Meth and Fentanyl Are the Greatest Threats of the Drug Problem in Hawaii; Health Risks, Rehabilitation and Community Outreach
by Edwin Quinabo
While marijuana is the most used drug in Hawaii, persistently high methamphetamine hospital admissions and increasing fentanyl overdoses and penetration are identified as the greatest threats of the drug problem in Hawaii, according to the National Drug Intelligence Center.
Methamphetamine (crystal meth or ice)
Between July 2020 and December 2021, 263 drug-related deaths were recorded in Hawaii. Methamphetamine toxicity accounted for 64.3% of those deaths. In 2022, 64% of overdose deaths in the state involved psychostimulants, mostly methamphetamine. Meth addiction in Hawaii has been a persistent problem since the 1980s. Some estimates place the number of addicts in the state as high as 120,000. Hawaii has more residents who use meth than the national average.
Dr. Rainier Dennis D. Bautista, Clinical Professor, University of Hawaii John A. Burns School of Medicine, told the Hawaii Filipino Chronicle, methamphetamine, or “ice,” remains one of the most significant substance use issues in Hawaii. “It continues to cause widespread harm, contributing to psychiatric crises, domestic instability, and chronic medical conditions. Based on recent state data, methamphetamine was involved in 222 overdose deaths in 2023, showing a continued and devastating presence in our communities,” he said.
The social cost of methamphetamine is between $41-68 billion dollars, studies show, which includes lost potential from meth use, meth-related impacts, and the burden of addiction on dependent users and their premature mortality.
Health risks of meth use
According to the Mayo
Clinic, methamphetamine is a highly addictive stimulant that dramatically increases dopamine levels, leading to intense euphoria, rapid dependence and severe health risks, including heart problems, psychosis and death. Users experience emergent, acute, subacute, and chronic injuries to neurologic,
cardiac, pulmonary, dental, and other systems. The longterm effects include damage to the heart, liver and brain. Producers can sustain life-threatening injuries in the frequent fires and explosions that result when volatile chemicals are combined. Methamphetamine (continue on S3)
Hawaii Among Top 10 U.S. States in Stroke-related Deaths
By Jim Bea Sampaga
Anew study found that Hawaii ranks fifth in the highest stroke-related deaths per 100,000 residents in the United States.
In a study by Sukuzi Law Offices, a criminal defense and
personal injury law firm, they examined 2023 stroke-related death data across the U.S. from the National Safety Council’s Injury Facts.
The rates of death were compared to the population data of each state to find the stroke-related deaths per 100,000 residents.
Hawaii, which occupies the
fifth spot after Alabama, had a total of 849 stroke-related deaths in 2023. The state’s rate is 62.29 stroke-related deaths per 100,000 residents, which is 30.5% higher than the national average of 47.7 deaths.
“The troubling rise in stroke-related deaths across Hawaii highlights the urgent need for immediate action at both
personal and governmental levels,” said Suzuki Law Offices.
“Additionally, it is essential for Hawaii to increase funding for public health initiatives focused on stroke prevention and awareness. Immediate access to medical intervention and long-term care resources is crucial in helping families navigate the challenges that follow a stroke.”
Hawaii’s First On-Campus Cancer Clinic to Open This Year
Two of Hawaii’s leading cancer care organizations have signed a memorandum to partner in developing an oncology clinic space in Kaka’ako.
The University of Hawaii Cancer Center and The Queen’s Health Systems are enhancing cancer care in the state by collaborating to integrate Queen’s oncology ser-
vices into the UH Cancer Center’s research facilities.
This partnership project will provide comprehensive cancer care and early-phase clinical trials under one roof. This will mark the first time UH offers on-campus clinical services for cancer patients.
“As a member of the Hawaiʻi Cancer Consortium, The Queen’s Health Systems has
always been one of the state’s most powerful allies in the fight against cancer,” said Naoto T. Ueno, director of the UH Cancer Center.
“This agreement builds on our mutually beneficial collaboration as we continue to save lives. It ensures patients in Hawaiʻi and the U.S.-Affiliated Pacific Islands can benefit from cancer research that yields better preventive care, earlier de -
tection, and improved treatment options.”
Hawaii’s first early-phase clinical research center for cancer is currently under construction, but the first and second floors are set to open by the end of the year.
Queen’s will lease the space on the third and fourth floors of its center’s ‘ewa wing, which will offer medical oncology, surgical oncology, and chemotherapy infusion services.
both increases libido and reduces inhibition, a synergy that increases the risk of STD for users and their partners.
Fentanyl
Since 2020, fentanyl related deaths in the state have quadrupled. In 2020, the state had 26 deaths; in 2021 there were 48 fentanyl-related deaths; in 2022 there were 79 and in 2023 there were 107. Experts warn a more powerful form of fentanyl – 100 times stronger – has reached Hawaii.
Gary Yabuta, executive director at Hawaii High Intensity Drug Trafficking Area, said law enforcement in Hawaii seized 20 pounds of Carfentanil, “that’s enough to kill every citizen or resident in the City and County of Honolulu, that’s how powerful it is,” Yabuta explained. Fentanyl’s potency is 50-100 times stronger than morphine and 25-40 times stronger than heroin.
Health and drug enforcement officials say fentanyl is a growing problem because it is being laced with methamphetamine, heroin, oxycontin, cocaine and marijuana. Dr. Christina Wang of the Hawaii Health and Harm Reduction Center said, “We’ve seen a real shift in drug supply to include fentanyl in almost anything. It took a little longer to see fentanyl hit our shores, but it’s here and so we really need to be proactive about how we’re managing and saving our community. Fentanyl is such a dangerous drug,” Dr. Wang said. “This is what’s causing the majority of overdose and deaths.”
Dr. Seiji Yamada, Professor in the University of Hawaii Department of Family Medicine and Community Health, said the medical community is concerned about how other drugs are laced with fentanyl, as 2 milligrams of fentanyl is fatal. He said as a method of harm reduction, fentanyl test strips are being used to de-
tect the presence of fentanyl in other drugs.
Fentanyl-related deaths rose by 35% in 2023, accounting for 107 confirmed fatalities, Dr. Bautista said. “Many overdoses involve fentanyl mixed into other drugs without the user’s knowledge, increasing the danger of accidental death. Certain areas, such as Honolulu’s ‘fentanyl triangle’ encompassing parts of Chinatown, Iwilei, and Ala Moana, have seen especially high rates of EMS overdose responses. The evolving landscape of substance use in Hawaii now involves both longstanding methamphetamine dependence and a disturbing rise in synthetic opioid fatalities,” he said.
