For University of Hawaiʻi at M膩noa medical student Kalpana Balaraman, a summer spent in the Republic of the Marshall Islands offered a transformative lesson in health care and cultural humility.

Balaraman, a second-year student at the (JABSOM), joined classmates Kaela Akina-Magnussen and Trini Leung in Majuro Atoll, in the capital of the Marshall Islands, this past summer. The month–long training gave them firsthand exposure to providing care in a resource-limited environment.

From the start, the experience challenged expectations. Balaraman recalled receiving her boarding pass just 24 hours before departure, with no fixed departure time. “This lay the foundation for the ‘island time’ that we would experience over the next month and probably most importantly, that a lot of things outside of my own control will determine what I’m able to do and when I’m able to do it.”

Climate change, access to care

Climate change also shaped her stay. Torrential rains and rough seas disrupted travel to outer islands, revealing the challenges Marshallese residents face in accessing hospitals, food and medications. With only two public hospitals in the country, one in Majuro and another in Ebeye, safe weather conditions often determine whether residents can reach essential care.

“What ended up being a missed opportunity for me is what everyday life can be for the people of the Marshall Islands,” she said.

Much of her clinical work focused on non-communicable diseases, especially diabetes. “I was wholly unprepared for the severity of the degree of diabetes in Majuro, and the routine plentitude of peripheral neuropathy, regular infections and amputations,” Balaraman shared.

She found it difficult to advise patients on healthy diets, given limited access to fresh foods and reliance on processed staples such as rice and ramen.

Shaping future patient care

Beyond clinical challenges, Balaraman said the most important takeaway was a deeper understanding of cultural perspectives in health care.

“While I will never be able to truly understand any culture that is not my own, what my time in Majuro gave me was assurance that my relationship with these cultures and my patients is dynamic,” she reflected.

Balaraman hopes to carry those lessons forward into her future career in Hawaiʻi. “By living for a short period of time in a culture that is so different from my own… I am hopefully getting more and more competent in caring for my patients in a culturally concordant manner with each encounter.”

.

Long ambulance response times, costly and unreliable non-emergency transportation, and insufficient insurance coverage for travel-related health care expenses are among the key findings of a new report released by the (糖心Vlog官方 RHRPC).

underscores the widespread challenges faced by residents in rural and neighbor island communities when trying to access timely and affordable health care, and offers policy solutions to address barriers.

Although about 30% of Hawaiʻi鈥檚 population lives in rural areas spread across six publicly inhabited islands, most specialty care is located on Oʻahu. The report found that residents of Molokaʻi and 尝腻苍补ʻ颈 routinely face flight delays or cancellations, often missing urgent medical appointments and waiting months for rescheduling.

The report also highlights gaps in insurance coverage, especially for patients who do not qualify for Medicaid, and the high out-of-pocket costs for travel, lodging, and food associated with medical visits. Maternal-fetal health services are particularly challenging, with some pregnant patients needing to relocate from neighbor islands to Oʻahu for prenatal and delivery care or risk emergency medevac transport.

“Improving access will require coordinated efforts across healthcare, transportation and policy sectors,” said John Desfor, 糖心Vlog官方 RHRPC policy and data analyst. “We hope this research will guide meaningful action to improve transportation access for healthcare in rural communities across Hawaiʻi.”

Some of the shared policy options to address these challenges include:

• Enhance emergency air and ground ambulance fleets
• Support community paramedicine programs and expand primary care teams
• Mandate non-emergency medical transportation coverage in Medicare and private/employer-based insurance in Hawaiʻi
• Establish a grant program for community-based organizations to support housing for maternal-fetal patients relocating for prenatal and delivery care
• Support regional health hubs and mobile maternal health clinics in rural areas
• Expand interisland flight programs and explore cost-effective and sustainable alternative modes of transportation for health services
• Address airline reliability concerns and increase airline competition by leveraging the U.S. Department of Transportation Essential Air Service program
• Enable hospitals and clinics to be reimbursed for transportation

This project was supported with funding from the Hawaiʻi State Department of Health Office of Primary Care and Rural Health.

