Well...I'm a PHN in an urban, very diverse area here in the US.
1. language/cultural barriers are huge. Luckily, we have access to an interpreter line and I speak spanish, but it can be very difficult. I work primarily with pregnant women, and some cultures that are very different from ours (such as Pakistani) do not allow the woman to be alone with me, the nurse. So I always have to meet with the patient with a man present and have no time to talk with the woman alone (about issues she won't discuss in front of husband/FIL/BIL--like contraception, domestic violence, etc). Just one example.
We also screen (most) foreing born kids for TB and many parents do not believe us when we tell them that BCG given previously will not cause a >10mm +PPD. If the CXR is neg many parents still refuse the 'preventative' INH treatment.
The biggest need for teaching--boy, I don't know where to start. Healthy diets, prevention of diabetes and heart disease, not to mention cancer. Prevention of STD transmission is huge. Some people view our STD clinics as a 'check-up' rather than preventing the need to come every other month.
One thing I WISH we had more money for would be prenatal courses for women from other countries (particularly central america--a huge undocumented population in my area) in their native language. Many women/girls have never delivered a baby in the US and it is a very different exp from back home. I can only convey so much info in the hour I meet with people and feel there needs to be something more.
Hope that helps!
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