Martina Leialoha Kamaka, M.D.

1. Who are you?

I am a Native Hawaiian family physician, a wife, a mother and an Associate Professor here in the Department of Native Hawaiian Health at the John A. Burns School of Medicine. I’ve been a faculty member at the School of Medicine for 20 years. I came to the medical school from private practice and although I’m a full time faculty member now, I continue to have a small clinical practice 1 day a week.

2. What are the issues you fight for?

My work here at the medical school is focused on cultural competency training, and one of the things I realized, especially when I was practicing medicine in the continental US, was that culture really does matter. When I was in medical school in the 80s, I was taught to treat everyone the same and be colorblind, but I realized in practice that you can’t do that. There are differences between different groups of people such as in the ways that you communicate with them… I realized that culture was actually quite important, that was something that was downplayed when I was in medical school. And it wasn’t just communication style - it also had something to do with traditional healing practices and how that interfaces with the Western medicine system.

I’ve had some good experiences with Chinese acupuncture personally and that peaked my interest in using traditional Hawaiian medicine. I began working with our traditional Native Hawaiian healers here in Hawai’i for myself and my family and then wanted to add learning about traditional Native Hawaiian medicine to the medical school curriculum. I realized that this is an important component of healthcare, and we need to train our physicians to be open to it, to be able to offer those kinds of options to our patients, and to be able to communicate with our traditional and complementary medicine healers. We have a whole longitudinal cultural competency curriculum here and we bring in healers and talk about traditional healing practices, but we especially focus on improving student communication skills.

Finally, health disparities in our communities is a travesty. For being as advanced a society as we are, that we have these kinds of health disparities in our country is just really sad. I mean there are multiple factors that contribute to health disparities, and what I’m passionate about is making sure that students understand what the health disparities are and the possible causes for them. For example, in our indigenous communities - Native Hawaiian, Native American and Alaska Natives - the impact of colonization is huge and must be addressed. But we also have all the issues that come with our immigrant populations - they will have other reasons for their health disparities. In general, many of these disparities involve the social determinants of health, for example poverty and the way our institutions are structured. So it’s really important for students to have an understanding of the origins of health disparities. Obviously as physicians we can’t, for example, fix the secondary education system of our children by ourselves, but we have a very powerful voice as advocates.

3. How did you get here?

I grew up in Hawaii in a town called Kaneohe on the island of Oahu. I got my undergraduate degree from the University of Notre Dame, in South Bend, Indiana and then I came back home to the John A. Burns School of Medicine for medical school. After that I went to Lancaster, Pennsylvania for my family medicine residency. I always thought I would come back home to practice, because I knew there was a real need for Native Hawaiian physicians, particularly female Native Hawaiian physicians. I just wasn’t sure when. I started in a small private practice in Lancaster, but I started feeling more and more like I really needed to come back home and do more. So I did come home and I was in private practice for a while when I became involved with the Association of Native Hawaiian Physicians. It was that connection that led to my current work at the School of Medicine.

4. How does activism/advocacy fit with your role in medicine?

You know, I just submitted a testimony to the state legislature - and that is something we can do to impact policy. I think students need to understand that when we have an MD behind our name, that is really powerful. People will listen to you. And so I think it’s important for students, especially those who come from marginalized communities, that we use our voice for our communities. We get really busy in our clinics, but we can’t separate what our patients are suffering from, from what’s going on in our communities. It’s incredibly important and we need to do what we can to try to rectify that, even if it’s just using our voice on a piece of legislation or speaking out on one policy that we’re passionate about that can make a difference in our community - if we all do that kind of thing, with every small action we take, we can be really successful collectively.

We can’t keep practicing medicine in this country the way we’ve been doing in the last 20, 30, 40 years. I’ve been practicing since 1989, and the health disparities of our communities haven’t gotten any better - in fact, some of them have gotten worse. And that shouldn’t be in a country like ours.

5. How does your identity influence your advocacy, if at all?

Being a female and a Native Hawaiian was huge because when I came to medical school, there weren’t many Native Hawaiian doctors. When I was trained - in the 80s - I was really trained in the Western model of education - very evidence-based, scientific. And then when I moved back home, and I opened up practice, all of a sudden I had a lot of Native Hawaiian patients. With that came the realization that I really didn’t know as much about my culture as I should have known. My patients were expecting me to know and yet, here I was, a Native Hawaiian who was so Western oriented.

For Native Hawaiians, we went through a cultural renaissance in the mid to late 1970s. For example, our language was almost lost. For my father’s generation, it was very shameful to speak Hawaiian. They were punished in school for speaking Hawaiian. It was also shameful to be a cultural practitioner - a lot of our traditional healing practices went underground. Then we went through this renaissance and our language came back and our cultural practices came back. I mean, we had hula before - but even that, what a lot of people thought of as hula was super different from our traditional hula - it was given a Hollywood slant. But our traditional hula came back, as did things like wayfinding (traditional navigation), eating our traditional foods, our martial arts, traditional healing practices...all of that came back. But it was around this time that I went away to college on the continent. I went to Notre Dame, and then medical school, and I was very “cocooned” in med school. I didn’t learn about cultural practices or the Hawaiian language. Remember, my father was punished for speaking Hawaiian and so he did not speak the language growing up. As a result, growing up, my family really didn’t do that many cultural things except for eating our traditional foods on special occasions as well as dancing hula and playing and singing Hawaiian music.

