The growing numbers of Indochinese refugees streaming into California are straining the state's health and welfare services to the breaking point, and medical officials here say the danger of an epidemic among the refugees, and perhaps among the general population, is growing daily.
State figures show 83,000 refugees in California. Under an increased national quota of 14,000 a month, officials expect refugee numbers in the state to reach 200,000 by 1982.
The wave of refugees comes at a particularly difficult time for the state's welfare agencies, which are trying to retrench under the impact of Proposition 13. At the same time, the federal program that provides most of the general support for the new arrivals is to expire in September, and its replacement, if it passes Congress as proposed, would exclude many of those who already are here but still need assistance.
The problems generated by the new refugees, pouring in aboard commercial and chartered aircraft at a rate of as many as 2,000 a day, are more severe than those of the Indochinese who fled here after the fall of Saigon. Unlike the earlier arrivals, these people speak no English - in fact are generally illiterate in their own language - and have neither money nor skills to help them assimilate into the workforce.
But the most immediate problem is health.
San Francisco, whose statistics generally are regarded as the best, has found that among the refugees here:
70 percent carry intestinal parasites, some communicable through food or poor hygiene.
40 percent show positive reactions to tuberculosis tests, meaning they have been exposed and infected. Two percent have active TB.
25 percent of the adults have hypertension.
10 percent suffer from infectious skin ailments.
Half show some emotional problems, and one in 10 has a problem severe enough to interfere with normal adjustment.
There also have been four cases of leprosy, one of measles and one fatal case of diphtheria - a 3-year-old boy in Los Angeles.
And 90 percent have had no immunizations.
"I'm so f------ far behind," says Dr. Austin Brewin, TB control officer at San Francisco General Hospital, "that I wish Melvin Laird was here to help me see the light at the end of the tunnel. We're swamped."
Brewin calls his program "a sort of floating crap game - we go out and meet the people...with portable screening."
Brewin says his staff can keep up with TB exams so far, but "in terms of doing a general physical exam and giving immunization, we are completely overwhelmed."
"The risk to people in San Francisco of getting TB is quite small," says Brewin, "but if we let things go, the risk to the general population goes up to a perceptible level."
Persons with TB may be excluded from entering the country under Immigration and Naturalization Services (INS) guidelines, unless they have relatives or a sponsor here and pledge in writing to seek immediate treatment. Local health agencies then are notified of the TB case. The new immigrant then is responsible for finding his or her way to the right clinic. If not, the already strained health service must find the immigrant.
Says David Ilchert, director of INS in San Francisco:
"This is a problem for health officials. If they [refugees] have the proper waivers and satisfy the consul abroad, then they proceed to their destination here, and the casework is passed along."
But once the immigrant arrives, he said, "whether or not the local departments are able to take care of them speedily and properly is a health problem, not an immigration problem.... To say they're slipping through with horrible diseases is not true. Inability to treat them may be true, but to say they're walking in uncared for and unnoticed is a lot of bull----."
More careful screening at Malaysian camps could keep out many ailing refugees, but might result in death to many, particularly malnourished children.
According to Eileen Brown, director of Queen of Angels Clinic in Los Angeles, many refugees have survived for two years "eating rice husks - not the kernel, just the husk - and whatever they can get from banana trees, not including the bananas, which are long gone."
On the floor of the Travis Air Force Base refugee reception center, this reporter saw a fair-skinned, red-haired child, seemingly the offspring of a GI.
Told of this, Brown sat bolt upright. "That's not a GI child," she said. Malnourished children are pale, she said. "The children who are that malnourished have hair that turns a russet color. It's an indication of extreme malnutrition to the point of danger.
"How could they be screened out? They'd just starve to death a little faster."
Even when help is available, there is always red tape.
To get food to refugees, Brown must search for refrigerators, as California requires food stamp recipients to own one. "It's hard to keep rice in a refrigerator," says Brown, "and I'm sure they stand empty, but there you have it."
Many refugees also must be instructed not to burn firewood on top of the stove.
Transportation to the clinic, says Brown, is a major need. "They get sick at home and have no one to bring them here." Queen of Angels also must pay for printing medicine labels in six languages, one of the many hidden costs of assistance.
The health problems compound others.
Because they lack skills, refugees can find jobs in only a few fields, one of which is food service.
