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Mile-high aloha just what doctor ordered for Oahu’s medically underserved  
By Air Force Staff Sgt. Nicole Manzanares, 140th Wing Public Affairs 
HIMIRT 
Colorado Air National Guard 1st Lt. Colin Greenwood cleans am open wound on a homeless man’s foot on the north shore of Oahu March 17. Hawaii’s high cost of living often makes it difficult for the state’s indigent to get regular health care.
Oahu, the third largest of the Hawaiian Islands, is a breathtaking world of lush, green beauty punctuated with jagged vertical mountains soaring upward more than 4,000 feet. To many, this is paradise; but in the shadows of urban sprawl, there are a growing number of unsheltered and homeless.

While indigence continues to be a concern for most major cities, the Center on Family at the University of Hawaii at Manoa reports Oahu has experienced significant growth in the number of homeless living on its leeward side.

For two weeks in March, members of the Colorado Air National Guard’s 140th Wing Medical Group took part in Hawaii’s Medical Innovative Readiness Training program – or HIMIRT– the state’s domestic civil-military training program, to help alleviate some of these issues – at least for a time. Also called “E Malama Kakou,” a Hawaiian phrase meaning “to care for all,” HIMIRT is a training alternative for Air National Guard units to conduct hands-on, real-world training missions tailored to a unit’s capabilities while providing a help to medically under-served communities in Hawaii.

From March 16-25, the 140th Medical Group traveled throughout various communities, providing non-emergency and preventive health care for the less fortunate. Divided into teams, the Airmen assisted five local clinics that historically have worked closely with HIMIRT: Ko’Olauloa Community Health and Wellness Center in Hau’ula, Kahuku Medical Center in Kahuku, two Waikiki Health Clinics in Honolulu and one satellite clinic on the northern shore of Oahu.

Friendly neighbors

“Waikiki Health Center provides a Friendly Neighbors program where we take community volunteers and partner them with senior citizens around Waikiki,” said Adrianna O’Donnel, the center’s chief marketing and development officer. “These senior citizens are isolated. Most of them want to continue living independently.”

Part of the 140th Medical Group went out with members from the Friendly Neighbors program to an apartment complex down the road from the center. They visited a disabled couple, one of whom was a hoarder.

Members of the 140th Medical Group and the WHC Friendly Neighbors program spent the better part of a week removing items from the home, which is easier said than done, considering the 23-story trip from the apartment to the dumpster.

“They accumulated all of these personal effects that it became a safety hazard,” said Lt. Col. Ron Prosise, 140th Wing chaplain, who volunteered time moving items from the apartment.

Ohua Avenue Clinic

The Waikiki Health Center also operates an HIV clinic and pharmacy out of its Ohua Avenue Clinic.

“Typically what is dispensed here is treatment for small ailments and infections, HIV medications, cholesterol (medications), anti-hypertension (medications) and some antibiotics.” said Capt. Jon Reilly, pharmacist for the 140th Medical Group who worked at Waikiki Health Center.

Maj. Frannie Goffinett, a registered nurse with the 140th Medical Group, who worked in the HIV clinic, explained that in addition to treatment, they often help patients find the additional resources they need. “We have a patient who is currently in the HIV residential housing facility and he was just released from the hospital, but he is experiencing some mental health issues. He needs a higher level of care, so we are calling resources in the area to find better treatment for him,” she explained.

Care-A-Vans

Another team from the 140th Medical Group worked out of the Care-A-Van drop-in clinic in Honolulu and a small clinic on the northern shore of Oahu.

Guardsmen in Care-A-Vans sought out homeless people along the beaches and parks of Honolulu and the northern shore of Oahu to provide medical advice and care if needed. The Care-A-Van, or mobile medical clinic, enhances services for the homeless by providing consultations, medical health advice, social services and examinations.

“There are some people that choose to be homeless but a lot of them are embarrassed by it, they are not proud of their current living situations and they really don’t want to talk about it,” said Maj. Corey Massey, a flight surgeon with the 140th Medical Group.

Some of the people around Honolulu that have been homeless for less than six months didn’t know that Waikiki Health Center was available to them. Many of them asked for help and were provided information and advice to help with their well-being.

