FACULTY SNAPSHOT: Dr. Neal Palafox’s mission of expanding health care in the Hawai`i and the Pacific

Neal A. Palafox, MD, MPH a JABSOM Professor, family physician, and activist addressing Pacific health disparities has recently earned the 2012 National LaSalle D. Leffall, Jr. MD Cancer Prevention and Control Award. This national recognition, presented only once every two years, recognizes individuals and organizations that have distinguished themselves in addressing the cancer crisis in minority and medically under-served communities through educational programs, clinical service, research, or public awareness.

Dr. Palafox’s journey is a fascinating one.  His family immigrated to Hawai`i from the Philippines in the early part of the century to work in the sugar cane fields of old Hawai`i. The senior Palafox decided field labor may not be his best asset, however.  After completing graduate school studying nutrition, he became the first Professor of Filipino ancestry at the University of Hawai`i system , in 1948.

Dr. Palafox prepares to speak at the 2013 Intercultural Cancer Conference, as Dr. Lee Buenconsejo-Lum attaches the microphone to his jacket.

Dr. Palafox prepares to speak at the 2013 Intercultural Cancer Conference, as Dr. Lee Buenconsejo-Lum attaches the microphone to his jacket.

Following this strong value of education, Dr. Neal Palafox entered medical school through the `Imi Ho`ōla Post-Baccalaureate program, an intensive, one year-long program which prepares promising students from under-served communities for medical school. After graduating from the John A. Burns School of Medicine (JABSOM), Dr. Palafox completed his residency training at UCLA and became the first National Health Service Corps physician posted to the Republic of the Marshall Islands. During his stay, he became an expert on Ciguatera poisoning, Hansen’s disease and health effects of the US nuclear testing program. Before long, Dr. Palafox was asked to be the Director of Public Health and Preventive Health Service for the entire island nation remaining in the Republic of the Marshall Islands for nearly a decade.

Never forgetting his Hawai`i roots, Palafox returned to Chair the Department of Family Medicine and Community Health. Shaped by his past, he has spent two decades developing an academic Department of Family Medicine and Community Health focused on understanding and addressing health disparities among the people of Hawai`i and Pacific region. Through his work with the medical school and Wahiawa General Hospital the Family Medicine Residency Program has trained nearly 100 family physicians to practice in rural and under-served settings. Over three quarters remain in clinical and leadership positions throughout Hawai`i. The Family Medicine Residency Program continues to be one of the major providers of clinical services to ambulatory and hospitalized patients in central O`ahu. As well as training medical and pharmacy students, the department also supports outreach services to the homeless through the JABSOM Homeless Outreach and Medical Education (HOME) Project.

Nuclear Weapons Testing and its Health Effects

From 1998 to 2008, Dr. Palafox was principal investigator investigating the health effects of the U.S. nuclear weapons testing program in the Marshall Islands, focusing on the lingering health impacts from nuclear tests conducted in the Pacific during the World War Two era. In 1999 and again in 2010, Dr. Palafox was invited to testify in Washington, D.C. to the President’s Cancer Panel on cancer-related challenges in the US Associated Pacific. His grants through the University have directed over 20 million dollars to Pacific related health programs.

In 2011, Dr. Palafox was granted a rare honor in recognition of his 28 years of health work in the Marshall Islands and the Pacific. He was given full citizenship to the Republic of the Marshall Islands (RMI). The award was presented to Dr. Palafox by the President and Cabinet of the RMI, and it includes an RMI Passport, RMI Diplomatic Passport, and land rights in the RMI. Only one other non- Marshallese person has ever been presented this level of citizenship and Diplomatic Passport in the history of the Marshall Islands.

Nena Tolena, of Korsrae – Federated States of the Marshall Islands, a member of the nominating committee said “Dr Palafox has brought us through uncharted waters where no one has gone before.”

Dr. Neal Palafox has earned extraordinary honors for his work and JABSOM during more than 30 years.

Dr. Neal Palafox has earned extraordinary honors for his work and JABSOM during more than 30 years.

