A pioneer in obstetrics and gynecology (OBGYN) who strengthened women’s health education in Hawaiʻi is being honored with a new endowed professorship at the University of Hawaiʻi at ²ÑÄå²Ô´Ç²¹â€™s (JABSOM).

Established through a gift from ÌÇÐÄVlog¹Ù·½ ²ÑÄå²Ô´Ç²¹ Professor of Law Emeritus Linda Krieger in honor of her father, John Krieger, the professorship recognizes his lasting impact on OBGYN training in the state in the 1960s.

John Krieger moved to Hawaiʻi in 1963, when the state faced a shortage of OBGYNs. Although already in practice, he returned to residency training to meet local licensing requirements.

“My father had been in practice for about six or seven years, but you couldn’t get a medical license here for a year if you moved here, so he went back to being a resident,” said Linda Krieger, a nationally respected law scholar and civil rights advocate. “That experience got him very interested in working on medical education, especially at the residency level.”

Krieger helped build OBGYN residency education at what was called The Queen’s Hospital at the time and later led residency training when JABSOM expanded to a four-year program.

“This was their whole life,” Linda said of her parents’ connection to Hawaiʻi. “My father really loved the multiculturalism here and the diversity of people and cultures. He felt very committed to that kind of community.”

First recipient carries legacy forward

The inaugural John A. Krieger Endowed Professorship was awarded to Lynne Saito-Tom, professor in the Department of OBGYN and Women’s Health at JABSOM. To Saito-Tom, the honor reflects her family’s deep commitment to education.

Her grandparents were unable to attend school beyond elementary level but believed strongly in higher education, ensuring their children went to college. Growing up in Wahiawā, her parents sacrificed daily—waking before sunrise and commuting long hours—so she could pursue her goals.

“Thanks to their sacrifices, I was able to pursue my educational goals of becoming a physician, the first in my family,” Saito-Tom said.

She added, “Dr. John Krieger, the first resident program director of our department, developed a strong curriculum for residency training, and I plan to utilize this endowment to advance medical education, including creating innovative curriculum, supporting trainees and enhancing faculty development.”

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University of Hawaiʻi at ²ÑÄå²Ô´Ç²¹ assistant professor Jonathan Huang is one of only 10 faculty members nationwide to be selected a fellow of the 2024–25 from the National Maternal and Child Health Workforce Development Center.

“I’m truly privileged to have the opportunity to draw on these resources to help strengthen what I and the Office of Public Health Studies can offer the broader community of maternal and child health practitioners, researchers and advocates,” said Huang.

The fellowship program aims to empower selected fellows in advancing their maternal and child health work and scholarship in areas including public health education, student mentorship, research and collaborative partnership development.

Developing a new course

Huang’s primary objective within this fellowship is to develop a comprehensive graduate course on epidemiologic methods to address the unique maternal and child health needs of Hawaiʻi, while supporting ongoing efforts to enhance the curriculum at ÌÇÐÄVlog¹Ù·½ ²ÑÄå²Ô´Ç²¹.

With input from community stakeholders, academia and public sectors, the curriculum may include topics such as quantifying disparities in pregnancy and child outcomes specific to Hawaiʻi, employing life course models, and navigating challenges posed by data scarcity due to issues like small sample sizes and historical lack of collection or disaggregation of race/ethnicity data relevant to Hawaiʻi (reporting data separately for different self-identified race/ethnicity communities).

With more than a decade of extensive research experience, Huang is an expert in exploring how social and environmental inequities materialize as health disparities, starting even before birth. He has actively engaged with diverse global communities, academics, and longitudinal cohort studies, with recent work focused on Southeast Asia.

Participation in this fellowship presents an invaluable opportunity for Huang to exchange ideas and best practices with the fellow selected faculty members from diverse backgrounds and communities. By leveraging this collaborative platform, he hopes to incorporate insights gained and tailor them to the specific needs of Hawaiʻi’s community.

