Ko'olauloa to get health clinic
By Eloise Aguiar
Advertiser Windward O'ahu Writer
Jeff Dierling, a diabetic, knows the fear of living with a health problem and no medical insurance.
Deborah Booker • The Honolulu Advertiser
It has forced him to wait until he has an extremely high blood-sugar count — a condition that could lead to coma — before seeking treatment at a hospital emergency room.
Joseph Naeata, 4, of La'ie, undergoes a physical exam by Dr. Miriam Chang at her office in Kahuku. Chang will be primary physician for the Ko'olauloa district's new clinic.
"I wound up in Kahuku emergency room on a weekly basis," said Dierling, explaining that he couldn't afford insulin or treatment and knew he could die if he allowed himself to go into a coma. But his only option was to wait until he was in crisis before seeking help at the emergency room. "I can remember times of lying on the beach crying, 'What the hell am I going to do?' "
A community health clinic like the ones in Waimanalo or Wai'anae could have treated Dierling, 35, for free but he didn't know about them. Now with residents in the Ko'olauloa district planning to open a similar clinic in their area within months, help could be on the way for Dierling and others like him.
The Ko'olauloa Community Health & Wellness Center Inc. has applied for a $650,000 federal grant that would be used to treat the uninsured, but the clinic will open whether the money comes through or not.
With its isolation and few available medical services, Ko'olauloa was designated a medically underserved area last year. But medical treatment in the district from Ka'a'awa to Pupukea also suffers because of the number of low-income families — roughly one-third of its population — as well as a medically uninsured rate that tops the state average and a large number of Pacific islanders who may face language barriers or cultural problems when they seek treatment.
Rick Spencer, a board member for Kahuku Hospital, said the hospital supports a community health center. Not only would it provide care for the uninsured, but it could also save them costly visits to the emergency room once they do become very sick and can't put off medical care.
"It's something a rural community, especially one that has relatively high unemployment, needs," Spencer said. "There's a lot of medically unserved people out here who wait until they're dying in order to use hospital services. It's better to get ahold of them and do some kind of care so they don't run up these extravagant costs in the hospital."
The hospital does provide low-cost healthcare at $20 a visit, and Spencer said he could see that service merging with the health center.
The Hawai'i Primary Care Association, a nonprofit group that focuses on providing a variety of health services for the underserved population in Hawai'i, estimates that there are 120,000 people in the state without insurance, said Beth Giesting, executive director.
Hawai'i has seen its rate of uninsured people double in the past two decades, from 5 percent of the population in the 1980s to 10 percent in 2001 (still good enough to be ranked No. 8 nationally).
Ko'olauloa is one of the districts where low income keeps people from receiving adequate healthcare, Giesting said. Added to that are the high number of Pacific islanders who live there and may have a communication problem because they don't speak English well or a cultural problem accepting Western medical treatment, she said.
But the health centers are sensitive to these problems, she said.
"The health centers are the safety net, catching the folks who otherwise fall between the cracks," Giesting said. "If they're not there, people who need health services are most likely to seek it at the emergency room because emergency rooms can't turn them away."
Moloka'i, Kona move ahead
The 11 community health centers in Hawai'i treated 73,500 patients last year, but there still is a need for more and expanded services, such as dental care or mental healthcare, Giesting said. Moloka'i is expected to open a center soon, and the Kona district of the Big Island is working to open a center by next year, she said.
"I think with the addition of services in Ko'olauloa (and Moloka'i and Kona), most of the underserved areas will have some service," she said. "But that is not the same as saying the services are adequate in every area."
Still there are other communities that could benefit from the medically underserved designation, including parts of Waipahu, Wahiawa and Hale'iwa, she said.
In requesting the medically underserved area designation, the state Department of Health estimated that Ko'olauloa, with a population of about 22,468, had a poverty level of 36 percent, or about 8,000 people, said Loretta Fuddy, chief of DOH Family Health Services Division.
"The multicultural composition of the population and isolated pockets of immigrants in single-family homes, farms and ranches form the basis of many cultural and linguistic barriers to primary care and public health information," Fuddy wrote in an application for the designation.
The health factors she listed to indicate need include a 6.91 percent infant mortality rate compared with the state average of 6.43 percent. There was also a 20.4 percent inadequate prenatal care rate, compared with the state average of 14.7 percent, and a 31.1 percent rate of pre-existing health conditions in mothers, compared with 29.2 percent.
Board organized last year
Although the idea of a community health center in Ko'olauloa has been discussed for at least five years, it wasn't until last January that a board of directors was organized, said Molly Maxwell-Stribling, president of the Ko'olauloa board. A kupuna council will help guide the center.
Maxwell-Stribling said that having been homeless and uninsured at times, she represents the homeless as well as the uninsured in organizing the clinic.
"I'm the person who speaks for people in the bushes," she said.
The center will provide services to the medically insured as well as the uninsured, Maxwell-Stribling said. It also will be a resource site where people can obtain information about other services, much like the Wai'anae Coast Comprehensive Health Center does.
Wai'anae's health center, which has 10 clinics in Leeward O'ahu and Waipahu, provides dental and mental healthcare, training at a health academy, transportation, cultural healing options and case management in which clients' basic needs such as housing, education and family relations are also tracked.
"It's a lifeline, not only health-wise but economic development wise," said Joyce O'Brien, associate director. "That's the case for Wai'anae. We're the major employer in Leeward."
The Ko'olauloa center has many of its components in place, including Hawaiian and Samoan healers, community resources and community support. Plus it can tap into state resources and support from the Hawaii Primary Care Association.
Dr. Miriam Chang, who has an office at the Kahuku Sugar Mill, will become the primary physician for the new health center, which will operate out of her present location.
Chang, who grew up in Kahuku and returned to the Islands two years ago, said she knew little about community health centers but immediately saw the benefits for the district, which she estimated had an uninsured rate of greater than 10 percent.
The center should know by March whether it qualified for the grant, she said.
Reach Eloise Aguiar at eaguiar@honoluluadvertiser.com or 234-5266.
