Ha'ilono (to tell the news)
April 2000
Newsletter of the Native Hawaiian Center of Excellence
John A. Burns School of Medicine
Volume 3, April 2000
University of Hawai'i at Mänoa
Senior Editor: 'Iwalani Else
In This Issue
- Ha'ilono is Hawaiian for "to tell
the news" and is a publication of the Native Hawaiian Center of
Excellence (NHCOE).
-
- The NHCOE at the John A. Burns
School of Medicine (JABSOM) began in 1991 funded by a grant from
the U.S. Department of Health and Human Services. The creation of
the NHCOE allowed the consolidation of over 25 years of program
efforts for minorities in medicine into a coordinated,
comprehensive effort to increase the number of Native Hawaiians in
medicine.
-
- The Ha'ilono is partially
supported by the: Division of Health Professions Diversity, Bureau
of Health Professions, Health Resources and Services
Administration, Department of Health and Human Services. Its
contents are solely the responsibility of the Native Hawaiian
Center of Excellence at the John A. Burns School of Medicine,
University of Hawai'i and do not necessarily represent the
official views of the Health Resources and Services
Administration.
A
Message from the Director, Benjamin Young, M.D.
Progress in accomplishing our objectives at the Native Hawaiian
Center of Excellence (NHCOE) has been steady. We have improved the
awareness of the role of the NHCOE among faculty at the John A.
Burns School of Medicine. There is increasing appreciation of the
impact of numerous diseases upon the Hawaiian population. A
statewide network has already been established with numerous schools
and community agencies to attract young people to the health
professions. "Cultural Competency" is a new "buzz word" heard
throughout the nation. So, we are planning to hold our first meeting
of all Native Hawaiian physicians in August, 2000 on the island of
Kaho'olawe to examine this issue. Focus at that conference (many
more conferences to come!) will be on developing cultural awareness
and, in particular, ethnobotany. We also hope all participants will
gain an appreciation for the island's archeological sites which have
remarkably survived the years of deliberate decimation.
One issue of the Pacific Health Dialog
will be published by the NHCOE sometime in year 2001 and this is the
first call for papers on topics dealing with the health of
Hawaiians.
A symposium for all faculty and
community physicians is in the making.
We have not lost sight of our vision
and mission: to ultimately improve the health of all Hawaiians.
(back to top)
Highlights from the NHCOE 2000
Conference for Faculty
Despite a flight cancellation due to
inclement weather (the conference started on Saturday instead of
Friday), the second conference sponsored by the NHCOE for faculty of
the John A. Burns School of Medicine (JABSOM) was very successful.
The purpose was to provide faculty with an insight into the unique
health issues Native Hawaiians face today and familiarize them with
the staff and services of the NHCOE.
Continuing Medical Education (CME)
credits were provided to physicians attending the conference by
Castle Medical Center. A special thank you to JoAnn Sakuma from
Castle Medical Center's Education and Training Division for
facilitating CME credits and thanks to all who made this conference
such a success!
Presenters:
Dr. R. Kekuni Blaisdell, Dr. Marjorie Mau, JoAnn Tsark, Dr. Benjamin
Young, Dr. Edwin Cadman, Dr. Emmett Aluli and Dr. Raymond Itagaki.
CARDIOVASCULAR RISK FACTORS IN
NATIVE HAWAIIANS
Atherosclerosis remains a major problem in Hawaii. A change in
diet and a sedentary life style have led to marked obesity,
affecting nearly 45% of the Hawaiian population. The mortality of
Hawaiians is nearly 10 years less than that of Asian women in
Hawaii. The cost burden to the State is enormous, both in actual
cost and indirect costs, such as in lost wages and productivity.
Hypertension, diabetes, elevated cholesterol, sedentary life style
and smoking are all major risk factors, in addition to family
history. There seems to be a significant variability within basic
ethnic groups with respect to the prevalence and significance of
these risk factors. There is a need to define a long-term strategy
to deal with these issues.
John A. Burns School of Medicine (JABSOM)
graduates constitute approximately 66% of the active physicians in
Hawaii today. In just one generation, this school has already had a
major impact in the health care delivery in this State. There is a
need to define a strategy for health in the upcoming century, to
define action items and to crystallize the role of JABSOM in the
next century.
Presenter:
Raymond Itagaki, M.D. received a bachelor's degree in Meteorology
from San Jose State College. He then entered the United States Air
Force and served in the military from 1965 to 1971. He served in
Vietnam and received the Bronze Star Award. After returning to the
United States, he entered medical school graduating with the first
medical class of JABSOM in 1975. His residency in Internal Medicine
was at the University of Colorado and his Cardiology Fellowship was
at the University of Utah. He was named Chairman of the State of
Hawaii Task Force for the Prevention of Coronary Artery Disease in
Hawaii, and he serves on the HMSA Board of Directors. On several
occasions, he was awarded the "Excellence in Teaching" at JABSOM.
