1. E aloha ē i ka ʻike maka me ka haʻahaʻa e.... E aloha ē
Mele ʻIke
E aloha ē i ka ʻike maka me ka haʻahaʻa e E aloha ē
E ola ē i ka ʻike naʻau me ka hoʻoāno ē... E aloha ē
E ʻike ē i ka ʻike loaʻa i ka puʻuwai ē, aʻo ikaika ē... E aloha ē
E aloha ē, e aloha ē, e aloha ē
To love all that you see with humility
To live what you feel with reverence
To know all that you possess with a heart of discipline
(from the writings shared by spiritual elder Hale Makua, translated by B. Pualani Case, 2004)
Honor and pleasure to have been invited to return to address the Hawaii Association of Physician Assistants
Hesitation at first when I received the invitation from Joel in June about a week after the protest began on Maunakea, then had this insane idea that somehow I would be able to provide a perspective of the Native Hawaiian Struggles that accompany the protests, and the challenges they might present to maintaining health
You see in traditional Native Hawaiian healing it is believe that healing is 10% physical and 90% spiritual. Therefore, when the spirit is ill, the person will be ill and vice versa, when the spirit is well then the person will be well.
This also means that unless the healer is able to identify the source of illness at the spiritual level then complete healing of the person cannot be accomplished.
In addressing you last year I had spoken about the E ola mau Native Hawaiian Health report, the impact of colonization on the health of Native Hawaiians and the challenges that continue to impact Hawaiians today. As the tension between Ku Kiʻaʻi Maunakea and the government continued to rise it became evident that the wounds of historical trauma inflicted over the past 150 years began to open
I had thought that in 5 months I could somehow begin to bring understanding to the forces impacting the health and well-being of Native Hawaiians.
Set lofty goal
Understand limitations of my own vision
Learn about what I do not know ( what do I not see)
What are the other possible perspectives
How can I begin to see beyond my own visual limitations
Infinite wisdom implies potential for infinite ways misunderstanding

2. Makawalu-- The infinite potential of exploring perspectives
Malia Lee, MD
Family Practice
Assistant Professor,
University of Hawaiʻi, Manoa
Native Hawaiian Center of Excellence
Department of Native Hawaiian Health
John A. Burns School of Medicine
14 October 2019
Sheraton Waikiki
Association of American Physician Assistants
Honor and pleasure to have been invited to return to address the Hawaii Association of Physician Assistants
Hesitation at first when I received the invitation from Joel in June about a week after the protest began on Maunakea, then had this insane idea that somehow I would be able to provide a perspective of the Native Hawaiian Struggles that accompany the protests, and the challenges they might present to maintaining health
You see in traditional Native Hawaiian healing it is believe that healing is 10% physical and 90% spiritual. Therefore, when the spirit is ill, the person will be ill and vice versa, when the spirit is well then the person will be well.
This also means that unless the healer is able to identify the source of illness at the spiritual level then complete healing of the person cannot be accomplished.
In addressing you last year I had spoken about the E ola mau Native Hawaiian Health report, the impact of colonization on the health of Native Hawaiians and the challenges that continue to impact Hawaiians today. As the tension between Ku Kiʻaʻi Maunakea and the government continued to rise it became evident that the wounds of historical trauma inflicted over the past 150 years began to open
I had thought that in 5 months I could somehow begin to bring understanding to the forces impacting the health and well-being of Native Hawaiians.
Set lofty goal
Understand limitations of my own vision
Learn about what I do not know ( what do I not see)
What are the other possible perspectives
How can I begin to see beyond my own visual limitations
Infinite wisdom implies potential for infinite ways misunderstanding

3. disclosure No commercial interests to report m
Infinite wisdom implies potential for infinite ways misunderstanding

