The EthnoMed Podcast

Provider Pulse Ep. 20: Crossing Oceans, Building Trust: Franky Erra and the Marshallese Community

• Dr. Duncan Reid, MD @ EthnoMed.org • Season 1 • Episode 20

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Franky Erra grew up on Majuro, the capital of the Marshall Islands—an archipelago shaped by ocean, community, and a deep history of resilience. In this episode, Franky traces his path from a close-knit childhood surrounded by family and coral lagoons to his current role as a Disease Research and Intervention Specialist with Public Health – Seattle & King County TB Program.

Through his story, we explore the Marshallese experience in America—from the legacy of U.S. nuclear testing and migration under the Compact of Free Association (COFA), to the challenges of navigating education, language, and healthcare systems far from home.

Franky reflects on the cultural bonds that sustain Marshallese identity, the mistrust that shapes health access, and his work building trust through tuberculosis outreach and community engagement.

Visit EthnoMed.org for additional resources. Follow us on YouTube and Instagram @EthnoMedUW

Franky Provider Pulse Episode 20: Recorded 25_10_01

Franky: [00:00:00] The world outside honestly , to me, didn't exist. it was just home.

I wanted to get out. I just wanted to leave to, to see what's outside the Marshall Islands. I think at that point, I had wanted to do something different.

 I wish I, talked more to folks that had careers, and just ask questions and see what a day-to-day, in those different roles would look like. 

Duncan: You're listening to the Provider Pulse series from the EthnoMed podcast. My name is Dr. Duncan Reid, a primary care physician in Harborview's International Medicine Clinic, and Medical Director of EthnoMed. Today's guest is Franky Erra, a disease research and intervention specialist with public health Seattle and King County.

Franky grew up on Majuro, the capital of the Marshall Islands, a chain of 29 coral atolls and five main islands scattered across the Pacific Ocean between Hawaii and Guam. From childhood In a tight-knit island community to his journey across the United States, from Indiana to Washington state, Franky's story traces the path of many [00:01:00] Marshallese migrants,  his search for opportunity, connection, and access to healthcare.

In this episode, Franky reflects on his childhood in the islands his path through education and the sense of purpose he's found in tuberculosis prevention work.

 

Duncan: Can you say the islands in the archipelago that you can remember? 

Franky: Jaluit, Ailinglaplap Jabat Namo Lib 

That's just one chain in the two chains of the Marshall Islands.

Duncan: Can you introduce yourself?

Franky: My name is Franky Erra. I'm originally from the Marshall Islands. I grew up on Majuro.

Duncan: And what do you do now?

Franky: I'm a disease research and intervention specialist with the TB program at Public Health in Seattle and King County. A lot of what I do is, outreach and community engagement. really with working with different community leaders and community representatives doing outreach and education.

Duncan: How long have you been in that role?

Franky: five years. As A disease research intervention specialist, . But [00:02:00] my job duties have been changing over time.

Duncan: What's a day look like for you right now?

Franky: Going out to a community, presenting a PowerPoint, talking about tuberculosis, encouraging people like, Hey, think about TB next time you go see your doctor and they're like, oh, I don't normally go see my doctor.

Honestly, I don't even have a doctor.

Duncan: What communities are you going to?

Franky: I do a lot of work in the Somali community. definitely the Marshallese community, Afghan, Ethiopian. 

Duncan: Can you take us back? So where were you born?

Franky: I was born in Maui, Hawaii. lived there for about four or five years . Then after that our family moved back to the Marshall Islands.

Duncan: And your parents are originally from the Marshall Islands?

Franky: Yep. Both parents originally from the Marshall Islands.

Duncan: You know why they were living in Maui?

Franky: They were there for school, a job corps program. , They were there for education. And then they had me and my younger brother,

Duncan: And then you said you're second born out of, there's five boys,

Franky: five boys. Yeah.

Duncan: your sec, and then you moved there when you were, and you moved back to the Marshall Islands. So it sounds like all your formative years are in the Marshall Islands.

Franky: Yes.

Duncan: Where did you go to school?

Franky: I went to this private school, , assumption Schools. It's a Catholic school. So I was there, kindergarten, middle school, high school. It's all in the same school. [00:03:00] Very small classrooms. About 20 students each classroom. In school, you don't switch classes. You stay in the same classroom. It's the teachers that, rotate.

Duncan: Here is a brief historical interlude about the Marshall Islands.

 The Marshall Islands are home to about 37,000 people and stretch across two parallel chains of coral atolls. Ratak the sunrise chain, , and Ralik the sunset chain, though small and land area, these islands span an ocean territory nearly the size of Mexico.

The original inhabitants came from the Solomon Islands with evidence of habitation on Bikini Atoll as early as 1200 BCE. The Spanish first visited the Marshall Islands in 1526, though there was not a sustained European presence until the 19th century when German trading firms dominated local trade of copra, the dried meat of coconuts. At the outbreak of World War I, Japan invaded and occupied the German held Marshall Islands in 1914. These were fortified during World War II until the US captured them in 1944.

