Rural areas cover about 6,000 square miles and make up 93.9% of Hawaii’s land area. The entire island of Molokai — population 7,400 — is considered rural. The least developed of the Hawaiian Islands, it is 25 miles from Oahu, 8.5 miles from Maui, and light years from Honolulu in terms of having the scope of services many of us take for granted.

On Molokai, the Molokai Community Health Center (MCHC) operates as one of Hawaii’s 14 federally qualified community health centers. Collectively, the centers deliver essential health care to 158,000 people in or near rural areas statewide.

MCHC is a community safety net that integrates primary medical and dental care with behavioral health, lifestyle health and wellness, health education, and supplemental nutrition programs for women, infants, and children. Over the years, it has evolved to meet community needs, adding services typically not offered by a traditional health care provider.

In 2017, the Hawaii Legislature passed measures permitting the use of telehealth for behavioral health services. MCHC seized this opportunity to build its telehealth capabilities from the ground up, including a process for reimbursements, while adhering to HIPAA compliance. This early adoption perfectly positioned the center to seamlessly expand its telehealth services to primary care years later, when the COVID-19 pandemic arrived.

During the pandemic, MCHC operated as a fiscal sponsor to multiple struggling nonprofits by offering opportunities to access much needed emergency COVID-19 economic relief. It also provided ongoing financial guidance and support in managing the funds received.

Molokai faces a severe food insecurity challenge. After Hawaiian Airlines discontinued service, including cargo service, to Molokai in January 2021, MCHC launched a Farm Fresh Food Drive and Food Pantry in partnership with Maui Food Bank. It has since grown into Molokai’s largest and most accessible Food Bank and is the only program offering fresh and frozen foods five days a week. The Food Pantry at the center continues to serve as a central hub and resource for the Molokai community.

Other initiatives include a medical transportation program that provides rides to patients who lack transportation to their health care appointments. Meanwhile, MCHC’s Mana Mobile medical clinic delivers high-quality health services to residents with limited or no broadband access (necessary for telehealth) and includes a complete exam room, restroom, vaccine refrigeration, blood draw station and telehealth services.

Oral health is another critical public health issue, particularly among Native Hawaiians and others in rural neighbor island communities. Planning is underway to double the size of the current dental clinic to provide for the growing needs of residents regardless of insurance status or ability to pay.

MCHC was the first health center in Hawaii to receive a grant to increase access to voting, becoming part of a national effort to integrate nonpartisan voter education into community health care delivery. Community health centers, because they rely on federal funding, must adhere to stringent federal requirements when providing services beyond those of traditional health care to underserved areas. But voter engagement is a natural extension of health care. Elected officials are less inclined to respond to the needs of communities that do not vote. So, removing barriers to voting — particularly in marginalized communities — helps ensure residents’ needs are considered, particularly with respect to addressing disparities in access to health care.

Molokai Community Health Center isn’t the only facility meeting the health needs of its community. But it’s an instructive model for primary care infrastructure and its transformative role in the lives of Hawaii’s underserved and vulnerable rural populations.

Helen Kekalia is CEO of Molokai Community Health Center; Robert Hirokawa is CEO of the Hawaii Primary Care Association.