Ka Wai Ola - Office of Hawaiian Affairs, Volume 10, Number 6, 1 June 1993 — Ola kino o nā Hawaiʻi [ARTICLE+ILLUSTRATION]

Ola kino o nā Hawaiʻi

Hawaiian healih horizons

Outreach program uses 'ohana to fight diabetes

by Patrick Johnston On the Wai'anae Coast, a group of enterprising young women are tackling diabetes by taking treatment out of the elinie and into the warmth and support of the 'ohana. Their goal: to bring modern medicine to native Hawaiians and other minorities but in a way that is both culturally sensitive and medically effective. 'Ohana Health Outreach is a new program based at the Wai'anae Coast Comprehensive Heakh Center and aims at getting health care to people who have difficulty with modern medicine and treatment. Mueh of the problem with modern medi-

eine is that it ignores emotional and eultural aspects that are an important part of Hawaiian lives and their approach to h e a 1 i n g . 'Ohana Health

Outreach helps close the cultural gap between practitioner and patient by using native Hawaiians and Samoans as eommunity health workers, sending them directly to the homes of patients. They monitor their heahh, help them take their medieine, and give them moral support in their struggle against the disease. "We go into the home, talk story, and try to get them some help," 'Ohana Outreach director Lolani Jameson says. "The eommunity heahh worker helps explain to them why they need medication and makes them more trusting of the system. She is the key person to make the link between the benefits of western medicine and Hawaiian culture. It (western medical treatment) is foreign to them, it is not their way." 'Ohana Outreach feels that if you ean also bring the family into the equation, either by providing moral support or by helping out with medication and lifestyle problems, many of the difficul-

ties that surround native Hawaiian diabetics ean be overeome. Says elinieal manager Sandra Hebert, "We onee had a patient who said there was no need to take care of himself because he was going to die by 50. Then he decided he wanted to see his kids grow up. ... It is real eommon for Hawaiians to live for today and die young. The key is to focus on the children and the 'ohana." In the home of Sarah Larinaga, an outreach participant, her daughter Mauna Kekua assists her by carefully controlling the kinds of food she eats, making sure not to add salt and avoiding the frying pan whenever possible.

"1 don't use salt or butter and I try to bake, not fry, f o o d s , " e x p 1 a i n s Kekua. "I also go to all the support group meetings and help give my

mom her shots." Larinaga has been a diabetic for 13 years and recently has developed blood circulation problems and cataracts. She joined the outreach program six months ago to help her get on track with her medication and diet. "Many diabetics in the eommunity have trouble sticking to the diet and medication that is subscribed to them," Jameson points out. "By coming to the home we educate them about the importance of food and medicine and encourage them to stay with the program." "1 didn't know things and 1 am pa'akikl (stubborn)," says Larinaga. "But after talking to Lani and Miehelle (senior eommunity heahh worker Miehelle Weaver) I ean understand better. ... They helped with the injection of insulin and about dieting, things that ean help me control diabetes. ... I don't know what I would do if they closed it up." The process of becoming a par-

ticipant on the Outreach program begins when a diabetic at the Wai'anae Coast Comprehensive Heahh Center is referred to the program by a physician. Program staff screen eaeh referral based on certain criteria. This includes not following medical advise, missing appointments, and having oqt-of-control blood sugar levels. Program staff then sit down with eaeh other and discuss the particular case, looking into the total needs of the patient and the best way to tackle the problem. Jameson says, "We approach eaeh participant holistically, looking into all features of their heahh and lifestyle. This way we feel we ean most effectively treat eaeh person and do it in a way that native Hawaiians understand." After examining the patient's circumstances 'Ohana staff develop a care plan, usually including a combination of exer-

cise, medication and diet. The plan is taken back to the patient who is given the ehoiee to accept or reject it. The program also helps diabetics, many of whom are poor and unfamiliar with government pro-

cedures, apply for medical assistance, either through SHIP, the state heahh insurance plan, or the federally funded Medicaid. "Applying for heahh insurance

involves filling out a mountain of forms," Jameson says. "Many of our participants can't get through them on their own." 'Ohana Outreach is in its second year and is funded by a three- year federal grant. Its fivemember staff represents the field workers of a eoalhion of eommunity and public agencies that provide technical, legislative and financial assistance. Coalition members include the Department of Heahh, Ke Ola Mamo, Nānākuli Hawaiian Homestead, Waj'anae Hawaiian Homestead, the Wai'anae Coast Comprehensive Heahh Center, Ke Ola O Hawai'i, the Wai'anae Human Services Coalition and the Hawai'i Cancer Informtaion Service. The federal grant for the 'Ohana Outreach program will end in a year and a half. After that time they will be looking to state agencies for funding and technical support.

Mueh of the problem with modern medicine is that it ignores emotional and cultural aspects that are an important part of Hawaiian lives and their approach to healing.

Community health worker Miehelle Weaver tests blood pressure of Outreach participant Sarah Larinaga at her home in Wai'anae. photo by Patrick Johnston

Lolani Jameson