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Show pie, data from this study showed prevalence rates of Hepatitis B (13%) among the Lost Boys to be over 6 times higher than in the normal population (< 2%). The Utah physician who initially examined them appropriately reviewed modes of transmission with all who tested positive and asked them to refer their roommates for Hepatitis B immunizations. Educating refugee patients regarding infectious disease will require time and careful communication, but is a necessary effort to undertake in order to protect the health of family, close contacts, and communities of these new Utahns. hi light of their history of malnutrition, the Lost Boys should be properly educated regarding diet and nutrition. They spent approximately 9 years of their life receiving no more than one bowl of corn mush per day for food. Thus, the assumption can be made that have little if any comprehension of healthy eating habits, such as balanced dieting and avoidance of dangerous food elements such as cholesterol and fat. Again, Utah's health care providers have an excellent opportunity to offer nutrition and dieting counsel to these and other refugee patients as they treat them. The data in this study revealed that most subjects rarely utilized the health care system once the 8-month period of Medi-caid coverage had expired. Whether or not this is the case with other Utah refugee populations is an issue that could be further explored. Since the United States health care system is complex, even to many who have been born and raised within the system, it must be inconceivably more difficult to refugee populations who may have never experienced such a system of insurance premiums, co-payments, HMOs, and escalated health care costs. Utah's health care providers as well as refugee placement agencies and support groups should take the opportunity to educate refugee patients such as the Lost Boys about their options for health care access once Medicaid is no longer available. They need to know about the costs, the options, and otherwise how to take care of themselves in our health care system. This is a difficult undertaking that hopefully can receive further attention in the future. CONCLUSION As this is a descriptive study intending only to characterize a population, answers to these questions are beyond the scope of this article. The hope in undertaking the study was not to answer such questions, rather to raise them. Further discussion of these and other questions regarding refugee health will hopefully be addressed by state and local health officials, health policy makers, and health care practitioners alike. The Lost Boys are a distinctive group of refugees who collectively and individually present unique medical and cultural issues to the Utah communities in which they live. Awareness of their history, sensitivity to their needs, and concern for their future are all part of the culturally competent health care that Utah health care professionals should provide. Additional research and discussion regarding the findings of this study will hopefully lead to greater cultural competence among Utah providers for this and other refugee populations. REFERENCES Centers for Disease Control (CDC), (n.d.). Division of tuberculosis elimination factsheet. Retrieved from nlij.> ww>v.cJ „' ^ \ ' - v \ ^ets Gavagan, T. & Brodyaga, L. (1998). Medical care for immigrants and refugees. American Family Physician. 5 7, 5:1061 -1071. Muennmg, P., Pallm, D., Sell, R., Chan, M. (1999). The cost effective- Table 3: Tuberculosis Testing TesyProcedure # Tested Chest X-Ray (CXR) for Tb 64* Test/Procedure # Tested Tuberculin skin test (PPD) 67 Chest X-Ray (CXR) for acti ve 36 Tb Kakuma Abnormal Pet Abnormal 20 31% Salt Lake City # Positive Pet Positive 53 79% 2 14% Comments 18 of 20 inactive, non-infectious; only 2 active, non-infectious. Comments Three subjects did not return to be checked. Two diagnosed with active, non-infectious Tb; thirteen who had ______________positive PPD test refused CXR.______________ 6 Visa Applications not present in medical records. Table 4: Physician Visits/Health Utilization Total # physician visits: (among 62 subjects*) 140 # Total visits during Medicaid coverage 133 (95%) # Visits after expiration of Medicaid: 7 (5%) Avg. # physician visits/subject/year: ' 2.02 Avg. # physician visits/subject/year during Medicaid coverage 3.22 Avg. # Physician visits/subject/year after expiration of Medicaid coverage 0.25 # physician visits/subject/year during Medicaid coverage compared to period 3.22/.25=12.9 after expiration of Medicaid coverage___________________________________________________ * 62 subjects considered; 8 subjects had incomplete or insufficient records for this analysis. Table 5: Most Common Symptoms and Complaints Symptom/complaint Gastrointestinal pain/difficulty Headaces Joint pain Skin disorders Respiratory tract Mental disorders # Subjects Pet. Subjects Comments 29 41% Most commonly frequent abdominal pain, cramping, diarrhea. 20 29% Most commonly chronic, frequent, recurrent. 14 20% Knee most common; 5 diagnosed with palletofemoral syndrome. 10 14% Itching, warts, infected scars, PPD irritation. 7 10% Bronchitis, sore throat, asthma. 3________________4%__________All 3 depression, 2 received medication, 1 referred to psychiatrist. Table 6: Parasites Test Schistosomiasis Ova & Parasite Combined ** # Tested 18 17 21 # Positive 11 12 19 Pet Positive 61% 71% 90% Comments High correlation with eosinophilia; test 99% specific; 98% sensitive for 8 Blastocystis hominis; 6 Escherichia coli; 2 Entamoeba hartmanni; 1 Endolimaz nan; 1 Giardia lamblia; 1 lodamoebi Butschilli* * Several had more than one parasite. ** Total number of those tested for parasites-either Schistosomiasis test, O&P test, or both. 50 Utah's Health: An Annual Review Volume LX |