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de Laat S, Musoni ER, Bezanson K, Yantzi R, Wahoush O, Nouvet E, Hunt M, Amir T, Bernard C, Ntizimira C, Schwartz L. They do their utmost: promise and limits of palliative care in two refugee camps in Rwanda, a qualitative study. Med Confl Surviv 2024; 40:153-181. [PMID: 38634428 DOI: 10.1080/13623699.2024.2339732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 04/03/2024] [Indexed: 04/19/2024]
Abstract
After often gruelling journeys, some refugees arrive at secure locations with severe injury or illness. Others find themselves shortly thereafter facing a life-limiting health condition. Palliative care has been the focus of recent research, and of academic and aid sector dialogue. In this study, we ask: What are experiences and needs of patients and care providers? What opportunities and obstacles exist to enhance or introduce means of reducing suffering for patients facing serious illness and injury in crisis settings? We present findings of a qualitative sub-study within a larger programme of research exploring moral and practical dimensions of palliative care in humanitarian crisis contexts. This paper presents vignettes about palliative care from refugees and care providers in two refugee camps in Rwanda, and is among the first to provide empirical evidence on first-hand experiences of individuals who have fled protracted conflict and face dying far from home. Along with narratives of their experiences, participants provided a range of recommendations from small (micro) interventions that are low cost, but high impact, through to larger (macro) changes at the systems and societal levels of benefit to policy developers and decision-makers.
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Affiliation(s)
- Sonya de Laat
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton Canada
| | | | | | - Rachel Yantzi
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton Canada
| | - Olive Wahoush
- School of Nursing, McMaster University, Hamilton, Canada
| | - Elysée Nouvet
- School of Health Studies, Western University, London, Canada
| | - Matthew Hunt
- School of Physical and Occupational Therapy, McGill University, Montreal, Canada
| | - Takhliq Amir
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton Canada
| | - Carrie Bernard
- Family and Community Medicine, University of Toronto, Toronto, Canada
| | | | - Lisa Schwartz
- Health Research Methods, Evidence and Impact, McMaster University, Hamilton Canada
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2
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Daubman BR, Khan F, Slater SE, Krakauer EL. Save lives and relieve suffering: The twin imperatives of humanitarian response and the role of palliative care. Front Oncol 2023; 13:1120380. [PMID: 36937419 PMCID: PMC10019816 DOI: 10.3389/fonc.2023.1120380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 02/10/2023] [Indexed: 03/06/2023] Open
Affiliation(s)
- Bethany-Rose Daubman
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- *Correspondence: Bethany-Rose Daubman,
| | - Farzana Khan
- Fasiuddin Khan Research Foundation, Palliative Care Division, Dhaka, Bangladesh
- University of Edinburgh, Global Health Division, Edinburgh, United Kingdom
| | - Sarah E. Slater
- Department of Medical Oncology, Division of Gastrointestinal Oncology, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA, United States
| | - Eric L. Krakauer
- Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- Department of Palliative Care, University of Medicine & Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
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Guo P, Alajarmeh S, Alarja G, Alrjoub W, Al-Essa A, Abusalem L, Mansour A, Sullivan R, Shamieh O, Harding R. Compounded trauma: A qualitative study of the challenges for refugees living with advanced cancer. Palliat Med 2021; 35:916-926. [PMID: 33765877 PMCID: PMC8114446 DOI: 10.1177/02692163211000236] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Although palliative care is now an essential health service under Universal Health Coverage, ensuring access and appropriate care for refugees is a specific challenge for this large population. AIM To identify the needs and experiences of adult refugees in Jordan with advanced cancer and informal caregivers. DESIGN A qualitative study using semi-structured interviews. SETTING/PARTICIPANTS Participants were purposively sampled at two Jordanian hospitals to achieve heterogeneity by age, gender, country of origin, and primary diagnosis. RESULTS Twenty-nine refugees (22 patients, 7 caregivers) participated, and four themes were generated: (1) Psychological distress and sustaining social support. Refugees often experienced unmet psychosocial needs. However, psychosocial support was reported either absent or limited. (2) Knowledge and uncertainty. Lack of information and poor communication between healthcare providers and patients caused significant distress due to uncertainty. (3) Family anxiety and support roles. Being away from the home country cut patients and caregivers off from their wider social support network, which added increased anxiety and responsibilities to caregivers. (4) Compounded trauma and poverty. Many refugees have experienced trauma related to war that may affect their physical and mental health. They faced serious financial crises caused by the rising cost of medicines and treatment. CONCLUSIONS This study reveals the impact of fractured families and networks on social support in advanced cancer, and the compounding trauma of the disease for refugees. Detailed person-centred assessment and emphasis on psychosocial support is essential, and home-based care should not presume community support for patients to remain at home.
