It may help people understand why the Marshall Islanders living in Northwest Arkansas distrust the American health-care system to know what was said about them by the director of the Atomic Energy Commission.
Though decades later he said his remarks were taken out of context, at an AEC meeting Merril Eisenbud spoke in 1956 about using the Marshallese to study the effect of radiation on humans from U.S. nuclear bomb testing on Bikini atoll:
“While it is true that these people do not live, I would say, the way Westerners do, civilized people, it is nevertheless true that these people are more like us than the mice.”
Two years earlier, in 1954, the United States had detonated Castle Bravo, at the time the most powerful nuclear device ever tested, but did not remove the islanders from nearby islands until three days later.
The bomb was one of 67 dropped on the Marshall Islands from 1946 to 1958.
That their families were used as medical guinea pigs is not forgotten by the Marshallese in Northwest Arkansas, which is second only to Hawaii in the number of Marshallese residents. While the number of Marshallese living in Arkansas is still small — less than half of 1 percent of the state’s population— they made up 5 percent of the cases of COVID-19 in Arkansas and 6 percent of the deaths from the virus as of Aug. 12.
The Latinx community of Northwest Arkansas, many members of which have their own reasons for shying away from testing, also makes up an outsized number of the state’s COVID-19 cases. While Hispanics make up 7 percent of Arkansas’s population by estimates made in 2015, they make up 22 percent of the state’s population that has tested positive. Language is an issue, and like the Marshallese, some Latinx people also have trust issues with officials, theirs stemming from fear of deportation.
Many in both communities are so-called essential workers, laboring in poultry plants. They know going into a workplace where coworkers have tested positive is risky, and they know they should not go in sick themselves, but they can ill afford to lose the pay.
A field team from the Centers for Disease Control and Prevention that visited Benton and Washington counties in June, after cases began to spike there, identified numerous barriers besides language to protecting the Marshallese and Latinx communities: conflicting messages on the virus and a lack of knowledge about its symptoms, a stigma attached to positive test results, the Arkansas Department of Health’s lack of bilingual contact tracers. The CDC team recommended targeted testing, such as in apartment complexes where cases were rampant, and communication methods that don’t require people to be literate in English.
To follow up and stem the march of the virus through these communities, the Northwest Arkansas Council, an economic development agency in Springdale, asked for and received a $7 million grant in the CARES Act dollars. A team organized by the University of Arkansas for Medical Sciences in Northwest Arkansas, Mercy Hospital, Washington Regional Medical Center and the Community Clinic will increase testing and contact tracing and provide case management.
The team’s advantage, and the reason it’s won funding separate from the health department’s contact tracing teams, is two-fold: 95 percent of their anticipated 60 hires will be bilingual, most of them Spanish-speaking, and they already are known to the communities through their clinical outreach.
The virus has spread quickly through the Marshallese and Latinx communities because of the intense family bonds each of the cultures share. It is not unusual for several generations to reside under one roof, putting grandparents — the most vulnerable to serious disease — at risk for illness.
The Marshallese are also particularly vulnerable to bad outcomes: Their rate of diabetes, which complicates treatment of the disease, is 40 percent on average. (It’s 10 percent in the U.S. overall.)
For the Marshallese, family means extended family. The word for “mother” means mother and mother’s sisters; “father” also means father’s brothers. If a Marshallese person were hospitalized, 30 people might show up to visit, Pearl McElfish, vice chancellor of UAMS Northwest, said.
But under COVID-19 protocols, no one can visit. That idea of being sick and alone means many Marshallese may reject the hospital; at least four Marshallese COVID-19 victims have died at home. That is “part of what we need to change,” McElfish said.
The grant will pay for targeted and serial testing of contacts with positive cases. “If we see that there are several people … [such as] eight people in one apartment complex, we’ll need to go to the entire complex and offer targeted testing,” McElfish said.
The issues surrounding contract tracing have been well-publicized: The health department is ramping up to get to somewhere around 700 contact tracers, but with an average of 700 or so new cases a day for a couple of months, the need to also contact the people the new cases identify as having been close, and the fact that not all case reports come with phone numbers, keeping up has been difficult.
McElfish expects the Northwest hospital partnership will be able to contact fewer than those who work with English-speaking Arkansans. Besides cultural issues, is the fact that many share cell phones or use temporary cell phones.
Contact tracers will not merely give instructions to isolate, but will ask, do you have the ability to self-quarantine? Can you stay away from the rest of your family? Can you stay in your house and not leave for two weeks, or will you need help getting groceries and performing the tasks you normally do for other people? If the answers are yes, the contact tracers will provide a list of resources: food delivery services, pharmacies that deliver medicines, a number to call if you need help. If the answer is no, a case manager will work to find solutions, including contacting pharmacies, providing letters for workplaces explaining why the patient can’t return to work and picking up paychecks if necessary. “We’ll arrange for food delivery once a week. We want to focus the resources where they are needed,” McElfish said. Workers will be provided full personal protective equipment if they need to make house calls.
The NWA Council team will get referrals from the health department based on language and Community Clinic and faith-based group outreach. “We have already been getting calls and emails from members of people in the communities who have been diagnosed and need help,” McElfish said.
McElfish, whose research has focused on health disparities, founded UAMS Northwest’s Office of Community Health and Research, which includes a free clinic for Marshallese patients in Fayetteville, in 2012. In 2015, she founded the first Center for Pacific Islander Health in the U.S., located on the UAMS Northwest Regional campus. “The plight of the Marshallese has captured my heart,” McElfish said. The daughter of Polish Jewish back-to-the-landers who moved to Nogo in Van Buren County, where McElfish was born, said many of her family members died during the Holocaust in World War II. “Part of what helped us win World War II is nuclear testing,” McElfish said, which the U.S. accelerated in 1946 in the Marshall Islands after the bombing of Nagasaki and Hiroshima. McElfish’s family’s survivors came to the U.S. and became successful citizens. The Marshallese are denied U.S. citizenship and benefits.
The success of the Northwest Arkansas effort will be measured in the trust the contact tracers can win and the success of convincing folks to quarantine, McElfish said. It’s possible the NWA Council could return to the legislature for approval of more CARES Act money. “It should be anticipated that if we have a spike [in cases], the need could go up,” McElfish said.
McElfish said it’s also important that the CARES Act committee and legislature approve applications from the Arkansas Coalition of Marshallese, which has applied for $475,000 for rent and food assistance. The committee tabled the proposal Aug. 5, but is expected to bring it up again at its meeting at 3:30 p.m. Monday, Aug. 17. “Funding for those resources is essential,” McElfish said.