JABSOM’s DEPARTMENT OF NATIVE HAWAIIAN HEALTH at 10: How it serves Hawai`i and partners with the community

2012 marks a decade since the Department of Native Hawaiian Health was established at the University of Hawai`i’s John A. Burns School of Medicine (JABSOM). The Department is the only clinical department in an accredited U.S. medical school specifically dedicated to improving the health of an indigenous people, Native Hawaiians.

Beginning this week, the Department is presenting a yearlong series of celebratory events to highlight the accomplishments of the past 10 years. Called Ulu Hina, Kū Papa (thriving and enduring), the inaugural event was a “Report to the Community” on November 15, 2012 at the JABSOM Medical Education Building.

“This will be a night of learning, sharing and collaborating, with our community partners, stakeholders and University of Hawai’i faculty and staff expected to attend,” said Dr. J. Keawe`aimoku Kaholokula, Chair of the Department of Native Hawaiian Health, before the event. “It is an opportunity for us to extend a mahalo to our academic and community partners for allowing us to work together, in the spirit of laulima (cooperation), to achieve our shared visions of a healthier Hawai‘i.”

During the ceremony, Dr. Kaholokula said, “I think because of our existence, we’ve been able to work more closely with our Hawaiian communities, as well as our Pacific Islander communities, in developing community-based and community-led health promotion programs, in a way of addressing overweight and obesity and diabetes, heart disease”.

Looking forward, Dr. Kaholokula said an important focus will be on disease prevention. “In order to do that, we need to go where people live, work, play. In the schools, in real work settings. In people’s communities and neighborhoods and really develop programs that help people be healthier and live the life they want to live,” he said.

History

In 2002, Dr. Ed Cadman, then Dean of JABSOM, established Native Hawaiian Health (NHH) as an academic and medical program at JABSOM. NHH embraces multi-disciplinary approaches to address health disparities experienced by Native Hawaiians and other groups.The program integrates the biomedical, behavioral, psychosocial, and public health sciences with Hawaiian cultural knowledge and wisdom. It applies these sciences and Hawaiian cultural knowledge to medical education, basic and clinical research, clinical services and training, and community-engagement.

Generous financial support from The Queen’s Healthcare System (QHS) helped the department take shape. Queen’s made an initial investment of $5 million dollars, which enabled JABSOM to form a clinical department. On October 16, 2003, the University of Hawai’i Board of Regents formally adopted the Native Hawaiian Health program.

Early Successes 

The `Imi Ho`ōla Post-Baccalaureate Program and the Native Hawaiian Center of Excellence (NHCOE) were incorporated into the Medical Education Division within the new Department of Native Hawaiian Health.

Annually, ‘Imi Ho‘ōla offers educational opportunities for up to 12 students from economically, socially, and/or educationally disadvantaged backgrounds who demonstrate the potential to pursue a career in medicine but have experienced challenges that hinder this process. The intensive one-year program integrates concepts in the sciences and humanities to strengthen the students’ basic science and clinical skills. In addition, the program develops their communication, critical thinking, professionalism, and learning skills. Upon successful completion of the one-year program, students enter JABSOM as first-year medical students. Of the 226 graduates of the program, 85% have gone on to provide primary care health services and 96% take care of underserved and/or disadvantaged populations. Forty (40%) of the graduates are of Native Hawaiian ancestry. The majority of graduates originate from rural and or underserved populations with a desire to return to their home community to practice medicine.

The NHCOE provides education and training enhancement programs to Native Hawaiian students and those at the post- doctoral stage of their career. The purpose of NHCOE is to improve the healthcare workforce in the State of Hawai‘i and to increase diversity in JABSOM faculty and students by providing education, research, and community partnership opportunities.

In collaboration with the UH School of Social Work, Kipuka Native Hawaiian Student Center at the UH at Hilo, and the Office of Student Equity, Excellence and Diversity (SEED), NHCOE has reached over 2,500 middle school, high school, and college students throughout the state. It exposes them to opportunities in the health careers, and has worked directly with 37 Native Hawaiian undergraduates through its Native Hawaiian Student Pathways to Medicine, enter medical school.

