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Hidden within
the North Pacific Ocean, the Republic of Marshall Islands is a
country consisting of 29 atolls and 5 isolated islands, all which
spread across 750,000 square kilometers of sea. Located 3,228
kilometers northeast of Papua New Guinea, the country has a land
area of 180 square kilometers and a population of approximately
67,000 people. Major industries in the Marshall Islands include
coconut oil, fishing and handicrafts. Although the country is
independent, it relies heavily on the United States for financial
support.
The Marshall Islands gained independence in 1986, previously the
country was administered by the United States. During 1946 and
1958, the US Army had used the Kwajalein, Enewetak, and Bikini
atolls for nuclear testing, which resulted in devastating affects
on the health of the indigenous population who had not been
evacuated from the area. Today, approximately 2,000 compensation
claims continue as a result of exposure to radiation.
The atolls, coral islands that circle reef like lagoons, are
divided into two groups including the Ratak Chain and the Relik
Chain. 24 atolls are inhabited by people, with 70 percent of the
population living within the Majuro and the Kwajalein atolls. The
Marshall Island population is made up mainly of expatriate
Americans and indigenous Marshallese.
Urbanization is a serious problem in the Marshall Islands, the
majority of residents are confined to the capital city Majuro and
the Ebeye Island, located on the Majuro and Kwajalein atolls
respectively. Residents of the Marshall Islands have been
increasingly moving towards these two atolls due to the
availability of work, health and infrastructure.
The capital Majuro, and Ebeye Island, continues to experience
health issues related to a poor sanitation and water system. The
populated area struggles to cope with the large amounts of waste
from households and fishing vessels. As a result of urbanization
and lack of adeqaute water supply, hygiene and sanitation, the
country suffers from outbreaks of communicable diseases including
typhoid, Hepatitis A, malaria, leprosy and tuberculosis.
Hospitals and health care facilities are confined to the two
populated regions of the Marshall Islands, Majuro and the
Kwajalein atoll. Emergency care, inpatient and specialized
services are available with medical care limited outside the two
atolls. Healthcare services are, however, limited in the country.
Basic diagnostic services are available including pap smears,
mammograms, tissue biopsies, colposcopy, endoscopy, and
colonoscopy. However, patients who require specialized medical
care, such as complex oncology or cardiac diagnostic and treatment
services, will need to travel overseas to Honolulu. As such, in
the event of a serious accident or an illness, emergency
evacuation to the capital city Majuro, or overseas to Honolulu
will be required. It is highly important that expats obtain a
Marshall Islands health insurance policy that provides coverage
for emergency evacuation and repatriation, as well as worldwide
medical coverage.
The Marshall Islands Ministry of Health has several divisions
including the Majuro Hospital services, Kwajalein Atoll health
care services and the Outer Island Health Care services. The
doctors in the Marshall Islands are predominantly American
expatriates, assisted by local Marshallese nursing staff. There is
one public hospital and one private clinic within the capital
Majuro; and one public hospital and two public health care centres
on Ebeye Island, within the Kwajalein atoll.
The Majuro Hospital is the referral centre for all serious illness
and health care conditions within the Marshall Islands. The Majuro
Hospital, funded by the US and built in 1980s, provides primary
care, emergency, diagnostic and inpatient services. The Majuro
Hospital provides specialized services in ophthalmology,
orthopedics, urology, obstetrics, gynecology, pediatrics, and
rehabilitation services.
The Ebeye Hospital, located on the populated Ebeye Island, is the
referral hospital for the Bureau of Kwajalein Atoll Health Care
Services. The Ebeye Hospital offers outpatient services, family
planning, pharmacy, dental, emergency, maternity, general surgery,
and other specialized services. However, the Ebeye Hospital lacks
modern medical equipment and supplies; as such, patients who
require specialized medical care are referred to the Majuro
Hospital. The Kwajalein Atoll Health Care Services also provides
medical care to nearby outer islands such as Ebadon and Santo,
which are inclusive of the Kwajalein atoll.
Within the Outer Island Health Care services, there are
approximately 54 healthcare centers. The level of medical care is
limited to primary care and patients are referred to either the
Majuro or Ebeye Hospital for specialized services. Health care
standards within the outer islands are expected to improve in the
near future. The United States has funded a program called the RMI
Four Atoll Health Care Program, which aims to increase the primary
health care services in the Enewetak, Bikini, Rongelap and the
Utrik communities. These communities will receive access to
dental, obstetrics, gynecology, vaccinations, diabetic and basic
cancer screening services.
The Marshall Islands experience outbreaks of communicable from
time to time, including typhoid fever, tuberculosis, and malaria.
An outbreak of typhoid occurred in 2007, 24 confirmed cases.
Typhoid is transmitted via contamination of faeces through food
and water sources. Typhoid typically presents with symptoms of
fever, rash and abdominal paid. Immediate medical attention is
required to receive the adequate level of care and prevent
deterioration.
Tuberculosis remains a public health problem in the Marshall
Islands. Tuberculosis is a bacterial disease that is spread
through the air from person to person. Although it is easy to
diagnose and treat, late detection can result in death. Another
form of the disease, called multi drug resistant tuberculosis
(MDR-TB), can develop when the course of antibiotic treatment is
not completed. The patient is unable to recover and the bacteria
becomes resistant to the first line of drugs. Reports of death
from MDR-TB have been reported from the Marshall Islands, within
Majuro and the Ebeye Island.
Expats living in Marshall Islands should exercise high caution by
practicing prevention methods. Transmission of communicable
diseases can be prevented through correct handling of food,
hygiene practice, and drinking bottled or sterilized water.
Hygiene practice should include washing hands before eating and
after use of toilet. Water sterilization can be achieved through
boiling water or using chlorine tablets. Vaccinations are also
available to treat some communicable diseases, such as Typhoid
Fever and Hepatitis.
The Marshall Islands are susceptible to floods due to it's
location within the pacific, low coast line and rising sea levels.
In 2008, the country suffered a flood which resulted in the
evacuation of the capital Majuro and the Ebeye Island. Many homes
were destroyed due to the 1.5 meter waves and torrential rain.
Expats should monitor the media for weather warnings on the
Marshall Islands for and instructions for emergency evacuation.
Emergency protocols should be adopted by residents to avoid risk
of injury during the event of an accident, serious illness or
criminal offense. The emergency contact number in Marshall Islands
is 625-4111 for ambulance and 625-8666 for the police department.
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