Yale program offers incoming refugees medical care and more, “they need a little attention”

NEW HAVEN – As Greater New Haven prepares to welcome large numbers of Afghan refugees, the Yale Refugee Health Program will be one of the first stops on the way to their relocation to America.

Health professionals, including mental health caregivers and hospital workers, deal with the usual ailments, but refugees can bring problems with trauma and psychological distress, as well as untreated illness or injury.

Work with Integrated services for refugees and immigrants, the Yale School of Medicine program offers more comprehensive services than a medical exam, including putting people in contact with housing and helping children get vaccinated and get into school .

“The situation is very uncertain and it is difficult to predict how many new people from Afghanistan we will have in the weeks or months to come,” said Dr Aniyizhai Annamalai, who heads the adult care of the program, which is hosted in the primary care center. at 150 Sargent Drive.

“What we’ve done is basically try to increase our capacity,” Annamalai said.

The program, launched in 2010, welcomes 250 or more refugees per year, depending on the number authorized by the US government.

“One year we went up to 800,” Annamalai said.

“We have doctors who are not in our system and who really want to help,” she said. “I worked to get on the right track in terms of accreditation and privileges. “

The trainee resident physicians and students “also want to join us,” she said.

The program also includes medical pivot students, who make appointments, collect prescriptions and do other work to help families.

From October 1, 2014 to July 31, Connecticut resettled 2,165 refugees, according to the Refugee processing center. In addition to IRIS, the Connecticut Institute for Refugees and Immigrants in Bridgeport resettles refugees in the state. The record dates back to fiscal 2016, when 819 arrived, largely from Syria and the Democratic Republic of the Congo.

Other countries of origin of the refugees are Eritrea, Burma, Sudan, Iraq and Somalia, according to the center. The number does not include those on special immigrant visas, Afghans who have assisted the US military as interpreters, drivers and in other tasks that put them at risk from the Taliban.

Ann O’Brien, director of community engagement for IRIS, said that once a refugee arrives he or she is a lawful permanent resident and is free to move from state to state, he or she So there is no way to know how many live in Connecticut at any time. given time. Refugees who settle in Connecticut within five years of arrival may benefit from the services of resettlement agencies.

Integrated Services for Refugees and Immigrants, New Haven, Conn.

Hearst Connecticut Media Group

O’Brien recently said the latest estimate predicted IRIS would host 700 refugees by September 2022, with at least 300 Afghans, possibly more, over the next three months.

Yale’s program is vital to resettlement efforts, O’Brien said.

“When refugees first arrive… one of our federal contractual requirements is an RHA, a refugee health assessment,” which must be completed within 30 days, she said.

“We have a health care coordinator who is notified of the arrival of a new family,” said O’Brien. “Once the family is sure they are coming, I think they can fix the meeting” before the family arrives.

“Very often, refugees will have ignored many health conditions fleeing their country or [have] been in a refugee camp. The Yale program will organize follow-up visits and arrange necessary medical care.

O’Brien described a refugee who was beaten in a camp and “they just had constant jaw pain that kept them from sleeping at night.”

“They need help with these tours, even if they speak perfect English,” she said. “It doesn’t matter what country they’re from, they need a little bit of TLC.”

O’Brien said Yale’s program benefits refugees because of the type of specialized medicine they need. It’s also useful because IRIS staff know that patients can be seen during specified time slots, “rather than our staff being on the phone trying to make appointments.” They are wonderful partners and they help us open doors for specialist visits if something needs special attention.

The children, in addition to undergoing a physical examination, receive the vaccines required for school. Federal requirements mean that “we have to have little butts in little seats in less than 30 days,” O’Brien said.

Yale New Haven Hospital, Cornell Scott-Hill Health and Fair Haven Community Health Care Primary Care Medical Center of the New Haven Primary Care Consortium at 150 Sargent Drive in New Haven, 2020.

Yale New Haven Hospital, Cornell Scott-Hill Health and Fair Haven Community Health Care Primary Care Medical Center of the New Haven Primary Care Consortium at 150 Sargent Drive in New Haven, 2020.

Peter Hvizdak / Hearst Connecticut Photo Media File

Dr Camille Brown, who heads the pediatric division of the program, said, “In pediatrics, what’s different from adults is that our families tend to be large families,” with up to eight children.

