As the Maui wildfires grabbed headlines last summer and fall, a locally-based pharmacy team quietly went door to door in devastated Lahaina to ensure survivors had their medications after returning home. A Native Hawaiʻian safety-net clinic also operated a donation center and set up a discreet way for people to request help.

The Maui wildfires last August, which claimed the lives of 100 people, presented a series of tragic circumstances. However, healthcare professionals with deep roots in the community, none of whom had emergency response experience, refused to be deterred and responded to the specific needs of their patients. And they did so in a way that reflects the benefits of building trust and familiarity with the local culture.

“We know Hawaiʻians. Even if it’s free, no one is going to come in and just take. That’s not our style. If we have nothing to contribute, we’re not going to take,” said Mālia Purdy, executive director of Hui No Ke Ola Pono, one of five Native Hawaiʻian healthcare systems.

Purdy, a Native Hawaiʻian, said that setting up a way to get aid to the folks who needed it most was just one part of her organization’s successful response. Immediately after the shelter at War Memorial Complex was established, staff members were there daily, despite Purdy telling them they could take time off to address the losses so many of them suffered.

“I told them (staff) to stay home. They came in anyway,” Purdy said.

All of their post-fire work was done in direct response to community needs – something they could determine due to the trust so many people had in them.

“It was our first natural disaster, so we were just trying to learn the protocol, what services were expected and if we could contribute to what was going on,” Purdy said.

Staff at Hui No Ke Ola Pono’s neighboring Mauliola pharmacy at Wailuku’s Cameron Center were working through the same questions as they were responding at War Memorial and beyond. Hui No Ke Ola Pono and Mauliola had created partnerships in the past, mostly around health education related to diabetes, hypertension, blood pressure monitoring, and smoking cessation. Hui No Ke Ola Pono also referred many of their patients to Mauliola, which has a nonprofit arm.

Like Hui No Ke Ola Pono, Mauliola Pharmacy staff had a bias for action after the fires and began sourcing and filling prescriptions on the day the War Memorial shelter opened. The two groups communicated needs as they responded to survivors and those hosting them in other parts of the island.

“We were trying to organize the chaos as much as possible,” said Tori Ching, director of operations at Mauliola Pharmacy. The pharmacy saw prescriptions jump from about 800 per day to 2,000 per day in the days after the fires.

Like Purdy and her team, Ching and her colleagues created systems on the fly to respond as quickly as possible while integrating new information and optimizing the response.

Once people were let back into Lahaina, Ching and her colleagues began going door-to-door in order to make sure residents had their medications, something she said might not have been at the top of their to-do lists after having lost their homes and, in some cases, loved ones.

The opportunity to help people in this way, Ching said, was based on trust that had been developed over the years.

“Working with patients who already have that trust, it helped us with accessibility,” she said.

“The number one thing when being in a smaller community or working with Native Hawaiʻian populations, our culture here is really based on Aloha and trust.”

Lomilomi and Ho’oponopono

Before the fires and after, Hui No Ke Ola Pono and Mauliola both strived to bridge the gap between traditional Hawaiʻian medicine, called Lāʻau lapaʻau, and Western medicine. Programming at Hui No Ke Ola Pono is built on foundational Native Hawaiʻian customs, beliefs, and practices, according to Purdy.

While Hui No Ke Ola Pono provides primary care, dentistry, behavioral healthcare, and cardiac rehabilitation, they also offer and train practitioners to offer Lomilomi and Ho’oponopono, Native Hawaiʻian healing services. Purdy described Lomilomi as “massage-like, but not nearly as relaxing, it’s more painful… you’re trying to work something out. It’s a practice to realign your body and bring your spirit back into you so you are in total alignment.”

Ho’oponopono, she said, is more “family-based conflict resolution. It’s family therapy but not family therapy.”

Offering them gives the clinic a chance to bring in patients who might not feel comfortable going to Western medicine-based clinics, Purdy said. And vice versa.

“Our native Hawaiʻian population has kind of a reputation for being untrusting of the Western medical system and so it’s important for us to provide access to other forms of healing. And on the island of Maui, we are the only health center that has linkages and ties to traditional healing practitioners.”

Mauliola Pharmacy also fulfills the role of providing a bridge between traditional and Western care. In June, the pharmacy purchased land with the intention of planting traditional crops and providing a resource for community members to reconnect with the land.

From Survival Mode to Rebirth

More than five months after the fires, Purdy and Ching said housing remains a major challenge for survivors on the island. Ching said many pharmacy patients are in “survival mode” as they are focused on finding and maintaining long-term housing.

Given this, she said it’s been hard for her and her colleagues to get patients to focus on things like monitoring their chronic conditions, even as pharmacy staff understand it’s not the priority for patients now.

“We are trying to provide services for the community that they actually need. So we want to come in with a level of awareness. We also want to get back to that place where we can make things like getting them to check their blood pressure a priority again,” Ching said.

Like many other nonprofits, Purdy said that her organization is in a long-term planning period, especially since many outside organizations are starting to offer less support. The overall goal, she said, is training and equipping people and teams that “plan to be on Maui forever.” A major focus has been mental health care and finding ways to bring in more resources.

One plan that has already been manifested is the new Lahaina Comprehensive Health Center. A partnership between Hui No Ke Ola Pono, Hawaiʻi’s Department of Health, Mālama I Ke Ola Health Center, Waiʻanae Coast Comprehensive Health Center, Hawaiʻi Island Community Health Center, and Mauliola Pharmacy, it offers all survivors a venue where they can receive treatment including primary care, wound care, dentistry, podiatry, behavioral care, and case management. As part of the initiative, volunteers and staffers go into the community to share information regarding available resources and check in on survivors.

As new health-related initiatives emerge, Purdy hopes that locals will also be a focus and play a leading role in rebuilding efforts more broadly, something she said should be less about optimizing for tourism and more on “the ways we care for the land, which holds a lot of historical significance,” she said.

Direct Relief has provided medical aid to Hui No Ke Ola Pono and Mauliola pharmacy, and financial aid to Hui No Ke Ola Pono, in response to Maui wildfires.