Multicultural Health
Translation, Interpreting and Communication
Edited by Meng Ji, Mustapha Taibi and Ineke H.M. Crezee
First published 2019 by Routledge
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A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
Names: Ji, Meng, 1982– editor. | Taibi, Mustapha, editor. | Crezee, Ineke, editor.
Title: Multicultural health translation, interpreting and communication / edited by Meng Ji, Mustapha Taibi and Ineke H.M. Crezee.
Description: New York, NY : Routledge, [2019] | Series: Routledge studies in empirical translation and multilingual communication ; 3 | Includes bibliographical references and index.
Identifiers: LCCN 2018050232 | ISBN 9781138543089 (hardback) | ISBN 9781351000390 (ebook)
Subjects: LCSH: Medicine–Translating. | Health facilities–Translating services. | Medical care–Translating. | Physician and patient.
Classification: LCC R119.5 .M85 2019 | DDC 610.1/4–dc23
LC record available at https://lccn.loc.gov/2018050232
ISBN: 978-1-138-54308-9 (hbk)
ISBN: 978-1-351-00039-0 (ebk)
Typeset in Times New Roman by Newgen Publishing UK
1
3 International perspectives and practices in healthcare interpreting with sign language interpreters: How
5 When pragmatic equivalence fails: Assessing a New Zealand
6 Translation methods used in Arabic translations of medical patient information leaflets 123
HALA SHARKAS
7 Impact of translated health information on CALD older people’s health literacy: A pilot study 138
MUSTAPHA TAIBI, PRANEE LIAMPUTTONG AND MICHAEL POLONSKY
PART III Understanding specialised health interpreting 159
8 Deaf healthcare professionals’ perspectives: Understanding the work of ASL-English healthcare interpreters 161
LAURIE SWABEY, ANDREA M. OLSON, CHRISTOPHER J. MORELAND AND AMY H. DREWEK
9 “I’m there sometimes as a just in case”: Examining role fluidity in healthcare interpreting 183
GEORGE MAJOR AND JEMINA NAPIER
10 Mental health interpreting: Challenges and opportunities
HANNEKE BOT
2.1 Conceptual model of HT & I’s place in the health outcomes equation 26
2.2 Criteria for reporting interpreter use in qualitative studies involving translation 30
5.1 The causal relationship between Nida’s four basic functions (Crezee et al., 2017, p. 5) 91
1.1 Ethnic breakdown of the usually resident Auckland population as per the 2013 census 4
1.2 Preferred language of care for LEP patients FY2013, Seattle Children’s Hospital 12
1.3 Aspects of navigator role emphasised most by various interviewees 14
4.1 The POCA health translation model 71
4.2 Suggested Chinese translation for the issue discussed in LC_2 (1) 73
4.3 Suggested Chinese translation for the issue discussed in LC_2 (2) 73
4.4 Suggested Chinese translation for the issue discussed in LC_2 (3) 74
4.5 Suggested Chinese translation for the issue discussed in LC_3 75
4.6 Suggested Chinese translation for the issues discussed in LC_4 77
4.7 Suggested Chinese translation for the issue discussed in LC_5 78
4.8 Suggested Chinese translation for the issue discussed in LC_6 (1) 79
4.9 Suggested Chinese translation for the issue discussed in LC_6 (2) 80
5.1 Translation assessment criteria
5.2 Pragmalinguistic factors for achieving pragmatic equivalence
5.3 Achieved translation qualities
5.4 Full quality of SR-F and OM-SR-F instances
5.5 Causing factors identified for SR-F and OM-SR-F
5.6 Linguistic features in pragmalinguistic failures
6.1 Frequency of translation procedures
6.2 Easy-to-understand calques
6.3 Hard-to-understand calques
6.4 Comparison between examples of amplification and their equivalent medical terms in dictionaries 133
7.1 Respondents’ comprehension and intent per translation version and medium of dissemination
8.1 Demographic, background characteristics, and experience of healthcare interpreters, designated healthcare interpreters, and deaf healthcare professionals
8.2 Most and least frequently demonstrated interpreter task categories from the perspective of deaf healthcare providers 170
8.3 Most and least important interpreter task categories from the perspective of deaf healthcare providers
8.4 Task categories that were in the top 20 for both frequency and importance by perspective (healthcare interpreters, DHIs, and DHPs)
171
172
8.5 Task categories that were in the top 20 for both frequency and importance, not in common across perspectives, by perspective (healthcare interpreters, DHIs, and DHPs) 173
Contributors
Hanneke Bot is a senior independent researcher and former practitioner of clinical psychotherapy.
Ineke Crezee is Associate Professor of Interpreting Studies at Auckland University of Technology, New Zealand.
Amy H. Drewek is a PhD candidate at Gallaudet University, USA.
Mele Tupou Gordon is with the Tongan Nurses’ Association, Auckland, New Zealand and Tonga.
Meng Ji is Associate Professor of Translation Studies at The University of Sydney, Australia.
Pranee Liamputtong is Professor of Public Health, School of Science and Health and a core member of the Translational Health Research Institute (THRI), Western Sydney University, Australia.
Shanshan Lin is PhD candidate in Chinese Studies and an accredited diabetes educator at The University of Sydney, Australia.
George Major is Senior Lecturer of Interpreting Studies at Auckland University of Technology, New Zealand.
Christopher J. Moreland is Associate Professor of Medicine at University of Texas Health Science Centre at San Antonio, USA.
Jemina Napier is Professor and Chair of Intercultural Communication at Heriot-Watt University, UK.
Andrea M. Olson is Professor of Psychology at St. Catherine University, USA.
Michael Polonsky is Alfred Deakin Professor and Chair in Marketing at Deakin University, Australia.
Debra Russell is Adjunct Faculty at University of British Columbia, Canada.
Hala Sharkas is Associate Professor of Translation Studies at United Arab Emirates University, United Arab Emirates.
List of contributors xi
Allison Squires is Associate Professor at Rory Meyers College of Nursing, New York University, USA.
Laurie Swabey is Professor of Interpreting at St. Catherine University, USA.
Mustapha Taibi is Associate Professor of Interpreting and Translation at Western Sydney University, Australia.
Wei Teng is Lecturer of Chinese and Translation Studies at University of Canterbury, Christchurch, New Zealand.
1 Cross-cultural and cross-linguistic access to the healthcare system
Case studies from Seattle and Auckland
Ineke Crezee
and
Mele Tupou Gordon
1.1 Introduction and background
Aotearoa-New Zealand is a country in the southwestern Pacific Ocean which was originally settled by Polynesian migrants. New Zealand, like many other countries around the world, has experienced a significant influx of NonEnglish Speaking Background (NESB) settlers since the 1950s when the first significant numbers of Dutch migrants arrived looking for a new life. The Dutch settlers, who shifted to the use of English relatively quickly (Crezee, 2008, 2012), were followed by Polynesian-speaking migrants from Pacific nations such as Samoa and Tonga (Wong Soon, 2016; Wilson, 2017) who came to New Zealand looking for work and to give their children a brighter future. Immigrants from South East Asia followed in the 1990s. The 21st century has seen an influx of migrants from Mainland China and from the Indian subcontinent.
Today, New Zealand has a usually resident population of 4,242,048, according to the 2013 census (Statistics New Zealand, 2013). Auckland is its largest and most ethnically diverse city, with a population of approximately 1.42 million in 2013 (Statistics New Zealand, 2013). The official languages of New Zealand are English, Māori and New Zealand Sign Language. Mandarin, Cantonese, Samoan, Tongan and Korean are among the ten most in demand languages for interpreting services (Department of Internal Affairs, 2013). The fact that speakers of these languages often need language access assistance suggests that they may not have easy access to information about a health system which may be very different from that in their countries of origin, or to information about common health conditions.
