TALKING STORY THE RIGHT WAY

PRECONFERENCE C

Althea Momi Kamau, M.P.H., R.N.
State of Hawaii Department of Health
3652 Kilauea Avenue
Honolulu, HI 96816

Loretta Fuddy A.C.S.W., M.P.H.
Department of Health
Family Health Services Division
1250 Punchbowl Street
Honolulu, HI 96813

TALKING STORY THE RIGHT WAY

Hawaii is geographically unique and generally unlike any other place within the United States. The State embraces a myriad of different traditions, cultures, and religions. The largest ethnic group makes up only 23.3 percent of the population, and Native Hawaiians constitute only 19.4 percent of the population. More than 1 in 3 residents of Hawaii (37 percent) are of mixed ethnicity. Immigrants born outside the U.S. make up 17.5 percent of the population; 24.8 percent of the population speaks a language other than English at home.

Despite the image of "paradise" or "The Health State," Hawaii is a place of contradictions and disparities. The State is in crises, struggling to deal with high rates of immigration, economic recession, a failing educational system, and issues of Hawaiian sovereignty. Hawaii has a high cost of living, low wages, and has one of the highest rates of women in the workforce to meet basic needs. Hawaii is the only State in the nation which has increased its roles of unemployment and welfare since welfare reform.

Geographic areas vary in ethnic make-up, resource distribution, and risk indicators. Native Hawaiians continue to suffer the economic, social, and health consequences of colonization. Native Hawaiians are more likely to be poor, less likely to access services, and are at greater risk for acute and chronic medical conditions than the population as a whole. Native Hawaiians also have higher rates of incarceration, documented violent behaviors, and substance abuse. Hawaiians make up the third largest group of victims and offenders in domestic violence-related homicides. Native Hawaiian children are the largest group of child abuse victims in the State, according to Department of Human Services statistics.

A great deal of attention is currently focused on Native Hawaiians because they are in a serious health and social crisis. They have also been described as strangers in their own land. Many agencies and programs in Hawaii work with Hawaiians to address different aspects of the human service agenda, some more successfully than others. Cultural competency has become the mantra of these agencies.

To work effectively with the Native Hawaiian population, strategies and approaches that are culturally relevant must be incorporated into care-giving. Further, an understanding of the history and the relationship of the Hawaiians with their world is essential to the implementation of these strategies. "Talking Story" has definitive cultural components to it and is necessary in setting the foundation for an authentic client-provider relationship. Knowledge of family history or genealogy further strengthens this approach.

"Talking Story" and other approaches will be explored during this presentation. Several programs under the oversight of the Maternal and Child Health Branch have utilized culturally-based strategies. Examples will be shared and current usage highlighted. Suggestions for replication with other programs will also be discussed.