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The Honolulu Advertiser
Posted on: Sunday, February 13, 2005

Clinic brings care to Kahuku

By Eloise Aguiar
Advertiser Windward O'ahu Writer

KAHUKU — Three months after its opening, the Ko'olauloa Community Health & Wellness Center is averaging 750 patients a month, and 40 percent of them have no insurance.

The clinic opened in a converted trailer that sits in the parking lot of the old Kahuku Sugar Mill, and it has been inundated with patients since Nov. 1. Most who come are from the surrounding area, but the clinic draws people from the North Shore as well, said Irene Carpenter, president of the clinic's board of directors.

"We're completely maxed out as far as clients goes," Carpenter said. "We've already extended our hours to accommodate more clients, and we're looking right now as a board at the need for more space."

Donations and several hundred thousand dollars in loans made the clinic possible, Carpenter said, adding that there was doubt whether the community could afford to open the center.

"Everyone said this is a poor community, you'll never get it; they can't pull together," she said. "There was constant negative comments."

For Fetu Nakauciri, who has two pre-school boys and a baby on the way, the clinic provides the preventive care she and her children need. Nakauciri, 27, and her children have no medical insurance. She tried to get her children into Quest, a state healthcare program for low-income families, but she said she was turned down.

"We are really fortunate to have this," said Nakauciri, a stay-at-home mom whose husband just started a new job. "It's like a big blessing."

The clinic provides primary healthcare, hospital care, mental health counseling, pediatric care, some gynecology services and Hawaiian healing.

The uninsured are asked to make a donation for the services they are provided based on their income level. Some pay no fee because they don't earn enough.

Services were scarce

Medical care at the clinic is provided for residents in the area that stretches from Ka'a'awa to Pupukea and that includes the financially struggling Kahuku Hospital. Only about 11 primary-care physicians serve the population of about 19,000. Although O'ahu's uninsured rate is about 3.9 percent, 40 percent of the center's monthly visits are from people without insurance, Carpenter said.

An official at the Wai'anae Coast Comprehensive Health Clinic, where 20 percent of patients are uninsured, said that the Kahuku numbers underscore the needs of that community.

"There has been such an unmet need, especially out there, because your nearest community health center is Waimanalo," said Joyce O'Brien, Wai'anae clinic's associate director. "It's been desperately needed."

Unable to secure a federal grant for a community health center, the board decided to move ahead because of the need and overwhelming support for the clinic, Carpenter said.

"The health center was completely funded by community donations and loans from people in the community," she said. "But mostly, there was a whole bunch of people in the community who said we deserve this, and we're going to do it."

Establishing the center took two years of planning, numerous requests for financing and forging partnerships with local practitioners, some of whom like Dr. Miriam Chang and Dr. Harry Ashe "donated" their practice to the center. Chang also donated equipment, and her state grants to treat uninsured people were transferred to the clinic.

Chang, the center's executive/medical director, downplayed her role in getting Ko'olauloa going. She said it wasn't a big sacrifice for her because she hadn't been practicing long in Kahuku, having returned about three years ago from St. Louis, Mo., where she lived for 19 years. Her practice in Kahuku focused on treating the uninsured, Chang said.

Money remains tight

Setting up the center as a non-profit allows it to seek more grants and to tap into money available through foundations and other entities, she said.

The clinic keeps growing. Recently a psychiatrist who lives in the area agreed to see patients one day a week, she said, adding that this was just another example of Ko'olauloa residents' willingness to help one another.

"It keeps snowballing," Chang said. "Stuff like that just keeps happening. It's amazing who steps up to help build, to donate."

Ko'olauloa was designated a medically under-served area based on such indicators as poverty levels, the number of physicians, the elderly population and infant mortality rate, said Josh Hekekia, with the state Office of Rural Health.

Having the designation allows a community health center to apply for federal money to provide medical services to the needy, but federal grants are difficult to obtain, Hekekia said.

Federal officials look at infrastructure and the ability to provide services within 90 days of receiving money, he said. A center must provide primary health-

care including obstetrics/gynecology, internal and family medicine, and psychiatric services, Hekekia said, adding that dental service must be added within six months.

"It's difficult to get the funding without the infrastructure, and difficult to set up the infrastructure without the funding," he said. "Kahuku is trying to set up the facility without funding in hopes of getting that funding someday."

On average, Ko'olauloa clinic gets 750 visits a month, said Mike Hopewell, the clinic's financial officer. The center has received several state grants that were a carry-over from Chang's practice to treat patients without insurance, but that money is running out, Hopewell said.

"The demand exceeds what we have been funded for," he said. "But we continue to see those people."

Although money for the uninsured is tight, Hopewell is confident that the center can continue operating with its broad-base funding through patient revenue from co-payments, insurance reimbursements, donations and grants.

"It's not a one-shot deal: We operate for a while, we get a big grant or we go under," he said. "We're going to be able to operate long enough to have a good start, to continue."

Reach Eloise Aguiar at eaguiar@honoluluadvertiser.com or 234-5266.