Ka Wai Ola - Office of Hawaiian Affairs, Volume 9, Number 4, 1 April 1992 — Hilo-Puna women benefit from study [ARTICLE+ILLUSTRATION]

Hilo-Puna women benefit from study

by Ann L. Moore Malama Na Wahine Hapai, a project to help pregnant minority women on the Big Island, has named its loeal advisory board members. They are: Wesley Segawa, chair, Colleen Alicuban, vice-chair, Antonia Lambayan, secretary, and Doris Ariki, Roland Kadota, Emma Kauhi, William Kikuehi, Dr. Robert King, Dr. Genevieve Kinney, Sonny Kinney, June Kunimoto, Susan Labrenz, Henry LeeLoy M.D., June Shibuya, Barry Taniguchi, John Uohara M.D., and Brian Wilson M.D.

The nursing practices model was set up to provide prenatal care to Native Hawaiian, Filipina and Japanese women living in the Hilo-Puna district of the island of Hawai'i. The goal of Malama Na Wahine Hapai is to complement standard prenatal services with community outreach using culturally sensitive methods to blend with the Hawai'i island lifestyle. They hope to amke it easier for minority women to get into and stay in the program.

The Public Health Nurses on the island received $2.5 million of a $3.5 million federal grant to implement the project. The other million goes to the University of California, San Francisco, for research and data analysis.Consultants and collaborators include faculty from University of Hawai'i-Hilo, University of Washington, University of Pennsylvania and the Nordic School of Public Health, Gotaborg, Sweden. This last does a lot of work with isolated people living in7the Artic Circle. June Kunimoto, Public Health nursing supervisor for Hawai'i is project director and Dyanne Affonso, R.N., of UCSF is the principal investigator.

In 1991, according to Kunimoto, data was collected on what problems exist in getting prenatal care to minority women on the Big Island. This is the year "when we implement what we have learned," she said. Within the project's projected lifespan of two to five years, the staff hopes to help improve both pregnancy and postpartum experince by reducing the number of low birth weight infants, by helping mothers carry babies to full term, by reducing birth complications and the associated costs because of longer hospital

stays, by increasing the women's healthy behavior, and by increasing the women's sense of meaning, mastery and self-esteem. The aims of the project eeho those of the Institute of Medicine report whieh expressed eoneem that programs for women who are poor or from ethnic minorities h*ad been "disrupted" and advocated that improving prenatal care for these women be implemented.

The Hilo-Puna district was specifically selected for three reasons, according to Affonso's presentation to the National Rural Health Association conference in May 1991. The reasons are: the majority of women who receive late or no prenatal care in East Hawai'i live in these census tracts; this district contributes to the state's maternal-neonatal morbidity and mortality from the settlement of ethnic groups that have increased the childbearing population of the district; recent volcanic eruptions by Kilauea have disturbed whatever stability existed in the district thereby increasing stress on childbearing women and their families. These factors decrease their perception that prenatal

care is important since there are more day-to-day worries they feel are more important. The problems that make it difficult for minority women are family conflicts because of unplanned pregnancy, multi-family households, unwed status, and the laek of reasonable living standards. The women often live in geographieal isolation. They don't use the health care that is available because they don't know about it or feel uncomfortable dealing with the clinics. Consequently the women get no professional care until they show up at clinics just before or at birthing time.

This is not the women's fault. Rather, prenatal care in these areas is poorly used because women's cultural beliefs are sometimes minimized and the women feel they are in conflict with elinie staff standards. They often feel the care is not culturally sensitive to their needs. Clinics often operate at hours when its difficult for the women to get to them. Laek of transportation is also an issue. Language, too, is often a problem. Not just that staff may not speak a particular language but that too often women are unable to understand the semantics and medical jargon. Care giving is often haphazard because the priorities of the health care professionals and the women are often in direct conflict, that is, prenatal care may be a low priority for women who are concerned daily with adequate meals and safe shelter.

The pilot project will address these concerns. Staff hopes to redress many of the procedures that brought about the present situation, according to the paper Affonso presented. To that end, six care-giving approaches were designed. These include using the resources of ethnic cultural healers, taking mobil clinics into rural towns, linking women with a "buddy" as a healthy role model, working with neighborhood women by using Neighborhood Women's Health Watch (NWHW), getting the existing programs to work with the new ones, and asking business leaders to offer incentives for healthy behavior.

Nurses will concentrate on four area within the overall care system: disease prevention, health promotion, psychological adaptation by reducing sympton distress, and helping women with their self-esteem.

Henry "Papa" Auwae and Kupuna Emma Kauhi, members of the Malama Na Wahine Hapai advisory eouneil.