There has been a fair sized community of Marshall Islanders in Springdale for a long time. They have been a health problem all this time. When they are diagnosed with something like this or even worse they usually refuse to take any medication unless paid for each dose and the health department has to watch them take the dose or they otherwise won’t do it. Very few of them will work as they have learned the welfare game very well. They are citizens because the Marshall Islands are under a U.S. mandate.
I’ve worked in NWRegional SICU in Springdale, so I am very familiar with the Marshallese in the area. I had forgotten that they were legal immigrants. But you are dead on.