Chuukese Women Face Health Care Barriers In Guam: Researcher

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54% of women in Guam who don’t get prenatal care are from Chuuk

By Jasmine Stole

HAGÅTÑA, Guam (Marianas Variety, Jan. 29, 2015) – Sarah Smith, an adjunct professor at the University of Guam, met with about 30 health professionals at the Non-Communicable Disease Consortium meeting on Wednesday and presented her doctoral dissertation on the social, historical and clinical contributions to disparities in health care among Chuukese women.

Smith said she interviewed and followed more than 200 Chuukese women for her dissertation and tracked their experiences at clinics on Guam.

Smith’s research revealed three main barriers that contributed to disparities in health care for women from Chuuk, including gaining access to health care, quality of care and confidentiality issues.

Smith said Chuukese women represent nine percent of women of childbearing age, yet they account for 54 percent of women with no prenatal care at birth. "I wanted to explore why (Chuukese) women in Guam and in Chuuk were not getting necessarily the care that they needed," she said. "I was looking at the clinic as a cultural entity as much as I was looking at Chuukese women as a cultural entity."

Transportation is among the top hindrances to accessing health care for women from Chuuk, Smith said. The quality of care at local clinics also limits the women’s access to care, Smith said.

With limited supply and resources, the clinics are doing the best they can but their best is still limiting. Smith said she discovered clinics emphasized prenatal care and many women needing reproductive treatment were turned away because of the lack of health care providers.

Turn away

"I found in the reproductive health area (providers) would turn away all (patients with) reproductive issues except prenatal care," she said. "Because it seems a more prominent issue, they’d say ‘Oh, you need an annual exam; call back next month.’ ‘Oh, you need this; call back next month.’ ... The problem is the catching up never really happened because there are more patients than providers."

Not understanding the health care system was also a barrier that women reported to Smith. As a native English speaker, Smith said she was confused at first how the system worked, and for non-native English speakers adjusting to living in new surroundings, figuring out the local health care system could be intimidating.

Language was another barrier for Chuukese women seeking health care on island. Smith said sometimes Chuukese women did not fully understand what providers were saying and at times even though both the provider and the patient spoke in English, English was a second language for them both.

"Their accents would be different and they wouldn’t understand each other’s English. There would be another loss of information there," she said.

The culture of public clinics also contributes as a barrier to quality health care. Smith said in her interviews, Chuukese women described a "rushed" feeling at clinics.

"I found out there was a hysterical rush which was a daily occurrence. It stresses out health care workers and patients alike," Smith said. "Providers were just trying to survive, see as many patients as possible."

This, in turn, ended up compromising treatment for patients, Smith said. "And it made it uncomfortable to ask questions," she said.

Smith said there was a notable hostility in the front areas of the clinics as it is usually a tense, hectic place. She found the workers at the front desk were often overworked and underpaid and would scold patients. One Chuukese patient Smith spoke to said once a patient gets past the front, "You get treated like a human."


Smith also noted that confidentiality is an issue for Chuukese women.

One clinic hired Chuukese health care workers which drew some women to the clinic because there was someone there that could understand them. However, some women also steered clear of the clinic because they did not want to explain their issues to another woman from Chuuk who could share her personal medical information.

Smith said it was not a reflection of the particular Chuukese women who were hired but it was understood in the entire culture. Smith said it was the same mindset of people in small communities elsewhere. A neighbor is also a doctor and one might feel embarrassed disclosing their personal medical issues to that person.

The issues faced by Chuukese women seeking health care on island, however, are not unique to Guam. "Many of these issues are relevant to patients seeking publicly funded care throughout the U.S. and abroad," Smith said.

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