Ha'ilono (to tell the news)
Newsletter of the Native Hawaiian Center of Excellence
John A. Burns School of Medicine
Volume 1, September 1999
University of Hawai'i at Mänoa
Senior Editor: 'Iwalani Else
A Message from the Director,
Benjamin Young, M.D.
Former Congressman Lou Stokes from Ohio was the catalyst for
federal funding leading to the establishment of 25 Centers of
Excellence throughout the United States. The University of Hawaii
(JABSOM) was one of the 25 that was initially funded in 1991.
The Centers of Excellence were charged with the development of
programs which would improve the health of minorities, specifically,
with Native Americans, Hispanics, and African Americans. Thus,
centers were instituted at schools such as Stanford, New Mexico,
Mississippi, Texas, and at many Historically Black Institutions
like Howard, Meharry, and Morehouse. These programs aimed at
increasing the numbers of those committed to working in underserved
communities, at improving the access to faculty positions for
upcoming medical educators, at making an impact on medical school
curriculum to reflect cultural values, and in directing students
and faculty to do more research in matters affecting the health
of minorities.
At JABSOM, we are very fortunate in recently receiving funding
to carry on the work with Native Hawaiians. Increasing the applicant
pool in health professions falls under the mantles of Ms. Iwalani
Else (O'ahu) and Mr. Kaloa Robinson (Neighbor Islands). Dr. Doric
Little focuses on student development. Dr. Shannon Hirose-Wong
heads up the research area. Ms. Janet Hesson is assisting with
the development of a clearinghouse for information on subjects
related to the health of Hawaiians. We will soon be hiring someone
to assist with curriculum development and with the training of
fellows.
Besides our first Native Hawaiian Center of Excellence (NHCOE)
conference in September 1999, we will be conducting several workshops
per year and will be contacting all Native Hawaiian physicians
and students to take part in these conferences (at our expense
of course!) to be held over the next three years. These conferences
will cover such exciting topics as "Medicinal Plants,"
"Conflict Resolution," and utilizing activities such
as surfing and paddling to maintain healthy states.
Finally, a future issue of the Pacific Health Dialog will be
published by our Center of Excellence and this is an initial
call for papers for this journal destined to be released in the
year 2001!
Welcome to our new offices!
At the end of April 1999, the NHCOE office moved to Biomedical
Sciences Building rooms B-204 and B-205. The rooms were cleaned
and the walls received a fresh coat of paint in the color of
University of Hawai'i industrial off-white. Each and every staff
member of the NHCOE helped paint the offices. Everyone has done
their part to make the office inviting for students, staff and
faculty alike. Dr. Young, an avid woodworker, sanded and polished
the koa paneling you'll see in the B-204 entrance way. Dr. Little's
husband Jim generously donated the ti-leaf and awa plants. We
still have a lot to do, but everyone is welcome to visit our
new home!
Native Hawaiian Center of
Excellence Conference
"Issues Affecting The Health of Hawaiians"
September 10-12, 1999
King Kamehameha Hotel, Kona, Hawai'i
The NHCOE is hosting its first conference
entitled: "Issues Affecting the Health of Hawaiians."
The conference will be held on September 10-12, 1999 at the King
Kamehameha Hotel in Kona, Hawai'i. Department chairs and selected
faculty and staff from the John A. Burns School of Medicine and
other guests have been invited to participate. The purpose of
the conference is two-fold: 1) to provide faculty and staff of
JABSOM insight into health issues Native Hawaiians face today
and 2) to introduce the NHCOE, its mission, staff and services.
Castle Medical Center is offering continuing medical education
(CME) credits to physicians who attend the conference.
Anticipated Agenda/Speakers
Friday, September 10, 1999
7:45-8:15 p.m.
Native Hawaiian Center of Excellence
Staff Presentations
8:15-9:15 p.m.
"The Impact of Disease on Hawai'i's
History"
Richard Kekuni Blaisdell, M.D.
Saturday, September 11, 1999
9:00-9:05 a.m.
"Overview of the Health of
Hawaiians"
Mele Look, M.B.A.
9:05-10:00 a.m.
"Risk Factors in Cardiovascular
Disease among Hawaiians"
Raymond Itagaki, M.D.
10:15-11:15 a.m.
"The Native Hawaiian Heart
Health Initiative: Overview"
N. Emmett Aluli, M.D.
"Moloka`i Cardiovascular Risk Screening (CRC) and Intervention"
Phillip W. Reyes, M.D.
"The Native Hawaiian Heart Health Initiative: What We are
Learning and What We are Planning - Interfacing with the University"
Phillip W. Reyes, M.D.
N. Emmett Aluli, M.D.
JoAnn Tsark, M.P.H.
11:15-12:15 p.m.
"Native Hawaiian Mental Health
Research Development Program"
Naleen Andrade, M.D.
Sunday, September 12, 1999
8:30-9:15 a.m.
"An Oncologist Reviews Lung
and Breast Cancer in Native
Hawaiians"
Clayton Chong, M.D.
9:15-10:15 a.m.
