Leadership Corner: Chiyome Leinaala Fukino, M.D.
Interviewed by Catherine E. Toth
Advertiser Staff Writer
Name: Chiyome Leinaala Fukino, M.D.
Age: 54
Title: Director
Organization: State Department of Health
High school: Kamehameha Schools
College: Bachelor of arts in psychology, Brandeis University; medical degree, John A. Burns School of Medicine, University of Hawai'i-Manoa
Breakthrough job: Fukino learned how to manage different kinds of people and balance finances as an administrative assistant for the student council at Brandeis University.
Little-known fact: As director of the state Health Department, Fukino is also the mayor of Kalawao County, which comprises Kalaupapa.
Major challenge: Dealing with medical issues specific to minority groups, in particular Native Hawaiians, in the state; letting the public know what the department does; and addressing the problem of an aging workforce.
Q. Hawai'i has long been considered a healthy state. Is that a misconception?
A. When the health statistics come out for the state, people say, "Wow, look at this, Hawai'i is a pretty healthy state." That's great, but the fact of the matter is that that's an average in our statistics. Comparing our population base with the rest of the nation, we do very well. But there are minority groups, subsections of the population, that don't do very well. Native Hawaiians are certainly one of these groups.
Q. You've been active in addressing the health issues of Native Hawaiians, including your involvement with E Ola Mau, a nonprofit organization of Native Hawaiian healthcare providers. What are the major issues in this particular ethnic group?
A. The poor health of Native Hawaiians wasn't something that was developed five or 10 years ago. It's been decades. We've made some strides, but we still have more work to do. And with each new wave of immigrants that come (to Hawai'i), there are issues pertaining to health from a public health standpoint. Many come from nations not as well developed, so they bring with them diseases ... And they come from areas that have almost no healthcare system to speak of.
Q. What are some strides that have been made to address the health issues among Native Hawaiians?
A. The first stride you have to make is recognizing there is an issue because you can't address it until you recognize there is a problem. I think data collection by the Department of Health has helped to give a clearer picture of what's going on. The E Ola Mau study done in the mid-1980s through funding that Sen. (Dan) Inouye had gotten from Congress documented for the first time the socioeconomic status of Native Hawaiians. And part of that (looked at) their health status. The other thing the (UH) Medical School can be very proud of is the fact that they were able to educate Native Hawaiian physicians who returned to the community to help. So we needed to have an awareness that there is a problem, we needed to have a group of people who were interested in treating that problem, then we needed to have the commitment of resources to deal with it.
Q. How important is cultural sensitivity when administering healthcare, especially in Hawai'i?
A. We have good healthcare coverage in the state because of the prepaid healthcare act and also our Medicaid coverage. But having coverage doesn't necessarily mean you will access care. So the important thing is to be sure that services are provided in a culturally appropriate way so that people are willing to go in and get those services. And that's another thing about this medical school that has been very good for the state. Part of the training emphasizes cultural sensitivity. And it's not just about minorities, but it's about how to understand certain groups of people, how they see the world and how we can talk to them because that's what it's all about, being able to communicate.
Q. Is the department often misunderstood by the public?
A. The public doesn't know what the Department of Health does. Part of that has been the (role) that it took historically. Nobody wanted to hear about big governments. The department actually does a lot of really good things for the people of Hawai'i, but we just don't advertise. Somehow we need to let the people of Hawai'i know what it is that we do, what their tax dollars are paying for. Public health at its very best is often invisible. If we are monitoring and keeping the water, the air, the streams and the beaches clean, you don't hear about us. If you think about it — and I actually had somebody tell me this — the only time you hear about the Department of Health is when something is going wrong. But the truth of the matter is lots of things go right. That's one of our challenges.
Q. What are other challenges your department is facing?
A. Another challenge we have, like other departments, is the fact that our workforce is aging. There aren't that many people who want to go into public health because it doesn't pay that well ... This is truly a service occupation. You have to want to do it because you really love it.
Q. What do you want people to understand about healthcare?
A. We, in the Department of Health, want people to understand that they have to assume more personal responsibility for their health. In America, everything is fast. Fix it with a pill or an ointment. And the fact of the matter is chronic diseases are often a result of not paying attention to the things that we have to do on a day-to-day basis to help us stay healthy.
We get so caught up in the fast pace of living that we're not enjoying life and we forget to take care of ourselves. The end result is you start getting the consequences of a combination of your diet, exercise habits and gene pool, manifesting in chronic diseases. We have to get across a tough message that most people don't want to hear. And that is we are all responsible for healthcare.
We have to take better care of ourselves so that the government doesn't have to take care of you later. Because then, you'll have no choice.
