A Healthy Future

Third in a 3-part series about health care on Molokai.

While Molokai has advanced healthcare facilities and a broad choice of providers compared to other small islands, health care professionals agree there’s still room for improvement.

One gap in services on Molokai is health care in the home, according to Molokai Public Health Nurse Kenneth Gonzales. This includes services like feeding and bathing for kupuna. Dr. Lorrin Pang, district health officer, said while it’s an important service, no one wants to pay for it. More and more people want to live and die at home, he added.

Improved home care is also on agenda for Na Pu`uwai. Executive Director Billy Akutagawa said he hopes to have fitness staff to visit kupuna at home and to offer more services for the homebound in the future.

Visiting specialists is another service Molokai health providers agree could be expanded. Molokai General Hospital (MGH) Vice President Randy Lite said specialists are hard to get because there are fewer patients to offset travel costs. .

Luckily, the technology to offer services without a specialist’s physical presence is being implemented. Telemedicine is a technology that allows medical information to be transferred remotely through audiovisual media. MGH President Janice Kalanihuia said MGH is already using telemedicine successfully, and is excited for the possibilities it provides.

On an island as small as Molokai, finding a balance between the number of patients and doctors available can be delicate. Dr. Kimo Alameda of the DOH is working with Molokai providers to find that balance through collaboration and communication. He stressed the importance of healthcare providers finding their niche in the system.

“Molokai doesn’t have many patients so you have to be careful with service overlap,” he said. 

Longtime Molokai doctor Paul Stevens said in his experience, Molokai has always been short on doctors. “I’ve been here over 50 years and it’s never been a crowd.”

Healthy Lifestyles
For many on Molokai, health doesn’t start at the doctor’s office – it starts as a part of everyday life. Akutagawa said people today would be much healthier if they reverted back to the Native Hawaiian diet of fresh, fat-free foods from their backyards and the active lifestyles of the old days.

Stevens agrees that changes in lifestyle may be the answer to a healthier island.

“Everybody should learn to take care of their own health as much as they can,” he said, adding that controlling obesity, smoking and diabetes could improve everyone’s health.

Akutagawa said that disease prevention is Na Pu`uwai’s target, and said they plan to work with communities around Molokai to build small fitness centers.

A healthy lifestyle is also the model of the Molokai Community Health Center. Executive Director Desiree Puhi said through education and an integrated approach to medicine, including alternative remedies and holistic approaches, she hopes to open a whole different way of looking at health.

Federal Changes
For Puhi, one priority is getting an island-wide electronic health record, which would allow a patient’s records to be accessed instantly by all island providers.

“Right now everybody works blind because it’s all on paper,” she said. ‘There’s a lot of duplication of tests.”

Federal mandates are already on their way to make electronic health records a norm across the country. The American Recovery and Reinvestment Act of 2009 offers incentives through Medicare to physicians using electronic records starting in 2011. Beginning in 2015, there will be financial penalties for hospitals and doctors that do not use the system.

Another upcoming federal change is the standard by which providers are reimbursed by insurance companies. Right now, reimbursement is based on the type of service provided – such as delivering a baby – according to Lite. Emphasis is on delivering a good service in as short a time as possible.

But soon, said Lite, reimbursement will be based on the quality of care provided to the patient. “Good outcomes will be paid more money.”

Finding a Balance
Molokai not only has the opportunity for the latest technological advances, but is balancing that with old fashioned community.

Molokai Drugs’ staff once counted pills by hand, but now a robot counts the pills and labels are printed at the press of a button, according to Judy Mikami.

“We have one foot in technology and one foot in tradition,” Mikami said. Pharmacy staff in the family business still hand checks the robot’s pill count, and there’s still a friendly face – not an automated voice – who knows your family’s medical history and explains your medication in person.

At the end of the day, collaboration among healthcare providers is the bottom line.

“I’d like for there to be a true Molokai health system, with all entities working together to agree what their niche is,” said Kalanihuia.

“Whatever the next big change, if we all work together and roll with the punches, we can make it happen,” said Claire Iveson of the Family Support Office.