"Diabetes Mellitus and Intervention
Programs to Effect Changes in Lifestyle among Hawaiians"
Marjorie Mau, M.D.
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Where
are they now?
Feature on Lawrence P.A. Burgess, M.D.
by Benjamin Young, M.D.
Colonel Lawrence P.A. Burgess is
the Chief of Surgery at Tripler Army Medical Center and graduated
from the United States Military Academy at West Point. He is
one of our own Native Hawaiians and following his career at the
John A. Burns School of Medicine (Class of 1980), he completed
his Otolaryngology training at Tripler, followed by a fellowship
in head and neck surgery at Stanford. Over the years, Dr. Burgess
distinguished himself with appointments as Professor of Surgery
at the Uniformed Services University of the Health Sciences,
at Bethesda, Maryland and at JABSOM, and is also the Otolaryngology
Consultant to the Surgeon General of the United States Army.
He has co-authored over 50 articles, book chapters and books
in his field. He also serves as a Senior Examiner for the American
Board of Otolaryngology.
Dr. Burgess attended Kamehameha, Punahou, and the Mercesburg
Academy in Pennsylvania but returned to Hawaii and graduated
from Roosevelt High School. His wife is Beth Ann, an elementary
level teacher at Kamehameha. He and Beth Ann are strongly committed
to the development and nurturing of young Hawaiian children.
He enjoys spending time in Beth's class giving anatomy lectures
or teaching chess. He also serves as a chaperone with Beth for
the Kamehameha elementary school choir. Dr. Burgess is an avid
golfer (Caution! His handicap is 7). He also enjoys fishing,
and was part of a team that won the prestigious Haleiwa Jackpot
by landing a 822 lb. marlin. Although he was always a class leader,
he was probably most noted at JABSOM for a disguised and camouflaged
smile thus giving him a notorious reputation as a very tough
poker player!
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The
Imi Ho'ola Post-Baccalaureate Program
by Nanette Judd, M.P.H., Ph.D.*
Are you interested in becoming a
physician and serving in Hawai'i or the broader Pacific region?
Since 1973, the Imi Ho'ola Post-baccalaureate Program, at the
University of Hawai'i's John A. Burns School of Medicine, has
provided this opportunity to over 3000 individuals from Hawai'i,
Guam, Micronesia, and American Samoa. The Imi Ho'ola Program
(those who seek to heal) is currently recruiting candidates for
the upcoming 2000-2001 school year.
Imi Ho'ola is a twelve-month program which offers a wide range
of educational experiences that prepares participants for the
challenges of medical school. The curriculum integrates concepts
in the sciences and humanities, and further develops communication
and problem-solving skills. Through seminars, lecture, and workshops,
participants develop critical thinking and learning skills, interact
with medical students and faculty, and meet other health care
professionals.
The application deadline for the 2000-2001 class is December
30, 1999. Eligible candidates are those from a disadvantaged
background who have strong potential and are highly motivated.
Candidates must also have demonstrated a commitment to serve
areas of need in Hawai'i and the Pacific. If you want to be a
part of the tradition of excellence and have a desire to serve
the community, call Agnes Malate or Dr. Nanette Judd at (808)
956-3466, or write to:
University of Hawai'i at Mänoa
John A. Burns School of Medicine
Imi Ho'ola Post-Baccalaureate Program
1960 East-West Road, Biomed C-203
Honolulu, HI 96822
*Dr. Judd is the director of
the Imi Ho'ola Program.
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A
warm welcome to Native Hawaiian first year medical students!
KRISTIN FERNANDEZ
Kristin Fernandez has a variety of interests. A graduate of Kamehameha
Schools, Kristin dances hula, participates in church activities
(including teaching younger student catechism), is active in
sports, especially running, swimming and volleyball. After high
school, she attended Notre Dame and graduated with a double major
in pre-medicine and French. After completing her degree, Kristin
returned to Hawai'i and started working at the Straub Foundation
where she designed and maintains a computerized vascular registry.
Concurrently, she pursued a Master's degree in Biomedical Sciences
at the University of Hawai'i at Mänoa. In that program she
focused on Molecular Biology and Genetics. Her research background
includes human DNA studies, characterizing jellyfish venom and
hypothesizing "Integrin-Associated Mechanisms in the Pathogenesis
of Hantaviral Diseases." Kristin was led to the field of
medicine by her interest in science and by the health status
of her family. She is interested in pediatrics and clinical research
and hopes to integrate both areas in her future practice.
ROXANNE FIGUEROA
A graduate of Baldwin High School on Maui, Roxanne Figueroa developed
an interest in medicine from her son, Kekoa. When Kekoa was younger,
he built up immunity to several of the prescription medications.
Confused and frustrated, Roxanne was determined to not only to
know, but have a detailed understanding of what was happening
with her son. After working at a furniture store, in Circuit
Court and at Kamehameha Schools, Roxanne went to college full-time.
