The John A. Burns School of Medicine: 50 Years of Healing in Hawaii by UHMed JABSOM

The John A. Burns School of Medicine 50 Years of Healing in Hawaiâ&#x20AC;&#x2DC;i

The John A. Burns School of Medicine 50 Years of Healing in Hawai‘i Larry Fleece

| | THE JOHN A. BURNS SCHOOL OF MEDICINE: 50 Years of Healing in Hawai‘i

CONTENTS Foreword

Chapter One

Walking the Ward: Help and Hope

Chapter Two

The Dream Takes Shape: Modest Beginnings

Chapter Three

The Four Year School: Forging Community Partnerships

Chapter Four

A Leap in Learning: The New Approach

Chapter Five

Outreach: Bringing Healing to the Peopel

Chapter Six

A Place to Call Home: The Campus at Kakaâ&#x20AC;&#x2DC;ako

Chapter Seven

The Best and the Brightest: Students of Medicine

Chapter Eight

Pride and Persistence: Pioneering Breakthroughs in Research

Design and production Angela Wu-Ki

Chapter Nine

Rich Rewards: Care and Commitment

Legacy Isle Publishing 1000 Bishop St., Suite 806 Honolulu, HI 96813 www.legacyislepublishing.net

Chapter Ten

Looking Forward: A Bright Future

Epilogue

Philanthropy and Community Support

Printed in Korea

Index

ÂŠ 2015 John A. Burns School of Medicine All rights reserved. No part of this book may be reproduced in any form or by any electronic or mechanical means, including information retrieval systems, without prior written permission from the publisher, except for brief passages quoted in reviews. ISBN 978-0-935690-X-X Library of Congress Control Number: 2015XXXXXX

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FOREWORD

he year: 1965.

Meanwhile, in Hawai‘i in the year 1965, outfielder Fred

A postage stamp and a Hershey bar both

cost a nickel. Julie Andrews ruled the movie box

Connery in Thunderball. The Beatles went to number one with “Ticket to Ride.” So

Education (LCME) and the American Medical Association’s

direct line, back in time to the life principles of the Islands’

League. Pro golfers converged on the Wai‘alae Country Club

Council on Medical Education (CME).

original inhabitants.

of its most vocal and determined supporter,

Surfing Championship came to Sunset Beach for the first time.

Governor John A. Burns.

down as part of the Navy’s explosives testing. And a popular young Hawaiian-Chinese entertainer

Righteous Brothers cried that “You’ve Lost That Lovin’ Feelin’.”

released his debut album. Its title? The Don Ho Show!

And the Supremes told us all to “Stop! In the Name of Love.” On TV, we got our first look at Green Acres, I Spy, F Troop

The year 1965 also saw a bold decision made by the

and Hogan’s Heroes.

legislature at the Hawai‘i State Capitol in Honolulu. This

At the supermarket, we got our first taste of Diet Pepsi, SpaghettiOs and Pop-Tarts. In Washington, President Lyndon Johnson escalated the war in Vietnam. And Congress required cigarette packs to

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lokahi, or unity, harmony and balance; and ‘ohana, the bond of family—endure today in the

And the years have seen the John A.

extended family of medical professionals of the

Burns School of Medicine (JABSOM) move

John A. Burns School of Medicine.

in 2005 to its current home on its 9.9-acre

Spanning the past fifty years, the members

campus in Kaka’ako, boasting state-of-the-

of the John A. Burns School of Medicine have

art teaching and research facilities.

displayed a tireless work ethic, a commitment to

The pages that follow here represent

excellence and unsurpassed care and compassion

just a snapshot of some of the milestones along the

treatment and care in the Islands—as state legislators came

road travelled by the many dedicated physicians, instructors,

together to authorize formation of a two-year medical school at

administrators and students of the John A. Burns School of

the University of Hawai‘i.

Medicine. Their collective achievements stand as a testament

pages that follow, and all of their colleagues—richly deserve to

to the advancements of an entirely modern medical education

be celebrated on this fiftieth anniversary of the establishment of

facility.

their institution.

vote have seen the school transition from a two- to four-year

Hazardous to Your Health.”

These principles—aloha, or love and compassion;

move would pave the way for the future of medical education,

The fifty years that have followed that history-making

carry a new warning: “Caution: Cigarette Smoking May Be

The years have seen the school take on the name

north shore of O‘ahu, the Duke Kahanamoku Invitational On the island of Kaho‘olawe, 500-ton TNT blasts rained

did the Rolling Stones, with “(I Can’t Get No) Satisfaction.” The

And the guiding spirit of the school can be traced, in a

Valentine hit .324 for the Hawaii Islanders of the Pacific Coast for the brand new Hawaiian Open Golf Tournament. On the

office in The Sound of Music alongside Sean

program, fully accredited by the Liaison Committee on Medical

in pursuing their vision of ALOHA—Attaining Lasting Optimal Health for All. These dedicated professionals—those recognized in the

| | FOREWORD

Larry Fleece

Honolulu, Hawai‘i

Chapter One

WALKING THE WARD: HELP AND HOPE “Best Friends”

Kainani says. “They told us it’s about an eight-month treatment with chemo then surgeries. So far he’s had two major surgeries. They took the tumor out and implanted a prosthesis—a metal rod—in his leg. He also had lung nodules they removed, and we’re thankful that they weren’t cancerous.” Kainani focuses on the good news. “He’s at the tail end of his treatment,” Kainani says with a nod. “He only has two more chemo rounds, then we’re done for now, except for check-ups.” After a moment, Kainani continues. “Of course it’ll be lifelong for him because of the implant in his leg. He has to take care for that.” It’s already been a tremendously difficult road that Kala has traveled. But on this day’s visit to KMCWC, he’s wearing a soft smile. His smile comes from his JABSOM graduates Donna knowledge that he’s not facing his Deng, Leah Dowsett and journey alone. He has the enormous Kristine Layugan visit with love and support of his family to help a young patient at Wilcox Wards. him through the tough days.

t’s a bit before 10 a.m. on a sunny Wednesday morning in Honolulu. Inside Kapi‘olani Medical Center for Women & Children (KMCWC), the elevator doors slide open onto the second floor and ten-year-old Kala Peter of ‘Ewa Beach rolls out into the halls of the pediatrics ward. Kala is in a wheelchair, his right leg raised and extended. For this journey to the hospital, he is wearing a black T-shirt with the emblem of one of his favorite superheroes—Batman— and a baseball cap turned backwards, hiding his missing hair. Kala’s mom, Kainani, pushes him down to the procedure room near the nurses’ station, where he is scheduled once again to change the dressings on a wound on his leg. It’s a trip that Kala and his parents have made many times before. Kala hurt his right knee a few months earlier. A visit to the doctor brought some difficult news for the family. “He was diagnosed with osteosarcoma, bone cancer,”

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And here at the hospital, he’s got someone else on his side. “It’s awesome,” Kainani says with a laugh. “He just lights up when he sees Dr. Kendra. It really helps lift his spirits.” Dr. Kendra Dilcher (JABSOM ’14) of Hale‘iwa is a pediatric resident at KMCWC and graduate of the John A. Burns School of Medicine. She’s been there for Kala on every step of his journey: through chemo, following surgeries and shadowing Kala’s team of doctors, including pediatric oncologist Dr. Darryl Glaser and orthopedic surgeon Dr. William Burkhalter. Today, Dr. Dilcher is there to pay Kala a visit as his leg wound dressing is changed. “Kala is doing amazingly well,” Dr. Dilcher says. “Some days when he comes in he’s been a little gloomy from the side effects of the chemo. After a couple of weeks of chemo, your blood count can go down. Sometimes you get fevers and just feel pretty sick. But now, this far along in his treatment, Kala is doing so much better and his prognosis is looking really good. He’s doing well in physical therapy, getting up, becoming able to use his leg. When I met him seven months ago, he wasn’t able to use it.” Dr. Dilcher and Kainani help him onto the examining table in the procedure room where he’ll have the bandages on his leg removed and fresh ones put on. As they position him, Dr. Dilcher tickles Kala to make him giggle. They both recall days when he wasn’t laughing. “Remember when we met?” Dr. Dilcher asks him, still tickling and teasing him.

“Yeah. I broke my femur,” Kala says. “It looked like you had a pathological fracture,” Dr. Dilcher says. “And you were in pain and crying—” “No, I wasn’t crying,” Kala interrupts, “because I recall it. I couldn’t move my leg a centimeter without it being like a whole siege of pain.” “Right, right, not crying, sorry, super strong,” Dr. Dilcher says with a smile. “Then when I came in, Dr. Glaser introduced me to you,” Kala says. “And then I don’t know what happened, but then we became like best friends. Yeah. We’re best friends.” Now Kala’s smile is broader. “And that was, what? Seven months ago?” Dr. Dilcher says, tugging on his baseball cap. “Feels like just yesterday!” Kala says. Dr. Dilcher says that in the months of his treatment, he’s become an advocate for other children with similar diagnoses. “When I was on the rotation working with other kids like him, Kala and his mom went and met them,” Dr. Dilcher says, “and Kala told them his success story, how awesome it’s been here at Kapi‘olani and getting to hang out with us, of course! He gave encouragement to kids with a new cancer diagnosis, just what they needed at the time. He said, ‘Look, I do too, but this is how awesome I am, and you can fight it too.’ Right?” “Well, I didn’t say it exactly like that!” Kala says.

“I don’t know what

happened, but then we

became like best friends.”

Lessons From the Children After “best friends” Kala Peter and Dr. Dilcher say their farewells for the morning, Dr. Dilcher writes some notes about the day’s visit and the healing progress of the post-surgery wound on his leg. “Today is one of the best days we’ve had,” Dr. Dilcher says. “Prior to my becoming a pediatrician, I thought of kids with cancer as such tragic figures, sad stories. But working with the kids, their families and the doctors here, I’ve learned that kids are so strong. They can survive things like undergoing chemo, major surgeries, family trauma. The kids are some of the most incredible, humble, strong people that I’ve met in my life.” And as much as Kala leans heavily on Dr. Dilcher for her wisdom, her support, her friendship—and some “doctor’s orders” tickling now and again—Dr. Dilcher says she has received enormous dividends in return. “Honestly? I never thought I’d be interested in working with kids like him because I was petrified that I would never be able to tell a mom, ‘You might lose your kid to cancer,’” Dr. Dilcher admits. “But after working with Kala, it’s been career-changing for me. I’ve seen what a difference just going in and tickling him, making him smile every day in the midst of chemo and surgeries can do. The impact he’s had on my life is motivation every day to be the best that I can be in the medical profession.” The powerful bond formed between Kala and Dr. Dilcher is not dissimilar from the thousands of close, trusting friendships between the students, residents and alumni physicians of the John A. Burns School of Medicine and their patients formed throughout the Islands every day. The friendships are formed in the hospitals of the Honolulu medical community.

They’re formed in hospitals JABSOM alumna Kendra Dilcher (left) and student and health clinics on the Neighbor Elizabeth Nakasone (JABSOM Islands. And they’re formed in Class of 2016) with patient medical facilities throughout the Kala Peter at Kapi‘olani Pacific, stretching across Micronesia, Medical Center for Women and Children. Melanesia and Polynesia. For the past five decades, residents of all ages throughout the state of Hawai‘i and beyond have come to rely on graduates of the John A. Burns School of Medicine for their health care. And just like Kala Peter of ‘Ewa Beach, they find enormous comfort in the knowledge that these medical professionals have been ably trained, here in Hawai‘i, for Hawai‘i. Their patients have come to recognize that this dedicated collection of physicians and health professionals from JABSOM cares deeply and passionately about those whom they treat and serve.

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THE JOHN A. BURNS SCHOOL OF MEDICINE: 50 Years of Healing in Hawai‘i

WALKING THE WARD: HELP AND HOPE

C h a p t e r Two

THE DREAM TAKES SHAPE: MODEST BEGINNINGS In the 1870s missionary physician Gerrit Judd (standing, with Princes Lot, left, and Liholiho) was appointed by the legislature to instruct ten young Hawaiian men in the practice of western medicine.

sowing the Seeds

t was in 1965 that the Hawai‘i State Legislature passed a resolution allotting funds for the establishment of a twoyear medical school at the University of Hawai‘i (UH). Most look upon that monumental milestone as the effective birth of formal medical education in the Islands. So it will no doubt surprise many to find that a serious movement toward medical education in the Islands actually happened nearly a full century earlier. And that education was administered in the Hawaiian language. According to the late historian, novelist and University of Hawai‘i professor O.A. “Ozzy” Bushnell, the call for medical education in the Islands was first answered in June of 1867, when the Hawaiian Evangelical Association, meeting in Honolulu, adopted a report from its own committee on medical instruction. The report pointed to a “pressing University of Hawai‘i medical school students, 1967. necessity for educating a sufficient

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number of native pupils to meet the wants of the people.” And the report went on to recommend a quite modest course of study for a select handful of students. “A simple course should be gone through which would qualify the pupils to be good nurses and tolerably safe practitioners.” Accordingly, the legislature of 1870 in Hawai‘i earmarked a budget of $4,000 within the Bureau of Public Instruction,

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specifically dedicated to the “medical education of Hawaiians.” Local missionary physician Dr. Gerrit P. Judd was appointed to oversee the instruction of ten young Hawaiian men, in their native tongue, in Western medicine. But Dr. Benjamin Young, Hawai‘i medical historian and former dean of students at the John A. Burns School of Medicine, points out that in that era there were questions and disagreements on both sides of the fence about the relative strengths of Western medicine versus Native Hawaiian medicine. “The status of Western medicine at that time was very questionable in efficacy,” Dr. Young says. “Though many times Hawaiian medical practice was unsuccessful, other times it was as good as, and sometimes better than, Western medicine. Hawaiian medical practices were particularly strong in keeping the environment clean, inviolate and free of pollutants and allowing periods for mana to replenish the land and oceans.” And Ozzy Bushnell, in his book Gifts of Civilization, writes: Let us not forget, in those days haole physicians were no better supplied with medicines and other therapies against infectious disease. More Hawaiians died in the years since 1805 than were born, whether or not the sick ones gained the help of physicians native or foreign. Nevertheless, the “experiment” of Western medical education for Native Hawaiians was indeed deemed a success. And the legislature in 1872 again appropriated funds—another $3,000 earmarked for “medical education of Hawaiian youth”—to continue the instruction program under Dr. Judd through 1874.

Judge Jim Burns: “My father But Dr. Judd’s wife, Laura, said, ‘Hey, us local people, suddenly took ill and died in October we can make good doctors of 1872. Within a month of her here!” Right: Gov. John A. Burns with President death, Dr. Judd himself was stricken Lyndon Johnson, Lady Bird by an attack of what was then called Johnson and U.S. Sen. Sparky apoplexy (likely a heart attack or fatal Matsunaga in 1966, a year stroke) and he died in July of 1873. after the State Legislature authorized funding for a With Dr. Judd’s passing, no one two-year medical school. stepped into his shoes to continue the medical instruction. The funds appropriated in 1872 were never used and the short early “experiment” in medical education in Hawai‘i died along with Dr. Judd.

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THE JOHN A. BURNS SCHOOL OF MEDICINE: 50 Years of Healing in Hawai‘i

The dream takes shape: modest beginnings

Hawai‘i in Transition In the modern era, the John A. Burns School of Medicine saw its formally sanctioned beginnings in 1965, with the Hawai‘i State Legislature’s authorization of funding for a two-year school of medicine. But the notion of advanced studies toward a medical degree had been germinating in the Islands for more than a decade prior. After World War II, the U.S. territory saw a gradual social and economic transformation as veterans returned to the Islands. Dr. Benjamin Young points to the period as a critical transitional time—a time aided by the determination of one man. “It was really the tremendous vision of John A. Burns, along with those returning nisei veterans from the war,” Dr. Young says. “They wanted to make this place a better place to live.” And Dr. Young says the road they faced was not an easy one. “Opportunities were very limited for people to go on to school, for people to climb rungs in that ladder of social and economic mobility. The returning veterans—and John Burns— wanted to make sure that the next generations in Hawai‘i did have opportunities. That was the early vision for the medical school—and also a law school—to improve the University of Hawai‘i.” By 1954, a political upheaval saw a shift in the makeup of the legislature from domination by what had largely been

descendants of missionaries to a new power structure more equitably representing all the people of Hawai`i. This shift in power changed the face of the University of Hawai‘i. The university had been, prior to that shift, generally regarded as a largely provincial institution, perhaps not competitive with Mainland schools. But Hawai‘i’s new leaders in 1954 set as one of their main priorities the improvement of the university in all areas. Statehood for Hawai‘i in 1959 quickly accelerated the transformation of the university. In their lucid history of the evolution of the John A. Burns School of Medicine, former medical school dean Terence “Terry” A. Rogers and former public affairs director Gardiner B. Jones described the two key effects that statehood had in upgrading the standing of the university:

“Opportunities were

very limited for people to go on to school.”

From the Islanders’ point of view, it stiffened resolve to end colonial dependence on the Mainland in every area possible, including education; from the Mainland’s point of view, the granting of statehood rapidly eroded the “foreign” image of Hawai‘i and opened eyes to the manifold opportunities afforded by the Islands in business, education, research, communications and other fields.

With its newfound pride as the fiftieth state serving as the backdrop, Hawai‘i set about making great strides in

opportunities for its residents in the field of medical education. In the fall of 1964, a $180,000 grant from the Commonwealth Fund and a $1,250,000 grant from the W.K. Kellogg Foundation went toward supporting a study of a two-year biomedical program and helped to finance a $7 million biomedical sciences building. Far beyond the money, it took several key visionary figures to champion the development of medical education at the University of Hawai‘i. Among the earliest was Robert W. Hiatt, a marine biologist who served as director of research at the university, and later, vice president for academic affairs. Hiatt had the foresight to establish research units that capitalized on Hawai‘i’s unique geographic and multiethnic position in the middle of the Pacific. Chief among the research units Hiatt helped to create was the Pacific Biomedical Research Center (PBRC), which was destined to become a foundational building block for the nascent medical school. Hiatt was not alone in his vision. His efforts at nurturing Hawai‘i-specific biomedical research and education had the strong backing of the university’s president at the time, Thomas Hale Hamilton. Hiatt further had the critical support of a champion for the cause in the political arena: Hawai‘i’s then-governor John A. Burns.

First UH medical school dean Governor Burns’ youngest Dr. Windsor Cutting (left) and son, retired state appeals judge Robert Hiatt, who helped to Jim Burns, remembers his father’s create the Pacific Biomedical words echoing through Resarch Center. their home. “As soon as he became governor,” Jim recalls about his father, “the first chance he got, he said, ‘I want a first-class university.’ To him, that meant first class in every arena: a medical school, a law school, even its athletic programs.” Governor Burns’ passion to establish top-notch programs at the UH—particularly the medical school—actually had its origins well before he became governor. And his goal of a medical school for Hawai‘i was not born out of a wish for some kind of status symbol or cultural

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THE JOHN A. BURNS SCHOOL OF MEDICINE: 50 Years of Healing in Hawai‘i

The dream takes shape: modest beginnings

window-dressing for the state. Rather, Jim says his father’s desire for quality medical care in the Islands stemmed from a reason that was far more personal. It was a reason that held Jim’s very life in the balance. “My mother was paralyzed by polio two years before I was born,” Jim explains. “When she became pregnant with me, all the doctors who saw her were from the Mainland. They all said to her, ‘You should abort. It’s too risky.’” Jim says that choice was not an option for his parents. “My father found a local guy to help take care of my mother while she was pregnant with me, and I was born,” Jim says. “I think my father just said, ‘Hey, us local people, we can make good doctors here. We don’t have to bring them in from the Mainland where they might not understand what’s going on here.’”