Health risks of Fentanyl
Fentanyl is a fully synthetic opioid sometimes prescribed for legitimate medical reasons but is also commonly synthesized in illicit labs and sold on the black market. Fentanyl carries many potential health risks when used by itself or in combination with other drugs. According to the American Addiction Center, Fentanyl misuse can include (but are not limited to): hallucinations and visual disturbances, drowsiness and nausea, confusion, constipation, respiratory distress, muscle rigidity, unconsciousness or sedation, seizures and overdose. Fentanyl can cause permanent brain damage due to hypoxia, which can occur due to overdose and can lead to reduced oxygen in the brain, as well as damage to other organs. It can worsen or cause new mental health conditions such as depression or anxiety, and in some cases, can be associated with a higher risk of suicide.
Drug rehabilitation
There are over 150 addiction treatment outpatient rehabs, 49 inpatient rehabs and 36 detox clinics in Hawaii. For assistance to accessing state
resources, contact the Hawaii Department of Health’s Alcohol and Drug Abuse Division at 808-692-7506.
Dr. Bautista said he works closely with social workers and behavioral health colleagues to connect patients to rehabilitation programs that match their needs -- whether inpatient, outpatient, or harm-reduction models. “In Hawaii, we often refer to Hina Mauka, The Queen’s Medical Center’s chemical dependency services, and other community-based providers. When possible, I also try to align patients with culturally appropriate care, particularly for Native Hawaiian and Filipino patients who may benefit from programs rooted in cultural identity and family involvement,” he said.
The Hawaii State DOH created the Hawai’i Coordinated Access Resource Entry System (Hawaii CARES), a statewide 24/7 coordination
center for support with substance use, mental health, and crisis intervention services. The State of Hawaii adopted the 988 dialing code. Calling the simple three digit number, 988, directs an individual to the Hawai’i CARES line.
Dr. Bautista said primary care providers can screen for substance use risk factors, provide trauma-informed counseling, and intervene before patterns of addiction take root.
Substance abuse treatment reduces costs for society, reduces crime and health care costs.
Risk Factors
Breaking New Ground for Youth at Risk: Program Summaries identified several risk factors for potential drug abuse.
Community Environment:
Living in an economically (continue on S4)
(Meth and Fentanyl....from S1)
COVER STORY
depressed area with:
• High unemployment
• Inadequate housing
• High prevalence of crime
• High prevalence of illegal drug use
Minority Status Involving:
• Racial discrimination
• Culture devalued in American society
• Differing generational levels of assimilation
• Cultural and language barriers to getting adequate health care and other social services
• Low educational levels
• Low achievement expectations from society
Family Environment:
• Alcohol and other drug dependency of parent(s)
• Parental abuse and neglect of children
• Antisocial, sexually deviant, or mentally ill parents
• High levels of family stress, including financial strain
• Large, overcrowded family
• Unemployed or underemployed parents
• Parents with little education
• Socially isolated parents
• Single female parent without family/other support
• Family instability
• High level of marital and family conflict and/or family violence
• Parental absenteeism due to separation, divorce, or death
• Lack of family rituals
• Inadequate parenting and little parent/child contact
• Frequent family moves
Negative Adolescent Behavior and Experiences:
• Lack of bonding to society (family, school, and community)
• Rebelliousness and nonconformity
• Resistance to authority
• Strong need for independence
• Cultural alienation
• Fragile ego
• Feelings of failure
COMMUNITY HEALTH AND WELLNESS
• Present versus future orientation
• Hopelessness
• Lack of self-confidence
• Low self-esteem
• Inability to form positive close relationships.
• Vulnerability to negative peer pressure
Dr. Yamada said, “from the revolutionary medicine perspective, we need to work with the man, the woman, their workplaces, and their societies to combat alienation, addictions, and violence against women and children. Revolutionary medicine is the medicine wherein health workers understand the social origins of illness and the need for social change to improve health conditions. It is created from the practice of the people’s struggles against their oppressive conditions.
“In both the literature and clinical practice, we see that drug use often begins as a response to deeper pain,” Dr. Bautista said, “Many individuals turn to substances to cope with trauma, mental health disorders, poverty, or social isolation. Some start using drugs recreationally or under peer pressure but quickly find themselves dependent due to how these substances alter brain chemistry and decision-making.
“In Hawaii, structural and socioeconomic issues such as housing insecurity, multigenerational poverty, and limited access to behavioral health care compound the problem. We also see intergenerational cycles of substance use in some families, and the effects of cultural displacement, particularly in immigrant and Native Hawaiian communities. Addiction is rarely just about the substance—it’s a reflection of broader unmet needs. Understanding this helps us treat the root causes, not just the symptoms,” Bautista said.
Clinical care and community outreach
“In both the literature and clinical practice, we see that drug use often begins as a response to deeper pain. Many individuals turn to substances to cope with trauma, mental health disorders, poverty, or social isolation. Some start using drugs recreationally or under peer pressure but quickly find themselves dependent due to how these substances alter brain chemistry and decision-making. In Hawaii, structural and socioeconomic issues such as housing insecurity, multigenerational poverty, and limited access to behavioral health care compound the problem. We also see intergenerational cycles of substance use in some families, and the effects of cultural displacement, particularly in immigrant and Native Hawaiian communities. Addiction is rarely just about the substance—it’s a reflection of broader unmet needs. Understanding this helps us treat the root causes, not just the symptoms.”
– Dr. rainier Dennis D. Bautista Clinical Professor, University of Hawaiʻi John A. Burns School of Medicine stitute, and as effective as narcotics, is the combination of Tylenol and ibuprofen. We can educate our patients -- not only to those who are addicted but to all patients -- about the risk and danger of opioid use and consequences of drug addiction would also help,” he said.
Dr. Bautista said the first step is to approach the patient with compassion, free of judgment, and to recognize addiction as a treatable medical condition—not a moral failing. “I assess for the specific substances being used, evaluate for withdrawal risks, and identify any coexisting mental health or social issues that may need to be addressed. For opioid use, medications such as buprenorphine (Suboxone) can be life-saving and are often the cornerstone of treatment. For methamphetamine or polysubstance use, treatment tends to rely more on behavioral therapies, intensive counseling, and structured recovery programs.”
