Ka Wai Ola - Office of Hawaiian Affairs, Volume 11, Number 2, 1 February 1994 — Hawaiian physician working to uniie the old with the new [ARTICLE+ILLUSTRATION]
Hawaiian physician working to uniie the old with the new
Interview by Patrick Johnston Chiyome Leina'ala Fukino is a private physician and president of E Ola Mau (To Live On), an eight-year-old health organization aimed at promoting native Hawaiian health. Presently one of their major tasks is working with kūpuna to make traditional healing more accessible to the general public. KWO: You are a W estern-trained physician and yet now lead an organization aimed at promoting traditional Hawaiian healers. Why are you doing this? Fukino: I don't believe that there is any one system that has all the answers. We do things differently but certainly every people, every civilization, has had some form of healing for its people to use; eenturies of Chinese traditions for example. Now we are trying to understand why certain medicines have worked. We're saying as native Hawaiians that, yes, we ean have both because there are valid things in both ways of treating people. KWO: Was there anything in your training or experience that showed you the benefits of traditional medicine? Fukino: I think if you're born and raised in Hawai'i that some part of traditional medicine was used by your family. Most of us, when we were growing up, were treated by different kinds of things: guava leaves for diarrhea, kukui nuts for constipation. That was just accepted. That's what your mother or your father or your tūtū gave you and it wasn't a bad thing. It was used to help you get better and so it's a part of what you are. Being a Westerntrained health-care provider doesn't take that away from you. And for me that's why I have this, I guess you would eall it, openminded approach to traditional
medicines. KWO: Why did you heeome a physician in the first plaee? Fukino: I īhink I've always been interested in helping people. It's just something I've always wanted to do. KWO: You studied at Kamehameha Schools. Did that affect your decision ? Fukino: Actually, when I was a junior at high school I went on an exchange program to Indianapolis and was there for a year. During that time I went to a career training program and was told, "You don't want to be a doctor. Girls don't want to be doctors. You have to be really smart to be a physician. You can't have a family." They went through a whole list of reasons why I shouldn't go into medicine. When you are a junior in high school sometimes you say, "OK, I didn't know that." So I went into psychology in college. But it still wasn't exactly what I wanted to do. One day, my father happened to be selling a vacuum cleaner to Dr. Ben Young who, at that time. was director of 'Imi Ho'ōla, a program trying to get underrepresented races into the medical profession. I was native Hawaiian, female, perfect. So I went into that class and I really enjoyed it and, well, here I am. It's been a very active life. It ean be just a job. It ean take some of your, or all of your time. For me it's gone the whole gamut. But now, with E Ola Mau, it takes up all of my time. KWO: Why did you get involved with E Ola Mau? Fukino: Actually it was with my
brother, Wayne Fukino, who is a physician on Kaua'i. A study was done 10 years ago (on native Hawaiian health) and was presented to the University of Hawai'i. Wayne and a group of other physicians, Kekuni Blaisdell, Emmett Aluli, were there. The question was raised, "Who is going to take care of this problem of native Hawaiian health?" where the statistics were so bad. We said, we would, and the seeds for the organization were sown. All types of health care providers got together to decide how to form this organization, what our goals would be, and how we would integrate traditional healing into our organization. I was in it from the very beginning, left for a period of time, then retumed. KWO: When did all this take plaee? Fukino: The first meetings took plaee in the mid-Eighties and E Ola Mau was formed in 1986. KWO: Was it difficult putting things together? Fukino: Yes. Forming an organization is really tough. It takes a lot of time. A lot of people stick, a lot of people fall off. You have to leave sometimes and eome back because it's such a consuming idea. The purpose of the organization, whieh is to achieve lōkahi for native Hawaiians, is a very big goal. Our people are so diverse in what they consider to be native Hawaiian. The whole idea of what is traditional Hawaiian culture I think is very controversial. I think we've got to admit that the eontroversy exists because we are such a mixed people. It's been 200 years of assimilation and sometimes it's hard to figure out
whieh ideas are traditionally Hawaiian and whieh ideas are really from other cultures. I think there is a Hawaiian culture. I'm just not sure that we all agree as to what it is. KWO: So is one ofthe goals ofE Ola Mau to use healing to unify the culture? Fukino: No. What I mean is we are fully geared toward health and our goal is to achieve lōkahi. But lōkahi is harmony of mind, body and spirit so, in a roundabout way, it's going to encompass that eventually. We have really looked at the task of trying to improve the health statistics of native Hawaiians but we have not limited ourselves to that. Eventually this whole concept of culture and assimilating the culture into making a whole person is going to become a part of that. But right now, it's not the focus. KWO: So your primary goal is to improve the overall health of native Hawaiians? Fukino: What we're interested in doing is seeing that the heakh of all native Hawaiians improves in all aspects. When we started in 1985-86 we were really the only organization that did this. All the other existing organizations had
their own kuleana. Bishop Estate was into education. Alu Like was job placement. So E Ola Mau was truly the only organization looking at health. When the Native Hawaiian Health Care Act was finally passed, E Ola Mau had a lot of input into making sure the money was used to help native continued on page 6
"I don't believe that there is one system that has all the answers. We do things differently but certainly every people, every civilization, has had some form of healing."