NATIVE HAWAIIAN HEART HEALTH
INITIATIVE AND MOLOKA'I PROGRAMS
This presentation is a comprehensive overview of cardiovascular
disease and risk factors among Native Hawaiians. The presentation
discusses the 15 year effort on Moloka'i to study the burden of
cardiovascular disease within that island community and the
development of culturally relevant interventions to address and
alleviate it. This Native Hawaiian Heart Health Initiative
integrates community resources on all islands with Native Hawaiian
physicians and is supported by national and local partners,
including the National Institute of Health - National Heart Lung and
Blood Institute, Moloka'i General Hospital, Na Pu'uwai, the Queen's
Health System, Papa Ola Lokahi, the Native Hawaiian Health Care
Systems, çAhahui o Nä Kauka, the Office of Hawaiian Affairs, the
Area Health Education Centers, the HMSA Foundation and others.
Presenters:
Noa Emmett Aluli, M.D. was in the first graduating class of the
John A. Burns School of Medicine in 1975. He completed his
undergraduate studies at Marquette University in Biology and
Chemistry, and following a year of the University of Hawai'i
Integrated Flexible Residency training, moved to Moloka'i to join a
Family Practice Clinic. He is a founding member of Na Pu'uwai, Inc.,
the Native Hawaiian Health Care System, and was the President of the
Board until 1997. With Dr. Phillip Reyes, he is the Co-Medical
Director of Moloka'i General Hospital. He is currently in private
practice on Moloka'i and serves as the Co-Medical Executive Director
at Moloka'i General Hospital.
Phillip W. Reyes, M.D. is a native of
the island of Moloka'i. He graduated from the University of Hawaii
with a degree in Zoology and entered the Imi Ho'ola program in 1979.
After graduation from medical school (JABSOM) he entered the
Internal Medicine Residency program at the University of Hawai'i and
then returned to Moloka'i where he was the Emergency Room Physician
and established the Out Patient Clinic at Moloka'i General Hospital.
He is the Medical Director of Na Pu'uwai, Inc., a Native Hawaiian
Healthcare System, and also is the Co-Medical Executive Director of
Moloka'i General Hospital.
THE HEALTH BURDEN OF DIABETES IN
NATIVE HAWAIIANS
Diabetes is a major health problem for Native Hawaiians (NH) and
is the 5th leading cause of death. Although diabetes was reported to
be associated with early morbidity and mortality in NH as early as
the late 1950's, small numbers, non-standardized methods, and study
bias limited these previous studies. The Native Hawaiian Health
Research (NHHR) Project, an ongoing epidemiological study since
1992, has provided probably the best epidemiological evidence
confirming the increased rates of diabetes mellitus and associated
risk factors in two rural NH communities. Experience and results
from the NHHR Project were used to launch the development of a
community-based diabetes lifestyle intervention for Native
Hawaiians.
The Native Hawaiian Diabetes
Intervention Program (NHDIP) collaborated with existing Native
Hawaiian Health Care Systems, community physicians, the Native
American Diabetes Project, the State Department of Health
Nutrition Branch and Queen's Hospital, among others, to develop a
diabetes lifestyle program to be administered by peer educators.
This program, entitled "Kulia Ola Kino Maikaçi" (strive for good
health), is the culmination of this partnership and was successfully
delivered to NH adults with, or at-risk for, diabetes in two rural
NH communities. Preliminary results of the NHDIP indicate that the
overall nutritional intake was relatively good based on national
standards. The diet was relatively low in fat, high in fiber, but
also high in total calories. In addition, most participants were
sedentary with regard to level of physical activity and were in
varying degrees of readiness for change.
Through our experiences on the NHDIP,
several lessons were learned that have potential for building a
model for future partnerships between communities who have specific
needs and "personalities." Researchers are needed who can contribute
scientific rigor and who can learn from a community's perspectives.
These relationships of trust and respect form the foundation for
completing our unfinished work in diabetes and ultimately in the
betterment of health for all Native Hawaiians.
Presenter:
Marjorie Mau, M.D. received her undergraduate and medical degrees
from Creighton University. Her Residency was completed at St.
Joseph's Hospital in Denver. She then went on to finish a Clinical
Endocrinology, Diabetes, and Metabolism fellowship at George
Washington University Medical Center. Currently, she is an Associate
Professor of Medicine, Department of Medicine at the John A. Burns
School of Medicine. Since 1992, she has been actively involved in
research involving Diabetes Mellitus and heart disease risk factors
in Native Hawaiians. She serves as the principal investigator of the
Native Hawaiian Diabetes Intervention Program (NIH) and the Diabetes
Worksite Pilot Project (CDC) as well as the Co- Investigator of the
Diabetes Prevention Program (NIH). She is the PI of other ongoing
projects and has other pending applications.
