May 27, 2015

PCORI Award Features New Face of Research

Melisa Laelan chuckled about her reaction to the first major study of a diabetes intervention tailored to her community of Marshall Islanders in northwest Arkansas.

“I was so excited I was literally jumping because this model could be exactly what we need in our community,” said Laelan, a co-investigator on the $2.3 million UAMS study funded by the Patient Centered Outcomes Research Institute (PCORI).

After 10 years in the U.S. Army, Laelan settled in Springdale in 2005, becoming the only U.S. certified court interpreter for the Marshallese. She is the founder and director of the Arkansas Coalition of Marshallese, which advocates for the area’s 10,000-plus Marshallese, and a member of the Arkansas Minority Health Commission. Her inspired work on behalf of the largest community of Marshall Islanders in the U.S. has been the subject of a 2012 feature story in the New York Times, and last fall she was named to the 2014 “40 Under Forty” class by the Northwest Arkansas Business Journal.

The New York Times article notes that Laelan is a royal princess “far from her Pacific Island home, presiding instead over a landlocked realm of grain silos and poultry processors.” Many of her people, the article said, “are adrift in a culture that confounds them.”

“I feel obligated to protect my people,” she told the Times.

The Marshall Islands were contaminated with radiation during U.S. nuclear weapons testing in the 1940s and 1950s, forcing many to flee their homeland. Since 1986 the Marshallese have been allowed to live, work and study in the U.S. without a visa or permanent resident card. They were drawn to northwestern Arkansas after word spread that jobs were available in the region’s poultry plants.

Marshall Islanders love the western processed foods introduced after World War II, Laelan said, but it has contributed to a diabetes epidemic. Limited data shows the diabetes rate among Marshall Islanders in northwest Arkansas is anywhere from 20-50 percent. That compares to an 8 percent national average. Pearl McElfish, M.B.A., director of research for the UAMS northwest Arkansas campus, notes that the law excludes the Marshallese from government health care programs.

Prior to the PCORI award, Laelan and UAMS researchers like McElfish and Peter Kohler, M.D., principal investigator on the PCORI award and vice chancellor for the UAMS campus in northwest Arkansas, had forged collaborative ties through other UAMS research and outreach projects. These included a Translational Research Institute (TRI) pilot award and a TRI-sponsored Marshallese Community Review Board. Those efforts as well as biostatistics support from TRI helped secure the PCORI award.

Empowered by PCORI’s emphasis on true partnerships between researchers and communities, Laelan represents a relatively new model for research. Marshallese stakeholders like Laelan compelled UAMS researchers to modify key pieces of the PCORI application to make it a better fit for their culture. For example, the community insisted that its proposed Diabetes Self-Management Education apply to whole families rather than individuals because Marshallese families share the same foods at mealtime.

Laelan facilitates the many interactions between researchers and the families participating in the research.

“Bottom line, we want to educate these families how to eat right,” she said. “My role is to make the process easier for the researchers and the families.”