Whether new to the United States or resettled for some time, refugees may have any of a wide variety of acute or chronic health conditions that can present in many ways. Musculoskeletal and mental health problems can complicate the detection of other infectious and/or chronic conditions. Some examples of potential and possibly concurrent health problems include oral health problems, tuberculosis, strongyloidiasis, hepatitis B, lead poisoning, and anemia and other nutritional deficiencies. The challenge for the provider is to evaluate a refugee with awareness of the subtle expressions of often multi-factorial acute and chronic conditions.
The pre-flight and flight conditions and duration for a given refugee population or individual will vary and may have a direct impact on their health status. Malnutrition, infections such as sexually transmitted diseases (STDs) or intestinal parasites, and conditions such as lead poisoning or anemia may present unique diagnostic and treatment challenges. Children may have weakened immune systems that lead to minimal signs and symptoms for some diseases or conditions. For example, a young refugee from Asia presenting with fatigue and anemia may have the sequelae of recent malaria, malnutrition, intestinal parasites and/or thalassemia among other diagnoses.
Clearly the evaluation of a resettled refugee can be quite complex and must be done in the context of their particular medical and social history. The evaluation of risk factors and potential exposures in the countries of origin and transition may create a framework for the assessment of current acute and chronic conditions. Catch-up vaccination and cancer screening, both routine and as indicated by various risk factors, are important parts of complete health care for refugees and vaccines will be required for school and Adjustment of Status to Permanent Resident. Providing medical care for resettled refugees is both challenging and rewarding. It requires knowledge of the historic medical and social conditions, attention to the varied and often subtle expressions of acute and chronic diseases, and a culturally competent approach to the individual and the community.