THE IMPACT OF DISEASE ON HAWAI'I
This presentation examines the health status of the Känaka Maoli
(indigenous Hawaiian) people over four eras: 1) from time immemorial
of Wäkea and Papa to the 1778 return of Lono or the chance arrival
of Capt. James Cook; 2) western and eastern contact, colonialism
with rapid depopulation and collapse of the old society; 3) the 1893
US armed invasion until the 1983 Native Hawaiians Study Commission
and 1985 E Ola Mau Reports; and 4) current healing of a wounded
people through cultural revitalization.
Presenter:
Richard Kekuni Blaisdell, M.D. graduated from the University of
Chicago in 1948 and interned at the Johns Hopkins Hospital. He has
held faculty positions at Tulane, Duke and the University of Chicago
and has been a visiting professor at Harvard and Rutgers. During the
Korean conflict, he served as a medical officer in Korea, Japan and
Taiwan. In 1959-1961, he was chief of hematology and research
associate at the Atomic Bomb Casualty Commission in Hiroshima and
Nagasaki. Since 1980, he has focused on the health plight of Känaka
Maoli (indigenous Hawaiians).
THE SCOURGE OF LEPROSY IN HAWAI'I
One of the most devastating diseases to affect the Hawaiians was
leprosy. In an effort to stem the tide of this epidemic, drastic
isolation measures were passed, snatching patients of all ages from
families and loved ones. These patients were then ostracized and
isolated on the stark but beautiful sectors of land at Kalawao and
Kalaupapa of the island of Moloka'i. The presentation highlights the
beauty of human compassion and the tragedy of human neglect. At the
end of the excursion to the former lazaretto, everyone will be able
to realize what Ernie Pyle meant when he said, "No man can say he
has experienced the curriculum of human emotion until he has stood
on the shores of Kalaupapa"
Presenter:
Benjamin Young, M.D. is currently the director of the Native
Hawaiian Center of Excellence at the John A. Burns School of
Medicine. He received his B.A. from Milligan College in English
Literature and completed his Master's degree in Church History from
Pepperdine University. He is a graduate of Howard University in
Washington, D.C., and completed his psychiatric residency training
at the University of Hawai'i. He was Dean of Students at JABSOM for
13 years and Vice-President of Student Affairs (University wide)
from 1986-1987. He entered private practice (Psychiatry) doing
primarily inpatient care and served as Chief of Staff at Castle
Medical Center from 1997-1998. He is on the National Advisory Board
for the Prevention of Violence under Surgeon General David Satcher
and is also the CEO of Ka Mana'o Corporation,
CANCER IN NATIVE HAWAIIANS
Cancer incidence and mortality rates among Native Hawaiians remain
high despite advances in health care. The incidences of lung cancer
are the highest among Native Hawaiian women and men. Breast cancer
mortality rates are one of the highest nationally for Native
Hawaiian women. Possible responsible factors include 1) cultural
barriers, 2) compliance to standard medical care, 3) accessibility
to health care, and 4) the cost of health care. Improved health
promotion and cancer prevention and control programs are needed.
Presenter:
Clayton Chong, M.D. is a graduate of the University of Hawai'i's
Imi Ho'ola program, medical school, internship, and residency at the
University of Hawai'i. He completed a fellowship at the University
of Texas M. D. Anderson Cancer Center in Medical Oncology. He was
Assistant Professor of Medicine at the University of Texas M. D.
Anderson Cancer Center from 1987 to 1988. He is a part of our
faculty at JABSOM and has been the Medical Director of the Institute
of Cancer since 1992.
PAPA OLA LOKAHI CANCER RESEARCH
PROJECT
Papa Ola Lokahi Cancer Network: In May 2000, Papa Ola Lokahi will
implement a new 5-year program entitled 'Imi Hale: Native Hawaiian
Cancer Research and Training Network, funded by the National Cancer
Institute. The program's goals are to increase cancer research
addressing Native Hawaiians, particularly among junior Hawaiian
researchers; increase cancer awareness among Native Hawaiians; and
increase participation of Native Hawaiians in cancer clinical
trials.
Presenter:
JoAnn Umilani Tsark, M.P.H. is the Research Director at Papa Ola
Lokahi. She was previously the Director of Development for the REHAB
Foundation and later, Director of Research, Education & Training at
the Rehabilitation Hospital of the Pacific. Her scope of activities
has included health program planning and implementation in Hawaiian
communities and outreach to the western Pacific. She was a guest
editor for the September 1998 issue of the Pacific Health Dialog,
which focused on Native Hawaiian Health.
MENTAL ILLNESS AND RELATED RESEARCH
INITIATIVES IN NATIVE HAWAIIANS
The Native Hawaiian Mental Health Research Development (NHMHRDP)
was formally established in 1991 with federal funding from the
National Institute of Mental Health (NIMH). Its mission: To create a
cadre of mental health researchers, whose scientific investigations
result in effective, culturally-appropriate prevention, intervention
and clinical treatment strategies, which improve the mental health
status of Native Hawaiians to the highest level possible. Its
vision: To provide the vehicle and mechanism for developing Native
Hawaiian clinician-researchers and academic leaders within academia.
