Healing Native Lives

Students seek to heal through the 'Imi Ho'ōla
post-baccalaureate program that helps the disadvantaged
enter the John A. Burns School of Medicine

Cover Story

"People are sometimes much more trusting, if they believe you are connected to them. The more I can help patients open up, the more I can get information that will help in making a good decision," says Kong.

Kong's experience underlines one of the main aims of 'Imi Ho'ōla. The post-baccalaureate program, which Kong attended, cherry-picks applicants from disadvantaged backgrounds who demonstrate that they have excellent minds for the healing arts as well as heartfelt commitment to the medically underserved Hawai'i and Pacific communities that they call home.

Known to help less-than-impeccable academic performers live up to their genuine potential, the program launches students into the University of Hawai'i's John A. Burns School of Medicine -- where 'Imi alums have acquitted themselves well with a 77 percent graduation rate and career choices that have taken them back to their roots, as promised.

"(Our 'Imi students) are carefully screened for their personal qualities. The ones who get in have altruistic motives for studying medicine. They aren't training to do cosmetic surgery in Beverly Hills," says Chessa DeCambra, an 'Imi Ho'ōla Program Assistant.

While the program doesn't apply racial or ethnic criteria in selecting disadvantaged students, nearly half of its 417 graduates since 1975 have Hawaiian ancestry. Kong was among four Native Hawaiians from the 2005 'Imi program who are in the UH medical school class of 2010, which has an overall enrollment of 16 students of Native Hawaiian ancestry -- a number that is not only unprecedented in Hawai'i's only medical school but is also noteworthy because it may help to offset what has historically been an under-representation of Native Hawaiians in top-flight medical professions.

The continuing success of 'Imi Ho'ōla and related scholarship assistance programs comes at a critical juncture. While the federally-mandated Native Hawaiian Healthcare Systems are in place to improve wellness education and access to care, the state's indigenous population continues to experience disproportionately high rates of chronic diseases -- notably cancer, diabetes and cardiovascular disease.

Natalie Kong, left, and fellow 'Imi Ho'ōla graduate Kapua Medeiros are now in their second year at the UH medical school. Blaine Fergerstrom photo.

The relationship between health and ethnicity is a complex matter, but it is clear that the disparities in native health status need to be addressed by physicians who can balance Western medical practice with Hawaiian values, says Dr. Kalani Brady, an associate professor of Native Hawaiian health at the UH medical school. "Western medicine's heavy emphasis on clinical measures can "reduce a person to his or her biology," notes Brady, while traditional Hawaiian medicine "took into consideration the spirit or na'au'au of the person." Brady calls the extreme social isolation of Hansen's Disease patients in Hawai'i a "blazing example of bad outcomes from a lopsidedly Western approach" and part of a long, sad history that has contributed to Native Hawaiian discomfort with standard medical practice.

Natalie Kong recalls that sense of discomfort a young child, when her family took her to see doctors at the only health center that served the Waimānalo Hawaiian Homestead land, where she grew up. "It seemed like a dark, neglected, scary place," she says, adding that she often went there with family members who were suffering from what she terms "the typical Hawaiian diseases" including cancer. "Someone has got to change this, I thought. And one day I just blurted out, 'I'll be a doctor.' "

Kong's parents supported her ambition, but they also told her that she would have to look for scholarship help, because they wouldn't be able to afford tuition. Then as an undergrad at University of Hawai'i at Mānoa, Kong split her major between pre-med and music -- unwittingly putting herself at a disadvantage in the tight competition to get into the UH medical school, which accepts only 55 out of 1,900 applicants a year . This is where 'Imi Ho'ōla came to Kong's rescue.

The 'Imi application process involves jumping through several hoops -- tests, interviews and essay writing, plus the lining up of financial aid packages that are not provided directly by 'Imi Ho'ōla. But all this work is nothing compared to the challenge of being in the program, which uses an innovative "problem-based learning" curriculum. This means students collaborate in small groups to diagnose complex "paper cases."

"You and your group have to figure out the best possible conclusion, given what everyone brings to the table. It's hard, because no one tells you that you have to accept a certain belief, but this is what it's like in the real world of medicine."

" 'Imi nurtures you as a person but it is no joke when it comes to the rigor," agrees Kapua Medeiros, 26, who also graduated from the 2005 'Imi program and joins Kong as one of the banner number of Native Hawaiians now in the second year at the UH medical school, where she also is a teaching assistant for an 'Imi anatomy class, helping newcomers brave their first lessons in the dissection of a cadaver.

