Noncompliant Bhutanese patients

[harnof]

Please advise me if anyone knows how to work with or deal with

Bhutanese patients.

I am a visiting nurse and the majority of my clients are Indian or Bhutanese.

When I enter their homes I always remove my shoes as they do, smile and begin to visit with them with my interpreter who will become their PCA ( care giver).

I can never get a straight answer to a question.

I can never get a yes or no.

Those who have diabetes have no idea what the diet is or what I am asking them or showing them. They refer to themselves as "very old lady" when they are still in their 50's.

Often the response is no response at all. But a foggy look and literally they shrug the shoulder toward any conversation re. their diagnosis.

I spend most of my time calling their Dr. offices trying to get answers that way.

Any advice would be most appreciated.

I am most aware of the difference in cultures. The lack of basic education and obvious lack of nutrition that I seem to be witness to. The elderly women cannot sign their names. I have them "x" for signatures.

They and I are each polite and friendly but a 1 hour evaluation ends up with lots of loose ends.

Thanks to Anyone who can provide specifics.

b

[Emergency RN]

This is not a quick fix, but if you wish to learn about Bhutan and Bhutanese, there is a wonderful list of sources that can be found in Google Books. Just type in Bhutan in the search box.

Also, general info regarding Bhutan:

CIA - The World Factbook

Culture of Bhutan - Wikipedia, the free encyclopedia

Health in Bhutan - Wikipedia, the free encyclopedia

http://www.itmonline.org/arts/bhutan.htm

Good luck

[emille]

Bhutanese refugees like most Asians tend to be detailed in their explanation hoping to give an in depth description.You will find them talking in long sentences.Often it ends up being non specific for the provider who wants a yes/no answer.

Re: food, vegetables aside, their staple diet is mainly inclusive of carb enriched products like rice,potatoes,bread. So, it can be quite challenging to modify this since this is the only type of food they've been used to their entire life.However, they are very open to changes and if educated properly, they may heed to your advice.

What you need is a good interpreter by which I mean, someone who understands the cultural nuances and not just speak the language. Many Bhutanese patients have confided to me about how they don't understand some interpreters. Not all Bhutanese people speak Indian(Hindi) and often they are given Hindi interpreters. So, getting a Nepali interpreter would be more helpful.

Life for many Bhutanese refugees starts early on.They get married early,have kids early on .So in their 50s,most of them are already grannies/grandpas.So that psychologically may make them feel older.Also, in the rough terrains w/ hard labor,you tend to age faster.Things like using SPF sunscreen,anti aging tx are considered a luxury.

Most elderly Bhutanese refugees have never been to school.So, that answers why they wouldn't know how to sign.

They put a lot of faith into the provider's hands like 'you know it all and we're just lay men/women' and will generally not question your judgement.

Hope that was helpful!

[ProBeeRN, BSN, RN]

I dont have much info on Bhutanese patients persay, but in homecare I run into this type of situation all the time- keep in mind that you can't set the same goals for each patient, and each patient needs to be approached differently in terms of disease teaching/ management/ etc based on culture/educational level/history.

In general, I'd say keep your phrasing short and simple, avoid long winded explanations, and watch your medical terminology. Sometimes I get a lot farther by saying "Do you check your sugar?"- while holding up my finger and pantomiming- than saying "Do you have a glucometer in the home?"

[harnof]

Emille and ProBeeRN,

Thank you so much for your quick and thorough explanations.

You're right re. the long ( looong!) explanations.

As for the interpreters these are usually Bhutanee people who are going to be the caregiver ( aids).

Appreciate your feedback!

Thanks.

[harnof]

EmergencyRN,

Didn't see your post at first.

I thank you also!