“We are excited for Jonathan and our students as maternal and child health is so vital yet understudied especially in Hawaiʻi,” said Eric Hurwitz, chair of the Office of Public Health Studies. “The innovative, community-informed course will be a great addition to our curriculum.”

will provide women’s health exams and birth control to women displaced or impacted by the Maui wildfires at its health center.

Three clinics in Lahaina Town were destroyed, and women’s health services were already booked out for months on the rest of Maui before the disaster. The is located on its campus and is open to community members as well as students, staff, and faculty. It is open Monday–Friday, 9 a.m.–4 p.m.

More on how to help Maui ʻohana and the Maui wildfires.

Hannah Litt is the nurse practitioner who staffs the center. In the past, she has provided women’s health care at both Kaiser Lahaina and Maui Medical Group office in Lahaina. Litt said the patients she cared for and their families have been in her thoughts constantly.

“I would love to help ease worries or stressors for the people on Maui who are already overwhelmed by loss or just don’t know where to turn,” Litt said.

The health center can dispense many birth control options for free on-site. Specific prescriptions for non-stock items can be called into a pharmacy.
For more information interested patients can call 808-984-3594 or 808-868-7799 (after hours), or email: hlitt@hawaii.edu.

A USDA rural development grant has resulted in big gains for prenatal healthcare for pregnant women in American Samoa. The $667,665 grant, part of $42 million for rural development across the United States and its territories, will be used to establish a maternal telemedicine network at the , the only hospital in American Samoa, working in collaboration with the University of Hawaiʻi at ²ÑÄå²Ô´Ç²¹ (JABSOM).

Years of working together on continuing education, distance learning, health workforce development, cancer prevention, control, and surveillance and telehealth laid the foundational groundwork for receiving this grant.

“Samoa is a lovely place with a rich Polynesian culture. It is relatively isolated, its population is about 55,000 people, and there is definitely a shortage of doctors,” said Kareem Khozaim, an associate professor at JABSOM and a University Health Partners physician. Khozaim worked and lived in American Samoa from 2014 to 2017.

Khozaim added, “Women there are eager for prenatal care and they would prefer to stay in American Samoa rather than fly to Honolulu for specialist services. The grant will make it possible for improvements such as new diagnostic and telehealth equipment so pregnant women living across four different islands can receive maternal-fetal medicine specialist services. Together, we help them manage pregnancy conditions on the ground, and coordinate transport for those with serious issues to Hawaiʻi.”

Additional funding to train healthcare workers

“Back in 2016–2018 when the Zika virus was severely impacting American Samoa, the CDC provided funding for an ultrasound machine. We found a high-definition ultrasound machine that was reconditioned and repurposed, so we helped them purchase it,” said Men-Jean Lee, chief of maternal-fetal medicine at JABSOM. “That machine was able to detect Zika-related anomalies in the fetus. However, during a visit, we discovered that no one there knew how to run the machine.”

A collaboration between JABSOM’s Lee Buenconsejo-Lum, Lee, Khozaim, as well a Christina Higa and Ginger Porter of ÌÇÐÄVlog¹Ù·½ ²ÑÄå²Ô´Ç²¹â€™s , was created in response to the USDA’s call for proposals to secure additional, more sophisticated ultrasound and telehealth equipment for American Samoa.

“Everyone is so grateful and excited for the grant, but it only pays for equipment,” Lee said. “So we are looking for additional funding for a team from ÌÇÐÄVlog¹Ù·½ ²ÑÄå²Ô´Ç²¹ and JABSOM to teach healthcare workers there how to use the equipment and assist with the launch of this telemedicine program. These types of services and missions are an important part of JABSOM.”

Read more on the .

Since 1995, the University of Hawaiʻi at ²ÑÄå²Ô´Ç²¹ John A. Burns School of Medicine Research Day and Awards has been a milestone moment for residents—and later on fellows—to present their research during their first few years as physicians. For the first time in its long history, the annual event was held virtually on its 25th anniversary.