After the war, the United States administered the [00:04:00] islands under the trust territory of the Pacific Islands. Between 1946 and 1958, the US conducted 67 nuclear tests on Bikini and Rongelap atolls, including Castle Bravo, a hydrogen bomb a thousand times more powerful than the nuclear bomb used in Hiroshima. Entire communities were displaced. Generations have lived with elevated rates of thyroid disease and cancer. In 1986, the Marshall Islands became self-governing under the compact of Free Association or COFA, allowing citizens to live and work freely in the US while the US retained defense rights and provided economic aid.

 Marshallese are allowed to live, work, and study in the United States indefinitely without a visa and are considered non-immigrants. Marshallese in the US were no longer eligible for Medicaid starting in 1996. Though access was restored in 2020. Medicaid benefits are now set to expire again in 2025. Now let's get back to our interview with Franky.

Franky: When I talk to people [00:05:00] when I try to explain where the Marshall Islands is, I sometimes say between Hawaiian and Guam. I grew up on Majuro, which is the capital of the Marshall Islands.

Duncan: And what is it like? because I've seen photos of it? And that's the most populated island,

Franky: It is. Um, yeah. But

Duncan: One of the highest populations. Do you feel it when you're there.

Franky: I don't, growing up it felt big to me, the island. I had a really nice childhood. I had fun. I remember playing basketball outside a lot on unpaved grounds in slippers. Definitely activities in the water the lagoon in the ocean. Swimming mostly. some fishing, some digging for clams. I would say I had a really fun childhood.

Duncan: So a lot of nature just right out the door.

Franky: A lot of nature stuff. Yeah.

Duncan: And all the other kids you're playing with, they're all Marshallese. They're all from the same area

Franky: Oh yeah.

Duncan: and, and the community's pretty tight as well.

Franky: I would say, um, we,  we, Marshallese, we're a very close knit community. Everybody kind of knows each other.

Duncan: So it was like really sounds like a great place to grow up. Weather is great.

Franky: Oh yeah, definitely. I think so. Yeah.

Duncan: And what is it like if you're walking around your neighborhood there? What do the houses look like?

Franky: When I think about it, it's a lot of homes built out of plywood, tin roofs. When I really think about it, it's all densely when packed. Homes right next to each other. Some might even share. A wall. It's really densely packed. but I never thought of that as like a bad thing.

It just felt very close, very community [00:06:00] oriented,

Duncan: And you're walking around everywhere

Franky: just walking around, seeing people day to day. It's a regular thing to see everybody, casually.

Duncan: and how long to walk to the beach.

Franky: Oh, not long. It's right there. I think you can see both sides of the water, the lagoon side on the ocean side a lot of times. 

Duncan: And how was school growing up?

Franky: It was fun. I'm trying to think. I can't really think about anything other than it was fun. 

Duncan: And what language was it in?

Franky: All the classes, all the courses, were taught in Marshallese, it was very beneficial for a lot of us. 'cause we primarily speak Marshallese. English was also, a subject that was offered, but Most classes were, in Marshallese.

As you grow up, like the older classes, middle school, high school, there are some folks from different islands, Pacific Islands like Fiji or Papua New Guinea, they're there to teach science, math.

Duncan: And are they teaching in English then?

Franky: They are teaching in English. Some of them pick up the language really quick though, so they try to speak in Marshallese.

Duncan: And would you say you were pretty bilingual growing up?

Franky: I think so, yeah. I think, having that early exposure to the English language in Hawaii helped me be [00:07:00] bilingual.

Duncan: And what was your sense of your place in the world growing up on the Marshall Islands, you're going through elementary school and middle school, right? You have a map probably in your classroom of where you are

Franky: The world outside honestly , to me, didn't exist. it was just home.

Duncan: What are the closest places? Guam, Hawaii.

Franky: Hawaii, Hawaii would be the the closest thing I would think

Duncan: And that's kind of on your radar? Yeah. And that's a place that's, I mean, what is it? Thousands of miles away.

Franky: Yeah.

Duncan: So does it feel like a world away when you're thinking about it as a kid?

Franky: I don't know. Growing up, it's not rare for Marshallese to go back and forth to Hawaii especially, um, you know, uh, I dunno if I should be saying this, but a lot of us go there to give birth for healthcare reasons, right? There's some things that are not available back home that's more available in Hawaii.

Duncan: And when you were growing up, was there a concept that Hawaii was part of the United States, or you think of it just as Hawaii?

Franky: Honestly, no, we didn't. I would just say it's Hawaii, and then everywhere else was considered the mainland. So it's Hawaii and then the mainland.

