One of our readers sent this newsletter from the Minnesota Department of Health (see below) regarding their programs for refugees (all at taxpayer expense).
 I am combining this Minnesota Dept of Health newsletter with an article posted by Ann Corcoran from the Refugee Resettlement Watch
regarding the nearly 1/2 billion dollars from the U.S. Treasury that goes to federal refugee contractors each year.  One of the directors of the contractors earns a measly $700,000 per year.
Most of our families came to this country  when there were no programs for immigrants such as being offered today.  It was hard work and tireless sacrifices of families to become established in this country but it made our  families and this country strong.  Will we be able to say the same about  today’s refugees ?   Nancy

The following summary of the newsletter is from one of our readers.  

This little newsletter is chock full of eye opening facts.  Minnesota Dept of Health puts it out.
I will try to summarize:
  • Malaria outreach to those traveling abroad to go home (dangerous and in fear of their lives kind of home) . I don’t understand them visiting their friends and relatives back home.  Taking vacations back to where they were persecuted WHAT a FRAUD
  • Getting a Grant (tax payers)
  • to educate about Female Genital Mutilation and Prevention
  • Secondary Refugees moving from the place they were placed, to Minnesota ( I guess to be with more of their own )
  • Mental Health Screening done here in the States instead of BEFORE they are brought here
  • Spotlight on humanitarian Sarah Bluhm who moved from Chicago where she worked with Rohyinga, Congolese, and Iraqi, back to Minneapolis.
This program is way worse than even I thought.  Using more taxpayer money to educate refugees about things that are going to infect the long time clean health bill of most Americans. Malaria, FGM, mental illness etc.
And none of this is required- only offered.
God help us.

Minnesota Department of Health

Refugee and International Health Quarterly

View this as a webpage

April 19, 2018

Greetings from the Refugee and International Health Program

In this edition of our newsletter, we give an update on our mental health screening pilot project, with insights from Dr. Georgi Kroupin of HealthPartners Center for International Health. We share findings from a study, in which the MDH Refugee and International Health Program (RIHP) is a partner, on malaria awareness among people visiting friends and relatives abroad. We also highlight data on secondary refugee arrivals since 2010 and check in with Sarah Bluhm, the new Program Manager supervising Catholic Charities’ refugee resettlement program.

Earlier this year, we covered the female genital cutting (FGC) prevention project that MDH RIHP and partners are undertaking. One component of this project is a grant program for community-based organizations. Please see the grant announcement in this edition or the Minnesota Female Genital Cutting Prevention and Outreach Grant Program page and share the information with organizations that might be interested.

Community Outreach: Malaria Awareness Among People Visiting Friends and Relatives Abroad

People who travel abroad to visit friends and relatives (VFRs) often travel to high-risk destinations and may fail to seek pre-travel medical advice. However, few formal studies have assessed the barriers to seeking pre-travel care and perceptions of malaria risk among VFRs. MDH RIHP is a partner in the Malaria VFR project, which aimed to describe the knowledge, attitudes, and practices of West African VFRs traveling to malaria-endemic countries. 

We held eight focus groups with West African VFRs who live in the Minneapolis-St. Paul area and eight additional focus groups with West African VFRs who live in the Bronx, NYC. Our Community Advisory Board and partners reviewed the themes generated from the focus groups, to ensure we stayed true to the original intent of focus group participants’ statements. Ninety-two people joined the focus groups and represented recent travel to five West African countries.

Many focus group participants said they considered malaria as they prepared for travel, but described many barriers to pre-travel care and to implementing prevention strategies while abroad. Barriers included: 

  • The high cost of provider visits and malaria-prevention drugs
  • Challenges advocating for themselves in health care settings
  • Concerns about offending people abroad by insisting upon prevention practices that inconvenience local hosts

Cultural barriers to accessing care were also identified: 

  • Some participants lacked familiarity with the concept of preventive care (vs. symptomatic or acute care), and participants cited hesitation to ask health care providers for more information or explanation in pre- and post-travel settings.
  • Participants also expressed low confidence in U.S. providers due to experiences with missed diagnoses or a perception that U.S. providers lacked sufficient training to be a resource on malaria and other tropical diseases. 

