Getting to Know your New Neighbors

1. Getting to Know your New Neighbors Marshallese People in Northwest Arkansas from Republic of the Marshall Islands

2. Just checking but Did you know? • State of Hawaii has the largest number of Marshallese outside of the Marshall Islands • 15,000 Marshallese have migrated out of the Marshall Islands • Northwest Arkansas has the largest number of Marshallese living in the continental United States

3. Hi, Hello, Good Morning, Good Afternoon, Good Evening Iakwe Ia – Rainbow Kwe - you

4. In order to work effectively with Marshallese patients, families, communities, & even Marshallese co-workers, there is need to: • Develop awareness that this new group of people are here in your midst • Get to know them-their cultural backgrounds, values, healthcare beliefs & practices, perceptions of health, healthcare needs, & other relevant areas • Learn & maintain cross cultural skills esp. in correct interpretation of their non-verbal communication

5. Reasons for the Out migrationCompact of Free Association allows entrance to U.S. with a passport, can travel back & forth, can live, work, go to school for the duration of the compact Education Employment Healthcare/Treatment for serious illnesses Going with families Why not

6. Marshallese Migration to NWA • In the 1970s John Moody came to attend college and settled in NWA. • By word of mouth, people started coming because they heard NWA had lots of job opportunities, affordable housings, good schools and easy financing of vehicles.

7. Marshallese Migration to NWA • In early 2000 - greatest influx of migration took place when the Republic of the Marshall Islands’ (RMI) government experienced downsizing of its workforce. • Marshallese are able to travel and move to the United States with only a passport issued by RMI government.

8. Health Effects of Nuclear Tests in the Marshall Islands Nuclear fallout – burns, hair falling out, sores, nausea, miscarriages,thyroid cancers, leukemia, jelly baby births…… Marshall Islands Nuclear Claims Tribunal list of 36 medical conditions www.nuclearclaimstribunal.com

9. How many Marshallese in Northwest Arkansas (NWA)? ? Arkansas Department of Education reported for 2007/2008 school year, 845students in Springdale School District specified in a survey that Marshallese language is spoken in their homes. There are 18 Marshallese churches estimated Marshallese population of 8,000, more living in Springdale

10. Everyone is being challenged. • Newcomers challenged with new culture,, legal & law issues, money management, culture shocks, limited English, limited access to healthcare, … • Service providers challenged with need to know who these people are, where from, why have they moved here, what is life like where they came from, why are they acting/behaving like that, what are they saying

11. Access to Health Care • NWA • Health insurance from work for immediate family • ARKids for children born in the U.S. • Bikini Health Insurance • St. Francis House • Free Clinic in Fayetteville • Dept of Public Health • Students in Migrant Programs. • Emergency Rooms • RMI • Subsidized by RMI Government

12. Barriers – what keep the Marshallese people from accessing health care - from participating, understanding, complying, and cooperating in medical care: • Financial constraints • Language barriers • Religious beliefs – God will cure through prayers and faith • Cultural beliefs and practices • Time and priority • Lack of health knowledge • Lack of awareness for community resources • Fear of blood, needles, surgeries,…. • Lack of transportation

13. Financial constraints • Many uninsured • Low wages to cover deductibles or co-pays • Expensive care • Limited concept of health insurance plans • deductibles, co-pay, out of pocket, • Not eligible for almost all social programs despite the fact that Marshallese are in the United States legally and paying taxes to Federal, State, Social Security, & Medicare.

14. No Access to Health Care • Individuals with Disabilities • Children and young adults whose parents are in the Marshall Islands • Those who were born in the Marshall Islands – children, teenagers, adults, elders.

15. Marshallese Understanding of Health Care • seek relief from discomfort rather than cure for an illness - follow up care not looked into if patient begins to feel relief. • Preventative care like Screening not viewed as necessary Case study suggestions by Willa Y Aaron & Dr. Julie Walsh Kroeker - Honolulu

16. Marshallese Understanding of Health Care • not understand concepts “prevention and early detection” • seek medical care ONLY when feeling sick

17. Beliefs on why people get sick? • Some diseases are believed to be the result of black magic. • A traditional king has supernatural spirits or demons who can make you sick if you offend the king by disobeying his orders, if you walk by their graveyard making loud noises… • Close family members like two sisters stop talking to each other after a fight.

18. Beliefs on why people get sick? When a person receiving traditional healing does not follow the rules and restrictions while being treated for 3 days. It is God punishing you for a major sin committed by you or by one or both of your parents.

