Debra Toledo-Ebreo, family planning educator at the Hamakua Health Center (HHC) serves the areas from Laupahoehoe to North Kohala. For the past 13 years, her job has taken her to public, private and charter schools, as well as to churches, community groups, and all sorts of public events. She offers health and puberty classes, sexuality education, life skills and communication classes. Preventing teen pregnancy is one of her top priorities.
“It is tough to be a teenager with the times now,” Toledo-Ebreo said. “We inform teenagers and then they make decisions. We let them know of the availability of our facility and the can come to the clinic whenever they need.”
The Hamakua Health Center, in operation since 1993, has served the North Hawaii in the model of the Patient Centered Medical Home (PCMH) which puts patients “at the center of the healthcare system, and provides dental, behavioral health and primary care that is ‘accessible, affordable, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective.’”
“Our philosophy is that we want our community members to stay healthy, not wait to get sick to come here,” said Irene Carpenter, CEO. Overall, HHC is centered around keeping people healthy as opposed to treating them when they are ill.
Services at both the Honoka’a facility and the Kohala Family Health Center include medical, dental, women’s health, behavior health services, a patient education program and a patient assistance program.
Carpenter explained that a new program is in place called Hi I Ola, which is funded through the Hawaii Health Connector. Five full time staff are in place to talk to small business, families, and individuals about signing up for health insurance.
Kai Gacayan, Community Insurance Coordinator for HHC said she helps people sign up for insurance so they “are not stuck with 100 percent of the bill.”
“We were just at Western Week and we try to ‘table’ all the events,” Gacayan said. “We’ve made contact with 500 to 600 people to give them information.
The enrollment for insurance is currently closed for families and individuals (sign-up is from fall to early spring), but small businesses may sign up for insurance year-round. Since ObamaCare was signed into law in March of 2010, changes in qualifications for healthcare have been made. Carpenter said even if people were told they couldn’t qualify within the last year, they should come in to sign up.
“Financial standards have been lowered, so everyone needs to re-register for Quest,” said Carpenter. “People need to call us, make an appointment and just check in.”
“I love this job,” Gacayan said. “I grew up in Paauilo and honestly, to give back to the community makes it all worth it.”
Another update Carpenter mentioned is that in January 2014, HHC hired Dr. Pam McKenna as a full-time pediatrician for both the Honoka’a and Kohala sites.
“This is a very family and community-oriented center, with local people helping local people,” McKenna said. “We’ve been making connections across Kohala to Waimea, to Honoka’a and we get to know a lot of people.”
McKenna was instrumental in setting up an initiative with Shriners Hospitals for Children - Honolulu, to have their doctors fly to HHC periodically to serve the community’s keiki. From orthopaedic, neuromusculosketal and neurodevelopmental disorders and diseases, the service provided by Shriners is invaluable and eliminates the need for sick children to travel to Honolulu.
Both HHC and the Kohala Family Health Center employ more than 80 people and provide services to almost 8,000 residents of North Hawaii. Considered “rural, ethnically diverse and underserved in many health professions,” Carpenter said HHC is the only provider of primary health care services in three of the county districts (with about 25,000 residents.) Both federally and state-funded, HHC is at maximum capacity and has outgrown its current location. Carpenter said they hope to expand in the future, and she said HHC is working with the USDA, Federal and State for funding.
“Hamakua Health Center owns some land next to NHERC (North Hawaii Education and Research Center) in Honoka’a, and we would like to re-build,” Carpenter said. “Our vision is a two-story facility with a meeting room, dental office and more space for doctor’s offices.” HHC has also written a grant for the Kohala site, which is located next to the Kohala hospital, and funding is what will determine the expansion.
Employed as a nurse for 27 years now, Beverly Cypriano has watched the community change. She started at the Sugar Company pharmacy and has since worked in various capacities including quality assurance and education.
“Education is what I enjoy most,” Cypriano said, who is now the diabetes nurse on a three-year research study sponsored by the Centers for Medicare and Medicaid Services. The program, called HI PRAISE (The Hawaii Patient Reward and Incentive Program to Support Empowerment), rewards participants who have diabetes, for increasing healthy behaviors.
“This is a new challenge for me,” said Cypriano. “Managing diabetes is a full-time job, and my hope is that the reward system gets people to help themselves.”
Diabetes patients have full-day routines which include watching the diet, exercise, daily medication, home glucose monitoring, medical appointments and specialty care. In the HI PRAISE program, HHC and Kohala Health has partnered with local business to provide incentives for their patients - Honoka’a Vegetable Stand, Ted’s Garage and Towing and Honoka’a Massage Therapy Clinic. As patients meet ADA goals, they can choose produce vouchers, gas cards and/or massage gift certificates as a reward for their compliance to the diabetes treatment plan.
“Patients meet with me at the office every three months. Together we set a self management goal, and the patient learns the action that will get them to the goal. I’m someone they can talk to, ask questions and I give them information,” Cypriano said. “One of the most impressive results of HI PRAISE is that patients who are enrolled and smoke have been willing to make a quit attempt with the support of a quit coach at the clinic.”
Cypriano said anyone with Type I or Type II diabetes is welcome to enroll in the program and looks forward to helping patients with their treatment plans. “We have the doctors, the resources, and I think we do a good job,” she said.
Another program at HHC is the Rural Outreach Services (ROS) initiative, in place since 2011. The ROS initiative is a public-private partnership of agencies which offers support for those who are in need, abused or down and out.
“We have one full-time person who helps people in need by showing them where to go,” Carpenter explained. “The Foodbank is called or a shelter is located - it’s a kind of resource center. We have agreements with many places in the community.”
HHC is also working with NHERC to create a series of free-to-the-public lectures to educate the community. Carpenter explained that it would be both HHC and private practice doctors helping people get back to taking charge of their health. Some of the lectures would be for high-schoolers on what to do if they are sick or pregnant, and other classes would be about how nutrition affects health.
“It’s been a year since I came here,” Carpenter said, “and the staff here is tremendous. They all work above and beyond their duties, and the Hamakua Health Center is here to connect people.”