More than 700 Asian refugees have gone through a special screening clinic -- the first of its kind in Maryland -- set up 17 months ago in cooperation with the Montgomery County Health Department at Holy Cross Hospital in Silver Spring.
The clinic, open Tuesdays and Fridays, gives Asian refugees the medical screening required by immigration law and provides inoculations for children.
The county and the hospital entered into the joint venture after the county found it had neither the money nor the space to care for the political refugees at its five regular public clinics, Holy Cross spokesman Thomas Burke said. Other jurisdictions in the Washington area have screened refugees only at public health facilities.
Immigration law bars entry to refugees and other immigrants suffering from contagious diseases that pose a threat to the American population. The federal government requires refugees to have medical records from overseas reprocessing centers that say they are free of any communicable disease, a Maryland health official said.
Waivers are granted only if refugees already are receiving treatment for diseases and only with the condition they will get follow-up care at a clinic, such as the one at Holy Cross.
Because of poor health standards in Southeast Asia, said Edith Wilson, refugee health coordinator for Maryland, the Centers for Disease Control require local health agencies to screen all Asian refugees. Political refugees from other parts of the world are offered the screening but are not required to go through it, Wilson said.
Roy Lindgren, director of county family health services, said Montgomery contributes an estimated $10,000 a year to the clinic. Burke said that in the fiscal year ended in May the hospital spent about $42,900 on 800 visits by refugees, many of whom made repeated visits to the facility near Montgomery Hills. Medicaid reimbursed the hospital for a small amount of the cost, he said.
The clinic tests the new arrivals -- all of whom are sponsored by churches or relief agencies -- for tuberculosis, malaria, hepatitis, intestinal parasites and skin diseases. But beyond the medical attention they receive, refugees interviewed indicated they find emotional support there. For many, they said, it provides the first sympathetic ear in the United States.
Sam Nang Ngo, the clinic's Cambodian translator, said that, as a political refugee herself, she knows how confusing life in America can be to new arrivals. Not knowing how to use the phone, for example, kept one woman from getting an ambulance to pick up a sick child, Ngo said. Other refugees miss clinic appointments because they cannot unscramble the bus system, she said.
Margaret Lutkoski, a registered nurse who oversees clinic operations, said she knew of a Cambodian woman who fried fish in Ajax because "in their country, everything in a container is food."
Ngo, Vietnamese translator Thu Tran and Lutkoski said they often get calls at home from refugees in trouble or just seeking directions to the nearest Asian food market. Others need help with doctors or dentists they are visiting for follow-up work.
"Bad teeth is a very, very big problem," Lutkoski said, as is finding private doctors and dentists willing to see patients who are the bearers of a Medicaid card or who have a past history of hepatitis.
"We now have a list of 10 or 12 doctors who will take referrals," Tran said. But often, she added, the new arrivals get lost on their way to first appointments.
A refugee's first two visits to the Holy Cross clinic include an interview with the translator and tests for tuberculosis and childhood diseases as well as a complete blood count, Lutkoski said. Many refugees arrive with no medical records, she said.
During the third and typically final visit, each patient is given a complete physical examination. "The test results are gone over and immediate treatment prescribed," said Dan C. Bui, who, along with Eve Kimball, is a volunteer physician at the clinic. "I'm a 'boat people,' too, and I know how surprised and happy they are to see an Oriental face in the clinic."
The screening clinic represents a small "epidemiological island" in the midst of a country largely free of the diseases flagged and treated there, and as such, the patients are of some interest to the National Institutes of Health, said Franklin A. Neva, chief of parasitical diseases at NIH. Neva's staff has seen more than 130 refugees from the clinic, he said.
"We are interested in certain parasitic diseases and so we do simple studies while we are treating the patients," Neva said.
Of particular relevance to the U.S. population is a recent discovery that a significant number of American prisoners at Asian camps during World War II still carry an intestinal parasite they acquired there. It is common among the refugees seen at Holy Cross, he said, adding there are often no symptoms other than general fatigue.
"Just because refugees have infections that we consider exotic or unusual does not mean that people in this country are free of the same infection," Neva said. "The polio virus was transmitted the same way. So whatever we learn can be generally applied."