse media campaign
promoting the Minnesota Vaccines for Children Program,
which offers free and low-cost shots to some children.
Refugee Health Program
625 Robert Street North
St. Paul, MN 55164-0975
1-877-676-5414, 651-201-5414
www.health.state.mn.us/refugee
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Provider Update: Hennepin County’s Model for Refugee Screening
By guest author Christine May, APRN, FNP. Christine
can be reached at [email protected].
Hennepin County Public Health Clinic (HCPHC) provides
HIV/STI services and tuberculosis care, as well as refugee
screening. Our clinic assumes dual roles as a local public
health (LPH) agency and a screening clinic for refugees.
At HCPHC, the first visit we schedule for refugees is with
a public health nurse (PHN) to review records and get
specimens for laboratory testing. The second visit is with
a nurse practitioner. These appointments are scheduled
for 40 minutes. This generous time frame allows us to
provide education and problem solving, in addition
completing refugee health assessment.
Many of our refugee patients feel well, so we introduce
the concept of primary care and routine health
maintenance. But a greater number don’t feel well, in the
way you don’t feel well after years of struggle, and no
access to regular health care, good nutrition, or a secure
life.
As a screening provider, I talk about what primary care
is, and connect them with clinics that are close to where
they live. I explain that they will be given a summary of
our visit and their lab results that they should give to
their next clinic. For patients with multiple symptoms, I
spend time explaining that all their concerns may not be
addressed at one appointment. I have noticed that when
refugees don’t feel comfortable with a provider, they may
change clinics. I encourage them to return to the same
clinic but ask for a different provider. I make sure to tell
them to never leave a clinic without something that has
the clinic’s name and address!
Because HCPHC does screening only, we are challenged
to get our patients connected to primary care for further
evaluation and follow-up. A unique feature of our public
health clinic is that one of our PHN positions is partially
supported by Temporary Assistance for Needy Families
(TANF) grant funding. This allows the PHN to follow up with
telephone calls and home visits for refugee families who
have children 6 years old and younger. As part of Child &
Teen Check-Ups, we participate in the Reach Out and Read
program, providing books to children up to age 6 and
modeling reading with children to parents. I confess, I never
tire of reading Five Little Monkeys Jumping on the Bed and
by the end of the book having the kids shouting back in
Somali “No more monkeys jumping on the bed!”
Changes and trends:
• While we have seen a dramatic decrease in the number of
new arrivals, we are still busy. In 2014, we screened more
secondary refugees than primary arrivals.
• Refugees seem more disadvantaged these days, perhaps
due to shifting socioeconomics of the county, such as
shortage of affordable housing that can accommodate
large families and fewer employment opportunities, as well
as the fact that most secondary refugees don’t have the
valuable support of the resettlement agencies.
• We are treating less latent TB infection due to a higher
specificity through use of the interferon gamma release
assay (IGRA) instead of the Tuberculin Skin Test (TST) for
screening.
• Changes in overseas screening, treatment and immunization have made a positive difference. We see fewer active
TB cases, a lower incidence of parasites, and more up-todate vaccines.
Community Outreach Update: Ayurvedic Medicine
Originating in India over 3,000 years ago, Ayurveda is
a holistic system of medicine that promotes balance
among the body, mind, spirit, and the environment.
People who practice Ayurveda often use herbal
compounds to treat illnesses and achieve balance.
These Ayurvedic medications sometimes contain
heavy metals like lead, mercury, and arsenic. Some
herbs are unintentionally grown in contaminated soil
or become contaminated during processing. In other
cases, manufacturers purposely introduce heavy metals
into Ayurvedic medications because of their seemingly
positive effects. For example, small amounts of lead can
calm the stomach. Manufacturers may claim that the
heavy metals have been “detoxified”, but these claims are
not supported by research.
Many Ayurvedic medications are imported into the
United States from India or purchased online. A recent
study found that one out of every five Ayurvedic
medications purchased online contains heavy metals.
This is concerning because lead can cause learning
and behavior disorders, infertility, and damage to
the kidneys and liver. These products are often produced
without regulatory oversight and consumers do not have
complete safety information. The contamination of Ayurvedic
medications with heavy metals is a pressing public health
issue because their use is on the rise. According to a CDC
survey, the use of Ayurvedic medications in the United States
increased by 39 percent between 2000 and 2007.
