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Show Table 1: Health Screening Upon Arrival in Utah. Test # Tested # Positive Pet. Positive Comments Hepatitis B 70 9 13% All chronic cases, likely neonatally acquired. HIV-1 70 0 0% All HIV positives already referred to HIV Clinic; none among this group. HIV-2 70 1 1.4% Two initially screened positive but confirmed negative by Western Blot. Syphillis 71 1 1.4% Medicated before coming to US. Screening # Screened # Abnormal Results/Comments Anemia 1 0 Only 1 subject screened for anemia; several others were tested later but based on diagnos- tic decision and not considered screening. Hearing 70 1 1 hearing compacted, removed material from ear. Vision 63 5 Only 5 outside of 20/30 vision; 28 had 20/20 vision. Dental 70 2 2 subjects with dental caries; referred to dentist. Diabetes 2 1 1 subject arrived with Type 1 diabetes; several others were tested later but based on diag- nostic decision and not considered screening. Table 2: Physical exams. Measurement # Subjects* Mean High Low Weight 67 140.4 178 110 Blood Pressure 64 117.3/77.6 152/100** 92/62*** Heart Rate 49 75.2 92 68 Respiratory Rate 47 17.9 20 15 * Likely all subjects measured; some did not have measurement (s) recorded on physical exam form. ** Measurements for same patient. *** Measurements for different patients. symptoms and psychosomatic symptoms." Further research into the mental condition of the Lost Boys could be revealing. Miscellaneous Notable Information Past medical history was usually not present in the medical records of the Sudanese youth. This is obviously due to the complete absence of medical records that accompanied their journey to Utah, as well as their own lack of awareness of their own medical history. As physicians often rely on past medical history in patient management, this is a significant factor in their health care. Traditional tribal markings were evident on a few subjects. Some presented with thin tribal marks on the head. A few others had four bottom jaw teeth removed as a part of a tribal ritual. One subject showed a large, 6-7 cm scar along with several smaller scars on his right shin. When asked about the nature of the scars, he indicated that they came from his flight on foot from his village in Sudan. Furthermore, communication is a significant issue in health care delivery to the Sudanese. Though most speak English quite competently, comprehension of medical terminology, insurance information, and medical instructions can be very difficult. For example, on the personal history form under the heading "Current Medications," two youth listed "Medicaid" and "IHC" (Intermountain Health Care). This indicates a lack of understanding of requested information. One can only speculate how many times such a lack of comprehension occurred, either while verbally receiving, reading, or explaining medical information. DISCUSSION AND RECOMMENDATIONS Several refugee patient care issues, refugee policy issues, and possible public health issues stem from this study of the Sudanese Lost Boys. Based on the data derived from this study, recommendations are made in the ensuing discussion that will hopefully be considered, analyzed, and/or further studied by appropriate professionals in order to enhance the quality of health care provided to refugee populations. Data from this study revealed a 79% prevalence among subjects of inactive, non-infectious tuberculosis (ie positive PPD skin test), hi Utah, treatment with an anti-tuberculosis drug regi- men that would cure the disease is currently an option rather than a requirement for PPD positive refugees (Utah Department of Health, 1997). This is because of the likelihood of non-adherence to treatment due to side effects and length of treatment (6-9 months) of such a regimen. When patients fail to adhere to their treatment regimen, drug-resistant Tb strains can arise, which can lead to prolonged infectiousness and the transmission of Tb within the community. However, about 10% of those affected with Tb and left untreated will develop active Tb disease at some point in life, at which point the Tb is highly contagious and infectious (this percentage may be even higher considering the prevalence of malnutrition and disease in the past of the Sudanese). Further consideration should be given to making Tb treatment a requirement rather than an option in the state of Utah (CDC, n.d.). Emphasis would have to be made on adherence strategies, such as directly observed therapy (DOT), coordination with outreach staff from the same cultural and language background as the refugees, or using incentives remove barriers to adherence. hi this study, only subjects complaining of gastrointestinal symptoms were tested for schistosomiasis, with 61% testing positive. Schistosomiasis, though only transmissible via an infected water source and thus not a public health threat in Utah, can pose great danger to the health of an infected individual. The causative parasite, however, can be easily treated via praziquantel, an effective and relatively inexpensive medication. Schistosomiasis is often asymptomatic in infected individuals, as it may be in several subjects of this study. Thus all refugees from areas where schistosomiasis is endemic should be either tested for schistosomiasis (and subsequently treated if positive) or medicated empirically with praziquantel. Further analysis should be done regarding the cost comparison of the testing/treatment option vs. empirical treatment for schistosomiasis. Due to the traumatic history of the Lost Boys, there may be undiscovered and untreated mental health problems may underlying their physical ailments. Utah's health care providers should be sensitive to the mental health situation and needs of these and other refugees and refer to an appropriate mental health professional when necessary. Health care providers have perhaps the best opportunity of anyone to educate refugee patients regarding infectious diseases and the possibility and mechanisms of their spread. For exam- Utah's Health: An Annual Review Volume IX 49 |