From the time the Molokai Dialysis Center was established in 1999, RDP has covered travel, lodging, and per diem expenses for hemodialysis technicians requiring training at the Saint Francis Medical Center’ Renal Institute (now Liberty Dialysis) on Oahu. Since then patient numbers have increased from six (6) at the facility’s opening to twenty-five (25) in 2007. These growing numbers have necessitated additional shifts, staffing, and consequently more training for which RDP continues to be supportive.

In 2004, dialysis services extended to the remote northern peninsula of Kalaupapa, whereby access is via a challenging 2.4 mile walk down a cliff-side switchback trail; by limited barge service (twice yearly); and by small commuter aircraft. Best known as a former Hansen’s Disease settlement and for the role of Belgian priest, Blessed Father Damien who administered to the afflicted; Kalaupapa holds a remnant population of elderly patients and those who serve them. Today, the National Park Service and the Hawaii State Department of Health hold key responsibility for the management of Kalaupapa (Kalawao County) and the care of its people. Residents number at thirty-eight (38), with twenty-five percent (25%) of patients living in urban Honolulu where more sophisticated medical services to treat disabilities associated with the disease process and the infirmities of age are available. It has been difficult to proffer services to this community, whose immediate needs are being met by the resident medical staff and two (2) physicians who fly in weekly to treat them. As a result patients requiring complex care are forced to relocate to other islands; thus taking on the added emotional burden of being dislocated from their community and the only home they’ve known.

Project leader Na Pu`uwai took the initiative to bring dialysis services to Kalaupapa. Na Pu`uwai facilitated meetings between agencies, legislators, and medical entities to begin the process of bringing patients back home. Primary partners in the project included: St. Francis Medical Center, Office of Hawaiian Affairs, Na Pu`uwai Native Hawaiian Health Care System, Hawaii State Department of Health, Molokai Enterprise Community - Ke ‘Aupuni Lokahi, MSM Joint Ventures (landlord), and the County of Maui, State Legislature, and the Hawaii Congressional delegation Senator Inouye and Representative Case. Training dollars and logistical support was also granted by RDP. The State Department of Health (DOH) provided oversight of the Kalaupapa Settlement and committed personnel and patient support in this project. The DOH established a position for the inclusion of dialysis-related responsibilities through their current care home staff and through this training for a dialysis technician.

The training program was developed, approved and implemented by the St. Francis Medical Center’s Renal Institute staff. The curriculum included training participants at different levels: basic dialysis technician for home dialysis; technician training for facility; and clinical nursing support. Two individuals were selected for work at the remote Kalaupapa site and an additional trainee to meet the expanded hours and increasing patient demand at the “topside” dialysis facility in Kaunakakai. Criteria for approval included commitment to completing the training, patient comfort with the trainees and, especially in the case of the Kalaupapa trainees, a willingness and commitment to relocate and work there. For the Kalaupapa training, the goal was to have technicians trained to enable the patients in need of dialysis the opportunity to return home to Kalaupapa instead of having to relocate and remain on Oahu for their dialysis treatments. There are two dialysis units now available at Kalaupapa. Since Kalaupapa does not have a hospital anymore and the designation is now a care home, the training that was provided focused on a quasi-home dialysis format.

An individual that had no prior medical training but demonstrated a commitment to learn a new skill and relocate to Kalaupapa, was recruited, selected, and trained. She is now living in Kalaupapa and is working full-time as a hemodialysis technician there. An RN working at Kalaupapa Care Home was recruited and given a refresher course in dialysis treatment at St. Francis. She serves as a back-up and is employed part-time to provide dialysis services and three-quarter time at the nursing unit for long-term care. For “topside” Molokai, the need for another registered nurse led to the recruitment and training of a RN now employed at the Molokai Dialysis Center in Kaunakakai.

The training components for Phase I included the first two (2) weeks in the classroom learning pathology, the science behind diabetes, and understanding the purpose for dialysis in patients experiencing renal failure. The remaining 3-4 weeks of instruction entailed hands-on work with the equipment under supervised conditions with actual patients and crisis training for emergency situations.

Phase II Training encompassed telemedicine training with the use of video-conferencing equipment and internship work. The Kalaupapa site posed unique challenges due to its remoteness and limited resources. The Kalaupapa trainees received additional training in case management, entering charts, placing orders for medication and unit supplies for dialysis.

The “topside” dialysis facility has the capability to hold teleconferencing for both patients and staff. The patients meet monthly with their social worker, dietician, physician (if needed), and the head nurse via teletechnology. This venue enables the Molokai patient to have contact with his/her dialysis team without having to travel off-island to Oahu. The staff uses videoconferencing for meetings or continuing education whenever there is a need in addition to scheduled meetings. There are plans to place a videoconferencing unit at Kalaupapa at the care home to enable the staff and patient(s) accessibility to St. Francis similar to their “topside” counterparts.

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