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Marshall Islanders: Migration Patterns and Health Care Challenges
NUR 440
February 9, 2015
Susan Maxwell

Marshall Islanders: Migration Patterns and Health Care Challenges
Marshallese come from the Marshall Islands in the Pacific Ocean. “The U.S. military used some of the islands to test nuclear weapons from 1947 to 1962” (Carpenter, n.d.). In 1954, the largest atomic bomb was dropped on one of the islands, and the strength of the bomb was 1000 times stronger than the bomb dropped on Hiroshima (Carpenter, n.d.). The fall out of the radiation was felt on many of the islands (Carpenter, n.d.). The radiation has caused many health problems including tuberculosis, hypertension, thyroid tumors, leprosy, birth anomalies, genetic mutations, increased risk of diabetes and a depressed immune system (Duke 2014). The islands gained their independence in 1986. Under a Compact of Free Association between the two countries any Marshallese with a valid passport can come to the United States legally, find a job and stay as long as he or she likes" (Carpenter, n.d.).
Northwest Arkansas, Springdale, in particular, has one of the largest Marshallese groups in the United States with approximately 6000 people (Duke, 2014). Marshallese moved to Arkansas because of the relatively lower cost of living, increased availability of unskilled jobs, and increased accessibility of education.
Marshallese are a vulnerable population in the United States related to their increased health problems, decreased financial stability, English as a second language, cultural barriers to acquiring health care, and decreased immune systems. Marshallese fit my definition of a vulnerable population. They are at high risk of many co-morbidities, failing health, lack of health care resources and being underserved by the health care community. The risk is increased because a diet that was once rich in fresh fish, breadfruit, coconut, and pandanas has modified to a diet of white rice and highly processed packaged foods (Duke, 2014). Part of the reason for the change in diet was because of the radiation in the Marshall Islands affecting local food and the second part is a learned behavior continued when they moved to the United States. Marshallese have the highest rate of Type II diabetes in the world (Duke, 2014). Although Marshallese pay income taxes, they are not allowed to receive Medicare, Medicaid or social security benefits. Part of the culture also involves families sharing children, sisters raise children collectively across multiple households, the word for mother and aunt are the same (Duke 2014). Few insurance policies cover policyholders' nieces and nephews. Collective parenting decreases accessibility to insurance. With reduced accessibility to insurance, patients tend to wait longer to come to the emergency room to obtain help. One thing that I disagree about in this article is that it states that the "Marshallese report that they wait far longer to be seen than other patients in emergency rooms”. (Duke, 2014, para. 16). Our nurses are trained in orientation regarding the particular needs of the Marshallese people. They generally tend to be sicker when they come to the emergency room. Our triage nurses try to get them seen faster knowing that no matter what they present with they tend to be sicker than the complaint given. For example, they may come in with a cough, congestion and runny nose. Typical childhood complaint, but these kids will have pneumonia. There is also poorer follow up with primary care physicians or clinics related to decreased insurance so our physicians are more aggressive in caring for this population.
Working in an emergency room setting for twenty years I have encountered many vulnerable groups, the elderly, the homeless, mentally ill, abused, uneducated, drug addiction and alcoholism. Patients deserve kindness, compassion and respect. Everyone at some time in their life will be vulnerable, and we all expect great care.

References
Carpenter, D. (n.d.). A New Island: The Marshallese in Arkansas [Video file]. Retrieved from
Arkansas Educational Television Network website: http://www.aetn.org/programs/anewisland

Duke, M. R. (2014, May). http://www.migrationpolicy.org/article/marshall-islanders-migration- patterns-and-health-care-challenges. Migration Policy Institute, (),. Retrieved from http://www.migrationpolicy.org/article/marshall-islanders-migration-patterns-and-health-care-challenges

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