美国国家公共电台 NPR A Policy Knot Leaves Oklahomans From Marshall Islands Struggling To Get Health Care

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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, BYLINE¹: The Enid Community Clinic is nestled in a row of run-down brick storefronts, the pharmacy² and auto³ 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 shuffles⁴ 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 diabetes⁵.

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 Christian⁶ college. Now they come knowing there are jobs at a meatpacking plant.

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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.

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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.

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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 pulverized⁷ 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 deformed⁸. 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 coconuts⁹, 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 Mote¹⁰, 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 eligible¹¹ for the Medicaid.

CRAIG: Unlike other states, Oklahoma didn't cover them with its own funds after the loss of federal health coverage¹².

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 citizenship¹³, 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 intimidating¹⁴, 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 taboo¹⁵ to talk about being sick.

MOTE: I feel frustrated¹⁶ 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.

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