Dr. Fortunato Elizaga, a primary care physician, said to help reduce the prevalence of drug addiction, one way is for primary care providers to avoid prescribing narcotics to our patients for moderate to severe pain. “An excellent sub-
“Beyond clinical care, the medical community can engage with schools, youth organizations, and cultural groups to provide education, mentorship, and community support. We need to help build resilience and protective factors in our keiki before they ever encounter substances,” Dr. Bautista said. “And we must advocate for systems that promote mental wellness, reduce stigma, and support recovery as part of comprehensive care. When patients are seen, supported, and surrounded by access—not barriers—our entire community becomes stronger and safer,” he said.
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Fatty Liver: A Silent Disease
By Nestor Heraña Jr., MD, FACP
Overview and Causes
Fatty liver disease, Nonalcoholic fatty liver disease (NAFLD) and Metabolic dysfunction-associated steatotic liver disease (MASLD) are different names for the same condition.
This is a disorder in which fat builds up in the liver due to multiple reasons such as excess weight, high blood sugar, high cholesterol, or high blood pressure.
When the liver has fat buildup and is inflamed, the condition is called “metabolic dysfunction-associated steatohepatitis” or “MASH.”
This problem is usually not brought about by alcohol consumption.
Symptoms
Most people with MASH have no symptoms. Some people may have vague symptoms like fatigue, a general feeling of being unwell, and discomfort in their upper right abdomen.
Diagnosis
MASH can be discovered following routine blood tests. Once found out, additional tests can be done to help confirm the presence of MASH and rule out other types of liver disease. An ultrasound or MRI may reveal fat accumulation in the liver.
Liver enzyme tests , which are blood tests that measure levels of substances produced or metabolized by the liver.
These can be represented by aspartate aminotransferase (AST) and alanine aminotransferase (ALT). These are elevated in most people
with MASH and can help diagnose the disorder.
A liver biopsy may be required to confirm MASH if other causes of liver disease cannot be excluded with standard blood and imaging tests.
A liver biopsy can also help determine the severity of inflammation, detect liver scarring called “fibrosis” or, in severe cases, “cirrhosis.”
Transient elastography, also called FibroScan®, is another noninvasive test that can be used to determine how “stiff” the liver is. This stiffness can then be used to estimate how much scarring there is in the liver and to determine if cirrhosis has developed.
Treatment
Treatment of MASH focuses on weight loss, controlling some of the medical conditions associated with MASH, such as diabetes, hypertension, hyperlipidemi,a and obesity, and monitoring for progression.
Losing weight can help to reverse MASH and improve the metabolic dysfunction. Weight loss should be gradual (for example, 1-2 lbs per week). A health care provider or nutritionist can provide an individualized weight loss plan.
Prognosis
MASH is typically a chronic, life-long condition. It is difficult to predict the progression of MASH in an individual, but weight loss can significantly improve or reverse MASH.
However, in some people, MASH gets worse over time. The most serious complication of MASH is cirrhosis, which is when the liver becomes severely scarred.
For people with severe forms of MASH who do not have diabetes, health care providers sometimes recommend supplements of low doses of vitamin E. Do not take vitamin E unless your health care provider recommends it.
Cirrhosis does not always cause symptoms, but when symptoms do occur, they can include swelling of the legs and abdomen, difficulty breathing or yellowing of skin and eyes. Cirrhosis can lead to liver failure and liver cancer.
To get more information, your health care provider is the best source regarding inquiries and concerns related to your medical problem.
Measles is Back — And Vaccination is Still the Best Protection
By Rainier Dennis D. Bautista MD, DABFM, FAAFP
For the first time in nearly a decade, a child in the United States has died from measles—a disease declared eliminated in the U.S. in 2000.
Yet now, in 2025, measles is back, spreading rapidly both nationally and globally.
This disturbing resurgence demands our urgent attention, particularly here in Hawaii and within our Filipino community.
The return of this dangerous illness underscores a simple truth: vaccines work, and we must never take their protection for granted.
Why Measles Is Dangerous
Measles is not a harmless childhood ailment. It is
highly contagious and can cause severe complications, including pneumonia, brain inflammation (encephalitis), permanent hearing loss, and even death.
Spread through airborne particles, measles can linger in the environment for hours, and up to 90% of unvaccinated individuals exposed will become infected.
Recent Real-Life Consequences
Samoa (2019): In one of the most devastating measles outbreaks in recent history, Samoa experienced over 5,700 infections and 83 deaths, the majority among young children. A dramatic drop in vaccination coverage, driven by
misinformation, left much of the population vulnerable. The government declared a state of emergency and shut down normal operations to conduct a mass vaccination campaign.
Ohio, USA (2022–2023): Central Ohio reported 85 confirmed cases of measles, primarily affecting unvaccinated children under age five. More than 40% of these children required hospitalization, many for severe dehydration and respiratory complications. This was one of the largest outbreaks in the U.S. in recent years, fueled by declining childhood vaccination rates.
Philadelphia, USA (2024): A cluster of cases erupted in a daycare and emergency department, infecting multiple children, including infants too young to be vaccinated. Several were hospitalized. The outbreak was traced to an unvaccinated individual who had traveled internationally.
Texas & New Mexico, USA (2025): As of the writing of this article, over 400 measles cases have been reported in Texas, with one confirmed pediatric death—the first U.S. measles death in nearly a decade. The child had no known underlying conditions. In New Mexico, 33 cases have been confirmed, mostly in unvaccinated individuals, and one additional measles-related death is under investigation. These outbreaks have reignited pub-
lic health warnings in areas with high vaccine exemption rates.
These are not just numbers—they are lives lost, children hospitalized, and communities disrupted. Measles is entirely preventable through vaccination. Its return is not due to medical failure, but to gaps in vaccine coverage and growing misinformation.
Vaccination: Our Best Defense
The measles, mumps, and rubella (MMR) vaccine is safe, effective, and widely available. A child needs two doses for full protection: the first dose at 12 to 15 months of age, and the second at 4 to 6 years. In Hawaii, this schedule is part of the routine childhood immunization program.
Adults born before 1957 are generally considered immune due to natural exposure. However, adults born in 1957 or later who have never had measles or the MMR vaccine should receive at least one dose.