Duncan: Hawaii, the mainland, and then you're in the

Franky: I'm just Washington. Yeah.

Duncan: and there was that compact of free association. When was independence gained for the Marshall Islands? Before you were born. Probably.

Franky: Yeah, I should know this.

Duncan: But was there a concept? There has [00:08:00] been this close relationship with the U.S. When you were growing up, did you feel like you were part of the US or did you feel American at all?

Franky: Never, yeah.

Duncan: And you technically are American because you were born

Franky: I am in

Duncan: in in Hawaii, but your identity was fully Marshallese 

Franky: Yeah. 

Duncan: and your feeling was in the Marshalls. No one has this affinity to the US particularly.

Franky: Mm-hmm. That's correct. Yeah.

Duncan: So you're going to school, you're going to this like elite private school in the neighborhood,  and you say you're a pretty good student.

What were your interests? Do you remember what you were thinking about doing .

Franky: Different things. I think at one point I wanted to be a pilot. I wanted to be an architect. and I think those were just things that I would see on tv. Looking back, I don't think a lot of us had any real exposure to what's out there or what's available or any opportunities. Which I think could be a big reason why, I didn't know what I wanted to be, growing up.

Duncan: In terms of opportunities, employment what are the main things that are in the Marshalls?

Franky: I can't think of many. Honestly, I think a lot of the workforce is, like government workers. 

Duncan: So there wasn't a lot of modeling for [00:09:00] these other professions, so you just picked it up in media or something. Sounds like the teachers are quite good, but then there's not real world exposure to any of these jobs.

And then you were going through high school. What were you interested in High school.

Franky: I wanted to be a mechanic. My grandfather, he owned a garage growing up. There's a lot of cars, people were bringing in their cars in, so that was his, business, just fixing cars. My uncles, that's how they learned. They never went to like official education to learn how to fix cars that were just learning through my grandpa.

So I think I wanted to be, a mechanic, but then. I don't know. I lost interest.

Duncan: So you were finishing up school and then what was your plan after graduating

Franky: I wanted to get out. I just wanted to leave to see what's outside the Marshall Islands. I think at that point, I had wanted to do something different, so I wanted to leave. My parents were like, if you don't find a school, after high school, you're gonna stay here.

You're not doing anything right. So I just googled, college mainland. First thing that showed up was Indiana, Fort Wayne, Indiana. I like, okay, I'm gonna apply. I got in and I was there for a couple years, [00:10:00] I dropped out. I think there was a big language barrier at that time.

I never realized, that there's also cultural differences and it was a big change for me. So I dropped out, moved back to the Marshall Islands.

Duncan: Did you apply anywhere else? or just to Fort Wayne,

Franky: Just Fort Wayne, Indiana.

Yeah, there was no real like research, you like what I wanna do and school.

Duncan: Did you have any idea what Indiana was or where it was?

Franky: No.

Duncan: So you had no idea what you're getting yourself into?

Franky: Nope. I just knew, that's where the pacers are. Indiana Pacers. Yeah. But that's it.

Duncan: And did you have any idea what you wanted to study?

Franky: I was enrolled in mechanical engineering.

Duncan: Oh wow. and what school was this?

Franky: Indiana Tech.

Duncan: And how did it work financially? Did they give you a scholarship or

Franky: Yeah. I was lucky enough to get scholarship from back home. I did pretty well in school, back home. I graduated second in my class. I just, you know,

Duncan: you found this place. You've got a full ride

Franky: pretty much, 

Duncan: You flew out there. Was it going, this is your first time to the mainland?

Franky: It wasn't my first time

Duncan: No. You've been to the mainland 

Franky: Yeah, [00:11:00] Arkansas for like family.

Duncan: and can you tell, can you tell listeners why Arkansas?

Franky: Why Arkansas? Uh, jobs. Yeah. There's, um, I had family there. They moved there ' cause of jobs, opportunities. Um, so, um, I don't know. There was family over there. I wanted to travel outside the Marshall Islands and Arkansas was where family was at.

Duncan: And it's the largest population of Marshallese on the mainland

Franky: It is,

Duncan: is in Arkansas. And how was that experience in Arkansas?

Franky: I liked it. honestly, So when I was in , Indiana for a year I didn't see any Marshallese at all. Or any Pacific Islander. It was a big change for me. So when I went one of those summers to Arkansas. I was like, whoa, look at Marshallese. Whoa, Marshallese.

There's a lot of Marshallese here in Arkansas. Never knew

Duncan: Did, Arkansas feel completely different than the Marshall Islands?

Franky: it did. but it also felt pretty similar. cause you see a lot of folks casually, like Pacific Islanders or Marshallese.

Duncan: And then when you went to Indiana, so it wasn't your first time on the mainland, but it's your first time in Indiana and you go there for school. How was that showing up to Indiana?

