Improved Overseas Medical Examinations Can Reduce Diseases in Indochinese Refugees Entering the United States

HRD-82-65: Published: Aug 5, 1982. Publicly Released: Aug 25, 1982.

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GAO was asked to evaluate both the medical procedures which were used to screen Indochinese refugees overseas and the followup procedures which were practiced in the United States to determine if those procedures were adequate for protecting the public health.

GAO found that many refugees were detained in overseas camps because they did not meet medical eligibility requirements. These requirements were relaxed in 1980 and refugees were routinely granted medical waivers; however, they were to receive followup care by health departments once in the United States. The incidence of serious and contagious diseases in the refugee population, including tuberculosis, hepatitis B, malaria, and leprosy, greatly exceeds that found in the general U.S. population. Although the Department of Health and Human Services (HHS) maintains that there is no public health problem, it has encouraged health departments to make special efforts to monitor refugees. State and local health departments have said that the refugees' health problems could be controlled if there were adequate funding; but they have also stated that providing services to the refugees hindered services to the general population. The refugees' medical examinations that were conducted overseas were not adequate to detect and treat certain health conditions and did not conform with standard American medical procedures. As a result, serious contagious diseases and other medical problems were not detected. These problems become difficult to handle once the refugees are dispersed into the general U.S. population. Further, the decisions to admit refugees were made before the medical examinations were performed. GAO believes that the overseas examinations and treatment procedures should be improved to preclude many of the difficulties in dealing with the refugees' health problems.

Recommendations for Executive Action

  1. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Attorney General should: (1) not admit refugees into the United States until they have received a thorough medical examination to diagnose health conditions specified in the Immigration and Nationality Act; (2) require that the results of medical examinations be used in making final determinations concerning the eligibility of refugees for admission; (3) not admit refugees with active tuberculosis, infectious leprosy, amebiasis, giardiasis, and malaria until treatment for these diseases has been completed, unless compelling reasons exist to justify a medical waiver.

    Agency Affected: Department of Justice

  2. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information..

    Recommendation: The Secretary, HHS, and the Secretary of State should require that the results of overseas medical examinations be provided to Immigration and Naturalization Service (INS) officials for use in the final INS determinations of eligibility of refugees for entry into the United States.

    Agency Affected: Department of Health and Human Services

  3. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary, HHS, and the Secretary of State should require that the results of overseas medical examinations be provided to Immigration and Naturalization Service (INS) officials for use in the final INS determinations of eligibility of refugees for entry into the United States.

    Agency Affected: Department of State

  4. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary, HHS, and the Secretary of State should ensure that medical records are developed and maintained while refugees in overseas camps are under the care of the United Nations High Commissioner for Refugees and are transferred to the overseas physicians before they perform the medical admissions examinations.

    Agency Affected: Department of Health and Human Services

  5. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary, HHS, and the Secretary of State should ensure that medical records are developed and maintained while refugees in overseas camps are under the care of the United Nations High Commissioner for Refugees and are transferred to the overseas physicians before they perform the medical admissions examinations.

    Agency Affected: Department of State

  6. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary, HHS, should transmit to the State or local health department at the refugee's destination all pertinent medical information available on the refugee.

    Agency Affected: Department of Health and Human Services

  7. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary, HHS, should require that treatment be initiated and completed in Southeast Asia for refugees with active tuberculosis, malaria, amebiasis, or giardiasis before they are cleared to enter the United States. In the case of leprosy, the treatment should be sufficient to render the patient noninfectious.

    Agency Affected: Department of Health and Human Services

  8. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary, HHS, should require that all refugees under age 15 be tested for tuberculosis because of the high incidence of tuberculosis in refugees under age 15 and the significant number of cases undetected overseas in this group.

    Agency Affected: Department of Health and Human Services

  9. Status: Closed - Implemented

    Comments: Please call 202/512-6100 for information.

    Recommendation: The Secretary, HHS, should arrange with the Secretary of State to change the procedures for giving overseas medical examinations to Indochinese refugees destined for the United States and request that a medical history and examination for each refugee be performed by a physician using medical procedures commonly used in the United States. This examination should include: (1) an examination for diseases commonly found in Southeast Asia, including tuberculosis, leprosy, parasites, hepatitis B, and malaria; the examination for tuberculosis should include analyses of sputum cultures to further verify the presence or absence of the disease; (2) an evaluation for mental illness; and (3) an examination of body systems to help the physician determine if the refugee is suffering from a health problem which may affect his or her ability to earn a living in the United States.

    Agency Affected: Department of Health and Human Services

 

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