Experts say new approach needed for Islander health

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Shortfalls in Pacific Islander health are an old problem that can only be solved with new ways of thinking, experts said at a recent conference.

Researchers from across the globe came together in Honolulu last month for the second Gathering for Pacific Islander Health to discuss issues such as diabetes and mental illness, which afflict islanders more than almost any other demographic group. The United States is home to hundreds of thousands of islanders, with more than 12,000 living in Northwest Arkansas, according to the University of Arkansas The University of Arkansas for Medical Sciences annual Gathering for Pacific Islander Health was held in early October in Honolulu. To learn more about the conference and its organizers and speakers, go to pacific healthgathering.com.

for Medical Sciences, which co-hosted the conference.

“In some ways, we’re here to learn, but also to be inspired,” said Dr. Andy Subica, a clinical psychologist and researcher at the University of California Riverside School of Medicine

who has worked with UAMS in recent years.

The litany of health problems has become all too familiar, said Dr. Raynald Samoa, a California endocrinologist who studies diabetes and obesity. Poverty, diets heavy in processed foods and, in the case of the Marshall Islands, dozens of American nuclear-weapon tests, have all contributed to high rates of cancer, obesity and rare diseases such as leprosy throughout the Pacific.

The Arkansas university’s surveys find roughly half of the Marshallese in Northwest Arkansas have diabetes, compared with about 9 percent of U.S. adults, and most are overweight.

“You get a little jaded, you know,” Samoa told the group, saying he was preaching to the choir. He compared islanders to people struggling to swim in a river. Doctors jump in to pull them out, he said, but researchers must figuratively go upriver to find the underlying reasons the people are in their situations in the first place instead of trying to fight each symptom on its own.

“These conditions that run together — diabetes, heart disease and cancer — they run together so often that it cannot be random,” Samoa said. Instead, the conditions could be linked. Diabetes, the body’s inability to respond to changing blood sugar levels, can feed into obesity when that sugar’s converted to fat, for instance. Stress, lack of sleep or exercise amplify those problems and can sap the brain’s power to learn and change unhealthy behaviors, frustrating health education campaigns.

“I likened it to there’s a lot of firewood, but there’s no matches,” Samoa said of the brain’s lack of resources in such a scenario. “If you plant that in your life, then this is the tree you’re ultimately going to sprout.”

Other conference speakers described the progress they’ve made uprooting the tree. In Northwest Arkansas, the medical university’s Center for Pacific Islander Health works with Marshallese community leaders to find the group’s health goals and the most effective ways to reach them together, such as with family and church-based exercise and diet programs.

Dr. Sheldon Riklon, a Marshallese family doctor who joined the university around the time of last year’s conference in Fayetteville, treats his fellow islanders at two clinics and pushes the community’s youth to go into health-related careers.

“I love working there,” Riklon told the conference. “I can see the potential of what we can do there with the students, with the community.”

Last year’s conference featured several calls for Arkansas to allow Marshallese access to public health care programs such as Medicaid. The state has since added Marshallese children to the ARKids First program, which pays most or all of the health care costs for tens of thousands of low-income children in the state.

Lucy Capelle, director of the Arkansas Coalition of Marshallese, said last month she planned to sign up two of her children when the program opens to them in January.

“Everyone is very happy about it,” she said. “At last, now they can enroll into ARKids, and they don’t have to worry about medical bills that they have.”

And the University of Arkansas partnered with United Way and other groups to encourage college savings accounts among Marshallese families and provide financial classes. The first one’s set for Thursday, Marcia Shobe, a social work professor at the university involved in the project, wrote in an email.

Back in the Marshall Islands, outreach efforts in churches and at bingo nights have helped providers screen hundreds of women for cancer, said Neiar Kabua, coordinator with the islands’ Comprehensive Cancer Control Program. She said she hopes to expand the effort to worksites and some of the more isolated islands.

Caolae Jones, a nurse, told the conference Dubuque, Iowa, has made some progress in diabetes screenings and control among its small Marshallese population by hiring a Marshallese health care worker.

These successes often run into the messiness of life, however. Kabua said the cancer outreach often was stuck with under-equipped clinics. Other researchers noted health programs often make a lot of progress at first before plateauing or sliding backward.

Subica, the California psychologist, pointed to a recent Los Angeles County program that tried to encourage the local Samoan population to seek out mental health services if needed. Samoans were involved in the effort, yet in two years the program managed to recruit fewer than five Samoans out of a population of 50,000, perhaps because of stigma around mental illness and the distractions of stress and poverty.

So Subica hopes to help with a project he’s begun with Nia Aitaoto, co-director of the Pacific Islander health center in Fayetteville and fondly referred to as queen of the Pacific by many attendees. The pair will run surveys and community focus groups in California and Arkansas to get firm mental health data for islanders specifically, which is often lacking in other studies, and find ways to put that data to good use.

“Pacific Islander communities have way more strengths than many communities I work with, but they’re just not integrated into any type of care,” Subica said.

Every islander health project like this should pursue wellness, not just the absence of disease, said Dr. Stevenson Kuartei from the nation of Palau north of Australia.

“Wellness is a public good because it allows for individuals to pursue and fulfill their potential,” he said.

“Everyone is very happy about it. At last, now they can enroll into ARKids, and they don’t have to worry about medical bills that they have.” — Lucy Capelle, director of the Arkansas Coalition of Marshallese