The presenters will report the outcomes achieved by the NHMHRDP
since 1991, including an important lead study, led by Dr. Yuen, on
suicide among Native Hawaiian youth.
Presenters:
Naleen Andrade, M.D. is a graduate of the University of Hawaii at
Hilo and the John A. Burns School of Medicine. She was Chief
Resident in Psychiatry and is currently Professor and Chair of the
Department of Psychiatry. She is the Director and Principal
Investigator of the Native Hawaiian Mental Health Research
Development Program.
Noelle Yuen, M.D. is a graduate of the
University of Rochester and the John A. Burns School of Medicine.
She remained at the University of Hawai'i and finished her residency
and fellowship in General, Child, and Adolescent Psychiatry. She is
Assistant Professor of Psychiatry at the John A. Burns School of
Medicine, the Clinical Director at the Leeward Family Guidance
Center and Co-Principal Investigator for the Hawai'i High Schools
Study. Her article on Suicide and Hawaiian Cultural Affiliation was
the lead article in the March 2000 edition of the Journal of the
Child and Adolescent Academy, the premier journal in Child
Psychiatry.
CVA AND SPEECH PATHOLOGY IN NATIVE
HAWAIIANS
Cardiovascular disease, including stroke, has a significant impact
on Native Hawaiians. Our presentation will be an overview of what
speech-language pathology does in the rehabilitation process and the
interactions we have with physicians. There will also be a brief
presentation on hearing disorders. Finally, we will be showing a
short video (about 7 minutes) featuring clients from our aphasia
clinic discussing how their disability in communication has affected
their daily lives.
Presenters:
Emi Isaki, Ph.D., CCC-SLP is an Assistant Professor and the
Speech-Language Pathology Clinic Director. Her areas of interest
include intercultural communication and neurogenic disorders. Her
current research has focused on communication and work re-entry
following traumatic brain injury. She received her B.S. and M.S.
from the University of Utah and her Ph.D. from the University of
Arizona.
Randy Weirather, Ph.D. is an Assistant
Professor at the University of Hawai'i and has been practicing
speech pathology for nearly 20 years. He received his doctoral
degree from the University of Upper Brittany in France and has since
taught and practiced in various universities on the mainland as well
as in Australia. He has more recently worked in geriatric care in
hospital and nursing home environments.
James Yates, Ph.D. is Professor and
Chair of Speech Pathology and Audiology at the John A. Burns School
of Medicine. He received his B.A. and M.A. from Texas Tech
University and his Ph.D. from the University of Denver. He has over
33 years of experience in the area of health service delivery to
disabled children and adults. He is the author of numerous
publications in the area of Speech Pathology.
by Sonja Evensen, Project Director
In June 1999, Dr. Shannon Hirose-Wong of the Native Hawaiian
Center of Excellence and members of the Waimänalo community met to
discuss the possibility of establishing a program, based on the
existing Hui Mälama o ke Kai program, for a Federal grant
application from the Family & Community Violence Prevention Program
(FCVP) funded by the Office of Minority Health, via Central State
University in Ohio. In October 1999, the Hui Mälama o ke Kai program
became the first Native Hawaiian recipient of the $200,000 a year
grant. The funding is for a 3-year cycle. There are 25 schools
nationwide who have received this grant.
The Hui Mälama o ke Kai is an after-school program that serves 43
sixth and seventh grade students from Waimänalo
Elementary/Intermediate and Blanche Pope Elementary schools. The
program name means "the group who takes care of the ocean," a name
chosen by the youth who participated in the pilot program a year
ago. The youth learn Hawaiian values, and they particularly
appreciated the value of mälama, which is what this program is all
about. Our "Code of Honor" is to respect and take care of (mälama)
self, others, and the 'äina (land).
The program got its start in 1998 when a handful of dedicated
Waimänalo residents and supporting agencies met together to discuss
the needs of the Waimänalo community. There was great concern about
the youth and the lack of structured and meaningful activity during
the critical time after school. The pressures of family, environment
and low self-esteem could easily lead the youth to trouble. Wanting
to provide some protection for the keiki (children), the group
envisioned a program that would use good role models and resources
around the community.
We place high value on the healing environment of the ocean and
what lessons we could learn from the connections to our 'äina. An
ocean based program offers many opportunities for the youth of
Waimänalo to experience activities that promote critical thinking,
team work, cooperation, relaxation, and good health. Many of the
kids are kinesthetic learners and experience a feeling of success in
the course of our program. The program is highly experiential and
employs culturally appropriate learning opportunities.
Each program is asked to include four major components in the FCVP
model: academic, personal development, cultural/recreational and
career development. We are encouraged to develop our programs in a
manner that fits our community.
