Ka Wai Ola - Office of Hawaiian Affairs, Volume 29, Number 3, 1 March 2012 — Mālama indeed [ARTICLE+ILLUSTRATION]

Mālama indeed

Mālama kekahi i kekahi, "take care of eaeh other," is a lesson Jerem Nohea Kaawaloa learned early in hfe. Raised in the Puna district, on the eastern side of Hawai'i Island, he knew firsthand what it was like to live in an area chronically underserved by doctors. That's why, when he completed his medical degree in 2004 at the John A Burns School of Medicine at the University of Hawai'i-Mānoa, Dr. Kaawaloa decided to begin his practice in Hilo, where he could mālama the people most in need. "For the longest time now we've had a shortage of physicians of all specialties, says Kaawaloa, a recent OHA Mālama Loan recipient. "I guess I saw medicine as one way to fill a need in my community." The opportunity to serve the Native Hawaiian community, along with the community at large, also influenced his decision to establish his practice in Hilo and "do what I ean to improve the access to quality medical care." Growing up in Kalapana, Kaawaloa was unaware of the heahh issues facing Native Hawaiians. The people he remembers were healthy, perhaps a result of living a more traditional lifestyle of fishing, hunting and farming. During his medical training, the disparities

in Native Hawaiian heahh within the general population - including heart disease, diabetes and cancer - heeame very real. Of the many medically underserved populations in the state, Hawai'i Island residents are among the hardest hit. A recent survey estimates 32 percent of Hawai'i Island physicians will diseonhnue service within the next five years. "It's pretty bad," says Kaawaloa. "We get numerous phone calls every day from patients looking for (primary-care) physicians." For patients needing specialists, the shortages ean be costly, too, oftentimes necessitating travel to O'ahu. Although Kaawaloa was ahead of the curve recognizing the need for more doctors in rural areas, he still faced the challenges of establishing his own medical practice. For up and coming doctors, that entails finding the hnaneial means to open an office, often while paying off student loan debt that averages $150,000. Kaawaloa was fortunate to get scholarships to help with the cost of his education. Unfortunately, there's no such thing as a scholarship that pays the rent on an office or the expense of filling it with furniture and medical equipment. Helping Kaawaloa fill the unmet need was a Mālama Loan, whieh in June 2009 allowed him to open his own primary-care practice in Hilo. The loan from OHA provided the capital he needed to lease office space, pay himself and his employees, and tide him over during the months it takes for new doctors to get their credentials, and thus be paid, by insurance companies. He found the Mālama Loan process "a breeze" compared with his subsequent experience getting a car loan and a mortgage, and says the

turnaround time was surprisingly quick. "I think it's just a terrific program," says Kaawaloa "It really helped me be more independent ... feel more confident that I was going to be able to make it on my own, whieh is kind of a scary thing to do." "It was pretty important part of getting my practice started," he says. "It was a big deal." According to a 2010 Hawai'i Physician Workforce Assessment by the University of Hawai'i, Hawai'i Island has the greatest need for more physicians. It faces a 38 percent shortfall. Statewide the shortfall is 22 percent, with 500 fewer physicians than are necessary for Hawai'i's population. In 2010, the UH medical school graduated a record number of Native Hawaiian physicians - 12 out of a class of 58. But with an anticipated 134 physicians retiring eaeh year, the statewide shortage is expected to worsen, potentially rising in the next decade to a 40 percent shortage in all disciplines. While Kaawaloa says there are ongoing efforts to resolve the problem - by the medical school, Legislature and state Sen. Josh Green - the laek of specialists and other medical resources tend to deter primary-care doctors from rural areas. There's also the laek of loeal people attending medical school. If more Hawai'i students would pursue medicine, he believes the shortage would be alleviated. Kaawaloa's old lesson, Mālama kekahi i kekahi, is one to share. ■ Mary Aliee Kaiulani Miīham, a Portland, Oregon-based freelance journalist, is a former newspaper reporter and columnist from Califomia's Central Coast.

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"I think it's just a terrific program. It really helped me be more independent ... feel more confident that I was going to be able to make it on my own, whieh is kind of a scary thing to do." — Dr. Jerem Nohea Kaawaloa, OHA Mālama Loan recipient

By Mary Aliee Milham

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