It Is Not Where You Die, But Who is With You When You Die: Evolving Palliative Care Practices Among Marshall Islanders in Hawai‘i
Lauren Okamoto MD; Anna Tamai MD; Sheldon Riklon MD; and Gregory G Maskarinec PhD
Many Marshall Islanders seek healthcare services in Hawai‘i. Little is known about traditional Marshallese palliative care practices. Our purpose was to learn about traditional Marshallese palliative care practices to provide culturally appropriate care. We convened 3 focus groups in 2011-2012 among Marshall Islanders living in or visiting the island of O‘ahu, Hawai‘i. Group facilitators were uniformly trained to conduct focus groups using a prepared script, with a native speaking interpreter. Data were analyzed using classical thematic triangulation methods to identify specific Marshallese palliative care practices and the effect of economic and social challenges in Hawai‘i. Nine females and ten males, ages 17-79 years, participated. A “good death” was defined as “peaceful and pain-free,” occurring naturally with avoidance of artificial life prolongation. Factors associated with “good death” included the gathering of family to absolve conflicts, and proper and timely cultural practices such as Ilomej (wake) and Eorak (post-burial memorial service). Dying at home is the norm among people living in the Marshall Islands. After migrating to Hawai‘i, having family present at the time of death was more important than the actual locale of death. Factors associated with “bad deaths” included young age, active suffering, accidents, suicides, or “black magic/curses,” lack of timely burial, or proper burial site. Barriers included mortuary fees, cost of transporting bodies, US government policies, and wait times for death certificates. There are many underlying cultural factors contributing to “good or bad” death. Overcoming identified barri practices necessary for a good death.
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