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Refugee illnesses often misdiagnosed in U.S.

Story Highlights

• Many refugee illnesses are not immediately recognized by U.S. doctors
• Parasites, hepatitis B, tuberculosis among common illnesses in relocated people
• Depression also often missed because patients don't talk about emotions
By Elizabeth Cohen
CNN
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ATLANTA, Georgia (CNN) -- Monykuch Deng is 5, but you'd never know it to look at him. In fact, he's the size of a 3-year-old.

As Monyjuch runs around his family's apartment outside Atlanta, Georgia, he's constantly hiking his pants up around his thin frame. Monykuch usually isn't very hungry and often skips dinner, his mom explains.

"He drink milk in small cup and not eat too much," said his mother, Rachel Bol. "When he eats he say, 'I have a bad stomach ache. My stomach is not OK.' "

For months after Monykuch's arrival last September from Sudan, doctors didn't recognize what was wrong with the exceptionally small, skinny child. Finally, a doctor accustomed to taking care of refugees figured it out: Monykuch was severely malnourished because of an intestinal parasite. (Video: Meet Monykuch and his doctor Video )

Dr. Carlos Franco, the doctor who made the diagnosis, says this isn't the first time he's caught a disease other doctors have missed.

"Not everyone is trained in these particular diseases in these particular populations," said Franco, assistant professor of medicine at Emory University School of Medicine.

As more and more refugees flee to the United States -- 20,000 had arrived this year through the end of May -- experts in refugee health care say U.S. doctors need to learn more about how to diagnose their often unique physical and emotional problems. (Interactive: The World's Refugee Crisis )

Franco said sometimes U.S. doctors also miss hepatitis B. Since children are vaccinated against the disease in the United States, doctors here aren't used to seeing it and often don't think to screen for it. Untreated hepatitis B can lead to cirrhosis of the liver and liver cancer.

Dr. Richard Adair, who treats about 1,000 refugees in Minnesota, added another disease to the list: tuberculosis. He said the disease often looks very different in young refugees.

"American doctors are used to seeing TB in older people, who acquired it when Franklin Roosevelt was president," said Adair, a clinical professor of internal medicine at the University of Minnesota. "In older people, it's a disease of the lungs....In younger people it can be in the lymph nodes, abdominal cavity and brain, so it's sometimes harder to recognize."

But refugee health experts said perhaps the most misdiagnosed illnesses are emotional ones. "TB and malaria are peanuts compared to the amount of chronic depression these people experience over time," said Dr. Richard F. Mollica, professor of psychiatry at Harvard Medical School and director of the Harvard Program in Refugee Trauma at Massachusetts General Hospital.

"Some refugees are tortured, some experience trauma," he said. "They had to give up everything to come to the U.S. They had to learn a language, get a job, and function in the U.S. The stress is enormous." (Impact Your World: How to help )

Mollica has followed refugee patients for 25 years, and found that these psychiatric issues become physical issues.

"Look at a study we did of Cambodians who settled in Long Beach, California. The rates of chronic depression 25 years later are 25 percent," he said. "People would say, 'Well of course -- these people lost their home. They had to flee to the U.S.' What's new is that we know it's killing people."

He said many studies have recently found a link between depression and heart disease, stroke, and diabetes. "I can list hundreds and hundreds of patients who have this problem," he said.

Catching depression early is crucial, but Mollica said many U.S. doctors miss it. He explained that while American patients may be well-versed in talking about their feelings, refugees often don't verbalize emotional issues and instead will tell their doctors about the physical manifestations of depression. "If a Cambodian says to me he has dizziness, headache, and extreme fatigue, that means to me they're seriously depressed," he said. "They're not going to walk in looking like the middle-class Caucasian person doctors are used to seeing,"

For now, Monykuch is on medication for the parasite, which is fairly easy to remedy once it's identified. However, the months before his illness was diagnosed have cost him precious developmental time. "If you take 10 months in the life of a child who is 5 years of age, those are 10 months that you would have had to promote better growth and better development," said Franco.

Elizabeth Cohen is a CNN Medical News correspondent.

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Monykuch Deng, 5, came to this country last year from Sudan. He's malnourished because of an intestinal parasite.

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