4. m
Describe the Hawaiian concept of individual and how it relates to the Hawaiian world view
Explain the concept of Makawalu (eight eyes)
Provide examples of how the makawalu relates to empathy, understanding, and conflict resolution
Objectives
In Ancient Hawaiian, The number eight (e walu) was used as a form of counting
“Makawalu (or eight eyes) stems from a belief that our intelligence is infinite: For each of the eight perspectives one might come up with, another eight will be possible (making 64), and on (to 512), and on (to 4,096), and on to infinite possibility. It is the expectation of abundance over scarcity” (3)
Reference
(3) Rosa Say, Makawalu: Counting our Thinking
November 16, 2011 by Rosa Say accessed
Infinite wisdom implies potential for infinite ways misunderstanding

5. m
Infinite wisdom implies potential for infinite ways misunderstanding

6. NHCOE NHCOE m Established 1990
Part of the Department of Native Hawaiian Health (DNHH) Medical Education division at JABSOM
HRSA Funded with Focuses on legislative objectives
Physician Workforce Development
Cultural Competence and Rural Health training
Student and Faculty Research and Development
Information Dissemination
I work for the Native Hawaiian Center of Excellence where I have been the Director for just under five years.
· Established 1990
· Part of the Department of Native Hawaiian Health (DNHH) Medical Education division at JABSOM
· HRSA Funded with Focuses on legislative objectives
o Workforce Development
o Cultural Competence and Rural Health training
o Student and Faculty Research and Development
o Information Dissemination

7. m
Mission:
To promote the physical and mental health of all Native Hawaiians by
recruiting students into the health professions,
conducting health disparities research,
promoting faculty and student development,
implementing cultural competence development training, and
disseminating information resources relevant to the health of Native Hawaiians
NHCOE
NHCOE Mission:
To promote the physical and mental health of all Native Hawaiians through
recruiting students into the health professions
health disparities research
promoting faculty and student development
cultural competence training
Disseminating Information Resources relevant to the health of native Hawaiians.

8. m
NHCOE
DNHH Mission:
to be a center of excellence in education, research, and quality healthcare practices committed to the optimal health and wellness of Kānaka ‘Ōiwi (Native Hawaiians), their families and communities, while embracing traditional Hawaiian values and practices.
DNHH
Is the only indigenous serving institution in a university setting in the world.
(est 2002)
three divisions: Research,
medical education and Community engagement
Its Mission:
to be a center of excellence in education, research, and quality healthcare practices committed to the optimal health and wellness of Kānaka ‘Ōiwi (Native Hawaiians), their families and communities, while embracing traditional Hawaiian values and practices.

9. m
NHCOE Programs delivered in Premedical undergraduate and medical student curricula include
the history of the overthrow
Cultural trauma
Health disparity
Sense of Place and genealogic significance
Cultural humility and patient care
Immersion and introduction to cultural practices and protocol
More recently, our department has been introducing ways to support student learning in relation to the events happening on Mauna Kea.
NHCOE
DNHH
Is the only indigenous serving institution in a university setting in the world.
(est 2002)
three divisions: Research,
medical education and Community engagement
Its Mission:
to be a center of excellence in education, research, and quality healthcare practices committed to the optimal health and wellness of Kānaka ‘Ōiwi (Native Hawaiians), their families and communities, while embracing traditional Hawaiian values and practices.

10. Hawaiian Worldview Native Hawaiian Core Values:m
Native Hawaiian Core Values:
Guiding principles integrated throughout the lives of the people
Aloha (love)
Haʻahaʻa (humility
Hoʻomana (spirituality)
Lokomaikaʻi (generosity)
ʻoluʻolu (graciousness)
Hoʻohiki (keeping promises)
Naʻauao (intelligence)
Maʻemaʻe (cleanliness)
Kōkua (helpfullness)
Hawaiian Worldview
In 2006, Ku’ulei Serna published “the application of Terror Management Theory to Native Hawaiian Well-being” (RF:slide 8)
“The TMT suggests that in order for an individual to maintain psychological calmness and composure, the individual must sustain
Faith in a culturally derived world view that influences reality with meaning and order and
The belief that one is a significant contributor to this reality
Based on the TMT model the self esteem, anxiety, and adaptive behaviors of hawaiian children are linked to
“Their identification of being Hawaiian
Their ability to practice Hawaiian core values and beliefs and
The restoration of collective cultural pride among native Hawaiians”
Infinite wisdom leaves potential for infinite ways misunderstanding