Maj. Marvin Lee, an internist with the 140th Medical Group, told of a woman who recently became homeless. A prior teacher in California, she had recently been laid off following a major medical procedure. She moved to Oahu without a plan and had been wandering the streets since. Unfortunately, she had already been physically assaulted while out on the streets. The Care-A-Van and 140th Medical Group members assisted her in finding a shelter and supplied her additional information to help get her back on her feet.

Ko'Olauloa Community Health and Wellness Center

On the other side of the island in Hau’ula, another 140th Medical Group team worked with the Ko'Olauloa Community Health and Wellness Center.

For many, the high cost of living forces the homeless and underserved into tent cities that have sprung up along Oahu’s shores, and the KCHWC makes an effort to reach out to them.

“You will see the homeless scattered about, most of them will be in their cars or hanging out by trees, small businesses or at the shopping centers,” said Michelle Malufau, outreach worker for the Ko'Olauloa Community Health and Wellness Center. “A lot of medical ailments you will see are skin rashes, diseases and open sores that haven’t healed. We will be providing, business cards and information on the health center as well as information on hygiene.”

Members of the 140th Medical Group were informed of key things to look for while searching for the homeless, such as old, beat up vehicles, and tents on the beach. Their days were busy throughout the IRT helping out the homeless by providing medical attention for a myriad of ailments.

“Working with the Air National Guard for the past two years has been a great experience for our community. This experience will be good for the 140th Medical Group to see what the homeless are facing out here compared to Colorado’s homeless,” said Malufau.

Kahuku Medical Center

The 140th Dental and Optometry Clinics worked out of the Kahuku Medical Center in Kahuku. Designated as a critical access hospital by the state of Hawaii and the Medicare program, the medical center is the emergency safety net for more than 22,500 residents and more than one million annual visitors.

“The dental group has been providing free dental exams, cleaning, x-rays and extractions to the local community. We have mainly seen adults around 20- to 30-years-old,” said 1st Lt. Michele Curtis, Medical Services Corps officer for the 140th Medical Group. “Some of the kids we have seen have never had the opportunity to see a dentist because there is not one within a 26 mile radius of Kahuku, and of the few we have seen, this is their first cleaning ever.”

In the first three days of the IRT, the dental team saw 54 patients and extracted more than 74 teeth. The most severe case was 14 extractions from one patient. “This could be due to a high sugar diet, not a lot of healthy eating habits and lack of brushing and flossing their teeth,” said Curtis.

“We have seen young people in their 20s with acute gum disease – you can generally smell these people coming, that is how dirty their mouths are – and it is from complete lack of care. … If they keep that up, by the time they are in their 30s, they will have no teeth,” said Maj. Joshua Wyte, a dentist in the 140th Medical Group. “So I have been taking out the worst ones (teeth) and I give (each patient) a toothbrush.”

Two new dental technicians recently joined the medical group and have not had the chance to practice their trade, and many technicians don’t practice the trade on the outside the military. The IRT provided them a working knowledge as they assisted the dentists and other dental technicians to clean teeth, sterilize instruments and working around the x-ray machine.

Capt. Jessica Salisbury, an optometrist in the 140th Medical Group saw patients on a walk-in basis, giving them a free eye exam, writing them prescriptions for eyeglasses if needed, and giving referrals if necessary.

In addition to the dental and optometry clinics, the 140th Medical Group provided CPR and basic life support classes to the clinic and community.

Many of the more than 100 people who attended the classes either work in the health care industry but were unable to get re-certified through their employers, or are local community members who just desired the training.

Final days

During the last few days of the HIMIRT, the 140th Medical Group participated in a food bank, followed by a health fair the next day, during which the Guardsmen provided medical screenings that included checking blood pressure, blood sugar and cholesterol, and provided dental and vision screenings, and women’s health services.

The overall readiness training mission’s success was proven through more than 3,000 services to more than 1,000 patients. The dental clinic provided 667 services to 168 patients with 136 extractions, 76 cleanings and 147 x-rays. The dental clinic alone provided more than $50,000 in free services to the Kahuku community.

“This is the first time we have done a humanitarian mission to the underserved within the U.S.,” said Lt. Col. Paul Shingledecker, 140th Medical Group commander. This is something that we have looked forward to doing for a while.”

3/26/2010