In New Zealand, Pacific migrants are overrepresented in health statistics relating to both child and adult obesity, and in those relating to non-communicable diseases such as Type 2 Diabetes, hypertension and cardiovascular diseases (Ministry of Health, 2012, 2015). Studies have shown that health outcomes are affected by a wide range of non-clinical factors including cultural and linguistic barriers, lack of understanding of the healthcare system, general educational background and low levels of health literacy. Pacific people, and people living in more deprived areas, continue to be
among those with poorer health outcomes and more unmet needs for healthcare (Ministry of Health, 2012, 2015). Adults in the most deprived areas also have “higher rates of most health risks including smoking, hazardous drinking, not eating at least the recommended servings of vegetables and fruit daily, physical inactivity and obesity” (Ministry of Health, 2015, key findings). Pacific people tend to live in the most deprived areas, and anecdotal evidence suggests that they may not attend appointments due to lack of transport and would benefit from more flexible and accessible options for accessing care. Failure to access care in a timely manner may lead to significant health issues later. Similarly, these patients may tell non-Pacific health providers what they think they want to hear – rather than what is actually going on – due to feelings of embarrassment (Tupou Gordon, pers. comm., 2018). This practice can lead to further problems later on if conditions remain untreated.
The New Zealand Ministry of Health (2006) also identified several health risks specific to the Asian population, including high rates of cardiovascular disease and diabetes, and a high risk of stroke amongst Chinese (Ministry of Health, 2006). Wong (2015, p. 3) suggests that “[s]tigmatisation, language barriers, lack of cultural competency and education in the New Zealand health system may all have contributed to this”. Wong (2015, p. 3) also points out that “the Asian ethnic group as a whole has lower rates of access to health services and healthcare utilisation, particularly the Chinese”. Such lower rates of healthcare utilisation include enrolment in primary health organisations (for primary healthcare), preventive screening services, disability support services, mental health services and access to residential care for the elderly (Jatrana & Crampton, 2009; Mehta, 2012; Wong, 2015). Women originating from the Indian subcontinent have higher rates of hypertension in pregnancy, while older Indian migrants are also more likely than the general population to suffer from high blood pressure.
Table 1.1 shows the ethnic breakdown of the Auckland population as per the 2013 census. Anecdotal evidence suggests a significant increase in the Asian population of Auckland between 2013 and 2018, although statistics from the 2018 census were not available to the authors at the time of writing.
Table 1.1 Ethnic breakdown of the usually resident Auckland population as per the 2013 census
In 2013, 11.8% of the population in New Zealand identified themselves as of Asian ethnicity – a 33% increase since 2006. Statistics New Zealand (2013) projects this to further increase by 3.4% every year for the next decade. Notably, the majority of the New Zealand Asian population (65.1%) resides in the Auckland region (Statistics New Zealand, 2013).
In recent years a significant number of older follower migrants (Tang, 2017) have entered New Zealand under the Family Reunion policy.
The Statistics New Zealand definition of “Asian” includes people with origins in the Asian continent from Afghanistan in the west to Japan in the east, and from Mongolia south to Indonesia (Ministry of Health, 2006; Rasanathan, Ameratunga, & Tse, 2006). This definition encompasses East, South and South East Asian ethnicities, excluding people from the Middle East, Russia and Central Asia (Rasanathan, Craig, & Perkins, 2004).
1.2 The problem
In both Auckland and Seattle, the problem consists in new immigrants experiencing barriers to accessing the healthcare system, which could include but is by no means limited to barriers of a social, linguistic or cultural nature. In Seattle, Seattle Children’s Hospital is a highly specialised paediatric facility, with 15% of its patients coming from Limited English Proficient (LEP) families in 2013. Hospital figures for these patients showed higher than average no-show rates at appointments, higher levels of in-hospital stay and higher levels of readmission to the hospital. In addition, the hospital itself is large and difficult to navigate. The hospital offers on-site, telephone and video interpreting, with colour and themed nomenclature (Ocean, Forest, River, Mountain) to help families find their way through the hospital, but it appeared that LEP families were still experiencing barriers to do with a lack of transport, lack of (adequate) housing, lack of knowledge about their children’s condition and prescribed treatment and a lack of trust in healthcare providers.
In New Zealand, the problem was initially seen as one involving lack of language access and lack of informed consent. The “unfortunate experiment” (Coney & Bunkle, 1987) which saw a number of women unknowingly participate in a large cervical cancer experiment, without being informed that the theory behind the experiment was untested, led to a government inquiry led by Judge Sylvia Cartwright. The Cartwright inquiry recommended the use of trained healthcare interpreters and the widespread implementation of Informed Consent (Cartwright, 1988). The right to effective communication was enshrined in the New Zealand Health and Disability Act (Health and Disability Commissioner, 1996).
The three Auckland-based District Health Boards all established interpreting and translation services between 1991 and 2000 (Crezee, 2009). A special healthcare interpreter training course was first provided in 1990 by what was then the Auckland Institute of Technology (Crezee, 2009). Over the years, the
availability of trained healthcare interpreters in all community languages has remained patchy, with many spoken language interpreters choosing not to have specialised healthcare interpreter training but instead starting work in health (and legal) settings following a three month general “liaison” interpreting course.
In 2017, the New Zealand Ministry of Business, Innovation and Employment (MBIE) set out to develop language assistance policy and guidelines, with the input of a “whole-of-government” project steering group (Ministry of Business, Innovation and Employment, 2017). MBIE commissioned a national market assessment of the language assistance services market in New Zealand, with the aim of identifying a preferred model for delivering language assistance services across government departments. A set of standards was identified, based on that developed by the Australian National Accreditation Authority for Translators and Interpreters (NAATI), and vetted by New Zealand stakeholders, including the national body for translators and interpreters (NZSTI), agencies providing translation and interpreting services and service coordinators (Ministry of Business, Innovation and Employment, 2016; Immigration New Zealand, 2018).
This chapter will look at the current provision of services established to address health inequalities identified among Pacific and Asian patient populations in Auckland, with a specific focus on initiatives aimed to improve the utilisation of health services by the Asian population, and those aimed at improving health literacy and health outcomes among the Pacific population. Data was obtained by way of interviews with stakeholders in Auckland, New Zealand, and interviews with stakeholders and a Focus Discussion Group at Seattle Children’s Hospital (SCH) in Seattle, Washington. Services discussed in Seattle include the provision of bilingual navigators and health interpreters at SCH. Auckland services will include health interpreting services and outreach by health interpreters in the South Auckland area, Asian Health Services in the Northern and Western parts of Auckland, and health interpreting services in Central Auckland. Specific attention will be paid to work by Tongan health professionals working with (older) Tongan speakers across Auckland. The literature review section will look at language assistance services, including those provided by health interpreters and bilingual patient navigators and bilingual healthcare providers.
1.3 Literature review
Language access
The right to a competent interpreter has been enshrined in Right 5 of the 1996 New Zealand Health and Disability Commissioner Act which reads: “Every consumer has the right to effective communication in a form, language and manner that enables the consumer to understand the information provided. Where necessary and reasonably practicable, this includes the right to a competent interpreter” (Health and Disability Commissioner, 1996).
Countries have sought to monitor the quality of interpretation; for example, Australia instituted a National Accreditation Authority for Translators and Interpreters (NAATI, 2018), which now also provides specialist accreditation for those wishing to work in medical or legal settings (reference), and the US has certification programs for healthcare and legal interpreters at the national and state level.
Qualified healthcare interpreters facilitate communication between health professionals and health consumers whose “preferred language of medical care” is not the dominant language of the recipient society. The benefits of professional medical interpreters have been clearly demonstrated over the past three decades (Jacobs, Shepard, Suaya & Stone, 2004; Karliner, Jacobs, Chen & Mutha, 2007; Tsuruta, Karim, Sawada & Mori, 2013; VanderWielen et al., 2014; Hsieh, 2015; Villalobos et al., 2016).