The Dream Becomes Reality Early in the 1960s, a host of elements would highlight the value and importance of a medical school in Hawai‘i. The first major step was the establishment of PBRC in 1960 as an organized research unit with a mission to capitalize on the growing opportunities in biological/biomedical research in the Pacific and to help develop a future medical school. Terry Rogers became the director of PBRC and would soon recruit Dr. Windsor C. Cutting to be dean of the new school. In 1962 Kevin Bunnell, a representative of the Western Interstate Commission on Higher Education (WICHE), visited the Islands and recommended a study for the feasibility of a two-year medical school program. Such a program would feed

medical students from Hawai’i Dr. John Cutting: His fatherd, dean Windsor Cutting, was “able to to existing four-year schools on establish something not just for the Mainland where the students Hawai‘i, but for the Pacific.” would complete their training. The two-year school was less difficult to establish and was designed to address what WICHE predicted would be a critical shortage of physicians in the western states by the 1970s. Later that same year, the university’s School of Public Health founding dean, Richard K.C. Lee, was named director of public health and medical activities, with one primary goal of transforming the public health school into a biomedical program. Discussions were undertaken to amalgamate the university’s departments of microbiology, biochemistry and

biophysics, genetics, physiology and pharmacology into one school of basic medical sciences, with plans to add essential departments of medicine, anatomy and pathology. And in 1963, two doctors from the medical school at UCLA, Dr. Robert Tschirgi and Dr. Richard Lockwood, were retained to prepare a report on the future of medical education in Hawai‘i. The resulting Tschirgi-Lockwood report recommended establishing a hybrid six-year biomedical sciences master’s program. It would combine four years of undergraduate work, including premedical studies, with two additional years of medical education, including clinical exposure. Though the Tschirgi-Lockwood report stopped short of specifically calling for creation of a separate, free-standing medical school, one key recommendation of the report—for students’ clinical work in local hospitals—prophetically laid the foundation for the precise path the John A. Burns School of Medicine would chart a full decade later as a four-year medical school. In their recommendations Tschirgi and Lockwood wrote: The proposal presented here is designed to affiliate clinical instruction for the Biomedical Sciences Master’s Program of the University of Hawai‘i with the structure of a revised community hospital medical education program. This combined plan permits optimal utilization and avoidance of duplication of already existing excellent facilities in the training of house officers. It would also offer the university the advantages of these same facilities in introducing the master’s program student to the rudiments of clinical medicine.

Ultimately, the winds of change in Hawai‘i in the mid1960s blew in favor of establishment of a new two-year medical school. With Governor Burns’ powerful and persuasive support, Hawai‘i’s two-year medical school program became a reality by virtue of legislative sanction in 1965. Dr. Cutting, a pharmacologist and former dean of the Stanford Medical School, took the reins as Hawai‘i’s first medical school dean. Terry Rogers, the previous director of PBRC, became associate dean under Cutting. Rogers would ultimately take the reins as dean following Cutting’s death in 1972. Both men left indelible marks on the shape and direction of medical education in Hawai‘i. Dean Cutting had earlier left the comfort of his position at Stanford in Palo Alto because he saw in Hawai‘i’s medical education future a frontier fraught with enormous value—for the Islands in particular, and for the region at large. “I think the big drawing factor to him was the fact that he would be able to establish something not just for Hawai‘i, but for the Pacific,” Cutting’s son, Dr. John Cutting, says. “He was very greatly interested in improving the medical education prospects for people throughout the Islands.” But Dr. John Cutting recalls that his father’s path was met with some resistance. “He had some dealings with the local medical establishment, convincing them that it was a good thing to have a school here,” John Cutting recalls. “He had to convince them that no, he was not going to take patients away from them. In fact, he wanted to recruit as many as he could onto his clinical faculty.” Dean Windsor Cutting’s vision for the future of medical education in Hawai‘i went far beyond the establishment of the initial two-year school. In a 1968 Honolulu Advertiser

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THE JOHN A. BURNS SCHOOL OF MEDICINE: 50 Years of Healing in Hawai‘i

The dream takes shape: modest beginnings

Former dean Dr. Terence Rogers: “A powerful force, a very dynamic guy.”

series by Jim Lewis on the future of the University of Hawai‘i Medical School, Cutting laid out his vision for the school as a centerpiece for medical education for the entire Pacific. “Hawai‘i should become a principal center for teaching and study of tropical disease,” Dr. Cutting said. “Although there is little tropical disease in Hawai‘i, the State can, and has, become a center for work in this field. Experience has shown that Hawai‘i is an excellent staging area for expeditions all over the Pacific and free Asia.” Dr. Benjamin Young recalls much about Dean Cutting that recommended him as the ideal steward for Hawai‘i’s budding medical education. “Even though Windsor Cutting came here—as the former dean of the Stanford Medical School— with credentials that would impress anyone across the nation, he was such a humble man,” Dr. Young says. Above all, Dr. Young recalls, Dr. Cutting was a man who put patient care and the quest for medical knowledge at the forefront. “It was back when I was a resident here, at Lē‘ahi Hospital,” Dr. Young recalls. “I was walking out of the hospital one day, and Dr. Cutting calls to me. Oh, boy! Here was the dean of the medical school calling me over. I was nobody, just a lowly resident. I was trembling with fear!” Dr. Young wondered if he had committed some sort of unintentional transgression during his residency for which he would be now held accountable in the eyes of the dean. Hardly. Instead, Dr. Cutting had spotted a teachable moment at hand. “He said to me, ‘You see that man over there?’” Dr. Young remembers. “I looked across the street, and there was a man with a shuffling gait, tremors in his hands. And

Dean Cutting wanted to take the time to explain to me the psychopharmacology of the man’s condition, and the findings of the day about dopamine and Parkinson’s disease.” The lessons of that encounter—about the fundamental value of scientific curiosity, and of passing the torch of learning—have spanned decades for Dr. Young. “What a wonderful man Windsor Cutting was, to have taken that time with me!” Dr. Young says. “That’s the kind of person he was.” Upon Dr. Cutting’s passing, his wife, Mary, continued to make contributions at the medical school for many years. As the true “heart and soul” of the dean’s office at the school, Mary shouldered much of the administrative work, along with handling most of the logistics for placing students at Pacific Island sites for clerkship electives. Dr. Cutting left a lasting impression on young students, faculty recruits and state officials as he built the young medical school. And meanwhile, his colleague, assistant dean Terry Rogers had been doing very much the same thing, in every way imaginable. “Terry was a powerful force,” recalls Dr. Christian Gulbrandsen, who ultimately succeeded Rogers as medical school dean. “He was a very dynamic guy, a big man and very forceful when he wanted to be,” Gulbrandsen says with a laugh. “Terry’s dream was to make sure that Pacific Islanders in Hawai‘i had a chance to go to medical school,” Dr. Gulbrandsen says. “And he was savvy enough to know that in order for that, for the medical school to become a reality, he really had to get to know the legislature. So he spent a lot of time one-on-one with the legislators at the Columbia Inn and other places around town. He really talked the way

they wanted to hear him talk. I truly think Terry was responsible for the development of the school. I think he was a real hero.” In truth, Terry Rogers had been helping to lay the foundation for the young medical school when he was at PBRC, even prior to Windsor Cutting’s arrival. “Terry Rogers had identified grant money available through the federal government for bio-med programs and med school expansions,” says Dr. Patricia Blanchette, founder of the John Early staff recruit Dr. Martin Rayner: “I was totally confident it was going to work.”

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THE JOHN A. BURNS SCHOOL OF MEDICINE: 50 Years of Healing in Hawai‘i

The dream takes shape: modest beginnings

A. Burns School of Medicine geriatrics department. “As one of the most vocal supporters of the need for a medical school in Hawai‘i, Rogers wrote grant proposals and helped to engineer the bringing together of forces to make it happen.” Additionally, Rogers displayed an early commitment to putting mechanisms in place for assuring diversity among the school’s student population, in ethnicity, in age and in gender. “I recall the time that some women students walked out of a lecture when a faculty member made sexist jokes,” Dr. Blanchette recalls. “Terry called a meeting of all the students, and he told us he’d issued a stern ‘cease and desist’ warning to all faculty members about disrespecting women. Rogers said he told the faculty that if they could not learn, they were no longer needed.” Rogers hailed from England, and one of his earliest staff recruits was a fellow Brit, a Ph.D. from Cambridge and the California Institute of Technology named Dr. Martin Rayner. Rayner had been working in postdoctoral studies at Cal Tech when he got the call from Rogers in 1964 to come to the Islands and have a look. “He called me up and said, ‘Do you want to come over here?’ So I said, ‘Yeah, okay. Uh, where is it?’” Rayner recalls. Rayner had no idea where Hawai‘i was on the map. But Dr. Rayner got his plane ticket just the same, and made his way to Hawai‘i. He spent his first night in the Islands sleeping at assistant dean Rogers’ house, then hopped in the

dean’s truck in the morning to take a tour of the Mānoa campus. “It was one of those wet summer mornings, and we were driving in on Dole Street,” Dr. Rayner recalls. “But as we were driving, the car in front of us broke down. The traffic backed up behind us, and we were all stuck.” That’s when Dr. Rayner got his first up-close look at Dr. Rogers’ problem-solving and administrative skills. “Terry said to me, ‘I’ve got rope in the back of the truck. Why don’t you get out, tie the rope on his bumper and we’ll pull him? I bet we can get him going.’” Dr. Rayner did as requested, hurrying into the rain and tying on the rope, as Dr. Rogers navigated his truck in front of the stalled car. “We set off towing the guy, and sure enough, he started up and was soon on his way,” Dr. Rayner recalls. “And I thought, This is a medical school dean? Doing something like that, just to help somebody else? That’s marvelous. I want to be here.” From that day in the rain—and the beginning of that friendship with Dr. Rogers—Dr. Rayner’s career with the medical school at the University of Hawai‘i would span fifty full years, until his retirement in December of 2014. Dr. Rayner wore an extensive assortment of hats during his tenure: as longtime neurosciences instructor in the classroom and the lab, as chair of the physiology department, project manager for the Hyperbaric Treatment Center of UH and as a member of countless key medical school committees.

“This is a medical school dean? That’s marvelous. I want to be here.”

But even in the earliest going—when the ultimate success of Hawai‘i’s medical school was still very much a question mark— Dr. Rayner never had a moment’s doubt about the school’s prospects looking forward. “I was totally confident it was going to work,” Dr. Rayner recalls. “Terry Rogers was a powerful human being, and he knew people. And the people he knew were very helpful.” And Dr. Rayner says he didn’t need to fret about the future of the medical school. After all, he had other things to worry about. “I lived in a little apartment in Waikı̄kı̄,” Rayner says. “And someone climbed on the building’s roof, then over and down into the apartment, and stole my chicken and my guitar. That really made me mad!” Not long after that, Dr. Rayner says, he was walking down Kūhiō Avenue when he saw a guy with his guitar. “‘That’s my guitar!’ I told him. And the guy said, ‘How do you know it’s yours?’ And I showed him where a crack was,

Gov. John A. Burns speaks from when I sat on it one day. So he at the UH medical school’s said, ‘I guess I better Inaugural Convocation give it back to you then.’ And I said, Ceremony. ‘Damn right you better!’” Dr. Rayner says he never got his chicken back. But what Hawai‘i got—thanks to the perseverance and dedication of visionary men like Governor John A. Burns, Dr. Windsor Cutting, Dr. Terry Rogers and their many dedicated and adventurous colleagues—was an ambitious young medical school with dreams of greatness.

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The dream takes shape: modest beginnings

C h a p t e r Th r e e

THE FOUR YEAR SCHOOL: FORGING COMMUNITY PARTNERSHIPS IN HAWAI‘I, FOR HAWAI‘I

he dream had been realized—in part. The new two-year medical school at the University of Hawai‘i graduated its first class of students in 1967. The program was initially built with its home base at Lē‘ahi Hospital, as a demanding regimen of study in the basic medical sciences. It laid the preclinical groundwork for students hoping to become physicians. But to realize their professional dreams, the students needed to then apply to and enroll in any of the various accredited medical schools on the Mainland for the remaining two years of their medical education. This—as it would turn out—was often more easily said than done. In 19__ the two-year medical “The four-year medical schools school relocated from Le‘ahi were looking out for their own Hospital (above) to the new state’s residents,” Dr. Benjamin Biomedical Sciences Building Young recalls. “It was actually very on the UH-Manoa campus (opposite). difficult for the students—Hawai‘i’s

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residents—to be accepted to Mainland medical schools.” For these students—and for the promise of better health care for future generations in the state of Hawai‘i—it became the driving passion of deans Windsor Cutting and Terry Rogers to transform the two-year program into a fully accredited four-year school at the University of Hawai‘i.

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Once again, they had the JABSOM students ca. 1970s inoculate one another in a critical support of Governor John A. training session. Burns. But the road for the medical school from two to four years was a long one indeed. “Even with the support of the legislature once he took office as governor, it still took my father three years just to get the two-year school started,” Jim Burns says. “It was a struggle. Then the students would head off to the Mainland. He wanted a four-year school, right here.” As the subject—and its attendant expense—was debated continuously through the years that followed, the clock was ticking loudly. “My father had only planned to serve two terms,” Jim recalls. “His second term ended in 1970. During that time, he was using a lot of his energy, convincing the legislature,

convincing the medical profession, convincing the hospitals— everybody in Hawai‘i—that yes, we needed a four-year medical school.” With that dream still high on the his list of “unfinished business,” Governor Burns successfully ran for a third term, and set about rallying support for a four-year program among his political allies. At the same time, Dean Windsor Cutting worked to lay the foundation for the transition from a two- to four-year school. Predictably, high on Dr. Cutting’s list of priorities was the hiring of suitable faculty members to help in the transition in the short run and to create solid, lasting medical education over the long term. Among Dr. Cutting’s early recruits was Dr. John “Jack” McDermott, a psychiatry professor from the University of Michigan. Dean Cutting invited McDermott to a meeting at the then two-year school’s Lē‘ahi Hospital facility, with high hopes that McDermott would agree to create the new school’s psychiatry department. “Windsor and I spent the morning together talking about the future of the school, McDermott recalls. “Around noon I finally said to him, ‘Okay. I need an office where I can get to work.’” This caught Dean Cutting off guard. “He said, ‘Oh, we hadn’t thought about that,’” McDermott says with a chuckle. “He said, ‘Let’s walk through the hospital and find something, Jack.’” Their hunt began. “We went downstairs, and Windsor found an unused X-ray room in the basement of the hospital,” McDermott says. “He said, ‘Don’t worry, this is only temporary.’ So I sat down in the X-ray room. Then I asked him, ‘Where’s

the phone?’ He said, ‘Well, there’s a public phone outside on the wall.’” It was under this hastily built arrangement that the new head of the department of psychiatry at the University of Hawai‘i medical school went to work. “I used the pay phone to call the NIH in Washington about grants that we were getting,” McDermott laughs. “I became known Dr. John McDermott (with Gov. down at NIH as ‘that George Ariyoshi, who helped establish a four-year medical guy who calls the school) first set up shop for his government collect’… new psychiatry department in an because that’s what I unused X-ray room in the Le‘ahi Hospital basement. had to do!”

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the four year school: Forging community partnerships

Starry-Eyed Idealists In the years that followed, the two-year school moved from its home at Lē‘ahi Hospital to the newly-constructed Biomedical Sciences Building on the campus of UH Mānoa. Then at last, in 1973, the Hawai‘i State Legislature made it possible for the school to expand its scope and become a fouryear degree granting program—thanks in no small part to the persistence of Governor Burns. “Had he not run for the third term, I don’t think we would have had a four-year medical school then,” Jim Burns says. State Senator Francis A. Wong, a vocal and active ally of Governor Burns’ quest for the medical school, credits the governor with leading the way. “Governor Burns was the catalyst to create a discussion about a medical school,” Senator Wong recalled in a conversation with JABSOM dean Jerris Hedges. “And at that time there was absolutely no community support.” In fact, there had been considerable resistance, fueled by a heavy barrage of questions about funding, administration and competition with the existing medical community in the state. But several factors helped carry the day in favor of the four-year program. “First, you could predict that with Hawai‘i’s aging population, you would have increased health care needs,” Dr. Young says. “Second, you needed to have a school that emphasized primary care. That was the goal for the school at the time. ‘Let’s produce more primary care physicians to meet the needs.’ And third, there was a real concern that the medical needs of the indigenous people of the Islands, and the ‘have-nots’ living here, were not having their medical needs met.”

Former dean Dr. Benjamin Late in the “home stretch” of Young: “(In the late 1960s) it the effort to make the four-year was very difficult for Hawai‘i school a reality, Governor Burns residents to be accepted to Mainland medical schools.” was stricken with cancer. His successor, then-acting govenor George Ariyoshi, stepped in to help shepherd the effort forward. Just a short time earlier, a similar need for succession had played itself out within the ranks of the medical school administration. Dean Windsor Cutting had also contracted cancer, complicated by heart issues—and assistant dean Terry Rogers was called upon to step into his shoes. As Dr. Cutting stepped down, the farewell speech that he gave contained powerful allusions to the struggle to realize the four-year school. “Don’t be afraid of being a starry-eyed idealist,” Dr. Cutting said. “There is a pedestrian in all of us. And to be sure, the world’s work has to be done. It’s not easy to be an idealist. The can’t-doers always outnumber the can-doers, and sometimes, sadly, those with the short view win.”

Fortunately, it was Dean Cutting and others like him—with the “long view” regarding a four-year medical program for Hawai‘i—who ended up emerging victorious. In his goodbye, Dr. Cutting knew full well it quite easily might have gone the other way. “My earnest advice,” Dean Cutting said in his speech, “is to face disappointment over such times with some well-selected unprintables and a couple of martinis, and then get back on the star-train with a new telescope.” In their final days, Dean Windsor Cutting and Governor John A. Burns saw their shared dream move ever closer toward becoming a reality. Dr. Cutting had spent decades as a medical educator. Governor Burns had spent decades as a political leader. Their legacies were to intersect in the creation of the four-year medical school at the University of Hawai‘i. Dr. Cutting’s son, John, says his father’s passion—until the end—was in the scientific process and the quest for learning. “The laboratory was really where his heart was most of the time,” Cutting says today. “As an illustration, when my father retired and built his house up on the North Shore, he had a separate little shed built in which he was going to keep his mice that he planned to be working on. He wasn’t ready to leave the bench.” Shortly before the passing of Governor Burns, he entered into an agreement that in all likelihood cemented the opportunity for formation of the four-year school. “My father really didn’t want things named after him. That was not his goal in life, to have his name on buildings,” Jim says. “But around 1973, there was a sentiment in Hawai‘i about the medical school that said, ‘Let’s either leave it a twoyear, or do away with it. It’s too expensive.’”

Jim recalls the final “hail Mary” effort at a solution. “A bunch of us got together and said, ‘What can we do?’” Jim says. “One of the ideas was, ‘You know what? Let’s put my dad’s name on that school, and see if they have the guts to dump it after that!’ I had to work very hard to get him to agree. He was already in his sickbed with terminal cancer. I went to him several times to say, ‘You want to save the medical school? We got to put your name on it.’ And he finally agreed. The name went on two months before he died.” Attaching John A. Burns’ name to the incipient medical school carried a world of weight. Dr. Naleen Andrade, former chair of the department of psychiatry at the medical school, says the respect for Governor Burns’ leadership spanned generations. “For my parents on our farm in south Kona, John A. Burns was like what FDR was for the average American in the Depression,” Andrade says. “He brought opportunity and promise for their kids. My parents saw themselves as common

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the four year school: Forging community partnerships

In 1966 Dr. Kekuni Blaisdell (shown here in 1976) was named the first chair of the University’s new School of Medicine and was later instrumental in establishing the school’s Native Hawaiian Center of Excellence, which began in 1991.

people, and Governor Burns brought them the hope that amongst their children was greatness.” Dr. McDermott says the addition of Governor Burns’ name was the element that ultimately tipped the scales in the four-year school’s favor. “What made it successful was the name ‘John A. Burns School of Medicine,’” McDermott says. “Governor Burns had huge credibility that went beyond any political affiliation.” The governor had the credibility…and he had the blueprint. “He really set the mission of the medical school by saying, ‘This school is going to be developing primary care physicians for the state of Hawai‘i,’” Dr. McDermott says. “That was his vision: to recruit kids from Hawai‘i who are smart enough to be doctors, but don’t have enough money to go to the Mainland to be a doctor.” So it was that in 1975, the first class of sixty-two students graduated with their medical doctor degrees from the John A. Burns School of Medicine.

