Marshallese hit hard by covid-19

They account for half of disease’s deaths in Northwest Arkansas

SPRINGDALE — Marshallese have suffered half the deaths so far in Northwest Arkansas from covid-19 while making up no more than 3% of the region’s population, figures show.

Fourteen of the 28 Northwest Arkansas residents who have died of the virus as of Friday have been Marshallese, according to Washington County Coroner Roger Morris and Benton County Coroner Daniel Oxford. Yet Marshallese account for about 3% of the region’s 520,000 residents, said Melisa Laelan, director of the Arkansas Coalition of Marshallese.

Her estimate of about 15,000 Marshallese living in the two counties is larger than the U.S. Census shows. Laelan has long maintained Arkansas’ Marshallese population was severely undercounted in the 2010 U.S. Census.

“The community is devastated,” said Eldon Alik, consul general for the Springdale consulate of the Republic of the Marshall Islands.

As of Friday, state Department of Health figures show 6% of all confirmed covid-19 cases in Arkansas are Pacific Islanders, a category that includes Marshallese. Pacific Islanders account for 0.4% of Arkansas’ population, according to the latest census estimate.

Community Clinic, which has four covid-19 testing sites in Northwest Arkansas, had tested 767 Marshallese patients as of Thursday, and 31% of them have tested positive, according to Judd Semingson, chief executive officer of Community Clinic.

Lack of testing as the pandemic took hold in March and April was the major factor in allowing the disease to spread among Marshallese Arkansans, said Dr. Sheldon Riklon. Riklon is a researcher at the Northwest campus of the University of Arkansas for Medical Sciences who also works as a family practice doctor at Community Clinic.

Laelan, meanwhile, was quoted in a March 17 Northwest Arkansas Democrat-Gazette article saying that the state’s coronavirus warnings weren’t reaching Marshallese because none of it came in the Marshallese language. Local groups did their best to translate and get the message out, she said. The islander community faced a similar situation during a mumps outbreak in Springdale schools in 2016, she said.

Riklon warned in an April 17 article in the Northwest Arkansas Democrat-Gazette that the lack of testing for covid-19 among Marshallese increased the likelihood it would spread quickly if it reached that population. He warned health agencies about the danger before that article appeared, he said.

“This is one time I wish I was wrong,” Riklon said in an interview Tuesday.

Dr. Jennifer Dillaha, the state Department of Health’s epidemiologist, said in a statement Friday the Marshallese community did receive priority for testing, but the severe shortage of tests in the pandemic’s early stages was a well-known, serious problem.

“The Marshallese have all along been on our top list to be watched,” the statement says. “Insufficient testing capacity was a problem for the whole state in mid-April.”

The department prioritized covid-19 testing for the Marshallese through its Bates Outreach Clinic, which is located in Springdale, she said. As soon as the department had access, it placed an “Abbott ID Now” machine capable of rapid test results for coronavirus at Community Clinic, the statement said.

Marshallese received follow-up testing of household members and other close contacts of coronavirus cases as soon as possible, the statement continued.

Two days after Riklon was quoted in the April 17 article, Dr. Nate Smith, state Secretary of Health, assured the public his department was keeping a close watch on the Marshallese. He gave that assurance in an April 19 public briefing on the pandemic. He noted the Marshallese appeared underrepresented in racial breakdowns of covid cases in the state.

“So, I’m not sure that we’ve captured all the Pacific Islanders there, but we’re working very closely with our Marshallese community to make sure we identify all cases and do appropriate contact tracing,” he said.

Then, at an April 23 briefing with the governor, Smith said: “We are particularly concerned about infections, hospitalizations and deaths in some of our harder to reach communities where there may be barriers of language or culture, so we are looking at that very carefully.

“We have already been working with the Latino community [and] the Marshallese community preparing messages culturally adapted and in the proper language. We will continue to do that but we will also make sure that we are doing adequate testing as well,” Smith said.

PEOPLE AT RISK

Northwest Arkansas is home to the largest population of Marshallese in the United States outside of Hawaii, census figures show. The Marshall Islands are a former territory of the United States

about 2,000 miles west of Hawaii. Marshallese are allowed to travel freely to the United States under a treaty between the two countries. Northwest Arkansas became a destination because of employment opportunities, a low cost of living and, as the Marshallese community here grew, an established community of fellow islanders, according to Alik, Laelan and others.

Marshallese have a high propensity for underlying health conditions that make an outbreak of covid-19 riskier, Riklon said. Those conditions include high blood pressure and diabetes.

“Lack of access to health care is a big problem among the Marshallese,” Riklon said. “The pregnant and children have access to Medicaid, but the adults are facing unemployment, jobs that never carried insurance benefits anyway and many of them part time, and no state or federal Medicaid. They are already worried about their bills.”

They are reluctant to pick up a doctor bill until they have no choice, by which time they are severely ill, he said. This problem is not restricted to covid-19, he said. The loss of work hours or jobs because of the pandemic make them less inclined to see a doctor whatever health problem they face, Riklon said.

“They have to buy groceries and pay their electric bill,” he said.

The biggest problems in controlling the pandemic among Marshallese are economic, said Pearl McElfish, vice chancellor at the Northwest campus of UAMS. She is active in attempts to come up with a coordinated response to the outbreak.

“Marshallese are not in the types of jobs you can work from home,” she said. “When you work for a cleaning service or in the poultry industry, you can’t self-isolate while working from your laptop.”

