June 30, 2009

He Mana‘o: June 2009

S. Kalani Brady MD, MPH, FACP

Hawai’i Medical Journal

I wish to commend to you an icon. He is a man responsible for so
many of us kauka (doctors) who have been inspired, guided, taught,
nurtured; a man who balanced personal mentoring with societal
change, with a return to recognition of our mana (spiritual energy),
our kuleana (responsibility).

Dr. Kekuni Blaisdell was the John A. Burns School of Medicine’s
first Chair of the Department of Medicine, well chosen for his
excellence in the practice of Western medicine. He is also kupuna
(senior advisor) in the University of Hawai‘i School of Medicine
Department of Native Hawaiian Health, the first department created
to study an aboriginal/first nation population of any medical school
in the United States.

Kekuni was born in 1925 to Nameleonalani Piltz and James
Keli‘ikauahi Akana, both bookkeepers. When he was 7, his father
passed on, and his mother later married William Kaha‘i Blaisdell,
who hanai (adopted) him and his older sister.

When at Kamehameha Schools, he was told he should be an
electrician, because trades were emphasized at that time: how could
a kanaka (Hawaiian) become a physician? In fact he was told by a
ha‘ole (non-Hawaiian) teacher that a few little dots in the Pacific
at the side of the world map were the insignificant Hawai‘i: much
different than our understanding of ka pae‘aina (our homeland) in
the center of ka moana nui (the great ocean, Pacific). He remembers
that at the time, “kanaka” was a derisive term rather than the definition
of human being.

Kekuni graduated from Kamehameha, and went to the churchsponsored
University of Redlands in California. This very conservative
campus atmosphere supported Kekuni’s desire to study, offering
little in the way of extracurricular distractions. He then attended
the prestigious University of Chicago for medical school, and after
completing his internship, he served in the US Army, including assignments
in Korea, Japan, and Taiwan, where he helped set up his
base’s first pathology lab.

Kekuni mastered every layer of health with a passion. As we
know, in medicine, there are several perspectives. The microbiologist
focuses on the world under a microscope. As a doctor in Taiwan
and later Chief of Hematology for the US Atomic Bomb Casualty
Commission, he spent much time in the microcosm of cells.

While in Japan, he adopted his hanai son, Mitsunori
Kamakanaka‘ilialoha, an orphan. In 1962, Kekuni married Irene
Hiroko Saito, and then returned to the University of Chicago,
where their daughter Helen Kaleleonalani was born. After six years
on faculty in Chicago, he was recruited to return to our fledgling
John A. Burns School of Medicine as chair of the largest and most
important field, the Department of Medicine. He helped establish
clinical training programs in Saipan, Palau, Chuuk, Pohnpei, and

As a doctor who finds my own greatest reward in clinical medicine,
I have marveled at Kekuni in the doctor/patient relationship. Unlike
many who bow to the constraints of time and the encroaching of
technology on the patient visit, Kekuni sat and listened to the patient.
He once said he chose academic medicine because it allowed
the time to care for patients the way he envisioned his calling. In
teaching his students, he espoused five principles:

1) the patient comes first.
2) bring science to the bedside.
3) doctor means teacher.
4) have fun at what you’re doing.
5) ka pae‘aina is a very special place.

Countless former haumana (students) use this mantra in their present
practice of medicine.

Many kauka would stop here, feeling that they had given enough to
the calling of medicine: not Kekuni. He ascended up the perspective
again from cellular and microscopic medicine to clinical medicine
one-on-one with patients to a population perspective, and finally to
an understanding of health in the context of our Hawaiian culture.
Rather than simply focus on health disparities in Native Hawaiians
from the perspective of education, socio-economic status, and
cultural differences leading to non-compliance with the Western
medical system, a common Western public health perspective, he
delved deeper into the root causes of poor health in many of our
kanaka maoli (native Hawaiians).

As a founder of E Ola Mau, an organization of kanaka maoli
healers, he provided some of the key early reports on the health of
Native Hawaiians, including the US Congressional Native Hawaiians
Study Commission Report and the 1985 E Ola Mau Native
Hawaiian Health Needs Study Report. These reports had a pivotal
impact on governmental recognition of the state of kanaka maoli
health, and still provide the foundation for further research in this
field. These reports led to the creation of the 1988 Native Hawaiian
Healthcare Improvement Act, and Papa Ola Lokahi, the Native
Hawaiian Healthcare System, which provides research, education,
and clinical healthcare on many of our Hawaiian islands. The reports
also helped support the creation of the Native Hawaiian Health
Scholarship Program to increase the number of Native Hawaiian
health professionals. Kekuni is also a charter member of the ‘Ahahui
o Na Kauka, the Native Hawaiian physicians organization, and a
permanent kupuna member of its Board.

While he might be considered the penultimate internist, he has a
deep knowledge of the healing practices of our culture. He describes
a totally different paradigm from Western medicine. He says that the
essence of wellness is lokahi (oneness) and pono (harmony) with
self, others, and all in the cosmos. Lokahi is inherent, having resulted
from the mating of the sky father Wakea with the earth mother Papa.
Since all things have this common heritage, all things are living,
conscious, and communicating siblings. Pono is maintained by
proper thoughts, feelings, and actions toward the spiritual as well as
the material world. Kekuni says that unfortunate outcomes such as
ma‘i, or illness, result from altered pono or impaired relationships
and loss of mana (spiritual energy). Wellness is primarily restored
by correcting impaired relationships through communication, with
supplemental la‘au, lomilomi, and other modalites used as appropriate
to bring about healing.

With his calm, gentle, but assertive manor, Kekuni Blaisdell
reminds us all of our cultural heritage and compels us to “imua e
na poki‘i

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