 This is Think Tech Hawaii, Community Matters here. Good afternoon and welcome to another episode of Likeable Science here on Think Tech Hawaii. I'm your host, Ethan Allen. With me today in the Think Tech studios is Dr. K. Loa Fox. Welcome, Dr. Fox. Aloha. And Likeable Science is all about how science is an integral and vital part of all of our lives. And K. Loa has made this a center of her research, actually. She studies that melding the intersection between traditional Hawaiian concepts of health, wellness, illness, and modern medicine. So maybe we can give the audience a little more specific focus on what it is you do. Yeah, yeah. No, thank you. Mahalo for having me here. My formal Western training is as a biomedical scientist and I train specifically in clinical research and clinical psychology. But as a native Hawaiian, it was really a part of my goal throughout my education was to make sure that I can hold on to my cultural beliefs and our values and those concepts that are very akin to some of the concepts that I was studying in school so that I could integrate them. So they're much more practical when I think of everyday solutions that can actually help improve native Hawaiian health for the long term. Yeah, it's very important and more and more we're coming to realize that science is not something that's divorced from societies and cultures. It springs from them and is deeply influenced by the values, the beliefs, the processes of the culture or society. So this makes great sense. You're sort of bringing that to the fore as a word. Yeah, absolutely. And then the idea of being sure it's applicable, again, to me that's really critical stuff that's very helpful in sort of what I'm trying to do here through the show is to make people understand the value of science. So congratulations and kudu too for taking this approach. So specifically you are looking at what though? So my research is actually focused on understanding the concept of Hawaiian ma'i. So what are Hawaiian perceptions of illness or sickness or disease or disorder? Which for us we actually conceptualize, it starts as an imbalance. It could be an imbalance in oneself. It could be an imbalance in one's family or with the way that we interact with the environment. It's multi-layered and it's a really dense concept that has a lot of meaning to it, both culturally but also through health and medicine too. Sure. It does tie into the whole sort of physiological concept of homeostasis where we are sort of delicate balance of a lot of forces, a lot of different life forms, a lot of different chemicals, all of being either playing and indeed if one of these drops out or spring is too strongly then we are out of balance in some sense. So it's really wonderful to hear that strong and striking parallel. So how did you sort of, what was your career path or your educational path to get into this? So I always acknowledge that for me learning starts within your family, within your community. So for me it started in that place. I had a wonderful grandmother who made sure that we always had Hawaiian values and practices in the home. I was lucky enough to start training with my uncle at the age of 18 who was revered in his knowledge in this subject. So I actually started training in traditional Hawaiian health and medicine long before I actually made it into the Johnny Byrne School of Medicine but then was able to integrate it later. Excellent. And you've done this over a while. KLO asked a string of awards and honors from local, national and even international organizations. So she's obviously made a real success at this whole thing. And where do you, you sort of said you wanted to apply this in a practical, pragmatic way. Can you expand on that a little bit? But what do you want to do with this? Yeah, I think this response for me has been really overwhelming in the past year or so. And I think it just touches on the point that so many of us really want a different system of health and health care and the way that we receive interventions or treatments. And so for many of us that are in Indigenous and Native communities, most often times we're actually looking to how can we go back to those traditional beliefs, those traditional values and in this case really articulating what are traditional practices that are still usable, that are still known to us today that we can reintegrate, that we can reinstate, that we can rebuild. That's very interesting. Some of the work I've been doing in relationship to water, we're doing sort of the same kind of things. We look back and say the Hawaiians used to review that water. We still do, yeah. They take care of the water very well and now we channelize it and get it off the island and dump sediment out into the looms. We shouldn't be doing that. We should obviously be learning from and taking our example from people who were much smarter and did much better practices. Yeah, I feel like that's a great illustrative point. So if the water is, if there's pathogens in the water, for example, if the water itself is imbalanced and that's the water that we're drinking from, that's the water that our children are, say, bathing or swimming in, it's, of course, we're going to get sick. We're going to become imbalanced from that water. So not only do we have to protect ourselves, we have to protect our natural and cultural resources, which was a part of our system of health and medicine for all of these generations. Exactly. Medicine was not sort of divorced and set off in a separate school, that's an hour rather is. But I think we're seeing some, even in mainstream medicine, some, the pendulum is starting to swing back a little bit. People are beginning to look at sort of, they call it personalized medicine or predictive medicine. Yes, yes. And sort of more on this concept of how do we keep people well, rather than let's wait until they get sick and start treating them. Yes. Yes. So that's, in that way, much more at the center I gather of the practices you speak