Ka Wai Ola - Office of Hawaiian Affairs, Volume 24, Number 12, 1 December 2007 — Healing Native Lives [ARTICLE+ILLUSTRATION]

Healing

Native

Lives

When medical student Natalie Kong shadows physicians on hospital rounds, more than a few patients do a double-take and tell her that she resembles a favorite nieee, or maybe a cousin or grand-daughter. This is a good thing, says the soft-spoken 30-year-old. "People are sometimes mueh more trusting, if they believe you are eonnected to them. The more I ean help patients open up, the more I ean get information that will help in making a good decision," says Kong. Kong's experience underlines one of the main aims of 'hni Ho'ōla. The post-baccalaureate program, whieh Kong attended, cherry-picks applicants from disadvantaged backgrounds who demonstrate that they have excellent minds for the healing arts as well as heartfelt commitment to the medically underserved Hawai'i and Pacific conununities that they eall home. Known to help less-than-impeccable academic perfonners live up to their genuine potential, the program launches students into the University of Hawai'i's John A. Burns School of Medicine — where 'hni alums have acquitted themselves well with a 77 percent graduation rate and career choices that have taken them back to their roots, as promised. "(Our 'hni students) are carefully screened for their personal qualities. The ones who get in have altruistic motives for studying medicine. They aren't

training to do cosmetic surgery in Beverly Hills," says Chessa DeCambra, an 'Imi Ho'ōla Program Assistant. While the program doesn't apply racial or ethnic criteria in selecting disadvantaged students, nearly half of its 417 graduates since 1975 have Hawaiian ancestry. Kong was among four Native Hawaiians from the 2005 'hni program who are in the UH medical school class of 2010, whieh has an overall enrollment of 16 students of Native Hawaiian ancestry — a number that is not only unprecedented in Hawai'i's only medical school but is also noteworthy because it may help to offset what has historically been an under-representa-tion of Native Hawaiians in top-flight medical professions. The continuing success of 'Imi Ho'ōla and related scholarship assistance programs comes at a critical juncture. While the federally-mandated Native Hawaiian Healthcare Systems are in plaee to improve wellness education and access to care, the state's indigenous populahon continues to experience disproportionately high rates of chronic diseases — notably cancer, diabetes and cardiovascular disease. The relationship between heahh and ethnicity is a complex matter, but it is clear that the disparities in native heahh status need to be addressed by physicians who ean halanee Western medical practice with Hawaiian values, says

Dr. Kalani Brady, an associate professor of Native Hawaiian heahh at the UH medical school. "Western medicine's heavy emphasis on elinieal measures ean "reduce a person to his or her biology," notes Brady, while traditional Hawaiian medicine "took into consideration the spirit or na'au'au of the person." Brady calls the extreme social isolation of Hansen's Disease patients in Hawai'i a "blazing example of bad outcomes from a lopsidedly Western approach" and part of a long, sad history that has contributed to Native Hawaiian discomfort with standard medical practice.

Natalie Kong recalls that sense of discomfort a young child, when her family took her to see doctors at the only heahh center that served the Waimānalo Hawaiian Homestead land, where she grew up. "It seemed like a dark, neglected, scary plaee," she says, adding that she often went there

with family members who were suffering from what she terms "the typical Hawaiian diseases" including cancer. "Someone has got to change this, I thought. And one day I just blurted out, 'I'll be a doctor.' " Kong's parents supported her ambition, but they also told her that she would have to look for scholarship help, because they wouldn't be able to afford tuition. Then as an undergrad at University of Hawai'i at Mānoa, Kong split her major between pre-med and music — unwittingly putting herself at a disadvantage in the tight competition to get into the UH medical

scnoot, wmen accepts onty out or r,yuu appticants a year . tms is where 'hni Ho'ōla eame to Kong's rescue. The 'hni application process involves jumping through several hoops — tests, interviews and essay writing, plus the lining up of hnaneial aid paek-

ages that are not provided directly by 'hni Ho'ōla. But all this work is nothing compared to the challenge of being in the program, whieh uses an innovative "problem-based learning" curriculum. This means students collaborate in small groups to diagnose complex "paper cases." "You and your group have to figure out the best possible conclusion, < given what everyone brings to the table. It's hard, because no one tells you 1 that you have to accept a certain belief, but this is what it's like in the real J world of medicine." " 'hni nurtures you as a person but it is no joke when it comes to the rigor," agrees Kapua Medeiros, 26, who also graduated from the 2005 'Imi program and joins Kong as one of the banner number of Native Hawaiians now in the second year at the UH medical school, where she also is a teaching assistant for an 'hni anatomy class, helping newcomers brave their first lessons in the dissection of a cadaver. "Coming here, I was ready for anything, even though I didn't look good on paper," says Medeiros, who graduated at the top of her Kamehameha class but then struggled to maintain a decent G.P.A. as a biochemistry major at the Ivy League's Dartmouth College in Hanover, New Hampshire.