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Affiliation(s)
- Ping Guo
- School of Nursing, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.,Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - Sawsan Alajarmeh
- Center for Palliative & Cancer Care in Conflict (CPCCC), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Ghadeer Alarja
- Department of Palliative Medicine, King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Waleed Alrjoub
- Center for Palliative & Cancer Care in Conflict (CPCCC), King Hussein Cancer Center (KHCC), Amman, Jordan
| | - Ayman Al-Essa
- Center for Palliative & Cancer Care in Conflict (CPCCC), King Hussein Cancer Center (KHCC), Amman, Jordan
| | | | - Asem Mansour
- Chief Executive Office, King Hussein Cancer Center (KHCC), Amman, Jordan
| | | | - Omar Shamieh
- Department of Palliative Medicine, King Hussein Cancer Center (KHCC), Amman, Jordan.,College of Medicine, the University of Jordan, Amman, Jordan
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Guo P, Chukwusa E, Asad M, Nimri O, Arqoub K, Alajarmeh S, Mansour A, Sullivan R, Shamieh O, Harding R. Changing Mortality and Place of Death in Response to Refugee Influx: A Population-Based Cross-Sectional Study in Jordan, 2005-2016. J Palliat Med 2021; 24:1616-1625. [PMID: 33826858 DOI: 10.1089/jpm.2020.0476] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Jordan faces complex health care challenges due to refugee influx and an aging population. Palliative care planning and delivery require data to ensure services respond to changing population needs. Objectives: To determine the trend in mortality and place of death in Jordan. Design: Population-based study. Setting/Subjects: Death registry data of adult decedents (n = 143,215), 2005-2016. Measurements: Descriptive statistics examined change in demographic and place of death (categorized as hospital and nonhospital). Binomial logistic regression compared the association between hospital deaths and demographic characteristics in 2008-2010, 2011-2013, and 2014-2016, with 2005-2007. Results: The annual number of deaths increased from 6792 in 2005 to 17,018 in 2016 (151% increase). Hospital was the most common place of death (93.7% of all deaths) in Jordan, and percentage of hospital deaths increased for Jordanian (82.6%-98.8%) and non-Jordanian decedents (88.1%-98.7%). There was an increased likelihood of hospital death among Jordanian decedents who died from nonischemic heart disease (odd ratio [OR]: 1.11, 95% confidence interval [CI]: 1.09-1.13, p < 0.001), atherosclerosis (OR: 1.10, 95% CI: 1.08-1.13, p < 0.001), renal failure (OR: 1.05, 95% CI: 1.02-1.08, p < 0.001), hemorrhagic fevers (OR: 1.09, 95% CI: 1.06-1.13, p < 0.001), and injury (OR: 1.18, 95% CI: 1.06-1.33, p < 0.001) in the period 2014-2016, compared with 2005-2007. There were similar increases in the likelihood of hospital death among non-Jordanians in 2014-2016 for the following conditions: malignant neoplasms (except leukemia), nonischemic heart disease, atherosclerosis, injury, and HIV, compared with 2005-2007. Conclusions: Country-level palliative care development must respond to both internal (aging) and external (refugee influx) population trends. Universal Health Coverage requires palliative care to move beyond cancer and meet population-specific needs. Community-based services should be prioritized and expanded to care for the patients with nonischemic heart disease, atherosclerosis, renal failure, hemorrhagic fevers, and injury.
