Clearing an Immigration medical examination for getting green card for United States is one big challenge that many immigrants face. There are several tests one needs to undergo before they can apply their application for further process. And an important immigration related medical screening is for Syphilis, a Sexually transmitted disease.
What is Syphilis?
Syphilis is caused by a bacterial spirochete Treponema pallidum. A spirochete is a thin spiral or coil-shaped bacterium that enters the body through the mucous membranes or breaks in the skin. It is transmitted sexually or vertically (from mother to child). In 90% of cases, the spirochete is transmitted by sexual contact.
Under Sexually transmitted syphilis there are
Primary Syphilis:
- The infection goes unnoticed when the organism enters the body.
After a gestation period of 10 – 90 days, a small painless pustule on the skin can be noticed. Usually it erodes forming a painless bloodless ulcer called Chancre is visible. The disease may resolve within a few days or the fluid that swarms with spirochetes may result being highly contagious.
- Secondary Syphilis:
Secondary syphilis are seen anywhere between six to eight weeks and six months after the infection begins.
- It is a systemic infection marked by the eruption of skin rashes and ulcers in the mucous membranes which is characterized by general malaise, anorexia, nausea, fever, headache, alopecia, bone and joint pain, or the appearance of a morbilliform rash that does not itch, flat white sores in the oral cavity and throat, and condylomata lata papules on the moist areas of the skin.
- The disease appears with a coppery color having no pain or itching, occurs on the palms of the hands and soles of feet. This is highly contagious during this stage.
Latent Syphilis
- Patient has no clinical signs or symptoms of the disease being present. It is usually discovered by serologic tests
Tertiary Syphilis
- Untreated syphilis usually occur in about 35-40% of patients anywhere between 1-30 years after infection.
- This is characterized by neurological, cardiovascular or gummatous complications.
Vertically transmitted syphilis
Congenital syphilis:
- This is usually transmitted prenatally by the mother to the fetus ( around 50% of infants are affected)
- This leads to Hutchinson’s incisors, mulberry molars, or rhagades
- Causes stillbirth in about 30% of infected mothers
- Symptomatic neurosyphilis occurs in 1-5% of these children, often characterized by sudden deafness (usually around 8-10 years or age) and/or interstitial keratitis or chorioretinitis.
Diagnosis
- Detection of syphilis is often delayed because of the varying length of the incubation period, and the possibility of not noticing at the initial chancre stage.
- Doctor can detect the possibility of the disease while taking the patient’s history, to determine if the patient falls into high risk based on their recent sexual contacts.
- Other symptoms, such as skin rashes or swollen lymph nodes, are also noted with respect to the dates of the patient’s sexual contacts.
- Only by a thorough diagnosis based on blood test will prove if the disease is positive or negative.
Blood tests
- Non-treponemal tests are serological tests that detect lipoidal substances released from cells during syphilis infection. These tests usually correlate with disease activity and become negative after adequate treatment.
- Treponemal tests are serological tests that detect syphilis antigens. These tests are generally more specific and less sensitive than non-treponemal tests.
- Darkfield microscopy can be used to visualise treponemes from a primary chancre or nasal secretions. Failure to identify treponemes does not exclude a syphilis diagnosis.
- Syphilis PCR can be performed on swabs from a primary chancre, nasal secretions or CSF. It is not adequately sensitive for screening (e.g. to blood)
- CSF should be collected for VDRL, FTA-Abs or PCR testing where neurosyphilis is suspected.
- What if the applicant has/ had syphilis?
- The form I-693 has check box which says no A or B condition exists and also Class A condition and Class B condition. Applicants with untreated syphilis are Class A condition.
Aliens applying for US Immigration should be correctly diagnosed with Syphilis, as to ensure that the affected applicants receive timely treatment. This will minimize the waiting time not only about the immigration process but also reduces the further spread of disease.
- Applicants with syphilis are treated using a standard syphilis treatment regimen before any medical report form is completed or signed. The result and treatment information, including medication, dose, and dates of treatment and route of administration are recorded for the purpose of medical examination for an immigrant from.
- Syphilis treated patient must present the panel doctor with a written certificate, signed by a doctor or public health official, proving that the applicant was effectively treated, then they are re-classified as a Class B condition, and the applicant may be medically cleared for Immigration process.
It is unbelievable to witness a county with so many faces from different origin, culture, food, artifacts like the way we see in USA, the gateway to millions of people eagerly waiting to enter their fantasy world.
Out of all the other countries, why do we get to see more number of immigrants in this country? The fundamental fact lies that the country has made it very resourceful and developed, especially the life of a common man’s. Every country has pros and cons but the intensity of having a decent life is something that every man dreams of and this is the result of Immigration. Some other factors like economic and/or political reasons, family re-unification, natural disasters or the wish to change one’s surroundings voluntarily contribute to immigration.
