A cramp, nothing. But a cramp turned into a fever, then wailing moans between cold shivers and hot sweats. The curly-haired boy I met in Italy, now lay trembling in the fetal position. I called home. “Dad,” I hesitated, feeling I might be paranoid, “where’s your appendix?” “Uuuggghhhh,” groaned Glen Simkins, the 30-year-old man who had been writing me songs on his guitar for three years. I had trouble thinking – please be a hangover, please be food poisoning, men don’t know cramps, please be whining, just wanting me to take care of you. But his next grunt echoed my stepfather’s answer, “It’s my right side.”

Photo TOM JOHNSON / Hanaside News

The morning after Halloween, I drove to Hana Health with chills. For two weeks, I had been researching a story on emergency health care in Hana. Health authorities told me, more medical care hinged on more money, more patients. But my selfish head would not hear reason, I heard the emotions of local aunties – women who had lost a sister, lost a son
– women who held my hands in prayer – women who looked me in the eye and said, “You never think it will happen to you.”

Suddenly, my loved one was the one lying in the back of the ambulance, and I was living the story I had been chasing. Standing alone in the Hana Health parking lot, I watched the ambulance turn left. Should I call one of the girls? Could I drive? Stop thinking. Go. Go. Go.

Details had been explained to me, health services are limited in a remote jungle, an emergency room cannot be funded by a small town population of 2,500. And during an interview on the front stoop of the clinic, Executive Director Cheryl Vasconcellos summed up the opinion of governing legislators. “People choose to live here,”said Vasconcellos, behind her sunglasses. “Born here or not, people choose to live with these limitations.”

Weeks earlier, we met at her office, a Hana Health trailer. Vasconcellos listed the priorities of the clinic – to provide primary medical care, urgent care, wellness and preventative care. But I was not sitting at her desk to ask her simple questions.

Since the start of Hanaside News, people have approached me, asking bluntly, “When are you gonna take on Hana Health?” They share a bad experience but do not care to attach their name. I do not want to write about decadeold disputes, but I do want to know, if my Mama fell on the King’s Trail, if my Daddy felt chest pains at Fagan’s Cross, any emergency – appendicitis – what would
happen? What would Hana Health do?

“Legally, we have no responsibility,” Vasconcellos conceded. “The state has never contracted with us to provide emergency care, they have contracted with us to provide primary care.” The state contracts American Medical Response to provide ambulatory service from Hana to Maui Memorial Hospital. But Vasconcellos drives the Hana Highway, she knows an emergency room waits two hours and 50-something miles away, she knows Hana Health must provide emergency services.

“It’s never been either emergency or prevention,” said Vasconcellos, clarifying a point of frustration. “There’s a definite misconception. We’ve always had emergency care, we will always have emergency, urgent care.” She proudly reports, since the clinic’s transition to a private non-profit in 1997, not a single day has passed without 24-hour medical coverage. When a doctor faces an emergency – a patient who may potentially die – the clinic stabilizes the patient for transport to the other side.

Now, the emergency the Hana ambulance carried, happened to be someone close to me. I pulled into our Nahiku driveway, left the Land Cruiser running. Grab his toothbrush. Grab his house slippers. Grab his medallion, the one he and his best friend have exchanged for years, trading back and forth in moments when the other may need to wear a reminder of strength around their neck.

Back on the road, listening to Willie Nelson’s ‘Honeysuckle Rose,’ coffee in my hand. I forgot to bring him a change of clothes. Drive.
Here’s the point in my story, where I may upset some readers. Right or wrong, these questions seeped into my mind – was Glen in an ambulance because I was writing this article? If we drove to Hana Health an hour earlier, would he have been sent home with the stomach flu?

I thought of our friend Moke Lono, a man who had fixed our brakes for free and fed us smoked pork at his wedding. In February, Lono went to Hana Health complaining of stomach pain. He was treated for acid reflux and swallowed pills for one month straight. But every week, a man who builds rock walls, returned to the clinic in pain.

“It wasn’t getting better,” remembers Lono. “They kept giving me stronger medicine ... They told me, maybe the medicine they giving me wasn’t working, let’s try another brand.”

Mid-March, his wife knew something was severely wrong, his eyes were yellow. She drove him to the emergency room at Maui Memorial. An ultrasound diagnosed gallstones. Lono underwent surgery, spent five days in the hospital and lost two months of work.

“It could have been prevented, if they gave me one blood test and one urine test,” said 33-year-old Lono. “They could have done the surgery an easier way, I could have had real small incisions, but too late ... they cut me open wide, I had maybe, 32 staples.”
Lono had a bag hanging out of his side collecting blood for one week. He had a bile bag for one month. He wonders if the acid reflux pills ate his stomach lining, because sometimes he wakes up sore in the middle of the night and walks around his house, trying to walk off his pain.

He blames Hana Health for not referring him to a specialist. “I don’t even take my kids there,” said the father of four boys. “I would only go to Hana Health for one emergency ... if I need an ambulance, or an air ambulance.”

In memory, I’ve reached the Ke`anae straightaway. And with each Willie track, a three-minute ditty, a seven-minute ballad,
I’m thinking of time. In present, it’s 8:27 p.m. My designer needs my story by morning, to lay the words on the page.