She started off at Maui Community College and worked her way
to the University of Hawai'i at Mänoa where she completed
a Bachelor's Degree in Zoology. After finishing her degree, she
participated in the Imi Ho'ola Post-Baccalaureate Program. Roxanne
enjoys powerwalking, step aerobics and singing. She is very proud
of her son. Kekoa is now 12 and is an avid basketball player
who just scored five 3-pointers at a recent game. Roxanne believes
that with perseverance, you can overcome any obstacle.
ALIN LEDFORD
It is hard to summarize the variety of Alin Ledford's accomplishments
and interests. While a student at Castle High School, he spent
a year in Chile as an exchange student. His ability to speak
Spanish paid off. After a year at BYU Laie, Alin went on a mission
to Uruguay for the Mormon Church. While he was there he assisted
with rural health and first aid. Once back in the states, he
married his high school sweetheart Heidi. They moved to Utah
where he earned a degree in medical technology. Alin was also
active in the Air Force Reserves with an air mobility unit assigned
to the front line. After returning to Hawai'i, Alin worked at
Queen's hospital and went back to BYU to complete a B.S. in Biology.
While at BYU, he received a research scholarship to investigate
antimicrobial effects on mamillian bacteria in the purple sea
urchin (wana). Kathleen Durante, M.D. was a role model and supported
Alin pursuing medicine. He worked for Dr. Durante for 5 years
as the back office nurse. Alin and Heidi have three children:
Bryson (6), Kilihea (4) and Courtney (5 months - whom he delivered!).
He trains horses and his future interests include neurosurgery
or trauma surgery.
STEVEN LUM
Interest in science is what led Steven Lum to medicine. After
graduating from Occidental College in Pasedena California with
a B.A. in Biology, Steven returned to Hawai'i to work at Queen's
hospital in Pathology for a more in depth experience in science.
He worked in the gross department and helped prepare specimens
and biopses. While working at Queen's, Steven returned to school,
this time at the University of Hawai'i's Master's Program in
Biomedical Sciences. He worked with Dr. Caan, a genetics researcher,
in the Haumana program for graduate students. While working in
Dr. Caan's lab, he helped screen native birds for malaria which
lead to his project "Detecting Malaria in Native Birds."
Steven enjoys rollerblading and is also an avid movie buff who
was, at one time, considering film school. His medical interests
are in neurology, forensic pathology and psychiatry.
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Ma'i
Öku'u - Ka Pae'äina's Greatest Epidemic: Some Persistent
Controversies and a new one.
by Richard Kekuni Blaisdell, M.D.*
It is said that in 1804, Kamehameha's
army of 7,000, poised on O'ahu's shores to cross Ka'ie'iewaho
channel and invade Kaua'i on a second attempt, was abruptly devastated
by ma'i 'öku'u (squatting sickness). (1) Although the conqueror
himself survived the explosive diarrheal illness, 5,000 to 175,000
people reportedly died throughout Ka Pae'äina (the Hawaiian
Archipelago). (2) Among the lonely warrior's many dead chiefs
and their families were two of his most trusted war counselors,
Ke'eaumoku (father of Ka'ahumanu) and Keawe-a-Heulu (great grandfather
of Kaläkaua and Lili'uokalani). (3)
Because of this catastrophic pestilence in 1804 and the earlier
Ka'ie'iewaho channel illwind of 1796, which capsized Kamehameha's
initial Peleleu armada, the people of Kaua'i rightly claim that
their island was never conquered by the Great Conqueror. (4)
Controversy continues in modern times over two main issues -
the nature of the epidemic and the number of persons who succumbed
in this historic disaster. (1,2) A third question is raised in
this article: Is there valid evidence that Kamehameha also contracted
ma'i 'öku'u?
Crucial in judgment are the sources - Kanaka Maoli (Indigenous
Hawaiian) and western, the timing of these accounts and the evidence.
The earliest "reports" of the great epidemic were undoubtedly
Kanaka Maoli and oral since the then "pre-literate"
c350,000 natives hosted fewer than c50 foreigners at that time.
Thus, written Kanaka Maoli accounts had to await literacy and
journalism skills of the indigenous people. These attributes
were not attained until 30-plus years later, beginning in 1835.
The writings were by US missionary-taught Lähainäluna
School student reporters who interviewed older, native observers.
(5)
Rev. R. Tinker's translation of
the students' "second-hand" reports into English in
1839 reads: "Around 1802 on O'ahu, Kamehameha was seized
by a malignant epidemic then common, from which he recovered,
but which proved fatal to a multitude of his subjects. The majority
of inhabitants were cut down. No proper care could be taken of
the sick. Men well in the morning were dead in the evening. This
sickness, called kau okuu (squatting time), greatly diminished
the population." (5)
Also in 1839, one of the students, David Malo, whose father served
under Kamehameha, reported that the epidemic began 11 years earlier,
extended over a long period of 9 years and was of holocaust proportions:
"In the reign of Kamehameha, from the time I was born (1793)
until I was nine years old (1802), the pestilence mai ahulau
(heaped bodies) visited the Hawaiian Islands, and ka pau nui
ana (majority) of the people from Hawaii to Niihau died. . .
