Photo: KOKO Team Pre Pandemic
The entire KOKO team, pre-pandemic. Clinic leadership includes Executive Director/Clinical Psychologist Dr. Claren Kealoha-Beaudet (standing far left); Associate Director/Clinical Psychologist Dr. Franco Acquaro (seated center front); and Medical Director/Internist Dr. Ken Riff (standing far right).
Photo: Claren Kealoha Beaudet
Dr. Claren Kealoha-Beaudet – Photos: Courtesy KOKO

When Dr. Claren Kealoha-Beaudet and the team at Kīpuka O Ke Ola (KOKO) applied for an OHA Community Grant more than a year ago, their plan was to use the funding to expand KOKO’s health center by adding a new wing that would house their Indigenous Healing and Women’s Health Services programs. Once the grant money was available, they went to work. They secured rental of additional office space adjacent to their existing facility in Kamuela on Hawaiʻi Island and began renovating. Their beautiful new wing opened in January 2020.

And then the coronavirus happened.

Immediately recognizing the seriousness of the disease and its potentially devastating impact on the community, and Native Hawaiians in particular, KOKO leadership took swift action. They shut down their new wing, moved their Indigenous Healing and Women’s Health Services back to the main clinic, and began another round of renovations in mid-March, this time converting the space to a COVID-19 testing facility.

“We put together a three-person COVID team who have been trained, and are regularly re-trained, in all protocols related to COVID-19 testing,” shared Kealoha-Beaudet. “We used the remaining OHA grant money to isolate the a/c in that wing to prevent cross contamination to the rest of the clinic via the HVAC system, as well as to purchase additional PPE and cleaning supplies.”

KOKO is a federally accredited Independent Rural Health Clinic. They offer the community integrated, holistic medicine and their services include primary health care (including pediatrics), women’s health, behavioral health and Indigenous health. Because Indigenous health services (lāʻau lapaʻau, lomilomi and acupuncture) are not covered by insurance, these services are offered free to KOKO’s primary care patients. The staff includes two medical doctors, two nurse practioners and three clinical psychologists, one of whom was recently recruited from Oʻahu to help KOKO meet the mental health needs of the community.

“The need for behavioral health services is going through the roof,” said Kealoha-Beaudet. “Since the pandemic began our patient caseload has increased by 30%. We did not want to turn people away so we had to hire a third clinical psychologist.”

Surprisingly, most of the new, pandemic-related mental health cases they are seeing are young, college-aged adults who are panicking about things like not being able to return to college or losing their financial aid and scholarships. And their fears about the future are resulting in tension and fighting within formerly peaceful households. Says Kealoha-Beaudet, “we are working with parents and their adult children to help them find ways to decompress and mālama one another instead of focusing on the disruption that the virus has caused to their life plans.”

In addition to accommodating the upswing in patients needing mental health services, thanks to their new, re-renovated COVID testing wing, KOKO is also able to safely accommodate the surge of medical patients worried about the coronavirus and seeking testing.

Before patients come to KOKO for COVID-19 testing, they have a telehealth appointment with one of the clinic’s doctors using Zoom or Facetime. Doctors use this time to triage patients and discuss any concerns or symptoms they may have to determine whether the patient should enter the testing wing or be tested outside. At KOKO all COVID-19 testing is scheduled between 1-3 p.m. daily so that the COVID team staff members are only using one set of PPE each per day, since PPE has become increasingly expensive and difficult to obtain.

As new information about COVID-19 becomes available, protocols are constantly being updated. So every Monday morning the entire staff gathers for training in the new COVID-19 protocols published the previous week before receiving clients.

Although necessary, these protocols take up a lot more time and affect all patients, not just those seeking COVID-19 testing. “The protocols have changed the way we flow – and our new flow is slow,” notes Kealoha-Beaudet. “where we might have seen 16 patients in-person each day, we now see just 10 to 12.”

A new development resulting from the pandemic and social distancing has been the transition of 30-40% of KOKO’s clients to telehealth.

KOKO has about 2,000 regular patients, most of whom are from Waimea, Kohala, Waikōloa and Puʻuanahulu. Managing chronic conditions is already difficult, but in a pandemic people with chronic conditions have to be really careful. So early on the KOKO team identified their patients who were most at risk, especially those with chronic upper respiratory conditions, and began calling regularly to check up on them. Staying close to their patients with chronic conditions is not something for which KOKO can bill insurance companies. However, this is an example of the proactive care and mālama that KOKO provides to its patients.

Their formula for success in the midst of the pandemic seems to be working. So far all of KOKO’s chronic patients are doing okay. “How lucky we are to live in Hawaiʻi where the (coronavirus) numbers are still manageable,” Kealoha-Beaudet reflected. She credits this to Hawaiʻi’s collectivist culture. “Here we look out for one another and it happens very organically and naturally.”