Ka Wai Ola - Office of Hawaiian Affairs, Volume 9, Number 8, 1 August 1992 — Hawaiian Health Horizons [ARTICLE+ILLUSTRATION]

Hawaiian Health Horizons

Hui No Ke Ola Pono: Hawaiians caring for Hawaiians

by Jeff Clark "Our clients eome to us because they see Hawaiians here," says Melanie Kala-Trono, executive director of Hui No Ke Ola Pono. "They see a Hawaiian organization with Hawaiians working here, and we look like them, we talk like them, we treat them how they're normally used to being treated. You don't have to really cross any barriers because you're in the same culture. You ean relate."

Hui No Ke Ola Pono — An Association to Strengthen and Perpetuate Life — is taking the lead in keeping Maui's Hawaiian population healthy. Housed in an old wooden building off Main Street in Wailuku, the private, nonprofit Hui advocates for Hawaiians, matching its clients with clinics, doctors, social agencies and other services needed for a healthy life. Hui No Ke Ola Pono is one of five island organizations established because the federal government, eon-

cerned that Hawanans had certain heahh needs that weren't being met, passed the Native Hawaiian Health Care Act in 1988. The Act provided funds for the establishment of a native Hawaiian health care system. An overseeing board named Papa Ola Lokahi was developed as the agency to administer the funds. The board is a consortium of the state

health department's Office of Hawaiian Heakh, the University of Hawai'i, Alu Like, E Ola Mau and the Office of Hawaiian Affairs. Trono has been the executive director of Hui No Ke Ola Pono since December. Hui No Ke Ola Pono has existed for over a year, mueh of whieh was used for planning. Keoki

Sousa served as the executive director last year during the planning stage. The Hui began serving the Hawaiian public last February.

The Hui concentrates on primary care, heahh promotion and disease prevention programs, and targeting diseases, such as diabetes and hypertension, that are prevalent among native Hawaiians. VVhat the Hui ean do for you The Act allows for the planning and management of heahh care systems

for native Hawaiians by native Hawaiians. The Hui is "communitybased," meaning the community dictates what services are provided. Trono said that rather than establishing a federally-identified entity and then trying to make it Hawaiian, the idea was to start Hawaiian, and then modify as necessary to meet federal requirements.

"Hui No Ke Ola Pono is focusing on case management in the first year, and that involves networking with the different community agencies and pri-

vate and puhlie organizations that provide different resources — social, eeonomie and health care," Trono said. "We offer native Hawaiians services that have a broad scope and we assess what their needs are. We do a llnaneial assessment, a heahh assess-

ment and a social-needs assessment." The Hui also helps its clients when their needs go beyond the strictly medical. "If they need food, housing, or whatever, we assess all those needs and try to hook them up with the different resources in the community," Trono said.

Trono explains how it works: "Let's say a native Hawaiian comes and needs health care but has no medieal insurance. We'll assess theireligibility for eenain insurance providers: Medicaid or SHIP (the state's free health insurance program) or HMSA. and we'll help them go through the application process and hook them up with a primary care provider. And if they have no transportation we'll transpon them."

Onee chents are reterred, Hui staff members monitor them to see that necessary follow-up is done. Heahh promotion and disease prevention are also employed and a big part of this is education. The Hui has presented diabetes screening clinics. a forum on aleohol and drug abuse. and a nutrition program. It is also irtvolved in plannine the Maui Native Hawaiian Diet, whieh targets the diabetic. the obese. and those at risk for different diseases.

Trono said the Hui is establishing a prenatal program, whieh will actually l'ollow the mother and her newborn unīil the child is 6 years old. The program is being developed partly in response to the large percentage of teen-age pregnancies antong Hawaiian women. Primarv care Trono said a big health problem for native Hawaiians on Maui is the laek of access to primary care. She defined primary care as "the first level of heahh care" — basic needs such as physicals, diagnosis, immunizations and preventative care. These are "outpatient" services, meaning a hospital stay is not required. Primary care providers include pediatricians, obstetricians

and general family practitioners. "Education and nutrition and how to take care of yourself' also fall under primary care, Trono said. Maui has lots of primary care providers, but few accept Medicaid, she explained, adding, "It's a

provider's market. "They ean piek and choose who they want, so those who don't get picked are those who can't afford or don't have insurance or have Medicaid, because Medicaid reimburses providers at a rate that is lower than their overhead costs. So even though they have Medicaid clients that they serve, they won't increase that number, otherwise they'd go out of business."

