For many expecting mothers on Maui, an obstetrician is difficult to find.
The situation has grown even more dire since the Aug. 8 wildfires displaced thousands of people, compounded by Maui’s only private practice recently opting to end its obstetrics services, which include the care of pregnant women and delivery of babies.
It has reached a crisis point, and though some temporary solutions are in place, advocates say long-term solutions are needed to address a chronic shortage of obstetricians on the Valley Isle which persisted even before the wildfires.
“Women who were affected are definitely going through the wringer on Maui,” said Sunny Chen, executive director of Healthy Mothers, Healthy Babies Coalition of Hawaii. “As a whole, collectively, we as a state and country should care more about women’s health.”
Last spring, Maui Lani Physicians and Surgeons had already announced it would be ending those services in October due to challenges including staffing issues, physician recruitment, and low reimbursements from insurance companies.
That left only two providers on Maui — Kaiser Permanente and Malama I Ke Ola Health Center, a federally qualified health care center in Wailuku.
It’s a challenge not only on Maui, but on many of the neighbor islands. The challenges are even greater on Lanai and Molokai, where patients have to rely on limited travel options to get to appointments.
In the initial weeks following the fires on Maui, the nonprofit helped provide medical aid and to distribute supplies to those in need. But there is a lot of work ahead trying to help women and babies access health care and social support services.
“With every disaster, there are worse health outcomes, including heart and blood pressure issues that come with increased stress,” Chen said. “We are trying to help as many people as we can along with community partners.”
This includes expecting mothers, some of whom are temporarily sheltered in Maui hotels or living in tents, who are having a hard time getting appointments for prenatal care.
Chen said long-term issues include inadequate reimbursements and health and transportation inequities. She said she stays up at night worrying about the lack of mental health providers to help expecting mothers.
Shoring up help
With the loss of the only private obstetrics practice on Maui, Hawaii Medical Service Association members were left with only two options — Malama I Ke Ola, which has historically served MedQUEST patients, or switching to Kaiser Permanente, which serves Kaiser members.
HMSA’s short-term solution for expectant Maui moms was to arrange travel and appointments for care on Oahu with physicians from The Queen’s Health System or Hawaii Pacific Health.
“We absolutely know it’s not ideal for a new mom to be flying,” said Dr. Stefanie Park, HMSA’s vice president and chief medical officer. “We absolutely want people to have the least stressful experience possible.”
HMSA last month announced a number of initiatives, including partnerships with Malama I Ke Ola, Queen’s University Medical Group and the Hawaii Independent Physicians Association to provide obstetrician care for members on Maui.
Malama has expanded its clinic space and capacity to accommodate all moms on Maui who need on-island care, according to HMSA, which recently helped the health center bring in a seventh obstetrician, Dr. Bethany Ambrosi.
Park credits Malama I Ke Ola and its CEO, Dr. John Vaz, for stepping up in times of need.
HMSA is also working with Queen’s to recruit full-time obstetricians to Maui. Until that happens, Queen’s is bringing experienced obstetricians from Queen’s to the Maui community in rotating shifts. They include Drs. Bliss Kaneshiro, Robb Ohtani, Shandhini Raidoo and Reni Soon, who will be helping with care and overnight deliveries.
Additionally, HMSA collaborated with the Hawaii Independent Physicians to provide clinical space for the visiting obstetricians at its office in Kahului.
“The doctors on the front lines are the heroes in this solution,” said Park. “They’re working longer hours to make sure access to care is possible.”
Flying to Oahu for care is still an option, based on individual coverage and preferences.
HMSA covers travel and accommodations costs for MedQUEST members when needed services are not available on their home island.
Commercial members, however, foot the bill for travel and accommodations if they choose a health care provider not on their home island.
Doctors are stretched
Doctors serving Maui are extremely busy, and stretched between patients and islands.
Malama I Ke Ola has doubled the number of babies it delivers each month, which is now an average of 60 to 65 deliveries compared with 30 to 35 monthly deliveries previously.
Dr. Men-Jean Lee flies to Maui to see patients at Malama I Ke Ola twice a month as part of a collaboration between the University of Hawaii John A. Burns School of Medicine and Hawaii Pacific Health.
Prior to the COVID-19 pandemic, she flew to Maui once a month, but increased visits to twice a month due to a higher volume of patients following the Lahaina wildfires and closure of the only private practice of obstetricians.
Once a month, she also flies to Kauai to provide care at Wilcox Medical Center. In between those flights, she provides telehealth consultations from the Fetal Diagnostic Center at Kap‘iolani Medical Center for Women and Children.
In addition to a shortage of obstetricians, there is also a shortage of sonographers in Hawaii, she said, which requires a specialized skill set. She brings a sonographer with her every time to provide a much-needed service due to Maui.
Lee estimates about 25% of pregnant women from neighbor islands have to fly over to Oahu to get needed sonograms due to the lack of highly skilled sonographers, sophisticated equipment, and maternal-fetal medicine providers.
The fetal ultrasound scans are vital to tracking the healthy development of the baby, including the screening for birth defects that help determine whether the delivery needs to take place on Oahu.
But travel can be stressful — and sometimes not an option — for expecting moms, who would have to take a day off from work or find child care for their children.
There are also undocumented workers and others with specific health issues who can not fly to Oahu for doctor’s appointments or care.
Searching for solutions
Kaiser Permanente has experienced a roughly 20% jump in deliveries over the past few months, according to Dr. Kristin Redenbaugh, Kaiser’s Maui section chief of OB-GYN.
Kaiser expanded its OB-GYN department on Maui and brought in an eighth OB-GYN doctor, along with a nurse practitioner and three certified nurse midwives, she said.
Maui patients also have access to KP Connected, which offers patients the option of combining in- person and virtual visits.
Obstetrician care is still available at the mobile vehicle in West Maui every Friday, until a temporary new clinic is opened in Kaanapali, which is expected soon. Kaiser’s Lahaina Clinic was destroyed by the fire.
On Hawaii island, said Lee, four JABSOM doctors are helping to take calls and cover prenatal care and labor and delivery services for each other at Hilo Medical Center.
This is ideal because delivering babies is labor- intensive, requiring long hours, which can lead to potential burnout over time, particularly for a solo obstetrician.
“Ultimately the deliveries are the hardest part,” she said. “It’s a struggle as a solo obstetrician to be on 24/7 and stay up all night delivering babies and then go to office the next day to see patients.”
JABSOM and the Pacific Basin Telehealth Resource Center are hoping to launch a new program this summer deploying telehealth vans on each Hawaiian island.
The vans would provide health exams, blood pressure checks and other services such as ultrasounds for those in rural areas.
Maui would be considered a top priority due to its shortage and needs.
“JABSOM has really fostered a network to enhance quality and access to care,” she said, “to try and help support the workforce shortage in maternal health on neighbor islands.”
