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Refugees Face Health Problems

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When the first Indochinese refugee settled in Linda Vista, Calif. in 1975, school officials had no clue that by 1981, 75 percent of the 1,200 students at Linda Vista Elementary School would be Vietnamese, Cambodian, Laotian, or Hmong children, many of whom would have serious, chronic health problems in addition to language and cultural differences.

For the last six years, community and school health workers have been continuously trying to screen, diagnose, and treat the array of illnesses and other conditions from which the immigrant children suffer.

Some progress has been made. But in a presentation to the American School Health Association last week, Linda Vista nurse-practitioner Sheila M. Pickwell emphasized that the health problems that confront Indochinese immigrant children, in Linda Vista and elsewhere, compounded by language and cultural differences, promise to keep health-care workers busy for a long time.

Linda Vista is not the only community that must cope with this situation, although the large number of refugees there makes the problems highly visible.

Between January 1977 and January 1980, a total of 41,246 Indochinese refugee children entered the California public schools, accord6ing to Ven Le, a consultant to the California State Department of Education's Transitional Program for Refugee Children.

And over the past year, 113,518 Indochinese refugees of school age have been resettled in the United States, according to Jose L. Martinez, program assistant in the U.S. Department of Education's Office of Bilingual Education.

In a 1979 report to Congress, the Congressional Research Service reported that the most immediate problem of many Asiatic refugees seemed to be health. "In a San Francisco study," the report noted, "70 percent carried intestinal parasites, some communicable through poor hygiene; 40 percent showed positive reaction to tuberculosis; and 10 percent suffered from infectious skin ailments."

Public-health and education officials in other states with growing refugee and immigrant populations, however, say that they have not encountered a substantial number of health-related problems among children of school age in these groups.

All Cubans and Haitians seeking refuge in Florida are immunized within 12 hours of their arrival unless they can show proof of earlier immunization, explained Dr. Dorothy Brown, a health department official in Dade County. "Most of them receive shots as soon as they walk through the portal," she said.

Dr. Hector Garcia, deputy director of the county health department, said that some adolescent refugees may have been immunized in their native countries against a number of childhood diseases--with the exception of rubella, because shots preventing that disease were not mandatory when they were young.

He said that his department currently is trying to screen for children who might fall into that category.

Paul Meptke, refugee-program coordinator in the Texas Department of Education, said he has received no indication that Indochinese children are showing a higher degree of health-related problems than their native counterparts in the state's school districts. But he added: "One of my concerns is that these are a very proud and independent people, and they might be hesitant to seek out the state's help if a problem should arise."

In the San Diego area, however, numerous problems have been docu3mented. Ms. Pickwell, who is on the faculty at the University of California at San Diego, described the ailments detected in physical examinations of 400 Indochinese school-children:

83 percent required immunizations for common childhood diseases;

49 percent suffered from "multiple caries;"

15 percent suffered from otitis media, or ear infections;

27 percent had positive reactions to skin tests for tuberculosis;

51 percent were anemic.

The children and their parents came to Linda Vista from refugee camps in southeast Asia. Ms. Pickwell said officials from the Centers for Disease Control (cdc), based in Atlanta, are responsible for screening out cases of active tuberculosis, mental disease, leprosy, venereal diseases, and other medical problems in the country of origin.

A cdc official said that accord6ing to their statistics, "in excess of 98 percent of all incoming refugees have a record of immunization against the seven most common childhood diseases." In some cases, the official said, "They're on their second or third series of shots."

But the cdc statistics do not jibe with the experience of the Linda Vista health-care officials. The children who come to Linda Vista, Ms. Pickwell said, are seldom immunized. Earlier this year there was a diphtheria scare, and "for a time, children were bringing us imunization records. That seems to have stopped. We go through phases," she said.

The other ailments for which cdc screens refugees also appear after the children leave the camps. "We see all these problems when they get to America, so somewhere there is a breakdown," Ms. Pickwell asserted. "Possibly there is a lag period. They're screened, they seem healthy, but by the time they get toel5lAmerica some of these diseases have come to the fore."

The conditions in refugee camps are still not ideal, Ms. Pickwell said. But the condition of children who have arrived recently indicates they are better than they were several years ago, though a number of the children have burn scars, the result of fires in the camps.

Once the refugees are resettled, Ms. Pickwell said, they are more concerned about learning the language and finding a job than they are about health care.

"We find that they do not tend to come to the office on their own, even now," she said. "They're not that concerned about their health, and they are very concerned with staying in school. They don't want to be sent home, and their parents don't want them sent home."

"At this time, immunizations are the worst problem," Ms. Pickwell said. California law requires thatinued on school children present proof of immunization, so if the children cannot offer such proof, the nurse must make sure they receive the necessary series of inoculations.

"That means getting rides and getting translators," she continued. "Sometimes we have health-department clinics in our school, but that's a huge job because you have to send home forms that the parents must sign."

Dental care is another problem area, Ms. Pickwell said. All of the children have some tooth decay; 49 percent have serious, severe dental problems,"teeth decayed clear down to the roots."

Many of the children have to go in the hospital and have an anesthetic to have their teeth repaired, she said.

Tuberculosis is also a problem, although there is little if any threat that it could spread among the children, she said. In the San Diego city schools, there is a 1.5-percent tuberculosis rate. This rate is the same as the national rate for tuberculosis among Indochinese in the United3States, Ms. Pickwell said.

Many of the children also suffer from otitis media, or ear infections, Ms. Pickwell said. "You take [apparently] well children out of the classroom to do a physical, and they have draining ears." Few, however, suffer hearing loss during or after the infections.

Skin lesions, such as infections and parasites,also continue to afflict the children. Many, but not all, skin problems develop in the refugee camps. Some problems, like scabies and lice, could be found in the schoolchildren of Linda Vista before the Indochinese immigrants arrived.

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