Ka Wai Ola - Office of Hawaiian Affairs, Volume 31, Number 11, 1 November 2014 — What's missing in the statistics on Native Hawaiian heahh disparities? [ARTICLE+ILLUSTRATION]

What's missing in the statistics on Native Hawaiian heahh disparities?

Trustee 's note: I would li.ke to express my mahalo to Claren Keal-oha-Beaudet, Psy.D., and Franco Acquaro, Ph.D., for contributing this month 's eolumn. Earlier this year, Trustee Lindsey asked us to share in his Ka Wai Ola eolumn the work Klpuka o ke Ola (an Integrated Native Hawaiian Heahh Clinic) is doing to address Native Hawaiian heahh disparities on the Big Island. We

shared a broad view of the dire physical, social and mental heahh issues facing the lāhui. Research supports the fact that Native Hawaiians are last in nearly all of the major indicators of heahh - including depression, obesity, incarceration, addictions, domestic violence, hypertension, anxiety, child abuse and neglect, diabetes, poverty and early mortality. Of course, few who live here need research to tell themthis. To open one's eyes is to see the intergenerational legacy of eultural trauma being played out everywhere in Hawai'i nei. Trustee Lindsey asked that we bring the statistics a bit more "to life" by providing real stories of Native Hawaiians we have recently served at Kīpuka o ke Ola. These stories are true, but some details have been changed to protect client privacy. Here are some representative stories: • Three families living near eaeh other in Hawaiian Homes have members struggling with diabetes, but only one of the families has heahh insurance. They now split the one insured person's monthly insulin and needles three ways - so all get at least some medication. • A 19-year-old female is struggling with an emerging schizophrenia disorder. She is beginning to have command thoughts that are instructing her to hurt herself. She is not receiving the appropriate psychiatric medications that could stabilize her condition because the prescribing provider is not specialized in psychotropic medications. • A 40-year-old male has Bipolar Disorder and has recently had two serious suicide

attempts. He has Quest insurance, but none of the loeal psychiatrists take that insurance because of its low reimbursement rate. He is currently unmedicated and in a manie state - with increasing thoughts of harming himself or others. • A 28-year-old female is struggling with intermittent psychotic episodes. Twice she has driven recklessly and crashed her car due to being in an active psychotic state - ending in arrest by the

poliee eaeh time. She will not go the hospital emergency room or meet with a psychiatrist because she does not trust the western medical model to meet their needs in a culturally respectful manner. She and her 'ohana believe the disorder is a spiritual dilemma, not a brain disorder. • A male in his early 30s has significant co-morbid conditions including traumatic abuse history, diabetes, unemployed, mild mental retardation and no support from his 'ohana. He engages in regular selfmutilation and self-medicates with illieiī substances. He bounces from residence to residence in the community as there are no treatment-based housing options. These clients are not just some abstract statistics. They suffer greatly and their debilitating circumstances negatively ripple throughout their 'ohana and the larger eommunity. These scenarios emphasize not only the very real health disparities Native Hawaiians face, but also underscore the deficits in our health-care system's response to them, including: laek of culturally informed services, laek of psychiatric care (especially to those without premium health insurance), many under-insured/uninsured eommunity members, laek of affordable housing, insufficient case-management services and limited therapeutic services across a eonhnuum of care. The Big Island is a Medically Underserved Area and the Native Hawaiian residents are a Medically Underserved Populahon. This clearly needs to be rectified. Please visit our webpage at www.kipuka okeola.com orcallus at (808) 885-5900. ■

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Rūbert K. Lindsey, Jr. Trustee, Hawai'i