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Updated 6/20/11 9:15 a.m.

Editor’s note: This is the first of two articles on Micronesians in Hawaii. Tomorrow we examine whether media coverage has contributed to negative attitudes toward the group. Also, to learn more about Micronesians and why they have special status in the United States, read this backgrounder.

Nia Aitaoto tells the story a lot — the one about the Micronesian skirt.

The flowing, bright floral skirts are worn by women throughout the thousands of small islands that populate the vast western Pacific.

Aitaoto, who has Hawaiian, Samoan and Yapese ancestry and was raised in Kosrae by Bible translator parents, says she wears the skirts occasionally when she is in Hawaii.

“When I use business wear, I look more Polynesian than Micronesian, but when I put the skirt on, it is just magic. It’s like I put a target on,” she told Civil Beat. “People treat me differently.”

Aitaoto cites examples: changes in voice tone in a doctor’s office, nurses not holding the door open for her, a supermarket clerk who assumed she was swiping an EBT card (used by people on public financial assistance) and not a debit card.

“I did not notice this before, but I have noticed in the last year and a half,” says Aitaoto, who is doing graduate research on Chuuk and Chuukese living in Hawaii. “It’s very blatant. The supermarket lady — I wanted to smack her. To me, that hurts.”

Aitaoto’s story — a story of discrimination against Micronesians in Hawaii — is a difficult one to digest in a society that prides itself on inclusion. As Gov. Neil Abercrombie himself has said many times, it is our diversity that defines us, not divides us.

But Civil Beat has found the experience of many Micronesians is defined by exclusion — that the group has become Hawaii’s newest underclass, with all the negative connotations that come with that term. Their exclusion extends from the racism described by Aitaoto to the anxiety caused by efforts against them by Hawaii’s congressional delegation and the state government.

The delegation recently urged the federal government to limit the number of Micronesians who come to Hawaii and receive medical treatment, even though a treaty gives them that right. Abercrombie, meanwhile, is appealing a federal court decision requiring the state to provide equal access to health care for Micronesians.

Who are the Micronesians?

Broadly speaking, “Micronesian” refers to a region of thousands of tiny islands in the Western Pacific, just as “Polynesian” includes Hawaii.

Many of the Micronesians in Hawaii, however, are from the Republic of Palau, the Republic of the Marshall Islands and the Federated States of Micronesia (Yap, Chuuk, Pohnpei and Kosrae). The three nations are covered under an agreement with the U.S. called the Compact of Free Association, or COFA.

Micronesians are eligible for visa-free entry into the U.S. without requirements for health screening. In turn, COFA allows the U.S. military to operate in the COFA region, namely at the Ronald Reagan Ballistic Missile Defense and Major Range Test Facility Base activity on Kwajalein Atoll and Wake Island.

Because of a lack of jobs and health problems, Micronesians have emigrated to the United States in growing numbers. According to recent census reports, the state has about 12,000 Micronesians, with more than 7,000 identifying themselves as Marshallese.

“As the population of Micronesians has increased, and as that visibility within global Hawaii society is increasing, discrimination towards them is probably on the rise,” Seiji Yamada, an associate professor at the John A. Burns School of Medicine who has studied the issue, told Civil Beat.

Micronesians ‘Main Target’ of Discrimination

Yamada is the author of “Discrimination in Hawaii and the Health of Micronesians,” published in the of the Hawaii Journal of Public Health.

Yamada believes the discrimination is a challenge to the state’s aloha ethos.

In a longer, unpublished version of the article that Yamada provided to Civil Beat, he writes, “People who live in Hawaii often congratulate themselves for their post-racial attitudes — partly because of interracial mixing, and partly because non-whites are in the majority. Hawaii has discrimination, however, in the society at large as well as within the health-care system.”

Yamada argues that the main targets of discrimination in Hawaii today are Micronesians and Marshallese.

In the Hawaii Journal of Public Health article, Yamada explains that many Micronesian migrants take unskilled jobs in the islands because they lack education and English language skills, are exploited by recruiters “whose practices border on human trafficking” and are discriminated against by landlords in the tight housing market.