Strengthening Family Medicine in Hawai`i

JABSOM’s current Chair of Family Medicine, Dr. Allen “Chip” Hixon said, “With a humble persistence, Neal A. Palafox, MD, MPH has shown a light on the health disparities shouldered by the people of Hawai`i and the Pacific. For over two decades, his community-based research and capacity building efforts has brought people together to address the complex issues of equity and the social determinants of health.”

Dr. Palafox’s work to organize systems of care in poorly resourced countries has attracted attention globally. Dr. Palafox was recently one of 20 people worldwide invited by the World Health Organization to be Founding Member and National Institutes of Health Global Health Office for the International Cancer Control Partnership in Geneva, Switzerland. In February of 2013, he was appointed as one of five members of the International Cancer Control Planning Scientific Committee for the upcoming Global Cancer Control Meeting for Central, South America, and Caribbean countries.

When we caught up with Dr. Palafox he was preparing to depart for a visiting Professorship in Okinawa, Tokyo and Fukushima, Japan.

We asked what Dr. Palafox will be doing on is latest journey, which begins at Chubu Hospital.
“JABSOM Associated Dean Dr. Satoru Izutsu, who leads global outreach at JABSOM, has arranged the exchange” Dr. Palafox said. “My duties will include lecturing and performing medical rounds with primary care physicians, residents and medical students at Chubu Hospital.  Lecture topics will include medical management of particular illnesses, improving health outcomes through non-communicable disease systems development, social determinants of health, radiation-related illness, health in the US Associated Pacific; and the development of primary care.  I will also be visiting health clinics several islands of Okinawa, going to patient homes with local island staff, and performing satellite medical rounds with several of the Okinawa dispensary systems in their island health system.

From June 1 through June 7th, you have been invited by Fukushima Medical University to lecture in Tokyo, and several sites in Fukushima. Tell us about those?
“Lectures will be centered on primary care development, radiation related illness, and non-communicable disease and social determinants of health. Dr Ryuki Kassai from Fukushima Medical University has invited me is sponsoring this part of the trip.”

What drives you to contribute so much of your energy for so long–over 30 years–to countries of the Pacific?
“The Pacific venue has engaged my thinking and actions around health and health care in a very personal, hands on, Pacific peoples perspective.  Living and working in the Marshall islands for almost a decade allowed me to work with all the US Associated Pacific Health Care systems, to document and bring attention to the medical needs of victims of US Nuclear Weapons testing in the Marshall Islands. I worked with Family Medicine development and training for 20 years, and also explored and helped develop health policy in the Pacific.  These experiences have provided me the background to serve the Pacific communities, look to achieve health equity, and to explore new ways of health system design for both the Pacific and Hawai`i.  Perhaps I can assist the Pacific communities, whether industrialized, island cultures, or longstanding health care systems as Japan to see different perspectives about health care systems development and health care which they may find useful.  I think Hawai`i can benefit from new medical models and ways of medical care and medical training design. What I do is certainly sparked by my Christian faith ”

What exactly will you be doing in Japan?
“Providing medical colleagues form Japan information about other health care systems, describing how the Pacific is intertwined and interdependent. I will offer my perspectives on providing primary care in industrialized nations. I’ll also be enjoying the academic interchange and learning about the Japanese medical systems– how they work and perhaps what can be incorporated into what we do in Hawai`i for better health outcomes. I wish to learn more about how they are working with the radiation-related issues from (the nuclear power plant catastrophe at) Fukushima and describe what was done (regarding nuclear exposure) in the Marshall Islands.” And, Dr. Palafox added, “I will be enjoying the people and culture; and making new friends– that is the best part!”

Three Decades of Service                                                                                                                    Dr. Neal Palafox has worked with the people and health systems of the Pacific to address health disparities since he completed residency training more than 30 years ago—he has built a strong family medicine department in Hawai`i while also bringing honor to the school by receiving some extraordinary national and international awards. Notably, he was the recipient of the 2004 Leonard Tow Humanism in Medicine Award, UH-JABSOM.

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