r-r.Tr. iU ! . i i-.K I , ■ ■ ■ ! , r I Dr. Chiyome Leina'ala Fukino
Chiyome Fukino
from page 2 Hawaiian health. Onee the Act was passed, then you had other organizations that were then being formed. You had the five island planning groups. They have specific tasks for eaeh island. Now what we see ourselves as doing is overseeing, making sure that problems are being addressed and identifying places where they are not being addressed and trying to hone in on those areas. We are not a service organization. We've always felt that we need to be in a policy-making position. We do research, education, but we don't actually service our population. KWO: What are some of the things you've accomplished? Fukino: The first thing we did was a survey regarding AIDS in order to develop an AIDS education program. In the past few years we have been finalizing a curriculum and the project will be completed this year. What we have been doing under a contract with the Office of Hawaiian Heahh is to try to help identify some of the barriers to integrating the two health systems, the modern and the tradihonal. Of course, the initial barrier is that the medicines have been underground for so long and the communication between kūpuna has been limited. So that needs to be addressed. We convene kūpuna and try to figure out how to transfer their knowledge. Do they want to be public? How do they want the public to access what they know? Those kinds of issues are what we are dealing with. But before we ean even do
that we have to get to the point where they are unified and have a eommon goal. The next thing that we, as an organization, are doing, is figuring out how to address the biggest problem, whieh is the legal issue. Western practitioners are scruti-
nized all over the plaee. We have licensing requirements, insurance requirements. You can't do anything without being responsible for it. So, basically, if you refer, as a physician, someone to a traditional healer and something happens, that patient could sue you. So how do you make this form of healing available to the general public and not compromise the people who are assisting them? That's what we have to try to help answer over the next two years. It's a large obstacle but with creative minds we ean do it. KWO: What was the goal of the recent Lapakahi conference? (See Jan. 1994, Ka Wai Ola) Fukino: Lapakahi was to rededicate the park for the use of tradi-
tional healers. You know, you ean convene traditional healers, you ean get them to say they are going to treat the public, but if they don't have the lā'au then what use is it? If you don't address the environmental concerns of the waters off Lapakahi, the limu, the sea animals that live in the bay that are a part of lā'au, then healers ean do nothing. It's more than just a symbolic gesture. What we want to do hopefully is to encourage the state to convert this into a living center, someplace that ean be used to grow lā'au and for kūpuna to meet and teach eaeh other. Another thing that E Ola Mau is involved with is to try to see how we ean preserve the lā'au everywhere for the use of the kūpuna. If you go up into the mountains and there is all sorts of development and there is no way to get the lā'au, then it doesn't matter what we do because the healing plants aren't there. We want to instill a sense of vision, of pride in kūpuna, to help outsiders understand that there is a need to preserve this cultural way of doing things. KWO: Do you think there will he a larger role for traditional medicines in the future. Fukino: If you really are interested in improving native Hawaiian heahh there needs to be more accessibility because there is enough of a segment of the native Hawaiian population that utilizes
traditional healing and needs it to be available. KWO: Whal are the main obstacles to incorporating traditional healing into mainstream Hawaiian society? Fukino: The legal system. Part of traditional healing is the way you look at who you are accountable to. If you believe that your mana or your right to practice comes from God then you may feel no need to be accountable to government. In your mind there is higher power that dictates what you do. So whether or not we ean ever get that system to be completely in sync with the traditional Westem system I don't know. That's why I think we need to have some creative approaches to this issue. Those of us who are in the Westem system know very clearly what our responsibilities are. Nobody will ever let us forget it. You cannot be on staff of a hospital without carrying a minimum of one and three million (dollars) liability coverage and that's a totally different concept from the traditional way of healing. Are you going to tell kūpuna that they have to carry a million dollars liability insurance and three million dollars aggregate? They're going to look at you and say, "What are you, crazy?" That's why I say there are some obstacles to having an open system. The difference between traditional Hawaiian medicine and Chinese herbalists is, if you go
down to the Chinese herbalist and say you have a cold, he'll whip through his recipe book and give you something. He has not made a diagnosis. You have gone in there and told him that you have a cold and need medicine. What he's given you is a food, it's not really a drug. On the other hand, the traditional healer asks you what your symptoms are, how your life is all together, prays, comes up with a diagnosis and makes medicines specifically for you. That's "practicing medicine" and that's where the hang-up comes: if you are going to have regulations on people who practice medicine then it has to be across the board. You can't say, "OK, all you people trained at the University of Hawai'i, we're going to license you but we're not going to license all these other guys, we're not going to require accountability even though they are technically practicing medicine." Native Americans are allowed to practice their medicines, but on their reservations in a reservation hospital. So technically they are not in the United States. I think it would be foolish for people to assume that native Hawaiians would not sue if problems arose out of traditional medieal treatments. I also think it's foolish to think that the use of traditional medicine should be limited to native Hawaiians. So when we address this problem it really is quite a big deal because it affects a lot of people.
"Are you going to tell kūpuna that they have to carry a million dollars liability insurance and three . million dollars aggregate? They're going to look at you and say, "What are you, crazy?"