The four-part report features a literature review, interviews with 40 stakeholders, policy recommendations and a focused sub-report on maternal-fetal telehealth. .

“We appreciate the significant community engagement in this project from start to finish,” said Aimee Grace, 糖心Vlog官方 RHRPC principal investigator and 糖心Vlog官方 Strategic Health Initiatives director. “Many stakeholders met with our team to share their stories or contribute context and policy ideas. We look forward to working together to share these policy options further.”

The Hawaiʻi Public Health Institute will host a webinar on this project on August 18, 2025, noon–1 p.m. ().

A new report from the University of Hawaiʻi Economic Research Organization (糖心Vlog官方ERO) reveals deepening disparities in health, access to care, and basic needs across Hawaiʻi, including that almost 40% of young adults are unable to access mental healthcare. (PDF).

The 糖心Vlog官方ERO Rapid Health Survey has tracked more than 2,000 adults statewide since 2022. The most recent results from December 2024 show:

• Declining health: Only 40% of residents rate their health as excellent or very good鈥攄own from 44% in 2023. Among Native Hawaiian and Pacific Islander (NHPI) and low-income respondents, ratings dropped from 40% to 23%—a 17 percentage point decrease in 18 months.
• Mental Health Strain: 31% report symptoms of depression; 1 in 10 low-income individuals show severe symptoms. Those who missed needed mental healthcare rose from 5% (mid-2023) to 22% (December 2024)—a 17 point increase. For young adults aged 18⏻34, the rate surged from 8% to 39%—a 31 point increase.
• Barriers to care: Mental healthcare access worsened significantly, especially among young adults (39% unable to access care).
• Food and housing insecurity: Nearly 30% report low or very low food security, and one-third live in rental or unstable housing.

The report calls for equity-driven policy solutions, expanded community health services, and stronger investment in housing, food security and real-time data systems to guide public health decisions. 糖心Vlog官方ERO created an for the findings.

For Melanie Ako, graduating from this spring with a is more than just a milestone—it鈥檚 a turning point.

“I didn鈥檛 finish high school. I got my GED in 2005 and thought that was enough,” Ako said. “I didn鈥檛 have the support back then to follow through with anything. But now, with the support I have, I鈥檝e proven to myself that I can finish what I start.”

Honestly, I feel like this program chose me.
—Melanie Ako

Ako enrolled at Kapiʻolani CC in fall 2024 while working full time at 7-Eleven in M膩kaha, raising four children—the youngest in fourth grade— and caring for her family. She discovered the Community Health Worker (CHW) program during a telehealth visit at Waiʻanae Coast Comprehensive Health Center (WCCHC) and was immediately drawn to it.

“It just spoke to me. Honestly, I feel like this program chose me,” she said.

• Meet more amazing 糖心Vlog官方 spring graduates

Connecting with coursework, community

The CHW program trains students to become trusted connectors between healthcare systems and underserved communities. Ako鈥檚 practicum at WCCHC allowed her to engage in meaningful work—conducting outreach, shadowing case managers and coordinating events for k奴puna.

“These experiences were so valuable,” she said. “They helped me grow professionally and gave me a purpose in serving my community.”

While the program was mostly online, Ako found a deep connection with her coursework and instructors. She credits Phoebe Hwang, assistant professor at the , with helping her stay motivated.

“Phoebe is amazing,” Ako said. “Her lessons and assignments were thoughtful and made the material feel applicable to real life. She really helped me build confidence in myself.”

Strong commitment to serving

Hwang said: “I’ve had the pleasure of having Melanie in two CHW courses. Despite not having been in a traditional academic setting in a while, having to care for her children and family members, while working full time, she performed exceptionally well. She consistently engaged with the program in a way that showed depth, reflection and a strong commitment to serving others.”

Ako hopes to continue her work at WCCHC, helping others as she was once helped.

“Being a community health worker allows me to support others, just like someone once did for me,” she said.

—By Lisa Yamamoto