Franky: I thought it was cold. , I think when I went, it was August, September, it was freezing. I don't know. To me it was cold. [00:12:00] Coming from somewhere that's really warm. Folks wearing shorts, they were wearing tank tops. I'm like, oh, the weather is very cold. Everything was big.

Buildings were big. I'm like, I've never seen buildings like this. I think the school was pretty diverse which was pretty cool, but not diverse enough where there was Pacific Islanders on campus.

Duncan: How was it academically, socially?

Franky: Academically, I think I did well, in the first year with pre-reqs, but you know. As I took on more classes, I was kind of struggling. I think a lot of it was language barriers, I kind of understood what each word meant in English, but you know, when you put 'em all together and like talk, I don't know, I don't get context a lot.

I never did. So I think that was like one of the big challenges for me going straight to, college.

Duncan: And you're taking engineering, which is a very rigorous course as well. And then, so how was that feeling?  Did you have friends and a support group there?

Franky: I did, yeah, I was lucky enough to make friends over there in Indiana. I tried to work part-time to get some money. So a lot of my friends were folks that were also working, in the school cafeteria. And of course my roommate.

Duncan: And these friends, were they immigrants too from different [00:13:00] places?

Franky: No. I would say they're like from New York, Detroit. so different than what I'm

Duncan: Was that your introduction to American culture

Franky: I would say. So, yeah,

Duncan: and how was it? Was it what you thought it was?

Franky: I honestly don't know what I thought it was. Um, I don't know what to expect, going to the mainland, but I would say I. I had really great friends. I made really great friends.

Duncan: And then things got tricky academically. It sounds like you said language was already an issue, so how did things play out?

Franky: I just dropped out, moved to Maui, back to Hawaii.

Duncan: What was your thinking during that? It was just not working 

Franky: I was thinking I'll just do this at a different school, like get all these pre-reqs done. It might be cheaper. I'll be less homesick 'cause I'll be with family. so I did that for about a year. And then even then I just lost focus, moved back home the Marshall Islands.

Duncan: So you had all this drive to leave the Marshalls,

Franky: Yeah, an opportunity.

Duncan: Yeah. Then it was you were encountering these challenges and it was just a lot of things going on. And then the homesickness that you're referring to too, 'cause you're just, I mean, Indiana is a different planet, right? The Midwest, and then you try to make it work and you came home. 

How did it feel going back home?

Franky: I was embarrassed. I was given so much opportunities, to be [00:14:00] successful. And, you know, it just didn't happen for me.

Duncan: So how are you dealing with that then?

Franky: I was lucky somebody had given me a job, to do environmental work conservation. So a lot of it was coordination and implementation of projects. So I think that motivated me again. Like, I can still do this, I can still do something.

One of the projects was for food security. We were trying to plant more breadfruit. It was a big source of food, but also a source of income for a lot of the islands. All the small atolls in the Marshall Islands.

So the project was planting a lot of breadfruits, getting support from the college. How to make sure that what you plant grows.

I wouldn't say there's a lot of opportunities for jobs for a lot of folks. So I think for a lot of folks outside of Majuro, income depends on the vegetation, right? So it's bread fruit, a lot of coconuts.

Right? and then a year into that, I had to move. 

Duncan: Why? 

Franky: for medical reasons. There were things available here in Washington, services that are not available back home.

Duncan: so it was a pretty quick turnaround. You were in college, kind of struggling with I think a lot of. Listeners can relate to what you're going through. It's tough even if your family's right next door, let alone like you're going to a different country to do these things. The conservation job gave you a sense of like structure gave you some meaning.

What were you, do you recall what you were doing there at all for those projects?

So how did you end up deciding to move to Washington?

Franky: Family. Yeah. [00:15:00] Had some, family here in Washington. So that was really the only reason why.

Duncan: And did you end up moving here with family too at that time? So you had your own family

Franky: had my own family living here.

Duncan: So where did you arrive to? Did you go to Seattle or where did you end up living?

Franky: Auburn. Yeah, it was a big change for me, honestly, still. Even though I'd been here, I've been to the mainland before. I think , the major adjustment for me was just being away from friends and family. I was lucky that I was able to find that connection, feel that connection to home through a small church community in Auburn.

So it was really just being around them that I was able to find that connection.

Duncan: And church did it play a big role for you when you were growing up?

Franky: Yeah it's big. Like, church every Sunday, it's a thing. Right?

I went to a Catholic church. I have friends or family that go to other, churches. 

Duncan: And the church you found in, in Auburn was at a Catholic church as well,

Franky: It was in a Catholic church. Uh, it's a Christian Church definitely, but it wasn't a Catholic church.

Duncan: but it was familiar

Franky: was familiar to me. Yeah.

Duncan: So then what were you doing for work then? What were your plans or what were you thinking?

Franky: I don't know. moved here. I had family that were helping me find a job. I started off going through [00:16:00] these job agencies

One of my family members took me there. The agency placed me at a warehouse building exhibits for conventions. So I did it for about a year.