Certain groups—such as healthcare workers, college students, and international travelers—may require two doses for full protection. If you’re unsure of your vaccination status, a blood test can confirm immunity, or your healthcare provider may recommend a booster. There is no harm in receiving an extra
Warm-Up Exercise As An Intervention For Overuse Injuries In Workers
By Arcelita Imasa, MD
Overuse injuries, which stem from repetitive tasks, improper posture, and continuous physical strain, are a common cause of musculoskeletal (MSK) disorders in occupational environments.
Structured warm-up routines offer a promising, evidence-based strategy for proactively addressing these injuries.
Benefits of Warm-Up Exercises in the Workplace
Exercise can be viewed as a therapeutic tool. Engaging in consistent physical activity has been shown to enhance cardiovascular performance and trigger the release of mood-boosting and energizing hormones like adrenaline.
Beyond enhancing general well-being, physical activity reduces the likelihood of heart disease, aids in weight management, and supports blood sugar control.
Participating in exercise programs before surgery, often called “prehabilitation,” has been associated with smoother recovery, especially when these programs are tailored in terms of intensity and consistency.
A warm-up is defined as a short session of low- to moderate-intensity physical activity performed before exercise or work.
This process gradually increases heart rate, circulation, and body temperature, and may include light aerobic movements, dynamic stretching, or job-specific motions.
The value of warm-up routines lies in four primary functions:
1. Preparing the mind for the task ahead (mental readiness)
2. Activating physiological systems and muscles
(physical readiness)
3. Enhancing performance and reducing fatigue
4. Minimizing the risk of injury, a concept borrowed from sports science and now being adapted to workplace contexts
These exercises help activate the nervous system, promote circulation, and improve the transportation of nutrients throughout the body. They condition the muscles, tendons, ligaments, and joints to function more efficiently during physical tasks.
Findings from sports science indicate that warm-ups are effective for activities requiring repetitive motion or exertion, and these principles are now being extended to workplace ergonomics.
Applying Warm-Up Exercise Programs in the Workplace
Warm-up routines can help mitigate occupational risk factors such as excessive exertion, repetitive tasks, and poor posture or ergonomics.
Common workplace MSK disorders include carpal tunnel syndrome, tendinitis, rotator cuff issues, and lower back or knee pain.
When designing workplace-specific warm-up routines, the following factors are essential:
• Assessing the nature of the worker’s tasks
• Targeting appropriate muscle groups (e.g., deltoids and triceps for pushing; biceps and back mus-
cles for pulling; glutes and leg muscles for standing or lifting)
• Clarifying goals: structural support, metabolic conditioning, or general function
• Including resistance training, balance, and flexibility exercises
• Beginning with large muscle groups and simple movements
• Tailoring exercises to individual capabilities
• Adjusting intensity, duration, and frequency as needed
In conclusion, warm-up exercises offer a practical and effective means of reducing workplace overuse injuries. They go beyond the benefits of simple stretching by preparing the body for continuous or demanding activity. Incorporating these routines into daily work schedules can play a critical role in injury prevention.
Start your workplace warm-up exercises today!
DR. ARCELITA IMASA is a practicing family physician and the secretary of the Hawaii Workers Center’s Executive Committee of the Board. She grew up in the Philippines before migrating to Hawaii with her family more than a decade ago.
HEALTHLINE Q & A COMMUNITY HEALTH AND WELLNESS
What is Osteoporosis?
By NAPCA Staff
In this column, we will aim to raise awareness about osteoporosis, highlighting the importance of early screening and timely diagnosis, with a special focus on older women in the Asian American, Native Hawaiian, and Pacific Islander communities.
QUESTION: What is osteoporosis? I heard that Asian American women are at facing high risk of osteoporosis.
ANSWER: Osteoporosis is a condition that weakens bones, making them more likely to break. It affects about 54 million adults, increasing the risk of fractures, disability, and loss of independence. 1 in 2 women over 50 will experience a fracture
in her lifetime. 2 out of 3 women with osteoporosis and a high risk of fracture will break a bone.
Asian American women are at particularly high risk due to naturally lower bone density and dietary factors. Many Asians are lactose intolerant, leading to lower calcium intake as dairy products, a main source of calcium, are often avoided.
ther bone loss and reduce the risk of fractures.
Q: What should older AANHPI women do to learn about bone health, screenings, and treatment options?
Without adequate calcium and vitamin D, bones become weaker, increasing the likelihood of fractures. Despite having one of the highest rates of osteoporosis, Asian American women are less likely to
be screened or treated for the condition compared to other populations.
Q: What are the hidden dangers of fractures from osteoporosis?
A: Osteoporosis is more common than people realize. Many times, breaking a bone is the first sign of the condition, so it is often called a “silent disease”. For older Asian American women, who are often caregivers in their families, a fracture can be life-changing.
60% of people with osteoporosis never fully regain their independence after a fracture. Many face longer hospital stays, higher surgical risks, and prolonged rehabilitation.
Chronic pain and reduced mobility can lead to isolation, depression, and an increased risk of death. Studies show that 32% of people die within a year of a hip fracture, and 10% die within a year of a spinal fracture.
NAPCA is dedicated to improving the quality of life of older Asian American, Native Hawaiian, and Pacific Islander adults.
We urge all older adults, especially women, to prioritize osteoporosis screening and treatment to prevent fur-
A: Osteoporosis is a serious condition, but it is often overlooked in the Asian American, Native Hawaiian, and Pacific Islander communities. While bone density tests are recommended for women 65 and older, fewer than 20% of patients who suffer from osteoporosis are properly assessed and treated. According to the National Health and Nutrition Examination Survey, only 7% of postmenopausal women report taking osteoporosis medication.
Older AANHPI adults, especially women, are strongly encouraged to prioritize bone health by undergoing bone density screening every year and treatments to prevent further bone loss and reduce the risk of fractures. If you or a loved one are at risk, speak with your healthcare provider about bone health, screenings, and treatment options to stay strong and independent for years to come. Prevention and early treatment can make a big difference.
If you have additional questions about Medicare, Medicaid, Affordable Care Act Health Insurance Marketplace, Social Security Retirement Benefit, Supplemental Security Income, or COVID/Flu vaccination, there are two ways you can reach us today:
Call: 1-800-336-2722
Email: askNAPCA@napca. org
THE NATIONAL ASIAN PACIFIC CENTER ON AGING (NAPCA) is a non-profit organization dedicated to improving the quality of life of AANHPI older adults and their families. We operate a NAPCA Senior Assistance Center for Older Adults and Caregivers which is available in 5 different languages.
