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Feature: October 2018

Loa Loa

Map of the estimated prevalence of eye worm history in Africa
Image source: WHO

The CDC recommends refugees from Loa loa-endemic countries in Africa "should not receive presumptive ivermectin for strongyloidiasis prior to departure. Management of Strongyloides should be deferred until arrival in the United States, unless Loa loa is excluded by reviewing a daytime (10 AM to 2 PM) Giemsa-stained blood smear. Deferral of treatment for strongyloides until after the refugee arrives in the United States is acceptable. Guidance is available for management of Strongyloides following arrival in the United States in the Domestic Intestinal Parasite Screening Guidelines.”

These recommendations apply to those coming through the IOM resettlement process or asylum seekers or immigrants who choose to be screened. Unfortunately, this approach misses many immigrants and asylum seekers who do not know about routine screening and many Africans who originate in non-Loa loa infected regions and do not think to tell their clinicians they migrated through Loa loa endemic areas, living there often for months to years.

Drs. Carey Jackson and Duncan Reid describe a recent case of Loa loa in a patient originating outside of the loiasis-endemic area, including resulting questions for clinicians surrounding infection screening and treatment. Read more...

Recent Features:

Implications for Health Care and Service Providers from Possible Immigration Legal Changes

The Protecting Immigrant Families (PIF) Campaign and other organizations are organizing around the possibility of federal changes to public charge rules that would impact many immigrant families.  Reports continue to circulate that many immigrants are turning down programs such as WIC and other nutrition programs out of fear that accessing this federal aid will make them ineligible for a green card if new rules are put into place.  


The change being considered would expand the categories of public benefits that could be held against an individual seeking legal status.  These categories might include nutrition programs like WIC or lunch programs, CHIP (Children's Health Insurance Program), educational assistance, child care services. If these changes are implemented it could mean the government could deny admission to the U.S. or refuse an application for lawful permanent residency if it is determined the applicant is likely to become a public charge—in other words, likely to use certain types of government assistance. These rule changes have not been publicly released to date, but the threat of policy change is already creating fear in immigrant and refugee communities who may put off health care visits or not enroll in services for children and families. It is critical that providers are aware of the potential impact and be ready to address these issues if new rules are proposed. Below are some resources with additional information:


Media Reports

Current Immigration Issues and Legal Challenges:
The following talk was given by Maggie Chen, JD from the Northwest Immigrant Rights Project to practitioners at Harborview Medical Center and provides an overview of the immigration and legal challenges that NWIRP has been responding to. 


Additional Resources:
Under A Trump Proposal, Lawful Immigrants Might Shun Medical Care, NPR, May 10, 2018  

Discussing Measles and MMR Vaccine with Your Somali Patients

Measles Infographic CDC
Image source:

Although techniques regarding how to discuss vaccines with vaccine hesitant parents as described in the literature remain relevant, there are additional considerations in the Somali community. Understanding what has led the Somali community to be wary of the MMR vaccine is critical to knowing how to approach the conversation in the clinic setting.

Dr. Anisa Ibrahim provides background information regarding concerns that arose in the Somali community about autism, and specific recommendations for providers regarding how to approach the conversation about measles and MMR vaccine with patients. 

Includes link to factsheet about measles in Somali language from Public Health-Seattle & King County

Read more... 


Community House Calls Program Videos

New videos highlight the work of Harborview's patient navigator program and caseworker / cultural mediator staff helping LEP patients from other cultures navigate the health care system.

See videos... 

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EthnoMed contains information about cultural beliefs, medical issues and related topics pertinent to the health care of immigrants to Seattle or the US, many of whom are refugees fleeing war-torn parts of the world.

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Refugee Health Weekly Roundup

This summary is compiled by the Washington State Department of Health Refugee Health Program. The Weekly Roundup highlights upcoming events and opportunities, resources and news relevant to refugee health. Some information is local to WA, but also what's on the national agenda. Read the latest edition of the Refugee Health Roundup.

Migrant Children and Health

The Migrant Children and Health Campaign has created a video featuring leaders in immigrant and refugee health advocacy introducing the facts about migrant children health and the continued history of racial and ethnic disease scaremongering in the U.S. For more information about this Campaign and to view the video "Migrant Children and Health: Borders, Boundaries, and Bigotry" click here.

Torture Resources

Resources for clinicians and advocates around issues of torture, often related to warfare and political repression.  Includes information about Northwest Health and Human Rights (NWHHR) coalition serving refugees, asylum seekers, and immigrants in Washington State.  Visit Caring for Survivors of Torture page for additional information.