There are many barriers to accessing care that Planned Parenthood fights to remove or ease for our patients.
However, in some places, a “barrier” can be a literal ocean between patient and provider. And in the state of Hawai’i, travel between islands is one of the top challenges for both patients and providers.
Kahului Health Center is one of two Planned Parenthood health centers in the state of Hawai’i, the other being Honolulu. Honolulu is located on the island of Oahu, and Kahului is on the island of Maui.
While there are 28 total health care facilities in the state of Hawai’i that provide abortion, only four of them are clinics (including the Planned Parenthood health centers), and 27 of them are in Oahu. The 186,738 people on the “big island” of Hawai’i, the 66,921 on Kauai, the 7,345 on Molokai, the 3,135 on Lanai and the 170 on Nihau do not have local health care facilities that provide abortions.
“If you want any kind of necessary health care procedure not offered on your island you have to fly,” explained Kahului Health Center Manager, Lisa Perry.
For the people of Hawai‘i, air travel presents a financial and logistical burden, and this was only made worse by the challenges of COVID-19.
The state of Hawaii’s COVID-19 precautions included mandatory 14-day self-quarantines for both inter-island and trans-pacific travel. And throughout the pandemic, the state of Hawai’i has lifted and re-instated inter-island travel restrictions, while different Hawaiian counties have created a patchwork of varying emergency rules and restrictions.
“Back in the early COVID days, we had to cancel two abortion days because our physicians could not fly here” from Oahu, Perry explained.
Deighton Kavarne, PPGNHI Area Services Director, expounded that for one month, these restrictions severely limited surgical abortion services for the entire state.
It wasn’t just patients flying to receive care that was held up.
Clinicians and providers fly between the islands to see patients, in some cases as a routine part of their work. The lead clinician at Kahului health center will often fly 10 times a month or more as part of her work. Additionally, all Planned Parenthood providers in Hawai’i frequently travel between Honolulu and Kahului to receive and provide training with other staff.
While exceptions are made for essential workers, Perry and Kavarne report that getting Planned Parenthood providers recognized as essential workers was sometimes difficult in the beginning of the COVID-19 pandemic.
Ultimately, providers were able to fly as essential workers, and patients were able to travel by air for necessary health care, with much bureaucratic persistence. As we found ways to lift restrictions for patients, “Planned Parenthood picked up the cost for our self-pay patients to fly out to Honolulu from Maui during this time [when clinicians were not able to fly],” Perry said.
“We’re doing whatever we can to help our patients. We cover the flights, the taxi from the airport to the health center, whatever the patient needs,” asserted Kavarne. “We find a lot of ways to get people solutions to cover the cost of care.”
“We always try to do whatever it takes so that we really are ‘care, no matter what,’” Perry agreed.
“Flying is expensive, and this is one of the ways as an organization we must walk our talk. If we are ‘care no matter what,’ we must provide that, no matter what,” said Kavarne. “We didn’t have a budget for it. This was one of those things we knew we had to do because we are Planned Parenthood.”
Perry also brought up the innovation of telehealth as a way to overcome the physical and financial challenges of travel, as well as the added necessity of social distancing during COVID.
Planned Parenthood patients accessed telehealth in droves during the COVID travel restrictions – something the Kahului health center was already well set up for.
“We’ve had a provider on the big island [of Hawai’i] that has been working remotely with our patients for years,” Kavarne said. “The newer technology we have is the direct-to-patient, which we’re working on expanding.”
Patients in both Honolulu and Kahului health can converse with a provider from either island, screen to screen within the health center. With direct-to-patient telehealth, a patient from any island of Hawai’i can talk with a provider on their computer, phone or tablet.
One Kahului patient recently reported, “Although telehealth poses its own issues and benefits, the video conference I had with [my clinician] worked great and she showed genuine interest, care, patience and definite competence!”
Kavarne said Planned Parenthood is working on expanding telehealth in Hawai’i so that patients can use the technology for a wider range of services. “The screen-to-screen technology is key to meeting the need for health care in communities across the islands,” he said.
Perry pointed out that Planned Parenthood was able to meet the needs of patients, thanks to community donors and organizations.
“We’re successful because our community sets us up to be,” Perry said, citing an example from 2020 in which the United Way of Maui granted the health center $16,000 a year for three years.
“When we lost Title X funding, it was really hard because we had so many young people needing pregnancy tests, STI tests, and these patients had limited financial resources. With that funding we were able to still say ‘we will see them, we will get them care,’’’ Perry said.
“If someone is a youth... and they have no financial means, we will always make sure they get seen, that they get what they need,” said Kavarne. He added that adults who self-pay without insurance can access assistance by completing an application in the health center.
Kavarne said, “When we lost Title X, we didn’t know what that would look like. We didn't know where we were going to be, so we had to innovate a new way to make sure we’re still there for everyone, and three years later we're still succeeding... and if it weren't for COVID we’d be doing even better.”
Kavarne noted that the Kahului team is small - many on their team must take on double or triple-duties and praised that the team followed COVID-19 policies and procedures to the letter throughout the pandemic crisis.
“It’s a beautiful thing that we’re able to show up for our patients in Hawai’i throughout this.”
You can help small, remote health centers like Kahului continue to meet these big challenges by donating here.