In health care, discrimination “takes the form of inferior care or denial of services,” says Yamada. “Micronesians often complain of impersonal, brusque treatment.”

Yamada’s research documents examples:

Health center physicians attempting to refer patients to hospitals are told, “We don’t take patients from your clinic.” Front desk staff have been overheard saying that Micronesians are given undesirable appointment times because “they’re not going to keep it anyway.” A medical student notes that many opine that “everybody is sick of caring for and wasting their taxes on these people that have no appreciation for what is being done for them, and fake their illnesses to stay in the hospital for free food and board.” The student was even told by an attending physician, “We shoulda just wiped the islands off the earth when we had the chance.”

The discriminatory attitudes are rationalized, Yamada argues, by the belief that Micronesian patients won’t follow medical advice. In fact, he explains, they may not follow the advice because it hasn’t been communicated through a language interpreter.

“For their part, some Micronesians harbor suspicions that they are being subjected to unnecessary procedures for the sake of physician profit or experimentation,” according to Yamada.

Though Few in Number, Complaints Rising

William Hoshijo, executive director of the Hawaii Civil Rights Commission, says less than 1 percent of discrimination complaints filed with his office over the past three years have come from COFA complainants.

“We have seen an increase in the number of complaints filed by Compact States migrants, but they are still an absolutely small number of complaints,” he says. “This reflects a disproportionately low number of complaints, given the population estimates of migrants from the Compact States in Hawaii, but does not necessarily mean that this group does not face discrimination in Hawaii at a rate higher than other groups.”

In fact, Hoshijo said the explanation for the low number of complaints “is likely more complex” and includes a variety of factors such as language barriers, lack of understanding of government agencies that deal with discrimination and a “lack of trust and skills required to pursue complaints.”

“Those who face discrimination on a regular, daily basis may tend to accept it as unremarkable, part of everyday life, rather than something to complain about and seek redress for,” Hoshijo told Civil Beat.

Based on anecdotal accounts, reporting and formals complaints, Hoshijo says, “I have no doubt that there is discrimination against migrants from the Compact States in Hawaii.”

Hoshijo continues:

You can see it in some of the insider-outsider rhetoric used to describe them as a drain on resources, particularly in health and human services. While much of that discussion is focused on the responsibility of the federal government and whether Hawaii is getting its fair share of funding to offset the impact of migration, there is also some pretty vitriolic rhetoric in the mix, not unlike that used to scapegoat other immigrants and minority groups.”

‘Administration Itself Discriminated’

It is Micronesians’ drain on government resources that has attracted the most public attention, and likely contributed to discrimination.

The issue came to a head in 2010 when the Lingle Administration took Micronesians off the rolls of Med-QUEST, Hawaii’s Medicaid program, because of budget constraints. That January, the governor called the strain on Hawaii’s program an to local taxpayers.

“The Hawaii State administration itself discriminated against Micronesians by purging them from Med-QUEST,” Yamada wrote in his journal article. They were placed in a program called Basic Health Hawaii, which Yamada argues was “severely inadequate.”

Lawyers for Equal Justice and two prominent law firms sued the state, and last December U.S. District Court Judge Michael Seabright — citing the Equal Protection clause of the 14th Amendment — ruled against the state. Med-QUEST for Micronesians was reinstated in January.

The Abercrombie administration is appealing the case, and the governor has called for more federal assistance on COFA. The governor also met with members of Oahu’s Micronesian community last week to inform them that the state was going to appeal “but has no intention to continue Basic Health Hawaii,” according to an administration spokeswoman.

Deja Ostrowski, an Americorp Advocate for Lawyers for Equal Justice, told Civil Beat, “The No. 1 thing I am concerned about is that I feel there is an underlying assumption of Micronesians as a leech on social services. And I find that very discouraging, because they are not eligible for any means-tested federal benefits like general-assistance welfare.”

