Category: health issues

Refugee industry converging in Michigan for conference

~ Ann Corcoran ~ Leave a comment

The reason for the conference slated to begin at Michigan State University tomorrow is to bring together lots of levels of the refugee industry to discuss how to get refugees working; and in the case cited, recertified to work in certain professions in the US.

However, I’m wondering if the PR people couldn’t have found a better example of a suffering refugee.  The Associated Press story begins with Salah Hashem’s case:

DETROIT – When Salah Hashem slipped out of Iraq and into Turkey in 2006, he carried with him a host of papers, diplomas and official documents proving he had graduated from Baghdad University and had completed his medical residency.

When he arrived in the Worcester, Mass., area a year later, he put those papers to work, beginning a process of professional recertification in an attempt to resume his career in medicine.

But it was not to be.

The organization charged with validating foreign medical credentials told Hashem the name on his diploma wasn’t his.

The story sounds a tad bit shaky to me, but apparently not to the reporter who launches into this next paragraph without skipping a beat:

A stagnant economy, bureaucratic hurdles and difficulty adapting to a new professional scene are presenting refugees like Hashem and the organizations that serve them with a thorny problem: How to get highly skilled refugees in the U.S. back into their professional field.

Well, I guess you might call a name that doesn’t match on a medical document a bureaucratic hurdle, but it sounds to me that Mr. Hashem’s problems go beyond a stagnant economy and too much bureaucracy.  But, here is how it is all explained away.

In Hashem’s case, the Educational Commission for Foreign Medical Graduates raised questions stemming from an Iraqi custom — adding the names of several generations of one’s forefathers on formal documents.

“They rejected my application at that time. They said, `We need a paper from your medical school saying that you are a graduate,”‘ Hashem said. [Very reasonable request wouldn’t you say!]   Iraqi universities “make it difficult to get you your papers if you are in a foreign country. They don’t really want to help anybody that fled the country.”

The commission’s associate vice president of operations, Bill Kelly, said while the group is sensitive to cultural differences, the burden is on the candidate to prove the diploma is his or her own.   [Does that sound like too much bureaucracy to you? Sounds like the right kind of bureaucracy to me!]

“We have a responsibility to ensure that the diploma that someone gives us belongs to them. We tell them, ‘We need official legal documentation that both the names belong to you,”‘ said Kelly. “It may inconvenience them some but our feeling is that the integrity of our process must be protected.”  [Your integrity and the health of Mr. Hashem’s future patients!]

He barely failed!  When is the last time you heard that phrase.  We are accustomed to hearing “barely passed,” but “barely failed?’  

After retrieving the papers, Hashem registered for the first of four licensing exams. He barely failed his first attempt. Now, his brother has fled Baghdad after threats on his life and is unable to get the documentation a second time.

Barely failed!   Maybe more paperwork isn’t necessary afterall.

Immigrants who need a doctor in Minneapolis know where to go

~ Ann Corcoran ~ Leave a comment

The Hennepin County Medical Center has been the hospital of choice for the huge immigrant population of Minneapolis and on Saturday, in an article entitled ‘Foreign Ways and War Scars Test Hospital,’ the New York Times told us all about the good, the bad and the ugly of treating patients there.  Please read the whole article, often couched in touchy-feely terms, to see what medical professionals are up against.

Many arrive with health problems seldom seen in this country — vitamin deficiencies, intestinal parasites and infectious diseases like tuberculosis, for instance — and unusually high levels of emotional trauma and stress. Over time, as they pick up Western habits, some develop Western ailments, too, like obesity, diabetes and heart disease, and yet they often question the unfamiliar lifelong treatments these chronic diseases need.

Some also resist conventional medical wisdom or practices, forcing change on the hospital. The objections of Somali women to having babies delivered by male doctors has led Hennepin, gradually, to develop an obstetrical staff made up almost entirely of women.

Doctors here say that for many of these newcomers, the most common health problems, and the hardest to treat, lie at the blurry line between body and mind, where emotional scars from troubled pasts may surface as physical illness, pain and depression.

The article goes on to tell readers about the mental and cultural problems the staff must cope with in a hospital that spends $3 million a year on interpreters alone.

The Times reporter works so hard to tell us that the negative aspects are balanced by rewards, but as you wade through to the end, even the good natured Dr. Pryce has his limits.

The Personal Care Assistant racket

Calling the Somalis entrepreneurial, the reader has to go over this a couple of times to grasp how the Somalis have figured out how to game the system.

Somali patients have been asking them to fill out forms stating that they need personal-care assistants. Some do not need the help, Dr. Pryce said, but are being egged on by Somali-run health care agencies that want to collect insurance payments for the services.

