An Urgent Human Health Dilemma Facing Refugees and their Host Caregivers ?

The continuous waves of refugees from Africa and the Middle East to Europe present major inter­cultural challenges to European health professionals and to society at large. A recent workshop in Sicily brought together local physicians, nurses, psychologists and managers of governmental agencies, along with representatives from Lebanon, Israel, Iraq, Iran, Sudan, Tunisia, Jordan and the European Society of Medical Oncology (ESMO) to develop training programs aimed at formulating dialogue between regional professionals and refugees. A major barrier refugees face is a lack of verbal and cultural communication, which hinders their smooth absorption into the new society. Cultural mediators who speak Arabic and Italian and understand the refugees' faith, tradition and beliefs are vital to successfully build bridges of trust between caregivers and refugees. Most asylum seekers experience anxiety, fear, and depression upon arrival in Europe. To achieve trust, all workshop participants agreed to develop a palliative care model that would best suit the unique circumstances now facing some Mediterranean countries and assist in overcoming the suffering of refugees during their initial stay in Europe. Such a model would include bio-psychosocial elements, essential for a culturally sensitive approach and based on core ethical principles. DOI : 10.14302/issn. 2576-9383.jhhr-18-2111 Freely Available Online www.openaccesspub.org | JHHR CC-license DOI : 10.14302/issn.2576-9383.jhhr-18-2111 Vol-1 Issue 2 Pg. no. 1


Introduction
Refugees and migrants arriving in Europe seek a reasonable quality of life, after leaving their families, belongings and traditional existence. 1Due to the new environment, language and life styles, many refugees suffer emotional, psychological and spiritual distress. 2nce, a high percentage of these newcomers face severe challenges throughout their acclimatization process in the host communities.These emotional disorders do not require hospitalization but can be treated effectively in the community.
According to the most recent data processed and published by ISTAT, there were 5,029,000 foreigners residing in Italy as of 1 January 2017.They constitute 8.3% of the total number of Italian residents.
From the same data, it is recorded that are 2,425,000 families registered with at least one foreign member.Three quarters of these families are composed exclusively of foreigners. In

Characteristics of Health Service of Host Countries to the Immigration Population
The foreigner will then apply conditions of access to essential and continuous care that are not differentiated from those insured to the citizen.

By registering with the (SSN) National Health
System, the foreigner enjoys total equal treatment, in rights and duties, with respect to Italian citizens in health care, including the choice of a primary care It is important that there will be an integrated, multidisciplinary and multi-dimensional approach, with actions that are carried out in success stages: reception, orientation, and accompaniment.
The team must have a transcultural and multidisciplinary approach.
Refugees who reach a country with a new language and culture feel isolated and depersonalized and are in desperate need of a nurturing relationship, which subsequently enables them to feel a greater sense of personal value, and that they are not alone.
In recent research that the MECC conducted in the region, it was apparent while assessing professionals working on provision of palliative care, that nurses rather than physicians were more likely to provide supportive care.Of interest was the finding that in Middle East healthcare, professionals extended emotional care to 47% of their patients, 9  important role. 12In order to enhance this approach, the European Commission, in April 2016, adopted the slogan, "Lives with dignity: from aid-dependence to self-reliance," with the goal of strengthening the resilience and self-reliance of both the displaced and their host communities through a multi-actor approach from the onset of the displacement crisis.This approach aims to harness the productive capacities of refugees by helping them to access education, housing and livelihoods. 13Let us reiterate that military and social conflicts inflict more than short-term mental damage, as they might have long-term consequences on refugees' mental health and social functIoning. 14reover, a routine screening of psychological To support the long-term sustainability of a migrant-friendly approach to palliative care, we need to involve local communities of resident foreigners and indigenous citizens as a crucial part of the communication processes we want to foster. 16Indeed, the healthcare process we plan to shape is, and must be immersed in the social and cultural texture of Europe.As we look to the future, we will require new strategies and methods to effectively integrate palliative care within an evolving refugee landscape.Hence, we must tailor such care to meet their dynamic needs.To achieve this goal, organizations, scientific societies, fight to help migrant women in difficulty.Collaborative efforts between European caregivers and their Middle Eastern colleagues would be significant in overcoming the psychological-social-cultural-spiritual gaps, thereby enhancing provider-patient communication with a culturally sensitive approach.Such a Euro-Middle Eastern interaction will undoubtedly facilitate the integration and absorption of refugees after their arrival in Southern Europe.In these places any medical care needs to take into account the refugees' faith, cultural beliefs and spiritual needs.The initial triage at the port of entry will be carried out by a physician and a cultural mediator before referring the refugees to a shelter.Thereafter, the acculturation process may involve treatment of non-communicable diseases such as cardiovascular, diabetes, cancer and pulmonary disorders.With the years, we have learned that three pillars of palliative care are critical for improved outcomes that cause dramatic changes in human lives, including those of refugees: namely, communication, collaboration and coordination.The Value of Palliative Care Palliative care is a healthcare specialty that is both a philosophy and an organized, highly structured system for delivering care.Its services are significant in realizing the most ancient mission of medicine: "to care even when it cannot cure."Palliative care is provided through comprehensive management of the physical, psychological, social and spiritual needs of suffering people, while remaining sensitive to their personal spiritual, cultural, and religious values and beliefs.By experience, we have learned that increasing numbers of people seek spiritual care, especially when their situation approaches hopelessness.From the onset of palliative care practice, spirituality has been understood broadly, where religion is just one element of a spiritual life.Spirituality encompasses the individual's search for meaning and purpose in life and the experience of the transcendent.It also refers to communication with figure than that shown In a parallel study in the USA,

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Issue 2 Pg.no. 15 distress and cultural barriers, and effective interventions intended to support migrants psychologically, represent fundamental tools in promoting healthy Integration Into hosting communities and nations. 15The term palliative care is unknown to most refugees reaching European countries, and often they have difficulty in understanding the relevance of this relatively new subspecialty of their condition.Their embarrassment can be exacerbated by the doctor-patient communication gap.But despite such challenges, palliative care physicians in Sicily have succeeded in establishing a functional network within the incoming refugee and migrant populations.
public and governmental agencies need to increase time allotted for discussions, documentation systems, and communication between cultural mediators and the freshly arriving refugees, and allot more resources for targeted training on challenging communication scenarios.The professional caregivers who are the first to examine the refugees along southern European beaches are well positioned to be primary palliative care providers.At a later stage, when refugees are provided with shelter, clinicians may approach the goals of care in discussions with patients and families from different cultures, while attempting to avoid potentially inaccurate perceptions of these differences.There is a desperate need for further research on palliative care at all levels, starting with refugees' arrival in their new country and continuing throughout their physical and emotional treatment Interventions.19    Roles of Palliative Care in Mediating between Models of HealthcareThe MECC-MARELUCE workshop emphasized the need to promote palliative care in refugee communities in Sicily and elsewhere, with special emphasis on issues relating to mental health.In Europe, many refugees feel disappointed by the European approach to care, as they often face difficulties in understanding the relevance of the new types of interventions.Refugees' misgivings can often be exacerbated by the doctor-patient communica tion gap.We believe that palliative care is an ideal setting where the integration of a culturally sensitive approach can be of great benefit in absorbing refugees, and in aiding migrants fleeing from military conflicts and poverty in their native countries.As a starting point, workshop participants explained how they initiate educational and training courses for palliative care teams that include trained local personnel and representatives from refugee communities in Europe, the Middle East and Africa.