Jacintha Betti kisses her daughter, Aidrielyann in their yard in Celina, Ohio, on September 9, 2021. Jacintha moved to the United States from the Republic of the Marshall Islands after falling in love with her boyfriend, Michael, while he and his dad visited the islands. Most people migrate to the U.S. from the Republic of the Marshall Islands for job opportunities.

Before the first atomic bomb was detonated on Bikini Atoll in the tiny nation of the Marshall Islands, and before areas of the islands were dubbed the “Pacific Proving Grounds” because of the U.S. military’s nuclear tests from 1946 to 1958, the islanders living on these atolls were told that they would be able to return home following the tests. They were not told how long the testing would last. And when “snow” danced down onto their tropical homes, it was days before they were told it was nuclear fallout. When their skin burned and their hair fell out from the radiation exposure, they were not informed that the U.S. government was monitoring their health conditions as an ongoing research study. The United States used their remote island nation, and them, to test one of the most destructive weapons ever invented. Repeatedly.

After 67 nuclear tests and 75 years later, American compensation programs for this period of nuclear testing have been instituted. Yet, those programs have not fully addressed all aspects of the issue such as the far-reaching effects and long-lasting nature of radiation. After signing the Compact of Free Association (COFA) with the United States in 1986, the Marshallese were promised Medicare and Medicaid access, which they could use to treat any ongoing health complications from the nuclear tests. They were also allowed to relocate to the United States with special non-resident status as compensation. However, access to these healthcare programs was stripped in 1996 by the Personal Responsibility and Work Opportunity Reconciliation Act. For the next 25 years, Marshalles

Shellyanne Aknilang holds Aidrielyann and Amari back from playing with her grandmother, Lorene's, oxygen tank. It is very important in Marshallese culture that one’s parents are well taken care of. In the Joash family, both aging parents Jay and Lorene are cared for by their children and other younger relatives. With Lorene dealing with a tumor and Jay recovering from a stroke he experienced in 2017, the return of Medicare has greatly improved both their wellbeing and their children's ability to help them get the care they need. Lorene finds herself hospitalized frequently, although she would prefer to be home.

Robinson Lee shows his Republic of the Marshall Islands passport on November 7, 2021. In his experience, few people in Ohio have immediately known about the Marshall Islands and the nation’s relationship with the U.S., resulting in rejected passports and other services being denied to him and others. "We are the children they neglected," he says of U.S. government assistance.

Birash Joash, left, talks with his mother, Lorene, before she is taken to the hospital. Lorene has had ongoing health issues since the early 2010's. It began with asthma, which she received treatments for, but progressed to the point where she passed out and slipped into a coma during a routine visit with her family in Arkansas. She was comatose for eight months. Then, they found a tumor in her lung. Many Marshallese community members attribute their experiences with cancer to the Cold War-era testing in the Republic of the Marshall Islands. Of her experience at the hospitals before Medicare was reinstated, Lorene said that, "they treat me, but not real good because I don't have any insurance." Lorene's daughter, Primrose, believes that the long period of time without Medicare has negatively impacted the health of many in the Marshallese community. "Some of them didn't even go to the hospital because they [were] like, "what [are] they gonna do, just put a Band-Aid on me ... and say 'go home'?"

Birash Joash looks away while Aidrielyann, Jacintha, and Michael Joash watch the ambulance take Lorene to the hospital from their home on October 20, 2021. At the time, they weren't sure if she would be admitted to the hospital for care, or simply returned in the morning. Lorene is only ever home for one to two weeks before she begins having trouble breathing and her family must again call an ambulance and see her go. Her daughter, Primrose, sent in Lorene's Medicare application as soon as she possibly could once their eligibility had been reinstated, and believes her care has been drastically improved since then.

Lorene's husband, Jay, waits for her to return home. Whenever Lorene is not in the hospital, one of her children will help her clean her tracheostomy, which allows access for an artificial breathing tube to be inserted directly through a hole in her neck, and take her medications. The treatment process for Jay has been different. In 2017, Jay still worked. He had a job that covered his healthcare and paid the family's bills. However, one day, at a family friend's birthday party, he had a stroke. He sat down at a table and when he next moved to stand up, the right side of his entire body felt all wrong. Because he couldn't work, Jay was laid off. When the insurance plan covered by his employer ran out, Jay hadn't yet fully recovered and was still dealing with mobility issues on the right side of his entire body. While he could afford it, he bought his own insurance from Cobra. Eventually, this ran out as well. He still hadn't healed.