Patient navigators
Over the past few decades, there has been an increasing recognition that language may not be the only barrier affecting health outcomes. Divergent levels of health literacy have been linked to non-compliance with prescribed treatment, a limited awareness of potentially life-threatening symptoms and the inability to know when to seek medical help or follow-up treatment. Other barriers include poverty, lack of internet access (Atkinson, Salmond & Crampton, 2013) and lack of transport. In 1990, Dr. Freeman initiated one of the first patient navigator programmes in the United States to help overcome barriers to cancer screening (Freeman, 1990). Currently patient navigator services are utilised across an ever-widening range of healthcare settings, and bilingual navigator programs have been set up not only to lower cultural and linguistic barriers to healthcare access but also to enhance health literacy in non-English speaking patient populations (Freeman, 2006, 2012; Freeman & Rodriguez, 2011; Meade et al., 2014; Genoff et al., 2016; Wells, Valverde, Risendal, Esparza, Ustjanauskas, & Calhoon, 2016). Charlot and colleagues (2015) concluded that minority women may benefit from having patient navigators of the same race and ethnicity and speaking the same language.
Bilingual navigators
Freeman and Rodriguez (2011, pp. 3539–42) define the principles of patient navigation as follows (emphasis added):
1 Navigation is a patient-centric health care service delivery model.
2 Patient navigation serves to virtually integrate a fragmented healthcare system for the individual patient.
3 The core function of patient navigation is the elimination of barriers to timely care across all segments of the healthcare continuum.
4 Patient navigation should be defined with a clear scope of practice that distinguishes the role and responsibilities of the navigator from that of other providers.
5 Delivery of patient navigation services should be cost-effective and commensurate with the training and skills necessary to navigate an individual through a particular phase of the care continuum.
6 The determination of who should navigate should be determined by the level of skills required at a given phase of navigation.
7 In a given system of care there is the need to define the point at which navigation ends.
8 There is a need to navigate patient across disconnected systems of care, such as primary care sites and tertiary care sites.
9 Patient Navigation systems require coordination.
Language-concordant services
Green, Ngo-Metzger, Massagli, Phillips and Iezzoni (2005) concluded that LEP patients were less satisfied with their care than other patients and that both interpreter-mediated interactions or interactions with languageconcordant clinicians might be able to address such problems.
Cooper and Powe recommend that “health care system administrators organize the delivery of services to optimize providers’ ability to establish rapport and continuity in their relationships with ethnic minority patients” (2004, pp. 16–17). This chapter will describe two initiatives which involve Tongan health professionals working to help community members gain a better understanding of health conditions and the potentially dire consequences of not attending to these in a timely fashion.
Jih and colleagues (2015) concluded that patient-physician language concordance alone might not lead to improved uptake of preventive care services, based on their analysis of a population representative sample of LEP Latino and Asian patients. However, Parker and colleagues (2017) observed significant improvements in the control of blood glucose levels among LEP Latino patients with diabetes who switched to language concordant healthcare providers.
It is important to remember that language-concordant services may not be culture concordant. For instance, Spanish is spoken in Spain and in a wide range of different countries in South and Central America. In many cases Spanish will be the first language of the speakers, but in other cases it is the second language, Quecha or another native American language being a speaker’s actual first language. So while health providers may share a language with the patient, this does not mean that they share the same cultural, religious and health beliefs.
1.4 Method
Interviews were conducted in Seattle and Auckland in 2014 and 2017/2018 respectively, as well as a Focus Discussion Group with patient navigators at
Seattle Children’s Hospital (SCH) in September 2014. Approval was obtained from the Ethics Committee at Auckland University of Technology and institutional review board approval was obtained from Seattle Children’s Hospital.
In Seattle, interviews were held with patient navigators (PNs), the PN supervisor, the Director of the PN program, the hospital administrator, health interpreting service managers, and with providers (physicians and social workers) working with PNs. All interviewees were asked what they saw as the main difference between healthcare interpreter and navigator roles respectively.
In Auckland, interviews were held with managers of language- and cultureconcordant services, health professionals providing care and advice in their own language and managers of interpreting services. The bilingual providers interviewed in Auckland were involved in the Tongan Health Society (Sosaieti Tonga Ki He Mo’uilelei), the Tongan Nurses Association and Asian Health Services.
Interviews were recorded and transcribed and a themed analysis was used to identify recurrent concerns.
In both Seattle and Auckland, interviews were conducted with staff involved in providing or coordinating bilingual healthcare provision, patient navigation and/or interpreting services. These will be described in some detail.
1.5 Findings
Health interpreting services
Auckland
New Zealand is divided into 20 District Health Boards (DHBs), each of which receives public funding from the New Zealand government to provide primary and secondary healthcare to the populations in their catchment areas. In New Zealand healthcare providers must comply with legislation which requires them to provide patients with a competent interpreter where practicable: Right 5 of the Code of Rights provided for in the (1996) Health and Disability Commissioner’s Act, and Section 6 of the Mental Health Act, in relation to Compulsory Assessment and Treatment (Ministry of Health, 2018).
Since Auckland is New Zealand’s largest and most ethnically diverse city (Statistics New Zealand, 2013), the three Auckland DHBs (Waitemata DHB, Auckland DHB and Counties Manukau DHB) look after the healthcare needs of very diverse populations.
In 1991, Counties Manukau DHB (then: South Auckland Health) was the first DHB to offer a healthcare interpreting service. Auckland DHB followed in 1998, and Waitemata DHB in 2000, offering both a translation and interpreting service (WATIS) and a special Asian Health Support Service (now Asian Health Services). All three DHBs provide health interpreting services, some over the phone, but mostly face-to-face. Counties Manukau DHB (CMDHB) also provides video remote interpreting services (Magill and De
Crezee and Mele Tupou Gordon
Jong, 2017). All three interpreting services ask their casual and staff interpreters to sign a contract which includes the code of ethics of the New Zealand Society of Translators and Interpreters (NZSTI, 2013). This code prescribes impartiality. Interpreters working for all three services ring patients to remind them of upcoming appointments. All interpreting services report that these Appointment Confirmation calls (APC) help reduce no-show rates among LEP patients.
Healthcare interpreters at CMDHB in South Auckland, a geographical area which has a high number of High Intensive Users of Care, among their regular interpreting services now additionally provide some follow-up outreach services in the community to ensure patients know how to take their medication, and recognise the importance of follow-up care (de Jong, pers. comm., 2017).
Seattle
Seattle Children’s Hospital is a highly specialised facility, which has an “uncompensated care fund” to pay for the care of children whose families cannot afford to do so. The hospital collects data on families’ preferred language of medical care.
The hospital has a well-established interpreting service which includes staff interpreters for on-site interpreting, a telephone interpreting line and video remote interpreting services. Patient navigators are assigned to families who meet specific requirements as will be explained in Table 1.2.
Navigation and cross-cultural mediation
Auckland
Over the years a number of initiatives have aimed at reducing health disparities and improving health literacy. These included a project which saw community pharmacists involved in a project to ensure that low-literate patients in the more deprived areas of Auckland understood important information around prescribed medication (Walsh, Shuker & Merry, 2015). The realisation that patients may benefit from assistance by intercultural mediators (cf. Verrept & Coune, 2016) or cross-cultural liaisons led to the establishment of cultural liaison services or family-centred social work support by programmes such as Fonua Ola (2014). However, outcomes were not always measured, making it difficult to assess the success of interventions by cultural liaisons. A 2010 health literacy survey showed that Māori were more likely to have low health literacy than the general population. A special programme called Whanau Ora (Turia, 2011) was established to work with Māori patients. Following this, the Fanau Ola programme was established to assist Pacific people who were also Very High Intensive Users (VHIU) of health services. Fanau Ola presented the impressive results of its interventions with
167 patients in 2014. These included a 22% decrease in emergency care presentations, a 23% decrease in hospital admissions, a 31% decrease in inpatient events (3 hrs +), a 20% decrease in acute admissions, a 40% decrease in bed days, a 12% decrease in average length of stay, a 46% increase in Outpatient Appointments attended and a 30% decrease in the no-show rate to total outpatient appointments (Pacific Health Development, 2014).
According to the latest figures, Asians (defined very broadly as those originating from countries in the Asian region) make up between 20% and 30% of the Auckland population.
