Ka Wai Ola - Office of Hawaiian Affairs, Volume 26, Number 7, 1 Iulai 2009 — NATIVE HAWAIIAN WAY [ARTICLE+ILLUSTRATION]

NATIVE HAWAIIAN WAY

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The sprawling ahupua'a at the end of Kalihi Valley is a different world altogether from the puhlie housing projects, blighted storefronts and congested streets that make up the urban neighborhood of Kalihi just a few miles away. Here there are gardens of 'ōlena, kalo and other native crops, spacious forest trails, remnants of ancient Hawaiian terraces, a thicket of newly sprouted native koa trees, and a constant rustle of wind that drowns out the traffic sounds of Likelike Highway just beyond the valley's ridge. Everything for a healthy lifestyle is available here to residents of Kalihi. Many are Micronesian and Polynesian immigrants, and they share with the Kanaka Maoli - about 10 percent of the population here - high rates of chronic diseases associated with poor nutrition, laek of exercise and obesity. But credit for the fact that his valley now offers a sprawling green sanctuary that promotes a healthy lifestyle goes to these same residents. They've transformed the land and in the process they've been working on healing themselves through an innovative project of Kōkua Kalihi Valley (KKV) - a eommunity heahh center that has been offering comprehensive services to Kalihi families on a sliding pay scale for more than three decades. The nonprofit institution on School Street, the main drag of Kalihi, began leasing 100 acres of the valley from the state in 2006 with the intent of cultivating a land base for heahh. "This was an unusual move and I was a lihle nervous at first that some people would say, 'What the heek is a heahh center doing with a nature park?' But from the start there was this outpouring of support," says Dr. David Derauf, KKV executive director. Maybe it should have surprised no one. Derauf talks about how the Kalihi community eame together 30 years ago and successfully protected the valley from a developer of luxury homes. Derauf said that one of his patients, who later became a KKV board member, led that fight. But the valley subsequently became ruined by abuse and neglect. Invasive species overran the forest, illegal dumping littered the landscape, soil was stripped and sold conunercially. The patient-activist led the community again as residents eame to the rescue to shovel, haul, weed, till and muleh until the land could serve as the base for projects that have begun to unfold in the last three years as outdoor extensions of 14 KKV services. The park now offers KKV patients as well as numerous groups from the greater O'ahu area a nature park akin to a living classroom in Wellness 101. Through collaborations with both KKV services and non-profit organizations, people eome here to organically farm food crops - a low-cost way of improving nutrition, to engage in a massive reforestation project — a way to burn calories and reduce the risk for

diseases linked to obesity, and to learn from site interpreters Native Hawaiian medicines and stories that spring from land - a cultural path of meditation, you might say, meant to inspire the healthy expression of new stories for a new day. "It's a work-in-progress, but the community has demonstrated that they see access to green space as very important to heahh. The land is a source of food and spirit, and the support that is needed to undertake difficult changes in lifestyle probably comes from the land," said Derauf, a preventive medicine physician who has been working with the Kalihi heahh center for his entire 20 year medical career. The numerous program areas at the KKV nature park have been named Ho'oulu 'Āina - to grow whh the land. Now, eome new signs that the Kalihi eonununity drive to cultivate wellness and 'āina together as one is taking root elsewhere and seeding interest even beyond Hawai'i. Several nonprofit heakh organizations that serve prunarily Native Hawaiians are trying this approach to varying degrees. This includes Hui Mālama Ola Nā 'Ōiwi on Hawai'i Island - part of the statewide federally funded Native Hawaiian Heakh Care Systems (NHHCS), Wai'anae Coast Comprehensive Heakh Center, Waimānalo Heakh Center and the Hāna Community Heakh Center. "We are seeing a momentum in heakh programs that are appealing to core cultural values by establishing the connection to the land," said Mele Look, of the Department of Native Hawaiian Heakh at the University of Hawai'i Medical School, whieh has also collaborated with KKV since 2004 on developing nutrition programs. ECONOMYALSO DRIVING SELF-SUFFICIENCY Apart from culture, lean eeonomie times are also driving interest in growing food as a low-cost healthy alternative, while rising fuel prices have raised concerns about food security in an island enviromnent that depends mostly on outside imports to feed itsek, said Look, adding that in an eeonomie emneh, sek-sufficiency is more sustainable than going to the food bank. "So we are hitting the solution to a native heakh disparities on many levels simultaneously." Most of all, some people are finding they are feeling better after working on the land. At NHHCS' Hui Mālama in Hilo, home gardening has proven to be an effective eomplement to help diabetes patients wkh the oftentunes daunting details of self-managing the disease, whieh sometimes requires knowing how to administer your own shots and take your own blood sugar readings. The heakh center saw poor enrollment in its diabetes-education classes until k provided pre-cut wood for garden boxes, enhanced soil, a crash course in horticulture, plus a camera, so that patients would not only

plant produce at home but would eome back to the group and share stories of their green-thumb progress. "The sharing is part of a Hawaiian value, so now we have plenty of people coming back to class where they talk about their recipes. It's more positive than before when we just talked about ikness," said Look, adding that this activity has been especially effective in getting patients to shed the extra pounds that are a risk factor for diabetes and other chronic diseases, including cancer and hypertension. "We often don't get results from just telling obese patients that they need to lose 7 percent of their body weight to avoid becoming diabetic, but