We provide academic tutoring and skills building, personal
development (focusing on conflict resolution/violence prevention),
cultural education, career development (exposure to various careers
and their requirements) and a recreational component related to
ocean activities, such as canoe paddling, fishing, and water safety.
At no cost to the participant, our program provides a safe
environment with high staff-to-student ratio (at least 1:7), making
use of good role models from the community (mostly volunteers),
opportunities to experience new activities and places, and healthy
snacks. Our program has strong community support including both
schools, many of the local businesses, supporting agencies, as well
as many community groups and individuals.
Hui Malama O Ke Kai partners
include:
Department of Parks and Recreation, Queen Lili'uokalani Children's
Center, Kamehameha School's Native Hawaiian Safe and Drug Free
Schools and Communities Program, Waimänalo Canoe Club, Waimänalo
Community Development Corporation, Naturally Hawaiian Galleries,
City and County Lifeguards, University of Hawai'i, Ku I Ka Mana,
Friends of Waimänalo, Blanche Pope Elementary School, Waimänalo
Elementary/Intermediate School, Kailua High School, Windward
Community College, Hawai'i Pacific University, Kapi'olani Community
College, Hawai'i Job Corps, Marine Corps Base-Hawai'i, Waimänalo
Seniors, Hawaiian Sailing Canoe Association, Polynesian Voyaging
Society, Sea Life Park, Oceanic Institute, Keneke's, C & K Beach
Service, Point Break Surf Shop, da Hui, Roxy, Quicksilver, Hawaiian
Island Creations, Blue Planet Surf Shop, Jambha Juice, Earthevents,
Kaneshiro's Egg Farm, farmers from Ho'omaluhia, and a growing crew
of volunteers.
Students and parents of
Hui Mälama O Ke Kai
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Na iwi o ke kino kanaka (The bones of the human body) II: Na
inoa (the names) by R. Kekuni Blaisdell, M.D.*
In the last issue of Ha'ilono, we
learned that New England Calvinist Kauka (Doctor) Gerrit Parmale
Judd was apparently the first Westerner to systematically record nä
inoa (the names) of ke kino kanaka (the human body) ma ka 'ölelo
makuahine (in the mother Kanaka Maoli tongue).
These inoa iwi (bone names) appeared in
a puke (book), the first publication on human anatomy in our Kanaka
Maoli language. (1) The book was printed in the missionary print
shop in Honolulu in 1838 and was titled Anatomia (anatomy) He
Palapala Ia e Hoike Ai i Ke Ano O Ko Ke Kanaka Kino (A Book to
Illustrate the Nature of the Human Body). The new document was used
for instruction in the missionary Lahainäluna School on Maui at that
early date. (2) It is likely that later, in 1870, when Kauka Judd
opened the first school of western medicine for 10 Kanaka Maoli men
students in Honolulu, this book became the basic anatomy text. (3)
Kauka Judd did not reveal the kumu
(source) of his hua 'ölelo (Hawaiian terms) for nä iwi (the bones).
However, in 1960, his descendant biographer, Gerrit P. Judd IV,
recorded that the kauka "contributed almost all of the anatomical
words in the Hawaiian language" and that the copperplate engravings,
including the kneeling skeleton (Figure 1), came from Jerome V.C.
Smith's Class Book of Anatomy, published four years earlier, in
1834. (2,4).
It is reasonable to assume that the
kauka had native kökua (helpers) for his Anatomia in 1838. One year
later, in 1839, he acknowledged three contributors to his other
"book" on lapa'au (Hawaiian medicine). (5) This "book" was not
published until 1858-1859 when it appeared serially in the Hawaiian
language newspaper Ka Hae Hawai'i. The kauka's native assistants
then were Kehaha, and two writers, Kaho'ohana and Kalama. For a
time, Kauka Judd also had a fourth kökua named Kalili.
How much, if any, these natives or
others contributed to the text and illustrations in Anatomia must
remain speculative for the present. From the available limited
sources, including Judd's Anatomia, we have only fragmented clues on
the extent of pre-western natives' knowledge of anatomy, physiology,
surgery and the other medical sciences as know to Westerners.
Given the scanty evidence in Kauka
Judd's Anatomia, it appears that:
* At least two of Judd's hua 'ölelo iwi
(bone terms) are not Kanaka Maoli in origin, although they are
Hawaiianized. For example, kubita for the ulna in the forearm and
hamare for the malleus (hammar) in the pepeiao waena (middle ear).
* Most of the inoa iwi are distinctly
Kanaka Maoli and, thus, may have been used in pre-Western times. For
example, iwi lei (lei bone) for the clavicle; iwi hoehoe (canoe
paddle bone) for the scapula; iwi huamoa (chicken egg) i ka lua (in
the pit) for the head of the femur in the acetabulum.
* Some iwi have multiple names. For
example, iwi lei and iwi lae for the frontal bone; and iwi ä and iwi
älalo for the mandible.
* Some different bones or structures
have the same name. For example, iwi lei for the clavicle and the
frontal bone; and iwi hoehoe for the scapula and a middle ear
ossicle.