11. Native Hawaiian Nohona Hawaiʻi:m
Native Hawaiian Nohona Hawaiʻi:
the people are connected to a higher power and to the land that nuturishes and provides
Ke Akua,
ka ʻuhane
God
Hawaiian Worldview
Lokahi
Living in
balance with all three
Na Kanaka
People
Ka ʻaina
Land/Sea
The Hawaiian core values integrated with a deep regard for ke Akua, ka ʻāina and ka au, God, land and self and if any are out of balance then all suffer the consequences.
Infinite wisdom leaves potential for infinite ways misunderstanding

12. Conceptualizing the individualm
Conceptualizing the individual
God
nature
world
community
ohana
Indigenous knowledge
self
Infinite wisdom implies potential for infinite ways misunderstanding
Laurie D. McCubbin, Anthony Marsella. Native Hawaiians and Psychology: The Cultural and Historical Context of Indigenous Ways of Knowing. Cultural Diversity and Ethnic Minority Psychology, American Psychological Association 2009, Vol. 15, No. 4, 374 –387

13. Seeing Self in Community
Indigenous knowledge
Infinite wisdom implies potential for infinite ways misunderstanding

14. Righting the wrongs of devastation Mālama ʻāina
Photo from Hawai Paddle sports
Kaho’olawe Island, Hawai’i. Photo: Island Conservation/MJ Mazurek
With the revival of Hawaiian language, culture, and understanding came the new Hawaiian Renaissance which heightened in the 1970s
When I grew up, I knew that my grandmother and grandfather knew Hawaiian when they were young but they never really spoke it. I learned hula as a child but it was more Auwana or the colonized version of dance. For me, being Hawaiian meant that we worked hard, we listened, we learned by observation and were respectful of our elders.
What I did not know is that while I was growing up a Hawaiian cultural revival was just beginning.
The mid to late 70’s marked a time of
o intense land struggles such as that of Kalama Valley, Kahoʻolawe and Waiāhole/Waikāne, Makua valley
The word "Makua" translates from the Hawaiian language to "parent." Legend has it that Makua Valley was the place where man was first created. It is also considered to be the point from which souls depart this world for the afterlife after their human form has been cast off.
o a resurgence of traditional practices such as loʻi kalo (taro patch) farming, folk arts, and mālama ʻāina (traditional forestry/ land healing and restoration).
o Polynesian voyaging-- In 1975, the Polynesian Voyaging Society built the Hōkūle‘a, a replica of an ancient Polynesian voyaging canoe which re-adopted non-instrument wayfinding navigation
· The movement sometimes touches upon politics, including issues dealing with Native Hawaiians and restoration of Hawaiian independence. Amongst the outcomes was the Constitution of 1978, which produced the Office of Hawaiian Affairs and reclaiming federal land to the State like Kahoolawe and the E ola Mau report which I spoke about last year.
Photo credit Malama Makua
Photo credit Malama Makua

15. m
Na makawalu
makawalu
In Ancient Hawaiian, The number eight (e walu) was used as a form of counting
“Makawalu (or eight eyes) stems from a belief that our intelligence is infinite: For each of the eight perspectives one might come up with, another eight will be possible (making 64), and on (to 512), and on (to 4,096), and on to infinite possibility. It is the expectation of abundance over scarcity” (3)
Reference
(3) Rosa Say, Makawalu: Counting our Thinking
November 16, 2011 by Rosa Say accessed
Infinite wisdom implies potential for infinite ways misunderstanding

16. m
Na makawalu
In Ancient Hawaiian, The number eight (e walu) was used as a form of counting
“Makawalu (or eight eyes) stems from a belief that our intelligence is infinite: For each of the eight perspectives one might come up with, another eight will be possible (making 64), and on (to 512), and on (to 4,096), and on to infinite possibility. It is the expectation of abundance over scarcity” (3)
Reference
(3) Rosa Say, Makawalu: Counting our Thinking
November 16, 2011 by Rosa Say accessed
Infinite wisdom implies potential for infinite ways misunderstanding