Bridges to the Community In the years immediately preceding the Hawai‘i State Legislature’s authorization of funds to support the University of Hawai‘i’s new four-year medical school, a report regarding its viability was prepared at the request of university president Harlan Cleveland. The report was prepared by a distinguished four-member team of medical experts from the Mainland, led by Cornell University faculty professor Dr. Walsh McDermott. The report concluded that the expansion of the two-year school was a “uniquely desirable goal”—under one very

students from the medical school at various community hospitals in Hawai‘i “would assure an evenness of high quality medical care in those facilities now utilized by most of the people.” Dr. Windsor Cutting, dean of the two-year school, had long dreamed of creating a new university hospital in Honolulu dedicated to the school as both a teaching facility and a venue for patient care. So the conclusions of the report from Walsh McDermott and his colleagues came as a significant blow to the dean. “Dr. Cutting was stunned by the recommendations,” Dr. Benjamin Young says. “But the advice that Hawai‘i should utilize the community-based hospitals for its teaching eventually proved to be so valuable, first for simply economic reasons. Had a university hospital been established, the finances would have been overwhelming. We would have been in serious trouble.” And it was about more than just the money. “The new model put the community hospitals in close touch with medical education,” Dr. Young says. “Where you have them as stakeholders in the education, all working toward the health of the community, it’s the optimal way to make sure that all of the needs of the people are addressed.” But there was some initial opposition, even among the existing medical community in the Islands, over the movement toward the new medical school. Many of Hawai‘i’s practicing physicians believed that a new medical school necessarily

meant a new teaching hospital, and they disdained the unwanted competition. Will Henderson, president emeritus of The Queen’s Medical Center, recalled in a conversation with JABSOM dean Jerris Hedges, “The doctors were not supporting this program. They had serious concerns about a hospital and a medical school in this community.” “There was a wall in this community that was totally against that,” Henderson recalled. “I think it would have been a very serious concern and problem in our community if somehow we had permitted the total program of a school and a hospital to be on campus.” Henderson said what carried the day was some concerted salesmanship for the fresh concept of a partnership between the new four-year school and the community hospitals on O‘ahu. “We had to go almost one by one, physician to physician, and we talked to each one of them,” Henderson said. “We said, ‘We can make this go.’ And we began to garner some support from leading physicians. When we sold the idea that we could deliver the educational opportunity, and that the various hospitals would provide clinical facilities, pay house staff, for faculty and other things, it was almost a slam dunk.” Dr. John McDermott says the adoption of the communityhospital-based system—a clear departure from the traditional systems of many Mainland medical schools—was critical for Hawai‘i.

“Had a university hospital been established, the finances would

The student lu‘au hosted by important condition. Its author Dr. Charles Judd (left center) advised that, rather than building and his wife, Mary, in 1975 the new school around a separate, launched a JABSOM tradition dedicated university hospital (as was that continues today. the case with many top Mainland medical schools), the University of Hawai‘i would be wellserved by making “a multi-hospital clinical teaching system… the option of choice.” Their reasons for this recommendation were manifold. First, the recommended path would establish cooperation between the existing medical community and the school, rather than creating a competing medical care system. Second, the addition of more beds through a university hospital—a costly undertaking—was not needed at the time in Honolulu. And third, the authors advised that the involvement of faculty and

have been overwhelming.”

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the four year school: Forging community partnerships

“We really needed to learn what the medical system was in the community, this community, because many of us had come from university hospitals,” McDermott says. “The kiss of death would have been, ‘This is the way we did it back at the University of Michigan or Yale or Stanford.’ Our medical students in their third and fourth years needed to be taught in a clinical situation with acute medical problems—psychiatric, surgical, medical, pediatric. The hospitals in town were really what we needed to learn about the culture—how they ran administratively, how the medical staffs approached the problems and took care of patients in those hospitals.” Pioneering early faculty member Dr. Martin Rayner, who helped build the neurosciences department, recalls the benefits that the community-based system provided from its inception. “It was wonderful,” Rayner says. “We had access to Queen’s, Kapi‘olani, other places. And we started to build faculty from them and into them. That was really the beginning and the founding of the school as it should be.” The relationship between the medical students and the residents—and the many community hospitals in Hawai‘i where they get their clinical training—has been a critical opportunity for them to view a mirror of the culture in the Islands. “Historically, many of the hospitals were identified ethnically,” says Dr. Satoru Izutsu, vice dean of the medical school. “Kuakini for the Japanese, St. Francis for the Filipinos and the Chinese, Straub for the haoles and Queen’s for the Hawaiians and the haoles, and so on.” Dr. Izutsu says that although the use of community hospitals by different ethnic populations is much different today, this exposure to multiple practice settings with embedded cultural

Vice dean Dr. Satoru Izutsu: sensitivity continues to serve the “Historically, many of the students well. hospitals were identified “Today the hospitals are very ethnically—Kuakini for the multiethnic, which represents the Japanese, St. Francis for the Filipinos and the Chinese, society of Hawai‘i,” Dr. Izutsu says. and so on.” Right: Queen’s “These hospitals have a very good Hospital in 1905. sense for training related to cultural issues connected to illness and health. That’s a very invaluable orientation for our students.” “The fact that we’re a community-based medical school, so integrated with our healthcare partners from the very beginning of our genesis, absolutely defines us,” says Dr. Richard Kasuya, associate dean for medical education. “We could have taken a different path, and I’m so glad that our forefathers chose not to.” And Dr. Kasuya says the effectiveness of the communitybased hospital system for Hawai‘i extends well beyond Honolulu, across the ocean.

Associate dean Dr. Richard “We are moving more Kasuya: “The fact that we’re and more toward providing a community-based medical our students experiences and school absolutely defines us. opportunities on the other islands beyond O‘ahu,” Dr. Kasuya says. “Hawai‘i is a unique place. Our diverse patient population is unlike any that I’ve ever seen elsewhere. So giving our students a chance to see and practice and learn—in these various communities across the state—is absolutely critical for them. It’s a very important step for the medical school to continue to grow on. The more our students see the wonderful opportunities that are out there for them, the easier it will be for them to make a decision about where they’ll best fit in their future career.” One important residual effect of the community-based system has meant giving students a true sense of place within the local medical system. “From the very start for our students, there has been a

connection to the community and to the community doctors,” says Dr. Nanette Judd, former director of the medical school’s ‘Imi Ho‘ola Post-Baccalaureate program. “It’s simply been the right way to do it. The system encourages our students to remain in Hawai‘i, to pursue opportunities here, to make a difference in the community.” John A. Burns School of Medicine dean Jerris Hedges today reflects on the creation of the community-based hospital system as a defining masterstroke for the school. “The local teaching hospitals clearly have been major contributors to our educational program,” Dean Hedges says. “We have wonderful relationships at our affiliated teaching hospitals, including The Queen’s Medical Center, Kuakini Health System, Kapi‘olani Medical Center, Kaiser Permanente, Wahiawā General Hospital, Straub Clinic, Tripler Army Medical Center and the VA medical clinic.” “It’s been an opportunity to link with hospitals that have very strong connections with their practicing physicians and with the local community they serve,” Dean Hedges continues. “We get the opportunity to help the hospitals, strengthen the niche that they have developed. And we provide a strong academic component that the practicing physicians enjoy—because they keep a hand in the academic side of medicine, similar to the way in which they were trained.” Further, the benefit is not just for the physicians. “The patients benefit from the cutting-edge techniques and research that we can bring as a school,” Dr. Hedges says. “So it’s truly the best of all worlds, by bringing new innovations in medicine to the community and getting the community engaged and involved in the operation of the medical school.”

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the four year school: Forging community partnerships

C h a p t e r Fo u r

A LEAP IN LEARNING: THE NEW APPROACH AT WORK IN WAIMEA

p on the white board in the conference room of a small community health clinic in Waimea on the Big Island, space is quickly running out. That’s because a small group of first-year medical students from the John A. Burns School of Medicine is hastily filling up the board with a host of notes in grease pen. “Symptoms: distended belly, fever, abdominal pain, diarrhea,” they write in one column. More symptoms will follow, scrawled in rapid-fire up on the board. In other columns of their case mapping, the students quickly jot down lengthy lists of social issues, family health history, hypotheses and further learning issues to research and explore. In 1976 students (left to right) Kerrianne Garcia, Franchesca Their notes pertain to a Singeo, Pat Chin and Franci hypothetical case they’ve been Tryka pose for a poster given, concerning a four-year-old entitled “We Are Going To Be Doctors!” (opposite) Chinese boy who has come to the

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JABSOM dean Dr. Christian doctor with serious health issues. Gulbrandsen introduced PBL to The five JABSOM students the medical school in 1989. on this day—Xuan-Lan Doan, Laura Houk, Michele Kanemori, Brandon Kobayashi and Erica Lee—are immersed in an educational tutorial method called problem-based learning (PBL). Each of their entries up on the white board is accompanied by spirited discussion, involving immediate, informal give-and-take among all the students.

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Laura Houk (JABSOM The students are guided in their ’18): “As you get more discourse by Dr. Gulbrandsen, former comfortable with your dean of the John A. Burns School of group, the trust grows.” Medicine. Dr. Gulbrandsen also happens to be the man who brought the problem-based learning method to the medical school in 1989. “In problem-based learning,” Dr. Gulbrandsen explains, “students are presented cases in piecemeal fashion. They’re asked to consider the facts of the case, to come up with some hypotheses to explain those facts or circumstances, then to determine what learning issues they have in order to check their hypotheses.” Though Dr. Gulbrandsen is in the room with the firstyears—functioning as a facilitator to offer them questions and give them guidance—it is the students themselves who do the “heavy-lifting” in evaluating the facts.

Michelle Kanemori (JABSOM “It really is a self-directed ’18): “The greatest benefit learning process,” Gulbrandsen to problem-based learning says. “It teaches the students how is that it teaches us how to to form a group and how to make think like a physician.”about real problems.” the group successful—because they’re going to have to be doing that for the rest of their lives.” At the outset of each PBL session, the students who are hunkered down together in class in Waimea have only been told the bare minimum about the day’s hypothetical case. “We were told that the little boy has nephrotic syndrome,” says Laura Houk (JABSOM ’18) from Kailua. “I have to confess, at this point I don’t yet know what that is. But that’s how this starts.” “We’ve identified some key issues to learn about for next time,” Xuan-Lan Doan (JABSOM ’18), from Philadelphia, says. “Specifically, around the subject of nephrotic syndrome, there

Erica Lee (JABSOM ’18): “It are issues involving the kidneys fosters independent learning, and renal diseases. I think we can which we’ll need to have as see that the renal system in this physicians, because we’re unit is really integral to making going to be learning for the rest of our lives.” sure your body works the way it’s supposed to work.” “The greatest benefit to the PBL process is that it teaches us how to think like a physician,” says Michele Kanemori (JABSOM ’18) of Wahiawa. “It teaches us to gather facts, then hypothesize what the diagnosis might be. Then we can rule the diagnosis in or out, based on what further information we learn. It’s a much more effective process in training to be a physician than just learning from a textbook.” “I really like it,” says Erica Lee (JABSOM ’18), originally from the Big Island town of Waimea. “It fosters a lot of independent learning, which we’ll need to have as physicians because we’re going to be learning for the rest of our lives. In

Brandon Kobayashi (JABSOM lectures it’s easy to get lost and ’18): “The critical thinking to feel really disconnected with skills that we’re building what you’ll actually be doing. will definitely help us to be I think PBL does a good job of better doctors.” relating the science behind an issue to the actual practice of medicine.” “In PBL, your classmates are counting on you to really speak your mind and it takes a lot of teamwork,” says Brandon Kobayashi (JABSOM ’18) from Aiea. “I know that all my classmates here are supporting me and I get the chance to reciprocate. That team process, building on information, will ultimately be very useful when we see patients. Initially, we may not know what’s happening with them. The critical thinking skills that we’re building will definitely help us to be better doctors.”

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THE JOHN A. BURNS SCHOOL OF MEDICINE: 50 Years of Healing in Hawai‘i

A Leap In Learning: The New Appoach

A Quantum Leap From Lectures Historically, prior to the advent of problem-based learning, students across the nation in the beginning years of their medical school careers were required to assimilate seemingly endless volumes of information on their own. They sat in large classes, listening to lengthy lectures from the faculty, then they would pore over thicker-than-thick textbooks filled with the same material. “The first and second year was always the big problem in medical education,” Dr. Gulbrandsen concedes. “The third and the fourth year were a lot more hands-on. But the first and second year, you could have done that with videos instead of teachers.” After Dr. Gulbrandsen joined what was then the University of Hawai‘i School of Medicine in 1971, he became chairman of the school’s department of medicine, then director of the Integrated Medical Residency program. Upon Dean Rogers’ retirement in 1988, Dr. Gulbrandsen stepped into Rogers’ shoes as acting dean. Dr. Gulbrandsen’s unwavering interest in improving the quality of medical education led him and a handful of other handpicked UH medical school faculty members to an American Association of Medical Colleges (AAMC) conference that year. It was there that Dr. Gulbrandsen and his colleagues saw PBL in action, as demonstrated by Dr. William Schragge from McMaster University in Hamilton, Ontario, Canada. McMaster had implemented PBL as a learning method for its medical school professors with entirely positive results. Dr. Gulbrandsen was sufficiently impressed by the

problem-based learning method showcased at the AAMC conference to invite Dr. Schragge to come to Honolulu for a demonstration of the system to his faculty. Dr. Schragge agreed, and travelled to Honolulu to deliver the demonstration. But Dr. Gulbrandsen knew that he couldn’t implement PBL on his own. “At Dr. Schragge’s presentation, I handed out questionnaires to our faculty in attendance,” Dr. Gulbrandsen recalls. “I stood at the door to make sure the questionnaires were filled out. There were boxes on the questionnaire for our faculty to check regarding their support of the PBL system, with consents like, ‘I will be a tutor,’ ‘I will be a research person’ or ‘I will be an evaluator.’ I knew we had to have fortytwo people on board in order to make this work. I counted the questionnaires as they came in, and we had sixty who volunteered that they would lend a hand.” Accordingly, Dr. Gulbrandsen proudly announced at the gathering that PBL “was a go” for the John A. Burns School of Medicine. For an entirely modest $5,000 start-up cost to purchase the guide to the fundamentals of the problem-based learning system, Dr. Gulbrandsen made the PBL method “standard operating procedure” at JABSOM. It didn’t take long for the medical community across the country to take notice. “When we installed PBL, we became well-known on the Mainland,” Dr. Gulbrandsen says. “And I wasn’t shy about telling other schools to get with it. We had a lead article for the first time ever on the front page of Chronicles of Higher Education. In the article, I suggested that through PBL, medical schools everywhere could train doctors in a fashion that

Former department of was more effective…and more medicine chair Dr. Irwin friendly!” Schatz: “The students felt they As problem-based, smallwere an integral part of the group learning took hold in the medical school from day one, because they were talking classrooms of the medical school about real problems.” at Mānoa, faculty members saw a student population transformed. Dr. Irwin Schatz, former chair of the medical school’s department of medicine, says the change was palpable. “First of all, the morale of the students skyrocketed,” Schatz says. “There’s no question. The students felt like they were an integral part of the medical school from day one because they were talking about real problems and getting involved early on in a true clinical approach.” Dr. Schatz credits Dr. Gulbrandsen, along with Dr. Alex Anderson and Dr. Max Botticelli, with pioneering the early medical education curriculum for the school. And looking

back, Dr. Schatz says the problem-based learning method proved to make all the difference. “It was very exciting to see PBL established here,” Dr. Schatz says. “I think it really became one of the best PBL-based programs in the country.” Dr. Anderson says that among the many merits of the PBL program is the investment the students themselves make in their learning process. “The students accept the responsibility for their own learning,” Dr. Anderson says. “They’re guided through that process by their tutor and other resource faculty. When they reach the clinical years, these students are noted for their capability of obtaining the knowledge they need for working with real patients. They are more at ease with patients when they meet them, and are less reserved in gathering information and asking questions of the clinical faculty.” Dr. Gulbrandsen says that in very short order, he and his teaching colleagues began to see the fruits of their PBLteaching labors come home to roost. “After our first PBL graduating class, I got a call from the chief resident at the Mayo Clinic, who happened to go to our medical school under the old curriculum,” Dr. Gulbrandsen recalls. “He was really excited because one of our graduates was a first-year resident at the Mayo Clinic. He told me that during rounds that day, the oncology attending doctor said something that our former student disagreed with. They had a little debate about it—and our student won! It was clearly because she was so well-prepared—thanks to the PBL method, she and the rest of our students had been doing exactly that in small groups for four years. They argue, they talk, they make sure that their facts are straight and they understand them,” Dr. Gulbrandsen says, with

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no small hint of “parental pride” shining through. “That’s what makes me happy. That’s the way it should be.” Former JABSOM director of medical education Dr. Leslie Tam recalls that not only did PBL teach students new and effective patterns of thought, but the system was also able to cut away much of the overwhelming avalanche of rote fact memorization that had come before. “The strength of the PBL method is that it reduced curriculum overload by identifying what should be retained and what should be deleted,” Dr. Tam says. “In the old curriculum, each of a variety of disciplines—for example, pathology, physiology, microbiology, pharmacology and clinical—would be given ‘A to Z’ by the professors in their respective departments. Probably not until the third year—when sleep is at a minimum—would students need to sort out and integrate the separate disciplines. PBL’s strength during the medical school years was its ability to integrate disciplines through clinical relevance.”

JABSOM neurosciences professor Dr. Martin Rayner, who attended the initial Dr. Schragge-led PBL demonstration in 1988, was astonished at what he witnessed. “Honestly, up until then it never crossed my mind that students could teach each other,” Dr. Rayner confesses. “And there it was, happening right in front of us. I thought, My, this— this is a new world! This is a different sort of a world. They don’t need me as a lecturer,” Dr. Rayner recalls. “They need to get together and talk to each other and run through problems together.” Today Dr. Rayner says he’s witnessed the effectiveness of the PBL educational model firsthand over more than two-and-a-half decades at JABSOM. “In any good PBL class, they simply jabber at each other,” Dr. Rayner says with a smile. “They get excited. They talk. And they aren’t just talking. They’re talking about what they’re trying to learn. It’s incredibly exciting to see them doing that.” The ultimate takeaway from students’ active engagement in the PBL process is a skill set that will serve them well as physicians. “The process creates somebody who thinks about learning for themselves,” Dr. Rayner says. “It makes people who will try to work together to figure things out. And that’s what they’re there for. They’re there to be somebody for whom patients will go and say, ‘Tell me what’s wrong. What am I going to do? What should I do now?’”

“They aren’t just talking.

They’re talking about what they’re trying to learn.”

Still Paying Dividends The shift from textbook-and-lecture learning to cooperative small-group, problem-based learning represented an enormous paradigm shift in medical education at the John A. Burns School of Medicine—both for the students and for the faculty members as well.

Dr. Tam agrees that just as the system makes wiser, more intuitively inquisitive students of medicine, PBL also makes more effective teachers. “Through PBL, I have learned to be a better coach and facilitator of learning,” Dr. Tam says. “I’ve learned to listen more carefully, to understand where the student is in his or her understanding of a problem and to follow up with a question that helps students arrive at the answer through their own effort.” JABSOM associate director of the office of medical education Dr. Jill Omori says her training in the PBL method was truly transformational. “PBL not only helped me tremendously as a student, it actually shaped the person I have become today,” Dr. Omori says. “I was a very shy and timid person going into medical school, but by going through PBL, it really helped me to come out of my shell and feel comfortable interacting with others. It also significantly helped my self-esteem and confidence.” The PBL process further encourages students to research the most current, up-to-date responses to the health issues and conditions indicated in their hypothetical cases. “With problem-based learning you have the ability to not just give didactic lectures, but to give examples and have students look at how new technologies are going,” says JABSOM Institute for Biogenesis Research director Dr. Steven Ward. “PBL allows you to introduce the new technologies that are coming into medicine much more quickly than textbooks, which traditionally lag five or six years behind. The PBL process—through students’ own discovery, or through their facilitator—paves the way for information from a new article that’s just been published or a new technique much more readily than through old-school textbook teaching.”

Beyond its timeliness and currency, the PBL method allows students to more successfully navigate the daunting, almost mind-numbing volume of information they are required to process. “By the end of our medical students’ second year, they would have gone through over ninety health care problems that a physician sees in an office,” says Dr. Satoru Izutsu, JABSOM vice dean. “And they would have gone over roughly 25,000 to 30,000 facts. In the old days, the alternative was to sit in class for six to eight hours a day to lectures, falling asleep. Then when you leave the classroom you remember nothing. Then later you’re forced to sit down and cram for exams.” Another enormously beneficial aspect of the problembased learning method is its portability. Dr. Gulbrandsen says PBL was successfully implemented as the teaching model for the medical officers (MOs) training program on the island of Pohnpei in Micronesia. “We set up the medical school there and used our PBL as the teaching model. And the nice thing about PBL is you don’t need large classrooms and a lot of fancy stuff. You can do it under a coconut tree if you want to,” Dr. Gulbrandsen says. “The method worked beautifully. We trained many qualified MOs, and many of them went on to become directors of health of the various islands in Micronesia.”