Understanding the Threat of Respiratory Syncytial Virus in Adults
By Jon Avery Go, MD
Respiratory Syncytial Virus (RSV) is a contagious respiratory virus that primarily affects infants, young children, and the elderly. RSV positivity rates have shown significant seasonal variations, with outbreaks typically starting as early as October, peaking in January to February, and lasting until May. It is the third most commonly identified virus that causes respiratory hospitalizations. The virus spreads through inhaled droplets when an infected person coughs or sneezes, infecting the respiratory tract. It can survive on surfaces for hours, making it highly transmissible. Most adults who are symptomatic for RSV develop upper respiratory tract infection symptoms 3-5 days after being infected and symptoms can range from mild to severe. Common symptoms in -
clude congestion, runny nose, coughing, sore throat, wheezing, fever, a decreased appetite, and difficulty breathing. Severe cases can lead to pneumonia, respiratory failure, and acute cardiac events.
It is challenging to distinguish RSV from influenza, COVID-19 and other resporatory-borne illnesses. Treatment for RSV is mostly supportive care for recovery. Over-thecounter fever reducers and pain relievers work well along with hydration and rest. Antiviral therapy is reserved for those who are severely immunocompromised in an inpatient setting. Preventing RSV involves good hygiene practices such as frequent hand washing, disinfecting surfaces, and avoiding close contact with infected individuals.
The CDC recommends that all adults aged 75 and older receive a single dose of RSV
vaccine. It is also recommended for adults 60-74 years old who are at increased risk for developing severe disease. This includes people who have severe comorbidities such as cardiovascular disease, chronic lung disease, chronic liver disease, end stage renal disease, certain neurologic conditions, diabetes with complications and severe obesity. This also includes transplant patients, those undergoing chemotherapy (especially for leukemia or lymphoma), taking long-term immunosuppressants, and the frail and elderly living in long-term care facili -
ties. No booster dose has been recommended at this time. Preventive measures, including hand hygiene, avoiding close contact with sick individuals, and vaccination, are essential in reducing the spread of RSV in the community.
DR. JON AVERY GO is a board-certified Internal Medicine physician. He practices as a primary care doctor at Primary Care Clinic of Hawaii.
DOH Urges Parents of Seventh Graders to Schedule Well-Child Visits
Children undergo significant changes when they approach adolescence, such as physical, emotional, and social changes.
To prepare incoming seventh-grade students, the Hawaii Department of Health is encouraging parents of seventh-grade students to schedule a well-child visit as soon as possible.
A well-child visit includes a comprehensive physical exam that will ensure the child’s health and well-being are prepared for the transition from elementary to middle school.
The child’s immunization will be reviewed to stay updated with the vaccines needed to stay healthy and protect children from serious diseases.
Many children have not received vaccines since kindergarten, which means some of the protection they had when they started school has declined.
Moreover, incoming seventh-grade students are now old enough to receive additional vaccines to prevent them from other serious illnesses.
The Hawaii law requires all students to submit official documentation to their school that confirms they have received the required vaccinations and have had a physical exam before the first day of school.
they received the following vaccines:
• Tetanus, diphtheria, pertussis vaccine (Tdap)
• Meningococcal conjugate vaccine (MCV)
• Human papillomavirus vaccine (HPV)
provider.
Well-child visits are recommended at least once a year for children and youth so their healthcare providers can monitor the child’s growth and development while addressing physical activity, health, and behaviors.
Additionally, children new to Hawaii schools must complete a tuberculosis clearance form with their healthcare
For more information about Hawai‘i’s school health requirements, visit www.VaxToSchoolHawaii.com.
Nationwide Campaigns as House Republicans Plan Cuts of $880 Billion in Medicaid Funding
Numerous organizations from various states nationwide are holding ‘Save Medicaid’ awareness and petition campaigns to rally against the looming $880 million budget cut presented by Republicans in the U.S. Congress.
According to an analysis by the nonpartisan Congressional Budget Office (CBO), an estimated 2.3 to 8.6 million Americans could lose their Medicaid coverage.
In Hawaii, Medicaid is known locally as Quest. This federal and state-funded program provides health insurance coverage for over 400,000 residents across the Hawaiian Islands.
Medicaid turns 60 this year, and it ensures quality medical care, such as longterm care for those who meet certain criteria, including income, age, and disability.
It is still unclear what Medicaid cuts Republicans are eyeing to pursue. However, according to a USA Today re-
Before the first day of school this 2025-2026 school year, all seventh-grade students must provide proof that port, CBO examined potential cuts:
• Reducing federal payments to states that have expanded Medicaid enrollments under the Affordable Care Act (ACA)
• Capping spending per enrollee for the entire Medicaid populations
• Capping spending per enrollee under the ACA’s Medicaid expansion
• Revoke the Biden Administration rule on Medicaid eligibility
“Medicaid serves as a vital safety net for individuals and families who cannot afford private health insurance or who have limited access to employer-sponsored coverage,” said Francoise Culley-Trotman, CEO of AlohaCare, a community-led non-profit health plan organization.
About half of Hawaii’s children and around a third of residents rely on Medicaid for health coverage.
With the uncertainties brought by the possible Medicaid cuts, Hawaii residents who rely on Medicaid might face devastating impacts.
“They would be unable to come up with the funding likely to take care of their diabetes or their heart disease or other serious problems that they have,” said Dr. Jack Lewin of Hawaii Health Planning & Development Agency in an interview with Hawaii Public Radio.
“We would see some significant crises in terms of preventable morbidity and mortality across a population of people.”
Moreover, Hawaii residents from the island nations of Palau, the Marshall Islands, and the Federated States of Micronesia are also susceptible to the impacts of the Medicaid cuts.
“We just in the last couple of years succeeded in Congress in getting full access to Medicaid as part of the renegotiation of our treaties with those
countries,” said U.S. Representative Ed Case.
“Many, many parts of that community are very marginalized and in great need. Their health care is pretty critical, and access to Medicaid has been a lifesaver for those communities. And so any reduction in Medicaid is going to hurt them in particular.”
Senator Mazie Hirono emphasized the consequences of cutting Medicaid funding.
“Gutting Medicaid would have devastating consequences for so many in our communities, and stories about the crucial role this program serves in people’s lives will help to raise awareness of just how critical this program is,” she said.
