Chuukese

Chuukese people face many barriers to accessing medical care in Hawaiʻi, and now a new study shows that many Chuukese may experience racial discrimination, leading to poor access to appropriate healthcare.

The study also found that Chuukese people face other barriers including miscommunication with providers. They endure insensitive remarks when trying to access services, and face great difficulties navigating the healthcare system due to the differences between the US and Chuukese systems.

"This study highlights the importance of addressing racial discrimination, cultural beliefs, and community assets when working towards health and healthcare equity for the Chuukese," said Megan Kiyomi Inada, DrPH, the lead researcher on the study. Dr. Inada, formerly with UH Public Health, now works at Kokua Kalihi Valley Comprehensive Family Services, a federally-qualified health center in Kalihi.

For the study, Dr. Inada interviewed nine Chuukese community members in Hawaiʻi and eight healthcare providers, including physicians, interpreters, and community health workers who provide health services to Chuukese people. The researchers then analyzed transcripts of the interviews.

Results showed that almost all of the Chuukese community members in the study said that they or someone they know had received poor care or heard rude remarks from providers. Several providers in the study reported that they had witnessed colleagues discriminating against Chuukese patients.

The participants also reported that aside from racial discrimination, other barriers that prevent Chuukese people from getting the health care they need include a lack of appropriate healthcare coverage, financial resources, health literacy, and access to food and transportation.

In Chuuk, patients do not need to make appointments, nor do they need to pay to see providers. When they come to Hawai‘i, inadequate insurance coverage becomes a barrier.  Many migrants who come to the US from Micronesia are not able to fully participate in government programs such as Medicaid.

For those with limited English, this is compounded by communication barriers. Although some providers have interpreters available, Chuukese culture includes a general reluctance to discuss health problems with a person who is not a family member. Also, the prospect of seeing several physicians at different locations can quickly become overwhelming.

Still, the researchers reported that the study participants identified several solutions. Building trust with Chuukese community and educating patients on navigating the healthcare system, as well as educating providers about the Chuukese history and culture could help to reduce the barriers, they said.

“Mistaken assumptions and harmful stereotypes could be overcome by working to build stronger patient-provider relationships, mutual understanding, and respect,” notes Dr. Inada.

The study will be published in the January 2019 issue of the journal Social Medicine. Inada's co-authors included Kathryn L. Braun, DrPH, the director of UH Public Health, and Tetine Sentell, PhD, an associate professor with UH Public Health. Co-authors also included Parkey Mwarike, of the College of Micronesia in the Federated States of Micronesia, Kevin Cassel, DrPH, of the University of Hawai‘i Cancer Center, Randy Compton, JD, of the  William S. Richardson School of Law, and Seiji Yamada, MD, MPH, of the John A. Burns School of Medicine.

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