The Country Doctors
Meet three doctors who’ve given up city comforts to serve Native Hawaiians in some of the Islands’ most remote areas.
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Care in these communities will only improve with more Hawaiian physicians entering the workplace. In 1975, the John A. Burns School of Medicine graduated its first four-year class. At that time, there were only 11 Hawaiian doctors on record. Since then, 178 Native Hawaiian physicians have graduated from UH’s medical school. About 130 Native Hawaiian physicians now practice in Hawaii, representing nearly all specialties.
Each community requires a singular combination of educated skill and intuitive cultural awareness. Doctors who have chosen this path say they are constantly learning. But judging from the outstanding Native Hawaiian professionals profiled on these pages, they also have much to teach.
MOMI KAANOI, M.D.
Dr. Momi Kaanoi’s patients tell her she looks like their daughter and sounds like their mother. But it still took time for the Native Hawaiian graduate of the John A. Burns School of Medicine to gain the trust of fellow Hawaiians who hadn’t seen a physician in years.
“Practicing on a Neighbor Island is so different,” says the 34-year-old Kaanoi, who attended Sacred Hearts Academy through 12th grade. “Science is the easiest part.” Rather, it’s the art of medicine that challenges her constantly, “the kind of stuff that’s not taught in med school. Really spending time developing relationships … that’s what’s important to them. I try to give them the respect, power and authority to make decisions themselves. But if they feel that you’re too busy, or you don’t have time, they won’t come back.”
For those who simply won’t visit the clinic, Kaanoi makes old-fashioned house calls. She integrates traditional remedies by working unofficially with a Hawaiian healer, supplementing treatments but never substituting therapy for life-threatening illnesses. Rewards for her services range from saving lives to a deep appreciation from the community she has altered forever.
It wasn’t an easy path. During her residency and fellowship through the Department of Family Practice, she prepared for her job on Kauai with rotations in Hana, Molokai, Hilo and the Marshall Islands. “I knew I was going to work on a Neighbor Island because the need is greater there,” she says.
Late in 2001, Hoola Lahui Hawaii, the healthcare system —that provides services to those in need on Kauai, hired her to help open a clinic in Waimea. She was the sole provider. For two years she saw patients full-time and also served as the clinic’s administrator, conducted research, gave speeches around the state about colo-rectal cancer, traveled to meet healthcare demands on the other side of the island, and began a new satellite clinic in Anahola. “I did it because it needed to get done,” she says. Yet she admits with a laugh, “I look back and think, how in the world did I do it?’”
Two new doctors now help Kaanoi in the Waimea and Kapaa clinics (the latter opened in April), but she still juggles her roles as provider and administrator at all hours, dealing with four interruptions that require immediate attention during a 45-minute interview. It’s no wonder. As director of both clinics, she monitors all medical, dental and behavioral health, which includes social work, substance abuse counseling and case management. She also serves as medical director of Hoola Lahui Hawaii.
“I have the energy and the passion for it; otherwise I wouldn’t be doing it,” she says. “It’s very rewarding.” Patients express their gratitude by bringing poi and chicken luau to the clinic. And Kaanoi says her immersion has led to a deeper understanding of her native language, culture and history.
Now finishing her third year of service in return for the Native Hawaiian Health Scholarship, she is not sure what the future holds. She is interested in pursuing her Master’s in Public Health in her ongoing efforts to create a model to improve care for Hawaiians across the state.
Kaanoi is articulate and modest, with a sense of humor vigorous enough to carry her through the most difficult times. But for years, she admits that she didn’t feel smart enough to become a physician. An adviser in college confirmed these insecurities, urging Kaanoi to avoid medicine. “I never imagined I would be a doc. There’s just something about feeling like you’re not good enough,” she observes, linking it to the humility inherent in the culture. “Now, I love to go out into the community; I love to tell kids, If I can do it, you can do it!’”
Spending time that each patient requires and deserves while keeping clinics financially sustainable is the ultimate artistic endeavor. There’s little doubt that Kaanoi is up to the task. “It feels like it’s been a calling,” she says. “Everything that’s happened…is meant to be.”
BILL THOMAS, M.D.
Dr. Bill Thomas could easily think of the local supermarket on Molokai as his second office. Even in the produce section, the requests keep coming: “Did you get my lab test back?” or “I need more of that medicine, the small white one.”
He’s invited to many luau, which become opportunities for an impromptu clinic or a casual inquiry about a friend’s diabetes—sensitive confidentiality issues he must evade in a lighthearted manner. “In small towns, the culture of the community is different, and you sort of have to work within that,” says Thomas, a former restaurant manager who began his formal education at age 30 at Kapiolani Community College. He then progressed to the University of Hawaii, and graduated from medical school at the University of Massachusetts.
A query about what he does in his free time elicits a long pause. “Sometimes I go for three weeks without a day off,” he admits. He wants to start fishing, but confesses he hasn’t “seen a fish—except at the store.”
The patients cherish his dedication. Soon after he arrived, word spread that a Native Hawaiian—who speaks and understands Hawaiian—had come to town. People who hadn’t visited a physician in years came for a check-up. Accustomed to a revolving door of doctors, they asked if he planned to stay. “I kind of thought it would be unfair to the community to come in, work for a short amount of time, and then leave,” he says. Though the 44-year-old is obligated to stay one more year to fulfill his Native Hawaiian Health Scholarship requirement, he says he bought a house and has no plans to leave.
Consequently, free time may continue to elude him. One of three internists, Thomas takes call about 10 days each month, duty that sometimes requires 24-hour shifts. He’s the hospital’s chief of staff, consultant to the diabetes care program, and the medical director of Na Puuwai, the Native Hawaiian Healthcare System for Molokai and Lanai. He also covers the emergency room two to three days per month, and directs long-term care.
Treating a multitude of chronic illnesses such as diabetes, heart disease, lung disease, asthma—and polishing his pediatric skills, as well—can spell exhaustion without a break for recovery. “Some nights you’re in the hospital most of the time,” he says, “and that can be kind of draining.”
Yet the community’s gratitude always revives him. “The people are so appreciative of everything I do,” he says. Everyone says hello; they constantly include him. “I don’t feel like an outsider.”
Thomas has felt the island calling ever since he listened to legendary Molokai physician Emmett Aluli speak about practicing there. In a matter of days, recalls Thomas, “I knew it was a perfect match, and I didn’t apply anywhere else.”
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