These focus groups confirmed that barriers to adequate pre-travel care for VFR travelers to West Africa are multifaceted and extend beyond VFR travelers’ perception of the importance of malaria prevention. Interventions are currently taking shape, taking into account the role of health care providers (both pre- and post-travel) and the need to address system-level barriers to accessing care. Interventions will also build on community-based programs to support malaria prevention behaviors and offer culturally appropriate methods to encourage self-advocacy in health care settings.

Data: Secondary Refugees

Since starting the Secondary Refugee project in 2010, MDH RHP has been notified of 4,790 secondary refugee arrivals. The figure below describes the number of notifications MDH has received each year (blue bars), the number eligible for a health assessment (red bars), and the number who received a health assessment in Minnesota (green bars). Overall, 52% of secondary refugees were eligible for a health assessment in Minnesota, and 80% of those eligible received a health assessment.

The number of secondary refugee notifications to MDH peaked in 2015 (1,011) and fell to 551 in 2017, likely reflecting the lower volume of refugee arrivals nationally. Eighty-eight percent of all secondary refugee arrivals were Somali. The majority resided in Hennepin (39%), Stearns (18%), and Kandiyohi (17%) counties.

Figure describing total number of Secondary Refugee Notifications to MDH, number eligible for screening, and number screened in MN in 2010-2017.

Figure: Secondary Refugee Notifications to MDH, 2010-2017

Secondary refugees are individuals who initially settle in a state other than Minnesota but soon migrate to live in Minnesota. This migration can occur within days, weeks, months or a year of a refugee’s arrival to the U.S. Secondary refugees are eligible for a refugee health assessment if they have been in the U.S. less than one year and if they did not receive a health assessment in their primary state.

When local public health, a clinic, or a community-based organization is assisting a secondary refugee, they can complete a notification form and fax it to the MDH Refugee Health Program. (To request this notification form, send an email to The MDH RHP will then request the refugee’s overseas records, as well as domestic screening status and information, from the primary state, and forward that information to local public health.

Provider Update: Minnesota Mental Health Screening Pilot

Mental health screening belongs in the domestic Refugee Health Assessment, as a part of overall health and well-being for any person, and with special consideration for the challenges that refugees face from their initial flight to building a new life in Minnesota. MDH RIHP and partners have implemented a pilot screening process at four clinics, working toward an effective, standardized way to address mental health in refugee health screenings for adult primary refugees. For more information about the background and beginning of this pilot, please see the article in the January 2016 edition of the Refugee Health Quarterly.

Like other Minnesotans, people with refugee status may experience a range of mental health challenges. The goal of the Minnesota mental health screening pilot is to give health care providers an effective, brief and simple tool for connecting with patients and assessing whether their daily difficulties are related to mental health. The screening is designed to identify those who may be in need of assistance, with mental health needs that exceed their current coping abilities, regardless of the specific underlying mental health diagnosis.

In addition, it was important to build a set of questions that reflect experiences common for people from different cultures and are easy to translate into different languages. As Dr. Georgi Kroupin, Lead Mental Health Provider at pilot site HealthPartners Center for International Health, explains, “It really helps a lot to describe potential mental health problems in human terms, using lay language that represents patients’ experience, not clinicians’ academic training. The selected screening tool must be user-friendly for both providers and patients and facilitate the provider’s engagement with the patient.”

In this pilot phase, MDH RIHP is working with partners to finalize the screening questions. Currently, two similar but distinct sets of questions are in use. MDH RIHP and partners are working to understand which variation, or combination, best allows providers at diverse clinics throughout Minnesota to work with and address the needs of their refugee patients.

Two sets of mental health screening questions currently used in Minnesota pilot (note: differences are italicized)

Screening questions: HealthEast Roselawn, Hennepin County Public Health, and Olmsted County Public Health

In the past month, …

  1. Have you felt very sad?
  2. Have you been worrying/thinking too much?
  3. Have you had many bad dreams or nightmares?
  4. In the past month, have you avoided situations that remind you of the past? (PROMPT: Do you turn off the radio or TV if the program is disturbing?)
  5. Does any of the above stop you from doing things you need to do every day?

Screening questions: HealthPartners Center for International Health

In the past month, …

  1. Have you felt sad too much?
  2. Have you been worrying/thinking too much?
  3. Have you had sleep problems? If yes, have you had many bad dreams or nightmares?
  4. Have you had memory problems?
  5. Does any of the above stop you from doing things you need to do every day?