And then somebody that was doing like the CADing and the designing of these booths for these conventions was leaving. And one of the other designers was curious if I, that's something that I'd want to do. And I was like, yeah, teach me how to CAD, teach me how to design.

 

Duncan: Cadding, is that just computer aided design? Is that what it refers to? Yeah.

Franky: Yeah. So I was lucky, this person would stay a couple hours after work teaching me CAD design. A few months they opened up the position and I, got the role.

Duncan: So they invested all this time into you to do that. 

Franky: Yes. 

Duncan: Do you have an idea why they did that?

Franky: I'm not sure. I think they were just, they liked me. they wanted me to be successful, I guess, to grow, 

Duncan: Were they in your community too, or they, no, not even. But you're a social guy though.

Franky: I think so. Yeah. Yeah. For them to do that, I think maybe,

Duncan: But they invested a lot in, and then you gained [00:17:00] this really tangible skill and, , and then you got the job.

Franky: I got the job and then 2020 hit,

Duncan: Oh wow.

Franky: nobody was doing conventions anymore.

Duncan: Oh geez. So you were just getting set up for something that you were trained for. So then what happened?

Franky: yeah we got laid off. It started really slow, actually. We started doing stuff at home and then when they found out that people are not doing conventions anymore. I was laid off.

Duncan: And then what happened?

Franky: So I was unemployed for a few months. There was stuff going on in the community, like COVID related work. So they were looking for volunteers to distribute food, PPEs. So I kind of. fill my time volunteering and it was through that then one of the, directors with the, nonprofit that I was helping out with they knew that public health was hiring for contact tracers.

And they were looking for Pacific Islander to fill that contact tracing role. So the director was like, Hey, go for this and see if, you'll get hired. And I started working in public health as a contact tracer in 2020 or 2021.

Duncan: We heard a lot about contact tracing. It was all the rage during that time, What were you actually doing?

Franky: Calling people. [00:18:00] It felt like a call center. Just calls every day people calling in. And it's, people that were with COVID and, they were looking for assistance like food, information. Like what do I do? I got COVID. Am I supposed to isolate for how long?

So it's sharing that information getting them the resources, placing grocery orders, finding testing locations for them, scheduling appointments for testing for their household members. Calling contacts, all these folks that were, in contact with them, Collecting that information. who were you around last week? Uh, it's my cousin and them, them, here are their numbers.

Duncan: And how were people doing? Were people scared when they're calling into you?

Franky: Yes, there were a lot of folks that were scared. I remember calling contacts or people that were exposed. I remember them picking up my calls and were just skeptical, like, who, why are you calling me? And I'm like, oh somebody told me you were exposed to them. Or if it's somebody that's sick, we also get a list of everybody that's been sick with COVID.

So we call them, share education, share information and connect them to resources. So a lot of calls where folks like saying, why are you calling me? 'cause we're saying, are you this [00:19:00] person? You know, you're on this list you got COVID, can you confirm your date of birth?

'cause we gotta make sure it's you to share more information. They're like, what? I'm not gonna share my birthday with you. That's weird.

Duncan: And these were people from all communities, is that right? They weren't just specifically

pacific Islander. And how was this job? How was it feeling? 'cause this was an uncertain time, I think, for everyone. Did you feel like you were a part of helping people out?

Franky: I did. Yeah. You know, sharing that information, there was a lot of questions from community and a lot of folks were looking for resources. It was so early on that a lot of folks were looking for isolation spaces. So even that was connecting them to hotels, for them to isolate.

It was a scary time pretty overwhelming. Getting all those calls, it's almost every minute.

Duncan: And how about with your colleagues? Did you feel a sense of solidarity working in this field with them.

Franky: Yeah. Hearing their experiences as well. I think a lot of us were burnt out doing contact tracing.

Duncan: What was burning you out the most?

Franky: I think hearing people's experiences like them being scared, you know, what am I gonna do? I'm scared. I got [00:20:00] COVID. How is my family, how are they gonna be now that I'm sick with COVID? it's just hearing a lot of those experiences.

Duncan: So it sounds like you're hearing a cross section of the Seattle area, and you're just hearing from normal people and you're actually getting the clearest picture of what the real issues are and how this virus is affecting people. That's a lot. And you're not necessarily able to help everyone.

Franky: Yeah.

Duncan: So as this pandemic progressed vaccine came out. People are feeling a little bit better about things. What were you thinking? 

Franky: I'm gonna lose my job. It looks like things are getting better, things are getting more stable. I might lose my job pretty soon. I don't know what I'm gonna do. I went to the county website and started searching for similar roles and luckily, TB was there.

They were looking for somebody to help out with a TB project that was specific to the Marshallese community. And I was like, whoa, I'm Marshallese and what's going on with TB and the Marshallese community? Okay. And, that's where it all started.

