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Has health care access on Hawaiʻi Island improved or worsened with the pandemic? A survey seeks answers

Dr. Jennifer Wai-Yan Kalani Shrestha at Kaʻū Rural Health Clinic access to care hawaii island medical care doctor
Community First Hawaiʻi
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Dr. Jennifer Wai-Yan Kalani Shrestha at Kaʻū Rural Health Clinic

The coronavirus pandemic shed significant light on some of the gaps in health care access across the state. Efforts are underway on Hawaiʻi island to map out exactly what those gaps are and where they can be found.

Primary care physician Jennifer Wai-Yan Kalani Shrestha serves one of Hawaiʻi Island’s most isolated and rural communities – Kaʻū. She says it isn’t uncommon for her patients to forgo medical care if it is not accessible.

"I mean when you're asking someone to go see a specialist perhaps in Hilo or Kona, that is a big gas bill for people and time too," Shrestha said.

She says her dialysis patients, for example, will often skip treatment because there’s no dialysis center in Kaʻū. Shrestha hears their frustration on a daily basis.

"I don't care how it's gonna affect me, because I'm so tired having to go to dialysis for four hours, having to try to take the medical taxi which is another eight hours you know because you gotta pick up people from Ocean View, Na’alehu, Pahala," Shrestha recalled people telling her.

"It ends up being a 12-hour day for people. But they are just such a resilient group of folks that they can just make it through. But is it right to keep asking people to make it though? No," she told Hawaiʻi Public Radio.

This is just one snapshot that the Access to Care survey aims to capture. The survey was launched by the Big Island nonprofit Community First, a group of stakeholders including service providers and policymakers aiming to improve community health on the island.

"So this survey is really about helping us to be better informed when we talk about access," said Randy Kurohara, executive director of Community First. "Like what is it that the community is looking for? Is it primary care? Is it specialty care? What kind of specialty care? In what geographic areas are people looking to receive more care or more resources?"

Sherry Bracken
Sherry Bracken

Community-needs assessments are nothing new to the health care industry, says Dan Brinkman, CEO of the Hilo Medical Center.

His hospital conducts one every couple of years, but he says these assessments focus more on what public health data says patients need.

"It’s very different in some ways than asking all the people who live here what they think they need," Brinkman said. "And I think you really need both. Then you can get really good direction of what you can focus your resources on."

Brinkman is particularly curious as to how the pandemic may have changed the community’s perception of what they want when it comes to health care.

"Remember people hardly ever did anything telehealth. Now they’re doing a lot of telehealth. People used to be fine with flying everywhere. They’re not anymore," Brinkman told Hawaiʻi Public Radio. "Perceptions have changed and we as health care providers… want to improve the community’s health. I figure we should ask them."

202110_AccessToCare-5.jpg
Community First Hawaiʻi

That’s a welcome change says Kaʻū physician Shrestha, who was skeptical of the survey at first.

"You know what’s the point of being a part of the survey for institutions who haven’t respected these communities and have created disproportionate and marginalized effects for us," she said. "But because it is a community-based survey, I'm really hoping that this survey will not only equal to some research poster or points, but actually lead to change."

The Access to Care survey is available to Hawaiʻi Island residents online through the end of November. Physical surveys will also be available at pop-events at supermarkets and vaccination clinics.

The survey can be found online at communityfirsthawaii.org/access-to-care.

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