AlohaCare aims to raise awareness and advocate for Medicaid beneficiaries. To lend support, visit https://linktr.ee/sharemystory to submit a testimony on how Medicaid may have helped an individual or family through their health journey.
U.S. Renal Care: Taking Care of Hawaii for Over 20 Years
Keeping your kidneys healthy is a vital step in taking care of your body and health.
Cases of kidney disease are 30% greater in Hawaii than the national average. Filipinos, along with Native Hawaiians, Japanese, and Pacific Islanders, have the highest risk of kidney disease in Hawaii.
For over 20 years, U.S. Renal Care has been at the forefront of kidney care and dialysis in Hawaii.
With over 2,000 dialysis patients in Hawaii every month, U.S. Renal Care operates 20 in-center clinics, 13 home therapy programs, and four acute dialysis programs in Hawaii. Nationwide, they serve over 30,000 patients in 34 states.
The leading kidney care provider has a footprint all across the Aloha state with recent openings in Hilo, Kona Coast, and Kalihi, and future locations planned for Kauai, West Oahu, and Maui.
With numerous treatment options for chronic kidney patients, educational programs are also one of U.S. Renal Care’s top priorities to ensure patients and their families are knowledgeable about the different ways that can help them delay the onset of end-stage renal disease.
Moreover, U.S. Renal Care provides the latest and stateof-the-art dialysis machines, ultrasound for vascular access, heated and massage therapy recliners, and state-of-the-art water treatment systems in their clinics.
“We offer all dialysis modalities. We are the first to roll out the Tablo hemodialysis system in the hospital setting. We are also the first to adopt the Sonosite ultrasound system for vascular access cannulation,” said Pliny Arenas,
by HFC Staff
U.S. Renal Care Regional Vice President of Operations.
“We are the only region utilizing this technology 100% in all of our clinics.”
In Hawaii’s Best Awards presented by the Honolulu Star Advertiser, U.S. Renal Care is awarded the Best Dialysis Center Award in 2023 and 2024 for its up-to-date dialysis offerings and patient care.
Emphasizing their compassionate patient care, it will not be possible without the provider’s knowledgeable and caring staff.
With 500 employees in Hawaii, the staff consists of highly experienced directors of operations, area biomed managers, facility administrators, clinical supervisors, acute clinical coordinators, clinical specialists, social workers, dietitians, kidney care options educators, registered nurses, patient care technication, unit clerks, biomed technicians, and many more.
“We have highly skilled employees with an all-time high retention rate of 94%. We live by our values: excellence, partnership, inclusion, and compassion,” said Arenas.
For several years, U.S. Renal Care’s high retention rate is consistently recognized by Newsweek as one of America’s Greatest Workplaces for Diversity and Greatest Workplaces for Women.
As a Filipino-American, Arenas has been leading the operations of U.S. Renal Care in Hawaii for several years now. When asked about Filipino values, he incorporates in their operations and patient care, he said:
“Filipinos strive for excellence in what they do. We value a partnership that highlights the spirit of bayanihan Filipinos are inclusive and compassionate.”
Bayanihan, a Filipino term that highlights community and cooperation, is not just present in U.S. Renal Care’s clinics. They also share their bayanihan spirit by involving themselves in the Hawaii Filipino community.
U.S. Renal Care support various organizations such as Philippine Medical Association of Hawaii, Ohana
Medical Mission, Bayanihan Clinic Withouth Walls, Alzheimer’s Foundation, National Kidney Foundation, Binhi at Ani, FilAm Community of East Hawaii, and many more.
To learn more about U.S. Renal Care, visit www.usrenalcare.com. To set an appointment, call their Admissions Center at (808) 265-6081.
Staff at the Waipio branch of U.S. Renal Care
KIDNEY STONES 101
By Dr. Valerie Tan
Nephrolithiasis, or commonly known as kidney stones, is a common disease that affects 1 in 11 people in the United States, with incidence and prevalence rates increasing over the last several decades.
Men are more commonly affected than women, with a male-to-female ratio of 3:1, and having a family history of kidney stones further increases the risk.
Most stones develop in persons aged 20-49 years, with peak incidence among those aged 35-45 years, but it can occur in any age group.
Patients can have a single stone or multiple stones at the time of diagnosis. Kidney stones typically recur, and recurrence rates after the first stone episode are 14% at 1 year and up to 52% at 10 years.
The majority of kidney stones are made up of calcium, either in combination with other compounds like oxalate or phosphate, accounting for 75% of kidney stones.
The rest of the most common chemical types of kidney stones include struvite (magnesium ammonium phosphate) stones, uric acid stones, cystine stones and stones from precipitation of certain drugs or its metabolites.
Struvite stones account for 15% of stones and they are associated with chronic urinary tract infections (UTI) with certain kinds of bacteria. Uric acid stones account for 6% of kidney stones.
Approximately 25% of patients with uric acid stones have gout. Cystine stones account for 2% of stones, and they arise because of an intrinsic metabolic or genetic defect.
Drug-induced stones arise from the precipitation in the urine of drug components or metabolites.
The most common cause of kidney stones is low fluid intake, causing low volume of urine, which leads to high concentrations of stone-forming components in the urine.
This causes supersaturation of stone components like calcium, oxalate and uric acid in the urine, leading to crystal formation, which in turn becomes the nidus for further precipitation of the components, eventually forming a stone.
The stones first develop in the kidneys and then migrate to different parts of the urinary tract as they try to pass.
An acute kidney stone attack (renal colic) is described as excruciatingly painful, sometimes described as worse than childbirth. The stones cause symptoms when they become impacted within the ureter as they pass toward the bladder.
The colicky-type pain is primarily caused by the dilation, stretching, and spasm caused by the acute obstruction in the ureter.
It usually begins in the upper lateral mid back and then radiates down and to the front toward the groin.
Contrary to common belief, the severity of the pain depends on the degree and site of the obstruction, not on the size of the stone. Other symptoms can include blood in the
urine or symptoms of urinary infection.
Approximately 80-85% of stones pass spontaneously, while about 15-20% of patients with an acute stone attack will require hospitalization due to unrelenting pain, inability to keep food or water down, inability to pass the stone, or worse, presence of severe kidney infection.
Obstruction of the ureter by a kidney stone, especially complete obstruction, can lead to damage to the affected kidney because blood flow to the affected kidney decreases to approximately 50% after 72 hours and down to 12% after 8 weeks.