A View of the Whole Patient The PBL process is designed to help medical students consider all aspects of a hypothetical patient’s life and lifestyle: medical history, socioeconomic factors, ethnic and cultural histories,

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family health history and genetic influences and possible harmful behaviors or circumstances. That “wide-lens” view encourages students to pursue a far more comprehensive, all-embracing approach to patient care and treatment, rather than simple knee-jerk, by-the-book responses to symptoms. “When our students get together in their small groups, they talk about stories of patients and their families, their communities and the healthcare issues that they face,” says JABSOM associate dean for medical education Dr. Richard Kasuya. “From that conversation, they identify a list of topics that they think are relevant for them to learn about, then they go off and study those. They come back a few days later and teach each other what they’ve learned. To watch them in action teaching each other is very engaging. It’s active and it’s interactive. The process lets them consider all factors that may be contributing to a patient’s medical issues. It’s primarily the backbone of what we do.” “The intimacy of problem-based learning is a wonderful way to deliver medical education because it helps students to be doctors right from the start,” says Dr. John McDermott, former chair of the psychiatry department at JABSOM. “It gets students to be researchers right from the start because they’re researching a clinical problem. And the closeness allows the faculty to get to know the medical students very well. That doesn’t happen at many other schools.” Dr. Damon Sakai, JABSOM director of medical education, agrees. “In PBL we work with students over a long period of time, twelve to fourteen weeks per course, and we see them twice a week for three hours at a time,” Dr. Sakai says. “We really get

Medical education director to know them. I think that has led Damon Sakai: “There’s to a very unique and wonderful teamwork between the faculty learning environment here at and the students that I’ve not JABSOM, where there’s a sort of seen at any other school.” teamwork between the faculty and the students that I’ve not seen at any other school.” Learning to do “detective work” through the PBL process at the John A. Burns School of Medicine—peeling back diverse layers of clues and information about a patient’s complete health history—gives students the tools to become better doctors. “The problem-based learning process is structured with multiple levels of knowledge that interlock,” says JABSOM dean Dr. Jerris Hedges. “Students’ education begins with essential building blocks, like the cardiovascular system, the kidneys, the urinary system. But each block is presented as a collection of cases, with symptoms a person may have when they come to a doctor.” And Dr. Hedges says the PBL method is strikingly similar to the processes he undertook during his career in emergency medicine.

“It’s the way we practice in the emergency department,” Dr. Hedges says. “People come in generally without any label as to what sort of problem they have, but rather with a collection of symptoms. You then have to organize, think about what might be a common cause for that symptom, perhaps associated with their occupation, their age or with exposures they may have had through work, school or home. Then you think about the physiology, the anatomy, the biochemistry—all the basic sciences that we have to learn as medical students— and integrate that into solving the clinical puzzle for the care of that patient. Once students begin to understand how the basic science applies to their cases, they get excited. And I would say they’re at least a good year ahead of the thought processes of other students who have been through a standard lectureformat medical school presentation.” “The underlying deeper strength of the PBL curriculum is its ability to develop skills in becoming independent, lifelong learners,” Dr. Tam says. “Students tell me that in their fourthyear sub-internships, when they are being observed and rated alongside students from non-PBL schools by residency program

directors, Hawai‘i students always seem to be asking questions and looking up answers without prompting.” “Each unit gives me a different experience in terms of how I can better learn, or how I can teach myself better,” says JABSOM student Xuan-Lan Doan. “PBL gives you a chance to really do a lot of self-learning. And the process matches what we’re doing in the clinics, learning not just from a textbook, but learning from different perspectives.” “To tell you the truth, I rarely spoke in class before I came to JABSOM,” admits student Laura Houk. “But as you get more comfortable with your group, the trust grows and you get the hang of how the problem-based learning process works. I really enjoy it, personally.” “I feel like PBL gives us a small head start to being true doctors,” says Mark Pilar (JABSOM ’15). “We learn how to work with patients, to ask the right quesDr. Christian Gulbrandsen tions, to do the necessary evaluations. guides a problem-based So once we get thrown into clinical learning session for JABSOM medicine, working with patients in the students at a health clinic wards, it’s not foreign to us.” in Waimea.

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C h a p t e r Five

OUTREACH: BRINGING HEALING TO THE PEOPLE BLUEPRINT FOR INCLUSION

ome have chronic pain. Some have bruises or sores. Some have respiratory problems. Some have substance dependencies, or mental health issues. Others stop by for a simple wellness check. But for all of the folks who seek out the mobile van operated by the John A. Burns School of Medicine’s Homeless Outreach Medical Education (HOME) Project, there’s one common factor: each has been living on the streets, down on his or her luck. The van makes its way to four different clinics a week at five different low-income neighborhood sites across O‘ahu to provide health care for homeless families who live at statesponsored shelters and for families among the unsheltered homeless population. “It’s a free medical visit with our faculty and our medical students,” says Dr. Damon Sakai, JABSOM director of medical

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student education. “A segment of the population with the greatest need gets excellent medical care, and our medical students get to see the challenges of the homeless. I think that direct interaction leads to greater compassion for our future physicians.” HOME Project was founded in 2005 by family medicine and community health associate professor Dr. Jill Omori, in conjunction with the JABSOM Medical students help provide medical students. health care for Hawai‘i’s HOME’s mission is to improve unsheltered homeless homeless access to health care and population while learning to increase student and physician about the challenges of living on the streets. understanding of the healthcare needs of the homeless. “I was always interested in underserved care,” says Dr. Omori, “And going through JABSOM as a student, I felt there were not that many opportunities to work with this population. When I became a faculty member, I took the opportunity to apply for a grant through the federal Health Resources and Services Administration (HRSA) to improve the curriculum

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at the medical school with regard to the homeless and underserved care. HOME Project clinics came out of this curricular change.” “The goal of the program is not to just provide incidental services here and there,” says JABSOM associate dean of medical education Dr. Richard Kasuya. “It’s really to try to help these patients learn where state and other resources are to help them connect with those resources and perhaps show them a path where they can move beyond their current situation.” And HOME Project’s steady growth is testimony to its success. “We now service both sheltered and unsheltered homeless,” says Dr. Omori. “We also started a sub-program that provides mentorship for homeless teens. Currently our community health elective has twelve to fifteen students a year. One of the things that the students come to realize is that there is no stereotypical homeless patient. They’re all unique. They don’t fit into the picture that many lay people have of a mentally ill alcoholic or drug user.” Yet many of the homeless do share similar health issues. Among their biggest are recurring skin infections. Through HOME Project, they get the care they need—and JABSOM’s affiliated students gain some important real-world perspective. “HOME Project is a win-win program,” says Dr. Omori. “The patients we service benefit from having increased access to quality health care that they might not have otherwise. By providing our services, we’re filling a gap that currently exists between what the state and federal governments can provide for these individuals. The students themselves also benefit in many ways. They have increased exposure to the problems and needs of the homeless. And as the main care providers at the clinics,

fathers” Dr. Windsor Cutting and Dr. Rogers—shared a vision of inclusion at the school for all cultures and all races. “Dr. Cutting was concerned when he looked over the admitted class that there were so few Hawaiians,” recalls Dr. Benjamin Young, former dean of students at JABSOM. “He looked over the application packets, and he recognized that so many Native Hawaiians had good MCAT scores and good grade point averages. But they weren’t admitted because the bias was that only those applicants who had the very highest MCAT scores would make the best students and doctors. That wasn’t necessarily the case.” Dr. Cutting’s son, Dr. John Cutting, recalls that his father set out to rectify what he saw as a failing on the school’s part, in depriving Pacific Islanders of the opportunity for a career in medicine. “He set up a program where students from throughout the Pacific would come here and spend three years to do the first two years of medical school,” John Cutting says. “During that time, they’d be able to brush up on these things that they needed.” “The students would receive tutorials to get through the very difficult pre-clinical phase of medical education,” Dr. Young says. “Initially, ten students were invited to the medical school, and they were called ‘Dean’s Guests.” “He was trying to engage people in Samoa, and in other nations of the Pacific, and students from as far away as Okinawa,” Dr. Cutting says. “And he passed that spirit of inclusion forward.”

Dr. Terry Rogers, the man who succeeded Dr. Cutting in the dean’s chair, continued the school’s efforts at outreach and inclusion. “Terry Rogers said, ‘This is not a melting pot, this is a stew pot,’” remembers Dr. McDermott, former chair of the JABSOM psychiatry department. “His point was that Hawai‘i has a unique character of its own because of the mixture of different ingredients. They make up a stew where each piece retains some of its own flavor. It’s not homogenous. It’s a heterogeneous mix with values and beliefs and behaviors that should be protected and celebrated.” And as Dr. Rogers continued Dr. Cutting’s efforts at greater inclusion—specifically for Hawai‘i’s indigenous people—he came up with an innovative plan built from the Dean’s Guests program of Dr. Cutting. “Terry Rogers found that some of the students applying for medical school locally could benefit from beefing up their studies in the basic sciences in the pre-medical years,” says Dr. Young. “And that’s how ‘Imi Ho‘ola got started.” Dr. Rogers called on Dr. Young in 1972 to launch what became ‘Imi Ho‘ola—‘Those who seek to heal’—a program designed to give more Hawaiians and Pacific islanders access to a career in medicine. Now spanning more than four decades, the ‘Imi Ho‘ola Post-Baccalaureate Program has recruited promising students from historically under-represented or disadvantaged commu-

“Hawai‘i is a stew pot,

the students are empowered with more autonomy than they get at their usual clinical sites. They get to practice real medicine while helping those in need.”

HOME Project founder Dr. Jill Omori (right) teaches students to take blood pressure on site at a HOME clinic: “The students come to realize that there is no stereotypical homeless patient.”

The Earliest Outreach HOME Project’s mobile van is just one tangible form of the myriad ways in which JABSOM is bringing good medicine to the all the people of Hawai‘i—by the physicians and future physicians of Hawai‘i. It is a tradition and a mandate that began with the very inception of the medical school in the Islands. The first two deans of the medical school—“founding

where each ingredient retains some of its own flavor.”

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Former Imi Ho‘ola director nities. Twelve students per year are Dr. Nanette Judd: “A successful subjected to a rigorous, intensive medical education model that’s yearlong course of study in the made a difference.” basic sciences prior to their admission to the John A. Burns School of Medicine. “‘Imi Ho‘ola has been a successful medical education model that’s made a difference,” says Dr. Nanette Judd, former director of the program for more than two decades. “For students from disadvantaged, under-represented backgrounds, it’s helped these students achieve their dream of becoming a physician.” Nearly 100 percent of the 240 physicians who have participated in the ‘Imi Ho‘ola program—roughly forty percent of them Native Hawaiians—have graduated from JABSOM’s MD program. And Dr. Judd acknowledges that since its inception under Dr. Young and Dr. Rogers, ‘Imi Ho‘ola filled a gaping void. “For many decades earlier, there was a spiritual Hawaiian

Former psychiatry department saying that Hawaiians almost lost chair Dr. Naleen Andrade: their souls,” Dr. Judd says. “They “(Without Imi Ho‘ola) I became apathetic about who they seriously doubt that I would were as a people.” have become a physician.” Governor John A. Burns recognized this issue as he lobbied loudly during his administration for a medical school—and a law school—at the University of Hawai‘i that would admit and serve the young people of Hawai‘i. “Governor Burns said the problem with a lot of kids here is that they have an inferiority complex,” says former JABSOM dean Dr. Gulbrandsen. “He shared the passion of Dr. Cutting and Dr. Rogers to effect a change to that mindset.” In the formative start-up years of the ‘Imi Ho‘ola program there was of course the issue of funding. In this regard, Dr. Judd points to another key figure who also recognized the need in the Islands to be filled: U.S. senator Daniel K. Inouye.

“It was during the days of affirmative action,” Dr. Judd recalls. “Honestly, the funding programs available then were primarily designed for African-American issues. But Senator Inouye made our voices heard as well. He understood the plight of the Native Hawaiians, and the need for indigenous manpower for Hawai‘i. With Senator Inouye’s strong support, we were able to compete for grants and for federal funding.” For the many Native Hawaiian and disadvantaged families whose sons and daughters have been afforded the chance to enter medical school at JABSOM, the ‘Imi Ho‘ola program has proved to be a significant instrument for social change. “Historically, for our Native Hawaiians and those that come from the Pacific, as bright as they are, many don’t feel they’re good enough or as good as the other students,” Dr. Judd says. “We take them in, we meet their family and we tell the parents that there is this ‘ohana here. We tell them we’ll work together to support the students, and that we provide an educational opportunity through ‘Imi Ho‘ola. But it’s really up to the student to work hard, to persevere and to attain the level that they need.” One distinguished graduate of the ‘Imi Ho‘ola program is Dr. Naleen Andrade, former chair of the psychiatry department at JABSOM. When she was a young girl growing up on a coffee farm in south Kona on the Big Island, a career in medicine was the furthest thing from Dr. Andrade’s mind. “It’s hard to believe today, but back then, Hawaiian students were not encouraged in school,” Dr. Andrade recalls. “We were hindered by a number of socioeconomic and ethnic-cultural issues. So ‘Imi Ho‘ola was really made for kids like myself. Without it, I seriously doubt that I would have become a physician.” Students in the ‘Imi Ho‘ola program have not only received

a crash course in the essentials for In 2013-14, the school’s ‘Imi Ho‘ōla Post-Baccalaureate success in medical school, they’ve Program included students from also received close-up views Hawai‘i, Guam, Pohnpei and of the many specific medical the Philippines. problems facing Hawai‘i’s people. Efforts at giving ‘Imi Ho‘ola students an acute awareness of local health issues began with the program’s first director, Dr. Young. He served as the physician for the Polynesian Voyaging Society’s return voyage from Tahiti to Hawai‘i on board the Hōkūle‘a. “As we returned to Hawai‘i, in July of 1976 we landed at Kalaupapa on Moloka‘i,” Dr. Young recalls. “It was of course a settlement for patients with leprosy, or Hansen’s disease as it was subsequently called. The settlement had been mandated by King Kamehameha V in 1866.” Dr. Young recalls the evening their canoe pulled into the harbor at Kalaupapa.

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Annual visits to Kalaupapa, the Moloka‘ia Hansen’s disease settlement mandated by Kamehameha V (left) in 1866, gives today’s Imi Ho‘ola students a close-up look at Native Hawaiian health issues.

“It was my luck to be on watch that night with another crew member, Mel Kinney,” Dr. Young says. “And as I was looking around and talking to so many of the residents and patients there, I was thinking, This would be a wonderful place to bring ‘Imi Ho‘ola students. That’s how the project began, then continued every year, for medical students to go to Kalaupapa. Rather than just reading textbooks and viewing X-rays, they got to meet patients. They got to experience true medical history, to witness the difficulties these patients endured in a place of such stark and unusual beauty.” Following their unique opportunities in medical education, scores of graduates of the ‘Imi Ho‘ola program and the John A. Burns School of Medicine have found meaningful, significant ways to give back to their communities. “We did an alumni survey of our ‘Imi Ho‘ola graduates,” Dr. Judd says, “and we found that ninety-six percent of them were providing services to under-represented populations, disadvantaged populations. And those services represented

more than fifty percent of their practice. They have truly been giving back.” “We’ve had some amazing students come through the ‘Imi Ho‘ola program,” says Dr. Kasuya. “They’re leaders in our community, they’re leaders here at the medical school, they’re leaders in healthcare and they’re leaders in other parts of the world. There’s no question about how valuable the program has been.”

Caring for Hawai‘i’s Own The unbridled success of the ‘Imi Ho‘ola program at the John A. Burns School of Medicine spawned a greater awareness of health issues and health disparities among the Native Hawaiian population. The ensuing establishment of the Native Hawaiian Center of Excellence (NHCOE), built through the dogged support

of Dr. Gulbrandsen, sought to further the cause by providing education and training enhancement programs to Native Hawaiian students, and those at the post-doctoral stage of their career. “The Native Hawaiian Center of Excellence is, once again, all about providing opportunities,” says Dr. Nanette Judd. “There’s a medical education component, there’s a component that speaks to research and there’s also a component that provides health services.” Ultimately, under then JABSOM Dean Dr. Ed Cadman in 2003, both the ‘Imi Ho‘ola and the NHCOE programs became part of the newly-formed Department of Native Hawaiian Health (NHH). Dr. Marjorie Mau was appointed as the founding department chair of NHH in 2003. Under her leadership, the department grew to become the only clinical department in a U.S. medical school dedicated to the health and well-being of an indigenous population. “The Department of Native Hawaiian Health is the only department of its kind in the country: a multi-mission academic department in a medical school focused on the health of indigenous peoples,” says Dr. Satoru Izutsu. “We’re very proud of it. It focuses on the background and needs of the Hawaiian people through incorporation of the indigenous culture here in Hawai‘i as an important part of our medical education. It helps our students develop sensitivity to all the issues related to the Hawaiian culture. The department makes a terrific contribution, like no other school in the U.S.” NHH is comprised of four divisions: medical education, research, clinical teaching and services and community engagement. As one of eleven clinical departments at JABSOM,

the department’s mission is to be a center of excellence in education, research and quality healthcare practices for Native Hawaiians. Beyond its careful focus on Native Hawaiian health, a large swath of emphasis at the John A. Burns School of Medicine is placed squarely upon the most critical health and care issues facing all of the residents of the Islands. “We are vigilant at JABSOM to make certain that the most important health care needs in Hawai‘i are addressed in our curriculum,” Dr. Sakai says. “That’s why health issues like diabetes, obesity, smoking cessation and other health care disparities are very prominent portions of our curriculum.” And another critical outreach area for the faculty, students and researchers at the John A. Burns School of Medicine is in the field of geriatrics, or the study of and care for the aging. “If you’re interested in medical issues connected to aging, Hawai‘i is one of the most interesting places in the world to live,” says Dr. Patricia Blanchette, who founded the geriatrics department at JABSOM. “The life expectancy in Hawai‘i is the longest of any state in the nation,” Dr. Blanchette says. “Many people are living to be older. We’re pretty close to the point where one person in five is sixty-five or older in Hawai‘i—and it won’t be long before one in four will be sixty-five or older.”

