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WHO | Chagas disease (American trypanosomiasis)

WHO | Chagas disease (American trypanosomiasis).  Here is a Link to The World Health Organizations Chagas page.    
Communicating with  Your Latino Patient Perception of Illness   Patterns of Kinship and Decision Making   Comfort with Touch How does the Latino culture deal with illness? Explaining the Causes of Illness and Disease • Your patient may see illness as an imbalance. The imbalance may be between internal and external sources (for example, hot and cold, natural vs. supernatural, the soul is separate from the body). - Ask your patient, “Can you tell me what caused your illness?” • There are folk-defined diseases such as empacho (stomach ailment) and standard western medically defined diseases such as measles, asthma, and TB. • Many patients seek medical care from curanderos or other folk healers. - Ask about use of pharmaceuticals or home therapies such as herbal remedies or certain foods. Screen for possible patient use of injectables, especially antibiotics or vitamins. Ask if you can see the home treatment if your patient cannot identify the substance. Helping Your Patient Take an Active Role in Care and Recovery • Your patient may believe that God determines the outcome of illness. - Consider the impact religion will have in your patient’s active participation in health care recovery. You can validate your patient’s belief by asking, “Will God be served by taking the best care of yourself?” • The patient is seen as an innocent victim, and will be expected to be passive when ill. - Help your patient take an active role in his or her recovery.Understanding Concerns About Depression • Depression may not be seen as an illness. It is often seen as a weakness and an embarrassment to family. - Treat these issues with respect. You may want to also offer the services of a clergy member. **************************************************************************************** How are medical decisions made in the Latino culture? Making Decisions About Health Care • The mother determines when a family member requires medical care; the male head of the household gives permission to go to the medical center. • Head of household, often oldest adult male, is the decision-maker, but important decisions often involve the whole family. The family spokesperson is usually the father or oldest male. - Ask your patient about whom they want to be included in medical decisions. If the patient does not want to make medical decisions for themselves, let them know they need to prepare a Durable Power of Attorney for health care. - When possible, engage the whole family in discussions that involve decisions about care. Managing Medical News • The family would prefer to hear about bad medical news before the patient is informed. The family spokesperson usually delivers information about the severity of illness. The family may want to shield the patient from the bad news. - If your patient consents, meet with the identified persons to strategize how to communicate medical news.
Family Support
La familia – the family – is an important source of emotional support during recovery. Patients like to be able to see and embrace their family members. - Be aware of the importance of this and consider extending visiting hours. Explain the visitation policy at the time the patient is admitted or before a surgery, so that the family knows what to expect. • The family may want to allow the patient to remain passive during recovery while they provide complete support for activities of daily living. - Educate family members about the importance of the patient’s active participation during recovery. What are the Latino culture’s norms about touch? Understanding Relationships • Your patients value relationships. They prefer a polite and friendly encounter before a therapeutic relation. - Take time to develop relationships. Shake hands and greet your patient by name, or ask the patient what they prefer to be called. An older patient may prefer to be called Señor (Mr.) or Señora (Mrs.). Understanding Norms About Eye Contact and Body Language • Eye contact with health care professionals or people of authority may be avoided as a sign of respect. • For some patients, eye contact may be related to evil spirits. An illness may be attributed to receiving an “evil eye” or mal ojo. • Another example of evil eye is the belief that if you admire a child by looking without actually touching him or her, the child can become very ill. • When your patient nods his or her head, it does not necessarily signify agreement, but that he or she is listening to you. Silence is more likely a sign of not understanding or disagreement. - To ensure understanding, ask open-ended questions and encourage the patient to ask questions. Understanding Norms About Touch, Modesty, and Body Language • Consider the modesty of women and girls; having a female provider may be helpful. - Ask your patient about her gender preference for providers. Consider having a female attendant present when a male provider is examining a female patient. What is unique about this patient and family that you will not learn from tips or information about their culture? Country of origin, education, and income level make a difference about how your patient perceives illness and makes health decisions. What are the questions you want to ask to learn more about this patient and their family? Check Out These Resources to Learn More About Health Care and Latino Culture Culture and Nursing Care, A Pocket Guide, J.G. Lipson, S.L. Dibble, P.A. Minarik, 1997, pp. 203-215

