A Policy Knot Leaves Oklahomans From Marshall Islands Struggling To Get Health Care

Dec 25, 2018
Originally published on December 26, 2018 11:47 am

The prairie town of Enid, Okla. — population 50,122 — is best known as the state's "wheat capital." Enid is also home to a community of around 2,000 people who were born in the Marshall Islands. Most are low-income and struggling to get health care.

After World War II and until the 1980s, their homeland in the Central Pacific was a U.S.-administered territory, and for a part of that time, Americans used some islands in the region as a bombing range for testing nuclear weapons. Partly because of that history, a treaty now allows Marshallese to live and work in the U.S, as "indefinite legal residents."

But in Oklahoma, as noncitizens, the Marshallese aren't eligible for many state and federal health services. And that's a big problem says 42-year-old Terry Mote, who was born on the islands, but moved to Enid in 2007.

"I just want my family to be treated like the rest of those who are eligible for Medicaid, says Mote, who works as a Micronesian health adviser at the Garfield County Health Department, and lives in Enid with his wife, Lynn, and their five kids. His mom, Mojina, lives with them, too.

"Why the government came to our island to do [testing of] 67 bombs," Mote says, "and then they are just going to let us die over this?"

Between 1946 and 1958, after relocating whole villages to other islands to clear the way for weapons testing, the U.S. detonated 67 nuclear weapons at sites across the Marshall Islands and other territories.

Enid resident Daina Joseia is in her 60s. She has a childhood memory of what she later was told was the test of the Castle Bravo thermonuclear device on March 1, 1954 — the biggest and most destructive nuclear bomb detonated by the U.S. — 1,000 times as powerful as the bomb dropped on Hiroshima.

"It's like a real bright color, like a fire," Joseia says through a translator.

Clouds of radioactive, pulverized coral dust drifted across the islands, coating homes and people. Joseia says that, in the aftermath of the test, she remembers seeing people whose bodies were covered in burns, and others with their hair falling out.

In the following years, some people from the affected islands developed thyroid problems and cancer. Babies were born deformed.

Joseia sees a direct connection between her diabetes and the nuclear tests — not because there's a link between nuclear radiation and diabetes, but because the bombs contaminated the Marshall Islanders' traditional foods, like coconuts, fish and breadfruit. When their traditional diet too dangerous to eat, she explains, the Marshallese started to consume processed, imported foods — like spam and white rice.

Terry Mote is too young to remember the bombs being tested. He does, however, remember what they ate in the decades afterward.

"We begin to be [thinking] eating canned meat is a good thing," Mote says. "But then, at the end of the day, it's not good."

Today the Marshallese have among the highest rates of diabetes in the world.

Like Joseia, Mote's mother Mojina has diabetes, too. And like Joseia, she's uninsured. For Mote and his family, this became a huge problem when his mother had to go into the hospital for treatment and ended up needing to stay there for months.

"We had little knowledge on, you know, when you stay in the hospital for certain days — the bill is running," says Mote. "So by the time she got out from the hospital, I was so surprised."

The bill for treating the complications of her diabetes was $50,000, Mote says, and he could only pay part of it. It was only when he tried to enroll his mom in Medicaid or Medicare, that he found out Marshallese don't qualify for these programs.

The special relationship between the U.S. and the Marshall Islands — now the sovereign Republic of the Marshall Islands — is complicated, to say the least.

In 1983 the Marshall Islands, the Federated States of Micronesia and Palau signed the Compact of Free Association with the U.S., which allowed people from these island nations to settle in the U.S. with limited legal status.

This means that while a path to citizenship is available to them, those who resettled in the U.S. under the treaty were not automatically made citizens. Instead, they were classified as "nonimmigrants." At the time the Marshallese and other COFA communities in the U.S. were eligible for federal health programs.

But that changed in 1996, when Congress passed the Personal Responsibility and Work Opportunity Act. This major piece of welfare legislation effectively reworked the eligibility of people who came to the U.S. under the COFA agreement, stripping Marshall Islanders and other similar communities of their federal health benefits.