Waitemata DHB provides Asian Health Services, which includes the following:
• Inpatient support and support post-discharge from hospital
• iCare health information line and GP support
• Health promotion and prevention, including Asian breast screening support, Asian smokefree, CADS Asian counselling service and ACP advance care planning
• Cultural advice for health professionals
• Asian mental health service
• Waitemata translation and interpreting services (WATIS)
Seattle
Prior to commencing the Patient Navigator trial in 2008, Seattle Children’s Hospital already had systems in place to try to achieve health equity for a very diverse patient population, particularly focusing on LEP patients. Such systems included:
• Interpreter services – staff interpreters for the main languages and the use of the Family Interpreter line, as well as access to video remote interpreting services offered by external contractors
• Health information in a range of languages – the hospital has a wide range of health and health procedure related information in a range of patient languages
• Community Outreach Health Equity Liaisons – the hospital has health equity liaisons working with different communities to obtain feedback on how they have experienced (quality of) patient care at the hospital and what could be done to improve outcomes
• (Implemented after 2013: Pictograms – the hospital is spread out over four buildings, which have been given the names Ocean, Forest, River and Mountain. The way to the various buildings is indicated by means of signs with ocean, forest, river and mountain pictures. Lifts are named after animals (e.g. whale, otter, owl) which might be encountered in oceans, forests, rivers and mountains, and again signposted by pictures of the animals concerned)
Table 1.2 Preferred language of care for LEP patients FY2013, Seattle Children’s Hospital
Range of 20+ other languages
Note: LEP = Limited English Proficiency.
Source: Seattle Children’s Hospital Centre for Diversity and Health Equity, 2014.
Even so, such systems did not prove sufficient to prevent health disparities or reduce costs due to readmission, duration of in-hospital stay and high rates of missed appointments (no-show rates). Hospital staff were keen to address health disparities.
The impetus for the Patient Navigator trial came when the hospital received feedback from medical staff at a nearby public hospital about the fact that many Limited English Proficient (LEP) families were feeling lost and unable to navigate the hospital. They felt unable to make appointments or organise transportation to and from the hospital. It was suggested that SCH should initiate a Patient Navigator programme, similar to the Cultural Case Manager (CCM) programme in place at Harborview Public Hospital in Seattle (Ethnomed, 2014). This programme had been set up in 1994 to provide outreach services for LEP patients at the hospital. It was suggested that the SCH Navigator programme should be based at the hospital and that services be provided for LEP families who met a number of criteria for navigation.
Table 1.2 shows the preferred language of care for Limited English Proficient (LEP) patients at Seattle Children’s Hospital in 2013.
The initial navigator trial commenced in 2008, with the aid of a seed grant. When the initial grant money ran out, the programme received a 2-year grant of $277, 831.98 for a 2-year Patient Navigator pilot from the Pacific Hospital Preservation & Development Authority (PHPDA). An independent management consulting company was asked to carry out a programme evaluation. The PHPDA evaluation of the programme in 2011 showed significant improvement in the areas listed below.
Financial return
One of the results was a cost saving of approximately $1.2 million in inpatient costs, in return for direct annual personnel costs of about $210,000. In other words, every dollar invested in Patient Navigators saved about six dollars.
The no-show rate dropped to 5.4%, representing further savings of about $35,000. The number of interpreting assignments (interpretations) increased at discharge and during inpatient stays.
Patient families and healthcare professionals were also asked for feedback. There were significant improvements in satisfaction rates for navigated families (Spanish and Somali speaking) and healthcare providers. After the 2-year trial, a majority of the latter said that the quality of care for these LEP patients was now better, or about the same as it was for English-speaking patients. Hence, linguistic barriers to care delivery seemed to have been neutralised.
The evaluation showed that Patient Navigators played a significant role in teaching families how to deliver correct home care and prevent emergency and hospital readmissions. They also helped families make and keep the appointments from physician referrals. At the end of the grant, families with patient navigators were more likely to complete referrals than families in the same language groups without patient navigators. No-show rates (missed appointments) reduced by 32% for Somali families and by 21% for Spanish speaking families. LEP families were generally allocated a medical interpreter, unless they met specific criteria for Navigation.
Every effort was made to select those families where navigators could make a difference. In practice this meant families were selected (through referral by hospital medical, nursing or social work staff) with the highest need, where Navigation might make the most significant difference. Criteria for selection of families included:
• Families of children with medically complex conditions, where the child is being seen by specialists from a number of different specialties
• Limited English proficiency
• Low health literacy
Following the selection process, every effort was made to ensure staff within the hospital were familiar with the navigator role. Navigators received bimonthly support from key medical and nursing personnel. They were familiarised with the hospital’s strategic plan, procedures and priorities. Navigators had immediate access to their supervisor, which enabled them to discuss any potentially problematic situations, issues and dilemmas. Having the supervisor as a soundboard helped the navigators to adhere to their professional role boundaries and helped avoid situations in which navigators might become “a law onto themselves”, which would have potentially harmed families or created unnecessary conflict.
In general, the role of Patient Navigators revolves around reducing barriers to care, where such barriers may be related to cultural and linguistic divergences, financial issues, time issues (walk-in, flexi hours), transportation issues (not having car, public transport, time off from work), health literacy and general literacy/numeracy. While navigators cannot resolve such issues, they can make providers aware of them, with the families’ consent.
Table 1.3 Aspects of navigator role emphasised most by various interviewees
Pointing out missed inferences
Teaching role: Suggesting alternative ways of explaining complex medical matters; explaining how the healthcare system works
Trust Lowering register (rephrasing in “plain language”)
(cf. Mikkelson 2017)
Physicians’ views (n = 3)
Navigators’ views (n = 4)
Social workers’ views (n = 3)
Interpreting service staff views (n = 2)
Supervisor/director views (n = 2)
Interestingly, interviews with patient navigators showed that they viewed their role as a teaching role. The health providers interviewed emphasised the trust “navigated” families had in navigators. The providers said this enabled them to work with families in an atmosphere of trust. Table 1.3 was taken from a study reported on by Crezee and Roat (forthcoming). It shows the different perspectives on the navigator role. Interestingly, both navigators and interpreting service staff emphasised what they saw as the major points of difference between the interpreter role and the navigator role: pointing out missed inferences and rephrasing the message in plain language.
Bilingual and bicultural providers
Over the years, a number of initiatives have aimed at reducing health disparities and improving health literacy (Walsh, Shuker & Merry, 2015). At one point, CMDHB was offering language- and culture-concordant cultural liaison services to Pacific and Māori patients (Turia, 2011), however these are no longer being funded.
Bilingual provisions at Seattle Children’s Hospital (SCH)
SCH staff includes a number of bilingual providers. Some healthcare providers in the US are themselves second-generation migrants who grew up speaking the community language at home but then went through their primary, secondary and tertiary education using the dominant language of the country. In the US, English is the medium of instruction and students rarely follow classes in their home language. For health providers, this means that
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a house is often constructed. Upon arrival at the mountain, the construction is very rapid; this house could be occupied for a long time without trouble. This house thatched with banana leaves is famous for this story: Pumaia was the man, Kamakakehau was the woman. While living together [as husband and wife] they went up to the mountain to hew timber; Pumaia was deserted by the wife; she became Koae’s, a man from another place. Pumaia was killed by Koae; the house was called pumaia (banana tree); but because Pumaia was killed, this house was named laumaia (banana leaves). Pumaia was the chief of a district. The explanation concerning this famous story is lengthy, but it is proper that I should shorten [it].
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In its construction this house is similar to the house thatched with ti-leaves or banana leaves, but its thatch is the bark of the
laumaia, o kona mea i kaulana ai, o Pumaia ke kane a o Kamakakehau ka wahine, i ka wa o ko laua noho pu ana ua pii laua i ke kuahiwi i ke kua laau; ua haalele ia o Pumaia e ka wahine, ua lilo oia ia Koae, he kanaka ia no kekahi wahi mai, ua pepehi ia o Pumaia e Koae a make; a he pumaia ka inoa o ka hale; a no ka make ana o Pumaia, nolaila, kapa ia ai ka inoa o keia hale he laumaia. A o Pumaia nohoi, he kanaka aimoku ia no kekahi aina; he loihi aku no ka wehewehe ana o keia mea kaulana, aka, he pono nae ia’u e hoopokole.