As such, intervention within 4 weeks is recommended to avert permanent kidney damage.
Treatment for acute renal colic involves medical or surgical interventions or both.
Patients with uncomplicated ureteral stones that are 10 mm or less in diameter and are close to the bladder can be managed with aggressive medical measures with IV fluids and pain control.
Larger stones that seem unlikely to pass spontaneously require some type of surgical procedure and possibly hospitalization. However, most patients with acute renal colic can be treated on an outpatient basis.
Treatment of kidney stones does not end with the spontaneous passage or surgical removal of the stone.
Subsequent metabolic and medical evaluations for risk factors are indicated due to the high risk of recurrence, especially for those who present with multiple stones, who have a personal or family history of previous stones, are younger in age, or who have residual stones after treatment.
Metabolic evaluation for stone risk factors involves a 24hour urine collection to evaluate for high concentrations in the urine of calcium, uric acid, or oxalate, or low concentrations of citrate.
Your medical provider can advise dietary changes or prescribe medications to alkalinize the urine to decrease the risk factors for further stone formation.
The most important aspect of medical therapy, however, is maintaining high fluid intake, which subsequently increases urine volume, effectively decreasing the risk of supersaturation of calcium, uric acid, and oxalate.
The goal is to increase fluid intake enough to achieve a 24hour urine volume of at least 2.5 liters.
General dietary modifications include avoiding excessive intake of sodium (salt), animal protein, and high purine foods (eg, organ meats, legumes, fatty fish, meat extracts, gravies).
Although medical therapy and dietary changes generally do not completely stop the tendency for stone formation, it is, however, effective at delaying further stone formation.
Increased fluid intake and dietary modifications can cut the stone recurrence rate by 60%, which may be enough to decrease stone episodes in one’s lifetime.
DR. VALERIE TAN is a board-certified physician in Internal Medicine and Nephrology. She practices as a Nephrologist at Hawaii Nephrologists LLC.
ASK A DOCTOR COMMUNITY HEALTH AND WELLNESS
(MEASLES ....from S6)
dose if your records are unclear.
The safety of the MMR vaccine has been firmly established in decades of research and monitoring. The notion that the MMR vaccine causes autism stems from a single fraudulent study published in 1998, which was later fully retracted and discredited. The lead author lost his medical license, and numerous largescale studies since then, including those involving hundreds of thousands of children, have found no link between the MMR vaccine and autism. Unfortunately, that false claim still circulates in some circles and continues to fuel vaccine hesitancy. It’s time we put that myth to rest, for the safety of our children and our communities.
Protecting Our Community
Vaccination protects not just individuals but the entire community, especially vital in multigenerational Filipino households where family gatherings and close interactions are common. Immunizing your family helps shield infants too young for vaccination, elders with weakened immune systems, and individuals with medical conditions that prohibit vaccination.
As community leaders, parents, and caregivers, we have a shared responsibility to advocate vaccination openly and frequently within our
families and community organizations.
Beware of Harmful “Remedies”
In times of concern, misinformation can promote unproven and harmful “alternative” remedies. These products have no scientific basis and can seriously harm your health, such as:
Vitamin megadoses – Vitamin A has benefits in cases of measles in patients who are malnourished and vitamin deficient, but excessive or unsupervised dosing—especially in children—can be toxic to the liver and bones.
Cod liver oil – Promoted for its vitamin A content, excessive use has caused liver damage in some cases during the Texas outbreak. Cod liver oil is not a treatment or preventive measure for measles and should not replace medical care.
Steroids – Corticosteroids suppress the immune system and are not recommended during active measles infection unless prescribed in very specific, controlled hospital settings. Improper use may worsen outcomes.
Antibiotics – Measles is a viral illness and does not respond to antibiotics. Misuse contributes to antibiotic resistance and delays appropriate care.
Essential oils taken internally or applied to the skin – Oils like oregano or eucalyptus are often promot -
ed online to “kill the virus,” but they are not antiviral and may cause allergic reactions or chemical burns, especially in children.
Unregulated herbal teas or tinctures – Some traditional remedies promoted on social media or in informal markets may include unsafe ingredients that interfere with medications or cause toxicity.
Measles “parties” – Intentionally exposing children to measles in the hopes of gaining natural immunity is not only outdated but extremely dangerous and irresponsible. Measles can lead to hospitalization or death even in healthy children.
These so-called “cures” can delay people from seeking real care or give a false sense of security. There is no substitute for vaccination.
What We Can Do
Check your children’s immunization records. Make sure they’re up to date, especially before school entry or international travel.
Get vaccinated yourself if needed. Don’t assume immunity—verify it. When in doubt, it is safe to get vaccinated again.
Educate your family. Talk to parents, aunties, uncles, and grandparents. Many grew up in a time when these diseases were common. Help them understand the importance of keeping vaccinations current.
Rely on trusted sources. The CDC, Hawaii State Department of Health, and your family physician are reliable sources of information, not influencers or viral posts.
During outbreaks, even individuals who’ve already received the recommended two doses of the MMR vaccine may be advised to get an additional dose, particularly if they are in high-risk environments such as healthcare settings, schools, or areas with active transmission.
The extra dose is safe and may help boost protection during times of heightened exposure. If your vaccination history is unclear, it’s better to get vaccinated than to risk infection.
As a family physician and a member of the Filipino community here in Hawaii, I’ve seen how quickly preventable illnesses can re-emerge when vigilance fades. Measles should not be a threat in 2025, yet here we are. Let’s not wait until it reaches our schools or neighborhoods before we act.
Vaccines are not simply a matter of opinion—they are an essential matter of public safety. Together, we can ensure that measles never again claims another child, another life, or another future.
DR. RAINIER BAUTISTA is a board-certified physician specializing in both Obesity Medicine and Family Medicine. He currently practices at the Primary Care Clinic of Hawaii and serves as the president of the Philippine Medical Association of Hawaii.
Hawaii Introduces Bill to Strengthen, Protect Health Care for Seniors
U.S. Senators Brian Schatz and Mazie Hirono, with U.S. Representatives Jill Tokuda and Ed Case, reintroduced a bicameral bill that would strengthen and protect healthcare for seniors in Hawaii.
“As more people reach Medicare age in Hawai‘i, we are seeing fewer health care providers because of the rising operating and living costs in our state,” said Schatz.