Despite circumstances caused by COVID-19, the department still found a way to celebrate its residents and fellows. They were able to present their research via Zoom, while maintaining social distancing guidelines.

This year’s event was dedicated to obstetricians and gynecologists who are currently serving on the frontlines of the pandemic, providing essential health care in Hawaiʻi’shospitals, offices and community clinics.

For two and a half hours, residents and fellows took turns sharing their hypothesis driven research with faculty attendees and colleagues on a variety of topics, such as racial and ethnic disparities, abortion, diet quality, home births and contraceptive methods. Following their presentations, awards were presented in three categories: Most Outstanding, Audience Choice and the Santosh Sharma Audience Choice Awards.

“We appreciate that even in the midst of this global pandemic, we can come together as a community to discover, learn and inspire each other in our common goal of advancing women’s health in Hawaiʻi and beyond,” said professor and department chair Ivica Zalud.

Also assisting with the event were Associate Professor Reni Soon and Assistant Professor Shandhini Raidoo.

Research Day Awards

Most Outstanding Resident Research Award
Sharareh Firouzbakht
“Abortion Knowledge Affecting Abortion Provision after Obstetrics and Gynecology Residency”

Audience Choice Award
Christina Buchanan
“Neonatal Hypoxic Ischemic Encephalopathy and Planned Home Birth”

Santosh Sharma Audience Choice Award
Chief residents who already submitted their research for publication:

Nikki Kumura
“Pharmacy Access to Ulipristal Acetate in Small Cities Throughout the United States”

Jennifer Wong
“An Investigation on the Completeness of Salpingectomy Intended for Ovarian Cancer Risk Reduction”

Jennifer Chin
“Buffered Lidocaine for Paracervical Blocks in First Trimester Outpatient Surgical Abortions”

Caroline Lau
“Duration of Foley catheter cervical ripening as a predictor of total length of labor”

As women age, their ability to get around affects their quality of life. A new study shows that older women’s physical functioning declines more rapidly if they develop urinary incontinence, according to public health researchers at the .

and , both assistant professors in the in the , collaborated with researchers in Brazil, Colombia and Canada to recruit approximately 900 women in their sixties and seventies from those three countries plus Albania. About 25 percent of women over age 60 experience urinary incontinence.

Study participants completed a short test of physical functioning, which included measuring the speed of their usual walking pace, checking their balance and testing how fast they could stand up from a chair. The women also completed a questionnaire about their health, which included a query about whether they had experienced any leakage of urine in the past week. After two years, the women repeated the physical functioning test.

Pirkle said the researchers were surprised by how much physical function had decreased over a two-year period in women who had reported experiencing urine leakage at the study’s start.

“The loss of physical function in this group was quite large and happened very rapidly,” said Pirkle. “We know that, as women age, they tend to experience more functional limitations and disability than men do. But the reasons for this gender gap are not clear.”

Cycle of incontinence and decreasing physical activity

Wu said one supposition is that women who experience incontinence start to engage in less physical activity out of fear of losing urine. This could lead to a vicious cycle, as a reduction in physical activity leads to worsening incontinence and overall health.

But it’s possible that other factors, such as giving birth to many children, may contribute to both urinary incontinence and a physical performance decline. Pirkle and Wu said the next step for the research team is to look at whether women’s reproductive lives, such as the number of children they have and their history of gynecological or obstetric problems, influence their risk of incontinence, as well as other health outcomes of importance to older women.

The study was published in the . Pirkle and Wu’s collaborators on the study include Luana Caroline de Assunção Cortez Corrêa and Saionara Maria Aires da Câmara of the Federal University of Rio Grande do Norte in Brazil; Afshin Vafaei of Lakehead University in Canada; and Carmen-Lucia Curcio of Universidad de Caldas in Colombia.

—By Theresa Kreif

Understanding healthcare terminology is critical to patient education and engagement, but healthcare vocabulary that may be familiar to clinicians and researchers is often not understood, or is misunderstood, by patients.