. Only 26 (sic) persons were left alive." (6)
Another, but younger, Lähainäluna student, Samuel Kamakau,
who began writing at about the same time, cited reported clinical
details with Kamehameha and his associates as victims: "It
was a very virulent pestilence, and those who contracted it died
quickly. A person on the highway would die before he could reach
home. . . . The body turned black at death. A few died a lingering
death, but never longer than 24 hours. If they were able to hold
out for a day they had a fair chance to live. Those who lived
generally lost their hair, hence the illness was called po'o
kole (head stripped bare). Kamehameha contracted the disease,
but managed to live through it. . . . His counselors all died,
and many of the chiefs and their families. There died also at
this time at Kapopo in Koko (O'ahu), Ke'eaumoku, the man who
was chiefly responsible for Kamehameha's rise to power. . . .
At Ka'a'awa in Ko'olauloa (O'ahu), died another of Kamehameha's
great war leaders, Keawe-a-Heulu. . . . the last of the four.
. . who suffered and gave their lives for the uniting of the
kingdom under Kamehameha." Also affected was high chiefess
Kapi'olani who accompanied Kamehameha to O'ahu. "She caught
the disease and her hair fell out." (7)
Kamakau was born in 1815, 11 years after the epidemic of 1804.
His account was not published until 1867 in the Kanaka Maoli
Kuokoa newspaper. At that time, Kamakau speculated that the highly
fatal acute diarrheal disorder was due to cholera, a diagnosis
that others have supported and opposed, as described below. However,
a century passed before Kamakau's writings were translated into
English by Mary Kawena Pukui and published by the Kamehameha
Schools in 1961.
The third native writer on ma'i 'öku'u, John Papa 'Ï'ï,
was close to Kamehameha, and yet left an ambiguous account. Born
in 1800, 'Ï'ï was 7 years younger than Malo, but 15
years older than Kamakau. Unlike those writers, he had intimate
knowledge of Kamehameha and the royal family. 'Ï'ï
was hanai (given) to his uncle Papa who was kahu (attendant)
of Kamehameha. Papa placed young 'Ï'ï in the household
of the king's son, Liholiho, so that 'Ï'ï was reared
in the royal court. However, 'Ï'ï apparently did not
begin to write about historical events in 1866, at age 66, for
the newspaper Kuokoa, and then for only 4 years until his death
in 1870. It was not until 1959 that 'Ï'ï's writings
were translated into English, also by Mary Kawena Pukui, and
published by the Bishop Museum. (8)
'Ï'ï could have been only 3 or 4 years of age at the
time of Kamehameha's illness of which he may have written more
than 60 years later: "In late 1803 or early 1804, while
he (Kamehameha) was living with the chiefs at Halaulani, Waipi'o,
Ewa (O'ahu), the king became ill. . . . When he recovered under
the treatment of Papa, his medical kahuna, he returned to Honolulu.
. . . This was shortly before the 'öku'u epidemic."
'Ï'ï did not specify the nature of Kamehameha's illness
at that time. It would appear that 'Ï'ï did not consider
it to be ma'i 'öku'u then. 'Ï'ï also described
Ke'öpüolani, the king's highest born wife, as being
seriously sick at that time, but the nature of her illness also
was not stated. Ke'eaumoku was identified then, but not as afflicted,
so he presumably had yet to die from ma'i 'öku'u when Kamehameha
was described by 'Ï'ï as ill.
In a later section of his writings, 'Ï'ï referred to
the "terrible ma'i 'öku'u," as occurring two years
later in 1806, with "the great death rate when the epidemic
spread among all of the chiefs and commoners of these islands."
He cited this debacle as the reason for the establishment of
heiau ho'öla (healing temples) by Kamehameha for "special
training of promising members of his Court in Honolulu as medical
kahuna."
All of the western references to the epidemic were also indirect.
The earliest account in 1804 was by Russian explorer Capt. Urey
Lisiansky who landed on the island of Hawai'i desiring to visit
Kamehameha. Upon learning that the king was on O'ahu and that
an epidemic was in force, Lisiansky bypassed O'ahu, reached Kaua'i
on June 19, 1804, and wrote of his meeting with Kaua'i ruling
chief Kaumuali'i: "I informed him (Kaumuali'i) that the
king was present on Wahoo (O'ahu); and that he would have been
at Otooway (Kaua'i) long ago, but for an epidemic disease, which
had spread amongst his troops, and would perhaps oblige him to
relinquish his conquests, and return home." Later, Lisiansky
noted: "By [Kamehameha's English advisor] Mr. [John] Young's
account, the forces of Hamamea (Kamehameha) now consist of about
7,000 natives and 50 Europeans." (9)
The second haole account, in 1806, referred to a "former
calamity." It was published in 1817 for British Capt. William
Mariner: "We came to anchor in Anahooroo (Honolulu) Bay.
. . . the chief of the island, hearing of a sick man on board,
refused permission to enter the close harbor, being afraid of
introducing disease into the country, which calamity had happened
on a former occasion, from an American ship." (10) The date
and nature of the "former calamity" were not recorded.
