The third year of medical school is when students at the University of Hawaiʻi John A. Burns School of Medicine do their longitudinal clerkships and get a glimpse of various specialties of medicine. They learn from Psychiatry, OB-GYN, Family Medicine, Internal Medicine, Pediatrics, and Surgery preceptors.
JABSOM students Ashley Lee and Joshua Kepler chose to spend half of their clerkship year on Maui because of their ties to the Valley Isle.
"That's where my mom's side of the family is from, and I wanted to reconnect with my ʻāina and then my ʻohana over there," Lee said. "My grandparents and my mom's family still live on Maui."
"I grew up on Maui; it's where all my family is," Kepler said. "My grandfather, my tūtū man, has been a pediatrician on Maui for almost 50 years." Kepler's father, Kenneth, is a 2000 graduate of JABSOM and practices Internal Medicine and occasionally covers acute care in Pediatrics at Kīhei-Wailea Medical Center.
"When I had the opportunity to return to Maui as part of my third year at JABSOM, I was really excited to go home and start connecting with patients that my family had already taken care of often," Kepler said.
With Lee at the JABSOM house in Makawao and Kepler with family in Kīhei, the students were on Maui for two months, soaking in the knowledge passed down by the doctors who taught them each day.
"We did hands-on clinical care," Lee said. "We would see patients, present them to our faculty supervisor or preceptor, and devise a plan together. This allows us to apply what we learned in the first two years and learn more by doing."
The two months on Maui allowed the JABSOM students to find their groove. They connected with their preceptors and patients and were familiar with their rotations.
That normalcy would be shattered on August 8 when strong winds brought on by Hurricane Dora ignited an inferno that set downtown Lāhainā ablaze. According to Maui County, the fires burned more than 2100 acres and claimed the lives of more than 100 people.
"Lāhainā was known as the land of the aliʻi. A lot of the aliʻi went to Lahainaluna. It was the former capital of Hawaiʻi, where King Kamehameha III lived. There were a lot of fish ponds, a lot of great cultural history, and even a burial ground for Princess Nahiʻenaʻena and Kuini Liliha," Lee said. "I think a lot of my community there is feeling the loss of their history and their culture."
Like many on Maui, the wildfires caught the JABSOM students off guard.
"I went home Tuesday night, and around midnight, our family got an emergency call notification to evacuate our house," Kepler said. We didn't think the fires were that close at the time, but in an abundance of caution, we left. We could return that next morning, and that's when the news broke to pretty much everyone. At the time, we had no idea the extent of what had happened in Lāhainā. There was no electricity or cell, so I was just as in the dark as everyone else."
Overnight, the third-year medical students would pivot from learning to doing. Over the next two weeks, they'd provide hands-on care for the hundreds who survived the deadliest US wildfire in over a century. Each student would treat or interact with upwards of 20 people daily in the two weeks after the fire.
"A lot of people had burns on their arms, their feet, a lot of people fled on foot from Lāhainā," Kepler said.
"We started going to the shelters with our preceptors, and then I think that's when we really saw the extent of it firsthand," Lee said. "We saw all the wounds, the burns, and the mental health extent of it, too."
The ties that brought our students to Maui also connected them to the tragedy. They, too, know people who lost everything.
"My cousin was living in Lāhainā for 15 years," Lee said. "He was a DJ at some bars in Lāhainā, and he was living right on Front Street. He contacted us and told us that he just got out with his car, his laptop, and the shorts that he had on. No slippers, no shirt, he lost his house. It became more real for me when I knew somebody affected by that."
Connecting with survivors became the new mission for the JABSOM students. They went to shelters at Maui High School and War Memorial Stadium, but they say the people there were just a fraction of the true number of people needing care.
"Most of the local people had family on Maui, so they weren't at the shelter. Those are the people who needed help, but they weren't coming out for help," Lee said.
Lee partnered with Mauna Medic Healers Hui, a grassroots Native Hawaiian medical care organization, and went into Lāhainā.
"A lot of them were just scared to leave where they were," Lee said. "They didn't know if the roads would be closed or if they could come back in if they went out to get resources or donations. They didn't even want to go out a few minutes to the gateway center where they were distributing donations because they would have to drive past like the fire, which was very traumatic for them. So we did a lot of house calls. We went to hotel rooms and talked to anybody staying at the beach parks."
The boots-on-the-ground approach allowed Lee to connect with patients who otherwise would likely be alone. She and Kepler practiced the skills they honed for the last two months and served the community in ways they never had before.
"The survivors would text the organizers of those different hubs and say, 'We're in this room at this hotel, and my baby is having a hard time breathing, and I don't want to leave here.' We would send a team immediately and rush to the hotel," Lee said. "There were a lot of kids too. We talked to a 15-year-old who refused to come out of his room because he was scared. We went to a hotel, and there was a baby with Down syndrome who had a G tube, and he was having a hard time breathing. We had to counsel the families and convince them to leave to seek more help."
The students got an up-close look at the disaster's devastating effects on people's physical and mental health. JABSOM students are taught to care for a patient as a whole, and because psychiatry is part of their rotations, Lee and Kepler were equipped to fill that need.
"I think mental health is a big concern, and right now, what I think they could use immediately is clarification and some transparency on what's going on, especially from the government and all of these different organizations coming in," Lee said.
At the clinics, Kepler treated survivors facing other immediate health issues.
"Some of them no longer have homes, but they still have their doctor's visits. Some of them still have homes but no loved ones," he said. "I've been focusing on the chronic disease management side and helping my preceptors ensure that we are still there to care for hypertension and diabetes. We want to make sure that that doesn't get out of control while the rest of life is just in disarray."
After two weeks of no days off from the aftermath of the tragedy, Lee and Kepler returned to JABSOM's Kakaʻako campus to attend required lectures. They would return to Maui days later to continue the on-the-spot training and healing that the people there need so much.
"I think the biggest theme right now is how we can bring aloha to this situation. That's what everyone is saying. There's so much finger-pointing and media and sorrow," she said. "We should focus more on bringing aloha to the situation, bringing everybody together, being unified, and helping one another."
"I'm grateful that the majority of the Maui community has been able to come together so quickly," Kepler said. "We haven't, at least in my lifetime, had a disaster like this on Maui. Immediately, everyone was doing everything they could to help out. Donating goods, volunteering at the shelter, flying helicopters, and driving up their boats. The entire island is coming together as one to provide aid in any way we can."
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