Duncan: Were you aware of, tuberculosis or latent TB growing up in the Marshall Islands

Franky: No. Tb. I mean TB, [00:21:00] yes. It was definitely a thing, you know, everybody kind of knew about TB, latent TB. No. I just never realized how, impacted we are with TB.

Duncan: And just for the quick stats, I think in the us what is the rate of tb? It's like 2.5 cases per a hundred thousand. And I think in the Marshalls it's something close to 500.

Franky: hundreds. The hundreds. Yeah. Yeah. That's insane.

Duncan: Here's some brief background about tuberculosis or TB. TB is an infectious disease caused by mycobacterium tuberculosis, a bacterium that most often affects the lungs. Most people who are exposed to the TB bacterium don't become sick right away.

Instead, the bacteria can remain in a latent state in the body in what's called latent TB infection, or LTBI. People with latent TB don't have symptoms and can't spread the disease, but there's always a risk that the infection can reactivate, especially in those with weakened immune systems, Public health programs in the U.S., like the one Franky works in focus on screening and treating latent TB [00:22:00] before it becomes active. Globally, it's estimated that about one quarter of the world's population has latent TB infection, and the case rates we mentioned earlier, around 500 per 100,000 people in the Marshall Islands refer to active TB cases, not latent infection.

 And did you ever know anyone with active TB when you were back home?

Franky: Probably. you know, nobody really said anything, and I don't think there's much stigma back home for TB. If you do have TB, they're like, oh, you know. That guy has TB. He's getting treated, but that's it. Nobody's like hiding it. I think it's kind of hard to hide it. Really?

Duncan: 'cause everyone's so close there.

Franky: Yeah.

Duncan: So then you signed up for this thing and you're like, oh, this is something I've heard about, but haven't really thought about that deeply. And the reason it was a big issue here is because a lot of the active TB cases, at least in that time, were in the Marshallese community in Washington state.

So how was that experience? So you signed up for the job. You got it.

Franky: I got it. Honestly, for me I was happy 'cause it meant connecting [00:23:00] again, with my community. When I was working In the warehouse with the booth designing. I was pretty, isolated from the Marshallese community, even though there was church. But that was the only thing. I still felt like I was pretty isolated.

So when I had that opportunity to do work in the Marshallese community, I was kind of happy to start doing work, helping folks. I felt like I was doing something meaningful.

Duncan: What were you doing as part of this job? Has it evolved over time .

Franky: Yeah, so when I first started, I was, hired to help with targeted testing. So we're trying to figure out how can we get testing services to our Marshallese community? How can we help them think about TB testing? I think one of the main, places where we got people tested was with, the nonprofit the Pacific Islander Community Association that helped me find a role in public health.

So we were working with them doing testing on site. I was there drawing blood.

Duncan: So you're doing blood draws, you're doing the QuantiFERON

Franky: that's doing Qft. Yes.

Duncan: and where was this at? Community centers or,

Franky: it was in their office. In FedErral way.

Duncan: And how are you getting people in?

Franky: There was another Marshallese that was working there, and they knew people in the community. So they were calling folks, Hey, we're doing this, every month or every other week, offering rental assistance, and other health screenings.

So [00:24:00] you should definitely come and do this.

And 

Duncan: people did they have a good sense of what they were getting tested for 

Franky: They did. I tried, I tried my best to, to educate them like, we're doing this for TB.

Duncan: But this was all new for them, right? This whole latent TB question.

Franky: Yes. sleeping TB, like, oh, didn't know

Duncan: And then how was it going? So some people tested positive. Were you the one that had to tell them?

Franky: I was the one, had to tell them. I would say a lot of folks that tested positive, they were interested in, receiving treatment.

Duncan: Most of that treatment then was, is it Rifampin?

Franky: I feel like it was that, or three hp,

Duncan: So it was like three or four months.

Franky: Three or four months. Mm-hmm.

Duncan: So how was this whole experience then you feel like you're working with your community? Sounds like people are responding pretty positively to this to outreach.

Franky: Mm-hmm. I felt like I was doing something meaningful, helping, folks from my community.

Duncan: And then where did things evolve into the work that you're doing now?

Franky: I hear that the program has been talking about expanding and doing more community-based work, doing more education, really giving more focus to TB infection other [00:25:00] than just, treating or offering services to contacts. You know, we'd like to engage community members and, raise awareness and help them think about TB.

Duncan: And what form does that community engagement take out here ? Are you presenting to them? Is it mainly at churches or their community events?

Franky: It is different. It's been evolving over time. So when we first created this new unit to do more TB infection focused efforts or activities, we started working with these group of community navigators that were already doing community related engagements because of COVID.

So there were already trusted messengers. They were in communities talking about the COVID vaccine, COVID testing. We approached them and ask if they'd like to do something similar with tuberculosis. And engagement has just been evolving over time.