The third foreign record, in 1807, identified yellow fever as
the responsible disease. The author was sea trader Isaac Iselin
who visited Kealakekua and wrote: "The depopulation is evident
and may. . . be accounted for . . . by a kind of epidemic of
yellow fever, said to have been brought. . . a few years ago,
and which makes dreadful havoc amongst the natives."
This was the first mention of yellow fever and no supporting
evidence was given. (11) We now know that yellow fever is manifested
by abrupt headache, backache, fever , vomiting of blood and jaundice.
Thus, the name of the infection - yellow fever. The disease is
caused by a virus which requires transmission by only certain
mosquitoes, such as the Aedes aegypti which is not found in Ka
Pae'äina. (12) The common non-Aedes mosquito, apparently
was not introduced to the islands until 1826. (13)
In 1847, US merchant James Jarves wrote: ". . . the great
pestilence of 1803 destroyed multitudes, and has been supposed
to have partaken of the character of the Asiatic Cholera. . .
Three hundred bodies were carried out to sea from Waikiki in
one day." (14) The Pacific Commercial Advertiser newspaper
in 1862, (15) Honolulu physician Arthur St. Mouritz in 1935 (16)
and State of Hawai'i statistician Robert Schmitt in 1970 (2)
pointed out that (western) physicians studying earlier descriptions
of eye witnesses also reached a diagnosis of cholera. A rapidly
spreading, diarrheal syndrome with collapse also fits with the
highly contagious fecal-oral transmission pattern of the cholera
vibrio bacterium. (12) Further, cholera is reported to have reached
California from Asia in the early 1800s. (2) However, the only
well documented epidemic of cholera in Ka Pae'äina was in
1895 when 64 Känaka Maoli died. (2)
Honolulu chronicler Thomas Thrum in 1897 wrote that an old time
Kaua'i resident spoke of natives' descriptions of ma'i 'öku'u
on that island "very much resembling the black plague. .
. . It probably had its origin by contagion from China through
the sandalwood trade." (17) Black skin discoloration in
ma'i 'öku'u, described by Kamakau, could have been due to
the cutaneous bleeding of bubonic plague. However, profound diarrhea
is not characteristic of the plague. Rather, "bubo"
(large painful lymph nodes) from the plague bacillus inoculation
by the bite of a rodent flea, muscle pain and fever with pneumonia
are the cardinal clinical features. (12)
Since the 1970s, microbiologist historian O. A. Bushnell has
championed typhoid, bacillary or amebic dysentery as the most
likely cause of ma'i 'öku'u. (1) He points out that the
dominant manifestation of ma'i 'öku'u, reflected in its
distinctive native name, was prodigious diarrhea. He then reasons
that long before 1804, hundreds of sailors aboard ships arriving
from over the world had ample opportunity to introduce fecal
pathogens, such as typhoid and shigella bacilli, that, he believes,
eventually caused the massive ma'i 'öku'u. Those virulent
microorganisms, spread among residents who were customarily careful
about disposing of their excrement, for long remained hidden.
However, Kamehameha's Peleleu cramped bivouac conditions for
7,000 men unleashed these microbes from the large quantities
of exposed human excrement and polluted the limited drinking
water and food of the armada on the sands of O'ahu.
In addition to the foregoing estimates of mortality, London missionary
William Ellis in 1822 and 1823 (18) and US missionary Levi Chamberlain
in 1828 (19) described evidence of rapid depopulation within
the previous 30 to 50 years due to two epidemics. Chamberlain
wrote that "more than half of the population. . . was swept
away. . . . Greater was the number of the dead, than of the living."
The highest figure was given by the Advertiser in 1862: "The
most reliable accounts and verbal traditions state that the plague
took off more than one-half of the population . . .[and] the
population was reduced in two years from 350,000 to 175,000."(15)
Demographer statistician Robert Schmitt has argued that the death
toll for ma'i 'öku'u has been much exaggerated. He believes
that this inflation resulted from: (1) an overestimated pre-ma'i
'öku'u population figure for 1778 at the time of the arrival
of Capt. James Cook; (2) depopulation due to other factors, such
as, famine, warfare, infanticide, venereal and other infections,
infertility and migration, (3) the inclusion of all of the islands,
whereas, ma'i 'öku'u was confined to O'ahu and only to Kamehameha's
troops. Schmitt concluded that the total number of deaths from
ma'i 'öku'u in 1804 was "probably well under 15,000
(out of perhaps 35,000 or 40,000 on O'ahu at the time). If only
Kamehameha's troops were affected, the mortality was certainly
not over 5,000."
On the other hand, history analyst David Stannard considers the
island population at the time of Capt. Cook's arrival to have
been double, not half, the figure given by Cook's Lt. James King.
Stannard also calls allusions to "infanticide" erroneous.
(17) Others point to the evidence that epidemics involved all
of the inhabited islands, including Kaua'i. Yet the precise nature
of most of these outbreaks was not clear in those times of old.
Given (1) the lack of detailed first-hand observations, by health
professionals as well as affected persons, at all of the sites
where ma'i 'öku'u allegedly occurred in the early 1800s,
(2) the inconsistencies and (3) the absence of reliable demographic
data, it would seem that uncertainties and controversies over
the nature of ma'i 'öku'u and the death toll will continue.
