Photo: Molokaʻi General Hospital
Molokaʻi General Hospital, operated by The Queen’s Medical Center, is one of only three medical facilities on the island. - Courtesy Photos

Late last year Hawaiʻi lost several of its Native Hawaiian doctors, including two long-time providers on Molokaʻi. The losses added strain to the island’s medical care system and disproportionately impacted Native Hawaiians, who make up 62% of the population.

Dr. Noa Emmett Aluli and Dr. William “Kāneloa” Thomas passed within months of each another in 2022 – Thomas on September 4 and Aluli on November 30. Together they provided care for about half of the island’s more than 7,500 residents, according to Dr. Kaʻohimanu Akiona, a Hawaiʻi Island physician who recently opened up an urgent care clinic on Molokaʻi.

Though many rural communities in Hawaiʻi struggle with having adequate medical care, Molokaʻi’s isolation amplifies that challenge.

“The access part [on Molokaʻi] is a thousand times more serious. For one, they don’t have much available on-island. Unlike the Big Island, they can’t just drive to the other side for care,” said Akiona. “They are locked out because there’s only one route on Mokulele [Airlines] and the schedule is inconsistent. It’s almost like the deck is stacked against them – so you can’t get the care to you, and you can’t get to the care.”

There are three medical health groups providing care on the island: Molokaʻi General Hospital operated by Queen’s Medical Center, the Molokaʻi Community Health Center, and Nā Puʻuwai. While these groups continue to provide care to the community, they also recognize that more help is needed.

Photo: Jan Kalanihuia
Molokaʻi General Hospital President Jan Kalanihuia

Referring to doctors Aluli and Thomas, Molokaʻi General Hospital President Jan Kalanihuia said in a statement, “We continue to mourn the loss of these two beloved members of our Molokaʻi ʻohana, who provided compassionate care to the residents on the island. Following their passing, Queen’s provided additional assistance to meet the health care needs of the community.”

Kalanihuia added that Queen’s currently has full-time providers who live on the island, and is bringing in temporary physicians to support the community’s needs while it works toward adding full-time providers.

The already high cost of providing care combined with the cost of travel make practicing medicine on Molokaʻi challenging. Akiona said her team decided they wanted to help fill the need for care despite the difficulties.

“My team said, ‘if we don’t try, I think we’ll all feel bad.’ I told them this is gonna be really hard and we might fail but everybody said, ‘if we fail, at least we tried,’” she said. “Because during the pandemic, we just saw too much. We were seeing people dying preventable deaths.”

Photo: Dr. Kaʻohimanu Akiona
Dr. Kaʻohimanu Akiona

Akiona began seeing patients three days a week on Molokaʻi in late May. By her fourth week of operation, she had seen 64 patients, a quarter of whom were kūpuna and high needs while 20% were children. She said the long-term need is for full-time primary care – the kind Aluli and Thomas provided – and an integrated system of specialists.

In an effort to ease the financial burden of opening an urgent care clinic, the Maui County Council appropriated $300,000 to the clinic. Maui Mayor Richard Bissen signed the budget into law in June.

Maui County Councilmember Keani Rawlins-Fernandez, who represents Molokaʻi, said that while the appropriation was not necessarily meant to be renewed annually, the county should help where it can. “Regardless of whose specific kuleana it is, whether county, state, federal, it’s all of our constituents,” she said. “This is our community, and we should be making sure essential needs like health care are taken care of.”

Asked whether Queen’s supports the establishment of independent private practices such as Akiona’s, Kalanihuia replied, “Queen’s recognizes the need for health care services on the island of Molokaʻi. We will continue to work collaboratively with other health care providers on the island to do what’s best for the residents.”

Fellow doctors and other medical care providers are watching the urgent care practice on Molokaʻi to see if it can be financially sustainable before they are willing to follow suit, said Akiona.

“We have to be able to thrive. I think the hardest part was trying to tell [doctors], you can either serve your community or feed your family,” she said. “The way the model works is we’ve built it on the backs of people who are willing to sacrifice so much that it became unsustainable.”

Lowering the cost of providing care and improving interisland transportation are critical pieces to improving medical access on Molokaʻi.

Looking further into the future, Rawlins said the island must invest in nurturing the next generation of homegrown doctors. “It’s incredible that Dr. Aluli came here and decided to spend his life here. And Dr. Akiona is willing to make a similar commitment. But we really need to be growing our own doctors, from our own community,” she said.

“I don’t have the answer to how this can be done yet. But having homegrown doctors we can financially support through medical school, and then [they] return. I think that is a pathway to securing the kind of health care that we need – those that will come and stay.”