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.