Even after the Hawaiʻi legislative session ended on May 2, 2025, Sen. Lynn DeCoite refused to give up on one of Molokaʻi’s most pressing needs: access to healthcare transportation.
“There’s an aging population, there’s needs, and even though doctors are trying to fill the gap, people are still retiring, and doctors who don’t live there cannot even get there on time,” said DeCoite.
For residents seeking specialized treatment, they travel by plane and when that is not available, by boat.
First elected to the House of Representatives in 2015, DeCoite has steadily introduced bills that would provide funding for reliable healthcare transportation for Molokaʻi. Over the past decade, DeCoite has introduced multiple bills to subsidize healthcare flights and costs for visiting physicians. This past session was no exception.
“My colleagues graciously supported it, but we couldn’t get the House to do it,” she said.
Undeterred, she has begun engaging with partners and organizations to bring much-needed investment to her home island. Specifically, she wants to create opportunities where traveling doctors can have reliable transportation and a place to stay for a few days to provide care.
“It’s working to fill the void of, you know, what we’re lacking. Whether it be just practitioners, it’s to try and put out more funding to help with costs.” said DeCoite.
Molokaʻi faces significant healthcare challenges due to its remote location and limited medical infrastructure. For residents, understanding the scope of available healthcare services and the limitations is crucial for planning and accessing necesary medical care.
The island’s population is about 7,400 residents. According to the 2021 Island Community Report by the Office of Hawaiian Affairs, approximately 65% of Molokaʻi’s residents are Native Hawaiian.
Two years ago, Molokaʻi lost two beloved physicians within months of one another – Dr. William Thomas, who passed away on Sept. 4, 2022, at the age of 63, and Dr. Emmett Aluli, the iconic leader of the Protect Kahoʻolawe ʻOhana, who passed away on Nov. 30, 2022, at age 78. Their deaths left an enormous gap in reliable primary care for the island, despite the continuation of traveling doctors.
After conducting many interviews, Molokaʻi General Hospital (MGH) president Janice Kalanihuia recently secured two doctors for MGH: an internal medicine provider and a pediatrician. One will begin in July and the second will start in November.
“We kissed a lot of frogs before we found the right ones,” said Kalanihuia. “We’re open to people coming here and moving; we watch to see how they integrate themselves into the community and how genuine they are, and their desire to be here.”
Kalanihuia says she is constantly tracking potential medical professionals as part of a recruitment effort.
MGH is the island’s only hospital, offering 24/7 emergency services, acute care, imaging, and outpatient treatments. It is fully operational and was recently recognized as one of the top 20 Critical Access Hospitals in the U.S. for quality care.
The island also has Nā Puʻuwai, which provides culturally grounded health services, chronic disease management, and wellness programs, and the Molokaʻi Community Health Center which offers primary care, dental, behavioral health, and mobile clinic services.
Kalanihuia noted that most residents seek primary care. “I think the kinds of services that we offer are fairly all-encompassing for rural [communities], because you have to remember, we don’t have any surgical capability. There are no on-island specialists, no anesthesiologists, so the kind of care we can provide is pretty narrow, but for a small community hospital, we are really well outfitted.”
MGH now has a wound care specialist at its facility once-a-week. “Previously you would have to get on a plane and go to Oʻahu for that kind of care – and a lot of people just did not do that. They opted to stay home until we sent them out and they ended up with amputations. So I think this service has really saved people’s limbs,” Kalanihuia said.
Medical needs that are complex and severe are what DeCoite is most concerned about. At times she has received calls from residents who need air transport, but no flights were available.
“When they’re stuck at the hospital and they cannot get on the airplane, I have to call the National Guard,” DeCoite said, adding that she has also reached out to those who own private helicopters for help. “That’s where we’re at.”
When DeCoite’s bill for subsidies had its first hearing this last legislative session, the Department of Transportation and the Chamber of Commerce offered favorable testimony.
“You know, nobody from Molokaʻi would testify, which was upsetting,” she said. DeCoite believes the lack of public testimony reflects the tension to preserve Molokaʻi’s identity without forgoing essential services or funding.
DeCoite wants to raise awareness of the challenges she faces in getting funds when there is a lack of community voices who favor business opportunities that would result in more transportation and lodging options on Molokaʻi.
In the meantime, the healthcare organizations on Molokaʻi continue to serve who and when they can.
“It’s a really serious business, and it’s a huge responsibility,” said Kalanihuia. “You know, I sit here with Emmett’s picture right over my shoulder, and I just think, you know, how would he want to see this unfold? What would he want to see happen? And then I try to do that.”
