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Dos and Don’ts for Foreign Travelers in the U.S.

by Anu Sarma on October 16, 2015 Comments Off on Dos and Don’ts for Foreign Travelers in the U.S.

Foreign visitors to the United States come to the country to see famous cities and natural wonders. More than 30 million people per year travel from far-flung locations to American soil. Some come to visit relatives and friends. Others are purely tourists, interested in absorbing the culture of one of the most powerful and famous countries in the world.

The United States is known for embracing people and customs of many cultures within its borders. In fact, so many people from other countries immigrate to the United States, it is often referred to as a “melting pot” of culture.

Foreign travelers to the US who are aware of the country’s diverse ethnicities might believe it’s a place where anything goes. By some measures, this is true. However, foreign visitors are often surprised to find out there are subtle cultural expectations and unwritten rules that must be followed in order to be perceived as a polite and respectable visitor.










Travel guidebooks often attempt to analyze these unwritten rules. Some of the books are more successful at this than others. Outdated books often share advice about traveling in the U.S. that no longer applies. Online sources, in some cases, provide better up-to-date cultural rules.

It’s okay to ask advice about culture when visiting the U.S.

The best advice may be to follow the lead of your American hosts. If you are not visiting family members or friends in the United States, it is perfectly acceptable to ask advice of anyone you encounter during your trip. For example, you can ask drivers, servers, store clerks and others to explain the country’s cultural expectations– especially those related to the service you are receiving.

Hotels often have concierge desks, where you can not only ask about interesting places to visit, but you also can obtain advice about etiquette, customs, and culture.

A few of the most common do’s and don’ts for traveling to the U.S. from foreign countries:

Do tip servers in restaurants. Many countries do not have a custom of tipping servers in restaurants . The United States has an unwritten rule that customers in restaurants share the cost of the servers’ labor. Servers often are paid a minimal hourly amount, with the expectation that customers will add a tip of 20% to the bill. Some customers pay a higher tip for exceptional service, but it can be considered cruel to pay a lower tip for so-so service. It is also customary to tip others who provide services, such as bellmen and taxi drivers.

Do be on time. In some countries around the world, an agreed-upon time for an event or meeting friends is only a guideline. In the United States, when a time is agreed upon it is generally expected all participants will arrive no later than 10 or 15 minutes after the agreed-upon time.

Do be discreet about politics. The political scene in the United States can be very volatile, depending on who you are talking to and what area of the country you are in. It’s not taboo to discuss politics, but it is important to make an effort not to offend your hosts or their friends– easy to do if you throw around your own opinions casually. It’s best to ask how people feel, rather than telling them how you feel.

Do obey all traffic signs and laws. Some countries’ laws are understood to be simply guidelines to help things run or smoothly. In the United States, laws are taken seriously, and if the laws are broken you could find yourself facing legal problems. If in doubt, ask someone about the laws in the city, county or state you are visiting.

Don’t smoke in undesignated areas. More than half of the states in the U.S. have local laws prohibiting smoking in public. Some cities prohibit smoking anywhere indoors. Because each state and city is different, it’s important to ask someone where smoking is allowed, if you are a smoker.

Don’t try to speak like an American. In the United States, you will be respected for your own mannerisms and personality. It’s not necessary to try to fit in by using American slang, taking on American habits or showing off your knowledge of American culture. In fact, if you attempt to do these things, it can be offensive and embarrassing.

Don’t make noises when you eat. In some countries, it’s okay and even expected to make slurping noises, burp or engage in loud conversation during meals. In the United States, the exact opposite is true.

Don’t get too close to people you don’t know well. Americans are somewhat formal when it comes to personal space. Most do not practice cheek kissing and, although hugs are okay in many situations, it usually is not appropriate to hug strangers or people you only know through others.

Don’t overstay your visa. Other countries may be lenient about this, but the United States takes it seriously. Many people try to get into the United States illegally, and not following the rules could land you in legal trouble.

If you follow most rules and make an effort to be sensitive to cultural habits of Americans, then you can relax and enjoy your adventure in the United States.

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Anu SarmaDos and Don’ts for Foreign Travelers in the U.S.

7 Ways to Provide Financial Support for Aging Parents

by Anu Sarma on June 18, 2015 Comments Off on 7 Ways to Provide Financial Support for Aging Parents

Ask most adults if they are prepared for the financial consequences of their parents getting older, and they will say no. The need to support ageing parents financially is not an issue that is discussed by many people. And when people do discuss it, the details often get lost. Do you know how you are going to support your parents as they age and need care? Have you worked out how much it could cost, and where you are going to get the money? If not, the time to start thinking about it is now. If your parents are not wealthy then the cost of care will fall to you, and without adequate funds your parents may end up on Medicaid, in a shared room in an assisted living facility – or you could take on the high personal burden of care yourself.

ageing parents









With a little forward planning and sound financial management you can reduce the burden of high costs for senior care. Here are seven tips for supporting your parents financially as they get older.