When I came home, there were so many expectations on the part of my patients that I was a Native Hawaiian physician, and I should know these things. When I started with the Ahahui o na Kauka (Association of Native Hawaiian Physicians) as a young doc, we tried to network with other young Native Hawaiian docs - we realized we all had the same issue, that we were raised very Western, but yet our patients were expecting more of us, and we were feeling kind of lost. We realized we needed to reconnect with our culture. We needed to connect with our land and our traditions.

I was lucky that I was able to combine this realization of the need to reconnect with our culture and land with the work that I was doing at the medical school. As the Ahahui o na Kauka got very serious about trying to help Native Hawaiian physicians reconnect to culture, my work at the Native Hawaiian Center of Excellence at the medical school was focusing on developing a cultural competency curriculum for faculty and physicians that targeted Native Hawaiians and their health disparities. We worked together - we embarked on conferences, immersions, and various activities to reconnect us as physicians to our culture, reconnect us to our land, our ancestors, our communities and also to open our minds. Traditional healing doesn’t always have “evidence” to justify how it works. All of the practices have a large prayer and spiritual component, and how do you measure that? You can’t measure that well. These are things that our ancestors have done for thousands of years and they work. For example, as Asian physicians, we don’t need someone to tell us that acupuncture works or not, we know, right?! So as a Western trained physicians, how do we bring these things together? How do we close health disparities? We want optimal health for our communities. Not just average - we want better than average. We want optimal. And how do we do that?

6. What are some challenges you've faced in your work?

My first challenge was having the confidence to even think that I could be a physician. I’m the first in my family in the healthcare field, and although my father was lucky enough to go to college, my mother did not. I was the first one to get an advanced degree. I wouldn’t say my family discouraged me, I just didn’t have that confidence that I was smart enough to do it. But the thing that made me decide to go for it - apply to medical school - was that I didn’t want to be 65 and look back on my life and say, “I wish I had.” I didn’t want to have regrets. And so my attitude was, “okay, I’m gonna go for it, but I also have to have Plan B ready,” because I honestly didn’t think I was smart enough.

And I kind of struggled with that feeling of am I smart enough, am I good enough, even when I did get into med school. There were very few Native Hawaiians. And so you feel like there’s a little more attention paid to you, and you feel like you have to prove yourself. That is a little more of an extra burden and you feel like you have to work a little harder. “Yes, I belong here!” I try to work with pre meds now, and I hope I’m able to change that mindset. You have to get past the stereotypes that Hawaiians are dumb - the stuff you hear when you are little.

I was probably lucky - as a woman, I never experienced really bad gender bias. In residency, I had a couple surgeons who would call me “sweetie” or something like that, but I never really felt harassed. However, even in residency, I still felt like I had to prove myself, like “who’s this Native Hawaiian woman?” In Lancaster, they had Mennonite, Amish, African American and Puerto Rican communities - these were very different from the communities in Hawaii. But being Native Hawaiian had it’s benefits. It made it easier for colleagues and patients to start conversations with me. Luckily, people were always curious about Hawaii which made it easier for them to ask me questions and start a conversation, like “Wow, you’re from Hawaii!” Once you start a conversation with a patient, you’re already opening the door to building rapport and trust, and this makes it easier to have a good therapeutic relationship.

Also, when you’re a physician coming from a minority background - interacting with other minorities, you have something in common. You may come from a very different culture, but some of the struggles are the same. You can connect somehow, and open up conversations.

7. What's your advice for health students getting into advocacy?

I’m active in the Association of Native Hawaiian Physicians, so I find out about issues from my colleagues when they need support. So my advice would be to get active, in your school, in organizations, or in communities back home - what are the issues coming up? What are the battles being fought? There are so many things out there - so the way you find it is to find something you’re interested in, do it, and then you’ll get introduced to more. There’s so much need everywhere!

An easy thing to do is to submit testimony. For example, there’s usually a government website for this. The hard thing is that there’s usually not a lot of time to submit it - - so you have to have an active network that will send you alerts when the testimony is needed. .

A lot of students come to medical school and already have passions from before - so you can go back to that. But if not, through rotations and electives you do get exposed to communities. I really encourage you to do at least one elective in an underserved community, because that kind of experience will really help you understand what issues affect their lives and you may find the thing you want to start advocating for.

8. What are you working on most recently?

I’m continuing my work for JABSOM in the area of improving health disparities through focusing on physician training. The IOM report, Unequal Treatment, talks about the importance of cross cultural communication in addressing health disparities… the patient - health provider communication, their interaction, is a contributor to maintaining health disparities. When we don’t know, as providers how to interact with people from different cultures, or when we have unconscious biases, those things contribute to health disparities. So it’s not just poverty, access to insurance, lack of providers, bad schools, lack of access to good jobs contributing to health disparities, but it’s also the communications between patients and the healthcare system and the providers that’s contributing. Institutional biases, our personal biases all play a role. For medical schools and residency programs, that’s one thing we can directly address - how our future providers interact with patients and to make sure that we as providers don’t contribute to the worsening of healthcare disparities and that we actually make them better.

9. Where can we follow your work? (asking for Twitter handle, blogs, etc.)

I am very approachable by email (which I know is not the favorite form of communication for a lot of students anymore) - I’m really happy to support students, answer any questions and I am willing to help mentor. It’s one thing I didn’t have a lot of early in my training - which would’ve helped a lot with my confidence. So I’m hoping to be that person for other people!