Health care crisis: The dearth of specialty services on Molokai has some asking, ‘Why bother?’

HONOLULU (HawaiiNewsNow) - On Molokai, there are so few medical services that people can’t get an MRI, surgery or anesthesia on island.

Most specialized care also requires a plane trip to Oahu or Maui.

Hawaii News Now found residents are resigned to the lack of care, but resilient in dealing with the challenge.

For many who live on Molokai, though, the lack of medical services has an impact — even before they are even born.

Lexis Kalawe, who is 22, gave birth to her son, Naio, seven months ago. Before he was born, she took a trip to Oahu to make sure the baby was developing properly.

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“They don’t have the resources over here to check the gender, to check if they have all their chromosomes to check if they have all their fingers or if they’re growing well you have to go fly over there,” she said.

Molokai Hospital doesn’t have the capability for advanced imaging, surgery or anesthesia so many moms, especially with risky pregnancies, deliver off island.

Sometimes, mothers in labor have to take emergency flights when there are complications.

“So, my auntie, she was literally giving birth, but they took her to the plane and they tied her legs shut. So the baby wouldn’t come out,” she said.

For births on island, midwives — especially those trained in Native Hawaiian practices — play a major role.

That was Kalawe’s choice.

“I just felt all these scenarios that I’m hearing that happened to people that I know close to me, it could happen to me. So, I knew if I was in my own home, I would feel way more comfortable with anything that happened,” she said.

Her son was born after a 16-hour labor, and she called in the midwife for the last moments.

“The cord was fine wrapped around his neck. I birthed him out. And she unwrapped it,” but Kalawe said there was no panic. “Nothing. It was nothing to freak out about.

“He cried one minute later, everything was fine.”

The choices available for those healthy and young, like Lexis Kalawe, are one thing.

But for kupuna the choice can be much starker when forced to fly to Oahu for specialists, according to private practice Dr. Kaohimanu Dang Akiona.

“They say ‘I don’t want to die on Oahu, you know, I want to be home if there’s a chance I might get worse. I don’t want to get stuck there,’” she said.

Akiona is the only M.D. in private practice on Molokai after taking over the clinic founded by Dr. Emmet Aluli, who died a year and a half ago.

She said she struggles to engage people with a medical system that seems to have passed the island by.

“Usually, some of the more the elderly kupuna and they just say ‘More better I die, humbug like that, you know, shoot just too much homework,’” Akiona said.

At a suburban house in Kaunakakai that was repurposed by the county for the Molokai Kupuna Program, Kaui Manera, a retired executive of Alu Like, said that it’s a “challenge” to be old on Molokai. “I’ve heard kupuna say, ‘I give up.’”

The program offers services to keep kupuna healthy and mobile.

For Mary Kalilikane, that means a a foot and leg massage from Chisa Kalani to help keep her on her feet.

“We get a lot of services we can’t get on this island,” Kelilikane said. “We get forgotten by the other islands.

“The podiatrist flies here like once a month,” added Kalani. “So, the feet go often overlooked and when your mobility is challenged that’s when your quality of life goes down. So it feels good to do this kind of service.”

The center also offers computer help for telemedicine and a gathering place to fight off helplessness and despair, side effects of an island with so many needs.

“It’s sad,” Manera said. “This is 2024 and I think poverty is a cruel, cruel monster and he’s alive and well on Molokai. I’ve heard kupuna say ‘why? Why bother?”

For many the answer to “why bother” is in the family ties — like those that gave Lexis Kalawe faith to go without a doctor.

When asked how her baby is doing, she smiles lovingly. “He’s perfect. He’s so perfect.”

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