Island time

UAMS creates unique program for Pacific Islanders

NWA Democrat-Gazette/DAVID GOTTSCHALK Nia Aitaoto, director of the Center for Pacific Islander Health in Fayetteville, brings her unique experience in public health and her life in the islands to help Islanders in Northwest Arkansas and around the world. The center is a program of the University of Arkansas for Medical Sciences Northwest.
NWA Democrat-Gazette/DAVID GOTTSCHALK Nia Aitaoto, director of the Center for Pacific Islander Health in Fayetteville, brings her unique experience in public health and her life in the islands to help Islanders in Northwest Arkansas and around the world. The center is a program of the University of Arkansas for Medical Sciences Northwest.

"The Marshallese have one of the highest rates of type 2 diabetes in the world," reads a press release from the University of Arkansas for Medical Sciences. "[The condition] affects as many as 50 percent of Islanders living in Northwest Arkansas. The Marshallese also suffer disproportionately from Hepatitis B, tuberculosis and Hansen's disease, as well as high rates of cancer, heart disease and obesity."

"They now have all the First World problems, but they also have island, Third World infections," said Nia Aitaoto, co-director of the Center for Pacific Islander Health in Fayetteville, a project of UAMS Northwest.

Island History

Micronesian colonists settled in the Marshall Islands some 2,000 to 4,000 years ago, said April Brown, a history professor at Northwest Arkansas Community College and president of the Marshallese Education Initiative. The group recently offered a class on Marshallese culture and language for area teachers.

“They made it on their own — with their own technology — before the West came in,” Brown said. Missionaries from Boston arrived in the islands in 1857.

The Germans held a protectorate in the late 1800s, and the Japanese took control in World War I.

“The Japanese improved the infrastructure of the Islands but were brutal to the Marshall Islanders during World War II,” Brown said. “But the Marshallese people have forgiven them.”

“In the 1940s, the U.S. took control of the Pacific,” Nia Aitaoto, co-director of the Center for Pacific Islander Health in Fayetteville, continued the story. After World War II, the United States tested its nuclear weapons capability in the Bikini Atolls of the Marshall Islands, resettling some natives in environments different from those they had known for generations. “The French did the same thing in Polynesia. It was not just one area of the Pacific,” Aitaoto said.

“The vegetation and fish were killed for generations [after the bomb tests],” said Aitaoto. “It took a long time to heal the land to grow.”

“People before would eat what was healthy,” said Anita Iban, a Marshallese community liaison for the Springdale Public Schools. “Then they ate all that canned stuff, frozen meat and frozen chicken, when they were used to fresh fish out of the water.”

A U.S. Navy survey in the early days of occupation found no diabetes and no hypertension among the people living on the islands, Aitaoto said. But to counter food shortages, the military introduced canned goods, white flour and sugar in the form of candy to the Islanders’ diets.

Today, the Compact of Free Association with the United States gives the States sole responsibility for international defense of the Marshall Islands, and it allows islanders to live and work in the United States and establishes economic and technical aid programs.

"And it's hard for the Pacific Islanders to focus [on their health and lifestyle]. They think [the conditions] are all separate, different, when they all might be related."

The Center for Pacific Islander Health was established in 2015 to bring quality health care to Islanders throughout the world. The center serves Pacific Islanders living in Northwest Arkansas, as well as those in U.S.-affiliated islands in American Samoa, Guam, the Northern Mariana Islands, Micronesia and Palau.

RESEARCH

In addition to acute care, disease prevention and management programs, the center's work will include research into the health disparity in the Pacific Islands, cultural training for health-care providers and training of community health workers.

It is the first academic health research center in the U.S. to focus solely on Pacific Islander health issues, according to a UAMS news release, although a similar program operates in New Zealand, Aitaoto noted.

"We know information on Pacific Islander health issues is limited because it is often aggregated with data from other Asian-American populations," said Pearl McElfish, director of the UAMS Office of Community Health and Research and co-director of the Islander health center. "However, data that is available indicates that Pacific Islanders face a number of health disparities, particularly related to chronic disease."

Anita Iban, a Marshallese liaison for the Springdale Public Schools, shared the plight of those who can't afford to leave the islands, who just wait at home for their time to die. Iban also told the story of her father, a former president of the Marshall Islands, who had to fly to Hawaii to have a broken limb set because of the health care shortage in the islands.

"It's kind of sad," she said.

"Most health decisions are made on data, research and results of studies to make decisions," Aitaoto said, but there is no data in place on Pacific Islanders. "So we think we have no problem. For a long time, we knew Pacific Islanders had diabetes. But they didn't know until they came to Arkansas.

"These Pacific Islanders battle for community and recognition," Aitaoto continued. "They are first-generation and a small population. They are very different, more sensitive."

And the Pacific Islander Center stands as their advocate.

"Researchers left the Pacific Islanders behind in genomics research," Aitaoto said -- especially because Pacific Islanders might be reluctant to turn to modern medicine rather than island remedies.

"The Americans say, 'Here, let us test something on you,'" she illustrated. "And we say, 'Yeah, just like you tested a bomb (in the 1940s and 1950s). That did not work out so much.'"

Also, the local Islander population is "not reaping the fruits of new technology," Aitaoto said. "Pharmaceutical tests were done on white men." But time is showing Pacific Islanders respond differently to the medicines.

"We will be in the community doing research and making it available, giving power to those who make decisions," Aitaoto said.

"And they probably will live as long and be as healthy as other Asians," she said.

The center will complete late this year a two-year random, controlled trial on the effectiveness of the culturally appropriate family model of diabetes education. More than 200 Marshallese adults with diabetes and their families participated -- the largest randomized controlled trial focused on the Marshallese ever conducted in the United States, according to UAMS.

