Many of us dream of escaping to a tropical island. Imagine a necklace of gem-like islands draped across the sparkling Pacific Ocean and blessed with perfect weather. Misty showers barely touch the skin in dazzling daylight; evening breezes cool and refresh. The land can be arid or lush, dangerous or peaceful. Its beauty can simply take your breath away.
Yet, in this wondrous place, many of the people of Hawai`i critically need oral health care. According to the Hawaiian Islands Oral Health Task Force, of the State’s neediest, children suffer disproportionately. Hawaiian children have one of the highest rates of dental caries in the nation; the State has the lowest proportion of residents with access to the benefits of fluoridated drinking water. While there is a favorable ratio of dentists to residents (1 dentist per 1,257 residents), there is a shortage of providers willing to treat the vulnerable populations, which exist in all urban and rural areas of the Hawaiian Islands.
“O`ahu.the Gathering Place”
Kokua Kalihi Valley Comprehensive Family Services
(KKV), formed in 1972 as a non-profit corporation in Honolulu on the island of O`ahu, Hawai`i, tends to the health and social service needs of the local community, which is over 95 percent Asian and Pacific Islander. Tucked between Pearl Harbor and downtown Honolulu, Kalihi Valley and its surrounding neighborhoods are the first home to a majority of the new immigrants to the State of Hawai`i. The area is at high risk for poor birth outcomes, substance abuse, youth delinquency, dental disease, and communicable diseases. A high percentage of the population lives below the Federal poverty level. Housed originally in the pastor’s office of Kalihi Baptist Church, the KKV started with a coordinator and four outreach workers who combed the valley connecting residents in need with existing services. Two physicians offered medical care in an apartment, sharing the space with public health nurses and the Mothers’ Sewing Club. A volunteer dentist began the dental program in 1973, the year that the facilities moved to renovated surplus military trailers.
Today, a staff of eighty offers services in seventeen languages and from five locations. One of the KKV locations, the Charles Judd Community Health Center opened in March 2001. It is a modern fully integrated medical, dental, and behavioral health facility, which provides primary dental and family medical care and perinatal, family planning, and nutrition services. The center offers special services in geriatrics, social services, and health education. The Federal Bureau of Primary Health Care, Primary Care Effectiveness Review assesses the center. Residents in pediatrics and obstetrics and gynecology from Queens and Kapiolani Children’s Hospitals train at the center. The dental team consists of four full-time dentists, one full-time dental hygienist, and eleven dental assistants. Dental services include preventive, primary, and general dentistry. About 50 percent of the services are for pediatric patients. Other services include endodontics, oral and maxillofacial surgery, and prosthetics. The dental staff sponsors three community outreach programs. It provides over 14,000 dental sealants in five schools, classroom education, and intervention and prevention for children between zero and five years. The staff at the health center is collegial and committed to its mission. Many on the staff are long-term employees. They are a friendly, closely-knit group that has treated many of the same families for years.
The Reverend Richard Wong and the Kaumakapili Church staff founded Kalihi-Palama Health Center in 1975. Their vision was to provide a walk-in health care clinic for many uninsured, poor, immigrant, and minority families. This vision continues for the center from its roots as a volunteer health clinic to the present as an integrated comprehensive health center. Kalihi-Palama, known throughout its Central O`ahu community, is just walking distance from Honolulu’s Chinatown. Tamashiro Market, O`ahu’s best known fishmarket is just around the corner from the clinic. The clinic provides comprehensive adult health care, women’s health, midwifery and family planning, behavioral health, pediatrics, optometry, and the WIC (women, infants and children) nutrition program led by teams of caring physicians, certified nurse practitioners, certified nurse midwives, certified medical assistants, and counselors. Kalihi-Palama has health educators who work in schools. They play an active role in the community by providing TB testing, diabetes screening, and health risk assessment programs to students. The multilingual staff can speak up to fifteen different dialects to assist the non-English speaking patients.
Kalihi Palama Health Center is a strong advocate for the homeless population. Today, the clinic has five satellite clinics to provide health care services for the homeless. The homeless project includes a team of health care providers, counselors, and case managers who find housing for the homeless and prepare them to live in the larger community. Since 1975, the clinic has grown rapidly, from a staff of 21 to more than 200 employees. The clinic strives to fulfill the vision of Reverend Wong to provide integrated health and social services to the community and others in need.
The dental team is made up of twenty-three staff, seven of whom are dentists and one hygienist. The team, unique from other departments, is cross trained to perform a challenging job. The dental department provides basic dental services including periodontics, prophylaxis, restorative dentistry, and routine endodontics, oral surgery, and prosthodontics. The department has a satellite clinic in the Institute of Human Service’s women’s shelter. The staff provides basic dental services to those residing inside the shelter, and within the area. The dental patients represent a cross-section of O`ahu’s population.
