Hi PPMC team!
Thanks for allowing me to pinch hit for Amy on a very snowy day! We were able to cover a LOT of ground — from the global refugee crisis and how the changes to the US policies regarding refugees impacts those attempting to come to this country to some interesting cases and common diseases seen among our refugee population.
As discussed, currently we have a record high share of individuals who are displaced from their homes. This is thought secondary to the number of conflicts, the extended duration of conflicts, and the fact that there are few long term solutions which means more people are in limbo.
We reviewed that while the number of refugees that have entered the US have waxed and waned over the years, until this year, we admitted individuals in proportion to the number displaced internationally. In fact, 2017 is the first year in which the United States decreased the number of refugees accepted into the country while the numbers of displaced individuals continued to climb. The Pew Research group notes that as of Oct 2017 only 28,000 refugees had been resettled in the U.S. which is far less than in 2016 where approximately 98,000 had been resettled. This is on track to accept just 0.2% of the world’s refugee population — which is much less than the historic average of 0.6% and even lower than the share admitted in 2001 and 2002 following the September 11th attacks (2). Even looking ahead to 2018, the Trump administration has proposed decreasing the refugee resettlement cap to 45,000 — down from 50,000 (2).
Additionally we covered several cases from our Refugee Clinic at Penn Center for Primary Care. We discussed the routine screening and testing performed in the clinic which is specific to the individual’s country of origin and then areas in which the lived in refugee camps.
We discussed the extremely common diagnosis of schistosomiasis and the international push to screen and treat everyone, especially young women — in an attempt to preserve fertility (4).
We also discussed Polio and the sequelae of prior infection. In addition to recognizing common complications of prior Polio infection, we discussed who needs boosters of their polio vaccine prior to travel — it’s approximately 25 countries — Not just the three with endemic Polio (Afghanistan, Pakistan, Nigeria)!
Lastly we discussed some complications of long term malnutrition including rickets. We discussed both Calcipenic Rickets and Phosphopenic Rickets and their respective lab abnormalities. Our patient likely had phosphopenic rickets based on lab findings, which in the US is most commonly secondary to renal wasting diseases or other genetic abnormality. However, in our Bhutanese refugee, her story lined up well for nutritional deficit which corrected with appropriate diet/supplementation.
- WHO Department of control of neglected tropical diseases. Female Genital Schisosomiasis. http://www.who.int/schistosomiasis/en/