In order to get immigrated to US, one has to go through a lot of process which takes years for them to get a Green card and one important and nearing step to get through that process is the I-693 form as also called Immigration Medical exam.
In order to protect the health of their public, the US government has reinforced some strict rules on immigrants who are applying for Green card and one such rule is getting a complete medical screening for specific diseases like mumps, measles, rubella, polio, tetanus and diphtheria toxoids, pertussis, Haemophilus influenzae type B, and hepatitis B, and vaccinations against vaccine-preventable diseases as recommended by the Advisory Committee on Immunization Practices.
As per their law, if any alien is not able to furnish documents of received vaccination against “Vaccine preventable diseases and other diseases as mentioned in CDP, then the applicant will lose the eligibility to get a Green card.
Overview of the Immigration Medical exam form
I-693 form consists of 4 parts which runs in 5 pages.
Part1 – A generic personal detail about oneself, that needs to be typed by the applicant in Capital letter with black ink only.
Information to be filled is:
- Applicants’ complete name, middle name and last name
- Complete home address with zip code
- Gender
- Date of Birth
- The most important is do not sign or date the form anywhere unless and until said by the civil surgeon.
Part 2 – Applicant medical examination Synopsis by Civil surgeon
- As per INA 212(a) law the diseases are classified as below
- Communicable disease of public health significance
- Physical or mental disorder associated with harmful behavior
- Drug abuse or addiction
- Vaccination details
- Communicable Diseases there are two disease that are tested
1-Tuberculosis (TB) – Initial screening test or Interferon Gamma Release Assay is conducted for all applicant 2 years of age and older. If any sign or symptom of TB is seen, Chest X-ray is done
2- Syphilis – Applicants of 15 years and older need to appear for Serologic test for Syphilis.
Physical or Mental disorders related with harmful behavior
The civil surgeons review the past history of the applicant and assess the mental status. During the screening of medical exam, or while taking medical history of the mental disorder, a surgeon will be able to diagnose if an applicant is facing any kind of physical or mental disorder that results in harmful behavior like major depression, bipolar disorder, schizophrenia, mental retardation
Surgeon also checks for harmful behavior that is associated with a mental or physical disorder that results in:
n Serious psychological or physical injury to the applicant or others (e.g. suicide attempt or pedophilia)
n A serious threat to health or safety (e.g. driving while intoxicated or verbally threatening to kill someone)
Drug Abuse/ Drug Addiction
Using American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria, surgeons see if the applicant is under drug addiction or not. They also check if an applicant is under Substance abuse or Substance dependence.
If substance abuse or dependence is found, the civil surgeon (or specialist, if referred) will document the applicant’s pattern of use and behavioral, physical, and psychological effects associated with the substance use or cessation of use.
Part 3 – Medical Certification of the Civil Surgeon
After completion of the medical test the doctor will put his comments and results in the form with his official stamp or seal along with date and signature
Part 4- Vaccination Record
All applicants applying for adjustment of status must provide with relevant Vaccination details that are specifically required by statue or as listed by CDC documents. The applicant’s age at the time of the medical examination is used to determine which vaccines are age-appropriate to administer.
- Note that all vaccines can be given on the same day as a TST or any time after TST is applied. However, if MMR, varicella, or live attenuated intranasal influenza vaccine (LAIV) is given before TST, at least 4 weeks is recommended before administering the TST. With that verification the civil surgeon will see if any additional vaccine needs to be given or not.
- An immigrant having lived so long and dreaming of becoming part of U.S should make his mind not to get depressed and wait for some more years only to see a better tomorrow to make their dream come true. So every immigrant should make sure that they documents are not fake, try to get vaccinated if needed and try to leave in a healthy environment.
Technology, healthcare, real business, education in US has reached far off places, but when it comes to immigration there seems to be a snail pace reform. The recent debate in the House of Republican leaders unveiled that the immigration system needs to have a “Standards” Principles, which wants to find a special path to citizenship for an estimated 11 million undocumented immigrants.
The preamble of these standards reads that the nation’s immigration systems are broken and laws are not enforced. This is not only resulting in economy downfall but caters to national security risk. There needs to be a bipartisan manner to solve the serious immigration system which cannot be tackled singly; and the solution for this is through step-by-step, with a common sense approach that will secure country borders, enforcing laws and by implementing a robust enforcement measures.
The outline does not provide a specific timeline for when undocumented residents could attain legal status but the plan would not explicitly bar eventual citizenship for those qualifying under existing employment and family- based categories.
Being a fundamental duty of any government to secure its borders, there seems to be very little done in this case. The policy seems to have some loose ends that makes pathway for people to cross the borders illegally or overstay their visas. The administration needs to put stringent policies so that it not only affects cross border deaths especially countries like Mexico, who try to enter illegally for a decent livelihood, but also helps those who are staying legally to attain green card in a more legal way.