But parasites and skin infections, say Dr. Jeff Newman, "could be a problem in food preparation."
Newman, an epidemiologist, is chief of preventive and community medicine at the Public Health Service Hospital. "A very definite concern," he says, is typhoid fever.
"You could conceivably get a Typhoid Mary situation with a food carrier, but you can prevent that with good screening. Even food handlers with these parasites, if given proper washing instructions, would be a minimal risk of passing it along."
Newman says he has seen no evidence of typhoid fever at his clinic, but Beverlee Myers, state health services director, says cases of typhoid fever are up 92 percent in Los Angeles and 58 percent statewide.
Many of those who work with the refugees are bitter.
Dr. William Clark, a physician at the clinic, surveyed the jammed waiting room, where an unconscious woman with a malaria attack was being carried through.
"I'd hate to stick a finger on anyone in this whole thing," he says, "except the politicians who say "Bring 'em all in." It makes headlines, but they're a little chary on the finances."
His comment is echoed by William Montgomery, director of the Adult Program Management Board of the State Social Services.
"The federal approach could be characterized as picking them up and dumping them. Then they forget about 'em. The federal government has supplied the money, it's true, but when the government says it will cut the funds, that's an abandonment of the refugees' problems."
Officials here worry about secondary migration, the movement to California of refugees settled elsewhere under the government's dispersal attempts.
"California has more refugees than the next five states," says Montgomery. "Texas is number two, and we have three times more than Texas. The federal government has spread the load, but experience has shown that California, because of weather and to some extent benefit levels, is a prime candidate for secondary migration, which we can't measure very well. The State Department doesn't track them down."
The State Department's official position is that refugees, once here, have a right to live wherever they wish. However, both federal and state estimates indicate that 30 percent of all refugees will end up in California.
Most refugee assistance money has come through IRAP, the Indochinese Refugee Assistance Program, which expires Sept. 30. IRAP has paid 100 percent of many refugee costs for an indefinite period. Most administrators here say it takes four years for refugees to reach self-sufficiency.Federal officials say two years is more like it for most refugees.
An administration-backed bill introduced by Sen. Edward Kennedy (D-Mass.) would cut off special assistance to any refugee here more than two years. That would eliminate all who arrived before late 1977. After the two years, federal participation would drop to whatever percentage it contributes to each state for regular welfare programs, usually 50 percent.
The bill is part of an effort to create a consistent national policy for immigrants, but whether it extends more assistance to the Indochinese, as federal officials contend, or is a drop in benefits, as local officials claim, is like seeing the glass half full or half empty.
According to Margaret Carpenter, spokesman for Ambassador-at-large Dick Clark, U.S. coordinator for refugee affairs, the Kennedy bill represents continued assistance. Cutting benefits, he says, "is not the intention - the first two years of full benefits are an initial investment, then the funding grows to what every other American citizen gets."
John Fleming, legislative assistant to Sen. Alan Cranston (D-Calif.), counters: "This bill is a substantial cut to the state, and in L.A. County would result in over 80 percent of the refugees now getting full federal assistance being put on straight welfare - SSDI, AFDC, or general assistance."
In California, general assistance is wholly a county responsibility. Over all, says Fleming, "the bill would force 2,700 refugees off the federal rolls and cost $37 million for the state and counties to pick them up."
Cranston and Sen. S. I. Hayakawa (R-Calif.) have cosponsored an amendment that would keep many of the refugees on federal aid, at least until local officials have more opportunity to study the problem.
"Our point is that the Kennedy bill is premature," says Montgomery. "We don't know where the hell the thing is going. All we know is, we heard the president say, "Send in the U.S. Seventh Fleet and pick 'em up."
Carpenter calls the Indochinese resourceful people who will "take jobs in the paper that go begging every day." Nationwide, she says, 94 percent of the Indochinese work force is employed, although the immigrants may have large families and require supplemental health benefits.
Carpenter rankles at criticism of federal officials. "There are some problems," she admits, "but we're very involved in trying to find solutions. Some people in California are very impatient and they expect the government to solve their problems." CAPTION: Picture 1, A young mother and her child arrive at California's Travis Air Force Base, joining an immigrant flood that threatens to swamp the state's resources, AP; Picture 2, A physician examines a refugee at Los Angeles' Queen of Angels Clinic, AP