Cultural Challenges in the Care of Refugees with End-Stage Renal Disease: What Western Nephrologists Should Know

Abstract

Forced migration is on the rise, mainly from the Middle East to western countries, resulting in unprecedented moral, political, and economic challenges for both refugees and host communities. Recent research showed that refugees represent around 1.5% of the dialysis population in several European and Middle Eastern countries surveyed. Despite the fact that refugees represent a small percentage of all dialysis patients in these countries, adequate care for this population is challenging. There are cultural differences between refugee patients with end-stage renal disease hailing from the Middle East, who are predominantly Muslims, and people from the western host countries. These differences may present a major obstacle in ensuring adequate patient care. In this study, we identify several of these issues that we believe western renal providers should be aware of.

International Society of Nephrology Global Kidney Health Atlas: structures, organization, and services for the management of kidney failure in the Middle East

“…ongoing conflicts and wars, 2 refugee crises and differences in language, 3 religious practices/beliefs, 4 and culture. 5 One study suggested the presence of additional, less obvious challenges, including variable availability of infrastructure, constraints on health expenditure related to gross national income, lack of data on kidney disease, and low-level awareness within the medical community and the public about the advances of therapeutic and preventive measures to reduce KF. 6 Regional bodies, such as the Middle East Society for Organ Transplantation, have been formed as a platform for filling the gaps and improving education, training, research, and collaboration within the region.…”

Exploring the care experiences of hemodialysis nurses: from the cultural sensitivity approach

“…As chronic kidney disease progresses, patients often need to make lifestyle changes, which can result in considerable psychological stress [ 32 ]. In the process of caring for HD patients, the participants of this study observed and clarified that the “refusal” of dialysis behavior was a manifestation of unacceptance exhibited by the patients.…”

“…Therefore, patients require comprehensive education about their RRT options. Adequate communication between healthcare professionals and patients is crucial when assisting patients in accepting dialysis [ 32 ]. In this study, the participants recognized that effective communication, employing language aligned with the patient’s cultural conventions and values, played a pivotal role in helping patients accept the realities of HD.…”

“…These results are consistent with those of multiple studies indicating that nurses have the closest relationship with patients and families, serving as evaluators, information providers, supporters, and educators. They respect and support all stakeholders after understanding their preferences and how they affect one another [ 32 , 38 ]. Moreover, through culturally sensitive communication, the participants of this study were able to encourage patients to “change their perspective” on receiving dialysis and utilized the support of kidney disease support groups and family members to provide patient support.…”

The Effects of the Situated Simulation Program on the Cultural Competence of Hemodialysis Nurses: A Quasi-Experimental Study

“…Culture plays a significant role in influencing the health behavior, disease cognition, response, and medical-seeking behavior of ESRD patients [10]. Taiwan is a multicultural society comprising diverse Han subgroups, as well as indigenous Malayo-Polynesian peoples and immigrants from all over the world [11].…”