In the past several years, a growing number of people from the islands of Micronesia have been flooding into cities across Iowa, such as Postville, Sioux City, Storm Lake, and my hometown, Dubuque. If you’d ask them what brought them to the heartland of the United States, I bet you’d be surprised by their answer. Because it was never their plan. And it relates back to events conveniently swept under that proverbial rug—at least in US history.
You see, after World War II, the US military convinced the Marshallese people they would be doing the whole world a favor—effectively ending wars forever—if they allowed nuclear testing on their islands. All in all, US officials detonated 67 nuclear bombs by the time testing finished in 1958. Sure, the Marshallese understood the immediate impact: being forced from their homes to other distant, “safer” areas and the obliteration of many islands in the chain. No one was prepared, though, for the health and climate challenges this sacrifice would present as time went on.
Fast forward to today, and the children and grandchildren of those directly impacted by the fallout know that choosing to stay or choosing to leave is literally a matter of life or death. They are plagued by diabetes and heart disease—directly attributed to their diet, which relies heavily on canned foods. Prior to the explosion of the bombs, most food was obtained from the huge ocean lagoons which were contaminated with radiation. After the explosions, the US sent food which included rice, canned meats, surplus peanut butter, cheese, and butter, all of which were high in fat, salt, and sugar and not part of their traditional diet. Setting cancer aside, they are also dealing with a wide variety of both communicable (such as Tuberculosis and Hansen’s disease) and non-communicable diseases.
Some Marshallese have been in Dubuque for years, initially to attend the Presbyterian Seminary. They liked the community and word spread back to their families in the Marshall Islands who joined them. This led to an initiative I’m proud to be part of—the Dubuque Pacific Islander Health Project.
Without really knowing it, every step I’ve taken in life has directly prepared me for the mission I’m on now with this health project. I’m still in awe of it.
I knew after graduating from college that I wanted to help people, far beyond my local community. I joined the Peace Corps and spent time living and working on Kosrae, in the Federated States of Micronesia, which isn’t in the Marshall Islands, but it is close by. Though the language is different, the culture is similar. Then I ended up joining our extended family in Hawaii to teach nursing, and while there, I did some initial research about the homeless population, many of which are Micronesian. Later, when I returned to the mainland to teach in Dubuque, I was surprised by the growing Marshallese community and reached out to several community leaders to simply get to know them better. They became like my family.
In 2015, informed by the concept of hot spotting, our local Pacific Islanders were found to be high users of emergency services at MercyOne Dubuque Medical Center. That seemed strange because there was the Crescent Community Health Center, a federally funded community health center designed to support their unique needs.
Hospital staff at MercyOne, Dubuque, knew I had formed friendships with some of the Marshallese and of my work in the Pacific as a Peace Corps Volunteer and educator. They asked me to present at grand rounds about who the Marshallese are, including dietary habits in-country and rates of illnesses such as diabetes and hypertension, along with other culturally appropriate information.
After the presentation, I met with the Vice President of Patient Services at the hospital along with a few other interested individuals. We understood how vital it was to figure out how to help these members of our community. We decided the only way to move forward was to bring us all together—in one room—to hear stories from all sides. We invited Crescent Community Health Center representatives, members of the local multicultural center, the VNA, local Sisters of St. Francis and Blessed Virgin Mary congregations, and most importantly, local Marshallese ministers (recognized as community leaders) and their wives. It became clear during those initial meetings that many of the Marshallese were unaware of how to access the community health clinic or were ineligible to return to the clinic due to nonpayment.
Now we were faced with the toughest question yet: how do we fix this? Together, our group determined that the best method was to hire a cultural broker and translator, someone who could aid in bridging the gap between providers and clients, along with an RN to aid with the medical concerns. And then another tough question: how do we pay for this? Fortunately, MercyOne had a community grant available, which the group received along with a commitment from Crescent Community Health Center to house and aid in financial support. Additionally, the grant paid the bad debt at the clinic for many of the Marshallese.
In 2017, we hired an RN, a social worker, and a Marshallese community health worker fluent in Marshallese, Kosraean, Pohnpeian, and English. They started seeking out individuals who had previously been to the clinic but stopped going because of nonpayment, and they educated the Marshallese community at large about the community and available resources.
Since the conception of the Pacific Islander Health Project, the goal has always been to improve the lives of the Marshallese living in the Dubuque area. Today, it’s gone far and above just health concerns. We’re now working on issues related to the social determinates of health such as employment, housing, and education. We’ve sponsored programs open to everyone to highlight the Marshallese population, to explain their status, to inform the community about the nuclear fallout survivors and their descendants, and why they have immigrated to the US.
For example, during one of our meetings, we learned that under the then-current administrative rules of the Department of Motor Vehicles (DMV), the Marshallese had to obtain a drivers’ license annually. What? We were floored. It was expensive, not to mention discriminatory. Our next task presented itself right then and there—we had to open the eyes of the Iowa DMV. We reached out to the Iowa Department of Human Rights’ Office of Asian and Pacific Islander Affairs. Through combined efforts, the DMV in Iowa changed the rules. They can now hold their license for eight years as of 1 January 2020—just like other Iowans.
I look back and see how much our group has been able to do, but then I look forward and see the mountains we’ve yet to cross. And one of the biggest is BIG because it’s political. Basically, in the 80s, through the Compacts of Free Association (COFA), the US government promised people from the Pacific Island countries (the Federated States of Micronesia, the Republic of the Marshall Islands, and the Republic of Palau) a lot of things, including the ability to enter, work, and go to school in the United States without visas. It also provided them with Medicaid, but welfare reform in the mid-90s extinguished the islanders from the list of eligible groups.
Lawmakers have been working to reverse this for a decade, but the path has been long and rocky. To boot, COFA expires in 2023. I don’t know what this will mean for my friends, my community. But as sure as I sit here sharing my story with you, my friends, you have my word that we’ll do everything we can.
Neil MacNaughton, PhD, RN, is a professor and assistant head of the University of Dubuque Nursing Department in Dubuque, Iowa, USA. He is a member of Sigma’s Gamma Chapter at the University of Iowa and was awarded the Karen L. Evans Immigrant Champion Award by the Immigrant Entrepreneurs Summit in 2018.