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

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

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

Director: Robert A. Peterson Team: General Accounting Office: Human Resources Division Phone: (202) 275-6207