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Feature: December 2018/January 2019

The North American Refugee Health Conference (NARHC) is the largest refugee health conference of its kind globally and it offers access to recent research and best practices in refugee health. The 2019 conference will be held in Toronto from June 14-16. Themes for this year’s conference will include the Rohingya crisis, Trauma, and Resiliency. Refugee health professionals and experts from related disciplines interested in addressing challenges for optimal care, research and advocacy for the refugee patient population and self-care for healers are encouraged to attend. Abstract submission is open thru December 10. For more details and registration information please visit

New ImageLive Better with Kidney Disease & Learn about Dialysis- Khmer (Cambodian)   

Increasingly, dialysis, a treatment for severe kidney disease, is of concern among Cambodian patients with diabetes. This 11-minute video slideshow presentation is narrated in English and Cambodian (Khmer) with matching subtitles and was developed by Megan Jane Melvin, DNP, ARNP, Cambodian Caseworker/Cultural Mediator Jennifer Huong, and Renal & Transplant Clinical Nurse Specialist Nancy Colobong Smith, MN, ARNP, CNN to help educate Cambodian patients and community members about dialysis. It is tailored to reflect common concerns and questions some Cambodians may have when learning about and considering dialysis. 

Khmer narrated version (click CC to view Closed Captions in Khmer):

See the above video also on YouTube, along with the English version of the video. 

Recent Features: 

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...

"Public Charge" Rule 

Proposed Policy Changes and Implications for Health Care of Immigrant Families

The Department of Homeland Security published the Notice of Proposed Rulemaking (NPRM) in the Federal Register on October 10, marking the beginning of the 60-day comment period. The comment period will end Monday, December 10.  

You can find the full text of the rule here, and federal comment portal for the rule here. (Some organizations are also providing portals for comment collection, documenting personal accounts of people harmed by the drafting and publication of the proposed rule, and other advocacy. See Resources below.)


Under a longstanding policy, the federal government may deny an individual entry into the U.S. or adjustment to legal permanent resident (LPR) status (green card) if an individual is determined likely to become a "public charge", someone who may depend on the government as their main source of support. The new proposed rule change would broaden consideration to include key safety net programs and specific standards for income, health, age and even English proficiency as part of public charge status determination. 

  • Under the proposed change, use of some previously excluded programs, including Medicaid, the Supplemental Nutrition Assistance Program (SNAP), the Medicare Part D Low-Income Subsidy Program, and several housing programs, could be factors considered in public charge determinations.
  • The changes would likely lead to broad decreases in participation in programs among legal immigrant families and their primarily U.S.-born children, beyond those individuals who are directly affected by the changes. 
  • Decreased participation in these programs would contribute to more uninsured individuals and negatively affect the health and financial stability of families and the growth and healthy development of their children.
  • Uncertainty and fear around the proposed rule change is already resulting in immigrants thinking to, or deciding to, forego benefits legally available to them and their families. Some may put off health care visits or not enroll in services for children and families. 
  • Not all immigrants are subject to the public charge test. Refugees and asylees, victims of domestic violence/human trafficking, and certain other applicants are exempt. As well, the proposed changes do not apply to lawful permanent residents applying for citizenship (“naturalization”).

It is critical that providers are aware of the potential impact and ready to address these issues now that the new rule is proposed. Below are some resources with additional information and avenues for action.


In Washington State, there is a broad coalition of nonprofit, public, and private sector organizations working to address the impact of the proposed rule change and protect families. This Protecting Immigrant Families (PIF) - WA coalition includes Children’s Alliance, OneAmerica, Northwest Immigrant Rights Project, Northwest Health Law Alliance, Northwest Harvest, the Washington State Hospital Association, and many others. Join PIF-WA's listserv here. Document personal accounts of people harmed by the drafting and publication of the proposed rule here. Join the National PIF listserv here where you can stay up to date with new resources being shared, such as reports, fact sheets and upcoming webinars.

Media Reports & News Releases

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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Welcome to EthnoMed

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.