Somalis in Minneapolis, often entrepreneurial and business minded, have opened the agencies to take advantage of relatively generous rules in Minnesota that were originally meant to help keep the elderly and chronically ill out of nursing homes.

Tricia Alvarado, director of home care for the Minnesota Visiting Nurse Agency, which evaluates requests for home help, agreed that there had been an explosion of Somali agencies, with 100 or so opening in just the last three years. Many are run by people without any medical training. And Ms. Alvarado confirmed that the agencies were putting a hard sell on potential clients.

” ‘Diabetes?’ ” Dr. Pryce said, relaying what he said was a typical conversation between a sick Somali and a Somali-run agency. ” ‘You need a personal-care assistant. Here’s a form. Give it to your doctor.’ “

Dr. Pryce turns down requests that he thinks are unwarranted, but patients argue and sometimes even act sicker than they really are.

The whole thing leaves him “hopping mad,” Dr. Pryce said. “I want to be a good steward of our resources, the tax money we’re all paying.”

The State of Minnesota is looking into the fraud.

The current situation with the Somalis is part of a larger problem in Minnesota: the number of clients, and the costs of personal care, more than doubled from 2002 to 2008, and the number of agencies more than tripled. A report in January by the state legislative auditor said, “Personal care services remain unacceptably vulnerable to fraud and abuse”; the state is drawing up plans to tighten its control of the services.

“I love the Somali people and their culture,” Dr. Pryce said. “I like taking care of them. It’s rewarding and interesting. They don’t drink, they don’t smoke much, they’re living the American dream, they need our help. Then you have this other side that’s really painful, this contentious issue of who gets what.”

Endnote:  I wonder what Dr. Pryce thought of the Somalis when shooting victims  were brought to Hennepin over the weekend, victims of Somali men shooting up a trailer because they were not invited to the party.

For new readers:  Here is a post I did in September of last year which shows how many Somali refugees we have taken in the past 25 years or so.  For some reason it is getting lots of readers lately so it reminded me to post it more frequently.

While I’m at it, here is another old post about how the State Department has had to shut down family reunification because of fraud in the Africa refugee program.

Refugee resettlement responsible for higher rates of TB in Minnesota

~ Ann Corcoran ~ Leave a comment

Just yesterday I told you about increased numbers of cases of drug resistant TB in states with high immigrant populations, now here is news specific to Minnesota.   On World TB Day (today) we are learning that Minnesota’s cases of TB are rising due to refugee resettlement.

The deadly disease has declined overall in the US since 1953.

“Many people might think that TB is a disease of the past because of its marked decline in the U.S., but it continues to be a problem today,” said Deborah Sodt, manager of the TB unit for the Minnesota Department of Health. Nationwide, the rate of TB disease has decreased more than tenfold since national reporting began in 1953. However, TB continues to be one of the deadliest diseases in the world, killing approximately 2 million people every year.

However, Minnesota’s cases have risen sharply in the last 15 years.

In Minnesota, active TB cases have increased 50 percent in 15 years, from 141 in 1993 to 211 in 2008. In 2007, the rate of TB disease in Minnesota of 4.6 cases per 100,000 people exceeded that of the nation (4.4 per 100,000) for the first time since 1953. Data on states’ TB rates for 2008 was released Friday by the Centers for Disease Control and Prevention in its Morbidity and Mortality Weekly Report, at Trends in Tuberculosis — United States, 2008.  [Here is the CDC report with a handy map showing which states have the worst TB]

Minnesota’s high numbers are attributed to refugee resettlement.

Minnesota’s TB rate is higher than surrounding states largely because of economic and cultural factors related to refugee resettlement. Similar to the trend seen in Minnesota in the early 1900s, when most of the TB cases occurred in newly-arriving European immigrants, more than 80 percent of the TB cases in Minnesota now occur in people who were born in countries where TB remains common and who later moved to Minnesota.

To see how many refugees Minnesota has resettled and from what countries, go to these databases.   Check out your state while you are there.   Minnesota does not have the highest number of refugees resettled, so it would be interesting to cross check the states with the highest number of refugees with the CDC report on TB.  Somone should do an analysis.

Drug-resistant TB on the rise in immigrant communities

~ Ann Corcoran ~ Leave a comment

Although numbers of cases of active Tuberculosis ( TB) have declined, health officials are worried about the increasing number of cases of drug-resistant TB they are seeing.    Refugees are permitted to enter the US with latent TB. This is one of the problems we have mentioned involving refugees who are not tracked by the volags (government-contracted resettlement agencies) or federal or state government in as soon as 3 months after their arrival in the US.

From Newsmax (hat tip Blulitespecial):

SAN FRANCISCO — Even as tuberculosis rates decline in the United States, drug-resistant strains of the disease showing up in states with large immigrant populations and are becoming increasingly hard to treat.