Reaching Out in All Directions The unique geography of the many individual islands of Hawai‘i dictates a dedicated outreach approach for delivering both healthcare and medical education. “We take our students and place them on the Neighbor

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Islands so they can get experience working in the communities in which we hope that they will choose to serve,” says JABSOM dean Dr. Jerris Hedges. “Traditionally, much of clinical medical education happens within hospitals located in urban settings,” Dr. Hedges says. “But by taking students and imbedding them in the more rural setting on a Neighbor Island, they have the opportunity to learn what the community is like and how they would practice in a different manner than what they would see in an urban setting.” “Our state is more than just Honolulu,” agrees Dr. Sakai. “We of course have many hospitals and clinics outside of O‘ahu, and we need our students to get an opportunity to experience that population, to care for that population and to learn about those communities. We know there’s a critical need for doctors in the rural communities on the Neighbor Islands. So we would be thrilled if our students fell in love with those communities identified and wanted to go back after medical school to care for the people there.” To this end, the John A. Burns School of Medicine has placed a priority on extending and amplifying its Neighbor Island clerkship and education programs. “The longitudinal clerkship program has expanded quite significantly to the Neighbor Islands, first to Hilo in 1996, Maui in 1999, Kauai in 2001 and lastly to Waimea in 2010,” says Dr. Jill Omori. “In total, the longitudinal program has trained over 123 students on the Neighbor Islands for their third year clerkship, and countless more students have had the opportunity to complete their family medicine clerkship on a Neighbor Island as well.” In addition, beginning in 2011, JABSOM started sending

students in their pre-clerkship years to complete one of their curricular units on the Big Island. “The students complete their PBL sessions, learn their clinical skills and complete their community health experience in either Hilo or Waimea,” says Dr. Omori. “So far thirty-five students have participated in our rural PBL initiative.” Dr. Hedges says students from JABSOM are often very pleasantly surprised by what they find during their study on the Neighbor Islands. “Quite often they’re enthused,” Dr. Hedges says, “because they didn’t realize how much they would be valued by those in the community who desperately need physicians. They’re also often surprised by how rewarding it can be to treat the spectrum of patients, from the very young to the very old, with a wider variation of conditions than you might see with a more discipline focused practice in an urban setting.” Dr. Jill Omori says the opportunity for JABSOM students to have medical education experiences on the Neighbor Islands is invaluable. “It really exposes the students to issues that are unique to each of these rural communities, and allows them to see firsthand the struggles in providing quality health care to these populations,” says Dr. Omori. “It also allows them to see the possibilities for practicing in these areas. They meet and spend time with the community physicians and learn what it would be like to practice there. They also get to know the character of the people in these rural areas, and they get to see the rich cultures of these small communities.” JABSOM students agree: it’s more than just the medicine. “I’ve been in an urban setting all my life, and I wanted some exposure to a rural setting,” says student Brandon

Kobayashi (JABSOM MD ’18) of his study unit in Waimea on the Big Island. “What has surprised me most is the friendliness,” Kobayashi says. “I get a really good vibe. When I go for a jog in the morning, people always wave to me. It’s a really nice gesture. I don’t see that in Honolulu too much.” Kobayashi’s JABSOM classmate Erica Lee (JABSOM ’18), who grew up in Waimea, has another reason for returning for her study. “There weren’t a lot of doctors here when I was growing up,” Lee says. “My parents and I would have to drive to Hilo or Kona to see the doctor. There’s a need here that’s inspired me to want to come back and help.” And their JABSOM classmate Laura Houk (JABSOM ’18) says during their time in Waimea, they’ve been getting the opportunity to “spread the word” about their chosen career path. “On Tuesdays they have us involved in something called Community Help,” Houk says. “We meet many of the high school kids here and the goal is to perhaps get them interested in a career in medicine. It’s just one more way to maybe grow the physician base here in Hawai‘i and to keep the physicians here.” An acute need for medical services has encouraged many JABSOM graduates to extend the reach and influence of the school even further, far across the Pacific. “Our graduates have opened the doors for opportunities in healthcare throughout the Pacific Basin,” says Dr. Benjamin

Young. “JABSOM alumni have taken leadership positions on the islands of Palau and Pohnpei. They’ve also guided healthcare on the islands of Rota and Tinian in the Marianas, farther south in Samoa, and in countless other Pacific Island communities.” And many JABSOM students find opportunities to participate in medical outreach programs across the Pacific long before they graduate. JABSOM’s Committee on Global Health and Medicine—within the dean’s office at the school— is a clearinghouse that coordinates JABSOM’s efforts in the global health arena. Chaired by vice dean Dr. Satoru Izutsu, the committee gathers current students, faculty members and physicians who share an interest in improving health throughout the world. Their Area Health Education Center (AHEC) supports credited and non-credited assignments throughout the Pacific Basin (Palau, Saipan, American Samoa and Micronesia), and the committee’s international relationships provide students with credit opportunities for work in Australia, Bali, Japan, Philippines, Taiwan, Thailand and New Zealand. From the distant reaches across the wide Pacific to the many health care clinics of the Neighbor Islands to the mobile HOME Project van offering free services to those most in need in the Islands—the faculty and students of the John A. Burns School of Medicine continue to make healthcare outreach an everyday priority.

“My parents and I would

have to drive from Hilo or Kona to see the doctor.”

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Chapter Six

A PLACE TO CALL HOME: THE CAMPUS AT KAKA‘AKO Eye on the prize

quiet man from Yale came to the John A. Burns School of Medicine in 1999 to chase what at the time seemed an almost impossible dream. Looking forward, new medical school dean Dr. Ed Cadman saw a new home for the medical school with the very best teaching facilities available for medical education and an ambitious biomedical research complex. “People thought he was nuts,” Dr. Benjamin Young confesses. The obstacles Dean Cadman faced at the outset of his tenure were monumental. The university as a whole was struggling financially. And though the medical school at Mānoa had gained acclaim for its problemThe John A. Burns School based learning curriculum, many of Medicine and University at the school knew it needed a of Hawai‘i Cancer Center serious research component to gain share the 9.9-acre campus in national respect. Kaka‘ako (opposite).

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Undaunted, Dr. Cadman came in with the expectation that adding a research arm at the medical school would provide a catalyst for Hawai‘i’s biotech industry. And despite his soft-spoken manner, Dr. Cadman still made sure his voice was heard. “He never said no to any invitation to give a talk,” Dr. Young says. Former dean Ed Cadman: “We “Whether the audience was one must really believe that we can or two people, or thousands of become great.” people. He would go out and talk about the medical school and its rewards and benefits.” Dean Cadman spoke to colleagues and friends, to faculty and students, to investors and donors and to Hawai‘i State

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Former Imi Ho‘ola director Legislators. “We must really Dr. Nanette Judd: “A successful believe that we can become great,” medical education model that’s Dr. Cadman said. made a difference.” And Dr. Cadman exhorted every student who passed through the doors of the medical school to strive for that same greatness. “Unlike climbing a mountain, there is no top to this journey, only plateaus and vistas along the way,” Dr. Cadman told the incoming medical students of the class of 2000. “When you reach those vistas, stop and turn around, look where you have been, then turn back and look where you wish to go.” Inevitably, in his tireless efforts to champion the cause of the medical school, Dr. Cadman ultimately got the ear of Hawai‘i’s then-governor Ben Cayetano. Governor Cayetano agreed to meet with the new dean. “It was supposed to be a ten-minute courtesy visit,” Cayetano

recalls. “You know, the kind of visit you want to get over with as soon as possible.” Ten minutes for Dr. Cadman in Governor Cayetano’s office turned into hours of discussion…and a lifelong friendship. “I found him to be fascinating,” Cayetano says. “I got to t rust him, and I liked him. Very humble. Very credible. Very much my style. Because I’m the kind of guy that has a self-defense mechanism for bureaucrats,” Cayetano says with a laugh. The governor liked Cadman’s style—and he also liked his message. “We had long discussions. Together we’d say, ‘When are we building a new medical school, getting it off the campus?’” Cayetano says. In truth, the seed had already been planted in Governor Cayetano’s mind for the value of strengthening the medical school in Hawai‘i. Improbably, it happened on the golf course…with the King of Malaysia. “My protocol officer had called me, and told me the King of Malaysia wanted to play golf with me,” Cayetano recalls. “As governor, I had an honorary membership at Wai‘alae, so I met the King for our round. While we’re playing, I said, ‘Your Majesty, what brings you to Hawai‘i?’ And the King of Malaysia tells me, ‘Well, every year I go to Stanford for my annual check-up. Then I stop in Hawai‘i for some rest and recreation.’ That got me thinking. Why shouldn’t the King be able to just come here for his check-up as well? I didn’t see any reason that we shouldn’t be able to provide the very best-quality health services, not only for world leaders, but for the people of Hawai‘i.” Together Dr. Cadman and Governor Cayetano—two

men now aligned on a mission—began to hunt for a suitable location where their shared vision of a new medical school could take shape. The first site the two men looked at was across from The Queen’s Medical Center, where the department of health sits. “That’s when I found out how political medicine is!” Cayetano says with a chuckle. “The other hospitals around town didn’t want the medical school there because they thought it would give Queen’s the edge!” The men kept looking. Then one day Dr. Cadman got a call from Governor Cayetano. “I took Dr. Cadman up to the tenth floor of the Gold Bond Building,” Cayetano says. “That’s where the Hawaii Community Development Corporation was at the time. And I took him to the window, and I pointed down to the space toward the beach in Kaka‘ako, and I said, ‘Doc,’—that’s what I called him—‘Doc, that’s where your new medical school will be!’ He was overjoyed.” In return for the promise of a new medical school, Governor Cayetano says he asked just one simple favor of Dr. Cadman. “I said, ‘We build the school for you, you can’t leave!’” Cayetano recalls. “He promised me he wouldn’t leave—and he said, ‘Governor, this will be my life’s last work.’” The site was occupied at the time by several produce companies who held long-term Before and after: The new leases. An amicable negotiation Kaka‘ako campus broke ground with the tenants began paving the in the fall of 2002 (top) and opened in the spring of 2005. way for Dr. Cadman’s dream.

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The Honolulu Board of Water Supply builds the well that provides the Kaka`ako campus with ocean-water air conditioning, the first saltwater cooling system in the Islands.

But that was just the first hurdle. A much bigger hurdle was the matter of paying for the new undertaking—which of course meant enlisting the state legislature’s support. “We had trouble getting the legislature to go along with it,” Cayetano concedes. “It was all about the money. They said, ‘How are you going to do this?’” It was through an odd, ironic sort of serendipity that the funding was found. “During my administration we managed to get a big settlement from the tobacco companies, compensating Hawai‘i for taxpayer money spent on tobacco-related diseases,” Cayetano says. The agreement with tobacco companies came to be known as the Master Settlement Agreement, a windfall in funds from “big tobacco” for forty-six states across the U.S. Governor Cayetano says the argument to put that money toward the new medical school was an easy one to make. “Tobacco is a major cause of all kinds of illnesses,” Cayetano

says. “So there was a clear connection, to pay for the place that educates the future doctors of Hawai‘i.” Indeed, language in the Master Settlement Agreement notes that states are to use these monies for tobacco cessation efforts and for addressing the long-term adverse health consequences of tobacco use. So it is particularly fitting that the money has helped to fund a facility that houses research programs to minimize tobacco use and one that trains generations of future doctors who will be the workforce to treat those suffering from tobacco-related disease in Hawai‘i.

Opening Doors Had Governor Cayetano and former dean Ed Cadman not been successful in locating a site for the new campus and breaking ground in 2002 on the University of Hawai‘i medical school, it is possible the school would have ceased to exist due to forces of nature. In late 2004, ten inches of rain fell in the Mānoa Valley over a twenty-four-hour period, sending a flash flood tearing through the UH campus. The torrent brought an eight-foot wall of water crashing through the UH library, and it decimated the biomed building where the med school was housed. “We had to evacuate the building,” former JABSOM dean of students Dr. Ben Young recalls. “Dean Cadman and associate dean Sam Shomaker helped navigate JABSOM through the deluge crisis, moving us all to various facilities spread across Honolulu.” Fortunately, the school was able to open in 2005 and accommodate much of the essential research and educational

missions while renovations at the biomed building continued. Amid much celebration, ground was broken for the new campus at Kaka‘ako in October of 2002, and the facility opened its doors to students and researchers in the spring of 2005. The $150 million complex, sitting on a 9.9-acre site, includes the education/administration building and the biosciences building. The complex incorporates energy efficiencies in its office and laboratories by adopting the U.S. Green Building Council’s (USGBC) Leadership on Energy and Environmental Design (LEED) Rating System. Then, borrowing from the tobacco settlement model that helped fund the initial phase of the new campus, in 2013 the University of Hawai‘i Cancer Center also opened its doors at Kaka‘ako. The six-story, 150,000-square-foot building was funded by revenue bonds backed by a portion of the state tax revenue on the sale of cigarettes. The cancer center houses world-class facilities for research on cancer biology, cancer prevention and control and epidemiology, as well as clinical and translational research. And the facility has also earned a LEED Gold Certification, signifying that it is an internationally recognized “green” building with operational systems in place to improve air and water quality, to reduce solid waste and to conserve energy. John A. Burns School of Medicine dean Dr. Jerris Hedges says the proximity of facilities at Kaka‘ako is a huge boon. “The opportunity for the cancer center and the medical school to work more closely around building strong, innovative cancer treatment programs is just now beginning to come together,” Dr. Hedges says. “I’m excited by that.” The education/administration building represents an

Left to right: In 2005 vice dean enduring focal point of the Sam Shomaker, University campus at Kaka‘ako. It frames the of Hawai‘i president David core mission of the John A. Burns McClain and dean Ed Cadman look on as Kahu ___________ School of Medicine, dedicated to ______________ performs the educating the future physicians of blessing at the grand opening of Hawai‘i. the Medical Education Building “The medical education on the new Kaka‘ako campus. building is specifically designed for the style of education that we provide,” says Dr. Damon Sakai, director of medical education at JABSOM. “It has many small media rooms for our small-group learning and student study sessions. We have a state-of-the-art center for clinical skills where we have people from the community train to take on the roles of patients with certain diseases. Our students can go room to room to examine

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THE JOHN A. BURNS SCHOOL OF MEDICINE: 50 Years of Healing in Hawai‘i

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Today JABSOM is flanked by the 150,000-square-foot University of Hawai‘i Cancer (left), which opened in early 2013.

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50 Years of Healing in Hawai‘i

these surrogate patients to practice their skills. We also have a wonderful simulation laboratory which we call SimTiki. The facility has mannequins that speak to you and scream and yell…or their heart might even stop! Then our students can do CPR and deliver the medications to save their lives. So our students have the capability of practicing these skills in our school before the students get to the hospital.” Dr. Sakai is quick to point out that for veteran medical professionals, the luxury of having access to this kind of skill building in an academic setting was not previously the case. “In our day, we learned to resuscitate a dying patient by resuscitating a dying patient,” Dr. Sakai says. “There was no other way. Now we have the facilities to teach those things in a way that’s safer for the people here in Hawai‘i. This facility is simply fantastic.” The all-under-three-roofs structure of the education building, research facility and cancer center on the campus at Kaka’ako promotes invaluable team building and cooperation. Associate dean for medical education Dr. Richard Kasuya says that the single home-base health sciences campus has created a true family atmosphere for all involved. “When you talk about the concept of ‘ohana, there clearly is a bond between the administration, the faculty, the students and the community here,” Dr. Kasuya says. “There is a very deep connection, a relationship that is quite special.” And that bond is evidenced by the return to Kaka‘ako of

many students of the John A. Burns School of Medicine who return to assume key roles in the school’s continuum of quality medical education. “The fact that many of our students are coming back and participating on the faculty—either in the teaching realm or the research or clinical realm—is extremely valuable,” Dr. Kasuya says. “If our graduates feel so strongly about the campus here at Kaka‘ako that they choose to come back to be part of the next generation, that’s the way the school will continue to be successful.” Dr. Marla Berry, the medical school’s chair of cellular molecular biology, also credits the move to Kaka‘ako with providing an invaluable new opportunity for teamwork. “Moving into this facility— bringing all the researchers from Mānoa, from Lē`ahi Hospital, from the cancer center, from The Queen’s Medical Center—having everyone in one facility instead of spread out all over Honolulu has really fostered collaborations,” Dr. Berry says. “It’s provided us with the opportunity to grow, and now with the cancer center building next door we having opportunities for even greater future scientific endeavors.” Today the campus at Kaka‘ako still bears the name of the man who initially made the medical school at the University of Hawai‘i at Mānoa a reality: John A. Burns. And though Governor Burns passed away three decades before the facility at Kaka‘ako opened its doors, his son knows his father would be thrilled.

“There is a very deep

connection, a relationship that is quite special.”

“It’s a beautiful facility. It’s a beautiful campus,” Jim says. “When a student comes here, he or she is thinking, Hey, I’m in a truly first-class place. I’d better participate at the best level I possibly can.” Jim says the school that bears his father’s name—the school that now provides an ideal learning, study and research environment for medical education and advancement—is truly the fulfillment of a dream. “I watched my father from 1946, when he jumped into the political arena,” Jim says. “I saw him devote his entire life to statehood and to the improvement of the state of Hawai‘i, to the establishment of the medical school in 1975. If you had said in 1946 that this was going to be accomplished,” Jim now says, surveying the campus at Kaka’ako, “they would have said, ‘No, you’re crazy. You’re drunk.’ So to see it here now I say, ‘You know what? This makes his life worthwhile.’ I think he would have been very proud. He would have said, ‘Hey, I succeeded.’” Indeed, in 2015, the school bearing John A. Burns’ name entered the top twenty primary care schools in the nation as ranked by the U.S. News & World Report. Former governor Cayetano says the ultimate success of Governor Burns’ vision, manifested at Kaka‘ako, operates on a variety of levels. “The John A. Burns School of Medicine here at Kaka‘ako is regarded by folks on the Mainland as an excellent medical school,” Cayetano says. “That lends a very valuable element of prestige to our state. The thinking becomes that this isn’t just a place where you come enjoy the sun and the sand and the surf. You can come here for a great medical education. You come here for doctors who have been educated here. You come

to a place where the demographics of the doctors and the nurses mirror those of Asia and the Pacific. It makes Hawai‘i attractive.” More importantly, Cayetano says, operation of the school adds to the state’s economy and provides numerous valuable career options for Hawai‘i’s young people. “We rely so heavily on tourism and the military,” Cayetano says. “Kaka‘ako helps open another revenue stream in the health fields. And it’s a huge opportunity for our young people to go into a variety of professions, from physicians to nurses, biotech researchers to other health professionals.” Yet the man whom Governor Cayetano came to respect for his quiet, unwavering stewardship of the new medical school at Kaka‘ako had precious little time to enjoy the fruits of his labors. In 2005—the same year the John A. Burns School of Medicine opened its doors in Kaka‘ako—Dr. Ed Cadman voluntarily stepped down from his chair in the dean’s office. Dr. Cadman had been diagnosed with a neurological degenerative disease called primary progressive aphasia, a form of dementia that robs people of their speech and slowly of their minds. Still, in his resignation speech to University of Hawai‘i Board of Regents, Dr. Cadman held his head high, looking as always to the future and exhibiting the same grace, humility and vision that had become his unmistakable trademark. “When I came to Hawai‘i in November 1999, the state had as one of its goals to diversify the economy with the biotechnology industry,” Dr. Cadman told the regents. “I articulated the state’s vision for this industry. It is your vision, not mine. Embrace it, surround it and build it. The renaissance is happening in Kaka‘ako.”

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C h a p t e r S e ve n

THE BEST AND THE BRIGHTEST: STUDENTS OF MEDICINE FROM THE MANY, FINDING THE FEW

“T

his past year we had roughly 2,200 applicants. We have room for sixty-six students.” John A. Burns School of Medicine vice dean Dr. Satoru Izutsu confesses that the process of winnowing the extraordinary group of candidates for admission to medical school at JABSOM is an arduous one indeed. “In our entering class of sixty-six, ninety percent are residents of the state of Hawai‘i, and we take ten percent who are applicants from the rest of the country,” Dr. Izutsu says. “With a population of roughly 1.4 million people in Hawai‘i, we have about 300 who apply annually to our school.” And Dr. Izutsu says the decision about every applicant, for every seat, in the medical school’s entering class is a critical one—because a large share of the students who fill those seats go on to become the medical professionals who practice in the state of Hawai‘i.

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“There are a little less than 3,000 practicing physicians in the state,” Dr. Izutsu says. “Currently, over half are graduates or faculty of the John A. Burns School of Medicine.” Exactly who are those students? And how are they chosen? “The ones that make it to the top have qualities where a paper and pencil analysis probably won’t reflect their potential,” Dr. Izutsu says. “We know that they’re bright In addition to their academic academically. But then we find that skills, JABSOM students are selected for their leadership, we need to ask other questions. compassion and sense of Do they have leadership skills? community service. Can they relate to people? Are they really compassionate about helping people? Finally, are they mentally and physically healthy? We review our answers to all of those questions, then the admissions committee tries to make the tough decisions. Yes, the students we accept are the brightest. But—for Hawai‘i—we want to make certain they’re the best.” And while there may not be a “typical” candidate who is accepted for admission to the school, JABSOM associate dean

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for medical education Dr. Richard Kasuya says most share some important characteristics. “First, they have a genuine love and concern for the state of Hawai‘i,” Dr. Kasuya says. “Whether they’re kama‘āina born and bred, or whether they’ve come from elsewhere in the U.S. or internationally, something brings them here because they love the state. Second, they’re obviously very bright. Out of the thousands of outstanding applicants, we can only accept a very small number. So we’re really talking about extremely bright students. Finally, there’s something more in them than just brain power. The most successful students here are people who can relate really well to others. We’re looking for medical students who have demonstrated that there is something quite shining in their character.” And Dr. Kasuya concedes: there’s one more factor that enters into the admissions equation. “I guess they need to be a little bit lucky,” Dr. Kasuya says with a laugh. “There are so many qualified applicants to our school, and I haven’t met a single student who didn’t think that luck was on their side!”