of, right? Mm-hmm. Could you give us an example of that? Right, so I think if we take the concept of preventative medicine and we look at these concepts before, say, they become imbalanced to begin with, that's a very Hawaiian way of thinking. And we're just starting to articulate that within medical research within the past few years, within the recent decades. But Hawaiians, we've been doing this for generations. So what I started to look at was this dual concept of what is ma'i that imbalanced the sickness, the diseases and disorders, and that of ola, what's our state of well-being, of overall wellness, of that life force that breathes mana into us as people. And so it was kind of understanding how the process of ma'i and ola are balanced for us in present day in looking at these concepts. Excellent. And apparently this was a matter of some concern, right? You said you found something like 7,000 different terms. Mm-hmm. Yeah. So that's, I mean... There's a little whammy. Right. One of them is just the Hawaiians are saying we see a correll over out of balance and imbalanced. They had a very nuanced understanding of different kinds of illness and different kinds of imbalances at work, right? Right. So as a biomedical scientist, of course, we're looking for evidence, right? So I started this process of looking for what are traditional exemplars that talk about these concepts of ma'i, these terms, right, that we can understand and articulate in present day. And so what I did was a full eight-arm research study that was very exploratory. And then we found over 7,000 terms, which to me is a massive indication that traditional Hawaiian practitioners of medicine value this concept so much that they've been passed down generation to generation. It's been recorded for us in the Hawaiian language newspapers. It's been written about by the great publishers like Malo and E.E. and Mary Kavena Pukui, for example. And so I was able to look at all of these different sources, combine the findings. And yes, we have found, and we're still finding, I'm still finding more, we found over 7,000 terms. That's really, it must be wonderful sort of digging into that wealth of knowledge. Particularly because it seems almost in a contrast. I'm not sure if this is, I may be mixing things here, or there's an attitude among some, at least out sort of across Micronesia, of sort of you're looking for today, you're not looking ahead, you're not caring for things that might be going wrong. We found this in my work with water, getting people to think about cleaning out the rainwater catchment systems is difficult. They sort of, they may build a system, but then they'll just let it be because they think it's good. So you're sort of talking about something, this is this, people are very much looking ahead, taking care in advance. Yeah. So I think in this case, what my work is specifically focused on is this concept of Maui Olalua, where it's long term, long lasting native Hawaiian health and wellness and life. Right. So we're looking five, seven generations out and trying to reconcile five to seven generations that have disintegrated our health and well-being over time. Yeah. It's certainly Hawaiian's have faced a huge onslaught of health issues ever since the western powers of me started visiting and it's really amazing to think about, yeah, let's try to think far in the future and consider what's it going to take, right? Right. What's that system going to look like? Right. Who are the health care practitioners as it were, who's your health care workforce? Yes. Yes. And really I suppose it's essentially everyone to a greater or lesser extent, right? Yes. I feel like my recommendations are always that it should be integrated and that when we put the patient at the center, when we really value the way that they articulate their own wellness, the wellness of their family, of their generations that come in the future, I think that including traditional concepts and values and the cultural work is really integral to where we're at right now as native Hawaiians and we're calling for action that makes sure that this is integrated into these plans moving forward for say the next 100, 150 years. Yeah. And it's very timely with all the different debates about health care and how health care is going to look like, how it's going to be provided, who's going to be paying for it, what's going to be covered. This is certainly a great contribution to have into that debate and valuable stuff because again it speaks to this issue of not, it's not a one-size-fits-all world, right? And there's a number of people who probably wouldn't care too much about that. The idea is you're talking about wouldn't have a lot of resonance with them, right? Right. But for you and for a lot of other people, it's critically central stuff. Yeah. Yeah. I think I'm just so honored to be a part of the field and the discipline at the time that I'm in right now. I think that health and health care, those topics are, they're around us every single day. The news, they're in what we read, they're in conversations in our workplace. They're absolutely at the university and the conversations that we're having. And so we don't have the answers though. And so I think it's time that when we put together and articulate plans of what that might look like in the future, you know, it's, we don't have bounds. We can be progressive. We can be integrative and we can certainly be integrative. Right. And you've got to, you've got to start raising the questions, talking about it. I mean, it's, it's somewhat like science itself, right? Science doesn't really claim to have the answer. Science just claims maybe to have a process for asking the questions. Right. And sort of driving the conversation forward in a productive way. And it sounds like a similar issue here. But yeah, because clearly if you, if a community or a family or an individual is not healthy, sort of almost nothing else matters. And sometimes that's very central to their, to