onee they experience the excitement of food they have grown themselves, then you see results." Rates of obesity in the Native Hawaiian population especially among children are at

an all-tune high, according to a recent Hawai'i Department of Health study. New USDA research links obesity to diets wkh insufficient quantities of fresh fruits and vegetables and also definitively ties the problem wkh low-ineome status; k recommends providing price subsidies to low-wage earners, whieh in Hawai'i would mean a large portion of Native Hawaiians. Look and other loeal heakh experts say subsidies may just encourage more of the same disconnect with doctor's orders, where as the bumper crop of land and wellness projects do a lot to motivate economically disadvantaged households to make wellness their daily kuleana. LAND SHIFTS HEALTH FROM A PASSIVE TO ACTIVE PURSUIT Meanwhile, a high profile nod to the effectiveness of healing land and body as one comes from the U.S. Centers for Disease Control, whieh has made the community nutrition garden at the KKV nature park and the Ho'oulu 'Āina programs a centerpiece of its recent publication on diabetes management. "They said this is a promising approach to managing a disease wkh culturally relevant protocols for encouraging

healthy living," said KKV's Dr. David Derauf. He said the article documented the improvement in patients' medical conditions by citing certain vital indicators. But Derauf adds that some of the drivers of the park's success elude scientific measurement. "If anyone of us is asked what are the attributes of feeling healthy, very few of us would answer, 'Oh, it was when I was having my blood pressure taken.' (Feeling healthy) has little to do wkh those measures we've tended to put so mueh stock in. It may be just as unportant to carry back to your family food you have grown, to feel like you belong to something bigger than yourself, to know you share

this sense of intunacy wkh the land. This is all a central part of conununity heakh, where the accent is on conununity. Personal resnonsibilitv

for heakh is one

thing, but it can't be isolated from support we receive from others. " KKV's acquisition of a land base to promote a healthy lifestyle was boosted in 2003 by a $200,000 grant from the Robert Wood Iohnson Foundation's Active Living by Design, a program that emphasizes social relationships in fostering conununity improvement in heakh. Derauf said one of the aims of the park programs has been to change the "us and them relationship" separating the whke coat medical professional from the layperson. If the naturepark activities are proving successful, Derauf believes k is partly a reflection of an ongoing dialogue at KKV, in whieh doctors and nurses "really listen to what the community is saying - or often what they are not saying." Derauf observes that many patients feel they don't have a voice in their own heakh care, because the exam room has made them feel uncomfortable. "So we started asking people if there are ways we could better engage them in their own heakh," he said. As a prune example, he points to the beginSee HEALĪH on page 21

www.oha.org/kwo

MO'OLELO NUI ■ C0VER FEATURE

■ KAWAIOLA ĪHE LIVING WAĪER 0F OHA

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HEALĪH Cūntinued fram page 17

nings of the now-acclainied nutrition garden. "We were cajoling, encouraging, exhorting the Micronesian women in our diabetes-management group to get more exercise, when finally the interpreter got up the gmnption to say there is no word in their language for 'exercise,' and we were dumbfounded that we hadn't even eonsidered this. Someone had the foresight to say inmiediately, 'Well, no exercise? Then what about farming?' " The women's response was swift, Derauf recalls. Many eome from islands with farmland that was either contaminated by U.S. nuclear testing decades ago or submerged by the more recent effects of global warming and sea-level rise. Thrilled to take up machetes at the KKV park, they hacked back jungle and for their first harvest carted away a eumulative 500 pounds of sweet potato for their home kitchens. "For me as a Native Hawaiian, to hear these stories of recent eolonial dispossession of land in Micronesia is a jarring reminder that if I stop participating in cultural ways to feed my family and being with eommunity, then I am less active. And the food I am eating is not so good and my spirit is weaker," says Puni Freitas, the education coordinator of Ho'oulu 'Āina public programs at the KKV park, where the site staff is comprised of just five people. Make that five very energetic people. REMEMBERING TIES TO THE LAND As Freitas bounds up a mountain to the upland forest, she stops to point out places where she has seen the reconnection with land work wonders for people. For example, she says, participants in KKV's Women's Way group for drug rehab often get emotional recognizing the 'ilima flower that a grandmother taught them to use for cramps or the pōpolo berry that an auntie onee used to heal a wound. "In the spaciousness of the park, they ean breathe fresh air, feel the sun and the wind on their faces, and talk story about their family or children in a way they wouldn't in a elinie," says Freitas.