tne nerce aeaaenue eompennon nugnt nave dampened the spirits of a less determined student, but Medeiros, who also grew up on Hawaiian Homestead land, the daughter of a Kaua'i fireman, in Anahola, had already demonstrated a remarkable aptitude for mixing the lā'au lapa'au of her ancestors with advanced lab science. While still in high school, she developed a way to extract an anti-cancerous compound from papaya seeds and won a national science prize for the project. "I considered becoming a researcher in natural products, but this would have required being tied to a research institution somewhere far away from the Native Hawaiian population, where I want to share my work," she says. Notwithstanding their passion to serve their own conununities, 'hni Ho'ōla's Native Hawaiian students may find in the future that they are up against some greater aihnents in the nahonal healthcare system. Hardy Spoehr, Director of Papa Ola Lōkahi, an

organization created in in Hawai'i, says that th laek of affordability of ] family doctors and sma rural and neighbor isla live in high concentratic "There has always beei status and social and ec we need to make sure people." However, Spoehr is of a younger generatior or heahh fairs 20 years

events back then? Toda; Spoehr adds that thc coincided with policies tion for Native Hawaiia health-care institutions competency is the offici values of medical practi ment regulations. All of these developi rates of chronic disease seem stubbornly stalled pan of a generation, it c; care to show up in the c In the meanhme, the

beyond the eall of the u the medicine they pract ents might have known,

By Liza Simnn | Public Affairs Specialist

'lmi Moments: (Top) 'lmi Ho'ōlo Alumnoe ond second yeor UH med students Notūlie Kong ond Kapua Medeiros on o break from their busy study schedule. (Bottom) Dr. Ming Tim Sing (standing) leads o lively I discussion group of 'lmi Ho'ōlo students. (Seoted from left) Kanoe-lehua de Silvo, Leah Wong, Seabrook Mow, ■ Nieole Boumhofer. - Photos: Plaine Fergeistrom

1988 under a federal mandate to improve native heahh e high costs of medical malpractice insurance and the iigh-tech medical specialties care are challenging both 11 hospitals to stay in business. This is especially so in nd coimnunities, where the state's Native Hawaiians in and are more likely to be underinsured or uninsured. i a direct correlation between the disparities in heahh :onomic struggles," says Spoehr. "For Hawai'i's sake, that the state's economy ean sustain Hawai'i's first heartened by what he calls the "wellness awareness" i of Native Hawaiians. "Think back to marathon races ago. How many Hawaiians would participate in those !, the numbers are way up." : entry of more Hawaiian youths into medicine has to improve. Access to care, heahh advocacy and educans during the last two decades. It is also ensuring that pay more attention to "cultural competency." Cultural al policy term/buzzword for the effort to match cultural tioners and patients, now a requirement under governnents correlate with noticeable trends toward reduced in younger Native Hawaiians — even if the statistics "Because heahh problems often change over the lifesm sometnnes take 20 years for improvements in heahh ata," Spoehr says. Native Hawaiian alums of 'Inii Ho'ōla are even going sual eight hours a day of study time to make sure that iee will be better than what their par-

Some have formed Kalama Kukui, a new support organization at the UH medieal school for indigenous students from Hawai'i and throughout the Pacific. Natalie Kong organized Kalama Kukui after returning from an international conference in New Zealand that highlighted heahh as an empowering and politicizing factor in the lives of the world's indigenous populations. "We want to get the word out that just because you are from Nānākuli, doesn't mean you won't even go to med school," says Kong. As part of walking the talk, the Kalama Kukui will soon be supporting a mentoring project that pairs Native Hawaiian medical students whh middleschoolers from several island schools. Some UH med students will be doing all this, just as they prepare to take their first round of medical boards at the end of their second year. Ironically, many are discovering that the time they put into medical studies isolates them from the people they dream of serving someday. "When your family and friends want you to go to dinner with them, you can't just up and leave," says Kapua Medeiros, explaining that her focus for the time being is brain surgery. "We're into the new unh on neuroscience. Cranium nerves are just so intricate," she marvels. To make sure she doesn't lose touch whh her roots, Natalie Kong recently enrolled in a lā'au lapa'au course under the direction of a loeal kumu. "I was feeling like I couldn't give h the attention h deserved so I wanted to withdraw, but (the kumu) talked me down. In the Hawaiian way of thinking, onee you start something, you must finish." Kong says she also draws strength from Hawaiian values in staying on course for the career of service that awaits her. "There is a sense of kuleana in Hawaiian culture. If I believe that heahh matters most, then I will do what I ean to make sure I ean care for others this way." I

SO YOU WANT TO BE A DOCTOR... Resources for Native Hawaiians: For more information on 'lmi Ho'ōla: (808) 692-1030 Next application eleaelline: Jan. 11,2008 ON THE WEB Pre-med advising Professions Advising Center (PAC) www.advising.hawaii.edu/artsci/pac UH John A. Bums School of Medicine (JABSOM) http://jabsom.hawaii.edu For financial aid to JABSOM www.hawaii.edu/fas For more information on the Native Hawaiian Health Scholarship Program www.nhhsp.org Association of Native Hawaiian Physicians www.kauka.org