* Some Kanaka Maoli terms are clearly
post-Western contact in their application. For example, wa'apä
(rowboat) for the shape of a carpal bone; ke'ehi (stapes or stirrup)
for the stirrup-shaped middle ear iwi.
* Many hua 'ölelo iwi (bone terms)
deserve further study for their probable origins. For example, 'öpe'ape'a
(bat) for the sphenoid; and uluna (pillow) for the humerus. More of
these hua 'ölelo will be featured in columns in Ha'ilono.
Later, we will also comment on uses of
iwi kanaka, beliefs about iwi and burials of skeletal remains.
REFERENCES
1. Judd, GP: Anatomia. (1838). He Palapla Ia E Hoike Ai I Ke Ano O
Ko Ke Kanaka Kino. Missionary Publication.
2. Judd, GP IV (1960). Dr. Judd. Hawai'i's Friend. University of
Hawai'i Press.
3. Busnell, OA: (1967). Hawai'i's first medical school. Hawai'i
Historical Review, 2 (9), 396
4. Smith, JVC: (1834). Class Book of Anatomy - Designed for
Schools. Alan Ticknor: Boston, MA.
5. Chun, MN. (1986). Hawaiian Medicine Book. He Buke Laau Lapaau
(Authored by Dr. GP Judd; translated by MN Chun), Bess Press.
Figure 1: Kanaka Maoli and western inoa
(names) for the principal iwi (bones) of the iwi kanaka (human
skeleton) shown in this kneeling ki'i (figure), from Kauka Gerrit P.
Judd's Anatomia of 1838. Graphic courtesy of the Hawai'i Medical
Library.
GLOSSARY OF TERMS
hua 'ölelo
- Hawaiian terms
hua 'ölelo iwi -
bone terms
inoa - names
inoa iwi - bone
names
iwi - bones
iwi hoehoe -
scapula
iwi huamoa i ka lua
- head of the femur in the acetabulum
iwi lei -
clavicle
iwi lae - frontal
bone
iwi kanaka -
human skeleton
Kanaka Maoli - indigenous
Hawaiian
kauka - Western
trained physician
ke kino kanaka -
the human body
ke'ehi - stapes
or stirrup (for stirrup shaped middle ear)
ki'i - figure
kökua - helpers
kumu - source,
teacher
lapa'au -
Hawaiian medicine
ma ka 'ölelo makuahine
- in the mother tongue
nä inoa - the
names
nä iwi - the
bones
nä iwi o ke kino kanaka
- bones of the human body
'öiwi - native
'öpe'ape'a -
sphenoid
pepeiao waena -
middle ear
puke - book
uluna - humerus
wa'a - canoe
wa'apä - carpal
bone
Words with dual
meanings
Clavicle - iwi lei
Frontal bone -
iwi lei, iwi lae
Mandible - iwi ä,
iwi 'älalo
Middle ear ossicle
- iwi hoehoe
Scapula - iwi
hoehoe
*Richard Kekuni Blaisdell, M.D. is a faculty member of the John A.
Burns School of Medicine with an interest in Hawaiian history and
highly proficient in the Hawaiian language.
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Updates on NHCOE Initatives
RECRUITMENT - O'AHU
(Increase the number of Hawaiian students (K-College)
considering a medical profession)
by 'Iwalani Else
There has been a wide variety of
recruitment activities on the island of O'ahu this Spring 2000
semester. We have made 19 recruitment trips on the island of O'ahu
since January and are hosting students from the Farrington Health
Academy (all interested in the health field!) for six weeks as part
of the University of Hawaii mentoring program. The semester has also
been busy with mock interviews, providing financial aid information
(70% of medical students receive some type of aid). Currently, we
are anxiously awaiting to hear which students will make up the 2000
entering JABSOM class. Good luck to all the applicants!
Summer is right around the corner and we are in the process of
selecting students for the University of Hawaii Medical Science
Summer Program (UHMS) - a three week residential program for public
high school students to introduce them to the health field,
sponsored and funded by the NHCOE. First year student Roxanne
Figuroa will be the kumu for these high school students. Another
summer opportunity for Native Hawaiian intermediate and high school
students to explore the health professions during the summer is the
Nä Pua No'eau (Center for Gifted and Talented Native Hawaiian
Children) two week summer programs. Kristen Fernandez, MS I, will be
the kumu for the intermediate-aged students. For anyone interested
in information on summer programs, please contact 'Iwalani Else at
(808) 956-6567 or e-mail at else@hawaii.edu.
________________
RETENTION
(Provide medical students with skills to help them through
medical school)
by Doric Little, Ed.D.
Student Development News Items
* MS I's are beginning Unit 3. Several
students are working on learning differences and /or study skills.
* MS II's have taken the Unit 5 MEQ and
are preparing for Boards Part 1. Dr. Little will work with Native
Hawaiian students individually and will give tips on preparing for
the Boards to the entire second year class on April 11, 2000. Dr.
