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This can be a challenge, Kay said. Someone might say she is sick because someone made her jealous and the envy has caused a mass in the stomach, for example.

In her position at the San Ysidro Health Center south of San Diego, Trang sees patients who have a connection to Mexico. The proximity of Mexico means patients can self-medicate at pharmacies south of the border, which are considerably more lax than their U.S. counterparts in dispensing medicines.

“We explain that you can’t just treat yourself,” she said. “A lot of times, it’s the medication that’s causing them to feel ill.”

Many of her patients do not see the point in maintenance health care until she is able to point to specific examples.

“A whopping blood pressure still needs to be controlled even if you don’t feel the symptoms,” she said.

Her patients often live in extended families who all become involved in the care, which can help, especially if a nurse wants to emphasize the potential devastation of a long-term illness that could be treated, Kay said.

At other times, keeping the family separate from patients is important. Kay has noticed that some Hispanic men, for example, give more detailed answers when they are questioned alone.

From her training and from her work, Kay has found herself surprised at the array of health care systems and beliefs in the world. Studying medicine along with different cultures was effective, she said.

“You bring all that together and try to be as open-minded as possible,” she said.

Ninety percent of Sanchez de Jeudy’s clientele speak Spanish, she said. Many come from Mexico and have different beliefs about medicine and disease.

Some do not understand why they must wear a mask or isolate themselves while others stop taking medications as soon as they feel better. Some assume TB is just a bad cold, treatable by dressing warmly and avoiding cold drinks.

Sanchez de Jeudy knows dismissing those beliefs would be a mistake.

“When you do that, they totally shut off and won’t listen to you,” she said.

Appreciating differences

For Joy Guideng, RN, director of cardiovascular services at University Medical Center in Las Vegas, years of experience have made her more sensitive not just to cultural differences, but to religious and personal differences as well.

She estimates that 90% of the care she gives patients is education, which requires sensitivity and an adroit use of general questions. Instead of recommending birth control, she might ask if a patient has even heard of it and would like information.

“From that information, we get what they know and what they don’t, and what they’re willing to take from us,” she said.

Guideng speaks Tagalog, the language of the Philippines, as do many of her colleagues. The staff has designated Spanish speakers who interpret as well, she said. In the past, a nurse might grab anyone on staff who spoke Spanish to translate, Guideng said, but now interpreters go through training that also teaches limitations on what can be said and ways to communicate effectively.

For other patients, the nurses have a conference phone line they use to get a certified interpreter for whatever language is needed.

Nurses can take classes, focus on empathy, or immerse themselves in other cultures, but those who have spent a great deal of time explaining the importance of following physicians’ orders only to see those orders ignored can feel frustrated.

“It’s not for us to judge what is good and what is bad,” Tang said. “It’s for us to devise strategies to provide the best care for the patient.”

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