For nearly a year, Hannah Litt has provided free women’s health care to individuals impacted by the Lahaina wildfire through a state-funded reproductive program at the University of Hawaii Maui College.
As the director and sole provider at the college’s health center, she has seen around 80 fire survivors, most of whom sought help accessing birth control.
“It was the need to pick up where they left off,” Litt said, pointing out that some women lost access to medication because of the disaster, “and recognizing that it was not a great time to get pregnant.”
There has long been a shortage of women’s health care providers — and health care providers in general — in Maui County, said Litt, who has worked as a nurse practitioner and certified nurse midwife on Maui since 2018.
Rising housing prices, the loss of key doctors, ongoing struggles with interisland transportation and the 2023 Maui fires have exacerbated the problem.
Today, residents are increasingly finding it difficult to get routine care. More than two-thirds of county residents experienced a delay in accessing health services in the last year, according to a recent report published by the Hawaii State Rural Health Association — a 21% increase from 2022.
A whopping 81% of medical professionals surveyed said they and their families struggled to get the appointments they needed.
Health care costs, a lack of transportation and challenges with language access are among the problems identified by health care providers in the report. However, an overwhelming 93% of respondents in the medical field pointed to a lack of providers as the biggest issue preventing the community from accessing health care.
“If I hired five new physicians today, my belief is that their panels will be full of patients within six to nine months,” said Cliff Alakai, administrator of Maui Medical Group. “There’s just a lot of people looking for health care out there.”
The issues are worse on Lanai and Molokai, which is still reeling from the loss of two primary care providers in 2022. Nearly everyone on Molokai — 97% of respondents — said there is a doctor shortage on the island. The remaining 3% were unsure.
“There was nobody saying, ‘Yes, we have enough,’” said lead researcher Lisa Grove. “As a pollster, it is never the case where you get that many people agreeing with one thing. You just don’t get that sort of unanimous consensus that there’s a problem.”
Transportation was the top health care-related concern among residents of Lanai and Molokai.
Unreliable interisland air transportation continues to be at the core of the issue. Respondents expressed frustration about limited flight options, highlighting delays and cancellations on Mokulele Airlines.
Grove, a Lanai resident, said that it is the “hit-or-miss” situation that creates stress.
Patients often fly out to Maui or Oahu a day in advance to ensure they make it to their doctor’s appointment on time, Grove said. This creates an added expense for lodging and food, easily amounting to hundreds of dollars for a single appointment that would take weeks to get reimbursed through insurance.
To make matters worse, airline issues are not just making it difficult for patients to leave the islands; health care providers primarily practicing on other islands are also finding it challenging to travel to Molokai and Lanai to serve patients.
“They either can’t get there, or they can’t get back,” said Lisa Rantz, president of the Hawaii State Rural Health Association. “Then all the patients that they were supposed to have the next day, they also need to be rescheduled. It’s just a logistical nightmare.”
Alakai said that patients from Lanai used to take a ferry to visit the group’s Lahaina clinic on Maui. It was a relatively convenient way for Lanai residents to see a physician because the Lahaina Small Boat Harbor was within walking distance of the clinic.
But last year’s fire, which obliterated the harbor, severed this lifeline connecting the two islands. While the ferry service has been restored, boats from Lanai now dock at Maalaea Small Boat Harbor, which is approximately 16 miles southeast of Lahaina and requires patients to arrange an additional car ride to the clinic.
While most of Litt’s new patients from fire-affected communities sought birth control, some reached out to her after wrestling with other delayed services such as follow-up appointments for Pap smear tests.
Some of the issues predate the fire. In March of 2023, Maui Lani Physicians and Surgeons, one of the island’s largest clinics providing obstetrics care, announced that it would end its OB practice.
The sudden decision put a burden on the two remaining major clinics, Malama I Ke Ola Health Center and Kaiser Permanente, as they strived to accommodate a surge of new patients.
This change has prompted some women from Maui to fly to Oahu for prenatal care, something women from Molokai and Lanai have been doing for years. Litt said flying for prenatal care can be problematic — especially in later stages of pregnancy when doctor visits are needed more frequently.
“It disrupts families, and it creates economic hardships as folks are parked on another island, waiting to deliver a baby,” Grove said.
Some acute problems that residents are currently struggling to get treatment for, such as breast cancer, can be traced back to the Covid-19 era, Alakai said. A lot of people stopped going to see their regular doctors during the pandemic, and things that could have been identified two or three years ago through check-ups like mammograms were missed.
This, coupled with the shortage of health care providers who were already preoccupied with Covid care, may have discouraged people from receiving preventative care, he said.
By the end of the year, Litt plans to begin supporting pregnant patients through her program. She just purchased an ultrasound machine through grant funds and hopes to provide first-trimester care for the community.
“This may be helpful, so that people aren’t going without care in the first trimester,” Litt said. “They can notice the pregnancy, find out how far along they are and see if they are high-risk, sooner rather than later.”
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This story was originally published by Honolulu Civil Beat and distributed through a partnership with The Associated Press.