Remote, Rural Kaʻū Prepares For Possible COVID-19 Surge

Apr 22, 2020

The Ka'u coast from Na'alehu to Pahala with Kilauea Volcano in the distance. The Ka'u district is nearly twice the size of the island of O'ahu with pockets of rural communities scattered over the rugged terrain.
Credit Ku'uwehi Hiraishi

At least one positive case of COVID-19 has been found in the Kaʻū region of the Big Island, according to state health officials. It's something this remote and rural district has been preparing months for.

The rugged terrain of Kaʻū stretches over more than 900 square miles on the southern part of Hawaiʻi Island. It’s a region rich in plantation history, coffee crops and, these days, uncertainty about COVID-19. Jessie Marques runs the Kaʻū Rural Health Community Association. 

The Ka'u Rural Health Community Association has been focused on preserving access to quality healthcare in the Ka'u community for more than 20 years.
Credit Jessie Marques

“A lot of people are overwhelmed, but also a lot of people donʻt quite understand how it's going to impact us here in Kaʻū,” says Marques.

Marques has been working closely with Kaʻū Hospital and Bay Clinic in Naʻalehu to provide a regional approach to community outreach and preparation for a possible surge.

“You know making sure thereʻs PPE available, hand sanitizer, masks, things like that,” says Marques.

Ka'u Hospital is the only hospital serving a community of nearly 9,000 people over more than 900 square-miles. It has 21-beds - 17 of those for long-term care patients, and the others for acute care. The facility also includes an 24-hour Emergency Room, a family health practice and rural health clinic, and an X-ray lab.
Credit Ka'u Hospital

Merilyn Harris, who runs the Kaʻū Hospital, says she currently has five acute care beds and one ventilator. This is the only hospital in the district serving nearly 9,000 Kaʻū residents.

“So we have plans in place that will ramp up our response based upon what the amount of spread in the community [is],” says Harris. “And so right now, weʻre just in prevention mode.”

Sheʻs isolated long-term care residents. Doctors are opting for telemedicine. And anyone entering the hospital is screened for a fever or respiratory symptoms. But if a patient presents COVID-19 symptoms, “that patient would most likely be sent to Hilo Medical Center or Kona Community Hospital right away because they can provide a higher level of care than what we can,” says Harris.

Hilo is an hour-long drive, which concerns Marques, who lives five minutes from Kaʻū Hospital. 

“If I got a fever and coughing, Iʻm not going to end up in the E.R. in Kaʻū. Iʻm going to end up in the E.R. in Hilo or in Kona,” says Marques. “And as a senior citizen on limited income, I donʻt have the means to pay for this. What happens if I refuse?”

Hawaiʻi County councilwoman for Kaʻū, Maile David, says medical costs should not be a barrier to care during the pandemic.

“I think thatʻs the last thing our people should be worried about,” says David.

She hopes some of the federal relief aid can help cover some of these costs. In the meantime, the focus is on social distancing and complying with stay-at-home orders. 

“Because access to medical care and access to everything else is very hard, I think that makes it even more of an urgency for people in rural areas to be very mindful and so they try as hard as they can to keep their families safe,” says David.