We look to them for how we should be doing outreach in these different communities. So it's either at community events, it's at churches, it's at residential areas, right? So we're in lobby sometimes doing presentations on a PowerPoint. In these local businesses,

So like coffee shop just meeting up with people and saying, Hey, [00:26:00] TB's a thing. Think about it.

Duncan: So this Community Navigator program, it's a part of, king County Public Health.

Franky: Yes, it's, a program within King County Public Health originally established to do similar work, but with COVID.

Duncan: community outreach, helping navigation and facilitation. And I think if I recall correctly, you have like an Arabic speaker, someone in the Kenyan community,

Franky: Oh yeah,. Many. We got a few

congolese community,

spanish speaking. Somebody from the Filipino community.

Samoan, Vietnamese. 

Duncan: So a lot of the communities that have some of the highest prevalence of LTBI. So then you were working with them. And when you were working with these community navigators, did you feel like some kinship with them even though they're from different communities? Yes.

Franky: I Think it was easy for me to be in those spaces ' cause of them. And I feel lucky that, they opened up. I feel like they opened up to me. they shared a lot of experiences that community members would have or did have with TB talked a lot about their culture back home, which was really great.

Honestly, just hearing their stories about back home, their culture, [00:27:00] food got to taste a lot of their food. Some say it's the cheapest way to travel. Right? Just talking stories with people and just hearing all these different things that they've been going through. 

Duncan: And in a way, did it remind you of your own origin stories

A little 

Franky: did, yeah. Yeah. I think a lot of times when the navigators, these community leaders are sharing a little bit about back home and I'm, also sharing like, oh, we kind of did something like that too. I kind of experienced something very similar back home.

Duncan: And being from the Marshalls, how does that influence the way you interract with communities in general not just your own community? 

Franky: I think I'm open to learning. I'm curious I just try to ask a lot of questions. I try to practice a lot of empathy, as someone that's immigrated from outside the us.

Duncan: What do Americans know about the Marshall Islands from your experience on a day-to-day basis. Say they're hanging out with Franky and then they find out you're from the Marshalls.

Franky: Nothing, honestly, which is really sad. Given the, strong history, the nuclear history, that we have with, with the U.S.

Duncan: So you would say with an average American that you're meeting

Franky: Nothing. Nothing. Uh, where is that? I think that's one of the main responses I get. [00:28:00] Where is the Marshall Islands

Duncan: And what do you tell them or what, information do you provide to them

Franky: Not much really, other than it's just a little bit past Hawaii. Keep traveling south.

Duncan: and do you find some people are interested in learning more or is that usually enough?

Franky: I do encounter some folks where they, just wanna learn more. Like, what's it like over there?

Duncan: And And what do you tell them?

Franky: I don't bring up the nuclear legacy, honestly, I just tell it's a great place. The water is warm, the beaches are clean. The people are very nice.

Duncan: Did you learn about that nuclear legacy when you were in school?

Franky: A little bit. I think there were opportunities for us to learn more about the legacy.

Duncan: So you knew a little bit about it, but not too much of the details About, what was it? There was two initial hydrogen bombs that were tested in bikini, I 

Franky: think that. All that information is available, but I still think that there's still an opportunity for us to learn more about the specifics. Like have that be a regular thing in classrooms. Right.

Duncan: You know, and I appreciate you introducing me to that history, because when we talk to [00:29:00] providers at Harborview about it, we ask who's taking care of a Marshallese person? Everyone raises their hand.

Franky: Hmm.

Duncan: And then I ask them, what do you know about the Marshallese people?

And most people know they speak Marshallese. And then there's a few people usually from the older generations that know the nuclear history. But even with doctors that are taking care of these patients, nothing. So we've made it like the staple. I know that you had to sit through a lot of those talks.

Franky: Mm.

Duncan: I know I'm really appreciative of you opening my eyes to that story. And I think it's so important. I think that story is emblematic of the lack of curiosity and the lack of knowledge that Americans have. Not just about the Marshall Islands, but about every group of immigrants that they encounter.

And then the other additional point is that ignorance actually has consequences. Very practical consequences as a physician. I really appreciate, your openness and your kindness, easing us into understanding that history. Because I think it's so profoundly important.

Franky: Right. Yeah. 'cause it, it can show why there's mistrust, right? It's not that [00:30:00] we just don't care. I think a lot of times our community members are missing appointments. I don't know. It's just, I don't think it's, that we don't care about what's going on.

It's that mistrust plays a big part

Duncan: And how is the community doing now? Would you say?

Franky: I still think. there's a lot of opportunities for us to think about health, to think about all these other things. For a lot of us, we've moved here. You know, we're, working now, we're receiving paychecks, right? But there's still a lot of opportunity for us to be in a better place.