“My team will help lead a large family” in what Brown called a “medical home,” a primary care clinic such as the Cornell Scott Hill Health Center or Fair Haven Community Health Care, which are part of a consortium in Sargent Drive centers with Yale New Haven Health.

Beyond providing primary care, “I think we see a little more like… that we support families with their medical needs but also their social needs. With performers, social workers and others, “we have a pretty multidisciplinary team,” Brown said.

“We also have the opportunity to work with care coordinators who can help families navigate the health care system,” Brown said. “We do a lot of awareness raising with the school system.” Many children “have had an interrupted education or were not homeschooled,” she said. “They have to have their first assessment with us before they can start school.”

Caregivers in the program “make sure the children assimilate well,” said Brown. “They’re not just learning a new language. They also fit into a new American school system. If there are problems, the school and medical teams must determine: “Is it a language problem? Is it a learning problem?

As IRIS strives to find affordable housing for newly arrived refugees, “unfortunately we encounter unsanitary and unsanitary living conditions here,” said Brown. And many children already have cognitive problems from exposure to lead before they arrive. “Afghanistan is one of the countries that has one of the highest lead loads in its environment” without “access to the specialists and the care that we would have here,” she said.

O’Brien said the agency makes its own selections of apartments it finds for its clients.

Anne O'Brien, Director of Community Engagement at Integrated Refugee & Immigrant Services of New Haven

Anne O’Brien, Director of Community Engagement at Integrated Refugee & Immigrant Services of New Haven

Contribution photo /

Brown said some children arrive with untreated medical conditions, including rare conditions like PKU, in which a baby lacks the enzyme needed to break down an amino acid. “We had a neurologically devastated child,” she said. “There are simple dietary changes that could be made when a baby is born. “

In addition, the team works with the “behavioral health needs of children, understanding the best, culturally sensitive and culturally humble way to manage the needs of children in families,” said Brown.

Refugees also arrive with emotional trauma and a sense of loss. “They mostly lived with the extended family,” Brown said. “Only part of this family will be resettled. There is fear and worry for the family members who have returned home.

Annamalai said that adults, “more than children, tend to suffer from the consequences of trauma. Children tend to be adaptable and flexible. Refugees may feel guilty for escaping while extended family members have been left behind.

“I think we’re going to see more of them now because of the situation in Afghanistan,” Annamalai said. “The United States relocates people as family units… but often leaves behind a sibling who is as much in danger as they were. The special immigrant visas granted to Afghans who worked with the US military to emigrate include only immediate family members.

After living in war zones, and then perhaps for years in a camp, arriving refugees may have untreated injuries. “We saw a severely burned family,” Annamalai said. They required reconstructive surgery.

“Among Afghan refugees, because we’ve seen special immigrant visa holders… these tend to be a bit younger,” but they too are “vulnerable to the effects of trauma and physical injury,” he said. she declared.

Mental and emotional trauma can also be difficult for refugees. With people coming from the Democratic Republic of Congo, “sometimes we have people with more extensive trauma due to the level of violence there,” Annamalai said. Afghans, on the other hand, may “receive threatening letters or their homes are bombed or family members threatened that they will be injured,” she said.

Adult refugees arrive here with diseases that Americans also suffer from, including diabetes and high blood pressure, Annamalai said, but they can also have latent tuberculosis because “they were exposed at some point in their lives to tuberculosis but never received preventive treatment “. It can be treated with anti-tuberculosis drugs, she said.

“For people coming from the Democratic Republic of Congo and Sudan, some of the African countries, we tend to see more parasitic intestinal disease,” Annamalai said. One is lymphatic filariasis, also known as elephantiasis, which is caused by parasitic roundworms and spread by mosquitoes. It can cause severe swelling of the legs, depending on the World Health Organization.

Refugees also worry about whether they “are going to create a life here and become financially independent,” Annamalai said. “The adults come from a place of good professional standing in their country,” Annamalai said, noting that they can only get jobs as dishwashers or cooks here, “and especially if you’re not at least reasonably proficient in English is difficult. “

“Beyond the refugee program, I think the internal medical schools have been very active… reaching out to Afghan patients… even those who have been here for a while,” Annamalai said.

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