Similarly, although all previous writers on Kamehameha apparently
have accepted that the warrior king also contracted, but survived,
the ma'i 'öku'u of c1804, critical reanalysis of the most
reliable account, that of court-insider John Papa 'Ï'ï,
now casts serious doubt on that long perpetuated assumption.
Unchangeable, however, was the profound impact of this early
19th century catastrophe on Kamehameha's military attempt to
conquer Kaua'i and unite Ka Pae'äina under his rule, its
key role in the rapid decline of the old society and the lasting
scar in the collective wailua (soul) of the Kanaka Maoli people
and nation.
References
1. Bushnell, OA. 1993. The Gifts
of Civilization. Germs and Genocide in Hawai'i. Univ Hawai'i
Press.
2. Schmitt, Robert C. 1970. The Okuu - Hawaii's Greatest Epidemic.
Haw Med J. 29:359-364.
3. Kamakau, Samuel M. 1961. Ruling Chiefs of Hawaii. (Translated
by Mary Kawena Pukui). Kamehmeha Schools Press.
4. Joesting, Edward. 1984. Kauai. The Separate Kingdom. Univ
Hawaii Press, Kauai Museum Assoc.
5. Ka Moolelo Hawaii. 1839. The Hawaiian Spectator. 2:225.
6. Malo, David. 1951. Hawaiian Antiquities. (Translated by Nathaniel
B. Emerson, 1898). Bishop Museum Press.
7. Ii, John Papa. 1959. Fragments of Hawaiian History. (Translated
by Mary Kawena Pukui. Edited by Dorothy B. Berrere). Bishop Museum
Press.
8. Lisiansky, Urey. 1814. A Voyage Round the World in the Years
1803-1806. John Booth and Longman, Hurst, Rees, Orme and Brown.
9. Martin, John, MD. 1817. An Account of the Natives of the Tonga
Islands. . . compiled and arranged from the extensive communications
of Mr. William Mariner. 10. Iselin, Isaac. 1808. Journal of a
Trading Voyage Around the World 1805-1808. McIlroy and Emmet.
11. Jong ED, McMullen R. 1995. The Travel and Tropical Medicine
Manual. Saunders.
12. Hardy, DE. 1960. Insects of Hawaii. Univ Hawai'i Press.
13. Jarves, James J. 1847. History of the Hawaiian or Sandwich
Islands. 3rd Ed. Charles E. Hitchcock.
14. No Ka Mai Ahulau. Ka Nupepa Kuokoa. February 28, 1863. Translated
by Sarah Nakoa. Archives of Hawaii. Hawaiian Journalism. Pacific
Commercial Advertiser, March 5, 1863.
15. Mouritz, A. 1935. Our Western Outpost Hawaii.
16. Thrum, Thomas G. 1897. Hawaiian Epidemics. Hawaiian Almanac
and Annual for 1897.
17. Stannard, David E. 1989. Before the Horror. The Population
of Hawai'i on the Eve of Western
Contact. Social Science Research Institute, Univ Hawai'i.
*Richard Kekuni Blaisdell, M.D.
is a faculty member of the John A. Burns School of Medicine and
an expert in Hawaiian history.
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Small
Pox
by Benjamin Young, M.D.
The Hawaiian word for Small Pox
is ma'i pu'upu'u li'ili'i (the sickness with many little pimples).
The summer of 1853 was an especially tragic period in Hawai'i's
history. The Hawaiians on O'ahu were overwhelmed and decimated
by Small Pox and an accurate number of those who perished will
never be known. Remarkably the islands of Ni'ihau, Moloka'i and
Läna'i escaped unscathed probably due to natural isolation,
vaccinations, and a very stringent quarantine.
It was the English physician Edward Jenner who observed that
milkmaids who caught the mild disease cowpox, did not develop
the dreaded and disfiguring disease of small pox. Jenner artificially
infected patients with material taken directly from the pustules
of sick cows. This process became known as "vaccination"
from the Latin word for cow, vacca. In fact, the town in Northern
California, "Vacaville" could be translated as "cow
town."
The scholar, Abraham Fornander, well known for his history of
the Polynesian people, came down with the disease in July, 1853.
Like many of the diseases that swept Hawai'i, nearly all the
victims were Hawaiians. At one point in downtown Honolulu, the
bodies were piled high one on top of each other and with few
available to bury the rotting corpses.
RECRUITMENT
(O'ahu & Neighbor Islands)
Increase the number of Hawaiian students (K-College) considering
a medical profession
RETENTION
Provide medical students with skills to help them through medical
school
FACULTY DEVELOPMENT
Prepare Native Hawaiian physicians to serve as medical school
faculty
CURRICULUM DEVELOPMENT
Introduce Native Hawaiian health issues into the medical school
curriculum
RESEARCH
Develop research skills in both students and faculty and aid
them in conducting research on Native Hawaiian health care issues
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RECRUITMENT
O'ahu
by 'Iwalani Else
It is the end of a busy summer!
