Marshallese Interpreters – Vital Voices for Pediatric Health Care in Arkansas

Overcoming Language Barriers

Babies and young children lack the language skills to explain hunger, discomfort or pain, so they cry. Most new parents understand the helplessness and frustration of guessing what will calm a crying child. When a fever or rash accompanies the cries, feelings of fear can creep in. These fears and frustrations are amplified if the hospital visit has language barriers.

"The families are tense or nervous," said Noda Lojkar, who has provided Marshallese interpretation services in northwest Arkansas for over six years. "When I walk in and say, 'lo̧kwe' ('Hello' in Marshallese), their face changes. They're more comfortable."

Lojkar and Rosalia Laluj are full-time Marshallese medical interpreters based at Arkansas Children's Northwest (ACNW) in Springdale. Laluj earned her certification in April from the Certification Commission for Healthcare Interpreters. 

According to the U.S. Census Bureau, Arkansas is home to over 15,000 Marshallese - one of the largest concentrations outside of the Republic of the Marshall Islands in the U.S. In the 1980s, the Marshallese began migrating from their island nation to Arkansas, many finding work at the Tyson plant. As the community has grown, the needs for services have increased.

When ACNW opened in 2018, it represented Arkansas Children’s commitment to bringing care closer to home for every child in the state, including the expanding Marshallese population in the northwest region.

Laluj has provided interpreter services at ACNW for the past three years. Prior to that, she interpreted for the Arkansas Department of Health and other agencies in the region. Laluj said she has been informally interpreting since she was a teenager on the islands. She frequently translated for family members during church activities or visits to the doctor because her English-speaking skills were the strongest. Laluj earned her official medical interpretation certification in April through the Certification Commission for Healthcare Interpreters and chose to join Arkansas Children's full-time.

"I saw the needs in the [Marshallese] community...struggling to navigate the health care system," Laluj said. "At Arkansas Children's Northwest, I can make a difference in our community."

Increasing Cultural Understanding

Straightforward translation is the simplest part of a medical interpreter's job. For example, when a non-English-speaking patient family calls, an interpreter can translate details like the date and time of an appointment or directions to the hospital from English to Marshallese. Things get more challenging when there is no word in Marshallese for a specific medical term. Interpreters like Laluj and Lojkar must find ways to explain the differences between 'germ,' 'disease,' and 'virus' to patients and their caregivers because the same Marshallese word describes all three. Similarly, there is no word for 'valve' in Marshallese, so when describing a condition involving a heart valve to a Marshallese family, Lojkar said he uses the Marshallese word for 'door.'

Medical interpreting is a two-way street, or a bridge, between health care providers and the Marshallese families. In addition to translating complex medical terminology from English to Marshallese, interpreters at Arkansas Children's also explain significant aspects of Marshallese culture to the care providers.

Traditional Marshallese medicine relies heavily on what Laluj describes as "massage healers and herbal remedies." Families sometimes prefer to try these techniques before agreeing to invasive surgical procedures. Religious leaders also play a substantial role in the Marshallese community on the islands and in Arkansas. Christianity is the primary religion, and some Marshallese families prefer consulting with their pastors before making medical decisions.

Outside the Doctor’s Office or Emergency Room

The impact of medical interpreters extends beyond the individual patient and translating for physicians and nurses. Marshallese interpreters also work with Arkansas Children's financial counselors, schedulers and social workers to communicate with patients and their caregivers. By fostering effective communication, they enhance the overall quality of care our health care system provides. They enable healthcare providers to fully understand a child's medical history, symptoms and concerns, leading to accurate diagnoses and appropriate treatments. In turn, this improves patient outcomes.

The Marshallese population in Arkansas is relatively small, making up less than 1% of the state's total population. In 2022, patients who self-identified as "Native Hawaiian or Other Pacific Islander" visited Arkansas Children's hospitals or clinics 4,708 times - less than 1% of total yearly patients. At Arkansas Children's, we are committed to providing nationally-ranked pediatric health care for every child in the state. Our Marshallese interpreters play a vital role in helping us meet that commitment.