Health officials acted quickly as refugees came for meat jobs
By Mike Shields
Khi News Service
Published Sunday, November 25, 2007
EMPORIA — When hundreds of Somali refugees began showing up to work at the meatpacking plant, nurses Lori Torres and Renee Hively were among the first to get to know the exotic, new arrivals.
"We got notified a day in advance that 70 Somalis were being transferred from a (Tyson Foods) plant in Nebraska," Hively recalled. "That 70 soon grew into 400, seemingly overnight."
"We literally had droves in our waiting room, waiting to see a public health official," Torres said.
Torres is the case manager for about 160 Somalis in Emporia who have been diagnosed with latent tuberculosis. Hively is her supervisor at the Flint Hills Community Health Center, which also serves as the Lyon County public health department.
State health officials say the influx of refugees to Emporia could have produced a calamity. Instead, thanks in no small part to Torres and Hively, the situation has been a model for dealing with unforeseen circumstances.
"What could have been an ultimate public health crisis has really just been an increase in public health work," said Phil Griffin, director of tuberculosis control and prevention for the Kansas Department of Health and Environment.
Kansas usually has about 3,000 cases of latent tuberculosis a year. "Latent" means the disease isn't contagious and responds to medication. Tuberculosis is a bacterial infection that most commonly attacks the lungs. In its active state it is communicable and deadly.
It has been largely eradicated in the United States, western Europe and other developed regions. But it remains widespread in Africa and elsewhere around the globe, killing 1.5 million people in 2005, according to the World Health Organization.
Latent TB, if untreated, can become active TB.
Quick and flexible
Before the Somalis began arriving in Emporia, the local health department tracked about 30 latent cases a year. Now Torres manages about 200 cases, about 80 percent of which she said are afflicted Somalis. She also handles the cases of two patients with active TB, one of whom is Somali.
Griffin credits Torres, Hively and Flint Hills' leaders for their quickness and flexibility in dealing with the surge in tuberculosis cases that hit Lyon County with the arrival of the Somalis, many of whom had spent years in refugee camps before arriving in the United States.
Tyson requires its workers to have at least basic health insurance, so most of the Somalis in Emporia have health insurance, officials said.
Griffin said the number of tuberculosis cases reported in Kansas this year will increase from 8 percent to 10 percent attributable to what is happening in Lyon County. In 2006, about 60 percent of the state's tuberculosis cases were in foreign-born individuals, he said.
"The scenario that happened in Emporia has been somewhat unique in that it is refugee resettlement activity going on with a particularly large population moving in all at one time," Griffin said. "But that same scenario could happen anywhere in the state where there is a large employer with any number of refugee groups."
Griffin said health officials in Emporia are particularly praiseworthy because they immediately recognized there was a surge in tuberculosis cases, determined it was linked to the refugees, and took quick steps to meet their needs instead of sitting back and waiting for the Somalis to figure out how to cope in their new environment.
Most of the Somalis are young men who have spent most or all of their lives in refugee camps. Most have little or no formal education, and many arrived malnourished or with other health problems.
Griffin said Torres had done an extraordinary job gaining the trust of the Somalis, whose culture is conservative, Muslim and patriarchal.
Hively said when tuberculosis cases were less common, each of the department's nurses divided the case management responsibilities, but with the surge it was decided Torres would take them all, in essence creating a full-time tuberculosis nurse position.
They also persuaded the clinic's managers to hire a full-time Somali translator.
Jobs at Tyson
Chuck Torres, Lori's husband, was working as a health nurse at the Tyson Foods beef processing plant when the Somalis arrived. After years in refugee camps with limited skills and poor nutrition, many had trouble adjusting to the rigorous demands of meat plant work.
"Six-foot-one and 110 pounds," he said, describing some of the young men he saw for pre-employment exams. "They were not really physically wrong for the job, but sometimes they were a little slow to assimilate. I tried to caution them it was hard work. I can see why a lot would develop stress-related illness."
In February 2006, Tyson closed two of its plants in Nebraska. Among the nearly 1,700 affected workers were the Somali refugees who were offered replacement jobs at the Emporia plant.
In the decades since it was founded, Emporia, first because of the railroad and then because of its meat plant, has been a magnet for immigrants. Mexicans came for the railroad work and a couple of generations later new waves from Mexico, Central America and Southeast Asia came to work at the meat plant.
The Somalis are the most recent and perhaps most exotic wave for this city of about 25,000 people. Not everyone in Emporia has been welcoming. There have been incidents of vandalism and an armed robbery attempt at the Ayan Restaurant, a Somali-owned eatery that also serves as an informal community center for the refugees.
An article posted Nov. 3 on the Emporia Gazette Web site about a state grant to Catholic Community Services to help the Somalis settling in Emporia drew scores of angry, anonymous reader reactions, including this one:
"Emporia is going to be its own 3rd world country before long because of all the damn, bleeding hearts."
"They came post 9/11. They're black and they're Muslim," Hively said, describing some of the hostility demonstrated toward the Somalis. "Emporia didn't have many black people before. This is a small town."
Lori Torres and Hively are involved with the Emporia Refugee Resettlement Alliance, a group that includes representatives from Tyson Foods, the justice system, social service agencies and others working to ease the strains of the influx on the community and the Somalis.
The total Somali population in Emporia is thought to be between 750 and 1,000, and the expectation is that the number will continue to grow as word of jobs spreads to Somali enclaves in Utah, Minnesota, Maine and Ohio.
Somalia has been strife torn and more or less lawless since a civil war began in 1991. Thousands of Somalis fled to neighboring countries and many are still in refugee camps in Kenya.
SOURCE: Khi News,November 25, 2007