Situated atop a grassy hillside overlooking the Pacific Ocean, the Waianae Coast Comprehensive Health Center (WCCHC) serves the Federally designated medically underserved rural community of Waianae (pop. 42,259). The Center, recognized as the third largest non-profit service provider in the State with gross revenues in excess of $28 million, employs over 440 individuals and provides primary care services through five clinic sites located on the Leeward Coast and Central O`ahu. The range of services includes: primary care (family practice, pediatrics, internal medicine); dentistry; 24 hour-emergent care; specialty care (orthodontics, podiatry, dermatology, OB-GYN, nephrology, allergy and clinical immunology, ENT, perinatology, general surgery, pain management); laboratory services; radiology; pharmacy; preventive health/education; medical nutrition/Women and Infant Care; Native Hawaiian healing; integrative/alternative medicine; adult day care; behavioral health; and health career training. Recent data show that the center provides care to about 24,000 individuals. Sixty-eight percent of patients are below 100% of the Federal poverty level; seventy-seven percent are Asian/Pacific Islanders, with 52% being Native Hawaiian.
The dental department is situated on the main campus and consists of a close knit group of three full-time general practitioners, one hygienist, six assistants, four front office/billing staff, and an office manager. The six-operatory facility was constructed in 1995 and designed to accommodate right or left hand delivery. All levels of services (emergency, preventive, interventive, and rehabilitative) are provided, with emphasis on the pediatric population. A dft rate in 5-9 year olds of 4.132, distinguishes the community as having one of the highest caries rate on the island. The department, however, is family oriented, allowing a full range of clinical experiences for providers and the opportunity to develop long-lasting ties with patients. Besides developing their technical proficiency, residents can expect to sharpen their skills in oral diagnosis, comprehensive treatment planning, personnel and fiscal management, preventive outreach services, and management of the medically compromised patient. By incorporating a global practice experience into the curriculum, WCCHC hopes to prepare future professionals with clinical, patient service, and business skills that will make them successful in the future.
“Kauai, the Garden Isle.”
Kauai Community Health Center is a component of the Kauai Veterans Memorial Hospital in Waimea, which was completed in 1957 to meet the increasing medical needs of the people of the surrounding communities. Today the hospital employs approximately 155 employees. The health center is located in the affiliated Kawaiola Medical Office Building, which was dedicated in 1996. An outcome of a collaborative strategic plan for health care for the West Kauai communities, the Kawaiola staff provides family health care, internal medicine, obstetrics and gynecology, pediatrics, and orthopedics. The community health center is a Federally qualified health clinic and reviewed by the Federal Bureau of Primary Health Care, Primary Care Effectiveness Review.
The staff of the dental clinic provides services to patients who have no other source of oral health care on Kauai, the uninsured, mentally disabled, and homeless. Native Hawaiians also come from the nearby island of Niihau for care. The patients typically range in age from 18 to 44 years and many suffer from cancer, diabetes, HIV, pulmonary-cardiovascular disease, and hypertension. The dental facilities are state-of-the-art with video teleconference (VTC) capabilities and digital radiography and anesthesia are available. The staff provides general dentistry and will soon offer crown and bridge and dentures on a sliding fee basis. While some patients are referred to O`ahu for oral and maxillofacial surgery, the health center is the only source of these services for Medicare patients and the homeless on Kauai. There are four general dentists, a full-time dental hygienist, five dental assistants, one dental assistant manager, two receptionists, and a case manager. A second health center has opened on the Eastside of Kauai adjacent to the Samuel Mahelona Medical Center in Kapaa. Its dental facility is also state-of-the-art with digital imaging and VTC capabilities. Both sites support telepharmacies along with one at a third location at Harbor Mall in Lihue. The new clinic has 30 employees including two general dentists, three dental assistants, a receptionist, and a part-time dental hygienist. The dental teams have extended sealant, fluoride varnish, and patient/parent education programs into the community. Education videos are culturally and age appropriate and emphasize the effects of oral infections on the rest of the body. There is only one dental specialist on Kauai. Medically complex patients who have no other recourse for oral health care will challenge dental residents.
”...Maui No Ka Oi…” – Maui is the best
In the shadow of the lush Iao Valley and circled by rainbows, the Maui Oral Health Center serves as the primary access to dental care for Maui’s 17,000 Medicaid patients. Maui Oral Health Initiative has a dual mission of education and service. The Maui Community College (MCC) Oral Health Initiative emerged in 2002 from the need for allied dental personnel (dental assistants and dental hygienists) and the oral health crisis on Maui. Facilities include the Maui Oral Health Center and a mobile dental van.
