Returning aloha

By Beverly Creamer
Advertiser Staff Writer

The Hau'ula Healthy Start conference room is bedlam. Toddlers dragging diapered 'okoles lurch toward a scattering of toys and Charmain Hee-Faleofa bends over a Hawaiian quilt square she's learning to sew.

Kehau Santiago, center, received her master's degree with help from a Native Hawaiian scholarship program and started Healthy Start in Hau'ula. Shannon Morgan, left, holds Holukai Ubando, and Gigi Chang holds Ikaika Morgan. Deborah Booker • The Honolulu Advertiser

"If it wasn't for them I wouldn't have bought a house," says Shannon Morgan, reaching out a hand to pat her baby. "There was more support than anything else. More encouragement."

The room is noisy with laughter, and program director Kehau Santiago nods and smiles at the words.

"If it feels good in my gut," she says of the new ideas she is always trying, "I'm running with it."

For five years Santiago, 32, has been "running with it" as a social worker serving the community where she grew up. That's how the quilting bees started. And the 'ukulele class that will eventually enable Filipo to teach other fathers how to make their own.

That's why outreach counselors visiting families arrive at the door not with a clipboard but with fish, poi or papaya.

It's all part of giving back for help that Santiago received from a unique program called the Native Hawaiian Health Professions Scholarship Program.

"It's very personal to want to come back to my community and want to make a difference," she says. "My own family had a lot of health problems. My mom just died at 51. And then my grandmother died. And my brother has bad diabetes and he's only 30."

In the ongoing battle to change health statistics in the Native Hawaiian community, the scholarship program is proving to be one more powerful tool. It's also one piece of a three-pronged effort to make a difference launched by Congress with passage of the Native Hawaiian Health Improvement Act 12 years ago.

That act created the Native Hawaiian Health Care System, a network of individual health systems on each island, and an overall coordinating body called Papa Ola Lokahi. It also financed the Health Professions Scholarship, which provides tuition and stipends for those of Hawaiian ancestry seeking advanced medical training. Although there is no blood quantum requirement, proof of ancestry is needed.

There's just one stipulation: For every year of help, the recipient must return a year of service in a medical position in the Hawaiian community. Job placement is done by the Hawai'i State Primary Care Association, to which Hawai'i's network of community clinics belong.

"The kind of students this appeals to are those who really have a gut feeling to serve the community," said director Sita Nissanka, who has been with the scholarship program almost since the beginning and is like a surrogate mother to the participants.

"Ten years from now, our students will be the decision-makers in the health field. They'll be making some of the important decisions for Native Hawaiians."

Dr. Michele Shimizu checks Gloria Hu before she receives a Caesarean section at Kahuku Hospital. Shimizu's practice makes it possible for prospective parents to have their babies close to home, but without a lot of high-tech equipment. Deborah Booker • The Honolulu Advertiser

The scholarship pays tuition for up to four years, plus a monthly stipend of $1,020 for living expenses. (It includes an annual 10 percent cost-of-living increase.) The total can amount to anywhere from $120,000 to $150,000 over four years, depending on the medical school to which the student is accepted. Although the scholarship is based on merit, Nissanka said, "practically every single student has financial need."

For Santiago, a community service position was a slam-dunk. She has already given back more than twice the requirement and has no plans to stop now.

"Growing up in a very volatile environment and watching my family deteriorate was a strong pull for me to want to go back home," she said. "I always had a personal desire to focus on Native Hawaiian health."

In rural communities like Hau'ula and Kahuku, in remote parts of the Neighbor Islands, and in urban areas where a high percentage of Native Hawaiian residents are below poverty level, the scholarship program is making a difference in the kind of medical care available.

At Kahuku Hospital on O'ahu's North Shore, Dr. Michele Shimizu's practice makes it possible for prospective parents to have their babies close to home.

"The scholarship gets people to underserved areas, hopefully to stay," said Shimizu, 34, who has made a long-term commitment to Kahuku though it has meant learning to do without much of the high-tech equipment she became accustomed to during residency.

"If I leave," she says, "there will be no one here to deliver babies."

Shimizu is grateful to the scholarship effort, but said money should be allocated to create jobs in the areas with the most need, so that people like her can be of help. "While the education is financed, the placement isn't," she said. "So if there's no job there, it makes it difficult."

The initiative is building a new generation of health-care professionals who recognize that cultural sensitivity makes a difference in reaching patients who have shunned medicine because of fear, discomfort or embarrassment.

"There are people out there who have a hard time with medicine regardless of who the doctor is," said Dr. Malia Lee, who has served from Hale'iwa to Wai'anae to Hana during her medical residency in the program. "Just having some cultural sensitivity is definitely a plus."