This year a group of six Native Hawaiian high school students
from Hilo participated in the NHCOE sponsored Medical Science
Summer Program (formerly the SPEBE program). The program utilizes
Problem-Based Learning, labs and guest speakers to introduce
participants to the field of medicine. The students spent four
weeks at the School of Medicine and lived at the University of
Hawaii dorms. These students are our future physicians, physical
therapists, and EMT's (see Kaloa Robinson's article for further
discussion).
The end of summer also marks the beginning of recruitment for
the 1999-2000 academic year. The upcoming year is filled with
visits to talk with high school and college students from around
the state of Hawaii. We have a full schedule and will be coming
to an area near you!
It is also time for prospective medical students to apply to
JABSOM. Many applicants have been stopping by for help with their
application, interviews, pre-requisite courses and any questions
they have about the long, and often times arduous, application
process to medical school.
On August 11, 1999, the Problem-Based Learning (PBL) Demonstration
showcased JABSOM's curriculum to prospective students, applicants
and those interested in how PBL works. The next PBL Demonstration
will be held on December 20, 1999. If you are interested in attending,
please call Iwalani Else at 956-6576.
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RECRUITMENT
Neighbor Islands
by Kaloa Robinson
The NHCOE Hilo office was directly
involved in this past summer's Hilo Youth Summer Employment Training
Program (HYSETP) at Hilo High School. The class was comprised
of 12 students entering grades 10-12. The instructors for the
class were recent UH Hilo Nursing students. The NHCOE Hilo office
had worked with Instructors Shauna Sherlock and Elizabeth Markt
on several other health activities before during their tenure
here at UHH. When the opportunity became available, it was a
perfect match for these recent Bachelor of Science Nursing students
to continue their leadership skills as instructors and role-models
for the students. HYSETP participants were involved in career-shadowing
activities every week, became CPR/First Aid certified, and were
exposed to in-depth subjects involving general biology and biology.
The NHCOE Hilo office will continue outreach with these students
during the school year.
As mentioned above, the NHCOE Mänoa office sponsored the
Medical Summer Science Program. This program consisted of six
native Hawaiian students from the Hilo area. These students learned
about Problem-Based Learning, had the opportunity to view the
dissection of a human brain, and had several guest lecturers
discussing issues pertinent to students their age. Students had
the opportunity to simulate life as a freshman at UH Mänoa
and they were able to experience life as a first-year medical
student.
Outreach to the various high schools throughout the neighbor
islands will continue this year. Hilo, Honoka'a, Kealakehe, Kohala,
Konawaena, Pähoa, and Waiäkea high schools will continue
on the island of Hawai'i; Baldwin, King Kekaulike, and Maui high
schools will continue on the island of Maui; Moloka'i high school
on Moloka'i; and Kapa'a high school with outreach beginning with
Waimea high school on the island of Kaua'i will start this fall
semester.
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RETENTION
by Doric Little, Ed.D.
The initial planning meeting of the "Junior Kauka Organization"
will be held this Fall. Coordinated by Doric Little, NHCOE staff,
Kim Burnie, Native Hawaiian Health Scholarship Placement Program,
and Natalie Relles, MS IV, this group plans to form an Association
of Native Hawaiian Medical Students to affiliate with the `Ahahui
o Nä Kauka, the Association of Native Hawaiian Physicians.
In addition to Relles, Burnie and Little, the Planning Team includes:
A Native Hawaiian Physician (to be announced), Celeste Frietas
(MS 3), Paul Kaiwi (MS 2), Kristin Fernandez (MS 1), Dr. Shannon
Hirose-Wong (NHCOE), and 'Iwalani Else (NHCOE).
Update on some of the Native Hawaiian
Physicians who have been assisted by the NHCOE while students
at JABSOM:
Daniel Garcia, M.D. - Returning
to Maui having completed his residency at Kaiser, San Francisco,
in Internal Medicine. Dr. Garcia will be based at the Maui Medical
Group and will serve as the Medical Director of the Native Hawaiian
Health Care System.
Momi Ka'anoi, M.D. - Serving as
a resident in Family Practice, Hawai'i and is currently working
in the Marshall Islands.
Alean Cook Palmer, M.D. - Serving
as a Resident in Family Practice, Hawai'i.
Kelli-Ann Voloch, M.D. - Serving
as a Pediatric Resident, Hawai'i.
Joy Jurek, M.D. and Bill Thomas,
M.D. - Serving as Internal Medicine Residents, Hawai'i.
Angela Pratt Poomaihealani, M.D.
- Serving as Resident in OB/GYN, Hawai'i.
Chris Wood, M.D. and Ray Teramoto,
M.D. - Serving as Residents in Psychiatry, Hawai'i.
Scott Johnson, M.D. - Serving as
General Surgery Resident, Hawai'i.
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RESEARCH
Shannon Hirose-Wong, Ph.D.
