The overseas medical examination and the initial public health screening are important milestones in the continuum of refugee health care. The overseas medical examination is required for all refugees accepted to resettle in the U.S. After arrival in the U.S., a refugee is linked with the domestic refugee health assessment by the resettlement agency responsible for their initial reception and placement.
Domestic Health Assessment
The domestic health assessment services are generally coordinated by state-level refugee health programs, with funding support from the federal Office of Refugee Resettlement. Services are delivered by local health departments or private clinics including community health centers and academic medical centers. The timing of the domestic health assessment is within the first 30 to 90 days after arrival.
The purpose of the domestic health assessment is to ensure follow-up of any Class A or Class B condition identified during the overseas medical examination, to identify conditions of public health importance, and to identify personal health conditions that may adversely affect resettlement. While states differ in the scope and organization of their domestic health assessments, in part a reflection of their public health capacities, health assessment programs often include some or all of the following components:
- Testing for infectious diseases including tuberculosis, parasitic infections, and hepatitis B;
- Immunizations, including review and evaluation of overseas immunization, and administration of vaccines in accordance with Advisory Committee on Immunization Practices recommendations;
- Health screening to evaluate and identify abnormalities in growth, vital signs, visual acuity, oral health, hematological indices, and urine chemistry that may indicate an underlying disease pathology or impaired nutritional status;
- Assessment for use of tobacco, alcohol, and other drugs;
- Health education to introduce a refugee to the U.S. health care system including primary care, insurance, and other health issues such as nutrition and safety.