Pacific Islanders have been hardest hit by COVID-19 in the islands. They are catching the virus in disproportion to their small numbers in the population. One reason is that -- as with young people -- public information on how to avoid the virus has been failing to reach them in ways they can act on it.
The numbers have been clear for months: Hawaii has the highest number of Pacific Islanders per capita in the country. However, the state’s communication with that underserved community has been ineffective in curbing the virus.
One key reason is a lack of services, explained Dr. David Derauf, executive director at Kokua Kalihi Valley Comprehensive Family Services, a health center that has served the community for 50 years.
He said a solid relationship with the Pacific Islander community is the key to good public messaging.
“It starts with a clear message and something that's actionable,” Derauf said.
Some messages disseminated by the state Department of Health were not relevant to many people in the Pacific Islander community. He cited advice from state health officials to those testing COVID-positive: isolate at home, in one’s own space with a private bathroom, if possible.
“I think we all know what a luxury that is to have a private bedroom and bathroom, particularly for many of the communities we're talking about here,” Derauf said.
“So when someone is told that advice, what would their natural response be? 'You clearly don't know anything about my life. Why should I listen?'”
Derauf said although he works with church ministers and leaders in the Pacific Islander community to have more people tested, it’s difficult to advocate for that when there are no supports in place after people test positive.
“When they find out they test positive, they don't get so much as a phone call from someone. They're not offered anything. . . All it means for them, in terms of their daily life is a loss of income because they can't go to work,” he said.
“They run the risk of losing their housing, of being able to put food on the table for their families. . . it's been painful for me to have to hear that.”
Derauf emphasized the need for the state to first talk to Pacific Islander community leaders, figure out what services are most needed and then quickly create those services and publicize them well.
That did not happen even though clusters in the community broke out as early as May, some in public housing projects where residents live in tight quarters.
He said the state has improved its outreach by implementing a hotel room program that can house a person who is unable to isolate in their home.
However, some of Derauf’s patients have told him that they did not accept the offer because they thought they would have to pay for the room.
Derauf also warned against stigmatizing the Pacific Islander community when the state creates communication campaigns and releases information. He also says the communication should be presented in the different languages of the Pacific Islands, including Marshallese and Chuukese.
The state posted YouTube videos in those two languages in mid-May but their viewership was limited -- 1,000 views for one and 150 for the other.
Tim Brown, infectious disease expert at the East-West Center, suggests the state first take a traditional marketing approach to the problem. That means identifying key populations, drafting messages directed at them, and then working with members of those communities to design and test the actual messages to be sent out.
Brown said if the state is able to set up the needed services and structures, they should be supported even after the pandemic.
“If we actually do stand up some response that goes beyond the health sector, that engages the various social sectors, that engages the communities, that engages the other organizations that need to be part of this. They can work with employers, for example, to guarantee that people don't lose their job because they have to go into isolation,” he said.
“This will not be the last outbreak of infectious disease. If we had systems like that set up, we would have detected the spread of COVID within these communities much, much earlier.”
One region of the country that has drawn praise for its supports and relationships within the Pacific Islander community is Portland, Oregon, which is part of Multnomah County.
Virginia Luka is the program specialist senior for the Pacific Islander community within the Multnomah County Health Department.
The program oversees a Pacific Islander Coalition that quickly jumped into action to support the community through the pandemic.
“We provided them with a test, but we also provided them with resources. So we gave them PPE. We gave them N-95 masks. We gave them printed flyers that were in different languages that told people about what is COVID, how can you protect your family,” she said.
“In a couple of the test sites, we even gave gift cards out to just let them know, 'Hey, we don't know, you know, what you're going through in your life, but here's a gift card that you can go shopping with or pay a bill.'”
Hawaii lacks a position like Luka’s in its health department. If it were to create one, it would take time: Luka said it took her about a year to fully organize the coalition.
But to start, the state could identify those in the community who have already built trusted relationships with the Pacific Islander community and Pacific Islanders themselves who can help the effort.
Luka said the state could also consider paying those community members so they don’t have to do the organizing work on top of their full-time jobs.
She said the coalition and her job have been critical in getting services to the Pacific Islander community, not just in Multnomah County but throughout Oregon.
“If we didn't have those things, I think, oh gosh, it would be heartbreaking,” she said. “I think more of us would be sick and dying, honestly, without the access to resources and the support systems.”
Pacific Islanders make up just 4% of Hawaii’s population. However, they account for 31 percent of those infected -- more than any other racial group.
Conpare that to Multnomah County, where Native Hawaiians and Pacific Islanders make up just 2% of the county’s COVID-19 cases. It’s the second lowest for a racial group in the area.