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Affiliation(s)
- Ping Guo
- School of Nursing, Institute of Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom.,Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Emeka Chukwusa
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
| | - Majed Asad
- Non-Communicable Diseases, Jordan Cancer Registry, The Ministry of Health, Amman, Jordan
| | - Omar Nimri
- Non-Communicable Diseases, Jordan Cancer Registry, The Ministry of Health, Amman, Jordan
| | - Kamal Arqoub
- Non-Communicable Diseases, Jordan Cancer Registry, The Ministry of Health, Amman, Jordan
| | - Sawsan Alajarmeh
- Center for Palliative and Cancer Care in Conflict, King Hussein Cancer Center, Amman, Jordan
| | | | - Richard Sullivan
- Institute of Cancer Policy, King's College London, London, United Kingdom
| | - Omar Shamieh
- Department of Palliative Care, Center for Palliative and Cancer Care in Conflict, King Hussein Cancer Centre, Amman, Jordan.,College of Medicine, University of Jordan, Amman, Jordan
| | - Richard Harding
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, United Kingdom
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de Laat S, Wahoush O, Jaber R, Khater W, Musoni E, Abu Siam I, Schwartz L. A case analysis of partnered research on palliative care for refugees in Jordan and Rwanda. Confl Health 2021; 15:2. [PMID: 33407734 PMCID: PMC7789221 DOI: 10.1186/s13031-020-00333-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 12/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This case analysis describes dilemmas and challenges of ethical partnering encountered in the process of conducting a research study that explored moral and practical dimensions of palliative care in humanitarian crisis settings. Two contexts are the focus of this case analysis: Jordan, an acute conflict-induced refugee situation, and Rwanda, a protracted conflict-induced refugee setting. The study's main goal was to better understand ways humanitarian organizations and health care providers might best support ethically and contextually appropriate palliative care in humanitarian contexts. An unintended outcome of the research was learning lessons about ethical dimensions of transnational research partnerships, which is the focus of this case analysis. DISCUSSION There exist ongoing challenges for international collaborative research in humanitarian conflict-induced settings. Research partnerships were crucial for connecting with key stakeholders associated with the full study (e.g., refugees with life limiting illness, local healthcare providers, aid organization representatives). While important relationships were established, obstacles limited our abilities to fully attain the type of mutual partnership we aimed for. Unique challenges faced during the research included: (a) building, nurturing and sustaining respectful and equitable research partnerships between collaborators in contexts of cultural difference and global inequality; (b) appropriate ethics review and challenges of responding to local decision-maker's research needs; and (c) equity and fairness towards vulnerable populations. Research strategies were adapted and applied to respond to these challenges with a specific focus on (d) research rewards and restitution. CONCLUSIONS This case analysis sheds light on the importance of understanding cultural norms in all research roles, building relationships with decision makers, and developing teams that include researchers from within humanitarian crisis settings to ensure that mutually beneficial research outcomes are ethical as well as culturally and contextually relevant.
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Affiliation(s)
- Sonya de Laat
- Global Health, McMaster University, MDCL 3500, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
| | - Olive Wahoush
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Rania Jaber
- Department of Philosophy, Institute on Ethics & Policy for Innovation, McMaster University, Hamilton, ON, Canada
| | - Wejdan Khater
- School of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | | | | | - Lisa Schwartz
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Kolomvotsou AI, Riza E. Management of Diabetes Mellitus in Refugee and Migrant Patients in a Primary Healthcare Setting in Greece: A Pilot Intervention. EPIDEMIOLGIA (BASEL, SWITZERLAND) 2021; 2:14-26. [PMID: 36417186 PMCID: PMC9620876 DOI: 10.3390/epidemiologia2010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 12/18/2020] [Accepted: 12/28/2020] [Indexed: 12/14/2022]
Abstract
Over the past years there is a substantial wave of migrants and refugees all over the world. Europe accepts approximately one-third of the international migrant population with Greece, in particular, having received large numbers of refugees and migrants by land and sea since the beginning of the civil war in Syria. Diabetes, a non-communicable disease, is a global health problem, affecting people in developing countries, refugees and migrants, and its basic treatment tool includes self-management and education. In this pilot study, we organized educational, interactive group sessions for diabetic refugees, based on culture, health, and nutritional needs according to a questionnaire developed for the study. The sessions were weekly, for two months, in the context of primary healthcare, organized by a dietitian. Nine individuals completed the sessions, five of nine were diagnosed in Greece and seven of nine needed diabetes education. Their waist circumference was above normal and they were all cooking at home. Their nutritional habits improved by attending the sessions and the interaction helped their social integration. They all found the sessions useful, and felt more self-confident regarding diabetes control and healthier.