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O ke ano o keia hale, ua like no ia me ka hale la-i a me ka hale laumaia ke ano o ke kukulu ana, aka, o ke pili o keia hale, he
koa tree. The bark of the koa is peeled and then thatched. This house is also constructed for mountain residence during the process of hewing a canoe, and for other purposes. Any kind of timber is used in its construction. Because it is covered with the bark of the koa, therefore it is called hale ilikoa. 213 [654]
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The house thatched with ama’u has no real post, no battens, no ridge; but in its construction, simply break the ama’u midrib and all, and stick them in the ground on that side and this side, leaving a place in between for occupation, then bring the tops [of the leaves] together, and lash them with cords. In the construction of some, posts, rafters and battens are used, similar to the construction of a grass thatched house, and after the frame work is up, the ama’u is thatched and fastened with cords.
ilikoa; ua akaakaa ia ka ili o ke koa a uhi mai mawaho. Ua hana
ia no keia hale no ka pii ana iuka i ke kalai waa a no na hana e ae
no hoi; a he pono laau no ko keia hale. No ka uhi ana ia i ka ilikoa, nolaila ua kapaia he hale ilikoa. [655]
’ .
O ka hale ama’u, aohe ona pou
laau maoli, aohe hoi he o-a, aohe kaupoku, aka, o kona ano, he uhaki mai no i ka ama’u me ka iwi a hou ma kela aoao keia aoao, me ka hookaawale nohoi ia waena i wahi e noho ai, a e hoopio ae nohoi ia luna a e hakii iho no me ke kaula.
O kekahi ua kukulu maoli ia no ka pou ke o-a a me na aho, e like me ko ka hale pili hana ana alaila papai aku ke ama’u mawaho me ka omau ia i ke kaula.
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This house is constructed in any way which the house builder desires, at the same time providing all the material necessary. It is covered outside with cane leaves bent around the battens; at the four corners of the house, ama’u is used; also the ridge. Because this house is covered with cane leaves, it is called a hale ha-ko (cane leaf house).
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This house is constructed when a person goes to the mountain to get olona, and he desires to stay awhile. He erects some timber [for posts] with some battens which are covered with ape leaves; it is named hale ape (ape leaf house).
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O keia hale, aia no i ke ano hale a ka mea makemake hana hale e hana ai me ka hoomakaukau no hoi i na mea apau o ka hale. O kona uhi mawaho, he ha-ko; ua pelupelu ia ka ha-ko i ka aho a ma na kihi eha o ka hale, he ama’u ka mea e hana ai, a pela nohoi ma kaupoku. No ka uhi ana ia o keia hale i ka ha-ko, ua kapaia kana inoa, he hale ha-ko.
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Ua kukulu ia keia hale no ka pii ana i uka i ke kahi olona, a makemake ke kanaka e moe iuka, kukulu ae no ia i na laau, me ka hoaho ana a uhi mai ka lau o ka ape mawaho; ua kapa ia kona inoa, he hale ape.
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This house will last as the house thatched with ti-leaves; it lasts for two years or more. This painiu does not grow on the ground; it grows on the ohia or other trees. Its thatching is like the ha-ko, the leaves being bent around the battens; and because the house is covered with painiu it is called a “painiu house.”
Ua like no ka paa o keia hale me ka hale la-i; ua paa no ia no na makahiki elua a oi ae. O keia painiu aole ia e ulu ma ka honua, aia kona wahi e ulu ai maluna o ka ohia, a laau e ae no hoi. O kona hana ana, ua like me ka ha-ko ka pelupelu ia o ka lau i ka aho; a no kona uhi ia ana i ke painiu ua kapaia kona inoa, he hale painiu.
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The posts of the house are erected and the battens are placed in position; then covered with banana leaves, on top of which set lumps of dirt, so the dirt would not fall into [the house]. Because it is covered with dirt it is called “he hale lepo.”
.214
The construction of this house is similar to that of the house thatched with ti-leaves; the
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Ua kukulu ia na laau o ka hale, a ua hoaho ia, alaila, e uhi iho maluna i ka laumaia, alaila, hoouhi mai ka eka lepo maluna iho o ka laumaia i ole e komo ka lepo iloko. No kona uhi ia ana i ka lepo ua kapa ia oia, he hale lepo.
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O ke ano o ka hana ana i keia hale, ua like me ka hana ana i ka hale la-i, he pelupelu mai, alaila,
leaves are bent over and placed on the battens; this [kind of] house is often seen in cultivated places in the wilderness.
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Its construction is similar to that of the house thatched with grass. Thatch cane leaves or uki grass first, and on that place kalamalo. This kind of a house is called “he hale kalamalo” (a kalamalo house). This kalamalo is somewhat like the scented [656]plant growing at Mr. Bishop’s place, which is perhaps called wailukini215 (a species of lucerne).
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The posts and the rafters of this house are erected, but the covering of this is pandanus leaves. Soak the lauhala in water until it is supple, then scrape off
hoopaa ia maloko o ka aho, ua ike nui ia keia hale ma na wahi mahiai iloko o na ulu laau.
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Ua like no kona kukulu ana me ke hale pili. O ka ha-ko maloko a i ole ia, he [657]uki, alaila, mawaho mai ke kalamalo. Ua kapaia keia hale, he hale kalamalo. Ua ano like keia kalamalo me ka mea ala ma kahi o Bishop, he wailukini paha kona inoa.
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Ua kukulu ia no na pou o keia hale a me na o-a aka, o ka uhi o keia mawaho he lauhala. Ho-u ia ka lauhala i ka wai a ma-u, alaila, koekoe aku ke kokala, a
the sharp thorns and thatch. This is done like the ti-leaves; the pandanus leaves are bent around the battens and fastened with strings.
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The new leaf of the loulu216 is used for covering the house; not the leaf-bud, however, but the new leaf which has opened up. This loulu is like the coconut. The tools which the ancients used in hewing house timber were sharp, hard rocks which had been brought to an edge.
Perhaps there are other kinds of houses, but because I am out of paper, I herewith cease.
J W .
pau ke kokala, alaila, papai aku; ua like ke pai ana me ko ka la-i, ho-o-o maloko o ka aho i ka lauhala, me ka hoopaa ia i ke kaula.
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O ka mu-o o ke loulu, oia ka mea e uhi ai mawaho o ka hale; aole nae o ka mu-o i mohala ole, aka, o ka mu-o i mohala. O ke ano o keia loulu, ua ano like no ia me ka niu. O na mea paahana a ka poe kahiko e oki ai i na laau kukulu hale, he mau pahoa oioi i hanaia a oi loa.
He mau hale aku no paha koe, aka, no ka pau e o kuu pepa, ke oki nei au maanei.
J W .
STORY OF THE LAUHALA. MOOLELO NO KA LAUHALA.
