Mercy community health nurse Caolae Jones and community health worker Irene Ernest lead a cooking demonstration in a diabetes education class, showing how to prepare good, healthful food within a diabetic diet.
Since 1992, Dubuque has grown as a home to a significant number of Marshallese people, estimated at about 600 individuals. The Marshallese have been, and continue to be at higher-than-normal risks for a variety of serious health issues, including obesity, diabetes and cancer. Experts argue their health issues may have resulted from the excessive nuclear testing done in the Marshall Islands by the United States from 1946-1958. The Marshal Islands are listed as one of the most contaminated places in the world by the Atomic Energy Association.
Under a 1986 Compact of Free Association (COFA) agreement with the Republic of the Marshall Islands, the Marshallese are allowed to freely come and work in the U.S. They are not US citizens but were initially eligible for some federal aid and safety net programs such as Medicaid. However, with welfare reform in 1996, non-citizens became excluded from such benefits.
“Many Marshallese are coming here for health care, economic opportunities and education, but they face many barriers, especially with accessing health care,” said Jennifer Cavanagh, director of case management and social services at Mercy Medical Center – Dubuque. “We want to help eliminate those barriers and ensure they receive the health services they need.”
Mercy helped launch the Dubuque Marshall Islands Health Project in 2015 to help Marshallese residents overcome financial, lingual and cultural barriers in obtaining much needed health care. The project is a collaboration that includes Mercy, Crescent Community Health Center, VNA, the city and county health departments, the city’s human rights department, University of Dubuque Nursing Department as well as leaders in the Marshallese community.
The program addresses the immediate health concerns and the long-range health outlook for the Marshallese. Through the program, a community health nurse was hired to provide more access to preventative care as well as a community health worker (a Marshallese person) to accompany Marshallese persons to medical and pharmacy appointments. This community health worker assists with language and communication difficulties and helps builds trust between the patient and health care provider.
Much work is still needed. Long-term goals of the Dubuque Marshall Islands Health Project include advocating for the restoration of Medicaid benefits in Iowa and across the US, fairer Iowa drivers’ license applications and a fair reaffirmation of the COFA agreements.
“We’re seeing positive changes among the Marshallese community with regard to accessing health care,” Cavanagh said. “Many are now able to schedule medical appointments or refill prescriptions. They’re becoming more comfortable reaching out for assistance from the community health worker when they encounter a barrier. These might seem like small successes, but they’re significant steps for preventative health care.”Share this story.