1. Work out what it costs to financially support your aging parents and what it would also cost in terms of your wellbeing and personal life if you had to provide the care for your parents yourself. Studies like the Genworth Cost of Care Survey show roughly what you can expect to pay in different states for different levels of care facility. You can also check the cost of providing live-in helpers, or carers that do not fully support the parent but will provide support like cleaning or grocery shopping. Knowing exactly what you are faced with will help focus your financial planning.

2. Look ahead and figure out the number of years you may need to provide financial support. Of course, it is hard to predict what needs a person will have in the future and what you will need to pay. But you could figure out a general idea of the time you may be paying and what you need to pay. Even if a parent is financially well off, how long will the money last – what happens when an aging parent runs out of money?

3. Consider long term care insurance. If you can afford it, have your parents take out this insurance as early on as possible, or you can pay for it before there are any problems of medical diagnoses that will make it impossible to insure your parent.

4. Educate yourself and work out what you need to set aside each month to pay for insurance, or to save in order to spend later on senior care.

5. Talk to your parents about financial issues. Even if they are not comfortable discussing things like this, insist on the conversation so that you can work out exactly what money they have and what you will need to provide. Talk to your parents about their views on aging and where they want to live when they can no longer take care of themselves. Make the conversation about you – focus on your need to manage your estate planning or your finances – and less on them, so they don’t feel threatened or anxious.

6. Look into care possibilities and the most appropriate forms of support. Even if you do not need it now it helps to understand what the options are and to be able to plan appropriately. For example, at the very least there are local transportation services that help aging parents get around, and adult daycare facilities out of the home plus daytime health service programs – the cost of these out of home services is considerably less than a live-in carer and it can work out as highly affordable. For less independent parents there is the possibility of in-home care. Or look at the range of assisted living facilities.

7. Look at lowering expenses for your parents including switching utilities, or having some “free” from the church come visit your parent for a while if they suffer from loneliness or isolation.

Smart planning now will remove the possibility of shock and distress further down the line. If you work together to discuss their needs and their assets you can prepare your family for the financial realities of getting older.

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Anu Sarma7 Ways to Provide Financial Support for Aging Parents

Best Travel Websites to Plan Your Holidays

by Anu Sarma on October 9, 2014 Comments Off on Best Travel Websites to Plan Your Holidays

When it comes to travelling to the best places in the world, travel websites are without a doubt one of the best options today. Offering flexibility, valuable information and great discounts, online travel guides are a great way to plan the perfect vacation. Travel websites are a great source of information that can help you find great travel deals and discounts. With the best flight fares, great hotel deals and top tourist attractions on the website itself, you can save on travel packages, air fares and much more. Make sure you keep your eyes open for discount coupons and plan your holidays accordingly. A great advantage of travel websites is that you can choose several destinations for your vacation and make your hotel and flight bookings on the website itself. You even make use of online travel resources to watch videos and pictures of the places you plan on visiting.


Here is a list of some travel websites that will help you plan your holidays:
Lonely planet is a very good travel guide site, offering details about various destinations, how to get there, history of the place and much more. This is by far the best site if you are planning a vacation on a budget. It gives a lot of information on budget accommodations and youth hostels that come handy to backpackers and solo travellers.

To know about the best travel deals and family destinations, Fodors is the best online travel guide. It offers great advice on resorts, holiday packages, flights, restaurants and lots more. Fodors gives you plenty of information with booking options too. It has travel blogs with personal experiences of seasoned travellers that give you first hand information about various destinations. Their online deals can get you amazing travel savings and the website’s travel trip idea ensures that you get to enjoy an unforgettable vacation. Fodors online guide provides you everything you need to know about your destination, whether it is accommodation, shopping or tourist attractions. Its travel forum gives you a chance to connect with a community of like minded travellers and share your travel questions and experiences with them.

This is an American website featuring destinations in America and Europe. Offering great travel tips and ideas on where to go and how to get there, this is the best site if you are planning to travel to Europe or America. It features all the best hotels and everything you need to know about your destination.

One of the biggest travel companies in the world, Travelocity offers discounts on vacation packages, cruise fares, hotels, airfares and much more. With Travelocity coupons, you can save a lot on your vacation packages. You can even read reviews on resorts, hotels and restaurants from other travellers and then decide where you want to stay and what activities you are interested in.

TripAdvisor is one of the best travel websites for useful reviews and advice on hotels, flights, restaurants, holiday packages and much more. You can find budget hotels, service apartments and home stays; the destination guides on the site are particularly useful. On TripAdvisor, you can get the best prices for tickets, accommodation and sight-seeing tours. Whether you are planning the perfect dream vacation or want the best hotel prices or a great deal on a cruise or at an all inclusive resort, you will find what you are looking for on TripAdvisor. On its interactive travel forums, you can read real reviews, comments and see candid photos by travellers and go with the best choice.

