-This report describes the social, cultural, and political economic factors impacting tuberculosis (TB) prevention and treatment for Marshall Islanders residing in Springdale, AR.-Data derive from 10 weeks of ethnographic fieldwork in Springdale. Research methods included unstructured interviews with key informants; semi-structured explanatory model interviews with former and current Marshallese TB patients or their family members; and participant observation at the Dr. Joseph Bates Outreach Clinic and the Marshallese community.-Marshall Islanders face significant structural and institutional barriers to TB prevention, identification, and treatment.

-Tuberculosis outbreaks are directly related to the experience of structural violence both in the Marshall Islands and United States including widespread conditions of poverty, overcrowding, and poor nutrition in both locales. Other structural barriers unique to Northwest Arkansas include strenuous low-income labor, residential vulnerability, poor or unavailable transportation, and inaccessibility of mainstream US health care system.-Economic constraints, lack of translational services, and mistrust between patients and care providers create difficulties for the locating and communicating with Marshallese patients.-Stigma associated with TB remains a challenge for screening and outreach efforts. Many Marshallese TB patients are afraid of contracting TB, and this places certain extended family members at greater risk than others.