Russian Patients

Communicating with  Your Russian Patient Perception of Illness   Patterns of Kinship and Decision Making   Comfort with Touch How does the Russian culture deal with illness? Explaining the Causes of Illness and Disease • Your patient and his or her family may believe that illness is caused by weather or social experiences, such as stress from the living situation or because of arguing with the family. - Ask your patient if they have experienced stresses or strains recently. • Your patient may not like to take excessive medications. When an option, ask your patients if they prefer over-the-counter or homeopathic medicine. • Spend time with the patient to show that the patient is cared for. Communicating with the Patient Experiencing Depression • Mental health does not receive due respect in the former Soviet Union. Even the word “mental” has negative connotations because it is connected with “mental illness.” - Use the term depression, not mental health or mental illness. - The social worker in your clinical area is a resource to help with referrals and other ways of addressing mental health issues. ****************************************************************************************** How are medical decisions made in the Russian culture? Making Decisions About Health Care • Often the extended family – a working-age couple, their children and parents – have immigrated together. They may have other family members who might have immigrated to the United States at other times. • There are strong kinship bonds and everyone in the family provides support and service during a crisis. • Decisions are made by the parents or the oldest child. • The elders are respected. • There are no major gender issues; decisions could be made by the mother, father, or eldest son or daughter.  - Ask your patient about whom they want to be included in medical decisions. Then meet with the identified family members to strategize how to communicate the medical news. If the patients do not want to make medical decisions for themselves, let them know they need to prepare a Durable Power of Attorney for health care. Managing Medical News • Bad medical news is often shielded from the patient by the family in the belief that telling the patient will only make the patient’s condition worse. - If the patient consents, meet with the designated persons to strategize how to communicate medical news so that you are sure of the patient’s informed consent for treatment. What are the Russian culture’s norms about touch? Understanding Norms About Touch and Body Issues - Direct eye contact with your patient is acceptable. - A handshake is welcome from the health care provider. Explaining Touching • Before touching your patient, always explain what will be done and why. • Your gender as the health care provider is not likely to be an issue for your patient when doing peri-care or assessing urinary catheters. • Your patient may prefer that opposite gender family members leave the room. - Find out if this is the case for your patient. • Female patients may prefer a female OB Gyn. - Ask your patient to learn about her preference. Understanding Concerns About Hygiene and Health • When sick, your patient may prefer sponge baths to daily baths or showers. • Your patient may not wash hair as frequently when sick, especially when in the hospital, for fear of catching a cold or headache. - Your patient may prefer to keep the room warm and the window shut. • Hygiene may be performed by the patient, family, or with the help of a nurse or aide. - Maintain modesty and privacy issues with patient’s opposite-gender family members present. What is unique about this patient and family that you will not learn from tips or information about their culture? Birth region, education, and income level make a difference about how your patient perceives illness and makes health decisions. What questions do you want to ask to learn more about this patient and their family? Check Out These Resources to Learn More About Health Care and the Russian Culture Ethnomed: http://ethnomed.org Culture and Nursing Care, A Pocket Guide, J.G. Lipson, S.L. Dibble, P.A. Minarik, 1997, pp. 239-249

