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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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Dr. Aaron Kauhane can’t get sick. Charged with keeping Lanai’s 3,000 full-time residents healthy, Kauhane works at the two acute-care bed Lanai Community Hospital with partner Dr. Jon Gasper. Together they cover clinical care, emergency room visits, extended care, and dispense medicine as pharmacists.

When his partner goes on vacation, says Kauhane, “that means I have to cover the E.R. a week at a time by myself, 24 hours a day.” Forget about catching up on sleep the next day. Clinical duties beckon. “My partner and I are the only medical clinic on the island. That’s why the turnover is so high.” Doctors last an average of three to four years on Lanai before moving on to other positions.

Kauhane has completed two years of his commitment to the Native Hawaiian Health Scholarship that put him through osteopathic school, and is not sure what he will do when he finishes. Though his family lived with him on Lanai for the first year, his wife and two children have since moved back to Oahu for work and school and the support of extended family. Kauhane commutes between islands.

“It’s challenging,” the 35-year-old admits of the frequent travel, separation from family and constant demands at work. “But I’m really trying to balance everything out.”

Spiritual rewards facilitate that equilibrium. “Even if I didn’t have the scholarship, I think this would have been hands-down the job for me,” says the Punahou School and Whittier College graduate. “As a family medicine physician, it has everything that I trained for. We cover the full spectrum of life.”

A typical day begins at 8 a.m. with clinical visits. Between patients, he’ll walk down the hall to the pharmacy to process prescriptions. Whoever is on call must “drop what we’re doing” to deal with any emergency that arises a few hundred feet away. “We play physician, pharmacist, case manager, social worker … dealing with medical conditions from top to bottom.”

Emergencies are never simple. If a person has a stroke, for instance, Kauhane will call Hawaii Air Ambulance. The patient is put on a triage list. Maybe he’ll get med-evacuated, maybe not. It depends on the caseload for the Air Ambulance, which can’t cover every island at any given moment.

Furthermore, women are not supposed to deliver babies on Lanai, but Kauhane and his partner typically deliver three to six babies each year. “That’s probably our biggest challenge,” he says. While expectant mothers are supposed to go to Maui or Oahu two to four weeks before they’re due, financial limitations can derail plans. If family isn’t available to provide room and board elsewhere, women will stay on Lanai as long as they can, showing up in the E.R. when they go into labor. Sometimes the window of opportunity to med-evac them slips away. So mother and infant risk remaining in a hospital ill-equipped to handle obstetrics emergencies.

Kauhane is committed to lobbying for the means to have a third physician work on Lanai so they can avoid rescheduling appointments or making elderly patients wait for their medication if one doctor becomes ill or must travel. His top priority is to keep the quality of service high. “I want to be here as long as I can be,” he says. “I want to make sure we have a system in place to meet the needs of the community.”


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Honolulu Magazine March 2019
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