No matter where you fall on the debate of whether we should allow immigrants into the country, they are here and need medical care just like anyone else. When any human steps into our exam rooms seeking medical care, it does not matter where they came from; we took an oath to treat all. That being said, recent immigrants have unique issues that physicians need to address.
What are some special considerations when treating immigrants?
Human Trafficking
When people think of human trafficking, they often think of the sex workers industry, but people are trafficked for many reasons: construction crews, farmhands, maid service, etc. We need to look for red flags. Are they always here with another person who does not allow them to speak? Do they have freedom of movement, meaning they can come and go as they please, or are they restricted to certain housing situations? Do they control their travel documents or is someone else holding them for safe keeping (ie, control)? Do they work long hours for little pay with little time off and no options to leave or refuse extra hours? These are all common situations for trafficking victims. We need to be on alert and realize this does not just happen in big cities.
PTSD
Studies show refugees and immigrants suffer high rates of PTSD and other mental health disorders. We need to discuss these issues with our patients to provide the treatment they may need.
Vaccine Status
Most countries have similar vaccine schedules. However, we will not know what vaccines an individual patient received unless we see the actual record. These records are often in different languages that require accurate translation. We cannot guess or say “something looks like” a certain vaccine. We need to be certain. Also, many countries vaccinate children with bacille Calmette-Guerin vaccine, and as a result, these patients will have positive purified protein derivative. If possible, we should use alternative screening methods.
Infectious Disease
People arriving from other countries may be carrying infections that we do not see often in the US. A patient with a fever coming from outside the US may have exposure to types of infections that what we are not used to seeing: typhoid, malaria, Dengue fever, etc. While the most common diseases (ie, COVID, influenza, or the common cold) remain the most likely cause of illness, physicians need an index of suspicion for other disease that are endemic in the region the patient comes from.
Cultural Differences
Distinct cultures promote different beliefs. Some people believe in more natural healing, while others deny the existence of mental health disease. We need to respect their beliefs but also educate them on proven science.
Language Barriers
If our patients do not understand what advise them, it is not going to help them. Fortunately, physicians have tools at their disposal. For example, translation apps work with most common languages, and many hospitals offer translation services via phone.
Lack of Resources
Many immigrants arrive in the US with few resources. We need to be sure they are getting adequate nutrition and, if not, connect them with social services who may be able to help them.
I practice in an area where there is a high population of immigrants from South America, the Middle East, and Eastern Europe. While these patients may have many cultural differences, they are all human. It is our calling to recognize the human needs inside the individuals that we care for.
