When I look at COVID-19 maps, which I’m doing at least several times a day, I usually start by clicking on my own state (Nevada) and sort of move outward from there, hitting other states, sometimes checking Mexico and Canada, and then going to hotspot countries like China, Iran, Italy, and Spain. My focus, both in checking maps and reading articles, has definitely been on the U.S. and other wealthy countries, a group that includes most of those hardest hit. And I have to admit, my geographic focus in life has been mostly on those countries too, crisis or no crisis.
But lately, because I’ve been looking into the geography of health and disease, I’ve been pulled out of my comfortable box more often. And one of those times was about a month ago, when I talked with two doctors in Honolulu, Neal Palafox and Seiji Yamada, to hear what they had to say about the health problems of Marshall Islanders. The Republic of the Marshall Islands is a poor country in the Western Pacific that has been battered by a perfect storm of woe—it’s probably best known as the place where the U.S. did an ungodly number of nuclear tests, irradiating many Marshallese in the process, and, more recently, for the prospect that the whole country may simply disappear under rising seas, an erasure by way of climate change. And, related to these disruptions, it is also a hotspot for type 2 diabetes and suicide, among other things.
Those two doctors, Palafox and Yamada, had a lot to tell me, much more than I can cram into a blog post. Yamada, in his demeanor and his knowledge of government machinations, reminded me a bit of the whistleblower Ed Snowden (and I mean that as a compliment!). His view of the U.S.’s actions in the Marshall Islands was damning, to say the least. For instance, he said that the U.S. military presence there has created what amounts to “an American apartheid,” with the Marshallese in the place of blacks in South Africa.
At some point, I’ll have to write more about what Yamada said. But here I want to recount a story that Neal Palafox told me about the nine years he spent working in the Marshall Islands in the 1980s and 1990s. I think it’s kind of a funny story, but it also has implications for the COVID-19 pandemic.
Palafox went to the Marshall Islands on a National Health Service Corps scholarship, and he said that his original goal in going there was to become the best clinician he could be in the area of family medicine. However, soon after he arrived, he was asked to add a new and unexpected role—to run the mental health program. His response was that he didn’t know much about that field. But then he was shown the mental health facilities, and found that the patients with the worst problems—the ones who had gotten “really psychotic and out of hand”—were being held in a jail. “I went there,” he said, “and I go ‘aaagh!’” And so, feeling like there was no option, he took on the job.
Next, Palafox was asked to take over the hemodialysis unit. He said he wasn’t a nephrologist, but they told him nobody was in charge of the unit, the supplies would sometimes run out, and they needed a physician to head the operation. So he took on that job too.
After that, he was asked if he could visit some of the more remote islands to do screenings for tuberculosis and leprosy, infectious diseases he knew little about, and he went and did it. Then he took on a monumental task, becoming the director of a nation-wide public health program, another area he had hardly any training in.
And, finally, he was asked to run a new program to help people who had been made sick from the nuclear testing. Palafox described what happened then, basically the same thing that had happened all the other times: “I said, ‘I don’t know anything about [it], what do I know about taking care of this stuff?’ [But] They said, ‘Well who’s going to do it?’ So I said ‘aaghh!’” And then, of course, he became head of the program.
So, in addition to practicing as a family physician, he did infectious disease screenings, and became the head of a mental health program, a hemodialysis unit, a national public health program, and a national program for people affected by nuclear fallout, despite the fact that he had hardly any prior experience in any of those fields other than the first one.
This story says something about Neal Palafox, and I guess that’s part of the reason I’m telling it. But, more to the point I want to make about COVID-19, it says a lot about the state of health care in the Marshall Islands. What Palafox did is beyond admirable, but it also underlines the glaring holes in the system. No doctor should have to wear that many hats, and, in countries like the U.S. or Italy or Japan, no one does.
And this brings me back to the COVID-19 map. Lately, after checking the numbers for Nevada and the rest of the U.S., I’ve been scrolling over to the Western Pacific, to the Marshall Islands. So far, the country is happily invisible—the islands themselves are too small to show up on the map, and there have been no confirmed cases to light up the area. And this is very good news, because, if COVID-19 were to take hold there, the bare-bones health care system would be almost immediately overwhelmed. It would be especially bad, because so many Marshallese have diabetes and other diseases that would make them more susceptible to becoming extremely sick or dying from the virus. And then the economic fallout would come, in a place without much in the way of government safety nets.
Fortunately, the leadership of the Marshall Islands, realizing how catastrophic COVID-19 could be, quickly closed off the country to international travelers. So, perhaps it will escape the disease or, at least, hold it off until a vaccine or some effective treatment is available.
The bigger problem, though, is that many poor countries are like the Marshall Islands in terms of health care (not to mention lack of economic safety nets). And the coronavirus has already reached most of those places. Another wave of the pandemic is coming, and it could be bigger than the one we’re now experiencing.
It’s yet another reason to do our part with social distancing and hygiene to keep this thing under control in places like the United States. We should be doing it not just so our own health care systems don’t get overwhelmed and our own economies don’t collapse, but also to ensure that when other places need help, as they almost surely will, we have the ability to give it.
We need to keep to our own little spots, for the sake of the whole world.
(Photo of Jaluit Atoll Lagoon, Marshall Islands, by Keith Polya via Wikimedia Commons.)