The Maui Oral Health Center serves as a classroom and clinical site for the MCC Dental Assisting Program (the dental hygiene program is proposed for fall 2007) and provides affordable and accessible oral/dental health care to the underserved, low-income, uninsured families of Maui. The Maui Oral Health Center is a 3,000 square foot facility in central Wailuku and has a large waiting room, a reception area, a classroom, seven operatories, and x-ray facilities. In October 2003 the Office of Social Ministry donated the Mobile Care Dental Van to Maui Community College. The Mobile Care Dental Van is a 40 ft. Airstream mobile unit that is ADA accessible. The van is fully equipped with two dental operatories, separate sterilization area, and patient intake space. The van has digital x-ray and DENTRIX, advanced software for dental office management.
Maui Oral Health Initiative has two full-time equivalent general dentists and a dental Director who teaches cosmetic and implant dentistry. A number of Maui dentists volunteer their time as members of the Maui Oral Health Initiative Advisory Committee and as dentists for the Mobile Dental Care project. In this role they work directly with the dental residents. The Initiative works closely with dental specialists in the community, who also act as specialty consultants for the dental residents.
Hawai`i, Island of the Lehua Blossom
Bay Clinic, Inc. is a not-for-profit organization founded in 1983 as a family planning clinic in Hilo on the island of Hawai`i. Over the past 21 years, the organization has grown to become the largest community health center network on the island. Bay Clinic, Inc. now specializes in providing healthcare to the rural underserved, and is a network of four Federally-qualified health centers (FQHC’s) providing comprehensive primary care and enabling services to thousands. Each of our centers provides general and preventive healthcare, inpatient care at Hilo Hospital, family planning, prenatal care, mental health counseling, and case management for those with multiple needs.
The Hilo Bay Clinic is less than a mile from Keaukaha, the oldest Hawaiian Homelands settlement on the island. This clinic serves as the main office for the organization. Its Women’s Health and Family Planning Department is the largest program of its kind on the Big Island, reminding all of us of the roots from which the organization has grown. More than 4,000 patients visit the clinic for over 10,000 medical visits a year.
The Pahoa Family Health Center opened in November 1991 with the help of a Federal Rural Health Outreach Grant and today is a thriving primary care center serving an area of 7,000 residents. Pahoa is almost 30 miles from the nearest emergency room, and transportation difficulties often complicate the healthcare needs of patients. Pahoa is part of the Puna District, where the health center remains the only primary care provider in a quickly growing district of 22,000 residents, large sprawling rural subdivisions, and a population where 49% of the residents receive welfare and/or food stamps.
The Ka’u Family Health Center is in Na’alehu, the center of the Ka’u District on the south end of the Big Island. In 1996 the last sugar plantation on the island closed down after more than a century. Hawai`i Family Medical Centers, a subsidiary of the state health care system, turned over the entire primary care operation to Bay Clinic, Inc. because they knew we would work with the community to begin a new era of healthcare there. Ka’u is an isolated district-70 miles from Hilo Hospital to the east, and 75 miles from Kona Hospital to the west. In a district with an unemployment rate exceeding 15%, a physician and a mid-level provider provide care in a seven-bedroom plantation house.
The Keaau Family Health Center opened in March 2003. It is located on the border of the Hilo and Puna district. This site is unique because it has a combination of medical and dental services. The Dental Clinic services primarily East Hawai`i. As we are the only operating community health center with dental service our patients, however, come from all over the island. East Hawai`i has over 48,000 patients, almost one-third of the island’s population, who are uninsured or underinsured. Most of these patients have nowhere else to turn for dental service. The Puna district has the highest poverty and crystal methamphetamine abuse rates in the state. The dental team consists of two dentists, four dental assistants, and one dental receptionist. There are five operatories. Our staff performs a wide variety of procedures in the areas of preventive dentistry, operative dentistry, fixed and removable prosthodontics, endodontics, periodontics, and oral surgery for adult and pediatric patients. Our plans for the future are to include dental services at our Hilo site in order to meet the community’s needs.
Islands of Myth and Mythical Beauty
Intrepid and master seafarers, Polynesians from the Marquesas discovered the island of Hawai`i possibly as early as the third century. They used the stars and color of the water and the currents and depth of the ocean to determine direction. The Tahitians conquered and subjugated the Marquesans around 1,000 A.D. Over time, they imposed a strict hierarchical social system, royal lineage, and religious beliefs grounded in human sacrifice and kapus, taboos. Gods and goddesses were plentiful, their legends powerful. Even today, guides and residents caution visitors not to take lava as a vacation souvenir-Pele, the goddess of volcanoes should not be disturbed. The ancient Hawaiians developed rich traditions in oral genealogy, song, dance, and crafts. They loved sports and games-holua, downhill wooden sled races; betting on the sled and foot races; surfing, with its special grounds for commoners and royalty; ulu maika, a kind of bowling; and konane, similar to checkers.