Ben Young, NHCOE Director, has organized a Neuro Review symposium
for Native Hawaiian students for April 18 to the 21, 2000 as Board
preparation.
* MS II's are completing their clinical
year. To this date, one Native Hawaiian has honored all rotations!
* MS IV's have all matched. Native
Hawaiians will be doing their residencies in North Carolina,
Pennsylvania, Minnesota, Colorado, Illinois, California, Nevada and
Hawaii.
* The Kauka Haumana are invited to Dr.
Little's home in Pupukea on April 22nd for a luncheon and
opportunity to share medical school information across the 4 years.
MS IV's are especially encouraged to attend, share insights and be
celebrated. Several of the Kauka Haumana will be staffing a table at
a Headstart Health Fair at Swanzee Beach Park on April 28, 2000 as a
public service gesture.
* Dr. Little is preparing a grant
proposal, Kula Lanakila "Winning at School", for 6, 7, and 8th grade
Native Hawaiian students at Waimanalo Elementary Schools. This study
skills program will offer another step in the NHCOE effort to
develop a pathway for academic success for Native Hawaiians.
*In March, Dr. Little spent one week in
Guam as a member of the Western Association of Schools and Colleges
Accreditation Team. The team's purpose was to validate the Self
Study of Guam Community College. As a faculty member of the Imi
Ho'ola Post Baccalaureate Program, she spent a weekend at Kalaupapa
with Imi Ho'ola students and staff, a tradition begun by Dr. Ben
Young more than 20 years ago.
(back to top)
The Efficacy of Ti by Celia Ehrlich, Ph.D.*
Hawaiians are all aware of Cordyline
fruticosa, the "Good Luck Plant," the green, scoop-ended ki (known
as ti or si in other parts of Polynesia). Its leaves make up the
skirts of hula dancers (when they are not replaced by plastic).
Children have used them as sleds on grassy slopes. They are wrappers
for food at luaus and covers for food in earth ovens and get woven
into serving mats. They fringe the nets used for hukilau fishing,
add mana to lures. They flutter from the bumpers of pick-up trucks
and serve as pom-poms for the local team at game competitions.
Healers use them in various ways, to spread under a patient's
sleeping mat, to brush someone who is overexcited. A healer may hold
ti leaves and strike a patient who is "possessed," moving the leaves
from head to feet and then shaking them out of a the doorway to keep
the ejected illness from coming back. Women still sprinkle rooms
with water using ti leaves to get rid of spirit presences. Even at
home, a woman may wear ki leaves in her bra to make herself feel
safer (Pukui, Haertig and Lee 1971).
Ki is present at Pohaku o Kane, family shrines that still exist
all over Hawai'i. At Waimea State Park, the leaves cover stones set
in a large enclosure. The ki plants growing near houses furnish more
than handy leaves; they offer protection to the people inside.
Formerly, ki grew at altars too, especially those for Lono and those
for Laka. Temples for Lono always had ki leaves for thatch; temples
for Ku had thatch of other leaves. People who walk on hot lava carry
ki leaves, not so much to honor Pele as to gain protection from her.
It is clear that the ki plant has associations with supernatural
power.
The Hawaiian ki plant is different from
other varieties in being larger and having larger underground stems,
"rhizomes." It was among the plants brought by the first settlers,
and this was essential since it did not grow wild in Hawai`i. Also,
this variety seldom or never sets seeds; it has to be grown from
stalks or rhizomes (Yen 1987). However, there are many other
varieties in other parts of Oceania, Melanesia and Island Southeast
Asia (Ehrlich 1999). The Maenge of New Britain cultivate about fifty
kinds, red, yellowish, green, black or purplish, with leaves plain
and striped, blotched and curled, thick and thin. Other groups may
maintain only two or three varieties, usually a red and a green. In
Hawai`i, red ki has no special significance, but in places to the
west, red ki has often been planted in sacred sites.
Red ki was the most important sacred
plant of the Karo Batak in Sumatra before their conversion to Islam
(Bartlett 1973:279). The Iban of Borneo have planted both red and
green ki after certain ceremonies (Richards 1981:316). The Kenyah
and other natives of Sarawak have planted reddish ki beside sacred
stones at small altars and beside house steps (Rousseau 1990:109). A
traditional ritualist of Kalimantan, Borneo, has explained the role
of ti (sawang) in Ngaju ceremonial life. It "grows at the place of
promising with the highest god" (Schiller 1986:235):
As man lives or dies the sawang
[italics added] is used. People always erect it. If there is a
promise between the living the wood must be planted, when there is a
promise with the dead it is finally thrown into the river. The
sawang is planted for the newly married, for the dead it is thrown
into the water.
