Getting to Know your New Getting to Know your New NeighborsNeighbors

Marshallese People Marshallese People in in

Northwest ArkansasNorthwest Arkansasfromfrom

Republic of the Marshall Republic of the Marshall IslandsIslands

Just checking but Did you know? State of Hawaii has the largest number of

Marshallese outside of the Marshall Islands

15,000 Marshallese have migrated out of the Marshall Islands

Northwest Arkansas has the largest number of Marshallese living in the continental United States

Ia – Rainbow

Kwe - you

Hi, Hello, Good Morning, Good Afternoon,Good Evening

In order to work effectively with Marshallese patients, families, communities, & even Marshallese co-workers, there is need to: Develop awareness that this new group of

people are here in your midst

Get to know them-their cultural backgrounds, values, healthcare beliefs & practices, perceptions of health, healthcare needs, & other relevant areas

Learn & maintain cross cultural skills esp. in correct interpretation of their non-verbal communication

Reasons for the Out migrationCompact of Free Association allows entrance to

U.S. with a passport, can travel back & forth, can live, work, go to school for the duration of

the compactEducationEmploymentHealthcare/Treatment for serious illnessesGoing with familiesWhy not

Marshallese Migration to NWA

In the 1970s John Moody came to attend college and settled in NWA.

By word of mouth, people started coming because they heard NWA had lots of job opportunities, affordable housings, good schools and easy financing of vehicles.

Marshallese Migration to NWA

In early 2000 - greatest influx of migration took place when the Republic of the Marshall Islands’ (RMI) government experienced downsizing of its workforce.

Marshallese are able to travel and move to the United States with only a passport issued by RMI government.

Health Effects of Nuclear Tests in the Marshall Islands

Nuclear fallout – burns, hair falling out, sores, nausea, miscarriages,thyroid cancers, leukemia, jelly baby births……

Marshall Islands Nuclear Claims Tribunal list of 36 medical conditions

www.nuclearclaimstribunal.com

How many Marshallese in Northwest Arkansas

(NWA)??Arkansas Department of Education reported for 2007/2008 school year, 845 students in Springdale School District specified in a survey that Marshallese language is spoken in their homes.There are 18 Marshallese churchesestimated Marshallese population of 8,000, more living in Springdale

Everyone is being challenged.

Newcomers challenged with new culture,, legal & law issues, money management, culture shocks, limited English, limited access to healthcare, …

Service providers challenged with need to know who these people are, where from, why have they moved here, what is life like where they came from, why are they acting/behaving like that, what are they saying

Access to Health CareNWA

-Health insurance from work for immediate family-ARKids for children born in the U.S.-Bikini Health Insurance-St. Francis House-Free Clinic in Fayetteville-Dept of Public Health-Students in Migrant Programs.-Emergency Rooms

RMI

-Subsidized by RMI Government

Barriers – what keep the Marshallese people from accessing health care - from participating, understanding, complying, and cooperating in medical care:

• Financial constraints• Language barriers• Religious beliefs – God will cure through

prayers and faith• Cultural beliefs and practices• Time and priority• Lack of health knowledge• Lack of awareness for community

resources• Fear of blood, needles, surgeries,….• Lack of transportation

Financial constraints• Many uninsured

• Low wages to cover deductibles or co-pays

• Expensive care

• Limited concept of health insurance plansdeductibles, co-pay, out of

pocket,

• Not eligible for almost all social programs despite the fact that Marshallese are in the United States legally and paying taxes to Federal, State, Social Security, & Medicare.

No Access to Health Care Individuals with Disabilities

Children and young adults whose parents are in the Marshall Islands

Those who were born in the Marshall Islands – children, teenagers, adults, elders.

•seek relief from discomfort rather than cure for an illness - follow up care not looked into if patient begins to feel relief.

•Preventative care like Screening not viewed as necessary

Marshallese Understanding of Health Care

Case study suggestions by Willa Y Aaron & Dr. Julie Walsh Kroeker - Honolulu

•not understand concepts “prevention and early detection”

•seek medical care ONLY when feeling sick

Marshallese Understanding of Health Care

Beliefs on why people get sick?•Some diseases are believed to be the result of black magic.

•A traditional king has supernatural spirits or demons who can make you sick if you offend the king by disobeying his orders, if you walk by their graveyard making loud noises…

•Close family members like two sisters stop talking to each other after a fight.

Beliefs on why people get sick?When a person receiving traditional healing does not follow the rules and restrictions while being treated for 3 days.

It is God punishing you for a major sin committed by you or by one or both of your parents.