Paths to Medicine Driven by Passions Conversations with current students and graduates of the John A. Burns School of Medicine yield a host of reasons for choosing a career path in the medical profession. And for many, the notion began as early as childhood. “I was the oldest in a large extended family,” says pediatric resident Dr. Kristine Layugan (JABSOM ’12). “There was lots of babysitting with my siblings and cousins. I knew early on

Dr. Kristine Layugan I wanted to purse a career with (JABSOM ’12): “I knew early children, and I was fascinated by on I wanted to pursue a career the sciences, health and medicine. with children.” I shadowed my pediatrician and it went from there. I thought becoming a pediatrician was the perfect job for me.” For Layugan’s colleague, pediatric resident Dr. Kendra Dilcher, the notion of doctoring was literally “all in the family” at an early age. “I was born and raised in Hale‘iwa, out on the North Shore,” Dr. Dilcher says. “My dad is a country doctor. He works in Hale‘iwa, barefoot, no white coats there, and my mom helps him run his office. Throughout my childhood I basically worked in the office with my dad, sewing up surfers, taking care of the babies while my dad saw the parents, learning true local familystyle medicine.” And Dilcher says that early familiarity is paying big dividends today in her pediatric duties at Kapi‘olani Medical

Dr. Kendra Dilcher Center for Women & Children. (JABSOM ’14): “I know the “When I go out to the malls, families, I know the lifestyle, go out to the beaches, everybody’s the culture.” like, ‘Dr. Kendra! Dr. Kendra!’ It’s a community that supported me through all of my education. I know the families, I know the lifestyle, the culture. So when I go to interact with the kids now at Kapi‘olani, I understand where they’re coming from, and they respect that about me. It’s not the traditional ‘I’m your doctor, this is what you’re going to do’ kind of approach. Now I can give back to them as their Dr. Kendra.” Another of Dilcher’s colleagues, KMCWC pediatrics clerkship director Dr. Kyra Len (JABSOM ’03) literally “grew up” in the system. “I actually started at Kapi‘olani when I was in high school because I used to volunteer in the playroom,” Dr. Len says. “That experience, being able to play with the kids there, led to my being able to participate in their care as a medical student,

Dr. Kyra Len (JABSOM ‘03): “I then to my return as an attending actually started at Kapi‘olani physician, taking care of patients.” (Medical Center) in high school, Many of the students and because I used to volunteer in alumni of the John A. Burns the playroom.” School of Medicine echo Dr. Kasuya’s words regarding their fostering an abiding love for helping the people of Hawai‘i. Student Erica Lee hopes to perhaps return to practice medicine in her hometown. “Growing up here, I’ve seen the shortage of physicians,” Lee said during her MD3 study term in Waimea. “My parents and I always had to drive to Hilo or Kona to go see the doctor. Seeing that there’s a need here has inspired me to want to come back and help.” Laura Houk (JABSOM ’18) is still in the process of choosing her medical career path—based on what will serve the Islands best. “I was attracted to medicine because I want to go where

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THE BEST AND THE BRIGHTEST: STUDENTS OF MEDICINE

there is need,” Houk says. “I want to pick my direction in medicine based on what Hawai‘i needs. I have an interest in geriatrics, and there is a critical need in Hawai‘i now for geriatricians, also for physicians who go to rural areas. So I’m factoring those elements into my career plan.” JABSOM students and graduates have learned about—and are prepared to deal with—the many medical needs endemic to Hawai‘i. Pediatric residency intern Dr. Blair Limm (JABSOM ’14) says her training has taught her a great deal regarding the health issues specifically afflicting the people of the Islands. “Kawasaki disease is more prevalent in Asian communities,” Dr. Limm says. “Rheumatic heart disease and a kidney disorder called post-streptococcal glomerulonephritis are more prevalent in those of Polynesian descent, along with a staph infection called methicillin-resistant staph aureus. These are things we see more commonly than in other hospitals throughout the U.S. We also see cultural differences in patients from Micronesia, Polynesia, Asia and other nations of the Pacific that affect our health care approach. These are all important to me because I want to become a physician in the Hawai‘i community, and treat the unique diseases here in the Islands.” The dedication of students at the John A. Burns School of Medicine to serving Hawai‘i is also viewed from another perspective: that of an appreciative parent. “I hear the conversations among my son and his classmates,” says Tina Semenza, whose son John and his friends graduated from JABSOM. “They’re all local Hawai‘i kids, they all went to school here and they all came home to practice medicine. They just want to help people. They live in the moment to heal, instead of thinking, ‘I want a big house, I want a big car.’ When you come home to Hawai‘i, it’s about

lifestyle and family instead of economics, and you see it with these kids.” It’s the mindset that JABSOM student Kristine Layugan has already adopted, as she embarks on her medical education. “There’s just so much good that you can do, working with families, and they’re so grateful,” Layugan says. “I just love Hawai‘i and the people, and I want to help take care of Hawai‘i and their children and families.” Fortunately for the people of Hawai‘i, Layugan is hardly alone in her sentiment. Historically, there has been an irresistible draw for the lion’s share of JABSOM alumni to pursue their medical practice here in the Islands. “When we teach our students what they need to learn to be a physician here in Hawai‘i, we have a great probability of retaining them,” says JABSOM dean Dr. Jerris Hedges. “In fact, if they finish medical school here, then do their residency in their chosen discipline here in Hawai‘i, we have an over eighty-five percent practitioner retention rate. That’s the very best in the nation.”

With a Little Help From Some Friends Some of Hawai‘i’s best and brightest may have never had the opportunity to see the inside of a classroom at the John A. Burns School of Medicine were it not for a bit of financial assistance through scholarships. “I was very fortunate to be a Weinman Fellow,” says Dr. Alyson Tamamoto (JABSOM ’11), co-chief resident in the pediatrics department at KMCWC. “Barry and Virginia Weinman offered to pay my tuition for all four years of medical

school, plus an educational Dr. Alyson Tamamoto (JABSOM ’11): “I was one of stipend for four years. I was one four Weinman Fellows in our of four Weinman Fellows in our class, and it was an amazing class, and it was an amazing opportunity for me.” opportunity for me. It meant the world to me. I was so fortunate to have the Weinberg Foundation support me through medical school.” Another recipient of the Weinman Foundation’s largesse is resident Dr. Kristine Layugan. “It’s so expensive to go through medical school,” Dr. Layugan says. “To not have an enormous financial burden after medical school has been such a blessing, and I’m just so grateful to the Weinmans for their support.” Pediatrics residency intern Dr. Blair Limm says her fouryear scholarship at JABSOM not only eased what would have been a tremendous financial burden, but it also allowed her to freely choose the career path of her dreams. “Without the scholarship, I would not have had the luxury

Dr. Blair Limm (JABSOM ’14): of choosing my path in a primary “I want to become a physician care field like pediatrics,” Dr. in the Hawai‘i community and Limm says. “Because of the high treat the unique diseases here cost of medical school, many of in the Islands.” the graduates end up choosing a specialty that they hope will be the most lucrative or profitable. Thanks to my scholarship, I was able to choose something that I love instead of worrying about the financial burden hanging over my head.” Sometimes it takes resourcefulness, persistence and a bit of creativity to ease the financial burden of medical school. JABSOM student Michele Kanemori (JABSOM ’18) and her family cobbled together a handful of scholarships to pave her way. “I received a JABSOM MD Alumni scholarship, and a Will J. Henderson Aloha Fund scholarship,” Kanemori says. “The scholarships have made a tremendous difference for me. It has motivated me to work even harder, and to give back once I graduate, to find a way to help other students in the future.”

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Lives Held in the Balance Undeniably, any prospective student applying to the John A. Burns School of Medicine is facing slim odds of acceptance, then a heavy financial burden after admittance. But if the stakes for those seeking enrollment at JABSOM seem dauntingly high, perhaps that’s as it should be. After all, the path to a medical degree is no casual undertaking; it demands a 100 percent commitment, 24/7. And the very lives of the people of Hawai‘i quite literally hang in the balance. “I’m in the ICU right now—the intensive care unit,” says pediatric resident Dr. Donna Deng (JABSOM ’12) about her cycle of training. “Having to try to resuscitate a patient is the most chilling, nerve-racking situation you can imagine. Especially in pediatrics. One day these kids were just running and playing, then some kind of infection or illness landed them in the ICU. Then everyone’s doing chest compressions, administering medications, and those are the moments when you simply don’t know what the outcome will be. Almost equally as tough from a doctor’s perspective is having to share bad news with a family, perhaps a life-threatening diagnosis like cancer or other serious illness. But the John A. Burns School of Medicine has taught us how to think out loud, to talk to people, to reflect, listen and to be there for them. Those are the moments a family will remember for a lifetime. And our preparation at JABSOM lets us help them at those critical times.” JABSOM student Xuan-Lan Doan (JABSOM ’18), from Philadelphia, says the training to deal with those “big moments” in medicine begins early. “My most recent clinical skills preceptorship was in the

Dr. Donna Deng (JABSOM cardiology and pulmonary unit,” ’12): “JABSOM has taught us Doan says. “Our preceptor how to think out loud, to talk to physician was consulting someone people, to reflect, listen and to who had just been diagnosed with be there for them. cancer. It was very raw emotion, and it brought us an exposure to the real humanity underlying the medicine. I’ve had an experience with cancer in my family, so for me there was a very personal filter. The clinical exposure, the real-world medical and emotional challenges—you get all of that right away at JABSOM.”

“Greatness Waiting to be Made Possible” It is not hyperbole to suggest that the good health of the people of Hawai‘i can be traced in large part to the talented, skilled, dedicated students and alumni of the John A. Burns School of Medicine.

Xuan-Lan Doan (JABSOM ’18): “Hawai‘i ranks highest in “The clinical exposure, the realhealth among all other states,” world medical and emotional says Dr. F. Don Parsa, chief of challenges—you get all of that the plastic surgery division at right away at JABSOM.” JABSOM. “It’s my firm belief that it’s because of our medical school, and the quality of the medical students that we select. Our students are not only selected on scholastic achievements. They’re selected on their humanism, on the service they provide to the community and the service they have provided in the past. They become superb, giving individuals when they finish medical school, and we are all truly blessed in having our students join the community, as servants of the people.” And the concept was sewn into the foundational fabric of the John A. Burns School of Medicine: students who pass through JABSOM’s doors as graduates will then go on to serve the community of Hawai‘i. “We’ve been able to live that mission over the past five

decades,” says Dr. Richard Kasuya, associate dean for medical education at JABSOM. “There is a very deep connection between our administration and faculty, our students and the community at large. It’s an interesting relationship we have here, and I think it’s quite special.” Thanks to JABSOM students’ unsurpassed commitment as medical professionals—and their unique puzzle-solving skills through their problem-based learning training—they are held in high regard across the nation and around the world. “If I hear that they come from this medical school, I say, ‘You’re my doctor,’” says retired state appeals judge Jim Burns. “There’s no doubt about it, these are first-class doctors. I’d put them up against any physician, anywhere in the country. In fact, I keep hearing when they go to the Mainland for their residencies,” Jim says, “the others say, ‘Hey, these docs from Hawai‘i are ahead of us!’” And Dr. Naleen Andrade, former chair of the psychiatry department at JABSOM, has a message for the benefactors who have invested in the students at the John A. Burns School of Medicine. “For those of you who are donors that give to our school,” Dr. Andrade says, “I can assure you that your gifts are not wasted. I am living proof of the kind of dedication. I would never have become a physician. I came from humble beginnings, and because of your donations, because of the commitment of our state legislators and the namesake for our school, Governor John A. Burns, I exist. There are many other remarkable students from our school whom I’ve had the opportunity, the pleasure and the honor to mentor. And for the next generation, it is as Governor Burns said, ‘Amongst Hawai‘i’s children, there is a greatness waiting to be made possible.’”

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Chapter Eight

PRIDE AND PERSISTENCE: PIONEERING BREAKTHROUGHS IN RESEARCH FIFTY MICE LEAD THE WAY

ll it took to land the University of Hawai‘i’s John A. Burns School of Medicine squarely at the center of the esteemed international medical research community…was fifty identical mice. The year was 1998. And those mice were, of course, the product of decades of work and dedication by the legendary Japanese-born University of Hawai‘i reproductive biology pioneer Dr. Ryuzo “Yana” Yanagimachi. The mice made Dr. Yanagimachi and his research team famous. But before the fame, the foundation had been laid by years of hard work and “out of the box” thinking on Dr. Yanagimachi’s part. “Yana’s early work here at the University of Hawai‘i paved the way for the entire field of test-tube babies and ART, or assisted reproductive technologies,” explains Dr. Steven Ward, director Researcher Jonathan _______ of the John A. Burns School of ______ at work in JABSOM’s Collier Lab. Medicine Institute for Biogenesis

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Research. “If a couple can’t get pregnant, there are two main ways we can help. We can take the eggs and the sperm and put them in a test tube and let the sperm find the egg—this happens a lot easier than it would in the body. Or—and this is what Yana pioneered—we can take a needle and actually pick up the sperm and inject it into the egg. Practitioners create millions of babies every year through those two technologies. And this was all due to the work of Yana at the beginning.” But—after Dr. Yanagimachi’s breakthrough work in ART— from whence all the mice? They came on the heels of Dolly, the sheep cloned in 1997 by scientists in Scotland. The world took notice of the cloning achievement, though some were skeptical. After all, Dolly was the only animal produced, out of 400 tries. Dr. Yanagimachi and his team, including Dr. Teruhiko Wakayama, believed they could do better. They devised a new, more reliable cloning method that produced three generations of cloned mice starting with a single cloned mouse they named Cumulina. She was given her name because Dr. Yanagimachi and his team used nuclei from cumulus cells of adult mice.

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Reproductive biology pioneer Dr. Ryuzo Yanagimachi: Groundbreaking research in the cloning of mice (below) made “Yana” and his team the darlings of the international science community.

They then produced fifty mouse clones—using what became known as the “Honolulu Technique”—and even showed that they were able to produce clones of clones. The work made Yana and his team the darlings of the international science community. Then in the following year, members of Dr. Yanagimachi’s team advanced the science further by demonstrating a new method of transgenesis, or the transferring of genetic information or DNA from one animal to another. And they did it in a headline-grabbing way—by creating a species of mice with DNA information that made them glow in a shade of green. Why green? “Mice of course are never really green,” Dr. Ward says. “But to prove that the cloned mice were actually the product of their fertilization technique, Yana and his team injected a green fluorescent jellyfish protein as a marker that fluoresces under black light.” Some might say the world does not need green mice. But those mice—and the work of Dr. Yanagimachi and his team— have become the foundational model for reproductive and cloning research worldwide. Most in the science community agree that the logical extrapolation of Dr. Yanagimachi’s techniques and research can lead to myriad treatments and cures for disease—through safe and guided, targeted and controlled re-direction of healthy DNA—in plants, in animals and ultimately in all of us. The legacy of Dr. Yanagimachi’s mice even lives on as a valuable daily research tool at the John A. Burns School of Medicine’s Biological Sciences Research Facility. Two $10 million cycles of grant money from the Center of Biological Research Excellence (COBRE) are the tip of

the research funding iceberg that has supported faculty and research positions at the facility. And thanks to the infusion of that funding, the COBRE grants have also paid for more green mice. “We were allowed to set up a core facility so that we could make these green mice for everybody in the medical school,” Dr. Ward says. “These genetically modified green mice allow you to create mice that have particular diseases that you can then study.”

Paradigm Shift The disposition toward the support

embraced those efforts, for the ultimate overall benefit of both the medical school and the state of Hawai‘i. Through coordination with Dr. Frederick Greenwood, director of the Pacific Biomedical Research Center, Dean Cadman built a model that funneled grant funding for research into the medical school system. “Dr. Cadman said, ‘I want your grants, bring me your grants,’” Ward says. “He said, ‘The more grants you get, the better. Let’s change this thing into a culture of research.’” Governor Cayetano recalls that Dr. Cadman described the research-funding model to him as they made plans for the research facility at the Kaka‘ako campus. “I said to him, ‘How will we pay the professors, the researchers?’” Cayetano recalls. “And he said, ‘I’ll bring in people from schools like Harvard and Yale. At Harvard and Yale, they don’t pay the faculty.’” Cayetano says he was perplexed. “I didn’t know that. And I said, ‘Really? How are they funded?’ And he said, ‘These guys, these women are so good, they go in and get grants. And they pay themselves.’ That’s the model that he explained to me.” Dr. Ward, who had come from Rutgers University, along with Dr. Marla Berry, the current chair of cellular molecular biology at the John A. Burns School of Medicine, were among the earliest researchers lured by Dr. Cadman’s new model. “I was at Harvard, and I had National Institutes of Health funding, and it turned out that the timing was perfect,” Dr.

“Dr. Cadman changed

the culture of this medical

and development of research at the John A. Burns School of Medicine underwent an enormous paradigm shift around 2005 through the vision of medical school dean Ed Cadman. Dr. Cadman had not only been instrumental in working with Governor Ben Cayetano to establish the medical school’s new Kaka‘ako campus, he had also encouraged an entirely new approach to the pattern of funding for research at the school. “Dr. Cadman changed the culture of this medical school 180 degrees,” Dr. Ward says. “Before Dr. Cadman came here, everybody who wanted to do research had to fight a tidal wave to do it.” Instead of avoiding the efforts required to do research, for fear of expense or administrative challenges, Dr. Cadman

school 180 degrees.”

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Biogenesis research director Berry says. “Dr. Cadman was Dr. Steven Ward: One of the dedicated to showing that the first researchers beckoned to University of Hawai‘i could attract Hawai‘i by Dean Cadman’s people from top-tier schools with new grant funding model. track records of funding, and a number of other top researchers followed.” The funding histories of the work of both Dr. Berry and Dr. Ward provide good examples of the effectiveness and success of Dr. Cadman’s model. “I’m in the nineteenth year of funding from the National Institute for Diabetes, Digestive Diseases and Kidney Disorders,” Dr. Berry says of her research in the field of selenium applications and effects. “I’ve also had funding from the Neurological Institute, the National Institute for Neurological Diseases and Stroke and the National Institute for Minority Health and Health Disorders, as well as other grant sources.”

Dr. Ward points out that his group’s $20 million in COBRE funding over a ten-year period brings money to the state of Hawai‘i. “Eighty percent of that $20 million goes directly into the Hawai‘i economy,” Ward says. “And the same goes for our funding here at our institute for biogenesis research. The institute has turned its initial $2 million start-up cost into grant funding revenues of $36 million, eighty percent of which also goes into the state economy.” The funding supports a host of research projects that cover the gamut of the medical disciplines. “Our work has focused on trying to understand how selenium gets into proteins, and its role in neurodevelopment, neurogenerative diseases, immunology, endocrinology, diabetes and metabolism,” Dr. Berry says. “We’ve just done a recent study accepted for publication that examined the role of selenium in protecting women from the toxicity of mercury in the fish they might eat during pregnancy.” “I’m very interested in sperm chromatin structure. My research is…sort of unique,” Dr. Ward says with a laugh. “The idea is that the sperm is bringing into the egg more than just the DNA. It brings not just the genes, but it brings with it the ‘instructions’ on how to use the genes.” Dr. Ward describes the fertilization process he and his team have been analyzing by way of an analogy. “Imagine an old tape cassette, with our DNA molecules as a long string, like the tape in the cassette,” Dr. Ward says. “If that long ‘tape’ of DNA were pulled out of the cassette and piled on top of it, you certainly wouldn’t be able to play the tape in a tape recorder.” Dr. Ward says his team’s studies have demonstrated that previously unidentified components in the male sperm function—much like the tape cassette in the analogy—in fact

help guide and organize DNA in the embryo, allowing for a healthy birth. “Our work becomes critically important where men and women are having trouble getting pregnant,” Dr. Ward says. “If the wife’s diagnostic tests come back as normal, we can then examine the chromosome structure of the husband’s sperm, perhaps identify abnormalities and advise the couple on the best path forward.”

Body and Mind Alongside the study of physical health for the people of Hawai‘i, research at the John A. Burns School of Medicine has made milestone strides in the study of mental health. Dr. Naleen Andrade, former chair of the department of psychiatry at the medical school, pioneered the research into Native Hawaiian mental health. “We completed an epidemiologic project with 7,000 Native Hawaiian kids in the state of Hawai‘i on three different islands,” Dr. Andrade says. “They were all high schools students. And the knowledge we extracted from that study formed the foundation for all the future research that unfolded with youth in Hawai‘i.” “Roughly twenty-seven percent of the kids studied were Native Hawaiian. It was the largest number of Native Hawaiians ever assessed in a community-based setting. The balance was made up of all the other ethnic backgrounds of high school kids in Hawai‘i. So we had a wonderful epidemiologic map to work with going forward, to really shape treatment, prevention and ways of thinking about how Hawaiian culture impacts youth.”

