I created this presentation for the Special Medical Case Manager at Exodus Refugee to deliver to healthcare providers in Indianapolis in order to educate them on the refugee population.

2. Zaw Win Aung
Special Medical Case Manager
1125 Brookside Ave. Suite C9
Indianapolis IN 46202
317-921-0836
www.exodusrefugee.org

3. Presentation Title | Page 3Exodus Refugee The Life Ahead
Exodus Refugee Immigration works with refugees—worldwide
victims of persecution,injustice and war— to establish
self-sufficient lives in freedom and sanctuary for
themselves and their families in Indiana.
Mission Statement

4. Presentation Title | Page 4Exodus Refugee The Life Ahead
“a person who "owing to a well-founded fear
of being persecuted for reasons of race, religion,
nationality, membership of a particular social
group, or political opinion, is outside the country
of his nationality, and is unable to or, owing to
such fear, is unwilling to avail himself of
the protection of that country."
A REFUGEE IS…

5. Presentation Title | Page 5Exodus Refugee The Life Ahead
Resettlement
• Airport Pick-Up & Welcome
• Orientations
-Life in America, culture, apartment, safety
budget, employment, resettlement plan
• Services
- Welfare (within 7 days)
- Social security (10 days)
- Employment referral & English classes (10 days)
- School enrollment (30 days)
- Health screening & referral for treatment (30 days)
• Goals employment by 90 days,
self-sufficiency by 180

6. Presentation Title | Page 6Exodus Refugee The Life Ahead
Why Indiana?
• Welcoming Community
• Resources services, transportation
• Employment
• Cost of living
• Safety
• A future
Welcome to
the
Hoosier State Refugee Communities
• Experienced traumatic circumstances
• Loss of homeland, familiar
• Strong sense of community, ethnic and national pride
• Courageous, full of hope
• Strong sense of community
• Ethnic and national pride

7. Presentation Title | Page 7Exodus Refugee The Life Ahead
Refugee Contributions
• Food, art, ritual
• Diversity
• Language, religion
• Strong family values
• Community service
• Civic pride
• Consumers
• Industrious workforce
• Professionals in a variety of fields
• Generations of passionate, committed citizens

8. Presentation Title | Page 8Exodus Refugee The Life Ahead
Ethnicities Resettled 2013
Iraq, 22
Congo, 15
Bhutan, 14
Eritrea, 8
China, 7
Somalia, 3
Ethiopia, 2
Chin, 523
Karen, 71
Karenni, 16
Burmese, 14
Kachin, 11
Arkanese, 5
Mon, 4
Arakan, 1
90% from Burma, 73% Chin
71 of 716
individuals from
other countries

9. Presentation Title | Page 9Exodus Refugee The Life Ahead
Burma (Myanmar)

10. Presentation Title | Page 10Exodus Refugee The Life Ahead
The People of Burma
States
• Chin State
• Kachin State
• Kayin (Karen) State
• Kayah (Karenni)
State
• Mon State
• Rakhine (Arakan)
State
• Shan State

11. Presentation Title | Page 11Exodus Refugee The Life Ahead
Many Languages
• More than 100 dialects spoken in Burma
• Today, Burmese is the Official Language, English is secondary
• Burmese taught in schools in the major cities; Military Regime prohibits
education in ethnic dialects
• Usage of minority languages is
discouraged
• Other major languages spoken:
Shan3,200,000
Karen dialects2,600,000
Kachin900,000
Chin dialects780,000
Mon750,000
Rakhine730,000
Karenni/Kayah

12. Presentation Title | Page 12Exodus Refugee The Life Ahead
History of Burma
• 1948 Independence from British rule Democracy
• 1962 Military Rule
• 1962-1977 Student Protests
• 1988 Uprising-Security forces
massacred 1000s of students and protestors

13. Presentation Title | Page 13Exodus Refugee The Life Ahead
Why People are Fleeing Burma
• Forced labor
• Economic oppression
• Political suppression
• Racial discrimination
• Ethnic Fighting
• Religious persecutions
• Silencing those speaking
out against military rule
Chin State Flag Karen State Flag