Restrictions when on Traditional treatment:

Do not share your food & drink with other people Do not let others use your plate, cup, and

spoon/fork, wash them separately from other dishes, better to use disposable paper wares

Dispose of your leftovers properly Do not eat & drink steaming hot food & drink Do not take a hot bath Do not eat salt or swim in the ocean Restrain from having intercourse Careful when you walk outside not to step on

animal/human wastes

Cultural Healthcare Beliefs and Practices

•Traditional herbal medicines Use of various local plants to treat sicknesses like skin rashes & other skin problems, hemorrhages, boils, ..

•Chanting while blowing on a wound to stop the bleeding, to cure burns•After birth medicinal bathing for both the mother and newborn baby•Eat a particular part of an octopus body to prevent motion sickness•Medicinal skills are kept in a family

Traditional Medicines

Apply massage to the abdomen area to break any lumps believe to cause children to have continuous high fever – technique of massaging boys is different from one used for girls,…

Massage with coconut oil and cool water for healing

Massage to remedy fractured bones

Calling Names – showing respect Called by first name Called by title plus first or last name for

kings, landlords, pastors Call elders by saying “Lillab” meaning

elder lady & “lōllab” meaning elder man Children often called by their nicknames

& babyish names “jiron” for girls & “labburo” for boys

Unacceptable behaviors Younger males & females have to listen to

elders – without asking questions or else it is perceived as talking back

Stand among those seated especially if you are a female

Females joking with brothers & uncles Females walking over brothers & uncles

while they are seated or laying down Females walking or sitting on their

sleeping mats, pillows, sheets, clothes

Unacceptable behaviors Females being seen going to the restrooms by brothers

& uncles Females being seen on a date by brothers & uncles Females wearing short shorts/skirts & pants females looking around for male mates Females getting drunk & acting disorderly sisters’ children marrying each other, only sister’s &

brother’s children can marry, & only if related as distant grandfather to granddaughter or distant grandmother to grandson

Touch somebody’s head especially first born if not close to that person

Public affections – kissing, holding hands, Holding hands by same genders especially males

Value of sharing

If a family’s fishermen came home with a big tuna fish, portions of it will be sliced, placed on a plate or bowl, & given to the neighbor. Neighbor will return plate fill with food, as well.

if not share your drink or food, even drink from same cup, you are thought of as a selfish person.

Proverb “jouj eo mour eo” – if you are kind & generous, you will live, you will survive

Non-Verbal Communications “Actions Speak Louder than Words”

Body Language Gestures Space Time General appearance

Body Language It is not polite to point or touch another

person’s head unless you are close to that person

Wave all fingers with palm facing down- Call someone to come over

Raise all eyebrows – to agree or say “yes” Raising eyebrows & nodding head at same

time-yes Raise your shoulders – I don’t know Shake your head side to side - no Make a hissing sound – to get one’s attention

Other cues…. Not direct – easier to tell another person Yes could mean no – even if not fully

understand – think it is not polite for the other person who might get tired of explaining

Giggling & smiling while being told blood sugar reading too high - may look childish & silly – may not know the seriousness of illness

Space – not too close

And more cues… Most men do not cry in public – crying

sign of weakness Marshallese time – best to wait for

everyone before starting an event, willingness to wait, not used to keeping a calendar, personal relationship or family events like death of a family member is more important than keeping a doctor’s appointment or even going to work

Cultural differences in nonverbal communication could create misunderstanding, misinterpretation,

miscommunication, misdiagnosis The challenge is learning to negotiate

between person’s beliefs and practices and culture of health agency.

If non-verbal cues are understood, patients will then be understood, diagnosed, & treated appropriately.

Show you care – start with your customer service – first to be seen as people come in, first to be heard when people call in –smile

Patient will then feel comfortable, feel included, and likely to comply.

Related Links:

www.yokwe.net

www.rmiembassyus.org

www.bikiniatoll.com

www.rimajol.com

Thank you very much!Thank you very much!Marshallese say, “Kommool Tata”Marshallese say, “Kommool Tata”

Bar Iakwe! Bar Iakwe!

Marshallese Outreach CoordinatorMarshallese Outreach Coordinator Jones Center for FamiliesJones Center for Families

Office of Diversity and InclusionOffice of Diversity and Inclusion

922 E. Emma -P.O. Box 2035-Springdale, AR - 72765922 E. Emma -P.O. Box 2035-Springdale, AR - 72765Phone: (479) 756-8090 Ext 244 – Fax: (479) 750-7444Phone: (479) 756-8090 Ext 244 – Fax: (479) 750-7444

Email: Email: chonggum@jcf.jonesnet.orgwww.jonesnet.orgwww.jonesnet.org

Carmen S. Chong GumCarmen S. Chong Gum