Research ______ _______ in a Dr. John McDermott, whom JABSOM research lab. Dr. Andrade succeeded as head of the psychiatry department, says Dr. Andrade’s research was indeed groundbreaking. “It was done by Hawaiian psychiatrists, with the Hawaiian people. They were able to get into the community, to get permission to be able to find out what the suicide rate was in teenagers,” Dr. McDermott says. “They found it was higher. Why was it higher? What were the nature of the mental disorders, the anxiety and depression in the Hawaiian teenagers? This opened the door for them, for all of us, to begin treatment work by getting into the schools and starting prevention.” And that important work continues today. “I’m interested in looking at communities and populations here in Hawai‘i,” Dr. Andrade says, “and in determining what kinds of behavioral and psychiatric interventions can reverse the trends, the mental health disparities. I’m interested in really

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looking at how we can get our kids and families to do better. The goal is to help them to be able to be engaged with their society, to thrive and to realize their dreams. For me, that is the path toward fulfilling the vision of Governor John A. Burns. I feel a real passion for that. Being a part of this school—with his name attached to it—makes it real.”

Look to Our Environment Down every hall at the John A. Burns School of Medicine Biological Sciences Research Facility, behind each door and whirling inside every centrifuge there are remarkable scientific breakthroughs brewing that feature a connection to the natural world. “Dr. Jun Panee here became interested in the healthful benefits of an extract from bamboo, a traditional Chinese medicine,” Dr. Berry says. “Dr. Panee took a serious scientific approach and collaborated with chemistry researchers to identify the healthful properties in bamboo. She discovered evidence of the bamboo extract’s effectiveness in fighting lipotoxicity, a syndrome that can play a role in heart disease, obesity and diabetes. Dr. Panee has also identified the bamboo extract’s strength in combatting breast cancer tumors. The work has been done in both cell culture and animal models.” Dr. Berry says Dr. Panee is now working on patenting and doing the requisite safety studies to move her team’s bamboo extract research into clinical trials. And Dr. Berry notes that studies like Dr. Panee’s— examining the health value of abundant, readily available, natural resources like bamboo—are indicative of the wealth of

Cellular molecular biology research frontiers still to explore chair Dr. Marla Berry: “There’s right here in Hawai‘i. a world of science out there “A lot of studies being done still to be discovered, whether here in Hawai‘i are focusing on it involves nutritional or environmental exposures.” the marine environment,” Dr. Berry explains. “There are corals and sponges and beautiful sea slugs with incredible colors that are derived from toxins in them that warn their predators not to eat them.” Dr. Berry says there are no doubt overlaps to be discovered between these marine life toxins and possible breakthrough medical treatments. “Researchers are finding that many of the marine environment organisms have analgesic and anti-cancer properties,” Dr. Berry says. “And Hawai‘i has so many species—both terrestrial plants and marine species—that are endemic here, found nowhere else in the world.” Exploring these healing powers of the Islands’ natural resources represents a continuum, which stretches back to the

healing wisdom of the Native Hawaiians. Their application of indigenous Island plants and herbs for medicinal use has been well documented by the University of Hawai‘i’s Departments of Native Hawaiian Health and Complementary and Alternative Medicine. And the echoes resonate today in the research labs at the John A. Burns School of Medicine. “With my work, selenium is a natural dietary component that we get from the soil and anything that grows in it,” Dr. Berry says. “Dr. Panee’s bamboo research is another prime example. There’s a world of science out there still to be discovered, whether it involves nutritional or environmental exposures. There’s so much more we don’t know than what we think we know.” There is also an invaluable symbiosis that has been established between the Islands’ natural resources—offering seemingly unlimited potential for medicinal applications—and the research done in Hawai‘i’s research labs to aid and sustain those same resources. “The papaya ringspot virus is a classic example of the real-world value of research here at the John A. Burns School of Medicine,” says Dr. Berry. “The virus was essentially wiping out the papaya industry here. Researchers here found a way to use a small amount of RNA to inhibit the virus from replicating, and essentially saved the papaya crop.”

Exciting New Frontiers The array of ongoing research projects at the John A. Burns School of Medicine is a complex mosaic that changes quite literally every day.

Institute for biogenesis research director Dr. Ward offers up a non-comprehensive list of a few current projects. “One team is trying to develop new vaccines to treat genetically-modified cancers. Another is, through genetics, working to block obesity in children born to obese mothers. Another team is analyzing the exact effect of drug use during pregnancy. And still others are dedicating their grant funding support to the study of diabetes and AIDS/HIV, both serious health issues in Hawai‘i.” Dean of the medical school Dr. Jerris Hedges reinforces the notion that the ongoing research at the John A. Burns School of Medicine has critical real-world applications. “We’re looking at many of the mechanisms by which viruses and bacteria cause disease in humans, and how they trigger the immune system,” Dr. Hedges says. “We’re looking at breakthrough applications in the cardiovascular system, including how you can deliver drugs and genes through micro-bubbles that can float through the circulation, then with a little ultrasound in a targeted area, open up and push their contents into the tissue where they can begin to have a therapeutic effect. We’re exploring both the basis of disease and new mechanisms for treatment. Our infectious disease program is even doing some work on determining how best to create a vaccine against Ebola. So without question, some very topical things are being addressed. Many in the public don’t appreciate the science that is coming out of our medical school. We have a focus on health disparities, and why certain ethnic or socioeconomic groups are more prone to particular illnesses than others. We’re focused on how to translate basic science knowledge to actual changes in diagnosis and care. We’re very much interested in looking at the imaging of the body, to find what sorts of clues that can give us in terms of

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Psychiatry and neurosciences people’s risk for disease as well professor Dr. William Haning: as early diagnosis. And there are “Meth use in the Islands led us efforts looking at natural products. to establish the first addictions We do that in conjunction with residency training program west of the Mississippi.” the drive to Hilo or Kona, looking at agents that may help prevent or treat cancer as well as a host of other illnesses including diabetes.” Often the research efforts on the campus at Kaka‘ako represent a response to a current, pressing health issue facing the people of Hawai‘i. Dr. William Haning, psychiatry and neurosciences professor at the medical school and principal investigator for the Pacific Addiction Research Center, has spearheaded research and clinical trials in methamphetamine addiction treatment. “It’s a health issue that started small but grew greater and greater,” Haning says. “And sadly, for a long time now we have

had the unwanted reputation of being the methamphetamineuse capital of the U.S. The problems associated with meth use in the Islands, along with alcohol and opiate dependence, led us to establish the first addictions residency training program west of the Mississippi. Our work in both research and training has helped us to be increasingly better at managing patients’ care.” Truly effective research efforts take a village of cooperation. Associate dean for medical education Dr. Richard Kasuya says an emphasis on interdepartmental study and sharing has enhanced the scope of research activities and achievements on the campus at Kaka‘ako. “One key area of focus has been the neurosciences, with links to behavioral health and geriatric care,” Dr. Kasuya says. “The further strength of the research effort has been in seeing how one center or one area of focus can really partner and branch out to others.” Medical school vice dean Dr. Satoru Izutsu also points to research milestones in several fields. “There have been key advancements here through research programs in malaria, programs in genomes and also in HIV research,” Dr. Izutsu says. And Dr. Izutsu is quick to point out that the pioneering research at the John A. Burns School of Medicine does not happen in a void, apart and separate from the medical education at the school; rather, the two “arms” of the school can and do work very much hand in hand. “Our students always have access to mentors within the research facility, for them to shadow or to help them if they choose to start a research project,” Dr. Izutsu explains. “Their work together will train students’ minds to understand that everything they do had a basis in gathering data to ultimately benefit their patients.”

Dr. Benjamin Young, former dean of students at the John A. Burns School of Medicine and past director of the Native Hawaiian Center of Excellence, echoes the sentiments of Dr. Izutsu regarding the importance of synchronicity between the school’s education and research branches. “There’s no question,” Dr. Young says, “In order to provide the best primary care services, or any services in the field of medicine, you’ve got to have the research data. Here, you have the two together working continuously to reach the ultimate goal of improving the health care for all people in Hawai‘i.” Data from the fiscal year 2013 shows that the John A. Burns School of Medicine brought in more than $40 million in so-called “extramural” funding by way of grants and contracts. This funding is vitally important to support faculty and the research mission in a community-based school like JABSOM, which does not have an integrated university hospital to generate income. The success of the school in generating this extramural funding is leading the way for the rest of the nation. Of the other thirteen American Public Land-Grant Universities (APLU) community-based schools across the country (out of the 141 LCME accredited MD-granting medicals schools in the U.S.), JABSOM’s funding for its research efforts places it on top. And Dean Hedges says the success of the research efforts at the John A. Burns School of Medicine—including finding the funding for it—is a tribute to dedication and resourcefulness of those working in the laboratories. “The research support brought in by our faculty is really among the best in the nation for a public, community-based school,” Hedges says. “Many universities have support that comes from their university hospital. Here in Hawai‘i, our

Researcher ____________ community hospital partners’ _____ ________________ primary focus is on delivering inside JABSOM’s Hyperbaric care to their patients. As a result, Treatment Center, which their ability to support research conducts clinical research and provides treatment for has been fairly limited. Most of the recreational divers and other grants that come in are the result patients requiring hyperbaric of hard work of the faculty who oxygen therapy. are overseeing both junior faculty and resident research. They are grants that are largely focused on the translation of science into new diagnostic tests and treatments, and ways in which we overcome disparities in health outcomes.” “Research is vitally important for a medical school,” Dr. Kasuya says. “It helps push knowledge forward. It helps to bring science to the treatment of the patients that we all care about.”

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Chapter Nine

RICH REWARDS: CARE AND COMMITMENT “I DISCOVERED WHO I AM”

s the students and alumni of the John A. Burns School of Medicine serve the health needs of the people of Hawai‘i, they reap immeasurable personal rewards. For the current students, there is the evergrowing awareness that their studies and their skill building— though challenging at every turn—represent the realization of their fullest potential. “When I started medical school, I knew I was passionate about medicine and I knew that this is what I wanted to do,” says JABSOM student Anna Flaherty (JABSOM ’15). “But it has been a long path. I had a lot of kind of stumbles and obstacles that I had to get over, and at each juncture I had to stop and think, Okay, is this really what I want to do? Do I want to commit this much of my life to school? Can I do this? Am I capable?” Flaherty says at each critical Opposite and right: Students juncture, she found the same answer and their families celebrate at Match Day 2015. to all of her questions.

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“Every time, the answer Anna Flaherty (JABSOM ’15): “For me, it’s really been was yes. Even though medical discovering who I am.” school is the most challenging time of your life, it’s also the most rewarding. For me, it’s really been discovering who I am,” Flaherty says. “It’s been coming to terms with what I love, what I’m good at and finding the specialty that I want to go into. That’s what medical school does for all of us and it’s helped to guide me on my own path.” Flaherty’s classmate Mark Pilar (JABSOM ’15) echoes her sentiments. “The biggest reward has been the personal growth,” Pilar says. “Coming into medical school as a first-year student, it’s just a Pandora’s box. You don’t know what’s going to come out of it. You walk into it, and you hear discussions around you about what’s ahead and it almost doesn’t sink in that you’re

Mark Pilar (JABSOM ’15): really here. It really took me all “The biggest reward has been of the first three years. It was the personal growth.” in my third year of medicine that I finally realized, ‘Hey! I’m going to be a doctor one day!’ I’m on a military program. It’s the Healthcare Profession Scholarship Program. So I’ll do my residency within the military over the next four to five years, then be contracted to work with the military for the following four to five years. And even though my path is set in that regard, it’s been the education here at JABSOM that has helped me grow into the role I’ll be assuming. It’s the best thing that could possibly happen.” JABSOM student Nikki Castel (JABSOM ’16) has found her personal rewards in the abiding spirit of belonging and cooperation blanketing the campus of the John A. Burns School of Medicine.

“It’s a powerful community Nikki Castel (JABSOM ’15): “It’s a powerful community feeling.” feeling,” Castel says. “We get so much help from the faculty in the first couple of years, and then we’re able to give back. For example, with the health services for the homeless program that the school runs, during our third year we rotate there, work with the professors and get the chance to give back a little bit. Of course, even during that time we’re still learning. But it feels kind of like a cycle, of giving and taking, giving and taking. It’s really nice.” Castel’s classmate January May Andaya (JABSOM ’16) says she is overwhelmed and humbled by the sheer magnitude of the responsibility every JABSOM student is afforded. “It’s such an amazing privilege to be in the field of medicine,” Andaya says. “You get the chance to meet so many different people, and they’re entrusting you with information

January May Andaya (JABSOM that is the most private and ’15): “It’s such an amazing important in their lives. They privilege to be in the field of share their hopes, their fears, their medicine.” toughest times and their happiest moments. It might be bringing a baby into the world or it might be losing a loved one. I’m honored to wake up every morning knowing that one day soon I’ll take the role of a physician, to be able to help others.”

Real-World Rewards It’s just a short trip after medical school—a bit further down the road along the continuum of the JABSOM physicians’ development and training—for them to begin to see their profound impact on the grateful patient community.

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And graduates of the John A. Burns School of Medicine say: the return they get is the stuff their dreams have been made of for many years. “The best thing about pediatrics is just watching the kids get better,” says Dr. Kyra Len (JABSOM ’03), clerkship director for pediatrics at Kapi’olani Medical Center for Women & Children. “They might come in very sick, but you give them a little medicine, or sometimes you sit back and they repair themselves. It’s an intense situation as families come in when their child is sick and feeling helpless. We get to play a very important role in that dynamic. Then we get to see the kids get better and we get to see how grateful the family is for helping their child.” Pediatrics resident Dr. Kendra Dilcher (JABSOM ’14) has seen that same gratitude from youngsters and their families in the “peds ward” at KMCWC. “I’ve felt privileged to watch the effects of what I had to offer them, even as a medical student,” Dr. Dilcher says. “With our whole medical team, we’ve been able to help young patients get up from being sick in bed, then get them out playing. For me that’s huge. It makes my day. I was lucky enough to be part of that during my MD training at KMCWC. And now, being a resident in the same facility, I get to see many of the same kids. Some of my favorite kiddos are the hematology-oncology kids who have cancer. I see them coming in for chemotherapy treatments. Being able to watch their progress, year in and year out—and how we’re helping them treat or cure their cancer—to me, it’s amazing.”

Pride In Their Mentors’ Eyes Plastic surgery division chief F. Don Parsa congratulating student Quinlinn Adolpho at the 2014 White Coat Ceremony: “My greatest reward has been getting to play a part in the teaching of these students.”

The men and women charged with the responsibility of training the students of the John A. Burns School of Medicine also enjoy rich rewards from their labors. That’s because they watch their charges head into diverse areas of specialty with an enduring kind of parental pride. “My ‘chicken skin’ moment is watching them graduate,” says Dr. Nanette Judd, former director of the ‘Imi Ho‘ola PostBaccalaureate Program. “To be there at graduation—to see the ‘Imi Ho‘ola students, and the students from the Native Hawaiian Center of Excellence go off to their specialty training, then come back home to make a difference—that is easily my greatest reward. Whenever I look back, the names all just run through my head. So many of them have made an enormous difference in giving back to the community, to improve the health of Hawai‘i’s people. That is, after all, the core mission of this medical school.” On occasion, the mentors at the John A. Burns School of Medicine receive tangible forms of evidence of the success of their students. Esteemed former JABSOM neurosciences professor Dr. Martin Rayner says one piece of that evidence came to him via the U.S. mail. “One of our neuroscience students went off to be a resident at a major neuroscience training center on the Mainland,” Dr. Rayner says. “He sent me a letter to say thank

“It’s intense when families

come in with children feeling sick and helpless.”

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you for all I’d done, for helping him. Then in his letter he said, ‘What I’ve discovered is that I know as much as anyone else who went to any school, anywhere in the country.’ He wrote me to say, ‘I’m at this place where we collect neuroscientists who are the best neuroscience residents in the country. And I’m as good as all of them.’ He finished with a message to me. He wrote, ‘You may not know it—but you’re running a really hot school!’” Dr. F. Don Parsa, chief of the plastic surgery division at the John A. Burns School of Medicine, says that in his roughly thirty-three-year tenure with the school, he has been thrilled to see a true legacy of medical professionalism passed down across generations within the extended JABSOM family. “Now I’m seeing the children of the students I’ve taught in the past entering the medical school and joining our ‘ohana, our family of physicians caring for Hawai‘i’s people,” Dr. Parsa says. “My greatest reward has been getting to play a part in the teaching of these students, who I know will be whole-heartedly serving the community in the future.” And many of JABSOM’s mentors—like JABSOM geriatrics department founder Dr. Patricia Blanchette—say their greatest joy is born out of the experience of seeing their students follow in their own professional footsteps. “People come to me and sing the praises of one of our former fellows in geriatric medicine, or one of our residents who took an interest in geriatrics when they were in training,” Dr. Blanchette says. “When people tell me how great they are, I love it. I love it because I love teaching, and when I hear that people I’ve taught are doing good work, that’s the best validation in the world.” “That’s where we get our greatest joy,” says Dr. Richard

The Sweet Sound of Gratitude

Dr. Patricia Blanchette: “When I Kasuya, associate dean for hear that people I’ve taught are medical education at JABSOM. doing good work, that’s the best “Seeing the students be successful, validation in the world.” seeing the great things they do after they graduate, we share in that pride.” And Dr. Kasuya says he and his colleagues follow—with hawk-like attention—every professional and personal transition and achievement of every one of their previous students. “We get really excited when we see one of our former students opening a practice, or maybe providing some expertise on the news,” Dr. Kasuya says. “It’s just very fulfilling for us to get to see that.”

Years pass and lives which once intersected on the campus of the John A. Burns School of Medicine or in the wards of the school’s participating community hospitals will transition in countless different directions. Then on occasion those life paths will cross again for a very specific purpose: an expression of gratitude. Such has been the case for JABSOM psychiatry professor and addictions treatment specialist Dr. William Haning. And Dr. Haning says invariably, the thanks are owed to the entire team of medical professionals at the medical school, all of whom played a critical role in a patient’s recovery. “I will have former patients come up to me and say, ‘Thank you so much for that turning point in my life,’” Dr. Haning says. “They’ll say ‘Thank you for your help resolving my addiction to alcohol,’ or other addictions. Candidly, you might struggle at first, trying to remember what you could have possibly said or done that had such a profound effect. The reality, of course, is that one of your colleagues did some follow work with the patient, to which they related well and ultimately tied it all together.” For all the graduates of the John A. Burns School of Medicine and their mentors, whether the words “thank you” are directed to a sole practitioner or to an entire medical team, the satisfaction and reward they bring are richly deserved. Dr. Benjamin Young, former dean of students at JABSOM, says that’s because the physicians the school produces are, quite literally, lifesavers. “No matter where you go—to the remote areas of the state of Hawai‘i, or to the inner cities, the towns, into every

hospital—there will be an At Wilcox Wards, Dr. Barry Mizuo confers with Dr. Donna individual who will say, ‘Had it Deng and fourth-year JABSOM not been for the John A. Burns student Jihey Yuk. School of Medicine, I would not be alive today,’” Dr. Young says. “The Japanese have a saying for it. Okage sama de. ‘Because of you, I am here.’ What a wonderful tribute for people to say that! It’s such a wonderful statement to hear that, coming from so many people. They truly appreciate the contributions of this medical school and its graduates.”

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C h a p t e r Te n

LOOKING FORWARD: A BRIGHT FUTURE NO TIME LIKE THE PRESENT

n March 2015, the John A. Burns School of Medicine received some happy and richly deserved news: In the latest rankings by U.S. News & World Report, JABSOM ranks among the top twenty medical schools in the country for primary care. Medical schools are ranked only in primary care and research categories. JABSOM’s ranking at number 19 marks the first time in the school’s fifty-year history it has been placed among the elite top twenty, and it signals great things ahead for the school and its response to the health needs of the people of Hawai‘i. But the need is great, and the need is now. JABSOM vice dean Dr. Satoru Izutsu says the mission of the medical school and its community-based hospitals lies in answering a critical shortage in the Islands. “Every day, on any given day, Pre-schoolers from we need about 700 more physicians Honolulu’s Unity School here in Hawai‘i than we have,” receive a primer in health Dr. Izutsu says. “Especially on the care from JABSOM staff.