their very existence. Yeah. And I think that that's part of my role as a scientist here in Hawaii is being a part of these conversations, being a part of these working groups, these task forces, where the dialogue is occurring and help to include, you know, culturally appropriate recommendations where they can be made. Yeah. We're doing, I've worked some with the Hawaii Public Health Association and we're doing stuff on oral health now. Right. I'm appalled to see the disparity and the fact that in third grade native Hawaiian kids are something like seven times more likely to have had experienced dental carries than Caucasian kids. Yes. Yes. And a lot of people don't actually realize that when you look at oral health, it's actually a precursor for so many other mahi, these illnesses, these sicknesses, these diseases and disorders that come later, you know, five, 10, 20 years down the line. It's all interconnected. Speaking of things being interconnected and coming later, we're going to have to take a brief break right now, but we are going to come back in about one minute. Dr. Kaloa Fox is here with me, your host Ethan Allen here on Likeable Science on Think Tech Hawaii, and we'll be back in a minute. I'm Tim Appachella, host for Moving Hawaii Forward, a show dedicated to transportation issues and traffic. We identify those areas where we do have problems in the state, but also the show is dedicated to trying to find solutions, not just detail our problems. So join me every other Tuesday on Moving Hawaii Forward. I'm Tim Appachella. Thank you. And you're back here on Likeable Science. I'm your host Ethan Allen here on Think Tech Hawaii. With me today in the Think Tech studios is Dr. Kaloa Fox. Welcome again. Hello. And we're talking about the intersections of traditional Hawaiian concepts of health and illness with those of modern medicine. Dr. Fox is doing a lot of interesting research into digging into some of the past ideas, we talked earlier, of the 7,000 different terms that relate to health or imbalance illness. Can you maybe talk a little more about some aspects of your research that you're particularly intrigued with? Yeah, mahalo. So the terms were just one outcome of the research question and the study that I had constructed. But part of the process was actually looking at what's the traditional Hawaiian system of health and care as it would have always been known to us that we want to rebuild and resurrect today. And so that's where some of the specific practices come in, right? So that's concepts like lomi lomi and ho'oponopono and la'aulapa au. Maybe you can just, I'm not sure how many of our audience know all those. Yeah. So lomi lomi is that a lot of people perceive it as like massage. So it's like, those are our experts of like physical medicine where that body was really manipulated. We would work on the tendons and the joints and then the body is realigned and then the illness, the sickness is actually then, it's spread so that then it leaves the person's body and then they are more whole and balanced again. So that's lomi lomi. Ho'oponopono is often performed within families or groups of kin. And so what it's looking to restore is that family bond and rebuild relational balance. And so that's where you would communicate where any disgruntlements to relatives maybe would have occurred. And then la'aulapa au is really our own pharmacopia and our plant-based medicine that's very related to ethnobotany today. Wow. So yeah. Those are just a few. Yeah. And this show is, again, it suggests the breadth, depth and sophistication of this whole area of study in the traditional Hawaiian society. Yeah. So what was most critical and important for me was to make sure that I approached the study and the work as a native Hawaiian to approach these Hawaiian concepts and these practitioners with much respect and to honor their knowledge and their wisdom from their lineages. And so I did work with 50 living of our traditional practitioners throughout the course of this research to really understand how does the concept of well-being and imbalance, how does it function for them as the healer, as the practitioner that sits with their clients, with their patients? No, I like your referencing it as a system. It suggests this level of understanding that these things aren't occurring in isolation as it's not just a germ here or a bad chemical here. It's how we're living our lives and how we're running into these and how we're ingesting them or avoiding them or fighting them off once they're within us. Right. So in my case, I've tried to use my traditional and Western education training to re-articulate what this legacy is and use my voice to help be a platform that elevates that this is what we do. Right? It is a system of care. It's not siloed. It's very relational. It's very collaborative in that it's the system in a whole that brings about wellness, that brings about Maliola. Sure. We can see that. We recognize more and more as you study ecosystems and looking at this on a global level that it's essentially impossible to think about any one thing as being separate. Everything is very interconnected. What we do here in Hawaii has impacts elsewhere, what folks are doing when they're doing mining in eastern China. It has impacts around the world. The dust goes up in the air. It swirls all around the world. I was reading a fascinating article recently that points out that we all, virtually everyone, has now some of the PCBs, basically, are found in almost everyone on Earth now. Because they were widely used for quite a few decades and got into all the air and the water systems and circulated around the globe, and people even who had no reason ever to run into them now, now have them. Right. So realistically, how do you see this moving ahead? What are the next steps? And how is this system that you envision for Hawaiians, how is it integrated into a larger system of health and medicine? Great question. So when I designed this study and the work, I