Many exciting things are underway
in the research component. Projects include:
*Survey of Hawaii Physicians*
Shannon Hirose-Wong is still mentoring Celeste Freitas and David
Mattson (Native Hawaiian MS-IIIs) on this project which seeks
to identify 1) ethnicity of Hawaii's physicians to assess the
number of practicing Native Hawaiian physicians, 2) location
of physician practice to determine the extent of service by Native
Hawaiian physicians in underserved areas, and 3) type of practice
as either primary or non-primary care in order to identify ways
to improve healthcare services for Native Hawaiians.
Celeste and David are currently writing up the "findings"
section of the project. We expect a final report to be completed
by October 1999.
*New Research Seminars*
As part of the effort to increase the participation of Native
Hawaiian medical students in research, Shannon Hirose-Wong is
working with Dr. Kenton Kramer of JABSOM's Office of Medical
Education to develop a series of research seminars for medical
students. In an effort to provide students, primarily MS-Is,
with BASIC knowledge of research to assist them with their Community
Medicine Projects, a series of seminars that will provide medical
students basic research design, methodology, implementation,
epidemiology and biostatistics while exposing them to Native
Hawaiian research and health issues is currently being designed.
Throughout the course, research design, methods and implementation
will refer to studies relating to Native Hawaiian health concerns.
Throughout units 1-3, this 3 part series of seminars will be
offered once a week beginning Tuesday, September 7, 1999.
*Clearinghouse on Native Hawaiian
Health Issues*
A clearinghouse, by definition, is an office that collects and
disseminates information. To assist researchers doing work on
Native Hawaiian health issues and disseminate research on Native
Hawaiian health issues, the research component of NHCOE is working
on creating a Clearinghouse devoted to Native Hawaiian health
issues. The Clearinghouse will serve as means for researchers
to conduct literature searches on Native Hawaiian health issues
and provide exposure for work done on Native Hawaiian health.
NHCOE's Janet Hesson and summer hire Ani Au are designing a database
to run literature searches via this website and collecting materials
to be included in this database. Both print and non-print materials
(e.g. conference presentations, websites, datasources, etc.)
will be included in this website. Once the database is established
guest writers will be recruited to compose "digests"
on current Hawaiian health topics. If you have materials or references
that you would like to include in the clearinghouse please contact
Janet Hesson, or Dr. Shannon Hirose-Wong.
*Telemedicine Project*
Dr. Loren Yamamoto of Kapi'olani Women and Children's Hospital
is working with, and mentoring NHCOE's fellows, Dr. Ming Tim
Sing and Dr. Cathy Bell, through a telemedicine research project
sponsored by the NHCOE. The project, Advancing the Applicability
of Telemedicine for Rural Tertiary Consultation Access, seeks
to: 1) Simplify telemedicine infrastructure and operations using
portable self contained multimedia laptop computers. 2) Improve
immediate telemedicine access to specialty consultants using
wireless telemedicine links and pocket computers. 3) Add scientific
evidence related to telemedicine in Hawaii to improve rural access
to tertiary care consultants to ultimately improve Native Hawaiian
health.
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Organizing
Hawaiian Physicians
by Peter Donnelly, M.D.
Ahahui O Nä Kauka, the Association
for Native Hawaiian physicians, is a new non-profit organization
that was incorporated in April 1998. The commitment to create
`Ahahui o Nä Kauka came out of Ka `Uhane Lokahi, the 1998
Native Hawaiian Health and Wellness Summit, held at Kapi`olani
Community College in March. Twenty-two Hawaiian physicians voluntarily
attended a session where fellowship was formed; presentations
were heard; thoughts and ideas were exchanged. By the end of
the session the feeling was unanimous - Hawaiian physicians need
to organize and actively participate in efforts to improve the
health and wellness of the Native Hawaiian people.
In recent years, it has become clear that minority physician
groups have been influential in helping to address the health
and wellness needs of their people. Examples of such groups nationally
are the Association of American Indian Physicians (AAIP) and
the Association of Black Cardiologists (ABC). Locally, the Philippine
Medical Association of Hawai`i (PMAH), established in 1978, has
built a strong membership and has become influential in promoting
and improving the general welfare of Filipino physicians and
the Filipino community in Hawai`i.
`Ahahui o Nä Kauka is being formed to provide an avenue
for Hawaiian physicians to participate in improving the health
and wellness of the Hawaiian people. Allopathic (M.D.) and osteopathic
(D.O) physicians of Native Hawaiian ancestry (no blood quantum
requirement) are eligible for Active membership and are expected
to constitute the core of the `Ahahui. Non-Hawaiian physicians
who have a shared interest in the mission of the `Ahahui are
eligible for Affiliate membership.
The mission of `Ahahui o Nä Kauka is twofold:
1. To help reverse the alarmingly poor health status of Native
Hawaiians, and then,
2. To sustain a healthy, thriving native population.
Other agencies and organizations are already working on Native
Hawaiian health care issues. The `Ahahui will not duplicate these
efforts. The intentions are to increase physician involvement
in current efforts, work in collaboration with existing groups
to achieve mutual goals and initiate new projects as necessary.
To contact the `Ahahui, write to:
`Ahahui o Nä Kauka
222 Merchant Street, Suite 206
Honolulu, HI 96817
Website: www.kauka.org
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