Last year, the Pacific Islander Health Center and UAMS hosted an international conference to share information with attendees representing various nations, the Centers for Disease Control and Prevention, federal health advocates and medical professionals from all over the world. Subsequent conferences will alternate between locations in the United States and the Pacific.

"I want Arkansans to see the Pacific states," Aitaoto said.

CLINIC

The North Street Clinic stands as the public face of the Pacific Islander Health Center. The clinic is staffed by Dr. Sheldon Riklon and a bevy of Marshallese staff members. Riklon is one of just two Marshallese physicians trained in the United States. He treats patients, oversees medical students as an assistant professor and is the inaugural holder of a distinguished professorship for health disparities.

The clinic has been a boon to a community that's not covered by the Affordable Care Act but is dealing with chronic diseases like diabetes and high blood pressure, Iban said. "Not a whole lot has opened up to help Pacific Islanders around the mainland," she added.

The clinic provides free care to Marshallese patients with diabetes who do not have health insurance or a primary care doctor. Patients receive care from UAMS students in medicine, nursing, pharmacy and physical therapy, under the direction of UAMS physicians and faculty. The care includes interpretation and ongoing support, and more complicated cases are referred to the UAMS Northwest specialty clinic.

Albious Latior's family recently has been touched by diabetes, dialysis and kidney failure, which led to death. Because Arkansas can be a difficult state in which to get Medicaid, members of the Marshallese community often will leave -- maybe for California -- to get better help for medical care, he said.

"Some who don't work, the elderly, have no place to go to get checkups," Latior said. "If they are really sick, they go to the emergency room." Most Marshallese workers are not part of the national insurance, he said, or their "children" are actually extended family members for whom the guardians cannot access insurance and aid programs.

"The center helps break barriers," Latior believes.

But its Marshallese staff members are the "silver bullet," Aitaoto said. "They have a large community engagement."

These are the folks who translate and explain conditions and treatment to their fellow Marshall Islanders. And because they are members of the community and appreciate the culture, patients build rapport and trust with them. During the outbreak of mumps in the fall, staff members helped with translations, radio programs, informational programs at area churches and with immunization clinics.

"Word of mouth travels fast," Aitaoto said. "We train our staff members to be leaders in their communities. And we've had huge support from the community and the Arkansas Coalition of Marshallese Pastors."

"Task force members from UAMS worked with community pastors to tell those people to stay out for 10 days," said Iban, the Marshallese liaison for Springdale Public Schools, whose husband is pastor of Anij Emman Church in Springdale.

Local center staff work closely with the Arkansas Department of Health and other area agencies.

"Having that partnership to the Department of Health and health organizations is valuable experience," Aitaoto said. "I like it when we work together. No man is an island. We are never successful by ourselves. We need to share resources."

CULTURE

Islander identity is based on the atoll or island on which each individual lived and continues in the United States, with much of the culture tied to the churches. "The population of Pacific Islander groups is different, but still highly collective," Aitaoto said. "Culturally, the Pacific Islanders have a holistic way of thinking. And we've expanded our program to manage diabetes and infectious diseases in the whole community."

For example, the health center now treats diabetes with a family model -- "because if one person in the family has it, chances are another will, too," Aitaoto said. Staff teach the entire family or church group about healthy living, healthy cooking, because in the community, "they all eat from one pot."

And, Iban admitted, the Marshallese people can sometimes be stubborn about changing their way of life.

Aitaoto said the center staff also hope to expand their research into cancer -- through fourth-generation survivors living here -- and mental illness, which was unknown in the islands and comes with quite a stigma.

"I think it would be great if my people would start talking about mental health," said Carlnis Jerry, a community liaison for Springdale schools, who recently helped lead a class in Marshallese language and culture for the Marshallese Education Initiative.

"We don't focus on one specific health condition," Aitaoto said. "We treat the culture as a whole -- their well-being. Their mind, their body, their spirit."

"They reach out and help us in so many ways," Iban said.

SENSE OF PLACE

The number of people from the Republic of the Marshall Islands and their descendents living in Northwest Arkansas is fluid. Aitaoto places it at 10,000 to 14,000, while the census records 7,000 Pacific Islanders.

Northwest Arkansas is home to the largest Marshallese population in the continental United States, UAMS documents state.

Enid, Okla., and Joplin, Mo., also count significant populations of Marshallese people, and both are within a few hours' drive, Aitaoto said. In addition to the Marshallese population, Northwest Arkansas is home to Chuukese, Pohnpeian, Samoans, Tongins and Hawaiian people, she added

"This is a great place to work and live," Aitaoto continued, speaking of Northwest Arkansas. "There are job opportunities. Housing is cheap."

Aitaoto said the Marshallese people also found a home in Northwest Arkansas because the cultural values are similar.

Marshall Islanders honor their ancestors as do generations of people raised in the South, she said. Also, faith -- which tends to be conservative -- is important to 98 percent of the Marshallese.

"And the other thing is food," she said. "They have it at all the family gatherings" -- although the delicacies might vary from culture to culture.

"Despite all that history has done wrong, they have a love of country, a sense of place here," Aitaoto said of the Islanders. "They honor the nation."

"In general, the population in this part of the world is very similar to that of the Marshall Islanders," Aitaoto concluded. "It's that mid-America thing. It's very easy to set up camp here.

"It's been a great migration."

And that migration led to the founding of the Center for Pacific Islander Health in Northwest Arkansas.

"We talked to our friends at the University of Hawaii, we talked to our collaborators around the country, and they all said that Arkansas -- that UAMS -- was uniquely positioned to take on this role and to have this health center, " Aitaoto said. "So, we like to say that we didn't choose Northwest Arkansas -- our people chose Arkansas by coming here and building their lives here."

NAN Our Town on 02/02/2017

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