In episode three of 'Ozarks ri-Ṃajeļ,' Dr. Sheldon Riklon is interviewed by Marcina Langrine, Communications Coordinator with the nonprofit Marshallese Educational Initiative headquartered in Springdale. Dr. Riklon divides his time between the Family Medicine Residency Program at University of Arkansas for Medical Sciences Office of Research and Community Health and the nonprofit Community Clinic in Springdale. A native of the Republic of the Marshall Islands, Dr. Riklon is one of only two Marshallese physicians practicing in the United States. The following is an edited excerpt from our full-length Listening Lab interview.
Marcina Langrine: "Good afternoon, Dr. Riklon. How are you?"
Sheldon Riklon: "Good afternoon Marcina, I'm doing well. Kommool tata."
Langrine: "So let's start with what endemic chronic diseases historically were pervasive among Marshallese back in the islands and the root causes? And can you summarize access to health care in the Marshall Islands, then and now?"
Riklon: "I was born on Ebeye Island on the Atoll of Kwajalein. You know, growing up in the 1960s, and 70s, I think it was mainly the infectious diseases that were more pervasive at that time, and they were quite endemic including tuberculosis and Hanson's Disease. Polio was, you know, something that we all worried about as well — we had a large number of cases, along with some SDIs, sexually transmitted diseases."
"Access to care in the islands at that point, including now, it's still mainly through the hospitals. That's one of the things that's very different from the Marshall Islands compared to the states. If you're sick or you need to see a physician, you go to the hospital to seek care. There was really no private clinics until recently, now there's just one. But otherwise you go to the hospital emergency room or outpatient clinic. If you're coughing, if you have pink eye, chest pain, anything and everything that is health-related, you go to the hospital, including for your vaccinations and immunizations as well. Also access to care back in the islands is quite different from what it is in the states because you really don't need insurance. As long as you are a resident, you can [obtain] medical care."
Langrine: "Do you feel that more islanders lean towards more traditional medicine rather than, you know, going to the hospital back in the Marshall Islands? And is that the same for Marshallese here in the States?"
Riklon: "I think it's more the older generations that would seek traditional Marshallese medicine first. And sometimes it’s easier because you know who you are supposed to seek care from. And traditional medicine, it varies. It can be just plants, herbs. But traditional medicine also involves plants, herbs and 'sayings' talking to certain [healers]. There's only certain people who practice it. And there's definitely more traditional medicine being practiced back in the islands than here in the states. And one of the reasons is because you don't have all the plants that we have back in the islands. A simple traditional medicine that we grow up with is coconut. I wish we had coconut trees here in Arkansas."
Langrine: "So the next question, for those who aren't aware, is that the Marshall Islands does have a nuclear legacy with the United States. In 1946 through 1958, the United States detonated 67 atmospheric nuclear and thermonuclear weapons in the Marshall Islands, at the time a U.N Trust Territory administered by the U.S. Government. What have been and continues to be the consequences of those Cold War weapons experiments on the Marshallese present at the time and descendants?"
Riklon: "I think that part of our history really continues to affect us. I do not see an end to it at this point. I mean, if you really think about it, 67 thermonuclear weapon tests detonated during those 12 years? It's more than 7,200 Hiroshima-sized bombs being detonated. And you are destroying lands, you know, islands vaporized. And then you're also destroying places where people get their food from. It affects the oceans, it affects the trees, the soil, the water. But it also affects the people themselves healthwise, physically, mentally, psychologically but also culturally, because we as Marshallese people, as islanders, our culture is also dependent on the land. It goes through your matrilineal heritage. You identify yourself on that piece of land, that your parents, your family's assigned to. There are some people that [remain permanently] displaced because they don't have that land anymore."
"And if you destroy the culture, the way you live every day from then to now, it's different. You go from a people dependent on the ocean, you go and harvest the crops, you climb the coconut trees and breadfruit trees, you're active every day. And you get fresh fruits and vegetables and can fish all the time. To now, where most of us, we have to go to the store, we're quite dependent on processed unhealthy foods."
"So health and culture and socioeconomic development, all those come into play, affecting us since then to now, that our cases of many chronic conditions are quite high. And many of the complications that come from it stem from that time, because of all these different kind of changes."
Langrine: "And so, let's move on to the next question. You know, after Marshallese leaders declared independence from centuries of foreign occupation in 1979, the Republic of the Marshall Islands entered into a formal Compact of Free Association with the U.S. in 1986. That compact allows the U.S. to maintain a remote strategic military base on the Marshall Islands, and islanders under the compact can freely travel to and live in the U.S. as legally-present migrants for work, education, and much needed medical care. But medical providers here in northwest Arkansas, who first treated Marshallese, reported a certain shyness and lack of complaint among islanders. So can you explain why that is?"