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Affiliation(s)
- Anastasia I Kolomvotsou
- Dietetic Department, Polyclinic of Olympic Village, 13672 Αxarnai, Attiki, Greece
- Correspondence: ; Tel.: +30-6973-204749
| | - Elena Riza
- Department of Hygiene, Epidemiology & Medical Statistics, School of Medical, National and Kapodistrian University of Athens, 75 Mikras Asias, 11527 Athens, Greece;
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Al Qadire MI, Alomari K. Syrian Refugees in Jordan: Barriers to Receiving Optimal Cancer Care. Clin J Oncol Nurs 2020; 24:707-710. [DOI: 10.1188/20.cjon.707-710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Yağcı-Küpeli B, Özkan A. Syrian and Turkish children with cancer: a comparison on survival and associated factors. Pediatr Hematol Oncol 2020; 37:707-716. [PMID: 32705959 DOI: 10.1080/08880018.2020.1795328] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Cure rates of childhood cancer need to be improved in low-income countries and vulnerable populations such as refugees. We aimed to compare the outcome and associated factors in Syrian refugee and Turkish children with cancer treated at our hospital.Files of patients were reviewed for age, tumor type, stage, treatment, compliance to treatment, relapse or progression status, outcomes, secondary malignancy (SM) and treatment-related mortality (TRM). Overall (OS) and event-free survival rates (EFS) were analyzed.105 refugees and 304 Turkish children were treated between January 2012 and January 2019. Median age and median follow-up time were significantly lower in the Syrian group (p=0.046, p<0.001, respectively). Metastatic or advanced-stage disease was significantly more frequent in refugees (p=0.002). Relapse or progression and poor compliance to treatment were more common in refugees (p=0.01, p<0.001, respectively). Rates of OS were 55.7% and 69.7%, EFS were 28.9% and 55.7% in Syrian and Turkish patients. OS and EFS were lower in refugees compared to Turkish patients (p=0.01, p<0.001, respectively). EFS was significantly lower in refugees with poor compliance to treatment (p<0.001). TRM was reported in 12 (8 Syrian, 4 Turkish) patients. SM was detected in 3 (2 Turkish, 1 Syrian) children.Inferior survival rates were detected in Syrian refugee children compared to Turkish children. Besides from cancer-specific factors such as stage and tumor type, a series of barriers in accessing cancer care resulting in poor compliance to treatment might have been responsible from lower survival rates in Syrian children.
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Affiliation(s)
- Begül Yağcı-Küpeli
- Department of Pediatric Hematology/Oncology, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
| | - Ayşe Özkan
- Department of Pediatric Hematology/Oncology, University of Health Sciences, Adana City Training and Research Hospital, Adana, Turkey
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9
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O’Connor M, Meageen S. Palliative care for asylum seekers living in the community in Australia. PROGRESS IN PALLIATIVE CARE 2020. [DOI: 10.1080/09699260.2020.1810936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Margaret O’Connor
- Nursing & Midwifery, Monash University, PO Box 627, Frankston, VIC 3199, Australia
- Melbourne City Mission Palliative Care, 427 Nicholson St, North Fitzroy, VIC 3068, Australia
| | - Sarah Meageen
- Melbourne City Mission Palliative Care, 427 Nicholson St, North Fitzroy, VIC 3068, Australia
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10
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Clancy M, Taylor J, Bradbury-Jones C, Phillimore J. A systematic review exploring palliative care for families who are forced migrants. J Adv Nurs 2020; 76:2872-2884. [PMID: 32865848 DOI: 10.1111/jan.14509] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 06/09/2020] [Accepted: 06/26/2020] [Indexed: 11/30/2022]
Abstract
AIMS To explore the palliative care experiences of forced migrant children, families, and healthcare professionals (HCPs) highlighting successes, challenges, and associated practice implications. DESIGN Systematic literature review. DATA SOURCES The following search engines were searched from 2008 - 2018: Allied and Complementary Medicine Database, Cumulative Index to Nursing and Allied Health, MEDLINE, Embase, ProQuest, Scopus, Psycinfo, and Web of Science. Extensive reference and citation checking were also conducted. REVIEW METHODS Systematic review followed PRISMA guidelines with prepared PROSPERO registered protocol #CRD42019129200. English language qualitative, quantitative, or mixed methods studies were eligible for inclusion. Study quality was appraised using the Mixed Methods Appraisal Tool (MMAT). RESULTS Eighteen studies (reported in 20 articles) met the final inclusion criteria. Most focused on challenges to care provision. Thematic analysis following methods proposed by Braun and Clarke was undertaken. Five themes were identified: (a) divergence of beliefs and expectations; (b) communication; (c) navigating healthcare systems; (d) burdens and coping strategies; and (e) training and knowledge. A compassionate, collaborative approach with mutual respect crossed themes and was linked to high-quality care. CONCLUSION Forced migrant families have multiple needs including physical and emotional support and help in navigating complex systems. Professional interpreters can ease communication barriers when resourced appropriately. Individualized care is crucial to addressing the intricate mosaic of culture such families present. A cultural sensitivity/insensitivity framework is presented that may help guide future interactions and priorities for those working in children's palliative care. IMPACT This systematic review explored the international experiences of palliative care for forced migrant families. The findings highlight the plight of families who experience multiple traumas and increased levels of grief and loss through their migration experiences and when caring for a child with a life-limiting condition. This research has potential to have an impact on professionals working with culturally diverse families in all palliative care settings.