Dr. Ming Tim Sing, standing, leads a group of 'Imi Ho'ōla students. From left, Kanoe-lehua de Silva, Leah Wang, Seabrook Mow and Nicole Baumhofer. Blaine Fergerstrom photo.

"Coming here, I was ready for anything, even though I didn't look good on paper," says Medeiros, who graduated at the top of her Kamehameha class but then struggled to maintain a decent G.P.A. as a biochemistry major at the Ivy League's Dartmouth College in Hanover, New Hampshire.

The fierce academic competition might have dampened the spirits of a less determined student, but Medeiros, who also grew up on Hawaiian Homestead land, the daughter of a Kaua'i fireman, in Anahola, had already demonstrated a remarkable aptitude for mixing the lā'au lapa'au of her ancestors with advanced lab science. While still in high school, she developed a way to extract an anti-cancerous compound from papaya seeds and won a national science prize for the project. "I considered becoming a researcher in natural products, but this would have required being tied to a research institution somewhere far away from the Native Hawaiian population, where I want to share my work," she says.

Notwithstanding their passion to serve their own communities, 'Imi Ho'ōla's Native Hawaiian students may find in the future that they are up against some greater ailments in thenational healthcare system.

Hardy Spoehr, Director of Papa Ola Lōkahi, an organization created in 1988 under a federal mandate to improve native health in Hawai'i, says that the high costs of medical malpractice insurance and the lack of affordability of high-tech medical specialties care are challenging both family doctors and small hospitals to stay in business. This is especially so in rural and neighbor island communities, where the state's Native Hawaiians live in high concentration and are more likely to be underinsured or uninsured. "There has always been a direct correlation between the disparities in health status and social and economic struggles," says Spoehr. "For Hawai'i's sake, we need to make sure that the state's economy can sustain Hawai'i's first people."

However, Spoehr is heartened by what he calls the "wellness awareness" of a younger generation of Native Hawaiians. "Think back to marathon races or health fairs 20 years ago. How many Hawaiians would participate in those events back then? Today, the numbers are way up."

Spoehr adds that the entry of more Hawaiian youths into medicine has coincided with policies to improve. Access to care, health advocacy and education for Native Hawaiians during the last two decades. It is also ensuring that health-care institutions pay more attention to "cultural competency." Cultural competency is the official policy term/buzzword for the effort to match cultural values of medical practitioners and patients, now a requirement under government regulations.

All of these developments correlate with noticeable trends toward reduced rates of chronic disease in younger Native Hawaiians -- even if the statistics seem stubbornly stalled, "Because health problems often change over the lifespan of a generation, it can sometimes take 20 years for improvements in health care to show up in the data," Spoehr says.

In the meantime, the Native Hawaiian alums of 'Imi Ho'ōla are even going beyond the call of the usual eight hours a day of study time to make sure that the medicine they practice will be better than what their parents might have known. Some have formed Kalama Kukui, a new support organization at the UH medical school for indigenous students from Hawai'i and throughout the Pacific.

Natalie Kong organized Kalama Kukui after returning from an international conference in New Zealand that highlighted health as an empowering and politicizing factor in the lives of the world's indigenous populations. "We want to get the word out that just because you are from Nānākuli, doesn't mean you won't even go to med school," says Kong.

As part of walking the talk, the Kalama Kukui will soon be supporting a mentoring project that pairs Native Hawaiian medical students with middle-schoolers from several island schools. Some UH med students will be doing all this, just as they prepare to take their first round of medical boards at the end of their second year.

Ironically, many are discovering that the time they put into medical studies isolates them from the people they dream of serving someday. "When your family and friends want you to go to dinner with them, you can't just up and leave," says Kapua Medeiros, explaining that her focus for the time being is brain surgery. "We're into the new unit on neuroscience. Cranium nerves are just so intricate," she marvels.

To make sure she doesn't lose touch with her roots, Natalie Kong recently enrolled in a lā'au lapa'au course under the direction of a local kumu. "I was feeling like I couldn't give it the attention it deserved so I wanted to withdraw, but (the kumu) talked me down. In the Hawaiian way of thinking, once you start something, you must finish."

Kong says she also draws strength from Hawaiian values in staying on course for the career of service that awaits her. "There is a sense of kuleana in Hawaiian culture. If I believe that health matters most, then I will do what I can to make sure I can care for others this way."