Too Sick to Go Home – Too Poor to Get Better

Micronesian migrants struggle to access health care in Oklahoma and Arkansas.


| Fall 2017



Marshall Island Sick

Ernest and Lenwa Joab outside their rental home in Enid, Oklahoma.

Photo by Krista Langlois

Lenwa doesn’t speak much. She had a stroke a few years ago, and has high blood pressure, diabetes, and poor vision. Her family worries that the coming winter will be hard on her, as it is on most elders who grew up without winter; who came to the United States to get better but are dying instead. Few imagined they’d die here, in a foreign land with Ford trucks in driveways and leaf blowers in yards. Soon, snow will shiver through the bare branches. Lenwa isn’t receiving any medical care.

The Joabs came to Oklahoma in 2007 from the Republic of the Marshall Islands, a tiny nation in Micronesia in the middle of the Pacific Ocean. Several of their seven children were already working in the United States, and after Ernest retired they came to join them for a while. Long journeys are nothing new for the Marshallese—the tiny islands they call home are scattered across vast distances of ocean, and for hundreds of years trade and marriage and war necessitated lengthy voyages in outrigger canoes. Moving is part of their culture.

Colonization in the 20th century only strengthened these skills. During World War II, when the Marshall Islands were occupied by the Japanese, battles and bombs forced many Marshallese off land they’d lived on for generations. After the war, the archipelago was ceded to U.S. control, and nuclear testing began: Between 1946 to 1958, the United States dropped the equivalent nuclear power of nearly 7,000 Hiroshimas on the Marshallese islands of Bikini and Rongelap. Dozens of families were permanently displaced from their lush homelands and resettled on barren islands that lacked reefs for fishing and land for growing taro and other staple crops.

Without access to traditional food, displaced families turned to the few imports available: white rice, canned tuna, SPAM, corned beef, refined sugar. Diabetes skyrocketed. Meanwhile, as more people crowded into urban centers with poor sanitation and access to clean drinking water, diseases like leprosy and typhoid spread. And Marshallese exposed to nuclear fallout experienced increased rates of birth defects and thyroid cancers.

Today, a Compact of Free Association that the Marshall Islands signed with the United States shortly before it gained independence in 1989 means that these health problems have arrived in places like Enid, Oklahoma.

The compact allows the United States to operate a large military base in the Marshall Islands, and in exchange any Marshallese citizen can live in the U.S. indefinitely, without a visa, green card or health screening upon entry.