Tuberculosis, hepatitis, internal parasites, malnutrition, anemia and dental problems are just a few of the illnesses Indochinese refugees brought to Northern Virginia on their flight to freedom.
So far these disease, quickly identified and treated by local health departments, have not posed any grave threat to the public health. But health officials are now worried about a related and potentially more troublesome problem: the costs of providing medical services for Indochinese refugees, who number 10,000 in Northern Virginia and are still arriving at a rate of about 150 families a month.
In seeking a solution to the problem, Arlington County Board Chairman Walter L. Frankland Jr. has asked the federal government to pay the county for refugee health service, which totaled $195,788 -- or 10 percent of the county health department budget -- in fiscal 1980.
Frankland, in a letter to Victor Palmieri, federal coordinator of refugee affairs, argued that the medical costs and other refugee services are the result of a national policy, and thus the federal government should aid local governments in providing these services.
"Those who have newly arrived in Arlington and those who are long-term residents must be provided necessary medical assistance as a protection to the community as a whole without jeopardizing the financial conditions of other programs," Frankland wrote in urging Palmieri to support the local pleas for financial help.
To find money in their budgets for the new expenses, Northern Virginia officials say, some local governments have been forced to reduce their staffs, which creates additional burdens for remaining staff members.
"We're straining, believe me," said Dr. Richard Miller, director of health services for Fairfax County and Northern Virginia director of the state health department. "We just keep moving people around, and so far we've been able to maintain the normal level of services for everyone, but we look at it as a potential problem."
Although Medicaid is supposed to pay some medical costs for eligible refugees, local officials say there have been some expensive loopholes in the system. Until two weeks ago, for example, Medicaid in Virginia did not pay for immunizations against communicable diseases or initial medical examinations of incoming refugees. Under new rules, Medicaid will provide some relief, although it does not fully cover the costs for those services. In Fairfax, for example, Medicaid will cover about $15 of the $111.43 bill for each screening exam performed by county health officials. Fairfax alone has spent $95,000 since last July for the tests.
These are precisely the medical costs that health officials expect will continue to strain their staffs and budgets. A recent survey by Dr. Raymond L. Schwartz, chief of Arlington's health service, identified a tuberculosis rate 18 times higher among Indochinese refugees than the indigenous population. Among Arlington refugees, 24 cases of tuberculosis were found in 1979, and that total may reach 64 in 1980, according to department projections.
The rising incidence of tuberculosis, a communicable disease, poses only "negilible" risks to the rest of the population because it is quickly identified in exams when the refugees arrive, said Schwartz.
Nevertheless, Schwartz said, just keeping up with the problem is straining county facilities, which can perform only 20 tuberculosis tests a week. Theoretically, persons with tuberculosis are not transferred from refugee camps until the disease is noncommunicable. But a slight error rate in the reading of chest X-rays in the camps has forced local health officials to conduct their own studies.
Beyond that, Schwartz' study revealed that 70 to 80 percent of the refugees in Arlington have intestinal parasites, as compared with less than 10 percent of the indigenous American population. The rate of Hepatitis-B carriers is thought to be about 15 percent versus the indigenous American level of about 3 percent, his record showed. These and other illnesses, such as certain skin infections like scabies and impetigo, are treated immediately because they are contagious.
Most dental services are not covered by Medicaid and become the financial responsibility of the refugees or their sponsors.
"They have horrendous dental problem," said Susanne Eisner of Indochinese Family Services. "Sometimes we will find a dentist who will work free, or the agency or family takes care of it . . . or it doesn't get done. The same thing happens among poor Americans. Dental care is something they often can't afford."
Doctors, however, are reluctant to provide free medical services to refugees, largely because they often are unable to communicate with those who don't speak English.
"A man came here very sick with dental problems," said Jackie Bong Wright, a refugee working with Indochinese Refugees Social Services in Alexandria. "The doctor gave him four kinds of pills to take at different times.He didn't understand and took them all at once, so he fainted.
"We don't like to go to the doctor," she explained. "Traditionally, when we don't feel well, we rub our skin and let it bleed. That's the best medicine for us. It gets out the evil. So even if we go to the doctor, we often don't take the pills he gives us right away."
Public health officials agreed with Wright that in this case, language is often as great a frustration as disease.
"Even in sign language, communication can be very deceptive," said Miller. "As a doctor, I'd hate like hell to communicate in sign language to try to solve a medical problem."
For that reason, everyone is crying for more translators. Title XX funds have been promised for interpreter services but as yet are undelivered, apparently because of red tape at the federal level, Northern Virginia health officials say. The problem could become worse, they say, since many of the newer refugees are not as well educated as earlier arrivals.
Wright says her agency is doing its best to keep up with the demand for translators, but sometimes the problem is met only on an emergency basis.
I took a family to the doctor for checkups," Wright recalled. "The year-and-a-half-old baby had to be hospitalized immediately with skin and stomach infections. When we got to the children's ward in the hospital, the nurse wouldn't let the mother -- who had been breast-feeding her baby -- stay with her.
"The child was terrified. The mother cried a lot. The nurse said it wasn't possible to change the rules. Finally, I convinced her. What we are also talking about here are cultural problems."