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Affiliation(s)
- Marie Clancy
- School of Nursing, University of Birmingham, Birmingham, UK.,School of Social Policy, Sociology and Criminology, University of Birmingham, Birmingham, UK.,School of Nursing and Midwifery, Birmingham City University, Birmingham, UK
| | - Julie Taylor
- School of Nursing, University of Birmingham, Birmingham, UK.,Birmingham Women's and Children's Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Jenny Phillimore
- School of Social Policy, Sociology and Criminology, University of Birmingham, Birmingham, UK
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Spiegel PB, Cheaib JG, Aziz SA, Abrahim O, Woodman M, Khalifa A, Jang M, Mateen FJ. Cancer in Syrian refugees in Jordan and Lebanon between 2015 and 2017. Lancet Oncol 2020; 21:e280-e291. [PMID: 32359503 DOI: 10.1016/s1470-2045(20)30160-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/04/2020] [Accepted: 03/04/2020] [Indexed: 01/19/2023]
Abstract
Protracted conflicts in the Middle East have led to successive waves of refugees crossing borders. Chronic, non-communicable diseases are now recognised as diseases that need to be addressed in such crises. Cancer, in particular, with its costly, multidisciplinary care, poses considerable financial and ethical challenges for policy makers. In 2014 and with funding from the United Nations High Commissioner for Refugees, we reported on cancer cases among Iraqi refugees in Jordan (2010-12) and Syria (2009-11). In this Policy Review, we provide data on 733 refugees referred to the United Nations High Commissioner for Refugees in Lebanon (2015-17) and Jordan (2016-17), analysed by cancer type, demographic risk factors, treatment coverage status, and cost. Results show the need for increased funding and evidence-based standard operating procedures across countries to ensure that patients have equitable access to care. We recommend a holistic response to humanitarian crises that includes education, screening, treatment, and palliative care for refugees and nationals and prioritises breast cancer and childhood cancers.
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Affiliation(s)
- Paul B Spiegel
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA; Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA.
| | - Joseph G Cheaib
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Saad Abdel Aziz
- Department of International Health, Johns Hopkins University, Baltimore, MD, USA
| | - Orit Abrahim
- Center for Humanitarian Health, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Woodman
- Office of the United Nations High Commissioner for Refugees, Beirut, Lebanon
| | - Adam Khalifa
- Office of the United Nations High Commissioner for Refugees, Damascus, Syria
| | - Minyoung Jang
- Johns Hopkins Bloomberg School of Public Health, and Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Farrah J Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Harvard University, Boston, MA, USA
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12
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Doherty M, Power L, Petrova M, Gunn S, Powell R, Coghlan R, Grant L, Sutton B, Khan F. Illness-related suffering and need for palliative care in Rohingya refugees and caregivers in Bangladesh: A cross-sectional study. PLoS Med 2020; 17:e1003011. [PMID: 32126076 PMCID: PMC7053708 DOI: 10.1371/journal.pmed.1003011] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 01/24/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Despite recognition that palliative care is an essential component of any humanitarian response, serious illness-related suffering continues to be pervasive in these settings. There is very limited evidence about the need for palliative care and symptom relief to guide the implementation of programs to alleviate the burden of serious illness-related suffering in these settings. A basic package of essential medications and supplies can provide pain relief and palliative care; however, the practical availability of these items has not been assessed. This study aimed to describe the illness-related suffering and need for palliative care in Rohingya refugees and caregivers in Bangladesh. METHODS AND FINDINGS Between November 20 and 24, 2017, we conducted a cross-sectional study of individuals with serious health problems (n = 156, 53% male) and caregivers (n = 155, 69% female) living in Rohingya refugee camps in Bangladesh, using convenience sampling to recruit participants at the community level (i.e., going house to house to identify eligible individuals). The serious health problems, recent healthcare experiences, need for medications and medical supplies, and basic needs of participants were explored through interviews with trained Rohingya community members, using an interview guide that had been piloted with Rohingya individuals to ensure it reflected the specificities of their refugee experience and culture. The most common diagnoses were significant physical disabilities (n = 100, 64.1%), treatment-resistant tuberculosis (TB) (n = 32, 20.5%), cancer (n = 15, 9.6%), and HIV infection (n = 3, 1.9%). Many individuals with serious health problems were experiencing significant pain (62%, n = 96), and pain treatments were largely ineffective (70%, n = 58). The average age was 44.8 years (range 2-100 years) for those with serious health problems and 34.9 years (range 8-75 years) for caregivers. Caregivers reported providing an average of 13.8 hours of care per day. Sleep difficulties (87.1%, n = 108), lack of appetite (58.1%, n = 72), and lack of pleasure in life (53.2%, n = 66) were the most commonly reported problems related to the caregiving role. The main limitations of this study were the use of convenience sampling and closed-ended interview questioning. CONCLUSIONS In this study we found that many individuals with serious health problems experienced significant physical, emotional, and social suffering due to a lack of access to pain and symptom relief and other essential components of palliative care. Humanitarian responses should develop and incorporate palliative care and symptom relief strategies that address the needs of all people with serious illness-related suffering and their caregivers.
