Medical Screening and Treatment of Indochinese Refugees

GAO discussed the adequacy of medical screening and the treatment of health problems for Indochinese refugees before they depart for, and after they arrive in, the United States. The information obtained to date raises serious questions as to whether appropriate attention is being given to potential public health problems posed by the large influx of Indochinese refugees. GAO concerns centered on whether: (1) the types of medical tests used overseas were reliable enough to insure that refugees with serious infectious diseases and other health problems were identified, and (2) adequate mechanisms exist to insure that those refugees with identified health problems receive the necessary treatment before they depart for the United States and after they have arrived. Health officials have expressed concern to GAO about the increase in tuberculosis and other infectious diseases that they are experiencing with refugees. In its review, GAO questioned whether the medical screening of Indochinese refugees overseas adequately identifies those with health problems that could adversely affect U.S. citizens. GAO observed the screening process at selected locations in the Far East and interviewed various officials involved in the refugee program. GAO questioned whether the methods used for detecting and treating refugees with tuberculosis are adequate to prevent the admission of refugees with active, infectious tuberculosis. Sputum smears which were performed on refugees whose x-rays indicate some suspicion of tuberculosis constituted the only method being used to determine whether the disease is infectious. The adequacy and reliability of this method was contested by several health officials. GAO also found that, under the overseas medical screening process, refugees may enter the United States with other diseases and health problems that are not detected or known to U.S. officials. The procedures used do not appear to be adequate to detect refugees with contagious diseases, such as malaria, hepatitis, or parasitic infestations. In addition, the procedures may not identify refugees with problems such as mental illness, mental retardation, alcohol and drug addiction, and many other health defects which could affect the ability of a refugee to earn a living. GAO believes that a reexamination of this country's policies and procedures is necessary. The Federal Government should take all reasonable steps to protect the public health consistent with its humanitarian obligatio