Ka Wai Ola - Office of Hawaiian Affairs, Volume 37, Number 5, 1 Mei 2020 — Take the Time to Listen [ARTICLE+ILLUSTRATION]

Take the Time to Listen

fl new generation of Hawaiian leaders are rising to the challenges facing our islands and our planet. E Ho'okanaka features these important new voices.

Marcus Iwane, MD, Chief, Kaiser Permanente Nōnōikeola Clinic. - Photos: Courtesy Kaiser Permanente

By Puanani Fernandez-Akamine and raised in Mililani, 0 'ahu, Marcus Kawika Iwane, 36, graduĒ Jated from Kamehameha Schools Kapālama and eameel his medical degree from UH's John A. Burns School of Medicine (JABSOM) Ē Ē where he was a Nadine Kahanamoku Scholar and Amenean Medical Association Minority Scholar. He comp!eted his residency training locally, eventually serving as a chief medical resident at Kuakini Medical Center. Upon completing his residency, Iwane, an internist and primary care physician, joined the Hawai'i Permanente Medical Group and he currently serves as chiefofKaiser Permanente 's Nānāikeola Clinic in Nānākuli. Iwane is vice president of 'Ahahui o nā Kauka ( the Association for Native Hawaiian Physicians) and in this capacity has partnered with community organizations and Indigenous physicians across the Pacific Basin to help host the hiennial Pacific Region Indigenous Doctors Congress (PRIDoC) whieh allows him to mentor medical students, residents and aspiring physicians in Hawai'i and beyond. What inspired you to heeome a doctor? "As a child, I spent many weekends with my kupuna in Nānākuli. I remember him working in his māla. He encouraged me to get my hands dirty and feel the 'āina. I remember hearing him speak to his kalo. I ean still taste the poi he made for us. It wasn't until I began to explore the idea of practicing medicine, that I realized that my grandfather had provided me with a solid foundation by demonstrating the importance of aloha 'āina, 'ōlelo Hawai'i and cultural heahh. I bring these values to my medical practice. "I enjoy getting to know my patients and seeing their progress over time.

The causes of health issues and some of the solutions are greatly influenced by unique social and cultural factors that aren't always addressed in medical school. I'm invigorated by the challenge of combining traditional Western knowledge with the wisdom of our ancestors." Who were your mentors? "Dr. Emmett Aluli, the late Dr. Kekuni Blasidell and Dr. DeeAnn Carpenter are three that quickly eome to mind. My mentors taught me the importance of building relationships that lead to trust. Relationships are key to effective health care. If a doctor has a bad relationship whh his or her patient, that patient will only eome in if they're very sick and the physician could miss a ehanee to catch something early. Good, trusting relationships between doctors and patients ean be extremely therapeutic and a healing force. Creating powerful, healthy relationships is what I love most about medicine. Another important tool is our ears. It's important to take the time to pause and listen. I find that a lot of times our patients will tell us what's wrong with them if we just listen hard enough." How has becoming a doctor changed you? "It has helped me to realize my kuleana to provide care to Native Hawaiians as well as to the broader community. This is what energizes me. I'm grateful to connect with so many people in our community and to help them. This positive energy also helps me to be a better husband and father. When I started my career, I quickly realized the challenges of applying book knowledge to elinieal practice, the 'art' of medicine. Primary care physicians must be well-versed, nimble, and adaptable. We must also appreciate that our patients ean teach us so mueh, we just have to listen.

L to R: Geoff Sewell, MD (President and Executive Medical Director); Marcus Iwane, MD (Chief, Nānōikeola Clinic); Eric Enos (Executive Director, Ka'ala Cultural Learning Center); Samir Patel, MD (Associate Medical Director, Primary Care), prepare plantings at Ka'ala Cultural Learning Center during Kaiser Permanente Hawai'i's Annual Day of Service. Hosted by Hawai'i Permanente Medical Group.

"I also found I really enjoy serving as a mentor. As chairperson for the student track of the 2018 Pacific Region Indigenous Doctors Congress in Hilo, I was able to mentor Indigenous medical students and residents. We sponsored a module focusing on the importance of aloha 'āina in promoting self-care among indigenous practitioners. Dr. Emmett Aluli says, 'The health of the land, is the health of the people, is the health of our nation.' I believe that for Native Hawaiian clinicians, practicing aloha 'āina is synonymous with practicing self-care." SEE MARCUS IWANE ON PAGE 14

MARCUS IWANE

Continued from page 13 What is your vision for the health of our lāhui? "Meelieine plays a very small role in a person's overall health. Behaviors and social circumstances have mueh greater impacts on heahh and wellness. Recently, one of my patients was having difficulty with his health. Come to find out he had given up his full-time job to care for his mother. Caring for kūpuna ean be incredibly rewarding, but it's also overwhelming and ean lead to burnout. "Only by taking the time to listen to our patients ean we fully grasp their health straggles. This is a paradigm shift. Doctors need to partner with community organizations to help address these issues. For example, we ean build relationships with respite programs in the community and "prescribe" them to help caregivers rest and recover. We have to go beyond the walls of our hospitals and clinics to identify creative solutions for our patients and improve health equity in our communities. This, to me, is the future of health care." Do you have mana'o for our lāhui during this pandemic? "Social distancing is difficult for us in Hawai'i, but it's had a significant protective impact on the spread of COVID-19 here in the islands. The 'ōlelo no'eau, 'Lālau aku 'oe i ka 'ulu i ka wēkiu, i ke alo no ka 'ulu a hala,' speaks of how we ean strive to reach the breadfruit at the top of the tree and miss the breadfrait in front of us. We're all waiting for the day when we ean spend time together again, go places without worrying and carry on with our usual routines. But we cannot miss the opportunities that are right in front of us. While we're at home together we have the ehanee to focus on strengthening our 'ohana. We also have extra time to invest in ourselves and learn new skills. In the community, we're supporting one another and uniting in ways that I never could've imagined. We must eonhnue to build upon this even after we've conquered COVID-19."

Any advice for young people aspiring to careers in health services?

Marcus Iwane, MD wilh wife and son working in ihe mōla at Ka'ala Cultural Learning Center during Kaiser Permanente Hawai'i's Annual Day of Service. Hosted by Hawai'i Permanente Medical Group. - Photo: Courtesy Kaiser Permanente

"It's a privilege and honor to serve our eommunity in health care. It's also a tremendous kuleana. When you're a physician or nurse, people share intimate and personal things about themselves and their lives and trast we'll do the right thing for their heahh. If you're comfortable with that kuleana, a career in heakh care may be right for you. I believe it's the responsibility of our entire heahh care system to improve the heahh of Native Hawaiians. One way to do this is by recruiting more Native Hawaiians to pursue jobs in heakh care. The more we do this, the healthier our lāhui will be." ■