Riklon: "I think there's different reasons, one of that is the language. For many of us Marshallese, you're not comfortable speaking English, so you don't say as much as you want to. And then whoever's there next to you, whether a formal interpreter or your son or daughter or granddaughter or grandson, would be your interpreter when they're seeing that provider. That's one reason. And the other reason is because of the nuclear legacy history. That basically makes us quite mistrustful of others. Right? Because as Marshallese, as islanders, we trust each other all the time, dependent on what the other person sees, says and does. And actually, that's our culture. You know, we help each other whenever we need help, it's a group dynamic."
Langrine: "Medical providers, you know, also saw evidence of widespread compromised immunity. Do you care to comment on that?"
Riklon: "Absolutely. If you think about the nuclear legacy, how radiation, how the radioactivity affects you? For people who work with Marshallese patients, they already know that we have all these chronic conditions that affect our immune system: diabetes, high blood pressure, cholesterol issue, dementia, strokes, all the different infectious diseases. We also have cancers, we have people on cancer drugs and immune modulators, but all those things affect our immune system and it's because of who we are."
Langrine: "And so the next question, you know, in the late 1990s and early 2000, most low-income Marshallese went to local ER's for medical care, providers reported. But things have changed. You know, today, qualified islanders can enroll in the federal health insurance marketplace, apply for Medicaid coverage and enroll their children in ARKids health insurance. Northwest Arkansas Community Clinics also provide much needed affordable primary care. What is the outcome of access to such entitlements?"
Riklon: "Well, first of all, thank goodness for that change. Arkansas has always been supportive of the Marshallese here, starting with the kids in the beginning, and then later in December 2020, when Medicaid was restored to us. I see more patients coming into the clinics now, where I work, and there's new ones every week, which is great because that's what they're supposed to do."
Langrine: "In closing, what more needs to be done to accommodate the medical needs of Ozarks Marshallese given the sacrifice our people made for U.S. national security during the Cold War, extending into today?"
Riklon: "I think the sacrifices we made has affected the whole world. So, you know, I think we deserve the royalty of the royal of all coverage for health care. Unfortunately, we are not at that stage yet, we are making small steps along the way, but we are not there yet. And it's great that we have the restoration of Medicaid for us. And you know, we have people, especially in Arkansas, that have always been quite supportive of us, especially in northwest Arkansas, through the federal government, the state, everybody has been quite supportive. Marshallese in different states and even our own folks back in the islands are kind of jealous that we have this relationship."
"But we need to continue to make sure that literacy in terms of health insurance are being explained, as well as all social net programs. Things are opening up under our [renegotiated] Compact of Free Association especially with, you know, disability insurance and food stamps, and all those kind of things, which is great. Those programs should be used for the people that need it, and most of our people need it. But as long as we can fix the policies and procedures to take action, you know, that'll be great, so we can access those services."
"The way I see it, as long as we're provided all the tools, just like Americans, we could get access to benefits. We deserve the same benefits, because we're here. We're American Marshallese. We pay our taxes. We have our [nuclear] history. So we should be given the chance and opportunity to access those different kinds of programs, including housing and other things, including education and other things. When you do that, you're basically investing into your own community. If you invest into your own community, you make your community prosper, you make your community healthier. You make them want to be productive members of the society. And for us, as Ozark Islanders, we love the Ozark Mountains, and we love northwest Arkansas. And we would be proud contributing community members. We just need to receive the same access, like everybody else."
Dr. Sheldon Riklon is the inaugural holder of the Peter O. Kohler M.D. Endowed Chair in Health Disparities at the University of Arkansas for Medical Sciences and the 2021 recipient of the Dr. Edith Irby Jones Excellence in Diversity and Inclusion Lifetime Achievement Award. Previous to moving to northwest Arkansas, Dr. Riklon was on faculty in the Family Medicine Residency Program at John A. Burns School of Medicine at the University of Hawaii.
This conversation has been edited for length and clarity. To hear more of the conversation with Marshallese physician, Dr. Sheldon Riklon, as well as previous episodes of "Ozarks Ri-Majel" visit: https://www.listeninglabkuaf.com/marshallese
'Ozarks ri-Ṃajeļ,' a special Listening Lab/KUAF Public Radio multimedia series, reveals how waves of legally-present Marshallese migrants have navigated new lives on the Arkansas Ozarks over the past thirty years. The series is directed by Listening Lab's Emerson Alexander, written and produced by KUAF news reporter Jacqueline Froelich, with assistance from KUAF news reporter Sophia Nourani, in partnership with the nonprofit Marshallese Educational Initiative.
