Title: Combating Migrant Health Disparities (submitted by: Elizabeth Ogunsanya)<br/>Author: Rachel Wiltjer<br/><a href='http://umem.org/profiles/resident/2046/'>[Click to email author]</a><hr/><p margin-bottom:="" margin-top:="" new="" style="color: rgb(0, 0, 0); font-size: medium; font-family: " times="">
Approximately 284,000 immigrants reside in Baltimore (10% of the total population). In April 2022, Governor Abbott of Texas began sending migrants from the US southern border to Washington, DC, with Arizona joining soon after. It is important for emergency providers to be aware of these changes and how new disparities may arise.</p>
<div color:="" margin:="" new="" padding:="" style="border: 0px; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-stretch: inherit; font-size: medium; line-height: inherit; font-family: " times="" vertical-align:="">
<span style="border: 0px; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: inherit;">1. Social Determinants of Health: A meta-analysis in 2018 suggests that Health literacy is a key determinant of health in refugee and migrant populations living in in high-income countries such as America. Using patient centered language and taking time to explain diagnoses are CRITICAL in caring for immigrant populations particularly in the ED. Use of appropriate language services are also important.</span></div>
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<div color:="" margin:="" new="" padding:="" style="border: 0px; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-stretch: inherit; font-size: medium; line-height: inherit; font-family: " times="" vertical-align:="">
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<span style="border: 0px; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: inherit;">2. Assess acute vs non-acute needs: A study done in pediatric migrant populations suggests that the severity of the reasons for visiting the ED and the hospitalization rates were not higher in the pediatric migrant population than in the general pediatric population. Some common non-urgent diagnoses include scabies, anemia, oral and dental disorders.</span></p>
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<span style="border: 0px; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: inherit;">3. Create a safe environment: In a study done in 2013, up to 12% of undocumented immigrants that presented to the ED expressed fear of discovery and consequent deportation. On further assessment there was the belief that medical staff are required to report these patients to immigration. It is important to proactively address inaccurate beliefs to promote a safe trusting environment.</span></p>
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<span style="border: 0px; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: inherit;">Resources in Baltimore/Maryland:</span></p>
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<span style="border: 0px; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: inherit;">-CASA</span></p>
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<span style="border: 0px; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: inherit;">-Esperanza Center</span></p>
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<span style="border: 0px; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: inherit;">-International Rescue Committee</span></p>
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<span style="border: 0px; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: inherit;">- John's Hopkins Centro Sol</span></p>
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<span style="border: 0px; font-style: inherit; font-variant: inherit; font-weight: inherit; font-stretch: inherit; line-height: inherit; font-family: inherit; margin: 0px; padding: 0px; vertical-align: baseline; color: inherit;">- National Immigration Law Center</span></p>
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<span style="color: rgb(0, 0, 0);">National Resources (US):</span></p>
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<span style="color: rgb(0, 0, 0);">-Rural Health Information Hub</span></p>
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<span style="color: rgb(0, 0, 0);">-National Resource Center for Refugees, Immigrants, and Migrants</span></p>
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<fieldset><legend>References</legend>
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<span font-size:="" new="" style="color: rgb(0, 0, 0); font-family: " times="">Mahmoud I, Eley R, Hou XY. Subjective reasons why immigrant patients attend the emergency department. BMC Emerg Med. 2015 Mar 28;15:4.</span></p>
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<span font-size:="" new="" style="color: rgb(0, 0, 0); font-family: " times="">Maldonado CZ, Rodriguez RM, Torres JR, Flores YS, Lovato LM. Fear of discovery among Latino immigrants presenting to the emergency department. Acad Emerg Med. 2013 Feb;20(2):155-61.</span></p>
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<span font-size:="" new="" style="color: rgb(0, 0, 0); font-family: " times="">Tarraf W, Vega W, González HM. Emergency department services use among immigrant and non-immigrant groups in the United States. J Immigr Minor Health. 2014 Aug;16(4):595-606.</span></p>
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<span font-size:="" new="" style="color: rgb(0, 0, 0); font-family: " times="">Zunino L, Colineaux H, Claudet I, Bréhin C. Description of a migrant pediatric population visiting the Toulouse Children's Hospital emergency department. Arch Pediatr. 2021 Oct;28(7):514-519.</span></div>
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