Once in the US system, the Hmong refugees still have many obstacles to overcome. Chronic malnutrition, previous poor health and lack of medical care all serve to intensify their illnesses. Preventive medicine is virtually unheard of within the Hmong culture in Laos. Immunizations are seldom up to date, if even administered at all. Anemia is prevalent, mostly due to poor diet and parasitic infections Lactose intolerance has been documented. Parasitic disease is endemic with a high prevalence for Plasmodium species, Giardia lambia, Clonorchis sinensis and Paragoniumus westernani. Due to antibiotic overuse and abuse, a number of these organisms often become resistant to the more commonly used antibiotic overuse and abuse, a number of these organisms often become resistant to the more commonly used antibiotics. Scabies and lice are also quite common. Respiratory conditions include pneumocystis carinii pneumonia (an often threatening fungal infection) and tuberculosis, which is more of a public health threat than a truly dangerous threat than a truly dangerous threat to an individual. Hepatitis, which is also common in Indochina, is also considered mostly along the lines of communicability and the need for infection control.