(Source: Hawai`i Journal of Medicine and Public Health.)

Research expansion

Today the department has grown to include the Center for Native and Pacific Health Disparities Research (The Center) which houses the Mālama Pu`uwai Project (maintaining the heart), PILI `Ohana Project (a community and academic partnership to eliminate obesity), and Hanapū Study. The Center is associated with the National Institute on Minority Health and Health Disparities (NIMHD), the National Heart, Lung, and Blood Institute (NHLBI), and the National Institutes of Health (NIH).

For 10 years, the Center for Native and Pacific Health Disparities Research has served as a regional focal point for research designed to eliminate health disparities and improve health outcomes for populations in the Pacific region including Native (eg, Native Hawaiians and Alaska Natives) and Pacific Peoples (eg, Pacific Islanders and Filipinos).

UH-Mānoa has based its clinical translational research program (RMATRIX) upon assisting the development of investigators focusing on reducing health differences that disproportionately impact Native Hawaiians.
Investigators affiliated with the department play important roles in RMATRIX’s campus-wide effort that leverages the work of the department’s Center for Native and Pacific Health Disparities Research and helps make research meaningful to the Native Hawaiian community.

Clinical services

Dr. Kalani Brady and his team of physicians, Drs. Peter Donnolly, Martina Kamaka and Chad Koyanagi, care for the Hansen’s disease patients of Kalaupapa on Moloka‘i as well as in Hale Mōhalu on O‘ahu. At the Lau Ola Clinic on O‘ahu, Drs. Kalani Brady and Dee-Ann Carpenter provide culturally-appropriate primary care services. Dr. Chad Koyanagi is available for psychiatric services, and Dr. Amy Wassman administers behavioral health services. In collaboration with the UH School of Pharmacy, Dr. Candace Tan, a clinical pharmacist, has joined the healthcare team.

Providers at the Lau Ola Clinic believe promoting wellness among Native Hawaiians improves Hawai`i’s overall health. “When you can improve the health of Native Hawaiians, you actually improve the health of everyone in Hawai`i,” explained Dr. Dee-Ann Carpenter, a JABSOM graduate and Lau Ola Clinic physician. “Because if you can take care of the people who are doing the worst, then all you are doing is raising the bar for everyone else.”

Lau Ola Clinic is also a training site for clinical teaching of JABSOM medical students and Internal Medicine residents, such as Dr. Marcus Iwane (a 3rd year resident). Additionally, the providers, staff, and students provide regular health care screenings and counseling at the Papakōlea Hawaiian Homestead Community Center and other venues, such as at the ‘Aha Kāne an ‘Aha Wāhine conferences and the annual cultural gathering at Pu‘ukoholā Heiau on Hawai‘i island.

Community Engagement

The Community Engagement Division, directed by Ms. Mele Look, MBA, enables and nurtures multiple community partnerships through an extensive 32-member community coalition called the Ulu Network. The membership includes 14 federally qualified community health centers (CHC) in Hawai‘i, five federally established Native Hawaiian Health Care Systems (NHHCS), two partners in California, and several rural community hospitals, and Hawaiian Civic Clubs that serve Native Hawaiians and other Pacific Peoples. Of the 32 members, 11 have been involved in 12 NIH-funded studies and 13 organizations have collaborated on 18 health information dissemination programs. A particularly effective program has been the Land, Food, and Health initiative that combines diabetes self-management classes and activities that reconnect patients with the Pacific concepts of land and health.

For MORE information:

Click here for DNHH 10 Year Celebration Slide Show

Link to Video report: Lau Ola Clinic

(The University of Hawai`i System Media Production Office and its Director Dan Meisenzahl contributed to this report. As did writers for the Hawai`i Journal of Medicine and Public Health. See the November issue at HJMPH for the full article.)

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