Diabetes Mellitus in the Marshall Islands: A Biopsychosocial Perspective
Although examples of health crisis cum economic development exist on every continent, this paper will attempt to address and dissect the healthcare situation in a tiny nation isolated in the middle of the Pacific Ocean, the Republic of the Marshall Islands. Not only does the health of the Marshallese warrant examination because these people particularly ill with a disease plaguing millions worldwide, with rates of diabetes mellitus on par with the highest in the world, but their situation is irrefutably linked historically and currently with the United States of America. The United States has played the key role in shaping the present state of the RMI through its historical involvement in the nuclear testing program of the 1950's, which will be discussed at length later in this paper. Likewise, the United States continues to play a significant role in the lives of Marshallese by acting as the second largest employer in the country, the Marshallese government being only slightly larger. The United States' military's Regan Test Site employs thousands of Marshallese citizens, thereby driving the Republic of the Marshall Islands' economy. Secondly, several thousand Marshallese individuals seek medical care in the United States, most often in Honolulu, Hawaii, every year. These offshore referrals are funded largely by American tax dollars through payments made to the Republic of the Marshall Islands in accordance with the Compact of Free Alliance. Only a few short months spent in an urban primary care facility in Hawaii enabled this author to have contact with several Marshallese patients and a professional staff who felt that understanding the Marshallese diabetes mellitus crisis by anyone working with the Marshallese population and the general public is essential for improvement.