17. m
UNDERSTANDING
Each lecture pairs a Native Hawaiian practitioner with a UH
faculty member on the following topics:
*Tuesday, October 29:
Geological and hydrological phenomena of
Maunakea
*Tuesday, November 21:
Meteorological phenomena and island weather
systems relevant to Maunakea
*January, 2020:
Biodiversity and climate/ecological zones on Maunakea
*February, 2020:
Human interactions on Maunakea pre-1778
*March, 2020:
Impact of Maunakea on our understanding about the nature of the universe
Infinite wisdom implies potential for infinite ways misunderstanding

18. Approaching makawalu Owai au? (who am I?) Owai oe? (Who are you?)
Identify elements of your own first visions
Who am I?
From whom? (Genealogy)
From where? (Sense of place)
Moʻolelo ( little story)
Owai oe? (Who are you?)
Identify similar level of understanding in patients
competing perspectives impacting patient care
Owai Makou? (who are we?)
Identify shared interests
Establish and approach to finding common ground
Approaching makawalu
Makawalu involves knowing your own perspective.
Infinite wisdom leaves potential for infinite ways misunderstanding

19. Owai oe? m Who are you? Gain an Awareness of patient perspectives
Ancestry
Family as first culture
Sense of place
Barriers to self care
Historical trauma
Competing interests
Cost
Infinite wisdom implies potential for infinite ways misunderstanding

20. EMPATHY What is Clinical Empathy?
Patients seek empathy from their physicians. Medical educators increasingly recognize this need…. Outside the field of medicine, empathy is a mode of understanding that specifically involves emotional resonance. In contrast, leading physician educators define empathy as a form of detached cognition...
...physicians' emotional attunement greatly serves the cognitive goal of understanding patients' emotions. This has important implications for teaching empathy.
Jodi Halpern, MD, PhD
J GEN INTERN MED 2003;18:670±674.
EMPATHY
Living with makawalu (eight eyes) enhances the potential for empathy.
Empathy is
An important characteristic that helps patients to feel that they are understood,
Feeling their provider is compassionate,
Improves willingness to comply with treatment,
Improves patient/caregiver relationships
When you are able to see and understand another person's perspective you are more likely to be able to perceive the emotions related to that perspective.
a mode of understanding that specifically involves emotional resonance. In contrast, leading physician educators define empathy as a form of detached cognition… (Jodi Halpern, MD, PhD J GEN INTERN MED 2003;18:670±674.)
Within NHCOE our cultural competency training efforts use Native Hawaiians as the host culture to help students to become aware of cultural differences that can impact communication and health outcomes.
The Cultural Competency curriculum (C3) was developed by Dr. Martina Kamaka and a C3 Committee consisting of physicians, educators, social workers, clinical anthropologist) and includes
Explanation of Native Hawaiian History and the impact of colonization on Hawaiian health disparities.
Effects of historical trauma
Methods for establishing patient rapport ( 4 habits, U no speak da kine?, mock interviewing, standardized patient exercises)
Presentations on Traditional NH Healing methods ( Laʻau Lapaʻau, lomilomi, hoʻoponopono)
Cultural immersion and reflections following service learning projects for NH Community groups.
Support for the indigenous student interest group
Deanʻs certificate of distinction in Native Hawaiian Health.
Infinite wisdom implies potential for infinite ways misunderstanding

21. m
Announcement From Michael Bruno, Provost, University of Hawaiʻi 10/09/2019
Mindful of our university's mottos of Malamalama (enlightenment)
and Maluna ae o na lahui a pau ke ola ke kanaka (above all nations
is humanity), I have engaged with faculty, staff, and students in
understanding the depth of the issues surrounding Maunakea across
multiple viewpoints. The critiques and criticisms offered are fair,
and they should motivate continuous reflection and action moving
forward. This process has reminded me that as members of the
academy, we have a profound responsibility to educate ourselves
about Maunakea, and to do so with open minds and with civility and
aloha.
UNDERSTANDING
The Native Hawaiian Center of Excellence
Infinite wisdom implies potential for infinite ways misunderstanding

