Impacts of Culture and Social Structures on Marshallese Health

Topics: U.S. Healthcare, Republic of the Marshall Islands, culture, trauma, discrimination

Key terms: displacement, participation observation

Original article: “Neocolonialism and Health Care Access Among Marshall Islanders in the United States” by Michael R. Duke

Introduction

As the coronavirus makes its way through the U.S. it has brought to light the many glaring failures of the healthcare system in the United States. This failure can be seen in one specific outbreak that took place in a Tyson poultry factory in Springdale, Arkansas. This outbreak is uniquely appropriate to portray the shortcomings of the healthcare system due to the large population of Marshallese that were involved. Marshall Islanders in the United States are a group that has been wronged by the U.S. government since the beginning of their interactions.

Historical Background

Their story begins when the Republic of the Marshall Islands (RMI), a former Japanese colony, became a protectorate of the U.S. government after World War II. In the 1940s and ‘50s, the United States carried out extensive nuclear weapons testing in the RMI. At the same time, U.S. authorities also conducted a long-term study on the effects of nuclear weapons on Marshallese communities without the consent or knowledge of the Marshallese themselves.

Weapons testing had an undeniable and wide-ranging impact on the Marshall Islanders that has caused them to suffer the consequences to this day. Firstly, radiation exposure led to high levels of cancer and thyroid conditions among the population, as well as miscarriages, stillbirths, and birth defects. The building of a military base on one of the islands displaced many Marshallese, resulting in high population density on other islands and fostering a disease like tuberculosis, which is prevalent in the RMI. Displacement is a type of migration that is typically caused by an external event such as climate change, war, or forcible removal. Additionally, radiation degraded traditional food sources, one of which is breadfruit trees which take very long to mature, leaving the Marshallese to rely on processed alternatives. This dietary change indirectly resulted in almost half the population now suffering from Type 2 diabetes. These traumas are continuous; as put by a Marshallese woman, “I cannot stop thinking about it” (p. 428).

Today, the relationship between the United States and a number of Pacific Island nations, including the Marshall Islands, is governed under the terms of the Compact of Free Association (COFA) treaty, which provides foreign aid to the RMI and allows its citizens to live and work in the United States without a visa in exchange for the United States maintaining control over the ocean surrounding the islands. One third of the Marshallese population now resides in the United States, and outside of Hawaii, the largest Marshallese American population center is Springdale, Arkansas, where many Marshallese work in the poultry industry. Many of these individuals have migrated in order to access healthcare and the better economic opportunity that the country offers. What they might not have realized when moving are the barriers in place that prevent them from accessing the things they came here for.

Anthropology as a Tool for Understanding

To better understand the health burden and barriers to healthcare access faced by the Marshallese population living in Springdale, Arkansas, anthropologist Michael Duke spent gathered information through participation observation and interviews. Participation observation is a common research method anthropologists use where they live alongside the people they are studying and observe their behavior. Duke observed the Marshallese in schools, churches, health clinics, and community meetings. The information below is a summary on how culture and social structures impact health.

What We Learned

Unfortunately, a cultural stigma exists against any form of illness, preventing the Marshallese from seeking treatment until their ailments have advanced significantly. As an interpreter who worked with Duke put it, “For a typical Marshallese, ‘If I’m breathing and I’m not in pain, I’m okay’” (p. 430). These cultural values prevent them from accepting the real source of their health burden, which is the weapons testing carried out by the U.S. government.

Perhaps the most disheartening of all is the discrimination faced by Marshallese when trying to access the health care they so clearly and uniquely deserve. Along with the many barriers they face for being poor, working class individuals, there are many more based on their ethnicity and nationality. People in their community, including healthcare providers, view them as “primitive and childlike” along with the prejudices they face for being “Others.” One of the nurses in the local hospital expressed that she always had to “tell them what to do.” The healthcare workers explained this was because they didn’t follow directions well, didn’t always pay what they owed, and were unclean. Many of their community members also associate them with disease due to their uniquely large healthcare burden. These prejudices are not only held by the people in their community but even more so by the health care providers who have vowed to treat all patients impartially. These views shape their treatment of the Marshallese, which is discriminatory in many different ways. For example, the Marshallese encounter much longer wait times in the ER compared to their white or Latino counterparts. Additionally, when seen, they face prejudice in their interactions with hospital staff. Many nurses expressed feelings similar to one that said, “You have to tell them what to do,” insinuating that most Marshallese lack intelligence and manners, especially compared to other ethnic groups. These harmful preconceived notions largely deter the Marshallese from seeking treatment at this hospital, further limiting their options for healthcare.

Other structural barriers exist such as the differing perceptions/definitions of family that are held within the Marshallese culture, preventing individuals from adding “family” to their health insurance plan. For example, in Marshallese culture maternal aunts are considered to be the same as a “mother.” This is not the same as the definition of a “mother” in the U.S., therefore, not eligible to be added onto their plan. On top of this, despite the Marshallese in the U.S. paying federal taxes and participating in payroll deductions, they are not allowed access to any federal benefits like Medicaid. Not only is the U.S. government denying responsibility for the health burden of the Marshallese, but they are also robbing them of the benefits that they pay for.

When denied access to medical healthcare, many turn to a higher power. “That is the only thing they are looking at right now, going to church and getting healing from God. Where else they can go to get healing when they don’t have insurance?” as noted by a churchgoer in the community.

Many Marshallese view joining the military to get citizenship as a way through these barriers. The Marshallese population in the U.S. shouldn’t have to join the military, the very institution that caused their problems in the first place, in an effort to get the basic rights and care that they need. It would be safe to say that the neocolonial tentacles of the U.S. are extended without restraint or remorse but, their subjects, like the Marshallese “deserve a better fate.”

The discrimination faced by the Marshallese stems from a perception of them as “others” and negative associations like foreigners being carriers of disease. As the coronavirus made its way to the U.S., it was readily associated with the Chinese due to its origin being in Wuhan, China, resulting in prejudice and hate crimes towards people of Chinese descent in the United States. This negative association is rooted in the notion that foreigners bring disease.

Conclusion

Healthcare access is more important than ever right now, especially for the Marshallese community living in Springdale, Arkansas. Cases in the community are still rising as the Governor of Arkansas is moving to reopen with many Marshallese still lacking appropriate healthcare coverage or access. It is the responsibility of the U.S. government, at all levels, to protect communities residing in the country, including those similar to the Marshallese who have historically faced barriers to healthcare access in the United States.