Email Slipped Through The Cracks
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While some have health insurance through their work, those who aren’t working or are elderly do not. Many don’t see a doctor unless it’s an emergency — a risky approach in a community where type 2 diabetes is startlingly common.“Most, by the time they see us their chronic conditions are way out of control or they have other things that could have been caught by health care maintenance, like cancers. By the time they’re seen, it’s advanced,” explained Dr. Sheldon Riklon, a family medicine doctor who is one of only two Marshallese doctors in the US and who was recently recruited to practice in northwest Arkansas. Sheldon Riklon is one of only two Marshallese doctors in the US and was recently recruited to practice in northwest Arkansas. KENNETH M RUGGIANO for STATThe special status of the Marshallese is conferred by a treaty called the Compact of Free Association, commonly known as COFA.
(It also covers the nations of Palau and the Federated States of Micronesia.) It was struck when the Marshalls, formerly under a US trusteeship, gained their independence in 1986.Some see the treaty as a debt payment of sorts. For a dozen years after World War II, the US used the Marshall Islands as a nuclear testing ground; 67 nuclear tests were conducted there. Some parts of the country — whose islands have a combined landmass about the size of the District of Columbia, but stretch over 4,500 square miles of ocean — remain uninhabitable.To this day, the US maintains control over the waters of the Republic of the Marshall Islands and retains a naval base there.Arkansas happens to be home to the largest community of Marshallese in the continental United States. Many work in Springdale’s ubiquitous factories, where they process chickens or make candles or package baby wipes.
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But they aren’t US citizens and so don’t legally qualify for social safety net programs. Some states have tried to address the situation. Oregon has passed a law adding COFA migrants back into its state Medicare program, and similar legislation is working its way through the Washington state legislature.
One of those clinics cares for Marshallese diabetes patients; it is operated with grant funding by the University of Arkansas for Medical Sciences, at its Fayetteville campus. “When I treat them and I know that they have no insurance, I do my best to keep them off insulin. Because insulin is very expensive,” Riklon said.Melisa Laelan knows that too well. Laelan, 38, is the director of the Arkansas Coalition of Marshallese, a group that advocates for the community. She is also a court translator, the first certified Marshallese court translator in the country. Marshallese women prepare dinner at the Marshallese Tabernacle Church in Springdale.
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Eric Gay/APA few years ago she was working at a baby wipes factory. Her mother, who was living with Laelan, had diabetes. She did not have insurance, and she didn’t qualify for Medicaid. She died of complications of diabetes.“Her insulin was costing me $300 a month. There were times that we had to go without those,” Laelan admitted.Jirkai Tatak, 52, is also a diabetic. He works as a pressman, printing the local issue of the Democrat Gazette.
To avoid the penalty the Affordable Care Act levies on people without health insurance, Tatak purchases the cheapest plan available to him. It covers little, he said.Tatak cannot afford to buy insurance for his wife and their two children who live with them; the premiums would leave the family nothing to live on.What does he do if he gets sick?
“That’s the question,” Tatak replied. “That’s the question.”It’s a question the Marshallese here have been asking for years, one echoed by local health service providers who struggle to cope with the community’s health needs.Local lawmakers appear to have heard their concerns. In mid-March the state Legislature passed a calling for the inclusion of Marshall Islands-born children in ARKids First, Arkansas’s Medicaid program for children under 19.