Refugee Health 2 Week Rotation Curriculum
Phoenix AZ

Updated 3/27/17

Objectives : total 6-8d of activities
- 2 week refugee health training for physicians
- Learn about the refugee experience
- Learn about common and key medical diagnosis
- Rotate through Refugee Pediatric / OBGYN / Dept of Health Clinics
- Accompany refugee re-settlement case managers
- Learn about Community Health Workers, Social Entrepreneurship

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Module 1 : Refugee Experience & Global Migration
1/2d self-study + 1/2d with CM doing new arrivals + 1/2d with CM on routine cases

Refugee Experience
-
Refugee Camps MSF Team Sudanese Refugee Camp; NPR 30 min audio
- Muslim Refugees General Background : Muslim Refugees Primer General
- WW2 European Refugees to Palestine & Syria
- Cultural Orientation Resource Center : see list of background profiles of refugee populations
- Afghanistan : Cultural Orientation Resource Center : Afghanis
- Iraq : Cultural Orientation Resource Center : Iraqi
- Syria : Cultural Orientation Resource Center : Syrians
- Burma (Myanmar) :  Cultural Orientation Resource Center : Burmese
- Inside Burma: Land of Fear (Part 1 of 5)
- Refugees from Burma : Their Backgrounds and Refugee Experiences
- Congo: A Migration History Marked by Crises and Restrictions;
- Congo and Africa's World War: Crash Course World History 221
- Sudan : Understanding Darfur

Global Trends in Migration
-
Migration Policy Institute : Refugees & Asylees in the USA; 10/2015  general review of data
- IRIN News : Migration Trends to Watch in 2017
- The Great Global Migration: Beyond the Refugee Crisis 60 min

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Module 2 : Initial Health Services
1/2 day self-study + 1/2 day at Dept of Health Refugee Clinic


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Module 3 : Community Health
1/2 day self-study

Community Health Workers
-
CHW - Brazilian Family Health Strategy (20min)
- The Role of the CHW; University of Vermont (1hr; power-point)
- Partners in Health (PIH) CHW Program Kit (OPTIONAL)

Social Entrepreneurship
-
The Meaning of Social Entrepreneurship; J. Gregory Dees, Duke
- PBS New Heroes ; 4x 55 min videos; (watch 1)
- Riders for Health : 8min ; example of social entrepreneurship; solving a key problem in healthcare with for-profit model.
- PBS Frontline World - Social Entrepreneurs; short video profile many enterprises.

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Module 4 : General Refugee Medicine
1 day self-study + 1-2 x 1/2 days refugee clinic

Barriers to Care
-
Healthcare Barriers of Refugees Post-Resettlement

Overview
-
Refugee Health Technical Assistance / Health Conditions  : introductory short articles reviewing chronic, infectious, women's health. Good primer with comments from refugee health standpoint.
- RHTA : Acculturation & Preventative Health
- RHTA : Dental Health ; Betel nut chew

Vaccine Guidelines -
-
CDC Domestic Vaccine Guidelines
    • - See FMC Adult Catch-up Vaccine Schedule (in folder, ask Rawan)

Key Medical Topics
Complaints and differentials are slightly different in refugee population. The standard protocols used in clinic should modified; ex. much low threshold for h.pylori testing or atypical presentations of depression or PTSD. Review either the linked articles or read corresponding chapters in the textbook; Refugee Health Care: An Essential Medical Guide.

- Constipation - common cause of abdominal pain both adult & peds
- Infectious Disease in Refugees & Immigrants (PPT); 67 slides, review many abnormalities and cases.
- Dyspepsia  / h.pylori ; AAFP Update on Functional Dyspepsia
- STD : Minn Dept of Health / STD Quick guide
- TB : Minn Dept of Health / TB Quick guide
- Malaria : Minn Dept of Health Quick Guide
- Parasite : Minn Dept of Health Quick Guide
- Cancer Screening : CDC Recommendations
- CBC Abnormalities : CDC Recommendations for f/u  (common issue!)
> Neutropenia : see uptodate topic / note Benign Ethnic Neutropenia
> Eosinophilia :
RHTA / Dr. W. Stauffer - eosinophilia
- Derm : Johns Hopkins Bloomberg Public Health PPT
- Female Genital Cutting : CDC Recs, MIHS / Dr. Crista Johnson is recognized as expert in this topic
- Mental Health : Minn Dept of Health Quick Guide
- U of Minnesota Quick Guides for with topics in TB / Immunizations / Hep B / STDs / Parasites / Malaria / Lead Screening / Mental Health
- Refugee Pediatrics Dr. Melissa Moore, U of Arizona COM Pediatrics, Pediatric Refugee Healthcare Essentials pdf

- (optional)
: Read “Indigenous Theories of Contagious Disease”
-
(optional) University of Minnesota (optional) : Introduction to Immigration & Refugee Health Course; 7hr webcourse, FREE
A.  The L.E.A.R.N. Model
B.  Effective Communication Across Language and Culture
C.  Ten Myths About Immigration (PDF)
D.  Best Practices in Immigrant and Refugee Health
E.  Domestic Screening Guidelines
F.  Immunization Issues in Immigrants and Refugees
G.  Mental Health in Resettlement and Adjustment
H.  Torture Survivors: Screening, Assessment and Referral
 
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Module 5 : Refugee Psych
1/2 day self-study

-
Common Mental Health Problems in Immigrants & Refugees : General Approach in Primary Care; CMAJ. 2011 Sep 6; 183(12): E959–E967.
-
CDC Recommendation on Mental Health Screening in Refugees
-
Screening for Emotional Distress & Mental Health
- RHS-15; Refugee Health Screener - 15. General screening tool for mental / emotional dx in refugees. RHS-15
-
Mental Illness among Trauma-Affected Populations; Bloomberg School of Public Health
-
Addressing Mental Health, PTSD, and Suicide in Refugee Communities; mental health talk; 54min; Gulf Coast Jewish Family Services
-
Somatization in Refugees; Yale School of Medicine

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Module 6 : Outside Learning
1-2 x 1/2 days in each clinic.

- MIHS Refugee Pediatric Clinic :
Dr. Mike Do, MIHS Pediatrics
- MIHS Refugee Women’s Clinic :
Dr. Crista Johnson, OBGYN
- Ardas Clinic :
Optional : Dr. PJ Parmar; Private FM Refugee Clinic in Denver; may contact to learn his clinic & care model (30min-1hr; teleconference)