The name of the lauhala217 was Ohiohikupua; it sprouted from the bottom of the ocean, and grew above the surface of the sea until it proudly stood like the sharp-pointed clouds which appear in the heavens. Some time after it had grown to quite a height, Pele set forth on her journey here to Hawaii, thinking she would soon arrive here, but it proved otherwise. On her way she struck the place where this pandanus tree grew and she was strangled by the sharp thorns of this lauhala, with us human beings, it seemed, helping from this side; Pele struggled by using her divine powers, but she could not extricate herself. Soon after, her brother, Paao by name, appeared, with a gourd of seawater. Said Pele, “I am in trouble indeed, brother.” Then he climbed up and from on top poured out the sea-water; the young leaves wilted and Pele was freed. Because she was full of anger Pele climbed on top and pulling out the leaf-buds, threw them hither and thither Some
O ka inoa o ka lauhala o Ohiohikupua; mai lalo mai o ke kai kona wahi i kupu mai ai, kupu ae la ia a hala maluna o ke kai, a ku kilakila iho la ia me he ao opua la i ka nana aku, a mahope iho o kona ulu ana ae a kiekie a he manawa loihi iki mahope iho. Hoomaka o Pele e hele i Hawaii nei, me kona manao e puka koke ana ia i Hawaii nei, eia ka aole; i kona hele ana mai ua kupono i kahi i ulu ai ua kumu hala nei, paa iho la ia i ka umiki ia e ke kokala o ua lauhala nei, o kakou aku ka hoi o kanaka ma keia aoao; hooke mai la o ua o Pele i ka mana ona a aole hemo, a mahope iki iho hiki mai ke kaikunane, o Paao kona inoa, me ka ipukai kai. I aku la o Pele: “Pilikia au la e ke kaikunane,” ia manawa pii ae la kela a maluna nini iho la i ke kai; mae iho ka muo alaila, hemo ae la o Pele. No ka nui o kona ukiuki, pii aela ia maluna huhuki i ka muo kiola ma kela wahi keia wahi. Kau mai la kekahi muo i Hawaii nei, oia ke kumu i ulu ai i Hawaii nei; o kahi i ulu mua ai, ma Kohala i
landed here on Hawaii. That is the reason it grows here on Hawaii. The place of its first growth was Kohala, Hawaii; therefore Pele was the one who brought it here to Hawaii.
Also, at that time we did not have mats, but because it occurred to a high prophetess at that time, whose name was Lauhiki, to convert this lauhala into mats by having women braid it, it was so done. The first woman who did the braiding was this same Lauhiki, and from her all other women learned.
Here is another use of the lauhala: it was used as sail for canoes in the olden [658]times; it originated from a man named Lonoauhi. The ones who braided it were this Lauhiki and her younger sister Haumea and their five daughters Kamehaikaua, Meahanipaoa, Lohea, Kahuihuimalanai and Kahoanohookaohu (that was the sail of the canoe of Kamehameha I). These persons were goddesses. The shape of the sail was round like the sun;
Hawaii; nolaila, o Pele ka mea nana i lawe mai i Hawaii nei.
Ina manawa no hoi aole o kakou moena, aka, mamuli o ka noonoo ana o kekahi alii kaulana oia wa, o Lauhiki kona inoa, e hoolilo i keia lauhala i moena mamuli o ka ulana ana o na wahine, a lilo i moena, o ka wahine mua no nana i ulana o Lauhiki no, no laila ike na wahine a pau.
Eia hoi kekahi hana a ka lauhala, o ka lilo ana i pea waa no ka wa kahiko, mamuli [659]no hoi o ka noonoo ana o kekahi kanaka o Lonoauhi kona inoa, o ka mea no nana i ulana o Lauhiki no, a me kona kaikaina o Haumea a me ka laua mau kaikamahine elima, Kamehaikaua, Meahanipaoa, Lohea, Kahuihuimalanai, Kahoanohookaohu, oia no ka pea o ka waa o Kamehameha ekahi. O keia poe he poe akua no lakou. O ke ano o ka pea ua
while sailing on the ocean this was spread on the mast of the canoe when it would really appear like the sun.
Here is another use: the drupes of its fruit were strung into wreaths for people in the olden times. The women who first strung them were Kahuihuimalanai and Kahoanohookaohu, and from them the custom has spread to this time.
Here is another thing: when this wreath dries on the neck, then it is preserved until a troublesome illness appears, such as a stomachache, or other illness for which this medicine is properly used, then it is obtained and fed [to the patient]; if it be for life, he lives; if it be for death, he dies.
These are the fragments concerning the lauhala which I have obtained; but I tell you they were not freely acquired, but were secured through purchase from an old man, he having stated that if he were not paid,
like me ka poepoe o ka la; i ka wa e holo ai ma ka moana, uhi ia iho la maluna o ke kia o ka waa, i ka nana aku ka, ua like io no me ka la.
Eia kekahi hana o ka lilo ana o ka hua i mea lei no na kanaka o ka wa kahiko. O na wahine nana i hana mua, o Kahuihuimalanai a me Kahoanohookaohu, a mai a laua mai ka laha ana mai a hiki i keia wa.
Eia kekahi; aia maloo ua lei ala i ka a-i, alaila malama iho la a hiki mai ka mai pilikia, he nahu paha a me na mai e kupono ana ia laau, alaila kii ia aku la e hanai; ina no ke ola, ua ola, ina no ka make, ua make.
O ia iho la kahi hunahuna o ka lauhala i loaa ia’u, aka, e hai wau ia oukou, aole i loaa wale mai, aka ua loaa mai mamuli o ke kuai ia ana aku, i kekahi wahi elemakule kahiko, me koiala olelo mai, ina aole e uku aku,
then he would not divulge anything. Therefore I thought there was no other way for me to quickly obtain them; so I consented. My expenditure was a real half a dollar. If this is repeated, I will continually be in need, my friends.
alaila, aole e loaa mai. Nolaila, noonoo iho wau, aohe wahi e loaa koke mai ai ia’u, nolaila, ua ae aku au; o ku’u lilo he hapalua dala maoli. Ina pela hou aku mau maoli ka nele e na hoa.
SOME THINGS IN THE BIBLE SIMILAR TO SOME THINGS DONE HERE IN HAWAII IN THE OLDEN TIME.
O KEKAHI MAU MEA O KA BAIBALA I ANO LIKE ME KEKAHI MAU MEA I HANAIA MA HAWAII NEI I KA WA KAHIKO.
There were guides which pointed out to me some of the things done in Hawaii nei which were similar to those [mentioned] in the Bible. First: the book known as the Moolelo Hawaii (Hawaiian History). Second: From some old people who are still living. From these sources were obtained material for comparison.
Elua no hoike nana i hai mai ia’u no kekahi mau mea o Hawaii nei i ano like me ko ka Baibala.
Akahi: O ka buke i kapaia
Moolelo Hawaii. Elua: Mai kekahi poe kahiko mai e ola nei; mailoko mai o keia mau hoike e loaa’i na mea i hoohalikeia.
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We know that, according to the Bible, Adam was the first man; Gen. 1:27, and from him came all the peoples of the earth. According to the Hawaiian version, Kahiko was the first man, and he begat Wakea, and the rest of the people; and they have a genealogy of their ancestors, just like Adam’s.
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It is shown in the Bible that Elijah was the one who ascended into heaven by the power of God: 2 Kings 2:11; and Jesus Christ ascended because of his divine attributes. Thus is it stated in Hawaii’s history: Lonomuku218 ascended to heaven; she was a woman and because her husband cut off her legs, therefore she was halted at the moon. If her husband had not cut off her legs, she would have
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Ua ike kakou ma ka Baibala, o Adamu ke kanaka makamua; Kin. 1:27, a mai iaia mai i laha mai ai na kanaka a pau loa o ka honua. Ma ko Hawaii nei hoi, o Kahiko ke kanaka makamua, a nana mai o Wakea, a me na kanaka apau; a he mookuauhau no, elike me ko Adamu.
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Ua ike ia ma ka Baibala o Elia ka mea i pii aku i ka lani, ma ka mana o ke Akua; 2 Nalii, 2:11, a o Iesu Kristo, ua pii no ia ma kona ano Akua. Pela hoi, ua oleloia ma ko Hawaii nei moolelo, o Lonomuku ka mea i pii i ka lani; he wahine ia, a no ke oki e ana o kana kane i ka wawae, nolaila ua noho ma ka mahina. Ina ka aole i oki ke kane i ka wawae ina ua hiki loa aku oia i kahi o ka la. O kona wahi i
reached the locality [660]of the sun. Her place of ascent was at Hana, the place called Hana-ualani-haahaa.219 That was the reason for so naming the place, and there is more.