Back in the garden under the noonday sun, Freitas is greeted by a KKV volunteer. At 82, Melvin Lee takes the bus to the end of the line in Kalihi Valley and rides his bike the rest of the way to get here. "Sometimes I meet people who cannot even use a hoe. I don't know how I acquired this knowledge. It's always been with me," he says with a laugh. Lee talks about growing up in this valley, catching 'o'opu, picking ti leaves for kālua pig and swimming in the nearby stream. Now he lives in an apartment, where he says he misses the land so mueh, he comes here regularly. Like a huge green magnet, the Ho'oulu 'Āina programs in the back of Kahhi Valley are attracting legions of volunteers on "community workdays" every third Saturday of the month. Families, church groups, hikers, schools and numerous nonprofit groups descend on the park and "do ehoke work," as Freitas puts it. Many return to take part in the several enviromnental and eultural site-interpretation programs, and in exchange, they continue to donate labor or plants - or, says Freitas, even an oli will do. "When you eome to the land, just don't eome empty-handed; be ready to give back," she says. More recently, nursing students from Windward Community College have formalized an agreement to work in the park for a set number of hours every week. Cheri Pokipala, who is on the verge of completing

the program, was so intrigued by an iniīial visit here that she proposed the plan to the student board of the WCC program, whieh incorporates both service learning and native values. In clarifying to her peers that they wouldn't necessarily be going to take blood pressure or pulse rates, but instead would be toiling alongside some elderly park users, her idea was at first greeted by skepticism, whieh she shrugs off. "We've become so independent as individuals and families living apart. We need to make an effort to learn eompassion and community - the aspects of nursing you can't get from a textbook," she says. A lesson she hopes to gain from the park visits is eultural sensitivity - also an aspect of medical care gaining new importance as hospitals looking to meet certain regulatory standards must show their medical staff is eapahle of understanding the prevailing eultural view of heahh for the population they serve. Pokipala, who volunteered in a lo'i patch as a eomponent of the nursing program, said she has found the link between heahh and land easy to understand: "It's sunple and therapeutic. You get in the mud. It's a great equalizer. You're away from all your stress. You feel better." No one is saying that connecting 'āina activity and healthy living is anything new. In fact, it's a principle of the Native Hawaiian Heahh Care Improvement Act, passed by Congress in 1988. However, all the new

effort to help the principle take root comes amid a gathering storm of healthcare challenges that are magnified for Native Hawaiians who are not only disproportionately affected by healthcare disparities but also by unequal access to quality heahh care, according to research by the Native Hawaiian heahh organization Papa Ola Lōkahi. This is the result of several factors including a doctor shortage in mral Hawai'i, loss of medical benefits for those who have lost jobs, combined whh soaring costs of medieal treatment. "Our current heahhcare system rewards specialty care and procedures that are very expensive but not necessarily good for wehness," says Beth Giesting of Hawai'i Primary Association. KKV's Derauf agrees. He adds that the U.S. spends more on heahh care per eapha but only ranks 40th on a global scale of national heahh outcomes. Giesting says h would be tempting to think that money alone ean buy quahty care for Native Hawaiians or that putting an insurance card in every Kanaka MaoU hand could be the answer - but the facts indicate this is not so, she says. "We need to turn the healthcare system upside down and focus on primary care, and by this we mean a long-term and stable relationship with a healthcare provider - not even necessarily a doctor, but someone like a nurse practitioner who knows the patient well enough to identify problems early." She says Hawai'i's community healthcare centers have this as their

aim and their new interest in eonnecting land and lifestyle shows that they "get the big picture that wellness is about more than making sure you get your annual screenings." Nonetheless, KKV and all other health centers are vulnerable to the proposed $42 million cut in Medicaid funding that Gov. Linda Lingle said she intends to implement sometime this year. A disproportionately high number of Native Hawaiian patients seen at the eommunity health centers are covered by Medicaid. Derauf says people shouldn't panie over the proposed cuts but should look seriously at some of the lessons many health professionals at KKV have learned from listening to patients from native eultures - to slow down some, take off the blinders to traditions that served the health of our ancestors and to not let cultural differences be obliterated by modern times. At the same time, not everyone agrees that getting back to the land guarantees Native Hawauans will get back to reducing health disparites. Dr. Kalani Brady, the new interim chair at the UH Medical School's Department of Native Hawaiian Health, cautions it's important not to overly romanticize the health value of the 'āina, since Native Hawaiians - like every other population, are not a monolith in the way they respond to certain types of food or activity. One good step, he says, is to use the tools of modern medical research to focus on Native Hawaiians. This would mark a sea change from existing research, whieh is largely based on data gathered in studies of Caucasian male populations. These studies, he said, set protocols for drug therapies and other medical interventions, based on the erroneous presumption that biology doesn't vary between groups. By researching how Kanaka Maoli fare in applying an old idea in new times, he said, we will gain an understanding of the degree to whieh going back to a tradition must also be blended with the abUity to adapt to an ever-changing environment that poses new challenges to the pursuit of wellness. Meanwhile, most agree that the land-based movement has this positive effect: the term native health, used so often in the same sentence with "problems," is now combined with "solutions." ■

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5 reasons to reduce risk by eating 5 portions of fruit and vegetables a day 1. They're paekeel with vitamins anel minerals. 2. They ean help you to maintain a healthy weight. 3. They're an excellent source of fiber anel antioxidants.

4. They help reduce obesity linked to heart disease, diabetes and some cancers.

5. Theytaste delicious and there'ssomuch variety to choose from.

Source: ll.S. Centers for Disease Control £