DISCUSSION
According to UNICEF data, from the start of the war in Ukraine on 24 February to 30 March 2022, more than 2 million children were forced to leave the country due to the violence and dangers linked to the conflict.10 Among these children and adolescents, there were also young cancer patients, particularly vulnerable to the risk of the interruption of treatment. To try to limit this detrimental effect, the SAFER-UKRAINE project was led by St. Jude Children’s Hospital (specifically its non-profit arm, St. Jude Global), with the aim of creating an international humanitarian network to provide pediatric cancer patients with the ability to safely leave Ukraine. The aim was to reach specialized hospitals for their pathologies, mainly throughout Europe11. According to SAFER Ukraine sources, around 1300 children with various forms of cancer managed to leave Ukraine through this channel and find placement in specialized oncology centers in Europe12. The Fondazione IRCCS Istituto Nazionale dei Tumori, in Milan, and IRCCS Policlinico San Matteo, in Pavia, also joined this international solidarity network, making themselves available to welcome Ukrainian pediatric oncology patients and continue their treatments. The arrival of the refugee children quickly catalyzed attention on the need to take charge of complex situations, in which patients, in addition to their underlying pathology, brought with them a wealth of potentially traumatic experiences, requiring healthcare workers to respond quickly and effectively to articulated needs and requiring multidisciplinary skills. To better understand the needs of patients and families (usually made up of mothers alone or possibly other female members, given the ban on men leaving the country), an anonymous questionnaire was developed, which could act as a tool for studying the cultural and family backgrounds, needs, emotions and collect their opinions regarding treatment and reception.13
Worthy of note is that, despite the fact that the questionnaires were anonymous and there was no rush in filling them, we only obtained the complete forms from 59% of the mothers, maybe as a sign of fear of possible sanctions in case of “wrong” or unwelcome answers. While the financial support for treatment and the stay in Italy was and still is mainly borne by the “consortium” formed between the public health system and the charities (the Soleterre association coordinated the project involving the patients included in this work through theDELIBERAZIONE N° XI / 6077 del 07/03/2022, Regione Lombardia ), 14% of families still believed in the possibility of being personally in debt with the organization.
It is significant to note how alongside hope (mostly linked to the clinical improvements of kids) there was also fear and sadness, as residues of the traumatic experience of forced and sudden flight from own country in addition to cancer experience14. As regards the emotions felt upon arrival in Italy, they were mainly characterized by an attitude of hope, both general and in the recovery or clinical improvement of their children, associated with a feeling of relief at having moved away from a dangerous situation (66% of the respondents). This fact represents a wealth of positive resources that are also important for children, who experience a relationship of mutual exchange with their parental figures, being influenced by and influencing their attitudes, thoughts, psychological state and ability to respond to stress15,16. However, around one mother in three also showed the emotions of fear or sadness, a residue of past traumatic experiences and the violence (direct or indirect) of war. In terms of the quality of the assistance received, overall satisfaction was evident, with a particular appreciation of the relationship established with healthcare personnel, which 95% of the respondents reported as positive. The theme of cure or improving the health of theor children was nevertheless reported also after the question ”what would allow you to enjoy your stay in Italy better?”, both directly and indirectly (for example in answers such as ”going home”, which would imply improvement in children’s health, or ”being in Italy for holidays and not for treatment”, with the same meaning).
The relationship with the Italian population was reported as positive and Italians described as welcoming, kind and generous. This aspect also represents an important point in determining the adaptation and resilience capabilities of children and parents. The absence of episodes or manifestations of intolerance and/or hostility facilitates integration for the immigrant and/or refugee population into the social context and the creation of social support networks, avoids isolation and the feeling of alienation17-19.
This investigation allowed us to focus on points that clinical practice had most highlighted as difficult. The interest in understanding the main barriers to effective communication between healthcare professionals and patients began from the fundamental issue of reconstructing their clinical history and current state of health. At the beginning of the flight from Ukraine, treatment plans and imaging were very often lacking or not translated, thus the resulting confused relationship could exclude families from control over their children’s health status20. Knowledge of information useful for reconstructing the cultural and psychological profile of both patients and family members, their hopes, expectations, needs and criticisms, could allow for better collaboration and therapeutic alliance.
In our opinion, the questionnaire tool could achieve this objective, providing a qualitative investigation method capable of obtaining a deeper understanding of the phenomenon and taking the point of view of the participants in the study21. A questionnaire is also certainly an advantageous tool from the point of view of costs and time, as it can be self-administered (i.e. completed independently by the respondent, at a time following administration) and does not require particular technological support to be completed. It also provides indications that are easy to interpret and quickly applicable to the clinical context.
The welcoming of any refugee is undoubtedly a bilateral process, which requires an investment in communication, relationships and knowledge and which can make positive use of mutual listening. It is therefore necessary to have awareness and consideration of differences, but also closeness and understanding of the other’s human experience, with the common aim, in our case, of achieving the best possible assistance.