really wanted it to not just be theoretical, which oftentimes our science can be. I wanted it to be really practical. I wanted it to be able to be used for not only clinicians, but also practitioners. So what I see first and foremost is there's an opportunity here to bring forth culturally and linguistically appropriate health services that are delivered to native Hawaiians, that articulate our language, that are embedded with our values, that have mana, they have this spirit to it that's more aligned to how we live and breathe and think within our own homes and our families. So some of this would be a matter of pulling these things out, either writing them down, making videos, running workshops, whatever it might take, right? Yes, yes. A lot of different ways probably to surface these and get them back into circulation. That's where we re-dynamize them, you know what I say, right? Yes. And then for me, I think my ultimate dream, and many of us in the community share this dream, is that we would love to see practitioners working hand in hand with clinicians, where we're looking at the patient together and we're really coming up with the best, the highest quality, the greatest impact for the patient. No, that would be wonderful. I mean, that does truly put the patient at the center and so it says, whatever is best for the patient, we'll work around and we'll do. And for some patients, yes, they're going to maybe want more of one, less of the other. I'm going to want to sort of borrow from both camps as it were, right? Yes. Oh, that's excellent. That's wonderful. So if you were to talk to students of any age, either young students or more advanced students who are interested in pursuing this, what advice would you give them? What would you tell them about the sort of background, the studies there? How should they prepare themselves if they want to pursue this area? Well, I love my own pathway. I love that I started within my own family and I look to that source of knowledge to begin with. But I also have been really fortunate to work with incredible mentors and experts and leaders in the field. And I feel like they really trained and imparted their knowledge on me so that I can be a part of these successive generations that are rebuilding what we hope to reclaim. So I feel like that's a part of it, is find a good mentor, find a great teacher talk to your grandparents, talk to an auntie or an uncle, just be open to learn and observe and to listen. So much of it is listening and it's making sure that you're aware of details that are around you, that you may not actually be attending to. Yeah, that's certainly critical for a lot of things is that learning to see what is out there, to appreciate that the nuance is. But you said something else that I thought was very intriguing. It's a need for this particular undertaking to understand that you're part of a bootstrapping process. There's not a huge cadre of people out there already practicing this. You're working in a pretty narrow interface right now with a pretty limited set of people. And you've got to have, I suspect, to succeed. You have to have a willingness to be sort of out there on that cutting edge. Not for some a comfortable place, I'm sure. Yes, no, I mean, Hawaii in general. So we have a physician shortage. We have a clinician shortage. We have an allied health professional shortage. It's the same in other Native and Indigenous communities too. And so every single one of us that goes into this field or into this discipline or into our organizations, we have a role in a kuleana to make sure that we continue to be that voice and that beacon so that more students and more learners can come in and that they feel welcomed and that they feel like they're valued in that system too when they learn. Yeah, I know a huge area of interest and study and work right now, particularly at UH Manoa, is trying to be seen as a very inclusive environment and provide the support that's needed to bring people, particularly people who are first generation college students, people who don't have the role of models, they have any academic background in their family or whatever. And people have come to recognize students from those backgrounds need, it's not just to throw them into the system and say, great, you've made it in UH Manoa, go forth and do well. They're not going to do it, right? They need to have, they need to see some role models. They need to have people to talk to. They need to have a sort of broader base of emotional support where people they can go to and say, I don't understand why I don't feel right here. It seems like all my classmates are doing X, I'm off your wanting to do Y. Yes, yeah. Sometimes I'm in these groups and these discussions and I sit there in disbelief of, this is us. We're Kanaka scientists. We are the Hawaiian intellectuals that are trying to address these concepts that we've always known. Hawaiians have always been scientists. We've had advanced methods for observation, for deduction, for experimentation. And so the more that we can tell those stories and it brings the students in, you watch them shift and change when they can envision themselves as a scientist. I mean, it's beautiful and that privilege and that responsibility really comes out for all of us. Yeah, and so much that was, if not entirely lost, at least it was hidden for a long while due to a variety of cultural factors and all that. And it's great now to see you're helping shine light on it, rediscover it, bring it forth so that people can really benefit from that. That's truly remarkable work. I thank you so much for coming on here. This has been a wonderful, wonderful half hour. I'm only sorry, it's so short. Seems like we could talk. We can keep going, yeah. Dr. Kaloa Fox here has been with me today. I'm your host Ethan Allen here on likeable science on Think Tech Hawaii. I'm only sorry we don't have more time to talk with her, but we'll be back next week for another episode of likeable science. See you then.