Korean Patients

Communicating with  Your Korean Patient Perception of Illness   Patterns of Kinship and Decision Making   Comfort with Touch How does the Korean culture deal with illness? Explaining the Cause of Illness and Disease • Your patient may follow Buddhist or Confucian doctrine, viewing illness and death as a natural part of life. • Symptoms may be seen as bad luck, misfortune or the result of “karma”– payback for something they did wrong in the past. • Your patient’s illness may be a response to stress in the family and other interpersonal relationships. • Health may be viewed as finding harmony between complementary energies such as cold and hot, female and male and dark and light. These forces are called “yin and yang.” - Ask your patient, “What do you call your problem? When did it start? What do you think caused the problem? Have you taken any medicines or folk medicines (herbs)? What results have you had from the medicines or herbs? Do you believe the illness is serious? How is your life going lately? Are you experiencing more stress, disagreements, and misunderstandings?” • Many patients seek medical care from hanui, a traditional herbal doctor. Hanyak or herbal medicines are widely used. Ginseng is a popular herb. - Build bridges between folk medicine and western care: when considering folk practices, determine when the remedies are beneficial, neutral, or harmful. Incorporate beneficial and neutral remedies into the plan of care. Consider potential drug interactions. Understanding the Relationship Between Physical and Mental Illness • Physical complaints are readily accepted. Mental illness is viewed as stigmatizing and threatening. As a result, psychological and social stress may be experienced bodily. • Hwabyung is an example of a Korean culture-bound illness, common in women. The cause of this illness is suppressed anger or intolerable tragic situations. Symptoms of hwabyung include a perceived stomach mass, palpitations, heat sensation, flushing, anxiety and irritability. • Your patient may believe that talking about the situation can relieve symptoms. - The Social Worker in your clinical area is a resource to help with referrals and other ways of addressing social stress issues. Helping Your Patient Understand Medications • Your patient may believe that western medicine is too strong and may not take the full dose or complete the course of treatment. Your patient may cut the dose in half or stop taking the medicine whether or not they feel better. - Explain that the dose is customized for your patient’s height, weight and metabolic needs. Describe the need to take the full dose whether your patient feels better right away or not. Ask open-ended questions to ensure understanding. - Alert: Be aware that your patient may have some enzyme deficiencies that require a reduction in medication dose. Contact inpatient or outpatient pharmacy for a consult on medications.
**************************************************************************** How are medical decisions made in the Korean culture? Making Decisions About Health Care
• Consult with the family in cases of serious or terminal illness. While the decision making is family focused, the husband, father, eldest son, or daughter may have the final say. The eldest male is often the spokesperson. - Ask your patient whom they want included in medical decisions. If the patient does not want to make medical decisions for themselves, let them know they need to prepare a Durable Power of Attorney for health care. - When possible, engage the whole family in discussions that involve decisions about care. Managing Medical News • Bad medical news is often shielded from the patient. The family may believe that the patient is in no condition to make a decision and that bad news dissolves hope. - Ask your patient whom he/she wants included in medical decisions. • Because of traditional Korean values of loyalty, the patient may trust that the parents and family will make the best decision for them. Therefore, advance directives may seem unnecessary to the patient and family. • The informed consent process may be a new experience for your patient. - If it is your patient’s first experience with informed consent, explain its purpose. What are the Korean culture’s norms about touch? Understanding Norms About Eye Contact and Body Language • Do not expect sustained direct eye contact. When you first meet your patient he or she may frequently look at you when you are not looking to become more comfortable. • Handshakes are appropriate between men; women do not shake hands. Respect is shown to authority figures by giving a gentle bow. Understanding Personal Space • Your patient may highly value emotional self-control, appearing stoic. Be aware that your patient may not show pain or ask for pain medications. Instead of asking your patient about pain, ask, “May I get you something for pain?” • Respect of your patient’s desire to keep emotions in control when asked about upsetting matters. Understanding Norms About Modesty • Consider the modesty of women and girls when giving a pelvic exam. Many young women are modest about having an exam and may prefer a female doctor to do it. In some cases, your patient may refuse a gynecologic exam from a provider of either gender. • Before you begin a gynecological exam, it is important to ask your patient, “May I examine you?” • Ask your patient if she prefers a female doctor, attendant, or interpreter to remain in the room during the exam. What is unique about this patient and family that you will not learn from culture tips or information? There are cultural differences based on age, ethnic group, generation, migration wave, and length of time away from Korea. Check Out These Resources to Learn More About Health Care and Korean Culture Culture and Nursing Care, A Pocket Guide, J.G. Lipson, S.L. Sibble, P.A. Minarik, 1997, pp. 280-290*. Explaining Illness Research, Theory, and Strategies, Whaley, Bryan B., Lawrence Erlbaum Associates, 2000, pp. 283-297