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Affiliation(s)
- Megan Doherty
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- World Child Cancer, London, United Kingdom
- * E-mail:
| | - Liam Power
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mila Petrova
- Cambridge Palliative and End of Life Care Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Scott Gunn
- Faculty of Medicine, Queens University, Kingston, Ontario, Canada
| | | | - Rachel Coghlan
- Centre for Humanitarian Leadership, Faculty of Arts and Education, Deakin University, Burwood, Victoria, Australia
| | - Liz Grant
- Usher Institute of Population Health Sciences and Informatics, Global Health Academy, Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom
| | - Brett Sutton
- Health Protection and Emergency Management, Department of Health and Human Services, Melbourne, Victoria, Australia
| | - Farzana Khan
- Fasiuddin Khan Research Foundation, Dhaka, Bangladesh
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13
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Madi F, Ismail H, Fouad FM, Kerbage H, Zaman S, Jayawickrama J, Sibai AM. Death, Dying, and End-of-Life Experiences Among Refugees: A Scoping Review. J Palliat Care 2018; 34:139-144. [PMID: 30458699 DOI: 10.1177/0825859718812770] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND: The objective of this scoping review is to identify and map the global literature on death, dying, and end-of-life experiences among refugees. The study aims at identifying gaps in the literature produced on the topic and informs areas for future research in the field. METHODS: We included articles that met the following inclusion criteria: (1) Population: Refugees and/or internally or externally displaced individuals due to wars, conflicts, nonnatural disasters, or emergencies; (2) Setting: End-of-life phase, dying, and death that took place following the refuge or displacement and reported after the year 1980; and (3) Study Design: All types of studies including but not limited to primary studies, narrative reviews, systematic reviews, news, editorials, commentaries, opinion pieces, technical reports, and policy briefs. A systematic search of the following electronic databases: Medline, Scopus, CINAHL, and JSTOR yielded 11 153 records. The search of the United Nations High Commissioner for Refugees database Refworld retrieved an additional 7510 records. RESULTS: Seven articles met our inclusion criteria. All articles were coauthored by scholars in universities/research institutes in high-income countries, and except for one, all were conducted in the country of the final settlement of refugees. One article adopted a qualitative approach, another article adopted a mixed-methods approach, one was a narrative review, and 4 articles were reviews of the literature. Three articles discussed access to medical/palliative care among older refugees, and 3 others addressed bereavement and death arrangements. Moreover, one article examined how transmigration and previous experiences from 2 cultural settings in home countries affect the contemplation of death and dying. IMPLICATIONS: Research on end-of-life experiences among refugees is sorely lacking. This study raises awareness of the need for empirical data on end-of-life challenges and palliative care among refugees, thus equipping humanitarian agencies with a more explicit and culturally sensitive lens targeting those with life-limiting conditions.
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Affiliation(s)
- Farah Madi
- 1 Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hussein Ismail
- 1 Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Fouad M Fouad
- 1 Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hala Kerbage
- 2 Faculty of Medicine, Universite Saint-Joseph, Beirut, Lebanon
| | - Shahaduz Zaman
- 3 Department of Global Health and Infection, University of Sussex, Brighton, United Kingdom
| | | | - Abla M Sibai
- 1 Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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