Michael helps Jay out of the car after they drove an hour and a half to visit Lorene in Kindred Hospital in Dayton, Ohio. According to the Johns Hopkins Medicine Center, "After six months, improvements [from a stroke] are possible but will be much slower. Most stroke patients reach a relatively steady state at this point. For some, this means a full recovery. Others will have ongoing impairments." Since he has become eligible for Medicare once again, the family has had Jay on a waiting list to get an appointment with a local physical therapy center. He has been on this waiting list since the early summer of 2021. In December, he finally received an appointment. His sons, Michael and Birash, will be taking him to each session and will help him along his healing journey.

Michael poses for a portrait on September 18, 2021. "It's just me returning the favor," says Michael Joash, on caring for his aging father, Jay. "It's just our duties to return the care and love he has given us all these years."

Michael, center, hangs out with his brother, Isshi Joash, right, and his friend, Joseph Momita, left, after watching a volleyball tournament in Celina, Ohio. The responsibility of caring for older generations is big, and one commonly shouldered throughout the Marshallese community.

Mike Capelle works as an upper-level manager at Pratt Industries, where he works in sustainable packaging. He hasn't applied for Medicare because he makes more money and gets healthcare through his job. Pushing past qualifying brackets of Medicare can result in less money going towards families as they must also pay for taxes, housing, food, and more. When the determinations are made by a family’s yearly gross income, it can result in a family being left with little else they can afford after paying their Medicare dues each month. For this reason, many people will try to work jobs that provide health insurance so that they will have more disposable income and be more capable of affording things in other aspects of their lives.

Lydia Bolkheim, left, and Primrose Joash, center, discuss shipments for the Ralik Ratak Alele store, one of two Marshallese groceries in Celina, OH. Lydia often helps people translate their online Medicare applications out of the store, which she runs with her fiance, Robinson Lee. Robinson has been planning to apply for grant funding to provide more Medicare application assistance, but the Marshallese Coalition has recently been disbanded following the approval of Medicaid for the community. "I am just waiting for something that can help," he says. Lydia's mother's side of the family were living on Rongelap Atoll at the time of the largest nuclear detonation tested on Bikini Atoll, called "Castle Bravo." Regarded as the worst radiological disaster in U.S. history, this explosion carried nuclear fallout along the wind currents to Rongelap. Lydia, along with many of her family members, has dealt with cancer which she attributes to the tests. Because of restrictive Medicare availability, she has had to travel to other states for care in the past.

Mike Capelle gets ready for his shift, which starts at 11pm since he is covering for his coworker. Usually, he starts slightly earlier.

Robinson Lee cries after listening to the anthem of Bikini Atoll, the place that he and his family were forcibly removed from to make way for nuclear testing in the Pacific during the 1950s. "Most of my ancestors are gone now, or at least those who left Bikini and were promised they could go back," says Robinson, owner of the Ralik Ratak Alele store in Celina, Ohio. "The struggle that they went through, the hard times that they went through, the starvation that they went through ... Every time I hear [the Bikini Atoll anthem], it reminds me of those stories and the broken promises."

Mike Capelle and Liner Bolkheim talk about Liner’s hopes to go to college for a career in dermatology. Mike and other community members help younger students find their goals in life every week by going in and mentoring them, providing great role models from within the Marshallese community. He and the other mentors have found that this program is one of the best ways to help youth find what they really want to do in life so that they can earn a living. When these jobs provide healthcare, the individuals will be less beholden to the restrictive limits of Medicare.

After the Castle Bravo test at Bikini Atoll on March 1st, 1954, nuclear fallout settled like snowflakes, covering Rongelap Atoll. The locals thought it was snow until it burned their skin with just a touch. According to the National Cancer Institute, a projected "55% of all cancers [on Rongelap] might be attributed to fallout exposure." Since Medicare and Medicaid have been reinstated to the COFA agreement, the Marshallese community experiences a much easier time accessing healthcare — though it will take time to recover from the 25-year period in which they were left without.