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Jonah was the man who lived in the belly of the fish, according to the Bible: Jonah 1:17. Kuikuipahu220 was Hawaii’s [celebrity] who lived in the belly of the shark. He was a chief of Kohala. Once he went surfing with a number of people; and while they were surfing, Kuikuipahu was taken by a shark. The place where he landed was Hana, at Kauiki hill; it was there he was discovered by some people. Eleio was the chief living at that time, and Kipola and Kipalalaia were the prophets; when Kuikuipahu was found, he was not dead; he was still alive.
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pii ai aia ma [661]Hana, ma kahi i kapa ia o Hana-ua-lani-haahaa, oia ka mea i kapaia’i oia wahi, a he mea e aku no kekahi.
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O Iona ke kanaka i noho iloko o ka opu o ka ia, wahi a ka Baibala; Iona 1:17, o Kuikuipahu hoi ko Hawaii nei iloko o ka opu o ka mano. He alii ia no Kohala; i kekahi manawa, hele oia i ka heenalu me na kanaka he lehulehu, a ia lakou e hee nalu ana, ua lilo aku la o Kuikuipahu i ke mano; a o kona wahi i pae ai ma Hana no, o ka puu o Kauiki, malaila kahi i ike ia’i e na kanaka. O Eleio ke alii ia manawa e noho ana; o Kipola hoi ame Kipalalaia, na kaula; i ka ike ia ana o Kuikuipahu aole i make, e ola ana no.
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Pharaoh and Herod were some of the cruel kings mentioned in the Bible; Exodus 1:8–22, Matt. 2:16, and there were also some others. Hakau221 was Hawaii’s cruel king. He was a chief of Waipio. This was the chief who proclaimed that the breasts of all females were to be cut off; and if he saw a man with well tattooed hands, or with good hair, or a woman with good hair, he immediately gave orders to have the hand or the head cut off. There were other cruel practices carried on by this chief. Owaia222 was another cruel chief. It is said that his time was a very bad period, full of debasing pleasures.
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When Jesus was being baptized by John, there was heard a voice crying out from heaven, saying, “Thou art my beloved son, in Thee I am well pleased.” Luke 3:22. And there were other
O Parao ame Herode kekahi o na alii hana ino i hoikeia ma ka Baibala; Puk. 1:8–22; Mat. 2:16, a me kekahi mau alii e aku nohoi. O Hakau hoi ko Hawaii nei alii hana ino. He alii ia no Waipio. O keia alii kai hoolaha ae e okiia ka waiu o na wahine apau loa, a ina e ike aku oia i ke kanaka lima kakau maikai, a me ka lauoho maikai ame ka wahine lauoho maikai, kauoha oia e okiia ke poo, ame ka lima. He mau mea ino e ae no kahi a keia alii i hana ai, Owaia hoi kekahi alii hana ino. Ua oleloia o ka manawa iaia he manawa ino loa piha i na lealea ino.
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I ko Iesu manawa i bapetisoia’i e Ioane, ua lohe ia he leo i pae mai la, mai ka lani mai, e olelo ana: “O oe no ka’u keiki punahele he oluolu loa ko’u ia oe;” Luk. 3:22, a he mau leo e
voices like this in the Bible. So it was here in Hawaii. There was a voice from the heaven enquiring, “Which of the chiefs down below lives righteously?” “It is Kahiko,”223 was the answer
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When Ahab was king of the Israelites, because of the many sins he committed, Elias, the prophet, said to him, “As the Lord God of the Israelites liveth, before whom I stand, there shall not be dew nor rain these years, but according to my word.” 1 Kings 17:1. Thus again: When Hua224 was king here on Maui, Luahoomoe was the [662]prophet at that time. Because Hua wanted to bake Luahoomoe in the oven, therefore he [Luahoomoe] told his sons where to go and live, because he was going to take away the rain (deprive the land of the rain).
Thus there were many other little things here in Hawaii which can
ae no kekahi e like me keia, ua loaa keia ma ka Baibala. Pela no hoi ma Hawaii nei, ua lohe ia no he leo mai ka lani mai e ninau ana: “Owai la ke alii o lalo i pono ka noho ana?” “O Kahiko,” wahi a ka haina.
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I ka manawa o Ahaba ke alii o ka Iseraela, no ka nui loa o kana hana ino, ua olelo aku ke kaula o Elia iaia: “Ma ke ola ana o Iehova ke Akua o ka Iseraela, imua ona e ku nei au, aole auanei he ua, aole hau i na makahiki ekolu, ma ka’u olelo wale no;” 1 Nalii 17:1. Pela no hoi. I ka wa o Hua ke alii o Maui nei o Luahoomoe, ke [663]kaula ia manawa, no ka manao ana o Hua e kalua ia o Luahoomoe i ka imu, nolaila, olelo kela i kana mau keiki, i kahi e noho ai, nokamea, e lawe ana ia i ka ua.
Pela hoi, he nui na mea liilii e ae o Hawaii nei i like me kekahi
be compared with some things in the Bible, but my illustrations thereon are sufficient.
February 15, 1872.
G. P .
THE DAYS AND THE MONTHS.
During the month of Ikuwa225 occurs the rain called Pohakoeleele;226 on the day called Hua227 at noon, a person goes to plant. These are the names of the stalks to be propagated: hualani, hokeo, lopa, likolehua and kawelo. 228
This is the method of planting: he takes three stalks, separating them one from the other with his fingers, and plants them. He leaves them until two months have passed; he goes to inspect them, and if he finds that they have grown well he says this:
mau mea o ka Baibala, aka, ua lawa ka’u hoike no keia.
February 15, 1872.
G. P
NA LA A ME NA MALAMA.
Iloko o ka malama o Ikua, o Poha-koeleele ka ua; i ka la o Hua, a i ke awakea hele aku oia e kanu. Eia ka inoa o na lau e kanu ai: Hualani, hokeo, lopa, likolehua, kawelo. Penei ke kanu ana; lawe aku oia ekolu lau me ka hookakahaka ana i ka lau me kona lima; a kanu aku oia, waiho aku a hala na mahina elua, hele aku oia e nana: a ike ua ulu pono, eia kana olelo: “Ua ola ka hoi keia noho ana ae, ua maikai ka ulu ana.” Aka, ina hele aku oia ua make a ua ponalo, kaumaha loa ia no ka puka pono
“The future [living] is provided for, the growth is good.” But if when he arrives, they are dead or drying up, he would feel grieved because they did not do well. The farmers know there is a time when plants do not grow well; that is the winter season when rains are plentiful and the shoots will die. But if a planter waits until the month of Ikiiki,229 of misty rain, that is when the rain is light and is easily scattered by the wind, on the day of Mohalu230 in the month of Ikiiki, [that] is the month for him to plant in the manner described above. These are the names of the potatoes to be planted: waipalupalu, kokoakeawe, kuapai, heauau and haole. He waits until the months of Kaaona231 and Hinaiaeleele232 are past when he goes again to look, and he finds that some are dead and some are growing. This is what he says: “My wife and children are saved by the baldheaded one.” He waits for some time longer until the grass grows, then he weeds it; this [weeding] is sufficient until the time that the potato is ripe. After
ole. Ua maopopo no i ka poe mahiai he wa no ia e puka pono ole ai ka lau, oiai ke kau hooilo ia, nui ka ua a make ka lau. Aka, noho mai oia iloko o ka malama o Ikiiki o ka ihunahuna ka ua, oia hoi, ka ua liilii pulelehua i ka makani, i ka la o Mohalu i ka malama o Ikiiki kanu oia e like me ka mea i hai ia ae la maluna. Eia ka inoa o na uala e kanu ai: Waipalupalu, kokoakeawe a he kuapai, heauau, he haole. Noho oia a hala ka malama o Kaaona a me Hinaiaeleele, hele hou aku oia e nana, a ike ua make kekahi a ua ola. Eia kana olelo: “Ua ola ka’u wahine ame ka’u mau keiki i kahi Ohulu;” noho ua kanaka nei a loihi a ala ka mauu, kuehu aku oia i ka mauu; a pau ia o ke oo no ia o ka lau. Alaila, waiho aku a loihi na la, alaila, kii aku ke kanaka mahiai, hooili i ka lepo; a loaa ka uala maka hooili ana i ka lepo, o ia hoi ka hua i ka wa ame ka hua i ka lala hahai mai oia i ka uala mua. Hoi aku oia a hiki i ka hale, hoa ka imu a kalua a moa hoihoi mai a ka hale, noho oia ma ka puka, penei oia e kahea ai: “Kela ao nui eleele i ka maka o ka opua la olalo iho, e
weeding, leave it for many days; when the planter comes again and hills up the soil. If any potato is found while hilling up the dirt, that is, the fruit in between the plants growing on the vine, he breaks off the first potato. He returns, lights a fire in the imu, cooks the potato until done, and brings it to the house. He sits beside the doorway and prays thus: “Ye large black cloud hanging below the eye of the narrow pointed clouds, give shade, protecting shade; guard this our garden, O Keaonui;233 do thou cast shade over this our garden, O Keaonui; shade thou from that corner to this corner; shade thou from that side to this side; shade not another’s garden lest you be scolded for shutting out the sun and chilling the owner of that garden. O Keaonui, shade thou this our field; shade thou the hills, shade thou the leaves of our food, so that the plants would grow and the [664]hills be filled with potatoes. O ye Keaonui, shade our garden from the head to the bottom, from the upper to the
malu malu kiai, kiai ae i ko kaua waena nei la o Keaonui, malu oe i ko kaua waena nei la, e Keaonui, e malu oe mai kela kihi a i keia kihi, e malu oe mai kela iwi a keia iwi; mai malu oe i ko hai waena o huhu ia oe i ke pani i ka la, koekoe ka mea nona ia waena. E Keaonui e! e malu oe i ko kaua waena nei; malu oe i ka pue, malu oe i ka lau o ka kaua ai, i ulu, i piha ka pue i ka [665]uala. E Keaonui e! e malu i ko kaua waena mai uka a kai, mai nae a lalo, elieli kapu, ua noa.”