Since January 2016, 947 screening results have been sent to MDH RIHP from the pilot clinics, with 105 (11%) “positive” screening results; 55 (52%) of the 105 refugees accepted a referral for follow-up services.  

Through pilot clinic feedback, MDH RIHP has also refined the training and data collection processes. Generally, the screening is considered “positive” if the patient gives two “yes” responses. As with other health screenings, these results are evaluated in the full context and clinical judgment of the provider, so a provider may note potential mental health needs despite an otherwise “negative” screening result. MDH RIHP is tracking the frequency and context of these cases. Through this pilot, MDH RIHP supports partners in building on established mental health referral best practices within diverse Minnesotan contexts. 

This pilot supports the health of our newest Minnesotans. Our aim is to remove potential barriers keeping people with refugee status from contributing their best to their new communities, while improving providers’ and health systems’ capability in addressing mental health with any patient. Dr. Kroupin puts it this way: “The adopted screening process will be a success when providers see it as useful and manageable … when it helps them to see their patients as whole persons and to build better partnerships with their patients.”

LPH-Resettlement Agency Spotlight: Sarah Bluhm

photo of Sarah Bluhm

Sarah Bluhm is the new Program Manager supervising Catholic Charities’ refugee resettlement program. Sarah recently moved back to her hometown of Minneapolis after five years at Heartland Alliance in Chicago as the Supervisor of Refugee Resettlement Services.

“I’m thrilled to be back in the Twin Cities continuing to do work that I love. In Chicago, I had the opportunity to work closely with Rohingya, Iraqi, Syrian and Congolese community members, and helped supervise one of the only LGBTQ-oriented programs in the country. I am excited to work in the Twin Cities with the Somali and Karen communities. One of the challenges of my role involves navigating the services offered to refugees on a county-by-county basis. The populations we work with here are much less centralized than I was accustomed to in Chicago, where all of the services were centered in one county. 

I’m really grateful to see how welcoming and inclusive Minnesotans are towards our participants; it’s something people truly take a lot of civic pride in. I’m also learning to appreciate just how developed the health care support system in Minnesota is for refugees. Every touch point my participants have with the health care system, whether it’s finding a provider, or connecting them with an interpreter, it all feels so integrated, making it easier to connect participants to the care they require.”


Minnesota Female Genital Cutting Prevention and Outreach Grant Program

The Minnesota Department of Health will provide one-time grants to community-based organizations in Minnesota communities that are impacted by female genital cutting (FGC), supporting community-led efforts to educate and inform communities about the health risks and emotional trauma inflicted by FGC practices and the criminal penalties associated with FGC. Organizations may propose educational programs, media campaigns, community conversations, and/or other engagement efforts related to FGC prevention in their Minnesota communities.

Find the Request for Proposals (RFP), more information and FAQ here: Minnesota Female Genital Cutting Prevention and Outreach Grant Program

Deadline: Friday, April 27, 2018

Please share widely with anyone who may be interested. Thank you!

Image depicting 6 women of different cultures

Refugee Recognition Month 2018 Poster Contest

As part of Minnesota’s June Refugee Recognition Month, you are invited to help design the 2018 Refugee Recognition poster which will be displayed on the Department of Human Services (DHS) website during June. The DHS Resettlement Office is seeking young artists who can illustrate the “Courage and Hope” that it takes to start over in Minnesota by creating an image for the June poster design. 

Please submit an original picture or image of what Refugee courage and hope means to you. 

2018 Theme: Courage and Hope.

Deadline: May 4, 2018

Parameters: 11×8.5 size – landscape orientation 

Photos: 330 PPI high quality resolution 

Graphics: vector based, CNYK color mode 

Eligible artists: school aged young people up through high school. Preference given to artists who have had refugee status or are the children of refugees. 

Images can be scanned and sent to: Seble Doble,

Or mailed: ATTENTION Seble Doble, MN Dept. of Human Services, PO Box 64961, St. Paul, MN 55164-0951

Upcoming Events

North American Refugee Health Conference

Registration for the 2018 North American Refugee Health Conference (June 7-9 in Portland, OR) is open! 

View the agenda and register: Society of Refugee Healthcare Providers: 2018 North American Refugee Health Conference



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