Expedia is one site that has all your travel needs covered. Its website has a variety of travel packages to various destinations at discounted prices. There are several travel deals that suit every budget, offering both fun and savings. Expedia truly makes your dream vacation come true with pocket friendly vacation deals, coupons to cut travel costs and much more.

Planning a holiday can be an expensive and a time consuming exercise, often taking away the enjoyment out of a trip. With so many travel websites to choose from, you can research your destination in advance and take control of your travel schedule. Every detail of your vacation can be pre-organised leaving you free to relax and enjoy your holiday.

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Anu SarmaBest Travel Websites to Plan Your Holidays

Multicultural Hospitals: Melting Pot of Medicine?

by Anu Sarma on June 5, 2014 Comments Off on Multicultural Hospitals: Melting Pot of Medicine?

I will apply, for the benefit of the sick, all measures that are required, avoiding those twin traps of overtreatment and therapeutic nihilism. I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.
-Excerpt of the Modern day version of the Hippocratic oath, written by Louis Lasagna (Academic Dean of School of Medicine, Tufts University)

Cultural competence is a term coined in 1989 by Cross et al, which effectively combines both words to describe an attribute needed to serve an ethnically diverse community. To be culturally competent means you have the ability to function effectively in a setting of beliefs, attitudes and values that are different from your own. Easier said than done, this skill requires a thorough knowledge of one’s own cultural beliefs and limitations as well as the capacity to identify and understand others’.


Although a valued skill gaining more and more recognition in all fields, as a result of our interconnected world, this dexterity is of particular importance in the healthcare field. Statistics point to an ever-increasing number of ethnicities not only seeking, but more importantly needing medical attention in the United States. There are also large numbers of prosperous immigrants travelling to American territories to obtain treatment.

Hospitals around the country have recognized this and are beginning to make the necessary changes. To that extent, they have begun to heavily invest in culturally sensitive programs. Every institution is different. In some cases the driving force behind the changes is purely financial, while in others it is the result of a visible need to better serve their patients. Either way, they are applying, for the benefit of the sick, all measures that are required.

Demographics are key drivers when deciding what cultures to target. Some hospitals, for example, are focusing on ethnic-related ailments, extensive interpreter support and strong alliances with local doctors. This happened in one case after detecting patterns in Chinese patients, who were unable to communicate their symptoms accurately, were misdiagnosed, discharged and consequently suffered an escalation of their previous symptoms. Needless to say, everyone in the community benefits from this increased cultural sensitivity.

In many cases, the care-providers and the patients speak the same language, are of the same ethnicity but do not share the same attitudes and values. In these cases, if there is no cultural awareness, the patients feel uncomfortable, since doctors and nurses, not knowing the correct questions to ask, make assumptions about their lifestyles and formulate a plan for care, based on false information. Needless to say, it does not adhere to the Hippocratic promise and deteriorates the patients’ emotional wellbeing.

Although language is the first distinguisher and many times barrier of cultural understanding, the caregivers’ beliefs are many times the largest impediment for the patient to heal successfully. Unbeknownst to most doctors, Native American tribes hold strong sentiments against the Western culture and firmly believe they are not capable of restoring their health. In one particular instance, a woman was in the hospital after a serious car accident. None of her family members appeared for the first week and she did not utter a word to any of the staff members. She was in a comatose state, although the tests indicated she had no brain injuries. Needless to say, the physicians were baffled. When her mother finally appeared, she requested to perform a water healing ceremony. The hospital agreed. Right after the ceremony, the woman spoke to her mother. It turns out, she had used one of her tribe’s consciousness altering techniques in order to avoid any contact with the “white doctors”. The hospital realized it needed to work with, and not against this belief and has consequently, begun to incorporate more Native American references into their practice, consulted with local tribes, offered training on alternative medicine and is flexible about allowing rituals and ceremonies. After all, there is art to medicine as well as science.

Hospitals seeking to increase the number of patients from a particular culture in order to increase their financial revenue are more proactive about cultural inclusion and hence, make every effort to recreate the warmth of their native countries. Some facilities have adapted their menus, the color of their paper and their interior decorating in order to make their foreign patients feel more at home. For a hospital serving South Asian patients, this meant changing the patient information pamphlets’ color. The practical, clean and very American white reminded those patients of death (clearly not something you want to publicize in a hospital!). So, the pamphlets were changed to red, the color of happiness. Who would’ve known that such a subtle difference could have such an impact on healing?

