Residents of Maui continue to recoup after August wildfires ravaged the area. More than three months after the blaze, pediatricians around the island say they are working to support mental and behavioral health needs during a time of tumultuous change for children and families. Their goal is to prevent isolation, create calming and supportive environments, and lead people to resources whenever possible.

People continue to grieve the losses—at least 97 people were killed—while navigating the new normal for daily life. Homes and businesses were destroyed, and displaced over 6,000 residents who continue to live at nearby resorts. With years expected for rebuilding, children have returned to school in new formats, like learning at home, in church buildings, or being bussed to new schools farther away. As all of these changes are made, residents are working together to limit the amount of re-traumatization that may happen.

Dr. Felicitas Livaudais, a pediatrician at the Kihei Clinic, said the multi-generational aspects of Hawai’ian culture are highlighted in how residents say goodbye and grieve their losses. The pediatrician said the community has prioritized healing ceremonies, visiting the burn site to say goodbye to their properties, and taking part in paddle outs for surfers who host ceremonies and lay flowers in the ocean.

In September, the federal government sent 25 public health officers to Maui to assist with behavioral and support services. Public health officers included psychologists, psychiatrists, social workers and nurse practitioners to offer education, complete assessments, and medical health referrals.

“Tragedies like the Maui wildfires have a profound human impact on communities,” said Assistant Secretary for Preparedness and Response Dawn O’Connell in a September news release. “We are committed to doing all we can to assist the people of Hawai’i, and we are working with partners on the ground to assess ongoing needs to support recovery efforts.”

The following month, local health centers and organizations worked together to offer a community health fair. Residents received flu and Covid-19 vaccines donated by Direct Relief, hygiene necessities to take home, haircuts, massages, and culturally important gifts like ukuleles. Medical professionals in the area reported over 2,000 people attended the event.

Dr. Livaudais was one of the doctors on hand at the health fair to administer vaccines to children and adults, and said that supporting people with physical and behavioral health will require culturally competent practices.

In Maui, cultural traditions and beliefs are of utmost importance, and community members are trying to incorporate those practices into healing work through culture, connection, and conditions.

One example is serving musubi, a popular Hawaiian snack made of spam in a teriyaki sauce with rice wrapped in nori, during twice-weekly “Talk Story” community meetings where people are encouraged to gather together to thwart isolation.

“The community is really trying to help each other,” Livaudais said. “It’s hard, but there’s a lot of community support.”

According to the American Psychiatric Association, most people who experience a natural disaster will eventually return to their original level of functioning. However, sadness, depression, difficulty falling asleep or concentrating, and a feeling of numbness are common issues following a tragedy.

The Hawaii Department of Health conducted a needs assessment that found the greatest needs of residents were financial recovery and finding a permanent residence, followed by access to employment. According to the Department, 41% of survey respondents reported a decline in a household member’s health following the fires, and 22% reported their mental health as poor or very poor.

In an email to Direct Relief, a Department of Health representative said that the behavioral health impact of the Maui fires is expected to be significant and long-lasting and that they expect behavioral health needs to grow as the community grieves. The Department said they are making community mental health services accessible, like telehealth grief counseling and in-person therapy.;

A lack of permanent housing has contributed to stress and anxiety. According to the American Red Cross, 6,643 residents, or 2,748 households, within the non-congregate shelter program were housed at local resorts in late November.

Dr. Cassandra Simonson, a pediatrician at Mālama I Ke Ola Health Center, said that the community has tried to respond to as many requests for help as possible—including birthday cakes for kids, clothing needs, and a job opportunity for a musician. She said that while resources are available, some people remain “frozen, and unable to pivot” because they don’t have anyone to talk to and figure out how to move forward after losing everything.

Both physicians expressed concern about the mental health of health workers and first responders and have changed processes to limit emotional distress for patients and providers. In the first two months after the fires, providers asked patients intake questions to determine whether patients had housing and if their families had survived; they have since changed those methods because the questions increased patients’ emotional distress.

Instead, the health center uses sensory-inclusive rooms and play therapy to work with families. The rooms have low lighting, a “crash place” for children to lie down, a fish tank with bubbles, and the option to listen to music or play with toys. Originally intended for autism evaluations, the room is also useful for fire victims.

“It’s just so soothing, and even the parents have said that they felt calmer in those rooms,” Simonson said.

Air quality has been a top concern for her patients’ parents as children re-enrolled in school. Many were supposed to be bussed from one side of the island to the other, passing through the burn site twice daily on the school bus. Simonson warned that driving through the burn site every day could be triggering for children who had to flee their homes.

To better support the many children who survived the fires, doctors statewide are working on a hotline for children who may be in mental distress. Volunteers will answer the phones and point parents and relatives to resources for child psychiatrists, which can be difficult to access without a specific insurance carrier.

“If we can establish safety, at least a general feeling of safety, that’s the goal,” she said.

Direct Relief supported Malama I Ke Ola Health Center and other community organizations during the Keiki Health Fair for Lahaina residents in Ka’anapali, Maui, when over 2,000 people attended to receive physicals, donated vaccinations from Direct Relief (RSV, flu, Covid-19, and TDAP), and to have lost medical records recreated. Direct Relief has supported Malama I Ke Ola Health Center with medical aid since the fires and also with emergency operating funds.