In a recently published in the Maternal and Child Health Journal, public health researchers found a lack of understanding of common obstetric terms used to measure maternal healthcare quality among women who recently gave birth on Oʻahu.

“Our research team interviewed 400 pregnant women to learn about their thought process and experiences in selecting a hospital to deliver their babies. We also assessed their understanding of terms often used to compare hospital quality in childbirth,” said Mary Guo, lead author and alumna of the ÌÇÐÄVlog¹Ù·½ ²ÑÄå²Ô´Ç²¹ (OPHS) graduate program. “Our data showed that many women lacked understanding of some very important terminology around childbirth outcomes.”

The interviews took place between July 2013 and January 2015.

In one example, the research team found that almost 40 percent of participants did not know or misunderstood “episiotomy,” which is a surgical incision made during delivery, as opposed to a natural tear. Possible complications for women following an episiotomy include infections, pain during sex in the months after delivery and fecal incontinence.

Most women are likely to care about such obstetric outcomes, but first need to know what these words mean. Some demographic factors were significantly associated with less comprehension of obstetric terminology, including being younger, having less education and identifying as Filipino, Japanese, Native Hawaiian or other Pacific Islander.

“The finding that many women were unfamiliar with important terminology around quality of healthcare in childbirth is significant. This highlights areas where improvement in patient education is needed,” said , co-author and associate professor in OPHS. “More efforts are also needed to address knowledge gaps to achieve health equity across education, age and race/ethnicity.”

For example, Sentell said physicians should use layman’s terms when communicating with patients. Also, healthcare providers should not assume that patients who nod in response or remain silent fully understand the relevant health information being conveyed.

Actively confirming patient understanding is important, Sentell emphasized.

The study was funded by the Agency for Healthcare Research and Quality.

—By Theresa Kreif

A University of Hawaiʻi at Mānoa study will examine placental tissue samples from women in Hawaiʻi who experienced preterm labor for the presence and type of oral bacteria. Oral bacteria that cause dental decay (cavities) can be transmitted through the bloodstream from the mouth to other parts of the body, including the placenta, and can contribute to the development of serious systemic diseases. About 40 percent of pregnant women experience dental decay, which is associated with pregnancy complications such as preterm labor, preterm birth and low birth weight infants.

The researchers have been awarded a $39,000 federal grant from the through the Research Centers in Minority Institutions Translational Research Network for the study.

“The first step of our project will be working in the lab, analyzing samples of placentas to determine the presence of any oral bacteria and, if so, what type is identified because there are many different types of oral bacteria,” said principal investigator , a ÌÇÐÄVlog¹Ù·½ Mānoa professor and Frances A. Matsuda Endowed Chair in Women’s Health. “Based on what we find, the second step will be working with our research team to design and conduct an intervention study to decrease the transmission of maternal oral bacteria to other parts of the body, as well as reduce transmission of the bacteria to the women’s infants.

Shannon said that the overall goal is to reduce dental disease in mothers so that they will not experience pregnancy complications like preterm labor and birth, or pass the cavity producing bacteria on to their infants and children. “We are committed to conducting research that can have a beneficial clinical impact for Hawaiʻi mothers and their keiki.”

Aiming to reduce pregnancy complications

Native Hawaiian, Pacific Islander and Filipino women have the highest rates of dental disease in Hawaiʻi. By identifying the presence and type of oral bacteria found in placental tissue, the researchers hope to increase understanding about the way oral bacteria can contribute to the development of preterm labor. Determining the type of bacteria can help in the development of clinical interventions to reduce the rates of pregnancy complications and other diseases associated with dental decay.

“Every day, nurses advance science and find solutions for preventable medical conditions. As leaders in nursing research, studies of this type allow us to focus on the unique needs of our local populations,” said , dean of the School of Nursing and Dental Hygiene. “Nurses not only provide safe, quality care to patients, but are also at the forefront of research to enhance health outcomes for generations to come.”