Update The annual burden to the state for services for Micronesians in 2007 was calculated by the Department of the Attorney General to be about $100 million¹, which is about 10 times the amount reimbursed by the federal government. Last month, Hawaii’s congressional delegation urged the government to curb Micronesian immigration to Hawaii by setting up medical screening centers in Micronesia.

Yamada told Civil Beat that he found the letter from Hawaii’s congressional delegation “very disappointing — that there is a proposed mechanism for excluding people. I think it is rather parallel to anti-immigrant sentiment in other jurisdictions in other states.”

Need for Cultural Understanding

Ironically, the experiences of Micronesians are not unlike those of the immigrants who preceded them to the islands.

“We forget where we came from,” says Julia Estrella, a second-generation Okinawan who works with the nonprofit advocacy group Micronesians United. “I am concerned about the negative stereotyping because people do not personally meet Micronesians and understand their culture. It’s especially difficult for the first generation because of their limited English.”

Ostrowski, the Americorp advocate, agrees.

“Why single them out? Because they are the last immigrant group, the newest,” she says. “The historical trend is to marginalize these populations. It’s going to take some time for them to be integrated into the educational system and become reporters and elected officials. There are already people that could do that, but we are not hearing these voices. That is the critical thing — that if we don’t hear those voices representing the indigenous knowledge and contributions they are making in Hawaii, then it is easy to stigmatize them.”

Nia Aitaoto, the Hawaiian-Samoan-Yapese who feels discrimination when wearing a Micronesian skirt, has researched that stigma and its lasting negative effects.

“It’s more than racism, because you internalize it,” she says. “And that is dangerous and harmful. I am noticing this more and more and, with the economy being bad, when resources are limited you always try to pick on the weakest. Even within Pacific Islanders there is discrimination. People want someone to blame, so they blame Micronesians.”

Masae Kintaro of Palau, a frequent visitor to Honolulu to see her daughter, says she notices people treating her differently when she wears a Micronesian skirt, too.

“Even though I am from Palau, where we don’t wear these skirts — it’s worn by women from Chuuk and Pohnpei — when we put these clothes on and get on the bus, people look at me differently,” she says. “They don’t realize that women proudly wear these skirts because it is part of their identity. They look at you like they are saying, ‘There they are.’ This is very sad. This is supposed to be the Aloha State where a lot of people are immigrants.”

A woman from Chuuk whom Civil Beat granted anonymity because she was afraid of the possible negative impact of speaking out, shared with Civil Beat her experiences after living in Hawaii for over two decades:

I feel really bad, because I feel for the local people, the natives, and I feel bad that we come and take things. But at same time I feel sorry for our people. They don’t understand that we are hated because of this, that we come to Hawaii as America and that we have the right under the Compact of Free Association.

And we come because we are sick, like the Marshallese from nuclear testing. For me, I would say sick from chronic disease, and that could be the lifestyle change. I grew up eating USDA canned food — corn beef, Spam, rice. Rice — my generation got hooked on it. We went through four different colonial powers — the Spanish, which brought religion, the Germans, Japanese, Americans.

The Chuukese woman says there is a great need for language translators, especially in the schools, to serve as “bridges” between cultures.

One high-profile example of a bridge is the story of Mau Piailug, the master navigator from the Caroline Islands of the Federated States of Micronesia who was recruited by the Polynesian Voyaging Society to teach traditional navigation methods to the crew of the Hokulea.

Aitaoto and Kintaro say they believe greater awareness and understanding of Micronesians can dispel stereotypes. So does Seiji Yamada, the medical school professor.

“Certainly over time Micronesian people will become part of the fabric of society in Hawaii in the way historically every new immigrant group has eventually become integrated in society,” he told Civil Beat. “I think that is inevitable. But it does seem we are in a period of a sort of anti-immigrant, nativist sentiment.”

How to forsake those sentiments?

Yamada says a “recognition of commonalities amongst people will be useful or helpful in bringing such developments in the future,” something he believes is more hopeful in part thanks to “the positive step” of the Med-QUEST ruling. “It was a significant step toward inclusion within the rubric of humans who deserve human rights to health.”