Ka Wai Ola - Office of Hawaiian Affairs, Volume 37, Number 8, 1 August 2020 — KOKO Provides Proactive Patient Care Amid the Pandemic [ARTICLE+ILLUSTRATION]

KOKO Provides Proactive Patient Care Amid the Pandemic

By Puanani Fernandez-Akamine When Dr. Claren Kealoha-Beaudet and the team at Kīpuka O Ke Ola (KOKO) applied for an OHA Community Grant more than a year ago, their plan was to use the funding to expand KOKO's health center by adding a new wing that would house their Indigenous Healing and Women's Health Services programs. Onee the grant money was available, they went to work. They secured rental of additional office space adjacent to their existing facility in Kamuela on Hawai'i Island and began renovating. Their beautiful new wine onened in January 2020.

And then the coronavirus happened. Immediately recognizing the seriousness of the disease and its potentially devastating impact on the community, and Native Hawaiians in particular, KOKO leadership took swift action. They shut down their new wing, moved their Indigenous Healing and Women's Healīh Services back to the main elinie, and began another round of renovations in mid-March, this time converting the space to a COVID-19 testing facility. "We put together a three-person COVID team who have been

trained, and are regularly re-trained, in all protocols related to COVID-19 testing," shared Kealoha-Beaudet. "We used the remaining OHA grant money to isolate the a/e in that wing to prevent cross contamination to the rest of the elinie via the HVAC system, as well as to purchase additional PPE and cleaning supplies." KOKO is a federally accredited Independent Rural Health Clinic. They offer the community integrated, holistic medieine and their services include primary health care (including pediatrics), women' s health, behavioral health and Indigenous heahh. Because Indigenous health services (lā'au lapa'au, lomilomi and acupuncture) are not covered by insurance, these services are offered free to KOKO's primary care patients. The staff includes two medical doctors, two nurse practioners and three elinieal psychologists, one of whom was recently recruited from O'ahu to help KOKO meet the mental heahh needs of the community. "The need for behavioral heahh services is going through the roof," said Kealoha-Beaudet. "Since the pandemic began

our patient caseload has increased by 30%. We did not want to turn people away so we had to hire a third elinieal psychologist." Surprisingly, most of the new, pandemic-related mental heahh cases they are seeing are young, college-aged adults who are panicking about things like not being able to return to college or losing their Ananeial aid and scholarships. And their fears about the future are resulting in tension and fighting whhin formerly peaceful households. Says Kealoha-Beau-det, "we are working with parents and their adult children to help them find ways to decompress and mālama one another instead of focusing on the disruption that the virus has caused to their life plans." In addition to accommodating the upswing in patients needing mental heahh services, thanks to their new, re-ren-ovated COVID testing wing, KOKO is also able to safely accommodate the surge of medical patients worried about the coronavirus and seeking testing. Before patients eome to KOKO for COVID-19 testing, they have a tele-health appointment with one of the clinic's doctors using Zoom or Facetime. Doctors use this time to triage patients and discuss any concerns or symptoms they may have to determine whether the patient should enter the testing wing or be tested outside. At KOKO all COVID-19 testing is scheduled between 1-3 p.m. daily so that the COVID team staff members are only using one set of PPE eaeh per day, since PPE has become increasingly expensive and difficult to obtain. As new information about COVID-19 becomes available, protocols are constantly being updated. So every Monday

morning the entire staff gathers for training in the new COVID-19 protocols published the previous week before receiving clients. Although necessary, these protocols take up a lot more time and affect all patients, not just those seeking COVID-19 testing. "The protocols have changed the way we flow - and our new flow is slow," notes Kealoha-Beaudet. "where we might have seen 16 patients in-person eaeh day, we now see just 10 to 12." A new development resuting from the pandemic and social distancing has been the transition of 30-40% of KOKO' s elients to tele-health. KOKO has about 2,000 regular patients, most of whom are from Waimea, Kohala, Waikōloa and Pu'uanahulu. Managing chronic conditions is already difficult, but in a pandemic people with chronic conditions have to be really careful. So early on the KOKO team identified their patients who were most at risk, especially those with chronic upper respiratory conditions, and began calling regularly to eheek up on them. Staying close to their patients with chronic conditions is not something for whieh KOKO ean bill insurance companies. However, this is an example of the proactive care and mālama that KOKO provides to its patients. Their formula for success in the midst of the pandemic seems to be working. So far all of KOKO' s chronic patients are doing okay. "How lucky we are to live in Hawai'i where the (coronavirus) numbers are still manageable," KealohaBeaudet reflected. She credits this to Hawai'i's collectivist culture. "Here we look out for one another and it happens very organically and naturally." ■

)r. Claren Kealoha-Beaudef - Photos: Courtesy KOKO

The entire KOKO leam, pre-pandemic. Clinic leadership includes Executive Director/Clinical Psychologist Dr. Claren Kealoha-Beaudet (standing far left); Associate Director/Clinical Psychologist Dr. Franco Acquaro (seated center front); and Medical Director/lnternist Dr. Ken Riff (standing far right).