As I walked out of the gate and lugged my oversized carry-ons down the escalator, it welcomed me. Not the Hawaiʻi sun that enveloped my entire body like a warm blanket, but the sweet fragrance that perfumed the air. This smell was all too familiar, prompting the same question that I ask myself upon each initial smelling of the plumeria leis that fill the airport, “How did I ever leave this place?”. Although I remind myself of the answer to this question each time, my mind can’t help but wonder what life would be like if I stayed in my home on the island of Maui.
I have been fortunate enough to receive a higher education at Santa Clara University, and upon hearing about the Jean Donovan Fellowship, I knew that I would pursue this opportunity with Hawaiʻi in mind. This summer I will be working with Hawaiʻi Primary Care Association, whose mission is to improve the health of communities in need by advocating for, expanding access to, and sustaining high quality health care through the statewide network of Community Health Centers. The island of Maui is home to the Mālama I Ke Ola Community Health Center. Mālama, translating “to take care/ to save,” and I Ke Ola translating to “a life”, embody the health center’s dedication to patient-centered care. They remain committed to the cause of healthcare access for all and believe that a strong primary care infrastructure is imperative for the island communities. Community health centers are the cornerstone of the healthcare system in Hawaiʻi, providing essential services to the most vulnerable. It is for this reason that I am overwhelmed with both elation and nervousness to begin my fellowship on Monday.
Although I am not entirely sure of what my fellowship duties will entail until my first day, my supervisor, Dr. Nead, and I have compiled a list of tasks. A general overview of these duties would include myself assisting with amassing and organizing resources, obtaining quantitative and qualitative data about at-risk populations, and case-management in the behavioral health clinic. More specifically, I will be involved with the newly-implemented OBGYN program for high-risk pregnant women and working closely with the prenatal case manager. Additionally I will analyze medical records for demographic information and highlighting care gaps. We will use Adverse Childhood Experiences (ACEs) as a way to help inform and improve this care. Thirty-five percent of the health center’s patients suffer with social or behavioral problems that require professional intervention. This problem is most pertinent to minorities, as many lack access to essential resources and are not seen in behavioral health settings. The scope of my responsibilities will also encompass research into the ways health care professionals can increase contact with these underrepresented groups, through direct care and education. Mālama offers a full range of healthcare services vital to Maui’s rapidly growing community, and I look forward to working with the different departments and producing a handout library that will respond to each of their psychoeducation needs.
Through my fellowship placement, I am looking to augment my interests within public health and psychology, while also giving back to a community that has shaped me. The word “paradise” is more often used as a synonym for “Hawaiʻi” and this perpetuates the idea that Hawaiʻi is perfect, a fallacy which is far from the truth. There is a discrepancy between the conception of Maui from those who visit for a week and those who have been born and raised on the island. This limited perspective paints a poorly-illustrated picture of Maui, as there are numerous disparities within the local populations. With a total population nearing 120,000, there is no public transportation system to connect the sparsely populated rural communities of the island to the resources found in central Maui. My ultimate goal of this fellowship is to challenge this conception of paradise and exhume Maui county’s pressing healthcare needs. Upon each return home, I discover something new. Whether it be new infrastructure, a new person, or a trail that reveals a new view of the island on which I have lived for more than 18 years. The construction and the growing amounts of people contribute to the fragility of the ecosystem, and these expansions threaten the symbiosis of the island and its native people. This fragility and unpredictability, I believe, represents the current healthcare system, and epitomizes my choice to work with Mālama I Ke Ola Health Center and its employees committed to building the future of healthcare.
-Kendra Laʻakeaokamahina Bean