Duncan: What is your identity now? Now that you've been living out here for a while, but you've spent your really formative years in the Marshall Islands,

Are you still a Marshallese guy

Franky: I still see myself as a Marshallese guy. Yeah. Yeah. I don't think I've ever claimed to be American Marshallese. I think I would still say I'm Marshallese.

Duncan: And what do you think for a lot of the community members that were at least born there, do they still feel like that Marshallese identity is the main identity they have?

Franky: Yes.

Duncan: How does that interract with just living in America? 'cause there's such a complicated history between the two countries.

Does that come out or is this just this very complex web of feelings that is inexpressible?

Franky: I, I don't know. No.

Duncan: Um,

Franky: I.

Duncan: I think I've harassed you enough, but it sounds like you're doing. Work that is meaningful to you? It sounds like this project has some longevity to it as well. I know that things got kind of put into upheaval during the COVID years, but it sounded like in, in a way, it was an opportunity for a lot of this community engagement that might not have happened otherwise. Um, what questions do you have for us or for me?

Franky: I don't know. I can't think of anything right now.

Duncan: What advice would you have to a young guy that's just like a young Franky in Majuro right now, who's 16 or 17, who's thinking about becoming a [00:31:00] mechanic? Saw on television that you can be an architect or, these things, seeing the path that you've gone through so far. What would you say to that kid?

Franky: I would say don't rush. I think I was rushing to leave and it was just wherever I ended up, you know, I wish I had done more research and, you know, be intentional about what I wanted to do. Right. I wish I had the exposure, like, what's out there, what opportunities are available for me?

 yeah, I wish I, talked more to folks that had careers, and just ask questions and see what a day-to-day, in those different roles would look like. Yeah. I just wish I approached folks that were actually in careers and try to gain, more exposure.

Duncan: How about the Marshallese youth here? It sounds like there might be an opportunity to have some mentorship or to reach out to them and get them exposure to the various different professions and what it takes to go into them.

Franky: Yeah. honestly, I think a lot of the youth here are not exposed enough to know what's out there. We still stay in these communities, in our circles, and I think it'd be the same message, right? Go out there try to gain some exposure, talk to people and I don't know [00:32:00] how, but just try to gain these exposure.

See, see what's out there.

Duncan: I wonder if there's a way that we can even just go interract with some of the young people in those communities though too,

Franky: Right. And I guess that could be the question, right? How can the youth get exposure, like it's available. what does being a physician look like?

Duncan: I'd be really interested in working with you on that. There was a radiologist that was here. His parents were refugees from Vietnam He's very dedicated to going out to middle schools and high schools and just meeting kids and just telling them about what he does and starting to think about the things you need to do in school to get there.

You can listen to our interview with Dr. Ethan Hua on Provider Pulse's, episode 15.

So I think if there is an interest in the Marshallese community, I think that would be a great thing to do because it sounds like a young Franky Erra would've benefited from that, 

Franky: Mm-hmm. 

Duncan: If someone just said, Hey, like this is what a physician is, Maybe a good undergrad that you could go to.

These are the steps or an engineer or any of those things. You have a good head on your shoulders. But then like all the pieces were just so complicated to put together.

Franky: Yeah.

At the [00:33:00] clinic, when the doctors are talking about patients and doing their diagnosis and evals. I'm like, wow, they're so cool to know all these things and to do all these things. It seems pretty cool. I think this is something that I might have been interested in if I was exposed to that work.

So I think it'd be great if we could do something for the youth here.

Duncan: The Marshallese community is such a unique population, and I think such an important one here. We're so grateful to Marshallese community, I think just for raising awareness about this latent TB and how to think about it.

Do you go back to the Marshalls at all?

Franky: Rarely, it's just so expensive. The ticket's

$4,000 for a round trip. So five hours from Seattle to Hawaii and pretty much another five to Majuro.

Duncan: When you go back, is it like home or what does it feel like 

Franky: Yeah. It feels like home.

Yeah. Still feels like home. Feel safe.

Duncan: Thanks for your time.

 Franky Erra's story reminds us that migration isn't only about distance. It's about continuity. From the coral atolls of Majuro to the clinics of Seattle. His path carries a rhythm of home, close-knit community, [00:34:00] faith and service. Today, he's helping others navigate a health system far from the islands, yet rooted in the same values that shaped him.

For many Marshallese families, the journey from nuclear testing to navigating modern healthcare is still unfolding. Franky's work reminds us that healing begins with understanding. You've been listening to the Provider Pulse series from the EthnoMed Podcast at Harborview Medical Center.

Special thanks to Franky Erra, the Pacific Islander Community Association and Public Health seattle King County for leadership in health outreach.

If you'd like to learn more about tuberculosis and the Marshallese community, check out our Marshallese TB cultural profile on the EthnoMed website.

I'm Dr. Duncan Reid. Thank you for listening and see you at our next episode.