In the decade since the scholarship began, 101 students have been accepted in the program: 41 in service now; 10 in residency; 25 in training; a number waiting for placement; and 13 who have finished service.

"The whole purpose is providing access to care for Native Hawaiians," Nissanka said. "The impact in the Hawaiian community is that there will be a group of well-trained, well-qualified Native Hawaiian health scholars who understand what cultural compatibility is and give service in a very culturally sensitive manner."

In many ways, that is already happening in such programs as the one begun by Santiago under Queen Lili'uokalani Trust that has the contract for Healthy Start.

Up the valley not far from the Healthy Start headquarters in the Hau'ula Shopping center, a lo'i on property owned by Lili'uokalani Trust, is being worked by families in the program. Santiago believes that those served, and those serving, can learn from one another. Many on staff now are former program participants.

While Healthy Start is aimed at preventing child abuse in families at risk, what it's doing in Hau'ula is strengthening families by building on their culture. "We all get in there and get dirty together," says Santiago of the taro patch.

"Our team developed culturally based care for Hawaiian families. It means things like not having to rush them on a visit. Taking them out to the lo'i. We're trying to integrate the culture into child abuse prevention and focus on what is happening in the family, not what's not happening."

In the past five years, the program has helped hundreds of families, and it adds another 75 each year. Referrals come from doctors, the hospital and other agencies.

For Santiago, who was a ward of the Queen Lili'uokalani Trust herself as a teen because of problems at home, intervention was life-saving. "There were social workers who were very nurturing," she said. "The positive role models came at the right time. The only place I could reach out to was the place I'm now working."

Pride gets in the way

On two mornings each week, Iwalani Moore, 42, points the Queen's Medical Center's blue Taurus north on the H-1 freeway and heads out through the expanse of pineapple fields on the leeward plain to modest homes of patients suffering from HIV.

Many are so sick they see few people, except Moore and social worker Pat LaFleur, who visit weekly to make sure medications are delivered on time, and appointments with psychologists are made. Only a handful of doctors and a few psychologists will see HIV patients, Moore said.

"They stay in their own homes because no care homes will take them," said Moore, a nurse practitioner with a master's degree who works in the HIV Community Care program for Native Hawaiians at the Queen's Medical Center. "Sometimes, we're the only people they see on an ongoing basis.

"The mothers, the homeless, the straight men, a lot of Native Hawaiians, fall through the cracks. Many of them are isolated because they've had the illness so long, and they've lost their friends to the disease. Or sometimes, family and friends get tired of being around."

From Wai'anae to Waialua, Kalihi to Makakilo, she and LaFleur cover 300 or more miles a week. Almost one-quarter of their clients are Pacific Islanders.

"Native Hawaiians are really proud about asking for help. And there's shame for the family," she says. "So a lot of times they don't seek care until literally the end. We have one man in his 30s who didn't reach out for help until just recently and now he has wasting syndrome and chronic diarrhea. He can't eat, and he's literally by himself."

After a decade on public assistance, it was the scholarship program that made it possible for Moore to go back to school for her degree. With the monthly stipend and tuition payments, she earned a bachelor's degree, then a master's degree in nursing, and became one of the first AIDS-certified registered nurses in the state.

But as a single parent, it also meant a commitment for her seven children, who picked up extra responsibilities to make it possible. "I sat down with them and said 'Are we in this together?' and they said 'Absolutely.'"

A new life

On Kaua'i, Cashmire Lopez, 46, is about to complete her master's degree in nursing. Now she's an acting instructor at Kaua'i Community College and will soon become a formal instructor of nursing. It means a better life for her family, the chance for others to learn the profession close to home, and the opportunity to make an impact on the health of her own people. It also means she's no longer dependent on welfare.

It's a long way from 1993 when she had to move to O'ahu for classes at the University of Hawai'i at Manoa, leaving her four kids on Kaua'i with her mother. "I came home on weekends in the beginning," she said. "But toward the end of the semester that got harder to do."

Lopez is also planning a diabetes education program partly because of what she sees both in the community and her own family. "I want to look at chronic diseases, especially diabetes," she said. "There are so many Hawaiians dying because of it. And many are so young."

Without the scholarship program, Lopez may not have reached as high. By the time she decided she wanted a master's, the Outreach College meant she could sit in a Kaua'i Community College auditorium and listen to a Manoa classroom lecture by computer link.

"I could keep my job, stay with my kids, have time with my grandkids and still be able to do my coursework."

Lopez's commitment has borne fruit in her own family, too. Her eldest daughter is in special education; her youngest is a college freshman studying social work and shooting for a master's, too.

Just like mom.