Researchers are concerned about this trend while funding for labor-intensive disease control programs is being cut in cities such as San Francisco, which has the highest TB rates in the country.

Drug resistance develops when patients start feeling better and interrupt their treatment, giving bacteria an opportunity to develop a defense against the medication.

The picture is grim, and World TB Day on Tuesday is an attempt to raise awareness of a disease that infects about 9 million people, particularly in Asia and Africa. About five percent of those patients are immune to the best drugs. About 2 million die annually.

Immigrant communities in states such as California are particularly vulnerable because many people are foreign born or travel frequently to countries where TB is a greater risk, such as Mexico, India and China

California leads the nation with 2,696 TB recorded cases in 2008_ and with 451 cases of drug-resistant TB identified between 1993 and 2007. About 83 percent of these drug-resistant cases involve immigrants born abroad.

If you are thinking, oh well, that is California, think again.   We began our coverage of TB in immigrant communities when we first read about Ft. Wayne, IN and its financially strapped health department here.   Check out our health issues category for lots more on TB.

Now, I am not saying we are Africa yet, but go back and read this post I wrote last June about the South African “prison” for drug-resistant TB patients.   What else can be done with these people?

High levels of autism in Minneapolis Somali community still a mystery

~ Ann Corcoran ~ Leave a comment

Update April 1st:  Minnesota Somali autism report out today, here.

It seems that the New York Times is increasingly publishing stories that are of interest to us.   Take for instance the information Judy posted on diversity in schools here last Saturday,  and then there is the story I posted on about the Iranian refugees in Iraq, here.   Now, I’ve found a lengthy discussion about the high levels of autism found among Somali children in Minneapolis, a subject we have written about previously in our ‘health issues’ category.

Autism is terrifying the community of Somali immigrants in Minneapolis, and some pediatricians and educators have joined parents in raising the alarm. But public health experts say it is hard to tell whether the apparent surge of cases is an actual outbreak, with a cause that can be addressed, or just a statistical fluke.

In an effort to find out, the Minnesota Department of Health is conducting an epidemiological survey in consultation with the federal Center for Disease Control and Prevention. This kind of conundrum, experts say, arises whenever there is a cluster of noncontagious illnesses.

Experts do not know what causes autism so its hard to pin down why this particular population should be susceptible, but note Stockholm Somalis are having the same problem.

Since the cause of autism is unknown, the authorities in Minnesota say it is hard to know even what to investigate.

“There are obviously some real concerns here, but we don’t want to make a cursory judgment,” said Buddy Ferguson, a health department spokesman. Even counting autism cases is difficult because the diagnoses are first made by the schools, not doctors, and population estimates for Somalis vary widely. Results are expected late this month.

Even if the department confirms that a cluster exists, it will not answer the question why. Still, Dr. Thun said a possible focus in one ethnic group “increases my sense that investigating it is essential.” The next step, he added, would be to look at Somalis in other cities.

A small recent study of refugees in schools in Stockholm found that Somalis were in classes for autistic children at three times the normal rate.

I think one problem with their analysis is that authorities have no clue what the Somali population is, it could be much higher than they are guessing and thus the rate of autism would be closer to normal for the population.

Somalis began arriving in Minneapolis in 1993, driven out by civil war; now their population in Minnesota is estimated at 30,000 to 60,000. The city is welcoming and social benefits are generous, but many live a life apart as conservative Muslims, the women in head scarves and long dresses.

Somalis arrived in smaller numbers before 1993 (see numbers here).  We resettled over 80,000 alone and they have been having large families for 25 years.   The population in Minnesota could be much much larger than 30,000-60,000.  So it seems to me that the first step is to make sure exactly what the size of the population is.

What causes it, no one really knows.

Speculation is rampant about possible causes: living conditions in Somalia or in refugee camps in Kenya; traditional medicines; intermarriage; genetic predisposition; vitamin D deficiencies due to a lack of sunlight; and, of course, vaccines.

But each theory has weaknesses.

Since speculation is rampant and since there is some suspicion of a genetic link, I’m guessing Islamic sanctioned polygamy should be factored in.  One man with some defective gene producing children with many wives could very quickly affect a whole population.  There is polygamy in the US Somali population.

Of course the anti-vaccine folks are lobbying Somalis to cut out vaccines.

Antivaccine activists are campaigning among them, which worries public health officials, especially because some families go back and forth to Somalia, where measles is still a significant cause of childhood death, according to Unicef.

I found this statement curious.  Somalia is a country undergoing extreme violence, we are told, and that is why so many Somalis have moved to the West.  Why then are there families going “back and forth to Somalia?”    Makes me wonder if they are taking their girls to visit the “doctor.”  And, then of course, that begs the question, if they can travel back and forth safely, why are they here and not back in Africa helping to improve their country.