They also need to work on the implementation of entry-exit visa tracking system by using right technology to verify visitor’s identity who fails to abide the law also verify immigrant employees work eligibility by implementing workable electronic employment verification system that result from any fraud.
The country has given opportunity for many foreign nationals and students to pursue their dream of entering world class colleges and universities here particularly in high skilled fields. These legal immigrants want to stay back as they have limited opening back in their home country, but due to insufficient visa and green card allocations it is becoming hard for them to stay back, and has resulted in exporting the talented labor and ingenuity to other countries. The government needs to look at this in a broader perspective since the exceptional individuals help grow the US economy.
Another area where the government needs to work is by addressing the temporary worker program – particularly the agricultural industry, which adds value to the economy and strengthens the national security by allowing realistic, enforceable and usable legal paths to enter the United States. The temporary workers are able to meet the economy of the country as they do not displace or take undue advantage of the American workers.
In the midst of this, the new reform principles from Boehner provide a path to citizenship for children. America has valued the children; by providing ample opportunities to make sure that the children of immigrants are not affected for the mistakes of their parents. They are working for a concrete legal resident and citizenship for those who were brought to this country as children for no fault of their own, who have considered this place alone as their home and importantly by meeting certain eligible standards and serve honorably in the military or attain college degree, justice will be done to this children.
According to Nancy Pelosi, looking at the other angles, the Republican principles raise more questions, like what about the DREAMers of becoming a US Citizen? What are the requirements for immigrants to live legally and how will it result in getting complete citizenship? Will the Republicans’ enforcement trigger more barriers instead of removing obstacles to comprehensive reform?
The document points out that the illegal immigrants could live legally and without fear provided they are willing to admit their culpability, pass rigorous background checks, pay significant fines and back taxes, develop proficiency in English and American civic and are capable of supporting themselves and their families by not accessing public benefits.
However the GOP outlines, which were discussed, insist that none of the principles can happen before specific enforcement triggers have been implemented.
The issue of how to deal with undocumented workers has been in the corner for the last 15 years, now being in the central component of immigration reform for over seven months after 68 Senators overwhelmingly passed a bipartisan immigration bill, the House Republicans responded with a flimsy document that only serves to underscore the callous attitude of the Republicans have toward their own nations’ immigrants.
Hope the draft of Standards for Immigration Reform that was being debated by the House Republicans mark an important
progress by bringing together Democrats and Republicans in ensuring to pass immigration reform this year.
easyIME.com is a free service, which streamlines the immigration medical process for green card aspirants by helping them locate the right USCIS Physician and schedule their Green Card Medical Exam online. Green card aspirants can also find immigration lawyers near their zip code through this service.
The Immigration reform is the hot topic in the United States. It has been almost a year now that President Mr. Barak Obama promised the nation to come up with strong immigration legislation which will boost the US economy and offer significant benefits to millions of illegal immigrants.
According to sources, Republicans are busy nowadays in crafting ‘principles’ to propose in the house instead of a comprehensive reform bill. The principles are nothing but a series of legislation proposals related to different immigration issues. However, we don’t know if we should be happy or not. These principles will be based on the most critical issue of last year’s reform bill – Border Security. For decades, the United States has been unfortunate as far as border security is concerned. Every year, thousands of illegal immigrants enter in the US for better living for their families. Border security is most critical problem that must be solved as early as possible.
The Comprehensive Immigration Reform Bill which was crafted by a gang of eight members (4 conservative Republicans and 4 Democrats) of bipartisan group is on stall right now. This bill consisted many key issues related to immigration like border security, merit based visa system and a pathway to citizenship to illegal immigrants. The Conservative Republicans were very much against to the pathway of citizenship provision. According to them, one cannot easily be a citizen of the United States who does not respect the US laws. They always wanted a series of immigration bills which handle different immigration issues separately.
In the comprehensive bill, there is a provision called 13 years of the pathway of citizenship proposed to undocumented immigrants. However, a recent survey by the pew research center revealed that for immigrants, reduction in deportation and legalization is more important than citizenship. Most of the Latino community agreed that legalization is more important and they are not satisfied with the republican’s role in the immigration reform process in the house. This is considered as a primary reason of the republican’s inclination towards immigration reform. The senate elections are approaching and both parties will try to get the attention of voters and why not? This is the perfect time to settle the biggest controversial issue to gather public attention. According to law experts, the immigration reform is likely to pass before the elections.
By the end of this month, the picture will be crystal clear. However, Speaker of the House, Mr. John Boehner and conservative Republicans will surely try to get credit for the immigration reform. My question is: will Democrats be in the agreement with conservatives for the compromised reform designed by them?
easyIME.com is a free service, which streamlines the immigration medical process for green card aspirants by helping them locate the right USCIS Physician and schedule their Green Card Medical Exam online. Green card aspirants can also find immigration lawyers near their zip code through this service.