19. Restrictions when on Traditional treatment: • Do not share your food & drink with other people • Do not let others use your plate, cup, and spoon/fork, wash them separately from other dishes, better to use disposable paper wares • Dispose of your leftovers properly • Do not eat & drink steaming hot food & drink • Do not take a hot bath • Do not eat salt or swim in the ocean • Restrain from having intercourse • Careful when you walk outside not to step on animal/human wastes

20. Cultural Healthcare Beliefs and Practices • Traditional herbal medicines Use of various local plants to treat sicknesses like skin rashes & other skin problems, hemorrhages, boils, .. • Chanting while blowing on a wound to stop the bleeding, to cure burns • After birth medicinal bathing for both the mother and newborn baby • Eat a particular part of an octopus body to prevent motion sickness • Medicinal skills are kept in a family

21. Traditional Medicines • Apply massage to the abdomen area to break any lumps believe to cause children to have continuous high fever – technique of massaging boys is different from one used for girls,… • Massage with coconut oil and cool water for healing • Massage to remedy fractured bones

22. Calling Names – showing respect • Called by first name • Called by title plus first or last name for kings, landlords, pastors • Call elders by saying “Lillab” meaning elder lady & “lōllab” meaning elder man • Children often called by their nicknames & babyish names “jiron” for girls & “labburo” for boys

23. Unacceptable behaviors • Younger males & females have to listen to elders – without asking questions or else it is perceived as talking back • Stand among those seated especially if you are a female • Females joking with brothers & uncles • Females walking over brothers & uncles while they are seated or laying down • Females walking or sitting on their sleeping mats, pillows, sheets, clothes

24. Unacceptable behaviors • Females being seen going to the restrooms by brothers & uncles • Females being seen on a date by brothers & uncles • Females wearing short shorts/skirts & pants • females looking around for male mates • Females getting drunk & acting disorderly • sisters’ children marrying each other, only sister’s & brother’s children can marry, & only if related as distant grandfather to granddaughter or distant grandmother to grandson • Touch somebody’s head especially first born if not close to that person • Public affections – kissing, holding hands, • Holding hands by same genders especially males

25. Value of sharing • If a family’s fishermen came home with a big tuna fish, portions of it will be sliced, placed on a plate or bowl, & given to the neighbor. Neighbor will return plate fill with food, as well. • if not share your drink or food, even drink from same cup, you are thought of as a selfish person. • Proverb “jouj eo mour eo” – if you are kind & generous, you will live, you will survive

26. Non-Verbal Communications “Actions Speak Louder than Words” • Body Language • Gestures • Space • Time • General appearance

27. Body Language • It is not polite to point or touch another person’s head unless you are close to that person • Wave all fingers with palm facing down- Call someone to come over • Raise all eyebrows – to agree or say “yes” • Raising eyebrows & nodding head at same time-yes • Raise your shoulders – I don’t know • Shake your head side to side - no • Make a hissing sound – to get one’s attention

28. Other cues…. • Not direct – easier to tellanother person • Yes could mean no – even if not fully understand – think it is not polite for the other person who might get tired of explaining • Giggling & smiling while being told blood sugar reading too high - may look childish & silly – may not know the seriousness of illness • Space – not too close

29. And more cues… • Most men do not cry in public – crying sign of weakness • Marshallese time – best to wait for everyone before starting an event, willingness to wait, not used to keeping a calendar, personal relationship or family events like death of a family member is more important than keeping a doctor’s appointment or even going to work

30. Cultural differences in nonverbal communication could create misunderstanding, misinterpretation, miscommunication, misdiagnosis • The challenge is learning to negotiate between person’s beliefs and practices and culture of health agency. • If non-verbal cues are understood, patients will then be understood, diagnosed, & treated appropriately. • Show you care – start with your customer service – first to be seen as people come in, first to be heard when people call in –smile • Patient will then feel comfortable, feel included, and likely to comply.

31. Thank you very much!Marshallese say, “Kommool Tata”Bar Iakwe! Related Links: www.yokwe.net www.rmiembassyus.org www.bikiniatoll.com www.rimajol.com

32. Carmen S. Chong Gum Marshallese Outreach Coordinator Jones Center for Families Office of Diversity and Inclusion 922 E. Emma -P.O. Box 2035-Springdale, AR - 72765 Phone: (479) 756-8090 Ext 244 – Fax: (479) 750-7444 Email: chonggum@jcf.jonesnet.org www.jonesnet.org