Ask people for permission to touch them, especially if it's above the shoulders.

Allow families to be intimately involved in their loved ones' care.

Respect a patient's decision to refuse treatment.

These are lessons Nitiporn "Beau" Machart is teaching staff members at the Wyoming Medical Center to help them better treat patients from Thailand and other countries in Southeast Asia.

A coworker, Patti Nelson, calls Machart "a lady of Thailand and a lady of Wyoming."

Machart moved to Wyoming from Thailand in 2004 with her husband. She previously worked as a nurse in a 700-bed hospital in Bangkok, the capital city, and when she came to the United States, she continued her nursing career at WMC.

While working in an American hospital, she has noticed differences in her role as a nurse and the way Thai and Wyoming patients view health care. She shared her experiences with colleagues Thursday as part of the hospital's cultural awareness program.

About two years ago, the hospital realized its patient population was growing more diverse, said Eileen Rissler, a registered nurse. The hospital decided to start hosting quarterly events to educate staff about other cultures.

Recently, the hospital has treated more patients from Southeast Asia and the Middle East, Rissler said.

"We can serve them better by exploring their culture," Rissler said. "They place a bigger value on family."

She said the concept of family in the United States has faded to some degree.

"It's important to respect their need for family to be around and realize decisions will be made by the group instead of the individual," Rissler said.

Machart said a Thai patient would have four times the amount of family visiting them than a Casper patient.

"Most patients are in private rooms, so family can stay 24 hours a day," Machart said. And the rooms are much larger to accommodate all the aunts and uncles.

Even though families in Thailand are close, Machart said, "I cannot go hug my mom or kiss her to show I love her."

Instead, she bows and tells her mother she loves her.

Thai people do not touch each other above the shoulders. This is an important behavior WMC nurses should remember if they are caring for a patient from Thailand or other Asian countries.

Also, Thai don't like to take pain medications or even show pain.

"Just out of open-heart surgery and they get two ibuprofen," Machart said. "Patients here are asking for pain medications every four hours."

Pain medication is a last resort, Rissler said.

"Seeking health care is often a last resort," Rissler said, "after other efforts have been tried like family knowledge, herbal and spiritual remedies."

Machart said her hospital in Bangkok would use acupuncture and have monks pray for patients.

Nelson, a pharmacist at the hospital, relates to what Machart has to say. She has had several foreign exchange students from Asia, including one from Thailand.

It's helpful for the staff to understand different cultures and in some cases, speak different languages, Nelson said.

"If our goal is to reach the best possible outcome for the patient, we have to know what that means to the patient and what is the best path to get there," Rissler said. "That means including the cultural and spiritual input of the patient."

Contact health reporter Allison Rupp at (307) 266-0534 or allison.rupp@trib.com.