“Our bill would help fix that, boosting Medicare payments to providers and protecting health care access for the 300,000 seniors in Hawai‘i who rely on Medicare.”
For Hirono, the bill “will help expand and protect access
to health care across the islands by ensuring that physicians and other health professionals are being fairly compensated.”
Called the Protecting Access To Care in Hawaii (PATCH) Act, the bill would provide fair Medicare reimbursements to Hawaii providers, help retain doctors in the state, and protect access to healthcare for seniors across Hawaii.
Medicare physician payments per beneficiary in Hawaii are among the lowest in the country. While health care operating costs in Hawaii are substantially higher than in other states, its Medicare reimbursement rates do not account for those rising costs.
The PATCH Act would
increase healthcare provider payments by up to 38%.
Representative Tokuda highlighted the importance of these increased payments.
“By adjusting Medicare payments to reflect the true costs of care in Hawai‘i, we can better support our doctors, strengthen local health systems, and ensure that our kūpuna aren’t left behind when they need care the most,” she said.
Representative Case shared that this bill is about taking care of our kupuna.
“The PATCH Act reinforces our commitment to Hawai‘i’s kūpuna by ensuring that their medical practitioners are adequately compensated for the care they provide to our seniors,” he said.
Hawaii Receives Historic $700M Settlement with Big Pharma
Announced in early May, Hawaii reached a $700 million settlement with two major pharmaceutical companies: Bristol-Myers Squibb and three US-based subsidiaries of Sanofi.
Filed in 2014, the lawsuit accused the two pharmaceutical companies of misleading marketing practices with their prescription medications.
“This is the largest settlement we’ve ever seen in our state,” said Hawaii Governor Josh Green.
“Let me say this, it’s a historic result that we’re grateful for, gratified by. I’m proud of the work by the Attorney General and her team. This result will help the state of Hawaii.”
The two companies will
pay $350 million each, with the full $700 million expected to be wired to the state by June 9, 2025. The payment will be deposited into Hawaii’s general fund.
The lawsuit highlighted that the companies violated Hawaii’s consumer protection laws.
“I also want to be clear— while this money is substantial, it is important to me that everyone who does business
Dengue Cases Rise In Hawaii
The Hawaii Department of Health confirmed there are currently eight active cases of dengue in the state, with seven on Oahu and one on Maui.
The individuals affected were exposed to the dengue virus while traveling in a region where the virus is common.
Dengue virus is transmitted from an infected person to a mosquito, and then to another person. Hawaii is home to the mosquitoes that can carry dengue but the disease is not endemic in the state, and cases are currently limited to travelers.
Mosquitoes only need a small amount of standing water to breed. Common breeding sites include buckets, water-catching plants, small containers, planters, rain barrels, and even cups left outside.
Pouring out containers of standing water can significantly reduce mosquito population by eliminating potential breeding grounds.
For tropical and subtropical areas of Central America, South America, Asia, the Middle East, Africa and several Pacific Islands, the risk of den-
gue is all ye round.
When visiting areas prone to the dengue virus, the Centers for Disease Control and Prevention advises travelers to take standard precautions such as using Environmental Protection Agency-registered insect repellent, wearing longsleeved shirts, and long pants outdoors, and sleeping in air-conditioned rooms, rooms with window screens or under insecticide-treated bed nets.
Moreover, travelers returning from dengue-endemic areas should take precautions
in the state of Hawaii, whether you’re a small shop or a multibillion-dollar oil company, knows the Attorney General’s Office will be relentless in our pursuit of consumer protection laws,” said Hawaii Attorney General Anne Lopez.
Once the wire payment is completed, the next step will be to identify areas where the funds can be used to serve Hawaii residents, according to state officials.
to prevent mosquito bites for three weeks.
Dengue symptoms can range from mild to severe and include fever, nausea, vomiting, rash, and body aches. Symptoms typically last two to seven days. Even with severe illness, most people can recover within a week from dengue virus.
Individuals experiencing symptoms should immediately contact their healthcare provider. Those who suspect a dengue infection are advised to call the Disease Reporting Line at (808) 586-4586.
The Gift of Healthy Eyesight
By Janet Kelley
As we age, the prevalence or risk of eye conditions and diseases increase. Consider making an eye exam appointment to ensure healthy eyes.
Approximately 37 million adults in America have age-related macular degeneration, cataract, diabetic retinopathy, or glaucoma, all of which can cause visual impairment or blindness.
Take charge of your eye health and preserve your sight by following simple yet highly effective tips.
“Many vision conditions may not present symptoms – but they can affect people in all stages of life,” says Dr. Steven Rhee, Medical Director, and head Ophthalmologist at Hawaiian Eye Center.
The easiest way to maintain healthy vision is to receive regular comprehensive eye exams.
In order to thoroughly ex-
amine a patient’s vision, an eye care professional will use drops to dilate and widen the pupils to check for common vision problems and eye diseases.
It is the best way to find out if you need glasses or contacts, or are in the initial stages of any eye-related diseases.
Here is how to keep you and your loved ones’ vision healthy:
• Help your loved ones book an annual eye exam, regardless of whether eye symptoms are present.
• Learn your family’s eye health history. It is important to know if anyone has been diagnosed with an eye disease or condition, since some are hereditary.
• Eat right to protect your sight: In particular, eat plenty of dark leafy greens such as spinach, kale, or collard greens, and fish that are high in omega-3 fatty acids.
• Wear protective eyewear when playing sports or doing activities around the home, such as painting, yard work, and home repairs.
• Quit smoking, or never start.
• Wear sunglasses that block out 90%+ ultraviolet A (UVA) and ultraviolet B (UVB) radiation.
• Wash your hands before taking out contacts and cleanse contact lenses properly to avoid infection.
Taking care of your eyes also benefits your overall health.
People with vision problems are more likely than those with good vision to have diabetes, poor hearing, heart problems, high blood pressure, lower back pain, and strokes, as well as an increased risk for falls, injury, and depression.
In addition to your comprehensive dilated eye exams, visit an eye care professional if you have:
• Decreased vision.
• Eye pain.
• Drainage or redness of the eye.
• Double vision.
• Diabetes.
• Floaters (tiny specks that appear to float before your eyes).
• Circles (halos) around light sources; or
• If you see flashes of light.
Give the gift of healthy eyes. To learn more about eye health, visit: www.hawaiianeye.com
