When refugees resettle in the United States, they’re provided up to eight months of public assistance, including medical coverage, effective beginning the day they arrive on U.S. soil. Even if a new arrival hasn't yet received a health insurance card, she can still see a doctor, and that doctor will be retroactively reimbursed for care.
That's especially important to know because obtaining insurance takes time, and sometimes people arrive with serious health problems such as diabetes, schizophrenia or cancer, from countries where they haven't received good care.
The Health Screening
All newly-arriving refugees complete a mandatory health screening at Mid County Health Center. The guidelines are established by the Centers for Disease Control and Prevention and include a general exam including nutritional history, immunizations, an emotional distress screening and lab testing for Malaria, lead toxicity, parasites, sexually-transmitted infections and Tuberculosis.
Patients with positive test results are then referred for further treatment, such as the Multnomah County Health Department's:
- Tuberculosis Clinic, where they receive free culturally-specific treatment including medication and monitoring.
- HIV Health Services Center, where they receive culturally-specific treatment, nursing care and social services.
More than a third of refugees report having been near death prior to resettlement, and about one-in-three have lost a family member or friend. Most have expended hunger or thirst, and nearly 70 percent have lived through combat. It's no wonder then that refugees experience astronomical rates of stress, depress and post-traumatic stress disorder compared to the general public. And symptoms can persist for years after a person is resettled.
The federal government recommends that as part of the initially physical health screening, states evaluate a person's mental health as well.
In Oregon, the mental health screening are conducted through Pathways to Wellness, a program of Lutheran Community Services Northwest. Patients can seek help through Lutheran's Multicultural Counseling Services, where staff offer counseling and referral services.
The state doesn't have enough mental health providers with the language and cultural skill to meet the needs of refugees. This is especially true when it comes to torture; it's just not something most patients will experience. Yet these residents are more likely to attempt suicide, experience aggression, depression, anxiety, alcohol and drug abuse, and PTSD.
Intercultural Psychiatric Program, the state's largest prover of mental health services to immigrant and refugee residents, maintains a Torture Treatment Center. Both the IPP and its Torture Treatment Center are part of the Oregon Health and Science University.
The state's refugee coordinator, Rhonda Prodzinski, is a manager at the Oregon Department of Human Services. She serves a supervisory role in how the state implements its contract with the U.S. Office of Refugee Resettlement. She has two staff who work fulltime within the state Department of Human Services to assure refugee families obtain social services including housing and food assistance. Regarding health the three primary players are:
State Refugee Health Coordinator: Tasha Wheatt-Delancy, director of Mid County Health Center, oversees the state's health screening process and helps refugee families transition from screening to primary and preventative care. Most families remain at her Multnomah County-run clinic for their primary care.
State Refugee Health Deputy: Charlene McGee, with the Multnomah County Health Department, helps state and local health officials navigate changes to insurance resulting from the Affordable Care Act, helps assure newly arriving refugees receive the primary care services they’re entitled to, and advocates for families when something goes wrong.
The Oregon Refugee Preventative Health Advisory Group: led by McGee, this group of refugee settlement case workers, Multnomah County Health Department staff and outside providers meets every three months to discuss the state's services to refugee residents, share best practices and overcome barriers to access. The group also has a Refugee Emotional Health Task Force focusing on mental health services for refugees.
- Ethnomed: This nonprofit provides cultural and religious information to help inform healthcare providers on the most effective ways to provider services. You can search by culture, health topic or language.
- Healthy Roads Media: This nonprofit has developed a long list of videos, handouts and radio files in a multiple languages on topics ranging from a health orientation for newly-arriving refugees, to mental health, disease, preventative care and emergency preparedness.
- U.S. Office of Refugee Resettlement: provides resources, videos and other materials on topics of preventative care, health insurance, mental health and torture.
- Refugee Health Profiles: The Centers for Disease Control and Prevention have begun publishing key health information about select populations, including Iraqi, Bhutanese and Congolese refugees.
- Civil Surgeons: One year after arriving in Oregon, a refugee can apply for permanent residency. The process requires applicants complete an I-693 Report of Medical Examination and Vaccination Record. Only an authorized civil surgeon can sign the form.