Red ki has been the most sacred plant
of the Ifugao in northern Luzon (Conklin 1967:253-54). It was the
rumbim plant of the Tsembaga Maring in New Guinea; Maring men
deposited their life spirits in a red ki plant when they went off to
battle (Rappaport 1968:132-33). The Kapauku of Irian Jaya say they
use green ti for white magic and red ti for black magic (Pospisil
1964:34). The Melpa in the Papuan highlands treat ti as a symbol of
their origins as a group (Strauss 1990:52,99). So do Niuans in
Polynesia (Smith 1902:205). And this is just a sample of the many
ways in which people to the west of Hawai'i have treated ki as a
sacred plant.
Evidently, the species Cordyline
fruticosa carries mana with it; the things people have done with it
suggest this indirectly and there are statements like that of the
Ngaju healer. Hawaiian ki still maintains some of this reputation,
although the achievement it best expresses is a scientific one.
Having a large rhizome became a priority in Oceania as soon as
people reversed the taboo on eating it. Selection for a large,
sterile plant like Hawaiian ki had to have happened before the first
settlers arrived. It is significant that New Zealand Maoris also had
an infertile, edible variety, but theirs has has become extinct.
When Hawaiians use ki leaves, they are continuing a tradition from
their prehistoric ancestors who knew how to improve an old plant as
food without losing its ceremonial quality.
REFERENCES
1. Adriani, N., and A. C. Kruyt. 1951.
The Bare'e-speaking Toraja of Central Celebes (The East Toraja). 5
Vols. J. K. Moulton, trans. Amsterdam: Noord Hollandische Uitgevers
Maatschappi.
2. Barrau, J. 1965 Witnesses of the
Past: Notes on Some Food Plants of Oceania. Ethnology 4:282-294.
3. Bartlett, H. H. 1973. The Labors of
the Datoe and Other Essays on the Bataks of Asahan (North Sumatra).
Michigan Papers on South and Southeast Asia, No. 5. Ann Arbor:
University of Michigan Center for South and Southeast Asian Studies.
4. Conklin, H. C. 1967. Ifugao
Ethnobotany 1905-1965: The 1911 Beyer-Merrill Report in Perspective.
Economic Botany 21:243-272.
5. Ehrlich, C. 1999. The Ethnobotany of
Cordyline fruticosa (L.) A. Chev.: the "Hawaiian Ti Plant." Ph.D.
dissertation (Anthropology). State University of Buffalo.
6. Leenhardt, M. 1946. Le Ti in
Nouvelle Caledonie. Journal de la Societe des Oceanistes 2:192-93.
7. Pospisil, L. 1964. Kapauku Papuans
and Their Law. Yale University Publications in Anthropology 54. New
Haven: Human Relations Area Files Press.
8. Pukui, M. K., E. W. Haertig, and C.
Lee. 1972. Nana I ke Kumu (Look to the source). Two Vols. Honolulu:
Hui Hanai.
9. Rappaport, R. A. 1968. Pigs for the
Ancestors. New Haven: Yale University Press.
10. Richards, A. J. N. 1981. Iban-English
Dictionary. New York: Cambridge University Press.
11. Rousseau, J. 1990. Central Borneo:
Ethnic Identity and Social Life
in a Stratified Society. Oxford: Clarendon.
12. Schiller, A. 1986. A Ngaju Ritual
Specialist and the Rationalization of Hindu-Kaharingan. Sarawak
Museum Journal 36 (57 n.s.):231-43.
13. Smith, S. P. 1902. History and
Traditions of Niue. Parts 1 and 2. Journal of the Polynesian Society
11:78-106.
14. Strauss, H. 1990. The Mi-culture of
the Mount Hagen People. B. Shields (trans), G. Sturzenhofecker and
A. J. Strathern (eds). Ethnology Monographs 13. Pittsburgh:
Department of Anthropology.
15. Yen, D. 1987. The Hawaiian ti plant
(Cordyline fruticosa L.): some botanical notes. Notes from Waimea
Arboretum and Botanical Garden 14(1):8-11.
* Dr. Ehrlich completed her Ph.D. in
Anthropology at the University of Buffalo after raising 5 children
with her husband Paul, a retired professor in Chemical Engineering.
As part of her degree, Dr. Ehrlich did field work in Tonga where she
became interested in the ritual use of the ki plant throughout the
Pacific. She is 73 years old.
(back to top)
Imi Ho'ola (those who seek to heal)
An important component of the Imi
Ho'ola Post-Baccalaureate Program is an annual field trip to
Kalaupapa on the island of Moloka'i, a leprosy settlement made
famous through the unselfish work of the martyr Father Damien.
Although leprosy is no longer a life-threatening disease, a strong
parallel exists between the psychological and sociological
consequences of leprosy and AIDS. The Program's community service
project this year consisted of visiting and entertaining patients at
the convalescent home. Fun was had by all! This trip was made
possible by the generosity of our hosts Richard and Gloria Marks.
 Imi Ho'ola Students and Faculty at
Kalaupopa, Island of Moloka'i.
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