Vietnamese Patients

Communicating with  Your Vietnamese Patient Perception of Illness   Patterns of Kinship and Decision Making   Comfort with Touch How does the Vietnamese culture deal with illness? Explaining the Cause of Illness and Disease • Your patient may explain illness: 1. As an imbalance between body and nature (yin and yang, male and female, dark and light), and folk cures for these imbalances are expressed as “hot and cold”; 2. As an obvious cause and effect relationship (rotten food or poisonous water), and medicinal herbs or therapeutic diets are used to cure these disorders; or 3. As a result of germs. - Ask your patient, “What do you call your problem? When did it start and why then? What do you think caused the problem? Have you treated the illness? Do you believe the illness is serious?” Building Bridges Between Folk Remedies and Western Health Care • Many patients will get their care from folk healers first, and will seek western medical care if the folk treatments fail. As a result, patients may present at the medical center acutely ill. • There are a variety of common folk remedies that your patient may use, including cao gio (coin rubbing) or bat gio (skin pinching). These remedies are used to allow unwanted winds or elements to escape the body. They are not harmful, and many patients report feeling better afterwards. - Build bridges between folk medicine and western care: when considering folk practices, determine when the remedies are beneficial, neutral, or harmful. Incorporate beneficial and neutral remedies into the plan of care. Consider potential drug interactions. Helping Your Patient Understand Medications • Your patient may believe that western medicine is too strong and may not take the full dose or complete the course of treatment. Your patient may cut the dose in half or stop taking the medicine whether they feel better or not. - Explain that the dose is customized for your patient’s height, weight and metabolic needs. Describe the need to take the full dose whether your patient feels better right away or not. Ask open-ended questions to ensure understanding. - Alert: Be aware your patient may have some enzyme deficiencies that require a reduction in medication dose. Contact inpatient or outpatient pharmacy for a consult on medications. Understanding the Meaning of a Hospital Stay or Surgery • Your patient may see the hospital stay or surgery as the last resort before death. A visit from a clergy member may also be perceived as a death-bed visit. - If possible, perform outpatient procedures or ensure understanding of why a hospital stay is necessary.  Check with your patient or family member before a member of the clergy visits your patient. - If your patient does not want to make decisions for him/herself, let your patient know he/she needs to prepare a Durable Power of Attorney for health care.  Obtain forms from Admitting or Social Work. • The informed consent process may be a new experience for your patient. - If it is your patient’s first experience with informed consent, explain its purpose. (The UWMC publication Information About Your Health Care is available in Vietnamese.) *************************************************************************************** How are medical decisions made in the Vietnamese culture? Making Decisions About Health Care • Consult with the family in cases of serious or terminal illness. The family may want to make the health care decisions to avoid worrying the patient. The family spokesperson is often the person with the best English. - Ask your patient whom he/she wants included in medical decisions. • Women act as primary providers at the bedside although the entire family may care for the hospitalized patient. - Be aware of the importance of family members serving in caregiver roles and consider extending visiting hours. Explain the visitation policy before admission or surgery so that the family knows what to expect. Understanding Communication about Health Care and Treatments • Your patient may nod, smile, and/or say “yes” or “ya” to acknowledge he/she heard you, rather than that he/she understands or approves. Your patient may be reluctant to say “no” to a doctor or health care provider because it may be considered disrespectful or cause disharmony. - Ask your patient open-ended questions to verify understanding and encourage them to ask questions. What are the Vietnamese culture’s norms about touch? Understanding Personal Space • Handshakes are appropriate between men; women do not shake hands. • Respect is shown to authority figures by giving a gentle bow and avoiding eye contact. • Your patient may highly value emotional self-control, appearing stoic. Be aware that your patient may not show pain or ask for pain medications. - Instead of asking your patient about pain, ask, “May I get you something for pain?” - Be respectful of your patient’s desire to keep emotions in control when asked about upsetting subject matters. • Some elder or new immigrant patients may consider the head sacred. Avoid touching it unless necessary. - If an exam or procedure requires head care, let your patient know in advance. Some patients may feel protected if the opposite side of the head or shoulder is also touched. - When examining your patient, do a head-to-toe assessment to honor the highest, most important part of the body first. Understanding Norms About Modesty • Consider the modesty of women and girls when giving a pelvic exam. Many young nulliparous women are modest about having an exam and may prefer a female doctor to do it. In some cases, your patient may refuse a gynecologic exam from a provider of either gender. - Before you begin a gynecological exam, it is important to ask your patient, “May I examine you?” - Ask your patient if she prefers a female doctor, attendant or interpreter to remain in the room during the exam. What is unique about this patient and family that you will not learn from tips or information about their culture? There are differences based on age, ethnic group, generation, migration wave, and length of time away from Vietnam. hat are the questions you want to ask to learn more about this patient and family? Check Out These Resources to Learn More About Health Care and Vietnamese Culture Ethnomed: http://ethnomed.org Culture and Nursing Care, A Pocket Guide, J.G. Lipson, S.L. Sibble, P.A. Minarik, 1997, pp. 280-290*. Explaining Illness Research, Theory, and Strategies, Whaley, Bryan B., Lawrence Erlbaum Associates, 2000, pp. 283-297*.