Marshallese Kids Added To State's Subsidized Healthcare But Barriers To The Doctor's Office Remain

May 30, 2018

Children whose families immigrated from the Marshall Islands to Arkansas are eligible for publicly-subsidized health insurance in the state for the first time this year. Healthcare advocates are pushing, uphill at the outset, to get them enrolled.

The extension of healthcare benefits for Marshallese kids is tied to a long history. The United States tested over 60 nuclear bombs on the Marshall Islands in the 1940’s and 1950’s. It caused long-term health and environmental damage according to some studies.  That's one reason that the Marshallese started to leave the island.

Eldon Alik, the Marshallese Consul in Springdale, believes he can trace the migration with one Marshallese in the mid-1980s who was studying in Oklahoma. He realized there was opportunity in Northwest Arkansas’s big chicken plants.

There are now about 12,000 Marshallese in the Springdale area because of a compact between the United States and the Marshall Islands allowing them to live and work here legally. That’s second in number only to Hawaii in the United States.

Marshall Islanders’ life expectancy is almost 20 years lower than Americans’ according to the World Health Organization.

Kathy Grisham runs the Community Clinic in Springdale and today sees high rates of cancer and diabetes among her patients.
 
“Diabetes is prevalent, and once you have diabetes, you have lots of problems that come with that, hypertension, heart disease, many things diabetes affect ... organ failure eventually,” she said.  
 
Five years ago, Grisham began to advocate for Marshallese children to be eligible for health insurance under the AR Kids First public health insurance program for children. She says there are also larger community concerns at stake.
 

Kathy Grisham is the director of the Community Clinic.
Credit Sarah Whites-Koditschek / Arkansas Public Media

“We had a mumps crisis a while back, and if you’re going to protect a population, which is what public health does, you’ve got to include and make access to everyone in the population possible,” she said.
 
In other words, she thinks everyone else is at risk if part of the population isn’t covered.
 
The state legislature finally approved eligibility for Marshallese children. It took effect in January.
 
But enrollment has been very low. Grisham estimates fewer than 20 out of the approximately 2,000 Marshallese children who live in the area have enrolled, and that was after the clinic made nearly a thousand phone calls to families.
 
Terriko Lokebo is Marshallese and a dental assistant in the clinic. She helps out as a translator because many Marshallese don’t speak English well enough to understand the doctors.
 
“I think they’re just afraid of talking to a foreigner if they don’t know English,” she said.
 
Lokebo says there are other obstacles besides the language barrier to get people into the clinic. For one thing, many can’t afford the co-pays and they don’t understand why they have to pay when healthcare was almost free back home.
 
It’s also hard to reach people because many can’t afford cell phones. Lokebo will often call relatives.
 
“And you’re trying to call the auntie about the sister, saying, ‘Hey we were trying to reach them and it’s so hard to reach them. Is there any way you can help us out?' With word of mouth it does help out, too.”
 
Etwell Kabinmeto immigrated with his wife nine years ago to Arkansas. His son is in the hospital after being attacked by a dog while playing basketball. Kabinmeto quit his job at one of the chicken plants to care for his son.
 
“I’m worried all the time because he doesn’t have health insurance, and I’m not working right now, and we don’t have any income.”
 
Eldon Alik, the Marshallese consul general, translates for Kabinmeto.

Etwell Kabinmeto (left) and Eldon Alik (right), the Marshallese consul in Springdale
Credit Sarah Whites-Koditschek / Arkansas Public Media

The doctors say Kabinmeto’s son has an infection and may be hospitalized for nine months.
 
Kabinmeto says he plans to enroll his son in the AR Kids First insurance program and hopes that will take care of the bills.
 
Kabinmeto likes Arkansas, but says it’s a lot more challenging than he expected.
 
“Here you have to know how to navigate how to live here. A family has to know how to find a home. But in the Marshall Islands, everything seems to be free. Not as much, you don’t have to really work hard at it,” he said.
 
Lots of families like Kabinmeto’s have shown interest in enrolling their kids in the AR Kids First program.
 
Melissa Laeland runs the Arkansas Coalition of Marshallese. She says unlike the clinic, her office is overwhelmed by interested parents.
 
Laeland thinks it’s because everyone in her office speaks Marshallese.
 
“And I think a lot of that has to do with our clients being able to relate to us, and not only that the language, the language accessibility that’s there.”
 
She says her office and the community clinic are working together to reach out to the Marshallese.
 
While Marshallese children have access to Medicaid, adults don’t. Laeland says the next step is to get Marshallese adults on to Medicaid. She feels the United States has an obligation after using the islands for nuclear weapons testing.
 
“I feel like we’ve sacrificed a lot only to be told ‘You can pay into this program, Medicaid, but you cannot use it. It’s a little hurtful.”
 
And Laeland hopes there will be more research on the health effects of the U.S. bomb testing in the Marshall Islands.
 
“Perhaps [that’s] why we’re experiencing chronic disease,” she said.
 
For now, the immediate goal is to get children enrolled and into doctors’ offices. The community clinic hopes the start of the school year in the fall will provide a good opportunity for more outreach. That’s when children will need to come into the clinic for annual vaccinations.

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