Captain James Cook discovered the islands in 1778 during his decade-long exploration of the South Pacific naming them the Sandwich Islands after the Earl of Sandwich. His arrivals on the islands, interrupted by his journey to find the Northwest Passage, coincided with the important Makahiki festival but his auspicious welcome as the god, Lono, ended a year later in his death. At the time of his death, the islands were controlled by warring chiefdoms. Other westerners followed and brought metal and weapons. Kamehameha I used his ambition and military cunning to consolidate his power and unify the Hawaiian Islands by 1810. After his death in 1819, his favorite wife conspired to share a meal with his son and successor. This seemingly simple event broke a strict taboo against women and toppled the system of kapu. Hawai`i was ripe for the arrival of missionaries and further western influence by haoles, whites. By the end of the 19th century, Sandford Dole, a son of missionaries, replaced Queen Liliuokalani in a “coup” by American businessmen. President McKinley annexed the islands in 1898, and Hawai`i joined the Union in 1959.
O`ahu, “the gathering place,” beckons travelers to the Hawaiian archipelago. This beautiful island, dotted by extinct volcanoes and split by two mountain ranges, is home to modern Honolulu and 75 percent of the state’s population. Robert Louis Stevenson once praised the quiet pleasures of Waikiki Beach, which now rivals the hustle and bustle of Miami Beach. Climb Diamond Head to gape at the panoramic view, contemplate the austere dignity of the Arizona Memorial, thrill at the skill and bravado of Banzai Pipeline surfers, or picnic on the pretty beaches of Waimanalo Bay. O`ahu offers the blended Eastern and Western cultural and urban life of Honolulu, the convenience of bedroom communities in Kaneohe and Kailua, and the escape of the North Shore and Waianae Coast. Take advantage of Kama`aina discounts available to state residents to enjoy local recreation, shopping, restaurants, and travel. Use O`ahu as the jumping off point to explore the incomparable beauty and diversity of the Neighbor Islands.
Wild, spectacular, lush, swampy, sunny, rainy, barren, tropical, all describe Kauai, the Garden Isle. It is the oldest island in the Hawaiian chain and imbued in legends and myth. Fiercely independent, Kauai never was conquered by another island chief. By trickery, kidnapping, marriage, and death, the kingdom of Kauai prevailed until 1824 when it became part of the unified Hawai`i. Formed from Mt. Waialeale, this central extinct volcanic peak is the wettest place on earth. In every direction from this spot, Kauai offers remarkable sites and climate. Headwaters flow into the richest river system in Hawai`i. Waterfalls gush into streams and valleys after rains on the North Shore. Cliffs slice down to the restless ocean along the Na Pali coast. Glorious beaches stretch invitingly along the western and southern sides of the island. The Waimea Canyon surprises and impresses as the Grand Canyon of the Pacific. The sheer beauty of Kauai overwhelms the senses and lingers in memories.
According to legend, the god Maui snared the island rather than a fish on a fishing line trying to prove his worth to his brothers. Geologists, taking a more practical view, believe the island was formed eons ago by the fusion of two volcanoes. King Kamehameha I established a residence in Lahaina after unifying the islands and it became a seat of commerce for whalers, traders, and explorers and eventually a magnet for missionaries. Today, tourism, sugar, and agriculture are primary industries amid the beauty of Maui. Lahaina remains a charming seaside village. The Iao Valley, once the burial place of royalty, is a hidden treasure. From the plush resorts of Wailea to the spectacular Hana Coast, Maui is well known for its beautiful beaches and world class hotels, water sports, cultural diversity, and natural beauty, For more than a decade, Maui has been voted “Best Island in the World” in the annual CONDE NAST TRAVELER Readers’ Choice Awards.
Thought to be the first of the Hawaiian Islands to be settled by Polynesians Hawai`i was named possibly for an ancient homeland by Tahitians who arrived a half century later. King Kamehameha I was born on Hawai`i about 1758 and launched his attacks on rivals to unify the islands from a secluded valley on the north coast. The arrival of missionaries soon brought ranchers, coffee growers, and sugar planters and with them an influx of cowboys from Central and South America and workers of Filipino, Japanese, Chinese, and Portuguese descents. The island is a wild mix of lush rainy tropics, gorgeous coastlines, arid desert, and lava beaches. Cozy towns and villages sprinkle this low-keyed island. The haunting moonscape of Volcanoes National Park beckons exploration. And above it all, Kilauea, fiery home to goddess Pele, Mauna Loa, and Mauna Kea rise majestically.
Hawai`i Sam Ishimura, DDS
AEGD Assistant Program Director
808.791.9428
© 2006 Lutheran Medical Center Department of Dental Medicine
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