22. m
Each lecture pairs a Native Hawaiian practitioner with a UH
faculty member on the following topics:
*Tuesday, October 29:
Geological and hydrological phenomena of Maunakea
*Tuesday, November 21:
Meteorological phenomena and island weather systems relevant to Maunakea
*January, 2020:
Biodiversity and climate/ecological zones on Maunakea
*February, 2020:
Human interactions on Maunakea pre-1778
*March, 2020:
Impact of Maunakea on our understanding about the nature of the universe
Sciences and the Sacred:
Conversations on Maunakea (
Other initiatives on campus sponsored by other colleges
The Aloha Aina Friday series hosted by the Native Hawaiian Place of Learning Advancement Office (
UNDERSTANDING
Each lecture pairs a Native Hawaiian practitioner with a UH
faculty member on the following topics:
*Tuesday, October 29:
Geological and hydrological phenomena of
Maunakea
*Tuesday, November 21:
Meteorological phenomena and island weather
systems relevant to Maunakea
*January, 2020:
Biodiversity and climate/ecological zones on Maunakea
*February, 2020:
Human interactions on Maunakea pre-1778
*March, 2020:
Impact of Maunakea on our understanding about the nature of the universe
Infinite wisdom implies potential for infinite ways misunderstanding

23. UNDERSTANDING From outside m To Center
Infinite wisdom implies potential for infinite ways misunderstanding

24. Summary Set lofty goals ( Kulia i ka nuʻu =strive for the summit)
Explore and understand the capacity and limitations of your own vision
Learn about what you do not know (See beyond your own eyes)
Try to understand the other possible perspectives
When you find yourself in opposition, Find common ground in an effort to reach a central solution
Infinite wisdom implies potential for infinite ways misunderstanding

25. UNDERSTANDING Referencesm
References
Halpern J. What is clinical empathy?. J Gen Intern Med. 2003;18(8):670–674. doi: /j x
Megan Shute, The History Of This Sacred Hawaiian Valley Is Terribly Heartbreaking. Hawaii July 21, 2018, accessed
Serna, Ku’ulei. THe Application of Terror Management Theory to Native Hawaiian Well-Being. Hūlili. Vol 3(1) (2006) p
UNDERSTANDING
Each lecture pairs a Native Hawaiian practitioner with a UH
faculty member on the following topics:
*Tuesday, October 29:
Geological and hydrological phenomena of
Maunakea
*Tuesday, November 21:
Meteorological phenomena and island weather
systems relevant to Maunakea
*January, 2020:
Biodiversity and climate/ecological zones on Maunakea
*February, 2020:
Human interactions on Maunakea pre-1778
*March, 2020:
Impact of Maunakea on our understanding about the nature of the universe
Infinite wisdom implies potential for infinite ways misunderstanding

26. Understanding perspectivem
Understanding perspective
Infinite wisdom isees the potential for infinite ways of misunderstanding and infinite levels of hope and possibility
So in my effort to understand
Infinite wisdom implies potential for infinite ways misunderstanding

27. m
UNDERSTANDING
Each lecture pairs a Native Hawaiian practitioner with a UH
faculty member on the following topics:
*Tuesday, October 29:
Geological and hydrological phenomena of
Maunakea
*Tuesday, November 21:
Meteorological phenomena and island weather
systems relevant to Maunakea
*January, 2020:
Biodiversity and climate/ecological zones on Maunakea
*February, 2020:
Human interactions on Maunakea pre-1778
*March, 2020:
Impact of Maunakea on our understanding about the nature of the universe
Infinite wisdom implies potential for infinite ways misunderstanding

28. Sense of Place
Where you come from matters

29. Source of Infinite Wisdom
Infinite wisdom implies potential for infinite ways misunderstanding