COMMENTARY
Facing Hawaii's doctor shortage
By Dr. Chiyome Fukino, Director, State Department of Health
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Have you checked out The Hot Seat? It's our opinion-page blog that brings in your elected leaders and people in the news and lets you ask the questions during a live online chat.
On The Hot Seat last week was Dr. Chiyome Fukino, director of the state Department of Health. Below is an excerpt from that Hot Seat session. To see the full conversation, go to the Hot Seat blog at www.honoluluadvertiser.com/opinion and click on the posting titled "On the Hot Seat: State Health Department Director Dr. Chiyome Fukino." (Names of questioners are screen names given during our online chat.)
Chih-Hao: As recent articles in The Advertiser have noted, there is a real crisis in the medical community of Hawai'i. We need to find innovative ways to recruit young doctors, nurses and other medical professionals to our rural areas, especially on our Neighbor Islands. Much of the discussion consists of pointing fingers at the large insurers of Hawai'i. However, having just returned from California, where many for-profit insurers charge much higher rates for lower quality, I don't believe that they are the one cause of this large problem. What I want to know is if the Health Department can put aside the blame game and work with everyone in the community, including patient advocacy groups, medical professionals, hospital administrators, legislators and even the insurers themselves in crafting a viable solution to this complex problem.
Dr. Chiyome Fukino: The Department of Health has worked tirelessly with all sectors of the healthcare delivery system. We can't afford to engage in the "blame game" because we are all in this together. Healthcare is an extremely complex industry. There is no one single solution. Many years and hundreds of thousands of dollars have been expended nationwide to deal with issues such as access to care, workforce shortages, infrastructure and legal matters.
The department has convened a workforce collaborative to assist in finding solutions for rural areas' healthcare workforce shortages.
Resources that are controlled by different entities for different purposes make it difficult to overcome the fragmented healthcare system. Government must invest in prevention efforts now to reduce the burden of chronic disease later (upstream investment to mitigate downstream cost).
One thing is for sure, is that everyone must assume personal responsibility for their individual health status ... appropriate diet, exercise, understanding your genetic traits (diabetes, hypertension, etc.).
Helen Gibson Ahn: I am reading a lot lately about viruses that we had never even heard of several years ago. In the last week alone, there have been issues of viral contaminations on cruise ships here in Hawai'i and in hospitals on the Mainland. A large-scale viral infection here could be catastrophic. What type of inspections does the Health Department do in our hospitals, medical offices and care centers to ensure rigorous sanitary practices are being maintained?
Fukino: The Department of Health Office of Health Care Assurance conducts routine inspections of all licensed healthcare facilities. OHCA also investigates all complaints received and conducts unannounced visits once a year on certain types of healthcare facilities.
In addition, the department also has 24/7 disease surveillance which monitors and investigates infectious disease issues statewide.
Hipoli: Over the past six years as director of the Department of Health, what are some of the accomplishments that you are proudest of? What have been some of the biggest challenges? Since you gave up a private practice to become the first female, the first Hawaiian director, has it been worth it?
Fukino: Moving from private practice to public service has been both challenging and rewarding for me. I am fortunate to have many dedicated, hard-working employees in the Department of Health.
To highlight some of the major accomplishments over the past almost five years:
Lisa: With regard to all the controversy over child immunizations and autism, what is your position on this issue?
Fukino: There is a lot of emotion around this issue. Nevertheless, the American Academy of Pediatrics and many healthcare experts agree that MMR vaccine is not responsible for recent increases in the number of children with autism. The Institute of Medicine also concluded that there is no association between autism and MMR vaccine or vaccines that contain thimerosol as a preservative.
The benefits of vaccination as protection against childhood illnesses far outweigh and perceived risk.
Kyle A.: What keeps you up at night in terms of a health crisis in Hawai'i? Is it a resistant epidemic from Asia, like bird flu? Or is it our location in the middle of nowhere with no immediate access to top-notch hospitals and doctors in the event of a huge disaster? And what are you doing to deal with this fear?
Fukino: What keeps me up at night? Knowing that the people of Hawai'i are not individually prepared for major disasters, such as pandemic flu and hurricanes. We do have top-notch hospitals and doctors, but any system can be overwhelmed if the majority of people in the community are not prepared to be self-sufficient for a reasonable period of time.
The department has been aggressively moving forward with our Pandemic Flu Response Plan. We are working with county, state, federal and private agencies on all hazard preparedness and community outreach.
Mkosasa: Does the state Health Department have any programs situated to attract and recruit the many locally born or raised health professionals in diaspora across the Mainland? As a health professional in Oregon interested in returning to Hawai'i, there are significant barriers to finding and applying for a health job in Hawaii. What can your department do about that?
Fukino: The Department of Health is not tasked with recruitment of health professionals. However, Hawai'i Health Systems Corp. (the public hospital system) does recruit physicians to fill specific positions.
E-Cabral: What is with the uprise with the sexually-transmitted diseases among adolescents? What happened to information regarding protection and prevention? This so-called superbug, how long has the state known about this?
Fukino: The increase of STD in adolescents is due to many factors, such as increased screening and surveillance efforts, improved medical referral and use of more sensitive diagnostic tests. The DOH STD/AIDS Prevention Program and the DOH Family Planning Program have partnered with DOE to provide education on STD prevention.
Dog23: Are there illnesses or diseases that affect people in Hawai'i more than elsewhere? Are you aware of any environmental illnesses, such as cancers specific to certain areas?
Fukino: Hawai'i has higher incidence of tuberculosis as compared to the rest of the nation. Recently, we have seen increases in Hansen's disease among immigrant populations.
We are not aware of any increases in cancers in specific areas in the state. Environmental cause and effect on specific diseases are very difficult to correlate.
M kuhn: Why is it that the government wants to increase taxes on cigarettes to pay for, among other things, children's healthcare, yet bans smoking everywhere?
Fukino: The cigarette tax and smoke-free workplace law are part of a comprehensive strategy to reduce tobacco use in our state; 1,200 people die from smoking and smoking-related diseases in Hawaii each year. It has been estimated that tobacco-related illnesses and deaths cost the people in Hawaii more than $644 million each year in medical costs and lost productivity.
The U.S. Centers for Disease Control and Prevention have recommended that state and local governments increase taxes on cigarettes to encourage smoking cessation and to assist in the payment of healthcare services caused by the devastating impact of tobacco use on smokers and nonsmokers exposed to tobacco smoke. In the United States, 53,800 nonsmokers die every year from smoking-related diseases.
Hawai'i should be very proud as we celebrate the first anniversary of our smoke-free workplace law that provides increased protection for employees from exposure to second-hand smoke. We encourage smokers to call 800-QUIT NOW for help.