After the 1996 legislation was passed, some states, including California and Oregon, used state funds to continue to provide health care services to COFA migrants, according to the Asian and Pacific Islander American Health Forum.

The state of Oklahoma did not choose to do so, which means even longtime legal residents of the state are not eligible for Medicaid and Medicare in Oklahoma if they happen to be Marshallese.

"People turned to me and ask for help," Mote says. "And they said, 'Hey, can the church help me pay my bills?' So I'm like, 'Hey, you know what? There's a lot of problem here.' "

Mote spends much of his time these days thinking about health problems in his community. He's reached out to lawmakers for help, but his attempts to get state legislation introduced that would get health coverage for Oklahoma's Marshallese community have so far failed.

It's a hard sell, he says, because Marshallese can't vote. And the path to citizenship, he says, is tough for a myriad of reasons.

Mote says most Marshallese in his community find the citizenship application process intimidating — and unaffordable. There's the language barrier, he says, and, maybe because the community is close-knit, there tends to be little sense of urgency to assimilate.

Plus, Mote says, most Marshallese believe it's taboo to talk about being sick.

"I feel frustrated," he says. "Because these people need to be healthy — need to be treated like human beings."

He is not giving up.

Mote says he is now applying for citizenship — because he wants to run for City Council and help give Marshallese in Enid a voice.

Copyright 2018 NPR. To see more, visit https://www.npr.org.

NOEL KING, HOST:

In the town of Enid, Okla., there's a tight-knit community of immigrants from the Marshall Islands. After World War II and up until the 1980s, their homeland in the South Pacific was a U.S.-administered territory. And for over a decade in the 1940s and '50s, the Americans used it for nuclear bomb tests.

A treaty now allows Marshallese to come to the U.S. and to live and work as indefinite legal residents. But in Oklahoma, as noncitizens, they get neither state nor federal health care services. Reporter Sarah Craig has the story.

SARAH CRAIG, BYLINE: The Enid Community Clinic is nestled in a row of run-down brick storefronts, the pharmacy and auto shop on either side closed for good.

JANET CORDELL: Good morning.

DAINA JOSEIA: Good morning.

CORDELL: How are you today?

JOSEIA: I'm fine, thank you.

CORDELL: Good, good, good.

CRAIG: Daina Joseia shuffles inside, leaning on her granddaughter for support. She wears a floral muumuu, like most Marshallese women.

CORDELL: Remember me? I'm Janet.

JOSEIA: Yeah.

CORDELL: OK.

CRAIG: Joseia came to see Nurse Janet Cordell for her diabetes.

CORDELL: So you're taking your medicine?

JOSEIA: Yeah.

CORDELL: OK. How often are you taking it?

JOSEIA: Every morning and night.

CORDELL: Good. You have to take it until it's all gone.

CRAIG: Joseia's kidneys are failing, and she needs regular dialysis. But she can't get it because, like most Marshallese in Enid, she's uninsured. It's been that way since 1996, when the Marshallese lost access to Medicaid and Medicare. All she has is this charity clinic.

CORDELL: I don't know what to tell you. We'll help you as much as we can, and you need to remember that taking your medicine, keeping your diabetes under control is going to help, but it's not going to cure it. We'll see you later. Give me a hug.

CRAIG: The first Marshallese came to Enid to attend a Christian college. Now they come knowing there are jobs at a meatpacking plant.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON #1: In the middle of the vast Pacific Ocean lies the tiny coral atoll of Bikini...

CRAIG: But they might not have come at all if it hadn't been for the nuclear tests.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON #1: ...With the atom bomb.

CRAIG: After World War II, the U.S. military took control of the Marshall Islands. They started moving people from island to island to clear a path for the bombs.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON #2: Three, two, one, zero.

CRAIG: Between 1946 and 1958, they detonated 67 nuclear weapons. Daina Joseia remembers, as a little girl, seeing the Bravo test, the biggest and most destructive bomb ever detonated. It carried the force of a thousand Hiroshimas.

JOSEIA: (Through interpreter) It's like a real bright color, like a fire.