As we progress deeper in to the 21st century, medics are learning that there is a lot more to healing than a one-size-fits-all approach. To that extent, many healthcare providers around the country are dramatically altering the way they perceive and understand healing. They are addressing these changes on a mental, emotional, physical and spiritual level in an attempt to accommodate a larger range of perceptions. While the goal may take different forms, the underlying principle remains the same, to provide the best care for every patient. It won’t be long before many hospitals turn into ethnic hospitals, specializing in culturally sensitive practices, or perhaps we will all be so culturally competent that we won’t know the difference. Either way the hospitals of the future promise to look very different.

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Anu SarmaMulticultural Hospitals: Melting Pot of Medicine?

Urgent Care v.s. Emergency Care

by Anu Sarma on March 20, 2014 Comments Off on Urgent Care v.s. Emergency Care

Our ability to make balanced and rational decisions is not at its best when we are sick, injured or in acute pain.  At such moments, our main focus is to restore balance and eliminate our agony.  To that extent, we might make decisions that do not really cater to our personal (or financial) wellbeing.

When we are unwell and do not have the choice of seeing our primary care physician, we must decide whether to seek assistance in the ER or at an Urgent Care Center. Hence, it is wise to know when to use the Emergency Room and when to use Urgent Care centers.  Both facilities are designed to alleviate medical conditions but do so at dramatically different costs and levels. Knowing where to go to treat what before a health crisis strikes is a wise strategy that will replenish your health more effectively and safeguard your finances from unnecessary charges.The definition of the word emergency might clue us in as to why the ER is so heavily overused. It is defined as “sudden crisis requiring action” and “needing immediate treatment”.  Without a doubt, this is the mindset we find ourselves when stricken with a malady that upsets our daily routines and comfort level.  While we may want to receive immediate care and attention, the truth is ER waits for non-traumatic injuries or illnesses can average up to four hours and have an average expense of $1,300 dollars per visit.

Urgent care

Perhaps, it is why Urgent Care centers are becoming more and more popular and widespread. These centers are more like small private clinics that are designed to treat minor/daily/common illnesses and injuries in a prompt and less comprehensive way; they are staffed by physicians, nurses and assistants that provide care for common injuries and illnesses in a quicker and more cost-effective way.

It makes sense, Emergency Rooms are designed and actually specialize in  maximizing  the chances of saving lives.  They are required to be open 24 hours and have state of the art facilities.  Whether you come in with pain in your ear or chest, a very thorough analysis of your current health situation will be performed.  This might include but may not be limited to blood work, urine samples, ultrasounds, cat scans or anything else required to better understand the exact cause of the patient’s distress.  If you are at the ER for a life-threatening emergency, all of this makes sense.  Nevertheless, if you are there as a result of an ear infection, you may find it excessive in more ways than one.  Misuse and overuse of the ER are, in fact, the main reasons for higher costs and rate increases for insurance premiums. Not to mention, an overbooking of the facilities that results in longer waits for patients with non-threatening cases.

According to the American College of Emergency Physicians you should visit an ER if any of the following signs are present:

  • Chest or pain pressure
  • Uncontrolled bleeding
  • Sudden or severe pain
  • Coughing or vomiting blood
  • Difficulty breathing or shortness of breath
  • Sudden dizziness, weakness, or changes in vision
  • Severe or persistent vomiting or diarrhea
  • Changes in mental status, such as confusion
  • Heavy bleeding
  • Large open wounds
  • Sudden change in vision
  • Chest pain
  • Sudden weakness
  • Trouble breathing
  • Major burns
  • Spinal injuries
  • Severe head injury
  • Loss of consciousness
  • Abdominal pain

  On the other hand they recommend visiting an Urgent Care center for the following:

  • Sprains
  • Strains
  • Minor broken bones
  • Mild asthma attacks
  • Minor infections
  • Small cuts
  • Sore throats
  • Rashes
  • Minor burns
  • Urinary tract infections
  • Pelvic infections

A quick examination of the difference in cost between treatment in the ER or at an Urgent Care facility for minor illnesses will further point out why Urgent care facilities are more cost effective when you are not experiencing any life-threatening issues.  For example, a case of acute bronchitis treated at the ER will average a total cost of $814 while the same illness with the same prescription will total $122 at the urgent care, treating acute pharyngitis at the ER will cost $620 while visiting a local urgent care will cost $93.  If you have an ear infection, you will spend $498 to feel better at the ER, while the Urgent Care will only need $100 of your money to solve the issue.

Consequently, it pays and well, to know when to go to the Emergency Room.  It also comes in handy to identify beforehand what Urgent Centers are near your home, work or children’s school.  If you are insured, call your insurance company and ask them which centers are in the network. Having a plan previously established before a crisis strikes will not only give you peace of mind, but will allow you to act promptly and without doubt when all your energy is drained by discomfort and clouds your best judgment.

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Anu SarmaUrgent Care v.s. Emergency Care