Jobs taken by Marshallese include food processing, particularly poultry, where people concentrate. Hundreds of covid-19 infections are among poultry plant workers, according to Health Department figures. Those plants are deemed essential industries by federal and state governments and are allowed to stay open despite the pandemic.

Gov. Asa Hutchinson has praised the efforts of Tyson Foods and other processors in their attempts to control the spread despite the crowded work conditions the jobs require.

“Tyson and others are taking this very seriously, and they are doing their best,” McElfish said. “I want to make that clear. But you can’t virtually cut up a chicken.”

The Arkansas Coalition of Marshallese estimates about 82% of Pacific Islanders in Arkansas have someone deemed an essential worker in the household. About 51% have household members with diabetes, obesity or high blood pressure, and 15% have household members who are 65 and older.

Economic factors are a much bigger obstacle in controlling the pandemic than cultural matters, McElfish said. The often-repeated fact Marshallese are very social and several generations of the same family often live in the same house is overemphasized, she said.

Marshallese families have several generations living in the same home because they can’t afford not to, she said. And they cannot afford enough room for social distancing at home. Living from paycheck to paycheck is common, she said, with many families afraid of missing work and losing wages.

“I know one household that went from four wage-earners to none” because of coronavirus exposure, she said.

Compounding all this is the Marshallese community is indeed close-knit, and most Marshallese in Northwest Arkansas came to the United States together, grew up together or have another connection, Alik said.

“When somebody dies, you know who it is. And if you don’t know them, you know who their grandparents are or who their brother or sister is,” he said.

PERSONAL COST

Alik said he worked closely organizing community events with Murjel Tarkwon, who died May 25 at age 63 of covid-19.

“I miss him dearly. He was a good friend,” Alik said.

Alik said he moved to Northwest Arkansas in 2017, and Tarkwon was one of the first people he met. Tarkwon helped him find a place to live and was humble despite being a descendant of Marshall Island chiefs, he said.

“He’s got royal blood, but he doesn’t show it,” Alik said.

Murjel Tarkwon’s son, Alister Tarkwon, 31, described his father as kind and humble. He mostly remembers his father enjoying taking part in community events and getting together with the family for holidays and birthdays.

Alister Tarkwon said his father, who had diabetes, died from covid-19 after being in the hospital for about three weeks. He was on a ventilator.

Alister Tarkwon’s mother first showed symptoms of the virus and then tested positive. Then he, his wife, father and two sisters, who all live together, all tested positive. His wife and two sisters did not show symptoms, he said.

Stories of stricken friends and family members are growing, according to others interviewed.

Throughout a conversation Wednesday, Anita Iban kept saying, “I know of one more. I heard about two more.” She was chronicling the members of her friends, family and church she knows who are sick or dead from covid-19.

Iban is a parent liaison for the Springdale School District, and her husband is the pastor of Anij Emman Church, an Assemblies of God congregation in Springdale.

“It’s eating up our community fast,” said Carlness Jerry with the Marshallese Education Initiative.

Jerry said the sickness has spread by community members who don’t know they have it — and some that know they have it but hide it for fear of losing wages.

Iban’s church organized three events to gather donations, food and personal protective equipment for Marshallese families. Jerry said her organization has shared grant money with groups helping the community.

“There’s not enough for all of them,” Iban said.

Jerry said her organization tries to stay updated on the latest news about the virus and prevention and share information through its website. But not everybody has a computer at home.

Iban noted many Marshallese people are taking precautions against the spread of the virus, such as staying at home, wearing masks and social distancing. She also noted church and family gatherings, birthdays and other events so important to the community have been canceled.

“From what I know, they can’t even get a venue,” Iban said. “People are afraid to hold big events.”

WHAT NOW?

“What we’re working toward, what we need, is to help people get tested and to get them the resources they need to self-isolate,” McElfish said.

“There’s a saying that goes ‘Don’t let the perfect be the enemy of the good,’” McElfish said. “We have to do this and do it now, not perfect a system. We don’t have months, weeks or even days.”

Despite an increase in testing in recent weeks, much of the disease’s spread among the Marshallese remains unknown, Riklon said

“I’m not sure we’ll be able to pinpoint where it started,” he said of the outbreak among Marshallese, citing the lack of early testing.

“We’re trying to find the hot spots, but that’s difficult to do because we have multiple hot spots. All we can do is keep practicing social distancing, wash our hands and stay home. Think twice about having to go out.”

There is at least one major exception to his advice to stay at home, Riklon said. Someone who feels sick should call his primary care physician and go to the doctor if so advised.

Covid-19 or not, someone in an infected household has to buy groceries. Assisting groups such as the Health Care Transformation Division of the Northwest Arkansas Council and the Marshallese Covid Task Force are having to improvise ways to deliver groceries to families in need so they don’t have to go to stores themselves, McElfish said.

“Everything we can do is barely enough,” she said.

“Marshallese are not in the types of jobs you can work from home. When you work for a cleaning service or in the poultry industry, you can’t self-isolate while working from your laptop.” — Pearl McElfish, vice chancellor at the Northwest campus of UAMS

Alex Golden can be reached by email at agolden@nwadg.com or on Twitter @NWAalexgolden. Doug Thompson can be reached by email at dthompson@nwadg. com or on Twitter @NWADoug. Laurinda Joenks contributed to this article.