In collaboration with the Environmental Health Division’s
Lead and Healthy Homes program, RIHP has taken early
steps to alert South Asian populations about the risks
associated with Ayurvedic medications. With the help of
community partners, including Ms. Raj Chaudhary at Asian
Indian Family Wellness and Ms. Kamala Puram at AshaUSA,
we have designed a fact sheet that will be translated into
several South Asian languages and distributed to community
members and local vendors. The fact sheet encourages South
Asians to stay informed about the source of their Ayurvedic
medications as well as their ingredients. It also encourages
South Asians with concerns to request a blood lead test and
speak with their doctors about what Ayurvedic medications
they take.
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Refugee Health Data: Lead Screening in Minnesota Refugee Children
Refugee children have up to three times the risk of lead
poisoning than the general population of Minnesota
children. In addition to increased exposure overseas
due to lead-containing gasoline, pollution, traditional
remedies, foods, ceramics, and utensils, refugee children
are at above average risk for lead poisoning in the United
States since they often resettle into high-risk areas with
older housing. Testing children for lead exposure is
important as even low-level exposures
can affect a child’s neurodevelopment.
had an elevated blood lead level. Refugee children from
Afghanistan had the highest prevalence of lead poisoning
upon arrival (27 percent), followed by refugees from Burma
(11 percent), the Democratic Republic of the Congo (11
percent), and Iraq (8 percent) (Figure 1).
For more information on lead testing in refugee children,
please see the Minnesota Department of Health’s Refugee
Provider Health Guide.
No safe blood lead level in children
has been identified. CDC recommends
checking the blood lead level of all newlyarrived refugee children aged 6 months to
16 years during their post-arrival refugee
health assessment (RHA). A follow-up
blood lead test should be conducted
on all refugee children in this age group
within 3-6 months post-resettlement.
927 primary refugee children <17 years
received a post-arrival RHA in Minnesota
from October 1, 2013 through September
30, 2014. Of these, 896 (97 percent) were
tested for lead poisoning. 67 (7 percent)
VOLAG Spotlight: MN Refugee Resettlement Director Updates
Lutheran Social Service – Yusuf Abdi
Yusuf Abdi became the new director of refugee services
for Lutheran Social Service (LSS) of MN in January 2015.
He has worked at LSS since 2007. LSS resettled his
family to Pelican Rapids, MN when he was in 6th grade
and Yusuf started as a volunteer at LSS when he was in
eighth grade. Yusuf’s goal for LSS this year is to increase
communication and seek solutions to meet the needs of
refugee populations. In the coming program year, LSS is
expecting to resettle 370 refugees in Minneapolis and 215
in St. Cloud.
Arrive Ministries – Michelle Eberhard
Michelle Eberhard has been the Director of Refugee Arrival
Services at Arrive Ministries since November 2014. With the
involvement of countless church teams around the Metro,
Arrive Ministries is able to supplement core resettlement
services delivery with invaluable community support,
lifelong friendships, and broader connections to resources
for the newest of neighbors among us. In the coming
program year, Arrive Ministries will resettle around 380
refugees in the Twin Cities and surrounding areas.
Catholic Charities – Katy Radloff
Catholic Charities St. Paul has a new Program Supervisor.
Katy Radloff joined their team on April 30 and comes to
Catholic Charities with experience in resettlement and a
passion for the work. Their goal for the next fiscal year is to
continue to build program capacity and strengthen Core
Services provision. Catholic Charities estimates that they
will resettle 305 refugees in the coming program year.
International Institute – Micaela Schuneman
Micaela Schuneman has been the Director of Refugee Services
at the International Institute of Minnesota since November
of 2014. Prior to joining the Institute, Micaela worked at the
Volunteer Lawyers Network and the Immigrant Law Center of
Minnesota. International Institute’s mission is to welcome New
Americans and provide services to help them integrate into
Minnesota. They do this through resettlement work, English
classes, and workforce training. In early June, they welcomed
their first two Congolese families to Minnesota. They look
forward to working with this new population as the community
grows in the Twin Cities. The Institute estimates they will
resettle 390 refugees in the coming program year.
Minnesota Council of Churches – Kristine Bjerkaas
Friesen and Laura Svoboda
Minnesota Council of Churches’ leadership transitions include
both Director and Assistant Director Roles. Kristine Bjerkaas
Friesen assumed the role of director of programs in January
2015. In February 2015, MCC welcomed Laura Svoboda
(formerly director of arrival services at Arrive Ministries), into
the role of assistant director of refugee services. A goal in all
of MCC’s work is to help build capacity within mainstream
community systems to work better with and for refugees. They
seek opportunities to educate, problem-solve, collaborate
and support our community partners in this ongoing goal of
refugee integration. MCC is tentatively expecting 425 arrivals in
the coming program year.
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