14. Presentation Title | Page 14Exodus Refugee The Life Ahead
Fleeing Their Homeland
• Lives Threatened
• Forced to leave without warning
• Not able to bring much, sometimes just family and clothes on their backs
• Families may be separated
In danger along the way:
• Fleeing in the jungle
• Malaria
• Starvation

15. Presentation Title | Page 15Exodus Refugee The Life Ahead
Thailand Refugee Camps Refugees in Malaysia

16. Presentation Title | Page 16Exodus Refugee The Life Ahead
Life in a Refugee Camp
You are living outside of space and of time, you have no roots, you
have no past, you don’t know whether you have a future. You have
no rights, you have no voice, you have nothing to participate in, you
are not a citizen, you have no papers, sometimes you haven’t even
got your name. You have to pinch yourself to reassure yourself that,
yes, I am alive, I am me, I am a human being. I am a person.
• Strict rules
• Basic Health Care
• Basic Education
• Crime
• No citizenship
• Overcrowded & Under-supplied
• Exposed to disease
• Disabling – cooking, working
-VairaVike-Freiberga,Latvian president and former refugee

17. Presentation Title | Page 17Exodus Refugee The Life Ahead
Nel Plah’s Karen Story

18. Presentation Title | Page 18Exodus Refugee The Life Ahead
Overseas Medical Screening
U.S. State Department
Each person is rigorously screened
before released to come to the U.S.
Not cleared to travel until not a
threat to others
Classified as:
“A” immediate follow up required upon
arrival to the US
“B” may require follow up

19. Presentation Title | Page 19Exodus Refugee The Life Ahead
Health Screening Part 2: Indianapolis
• Marion County Refugee Clinic
• TB (skin test), Immunizations, Parasites, Hepatitis A,B,C,
Lead, Sickle Cell, Gen exam… etc.
• TB Suspects referred to TARC
• All referred to Primary Care

20. Presentation Title | Page 20Exodus Refugee The Life Ahead
Challenges:
Navigating the U.S. Healthcare System
• Language 100s of dialects
• Miscommunication
• Say “yes” when they do not understand
• Say what they think you want to hear out of respect & politeness
• Showing emotion may not be culturally appropriate
• Misunderstanding of medical advice
• Open-ended questions helpful
• System/ Insurance/ Transportation

21. Presentation Title | Page 21Exodus Refugee The Life Ahead
Cultural Differences
• Female/Male doctor & patient relationships
• Changes in diet are used to treat illness
• Disease caused by spirit/Nat/ancestor
• Betel Nuts use (seed of Betel Palm- Areca catechu)
• Yellow lotion/make up
• Pregnancy and Delivery Rituals
• Traditional Medicine Used in Burma
o Hot/Cold balance
o Herbs, Coining
o Lead and arsenic in child meds
• Breastfeeding
o Publicly
o Until child is 2 years old

22. Presentation Title | Page 22Exodus Refugee The Life Ahead
Health Statistics (WHO)
Total population (2012) 52,797,000
GDP per capita (current USD) $1144
Life expectancy at birth m/f (years, 2012) 64/68
Probability of dying under five (per 1 000
live births, 2012)
52
Probability of dying between 15 and 60
years m/f (per 1 000 population, 2012)
242/184
Total expenditure on health per capita (Intl
$, 2012)
25
Total expenditure on health as % of GDP
(2012)
1.8 (US- 17.9, Malaysia- 4, India- 4.1)

23. Presentation Title | Page 23Exodus Refugee The Life Ahead
Hospitals in Burma
Total Number of Hospitals 924
Total beds available 41,804
Patients admitted 1,324,979
Highest causes of death:
Pregnancy, child birth, puerperium 17.9%
Infectious and parasitic diseases 16.7%
Injury, poisoning, other externals 16.5%
Source: Ministry of Health 2011

25. Thank you!
Exodus Refugee Immigration
1125 Brookside Ave, Suite C9
Indianapolis, Indiana 46202
317.921.0836
exodusrefugee.org