For University of Hawaiʻi at Mānoa medical student Kalpana Balaraman, a summer spent in the Republic of the Marshall Islands offered a transformative lesson in health care and cultural humility.
Balaraman, a second-year student at the John A. Burns School of Medicine (JABSOM), joined classmates Kaela Akina-Magnussen and Trini Leung in Majuro Atoll, in the capital of the Marshall Islands, this past summer. The month–long training gave them firsthand exposure to providing care in a resource-limited environment.
From the start, the experience challenged expectations. Balaraman recalled receiving her boarding pass just 24 hours before departure, with no fixed departure time. “This lay the foundation for the ‘island time’ that we would experience over the next month and probably most importantly, that a lot of things outside of my own control will determine what I’m able to do and when I’m able to do it.”
Climate change, access to care
Climate change also shaped her stay. Torrential rains and rough seas disrupted travel to outer islands, revealing the challenges Marshallese residents face in accessing hospitals, food and medications. With only two public hospitals in the country, one in Majuro and another in Ebeye, safe weather conditions often determine whether residents can reach essential care.
“What ended up being a missed opportunity for me is what everyday life can be for the people of the Marshall Islands,” she said.
Much of her clinical work focused on non-communicable diseases, especially diabetes. “I was wholly unprepared for the severity of the degree of diabetes in Majuro, and the routine plentitude of peripheral neuropathy, regular infections and amputations,” Balaraman shared.
She found it difficult to advise patients on healthy diets, given limited access to fresh foods and reliance on processed staples such as rice and ramen.
Shaping future patient care
Beyond clinical challenges, Balaraman said the most important takeaway was a deeper understanding of cultural perspectives in health care.
“While I will never be able to truly understand any culture that is not my own, what my time in Majuro gave me was assurance that my relationship with these cultures and my patients is dynamic,” she reflected.
Balaraman hopes to carry those lessons forward into her future career in Hawaiʻi. “By living for a short period of time in a culture that is so different from my own… I am hopefully getting more and more competent in caring for my patients in a culturally concordant manner with each encounter.”