CRAIG: That was 1954. Dangerous clouds drifted across the islands - radioactive pulverized coral dust coating homes and people. Joseia remembers seeing people with burns all over their bodies and their hair falling out. In the following years, people developed thyroid problems and cancer. Babies were born deformed. And Daina's convinced the bomb made her sick, too.

JOSEIA: (Through interpreter) We believe that all our health issues are coming from the nuclear testing.

CRAIG: Including her diabetes. The idea that radiation could lead to diabetes - it might sound strange, but there's a connection. The bombs contaminated their traditional foods, like coconuts, fish and breadfruit. They were too dangerous to eat. And so the Marshallese started to eat processed, imported foods, like Spam and white rice.

Another Enid resident, Terry Mote, spent his childhood on the islands eating that way. He's now 42, too young by decades to remember the bombs.

TERRY MOTE: We began to be like, you know, eating canned meat is a good thing. But then, at the end of the day, it's not good.

CRAIG: Today, the Marshallese have among the highest rates of diabetes in the world.

MOTE: Our environment is not safe. It's still contaminated.

CRAIG: Mote lives with his wife, Lynn, and their five kids. His mom, Mojina, lives with them, too. He works at the county health department. He's always thinking about the health problems in his community.

MOTE: (Singing) Teach me to walk...

CRAIG: Even in church.

MOTE: (Singing) ...In the light of his love.

CRAIG: After the service, Mote talks to the youth group about being healthy.

MOTE: What time you should go to bed?

UNIDENTIFIED CHILD: Nine.

MOTE: Eleven?

UNIDENTIFIED CHILD: Nine.

CRAIG: It was about five years ago that Mote's mom went into the hospital for her diabetes. She was there for months.

MOTE: We had little knowledge on, you know, when you stay in the hospital for certain days, the bill is running. So by the time she got out of the hospital, I was so surprised.

CRAIG: He says the bill was $50,000, and he could only pay part of it. Mote's mom wasn't insured. That's when he learned she couldn't get Medicaid or Medicare in Oklahoma. None of the Marshallese can.

MOTE: It's because No. 1 is I just want my family to be treated like the rest of those who are eligible for the Medicaid.

CRAIG: Unlike other states, Oklahoma didn't cover them with its own funds after the loss of federal health coverage.

MOTE: People turned to me and asked for help. And they said, hey, can the church help me pay my bills? So I'm like, hey, you know what, there's a lot of problem here.

CRAIG: Mote has asked lawmakers to help, but it's a hard sell because most Marshallese can't vote.

MOTE: We feel that we're left out by means of someone to represent us.

CRAIG: A 1983 treaty between the U.S. and the Marshall Islands lets Marshallese live here, but they only have limited status. They can apply for citizenship, but most aren't doing so. Terry says he's the only one he knows.

MOTE: And that's because the law to be a U.S. citizen is so tough on us.

CRAIG: He says most Marshallese find the process intimidating, unaffordable. And then there's the language barrier. And this is a close-knit community. There's no sense of urgency to assimilate. These also stand the way of getting health care. And most Marshallese think it's taboo to talk about being sick.

MOTE: I feel frustrated because these people need to be healthy, need to be treated like human beings.

CRAIG: Mote says he's applying for citizenship because he wants to run for city council. He wants the Marshallese to have a voice.

MOTE: Why the government came to our island to do 67 bomb testing, and then they're just going to let us die of this?

CRAIG: Some states, like California and Oregon, cover the Marshallese. Oregon has even set up a special insurance program. But Mote's attempts to introduce similar legislation in Oklahoma have failed. But he says he's not giving up.

For NPR News, I'm Sarah Craig, in Enid, Okla.

[POST-BROADCAST CORRECTION: In the audio, we say the Marshall Islands are in the South Pacific. In fact, they are in the Central Pacific Ocean. Also, in the audio and an earlier Web version the Castle Bravo test is said to be the largest nuclear explosion in history. In fact, it was the largest such bomb tested by the U.S. The Soviet Union's Tsar Bomba test in 1961 produced the largest nuclear explosion on record, according to the Preparatory Commission for the Comprehensive Nuclear-Test-Ban Treaty Organization.]

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.