The study, “Placental Oral Microbiota Associated with Preterm Labor in Hawaiʻi,” is led by Shannon and Assistant Professor . An interdisciplinary team will collaborate on the study including ÌÇÐÄVlog¹Ù·½ Mānoa’s Joshua Astern and Oelisoa Andriankaja and Evangelia Morou-Bermudez.

—By Desiree Uyeda

Faculty of the (OB-GYN) at the (JABSOM) are involved in nearly a third of the births in Hawaiʻi each year. Many of these physicians practice medicine through the University Health Partners of Hawaiʻi, which is JABSOM’s faculty practice plan.

JABSOM University Health Partners of Hawaiʻi faculty made the largest philanthropic investment in JABSOM to date by faculty. Using its professional service collections, the team donated $500,000 to create an endowment.

On January 28, the ÌÇÐÄVlog¹Ù·½ Board of Regents approved the Endowed Professorship in the Department of Obstetrics, Gynecology and Women’s Health at JABSOM.

“The OB-GYN faculty decided to make a gift with their earnings and the University Health Partners of Hawaiʻi Board voted unanimously to support this endowment,” said Shared Chip Ellis, University Health Partners’ chief financial officer. “The creation of the Department of OB-GYN Professorship is an ideal collaboration between the department and the faculty practice plan. We know that this endowment will have great outcomes. It will help the department attract, support and retain talented faculty who will give back to Hawaiʻi immeasurably. The endowment will also provide critical resources for faculty development and enhance the research, education, and community outreach missions of the department.”

JABSOM Dean said, “This is a very important gift for us. It is a powerful demonstration of how deeply the OB-GYN faculty believe in and support their department. They know that by investing in themselves they can do more to serve Hawaiʻi’s families. A gift of this magnitude will help ensure the future success of the department.”

“ is proud of our partnership with the faculty of the John A. Burns School of Medicine, which enables us to provide the specialized maternity care that our hospital is recognized for,” said Kapiʻolani CEO Martha Smith. “This endowment demonstrates their commitment to the health of Hawaiʻi’s women and children, and we are very grateful for their continued support and collaboration in providing quality patient care.”

Donna Vuchinich, president and CEO of the , said “These gifts signal a growing recognition that private support is critical to ensuring long-term departmental success. We are most grateful to these important donors who are making such a difference for Hawaiʻi.”

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University of Hawaiʻi medical students, residents and faculty from the are involved in the deliveries of one third of the babies born in Hawaiʻi every year, many of them high risk births.

Thanks to a $5 million dollar gift to the , the program will be able to invest in its clinical training, research and faculty development.

“This is a huge vote of confidence for what this department did in the past, what we’re doing now and what we want to do in the future for the state of Hawaiʻi and beyond, the Pacific Rim and even nationally,” said Dr. Ivica Zalud, chair of the Deparment of OB/GYN and Women’s Health.

The gift comes from the Kosasa family, who founded ABC Stores in 1964. It is the largest private philanthropic investment to date by an individual donor or family, to the university’s medical school. The gift is being given just as the medical school kicks off the 50th anniversary of its founding in 1965.

Dr. Thomas Kosasa represented the Kosasa family at an informal announcement to faculty and residents at , where he is professor emeritus in the Department of Obstetrics, Gynecology and Women’s Health.

Kosasa says part of the gift will create the $4 million Kosasa Endowed Chair for current department chair Zalud. The other $1 million will create two Kosasa Endowed professorships.

“I think the students will understand that what is given to you, you should give back. And I think that’s the most important thing is to give back. I’ve had a wonderful opportunity and education and I’d like to give that back to our medical school and to our students,” said Kosasa.

This isn’t the first gift from the Kosasa family—in 2000 the family invested in the start-up of the university’s .

“Now, 15 years later, we’ve created a whole new generation of scientists who are working on issues around maternal fetal medicine and helping families have children that might not otherwise have had the opportunity,” said Dr. Roy Magnusson, JABSOM associate dean for clinical affairs. “And so that kind of gift 15 years later keeps on giving and we hope to be really good stewards of this gift and to make sure it’s put to very good use.”