lower side; hallowed is the prayer; it is free.”
This prayer is the request of the gods to come and partake of the first fruit of their garden. He then waits until the first Mahoe234 is past, and during the second Mahoe on the day of Lono,235 he goes to get some potatoes for food, taking some of them to the heiau (temple). Because on that night the god returns to partake of the food of his planting devotee; thus the saying: “Lives he who has a god; dead is he who has none.” After these months during which the children and the parents have partaken of the food, these also being the last months of the rainy season, the summer again approaches. Let us drop the discussion about the winter season, and take up for consideration what is done during the summer.
;236 , .
O keia pule ana oia no ke kahea ana i ke akua e hoi e ai i ka hua mua o ka laua mea kanu. Noho aku oia a hala ka Mahoe mua, a komo aku iloko o ka Mahoe alua.
I ka po o Lono, kii aku oia e ai i ka uala, me ka lawe ana i ka uala i ka heiau; nokamea, oia ka po e hoi mai ai o ke akua, e ai i ka ai a kahi pulapula hooulu ai: “ola nohoi ka mea akua, make no hoi ka mea akua ole,” wahi a ka olelo. A hala keia mau malama o ka ai ana o na makua ame na keiki i ka ai, a o na malama hope no hoi keia o ka hooilo, o ka puka no ia iwaho o ke kau. Maanei kakou e waiho ai i ke kamailio ana no ka hooilo, e huli aku kakou e nana i na hana o ke kau.
: .
This is the method of cultivating Penei ka mahiai ana o ke kau.
during the summer: The farmer goes to select the mahakea, 237 that is a place where weeds grow in abundance; that is the best place for planting. This is how he knows: he cuts the weeds and leaves them on the ground, and rain falls, the leaves and the dirt become wet; that is why the stalks do not die when planted in the summer season, because the weeds cover the ground and retain the moisture in the soil. But when he cultivates, he does it during the days of Laaukukahi, Laaukulua, Laaupau, Olekukahi, Olekulua, Olepau, Kaloakukahi, Kaloakulua and Kaloapau;238 those are the best days during which to plant, a practice handed down by our ancestors.
After he has cut down the weeds he waits for the rain to fall; during the month of Welo,239 Pookole (short head) is the rain, that is the rain which we style a cloud-burst; then the farmer proceeds to crop off stalks. Here are the names of the different kinds of stalks which he gathers: pae, apo, kapapa, mohihi, uli
Hele aku aku ke kanaka mahiai e nana i kahi mahakea, oia hoi kahi nahelehele e ulu nui ana, oia kahi maikai i ka mahi ana. Penei e maopopo ai; i kona mahi ana i ka nahelehele a hina ilalo, a haule mai ka ua, a ma-u iho la ka lepo a me ka nahelehele, oia ke kumu e make ole ai ka lau ke puka iwaho o ke kau, nokamea, ua uhi iho ka nahelehele i ka ma-u o ka lepo. Aka, i ka mahiai ana o ua kanaka nei, iloko o na po o Laaukukahi, Laaukulua, Laaupau, ame Olekukahi, Olekulua, Olepau, ame Kaloakukahi, Kaloakulua, Kaloapau, oia na po maikai i ka mahiai ana, a he mau po no hoi i maa mai ko lakou kupuna mai.
I ka pau ana o ka mahiai ana, waiho aku ka mea mahiai o ka haule mai o ka ua; iloko o ka malama o Welo o pookole ka ua, oia ka ua, he ao ku ia kakou; alaila, hele aku ke kanaka mahiai e ako i ka lau. Eia na inoa o na lau ana e ako ai: he pae, he apo, he kapapa, he mohihi, he uli, a he paa. Oope
and paa. 240 He wraps these stalks in bundles and leaves them until the days when the Pleiades rise in the morning, when he proceeds to plant them. He plants them thus: he takes six stalks and keeps them separated as mentioned above; after planting, he waits for a number of days; then during the month of Nana,241 on the day of Kane,242 he goes to look at the potato field, and finds it is injured; that is, the stalks are all eaten by cutworms, some have come off and some are dead. During the month of Kaulua,243 on the day called Lono, in the evening, he goes to crop off some more stalks. These are the names of the stalks he gathers: hualani, poni, loepaa, awapuhi, uahiapele, pikonui and kupa. 244 He bundles these and sets them aside as described above. He waits until the month of Kaelo,245 on the day called Mauli246 in the evening when the moon sets; that [666]is the time to plant the stalks. He plants them in this way: he first distributes the stalks among the hills, eight to each hill; then he plants them. When
oia i keia mau lau a waiho aku, a hiki i na kakahiaka e puka mai ai na huihui, oia ka wa e kanu ai i na lau. Penei ke kanu ana: Lawe oia eono lau e kanu ai me ka hoohakahaka e like ma ka mea i hoike ia’e maluna; a pau kona kanu ana, noho oia a loihi kekahi mau la, hele aku oia i ka malama o Nana, i ka la o Kane, e nana i ka mala uala, ua nui ka poino; oia hoi ua pau i ka peeluamoeone a me ke kahuli a ua make wale iho no hoi kahi. I ka malama o Kaulua, i ka la o Lono, i ke ahiahi, hele aku oia e ako i na lau hou. Eia ka inoa o na lau e ako ai: hualani, poni loepaa, awapuhi, uahiapele, pikonui, kupa; oope oia a waiho aku e like me ka mea i hoike ia’e maluna, noho oia a hiki mai ka malama o Kaelo, i ka la o Mauli i ke ahiahi i ka wa e ili ai ka mahina, oia ka wa e kanu ai i ka lau. Penei ke kanu ana: Kiolaola mua keia i ka lau ma ka pue, ewalu nae lau o ka pue hookahi; kanu mai oia. A pau, noho aku oia a hala na malama ino, a loihi ka noho ana, a i ka malama o Kaaona hele oia e hooili i ka lepo i ka pue o ka uala, a