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Neighbor Islands, and in rural areas. We’re trying very, very hard to fix that disparity.” Medical school dean Dr. Jerris Hedges confirms that outreach and service throughout the fiftieth state is a top priority. “We’ll move toward our Neighbor Islands because that’s where, proportionate to the population, the greatest Dean Jerris Hedges: For the needs exist,” Dr. Hedges says. JABSOM ‘ohana, “there’s “We’ll work toward building health much more that can be done systems on the Neighbor Islands if we’re doing it together.” where the medical school will be a component. And we’ll grow training programs so that we can meet the needs of our population. We’re blessed to have a lot

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of very healthy aging in the Islands, but nonetheless, there is more illness as we age.” Dr. Naleen Andrade, former JABSOM psychiatry chair, says mechanisms are already being laid in place to extend and amplify the school’s outreach for care. “My job in the next five to ten years is to create the plan in which we can move our school to the next level,” Dr. Andrade says. “We have, for example, started a primary care consortium made up of Hawaii Pacific Health, Hawaii Medical Service Association (HMSA), The Queen’s Medical Center and our school’s department of family medicine and its nationally-ranked family medicine residency program. It’s the first primary care consortium of its kind here in the Islands. And we hope to spread that out and take it to every island so that we can increase the numbers of family medicine doctors.” “We have an unusual place here because it’s a rather small community,” says former JABSOM dean of students Dr. Benjamin Young. “People know each other. And personal qualities are so important in making sure we graduate physicians who are going back into the community and relating to the people from whence they came. The hope is that as time passes, more young people will decide to practice in some areas of need, on the outer islands especially. Those from Hawai‘i who are admitted to the John A. Burns School of Medicine—with all their superb human qualities—will graduate and go back to their communities to serve.”

The Numbers Game and Patient Care Looking ahead, part of the response at the John A. Burns School of Medicine to Hawai‘i’s physician shortage involves a planned ramping up of the supply to meet the demand. “We’re increasing the size of our school’s entering class,” says Dr. Damon Sakai, director of medical education at JABSOM. “We’re looking to gradually increase it over the years, and we expect it to be at seventy students instead of our current sixty-six within the next five years. We’re also doing our best to retain the graduates in residency programs here in Hawai‘i. We know that if a student graduates from JABSOM and graduates from one of our residency programs—eighty-five percent of these students will stay and practice in Hawai‘i. So our residency programs are particularly important, and we’re looking for the kinds of candidates who are interested in going into areas of great need here at home.” Those areas of need come in a variety of forms—many of which are unique to Hawai‘i. “There’s a funny saying that if you’ve seen one medical school, you’ve seen one medical school,” says JABSOM associate dean for medical education Dr. Richard Kasuya. “We’re learning what we can from other schools around the country that are doing some creative, innovative things,” Dr. Kasuya says. “But we are all so different, and we have a tremendous investment here in defining exactly who we are,

“The hope is that more young people will decide to practice

on the outer islands especially.”

Members of the HABSOM independent of any other school. Class of 2016 suit up for Just as problem-based learning was surgery for the first time. a huge step forward for us—locally, nationally, internationally back in the late 1980s—I think in the next five years we may see us taking another big similar step,” Dr. Kasuya says, then adds with a laugh, “Stay tuned!” Dean Hedges suggests that the next big directional “revolution” at the John A. Burns School of Medicine may come in the area of research. “It’s very important for us to make sure that the research we do is relevant for the populations we serve,” Dr. Hedges says. “For example, here in Hawaii—much like elsewhere in the U.S.—we’ve found it’s common for folks to overindulge in terms of food, leading to type 2 or adult onset diabetes. As a result, we’re actively engaged in looking at what happens at the tissue level, looking for things that alter the function of our pancreas gland that controls the amount of insulin we produce, along

with several behavioral things to help people here in Hawai‘i manage their lifestyles better and reduce their risk of diabetes.” Dean Hedges adds that our state offers a unique sociological environment for this kind of focus. “The risks differ significantly between ethnic groups,” Dr. Hedges says. “We have the opportunity to sort that out here in Hawai‘i, much more so than in other parts of the U.S.” To this end, progress is already being made in regard to a variety of serious health issues—including obesity, cardiovascular disease, strokes, hypertension and diabetes—highly relevant to native populations in Hawai‘i and all across the Pacific. “Some of the most recent data show that many of the health care needs of so many of the Native Hawaiians have improved,” says Dr. Benjamin Young. “One of the most interesting factors about obesity and hypertension is that programs have been established to address the issues through culturally appropriate means. We never even considered that back in the 1970s. To combat poor nutrition and lack of exercise, why not use surfing? Why not use hula? Why not use lū’au? All these require mental focus, physical fitness and discipline. These are wonderful culturally appropriate activities, which we can use to address some of the health care needs.”

Better Technology, Better Health Care Providers The important strides forward in the years ahead for the John A. Burns School of Medicine will no doubt come in no small part due to enormous advancements in the ever-changing world of technology.

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psychiatrist in Honolulu looking on. It really made it possible for us to enhance the training of our students and residents on the outer islands.” And those were simply the early beginnings of the communication technology that today promises to powerfully link medical professionals across the state of Hawai‘i. “It’s so much easier now, thanks to the Internet,” Dr. Gulbrandsen says. “Of course, nothing replaces the personal, face-to-face contact between physician and patient. But now, whenever and wherever you want them, the support resources can be there electronically for the doctors and their patients, for the teachers and their students, for training and for care.”

Vital Partnerships

Dr. Gulbrandsen, former dean at JABSOM, recalls that even during his tenure faculty members, administrators and students at the school received an early glimpse at “the shape of things to come” through a partnership with Apple computers, GTE and a leading medical instruments manufacturer. “We arranged for Welch Allyn to retrofit their instruments so that video of procedures using those instruments could be seen over a dedicated fiber optic network,” Dr. Gulbrandsen

JABSOM nurtures its close says. “That meant, for example, that connection with the Native you could use a colonoscope in Hawaiian culture: an awa Hilo, or do a G.I. at Queen’s, and ceremony at the building of those viewing the network could see a shrine in the Mala La‘au Lapa‘au healing garden. what was going on. Or by using a skin camera, a primary care doctor far from Honolulu could show a lesion to a dermatologist in Honolulu. A psychiatrist in Hilo did some interviews with a

Perhaps the single most important frontier for the John A. Burns School of Medicine in the years ahead is the forging of key partnerships, both inside and outside the medical school. JABSOM dean Dr. Jerris Hedges points to a critically productive alliance that will be further nurtured within the boundaries of the campus at Kaka‘ako. “Over the last four years we’ve strengthened ties with the UH Cancer Center, creating new opportunities for collaboration in terms of diagnosis and treatment of cancer,” Dr. Hedges says. “The opportunity for the cancer center and the medical school to work more closely around building strong, innovative cancer treatment programs is just now beginning to come together. I’m excited by that.” And invaluable new inroads are being made into team building across a rainbow of medical education disciplines.

Dr. Patricia Blanchette, who founded the geriatrics program at JABSOM, says that looking forward, the key for training health care providers will also be on collaboration. “The practice of medicine is almost never done in isolation, just one discipline at a time,” Dr. Blanchette says. “The practice of medicine is generally multidisciplinary. Patient care can involve multiple types of specialty physicians. And it can involve doctors, nurses, social workers, therapists. I see a move toward collaborative teaching and education in the student years, where some of the introductory or midlevel coursework is done together. It’s exciting to think about that kind of collaborative learning. The move would be away from being medical student-specific and toward being interdisciplinary with other types of health care students who are perhaps looking to become nurses or social workers, all working together learning about issues.” An emphasis on collaboration in the future could also change the manner in which health care is delivered throughout the fiftieth state. “We’re seeing more consolidation of hospitals into systems that will collectively provide support,” says Dean Hedges. “I see the medical school as being able to partner with those hospitals, helping to organize core teaching faculty and leadership within the medical staffs that these hospitals really need to thrive. I’d like to see our practice plan—one of the key elements of community practice that the medical school brings—also be part of that driver for both recruiting and retaining some of the most talented students and residents we graduate, as practitioners, clinical researchers and teachers in our community. The health care that was delivered ten years ago will not be the health care delivered ten years from now,”

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Dr. Hedges predicts. “We will be working more with nurse practitioners, with pharmacists and with other allied health personnel to form teams of providers.” And Dr. Hedges says the work is already well underway at JABSOM. “One of the big areas I’ve been working on with my colleagues from the college of health science and social welfare—represented by medicine, nursing, public health, social work and our cancer center colleagues—is: How do we build a stronger collaborative team that solves health care problems? Part of the answer comes with the recognition that our scientists and physicians should be sharing knowledge and information,” Dr. Hedges says. “For example, things that look promising in the area of cancer treatment are probably promising in other areas as well. Breaking down the imaginary silos—of, say, surgeon versus medical provider or physician versus nurse—and building collaborations in their stead is important.”

Fifty More Years and Beyond It began as a mere pipe dream, five decades ago: a worldclass medical education program and facility for the people of Hawai‘i. The John A. Burns School of Medicine has, in the ensuing years, successfully navigated challenging waters that on occasion threatened its very existence. First, the school was brought to life through the ardent and unyielding determination and vision of its namesake, Governor John A. Burns, and its committed founding fathers.

Then in leaner financial times, the expense of the school became a continuing subject of controversy and debate in the halls and on the floor of Hawai‘i’s legislature. But throughout, the John A. Burns School of Medicine has managed not only to survive, but also to grow, to evolve and to consistently improve through a dedication and commitment to the very highest standards of scholarship in medical education and training. Today the John A. Burns School of Medicine, and all it represents—Hawai‘i’s finest medical students, residents and physicians, trained by truly distinguished, respected teaching professionals—is deeply and inexorably woven into the fabric of health care in the Islands. “It’s just a great place to be,” says JABSOM dean Dr. Jerris Hedges. “We have the best environment and we have people who are closely connected with their communities. Our family, our ‘ohana at the John A. Burns School of Medicine, feels that there is much more that can be done if we’re doing it together. If we’re all in the same canoe, all paddling in the same direction, we’ll succeed. That shared vision is what has meant the most to me.” And that shared vision, according to Dr. Benjamin Young, extends to everyone in the Islands, regardless of their individual histories. “This medical school was created for all the people of Hawai‘i, especially those who have come from difficult backgrounds,” Dr. Young says. “Children of the plantations, people who have struggled to make ends meet, people from very low socioeconomic status. They’ve all richly benefitted from the accomplishments of Hawai‘i’s own children who are the graduates of the John A. Burns School of Medicine.”

What remains for JABSOM in the years that lie ahead is an entire universe of exploration, innovation and excellence in medical education and health care delivery.

“If we look at the goals of our medical school into the future,” Dr. Young says, “Just like our ancestors, we must point our sails into the wind and reach for those landfalls that are still untouched.”

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Epilogue

PHILANTHROPY AND COMMUNITY SUPPORT RESOURCES FOR SUCCESS

ince JABSOM’s inception in 1965, the community has invested generously in the school in the belief that a strong medical school offers Hawai‘i’s young people the opportunity to earn professional degrees otherwise unavailable to them, and that its graduates—both practicing physicians and biomedical scientists—raise the quality of health care in our community and beyond. The Hawai‘i Congressional Delegation and the Hawai‘i State Legislature have played pivotal roles throughout the history of JABSOM; from researching possible models and costs for a two-year pre-clinical program, and later, a four-year medical degree granting program, to providing targeted programmatic and general support to the medical school over the years and designating funds from the Tobacco Master Settlement Agreement to build a state-of-the-art medical education and biomedical research facility in Kaka‘ako in 2005. Key teaching hospital partners and health care organizations throughout the state have invested time, energy and philanthropic support to develop effective medical education, clinical training and research programs at JABSOM. Kapi‘olani Medical Center for Women and Children, Kuakini Medical Center and The Queen’s Medical Center, for example, have all invested in facilities to house clinical

departments for faculty, medical students and residents to train, practice and conduct research. These teaching hospitals, along with Wahiawa General Hospital, also joined JABSOM in creating a joint venture, Hawai‘i Residency Programs, LLC so that young physicians can train in their chosen specialties under the guidance of faculty in multiple hospital and clinic settings throughout the state. The Queen’s Medical Center has invested very generously to establish and expand the Department of Native Hawaiian Health (DNHH) at JABSOM and to support students participating in the JABSOM ‘Imi Ho‘ola Post-Baccalaureate Program. The DNHH is the only medical school department in the nation focused on improving the health of an indigenous population. Our teaching hospitals and other key health care organizations in the state have provided crucial funding to recruit joint faculty members, seed funding for new residency and fellowship programs and medical student training opportunities on the Neighbor Islands.

launch its own Internal Giving Campaign for faculty and staff to invest in its mission. The annual campaign, “Starting from the Inside Out,” is cochaired by JABSOM faculty and emphasizes broad faculty and staff participation. Its goal is to develop a culture of philanthropy at the school and to demonstrate to the broader community the faculty and staff members’ belief in JABSOM’s mission. In 2008, pioneering campaign co-chairs Dr. Naleen Andrade and Dr. Elizabeth Tam secured gifts from 252 faculty and staff and raised a total of $96,863. Since then the campaign has grown dramatically. In 2014, Dr. Larry Burgess and Dr. Ken Nakamura led the campaign to another record, raising $398,552 from 394, or fifty-seven percent, of JABSOM faculty and staff.

PHILANTHROPIC PRIORITIES For the past six years, the school has worked with donors to invest in multiple programs and priorities, with a special focus on building its endowments, particularly for faculty chairs and professorships, student scholarships, research and rural and Neighbor Island training opportunities. As state funding for the school has declined in recent years, endowments provide much needed resources for ensuring the medical school’s future success.

FACULTY SUPPORT FACULTY AND STAFF GIVING The JABSOM ‘ohana generously supports the school as well. In 2008, JABSOM was the first unit across the UH System to

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Faculty endowments provide key resources for JABSOM leadership and faculty to invest in their respective departments and programs. To kick off its fiftieth anniversary year in

early 2015, JABSOM celebrated its first $5 million gift by an individual donor, the Kosasa family, to create the Kosasa Endowed Chair and two Kosasa Endowed Professorships in Obstetrics, Gynecology and Women’s Health. The medical school is very grateful to all of the donors over the years who have generously created the following faculty endowments.

STUDENT SUPPORT JABSOM’s role in training new doctors is especially critical now that our state faces a shortage of 800 doctors, a number which is growing as more doctors retire without enough young physicians to replace them. The outlook for the Neighbor Islands and rural areas is even more challenging. Medical school has a high price tag so scholarships are key to reducing this shortage. When our new doctors leave JABSOM, they face an average debt of more than $130,000— more than twice what it was just five years ago—and this debt load keeps climbing as tuition escalates. Scholarships allow medical students to make their career specialty decisions based on their passion rather than concern about financial debt and loan repayment. They free students to enter the primary care field, where the need is greatest, and to realize their dreams of practicing in Hawai‘i. JABSOM must be competitive in attracting Hawai‘i’s finest candidates. Scholarships enable us to draw intelligent, motivated and caring students from diverse backgrounds and to encourage exceptional students to attend JABSOM regardless of their financial circumstances.

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That’s why JABSOM has created and will direct net proceeds from the 50th Anniversary Gala to the 50th Anniversary Scholarship Fund. The medical school is very grateful to all of the donors who have created scholarships to benefit our students (see box, right), and we sincerely hope others will choose to invest in Hawai‘i’s health care future by doing the same.

ENDOWED DIRECTORSHIPS AND PROFESSORSHIPS

GENERAL SUPPORT Department of Psychiatry Several endowments at JABSOM founding chair Dr. Walter provide awards for excellence Char (seated) and , in various clinical and research standing left to right, Dr. disciplines. Others provide resources Naleen Andrade, Dr. John McDermott and current for pilot studies, bridge funding, travel chair Dr. Anthony Guerrero. to present outstanding work at the national level or to bring renowned scientists and clinicians here to share their expertise with faculty, graduate students and medical students. In celebration of the fiftieth anniversary, JABSOM will recognize the generosity of its donors by installing a donor wall in the lobby of the Medical Education Building in the summer of 2015. Private philanthropic support for JABSOM in the fiscal year ended June 30, 2014, totaling almost $12.3 million, setting a new record and bringing the six-year total in pledges, gifts and bequest intentions to almost $33 million. The donated value of endowments for JABSOM more than doubled during the same period.

Department of Psychiatry faculty and staff have launched a five-year fundraising effort to endow a professorship in honor of the department’s first three visionary leaders: The Walter F. Char, MD, John F. McDermott, MD and Naleen N. Andrade, MD Endowed Professorship in Psychiatry. Initial gifts from faculty and staff have provided almost seventy-five percent of the amount needed for the professorship, and they will reach out to the larger community to attain their further goal of endowing a chair. Other endowed directorships and professorships:

The Victor and Peggy Brandstrom Pavel Endowed Professorships (2) in Medicine The Dr. Edwin C. Cadman Distinguished Professorship in the Study of Neurodegenerative Disorders The Endowed Director of the Center for Cardiovascular Research The Kosasa Endowed Professorships (2) in Obstetrics, Gynecology and Women’s Health The Judith Dion Pyle Endowed Fund to support the Robert Hong, MD Professorship in the Cardiovascular Disease Fellowship Program

ENDOWED CHAIRS Chancellor Virginia S. Hinshaw Endowed Biomedical Research Scholarship Yoshitsugi Hokama Endowed Fund Jane Takako Fujii Hong Scholarship Shigeru and May Horio Memorial Scholarship Endowment Will J. Henderson Aloha Fund Samuro and Florence Y. Ichinose Scholarship Endowment Stella Lau In Memorial Scholarship Endowment Dr. Satoru Izutsu Fund in Global Health/Medicine Dr. David W. Jones Scholarship Nadine Alexander Kahanamoku Scholarship Endowment Kokame Family Scholarship Litchman Family Endowment in Geriatric Medicine Colin C. McCorriston, MD and Helen D. McCorriston Endowed Scholarship Nomura Emergency Medicine Travel Endowment North Hawaii Medical Education Program Endowment The F. Don Parsa, MD and Touri Parsa Endowment for Medical Student Research Support Wanda Jane Pavela Scholarship Endowment Rural Ambulatory Clinical Education (RACE) Endowment Stanley M. Saiki, Jr. MD Memorial Fund (pledge) Sakai Endowed Scholarship Richard Sherbahn, MD Endowed Scholarship (pledge) Mansfield and Charlotte Snyder Endowed Scholarship Hazel Tominaga Tsutsui Theodore ‘Imi Ho‘ola Scholarship Endowment Tarsavi Wati and Ishwar Dass ‘Imi Ho‘ola Endowment Rose K. L. Wong Endowment (pledge) Kerry T. Yasunobu Memorial Scholarship Yates ARCS Scholarship Endowment Yazawa Family Scholarship

The American Lung Association of Hawai‘i and Lē‘ahi Fund Endowed Chair in Respiratory Health The American Lung Association Endowed Chair in Education and Research in Pediatric Pulmonology The HMSA Endowed Chair for Health Care Services Quality Research The Kosasa Endowed Chair in Obstetrics, Gynecology and Women’s Health The Lakshmi Devi and Devraj Sharma Endowed Chair in Obstetrics, Gynecology and Women’s Health The Myron Pinky Thompson Endowed Chair in Research in Native Hawaiian Health The Kenneth Keiso Uyeda and Nora Saida Uyeda Endowed Chair in Geriatric Medicine The Barry and Virginia Weinman Endowed Dean’s Chair in Medicine

ENDOWED SCHOLARSHIPS Naleen N. Andrade, MD Endowed Scholarship at UH Mānoa Joseph E. Alicata Endowed Fund in Tropical Medicine and Infectious Diseases Kheng See Ang, MD and Lawrence J. Taff Endowed Scholarship Ronald and Carol Ayabe Endowed Scholarship Dr. Kekuni Blaisdell Endowed Fund for Native Hawaiian Health John A. Burns Foundation Endowed Student Fund Benjamin J. Cayetano Scholarship Endowment Empowerment Fund at JABSOM Elizabeth and Richard Grossman Endowed Scholarship Ralph and Jane Hale Scholarship Endowment

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THE JOHN A. BURNS SCHOOL OF MEDICINE: 50 Years of Healing in Hawai‘i

Epilogue

Index

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THE JOHN A. BURNS SCHOOL OF MEDICINE: 50 Years of Healing in Hawaiâ&#x20AC;&#x2DC;i

Index

ABOUT THE AUTHOR Larry Fleece learned to write at Kahala Elementary, Kaimuki Intermediate, and Kalani High School before going on to Stanford University and UCLA. He learned TV production from Frank Kelly and Phil Arnone at KGMB-TV, and has spent three decades working in the television industry in Los Angeles. His greatest joys come from time spent with his wife, Candace Whitaker Fleece, and their two children, Lindsay and Jesse.

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