But Trono and the Hui are working to address the problem. "We're asking for federal funds to contract with a primary care provider, a physician, to provide that service at least one day a week," Trono said. "One of the reasons for the necessity of the Native Hawaiian Health Care Act was because native Hawaiians were not accessing heaUh care. How eome? Why are native Hawaiians so high in certain diseases and (why is) the mortality rate so hieh?

"The program is here to address those barriers to access. We naturally are going to find Hawaiians who do not access heahh care and they're not going to have medical (insurance). They don't access it because they don't have medical or they don't know who the providers are. For example, native Hawaiian pregnant women are the last to see an Ob/Gyn. I think the average is after the first tliree months. Some of ihem will wait until the second or third trimester or go through their pregnancy without having a prenatal visit. ... lt's very dangerous.

"There are just cultural differences that create barriers. Those things are either ignored or people don't know that there's a problem. We're here to tell them that it is." Health care in Hana If access to heallh care is a problem for native Hawaiians on Maui as a whole, it is doubly difficult for residents of Hana. Hana is a very isolated community that takes hours to reach

by car. Flying or driving to provide health care to Hana residents is expensive and time-consuming, Trono said. Hana has no mental heahh services, no substance abuse services, no physieal therapy, no Ob/Gyn, no elderly care. A dentist goes there onee or twice a month.

The laek of services has created some frustration among Hana residents, Trono said, so any service going in has to be culturally sensitive and providers must be able "to empathize with a community that has gone without for so long." Fortunately, Hui No Ke Ola Pono operatcs an office in Hana. continued on page 23

Hawaiiam needing health eare services on Maui ean reach the folks at Hui No Ke Ola Pono by calling 244-4647. Gale DeCambra, program coordinator, and Mindy Lindsay, RN, case manager, are ready to serve.

The staff of Hui No Ke Ola Pono. Seated: Sarah Nakihei, outreach worker; Mindy Lindsay, RN, case manager; Melanie Kala-Trono, executive director; Kawika Davidson, outreach worker. Standing: Geraldine Kalawai'a, senior outreach worker; Gale DeCambra, program coordinator; and Mahealani Akau, office manager.

Hui No Ke Ola Pono

From page 16

The workers who staff the Hui's Hana office are native Hawaiian residents of the town who know Hana's culture and its history. Some of them speak Hawaiian. Trono and the Hui are proposing to establish another office in Lahaina this year. Lahaina, like Hana, is fairly isolated, and there are not as many primary care providers or social services in Lahaina as are needed, Trono said.

Traditional healing Part of the Hui's mandate is to help Hawaiians wanting to be treated in the traditional Hawaiian manner, and it has responded by networking with Maui's traditional healers. The Hui

maintains a list of healers but can't make direct referrals, so it simply provides clients with the list. Clients ean use such services as ho'oponopono, la'au lapa'au and lomilomi.

The Hui is a necessary bridge between Western and traditional care, because, just as a lot of Hawaiians have trouble accessing modem health care, many likewise don't know where to get traditional care. "The difficulty is that the last time that traditional native Hawaiian practitioners were recognized was over a hundred years ago," Trono explained. When Hawaiian culture was suppressed and Hawaiian religion largely replaced by Christianity, "traditional

healing went with it because it is based on spiritual beliefs," she said. The list contains fewer than 10 names. "Traditional Hawaiian practitioners, because they have not been recognized by the federal government for so long, are reluctant to be included because they think they may be

somehow regulated by a nonHawaiian government," Trono said. "I think a lot are watching the program to see how we handle it." There is no licensing of traditional Hawaiian healers, so they ean not be paid, she added. "We're here to support them in whatever way we ean."

E komo mai From February until the end of May, the Hui provided active case management for 1 39 families or indi-

viduals. The Hui proposed to register 1,000 clients in the first year, and has already more than exceeded that goal, Trono said.