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For Micronesians in Hawaiʻi, the struggle for health care can be traced back to nuclear tests

Kōkua Kalihi Valley clinic
Kōkua Kalihi Valley clinic
Kōkua Kalihi Valley started in 1972 with four female employees from the Kalihi Valley community whose job it was to walk door to door.

Nearly 25,000 Micronesians live in Hawaiʻi — and their struggle for affordable health care has lasted for more than 20 years. There have been recent changes, but challenges remain. This week, HPR’s Jackie Young looks at some of those changes and challenges — starting with some history.

After World War II, the U.S. Navy set off a series of 67 nuclear explosions in Micronesia over a dozen years. That’s the equivalent of more than 7,000 Hiroshima bombs. Today, many of the islands remain radioactive.

Dr. Neal Palafox of the University of Hawaiʻi medical school has been researching the Micronesian population since the 1980s — including the impact of nuclear fallout.

Neal Palafox UH medical school doctor
Dr. Neal Palafox of the University of Hawaiʻi medical school

“It contaminated the folks — direct radiation fallout — very, very high levels of radiation," Palafox said. "The current studies have shown out of the NCI (National Cancer Institute) that you can’t set up a wall for where the nuclear testing goes, and so it actually went all over the Marshall Islands … and it’s been shown the footprint of the radioactive strontium has actually reached Guam.”

Palafox and other health experts believe the Micronesians’ health was both directly and indirectly affected by the nuclear bombings.

Dr. David Derauf, executive director of Kōkua Kalihi Valley clinic, says the nuclear tests also disrupted the Micronesians’ traditional diets, resulting in chronic disease.

“All of the chronic diseases: hypertension; diabetes is very, very prevalent; … chronic kidney disease — very high rates of people requiring dialysis; cancer — we see much higher rates of cancer; coronary artery disease — all of which require constant medical attention," Derauf told Hawaiʻi Public Radio.

Hydrogen bomb test at the Bikini Atoll 1956 military
H-bomb test; radioactive clouds at the Bikini Atoll on May 21, 1956. (AP Photo)

The U.S. government approved the Compact of Free Association, or COFA, in 1986 for the Federated States of Micronesia, the Marshall Islands, and Palau.

It allowed those residents to live and work in the U.S. without a visa and gave them access to health care via Medicaid. But Micronesians were suddenly dropped from Medicaid as part of the 1996 Welfare Reform Act.

Nearly two decades later, about 8,000 were transferred to plans under the Affordable Care Act.

In Hawaiʻi Public Radio's next report, we’ll explain how that led to other complications — including here in Hawaiʻi. Stay tuned for parts two and three, examining Micronesians' struggle for health care in Hawaiʻi.

Jackie Young is the local host of Weekend Edition.
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