The refugee medical exam: What you need to do

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Applied Evidence

The refugee medical exam: What you need to do

J Fam Pract. 2012 December;61(12):E1-E10

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References

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TABLE 4
Summary recommendations for the domestic refugee medical exam

History Obtain and review predeparture treatment and medical evaluation Encourage sharing of personal narrative (ie, ask about country of origin, countries since fleeing, time in refugee camp, history of torture, “How did you become a refugee?”) Perform a review of systems, focusing on infectious diseases and mental health Ask about use of traditional medications or healing practices
Physical exam In addition to the essential components of the physical exam, pay attention to: Blood pressure Body mass index Infectious disease: pallor, splenomegaly, jaundice Skin: burns, scars, or other signs of trauma or ritual scarification Genitourinary: female circumcision Dental condition: caries, missing teeth, gingivitis, betel nut use Eyes: undiagnosed vision problems
Initial laboratory evaluation CBC with differential Basic metabolic panel (adults only) IGRA testing (or TST if <5 y old) Stool culture (first of 2) Hepatitis B serologies (HBsAg, HBsAb, HBcAb) HIV 1 and 2 antibodies Lead (if ≤16 y old) Titers (adults only): varicella, MMR, hepatitis B Optional: Urinalysis (if concern for Schistosomiasis), thick-and-thin blood smear (if concern for malaria)
Ongoing care Include: An introduction to the US health care system Immunizations Sex and age-based cancer screening (eg, mammogram, Pap smear) Chronic disease diagnosis and management Additional routine preventive health measures, including counseling on tobacco and alcohol use
CBC, complete blood count; HIV, human immunode"ciency virus; IGRA, interferon-gamma release assay; MMR, measles, mumps, rubella; TST, tuberculin skin testing. Adapted from: Centers for Disease Control and Prevention. Immigrant and Refugee Health: Guidelines for the US Domestic Medical Examination for Newly Arriving Refugees. Available at: http://www.cdc.gov/immigrantrefugeehealth/guidelines/domestic/domestic-guidelines.html. Accessed November 19, 2012.

Ongoing study is essential to better address the health care needs of refugees. Although they comprise only a small segment of immigrants living in the United States, the experience of caring for them may help develop models to provide better care to other foreign-born patients.

CORRESPONDENCE Marc Altshuler, MD, Department of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University, 833 Chestnut Street, Suite 301, Philadelphia, PA 19107; marc.altshuler@jefferson.edu