The indigenous people of Hawaii are reported to have some of the highest mortality rates for virtually all major chronic diseases. Obesity is also higher in Hawaiians than in non-Hawaiians, as is diabetes. Statistics like these have prompted health researchers to identify native Hawaiians as a vulnerable population.
Health care providers are looking to the past to heal Hawaiians of today. Ancient Hawaiians relied on a myriad of natural substances for healing purposes, including plants widely available today, like kukui, the state tree of Hawaii. Its nutmeats were used as a purgative while the flowers and sap were used to cure mouth sores. Noni, a type of mulberry, is still used as a tonic and has become the subject of clinical research for possible anti-cancer properties.
Creating connections between traditional healing and contemporary medical practice opens a door into indigenous communities, according to Kaloa Robinson. He heads Hui Malama Ola Na Oiwi , which provides medical services to the native Hawaiian community on the state's largest island.
"I guess the question is, what is the role of traditional medicine in today's society?" he muses. "We've found that even though they [native Hawaiians] go to see a physician, there's just something that's missing, the spiritual aspect that's missing. And practices like ho'oponopono is something we refer some of our clients to."
Ho'oponopono means 'to make things right,' according to Kaohu Chang Monfort, a nurse known for her healing expertise. She says her family routinely practiced this kind of group mediation and prayer when she was a child. "Ho'oponopono was number one. We never let the day go by, before the sun goes down, without ho'oponopono. You talk about what's bothering you. Nobody leaves until everything comes out." She recalls they could spend hours talking. "And when whatever's troubling you comes out, that's what the prayer is about, to help you heal."
Spending time with patients is an important part of health care, says Edna Baldado, a caseworker with Hui Malama who sees clients with diabetes. "Then they feel like you really care about them. Allowing them to have that space and that time, helping them feel like they're somebody worthwhile and important. That's a Hawaiian kind of value."
While ho'oponopono and spending time help heal the spirit, traditional healer Mary Fragas points out that nourishing food is essential for a healthy body. "The Hawaiians used to eat fish, poi, taro, potato, uloo [breadfruit]," she points out. Recognizing that, Hui Malama has hosted fish and poi gatherings around the Big Island, demonstrating healthy cooking techniques to encourage healthy eating.
Baldado says sharing food and conversation has been an effective way to expand Hui Malama's reach into the community, making more people aware of their range of services. "We want to promote eating our traditional foods, because that's the healthiest food," she tells the crowd at one of the gatherings. "If we eat that kind of stuff, we'll be like the Hawaiians of old." To scattered laughter, she adds, "They were slim, they could run for miles and not get tired!"
The fate of those 'Hawaiians of old' is similar to that of indigenous people across the globe. Less than a century after the first Europeans arrived in the islands in 1778, disease, war and famine had claimed over 80% of the native population. Disease is still taking a disproportionately high toll of Native Hawaiians, who die at greater rates from cancer, heart conditions and diabetes -- chronic diseases that afflict all ethnic groups.
In searching for the reasons why, state health official Kim Birnie notes that some of the research points to genetic causes. "But other [causes] are accessibility," she adds. "Are Hawaiians not getting care early enough? And if they're not, why not?"
Birnie is Communications Director for the agency that oversees the state's Native Hawaiian health care system. She says individual wellness is intertwined with social and economic conditions. "A lot of [our clients] are the working poor. They're working but they can't afford the rent. Or they want to work, but they have bad teeth. Having their teeth worked on gives them some confidence to be able to go out and apply for a job so they can pull themselves out of the homelessness. So it's all tied in."
Providing effective health care for Hawaiians requires bridging cultural, historical and social divides, according to caseworker Edna Baldado. "We have to kind of be innovative sometimes, but if it works [why not try it?]," she asks. "We're not doing anything that's going to be detrimental to us as individuals, or us as a people or to our organization. As long as we're not doing something that's going to be hurtful, we can do things a little more creatively."
One innovation that works is the Native Hawaiian Health Scholarship Program. Recipients - like Allison Grace - specialize in needed health professions, and after graduation, are placed in underserved areas. Grace says, "Being in the community is so different from being a doctor in the hospital, 'cause you get to talk to [patients] one on one, you get to spend time with them."
She has been assisting Dr. Joycelyn Jurik, who says their practice is truly outreach. "If there are individuals that we hear about that are having problems at the beach, we'll go to their van, we'll go walk the beach, find them in their tents, we'll walk the bushes, find them in the bushes, and that's where we'll see them!"
Grace says being Hawaiian themselves makes their relationship with their patients closer: "We live through it," she explains. "We see that diabetes runs rampant in our families, I think all our patients become Auntie and Uncle anyway."
Jurik agrees. "I don't think I call anyone Mister and Missus! So it's like, 'Auntie, when do you want to come see me again?' For them it's so comforting, they feel like family now. And we feel like they're family, too."