An approach to the Health of the Hawaiian people Presentation by: POKA LAENUI (HAYDEN F. BURGESS) Director, Institute for the Advancement of Hawaiian Affairs President, Pacific Asia Council of Indigenous Peoples 86-649 Puuhulu Road Wai'anae, Hawai'i 96792-2723 Tel: 1 (808) 696-5157 Fax: 1 (808) 696-7774 Draft: Compare with delivery. 'Ano ai me ke Aloha. (Greetings in the spirit of Aloha) We indigenous people must walk in two different worlds, a ha`ole (foreign) world and a Hawaiian world. But, we must walk with only one spirit. Because to walk in both worlds with a divided spirit results in disaster. Schizophrenia is what some would call our condition - a disassociation from our environment and a deterioration of our personality. We native Hawaiians are suffering from massive racial schizophrenia. The person who says, "I am ha`ole. Though the blood of Hawai'i's ancestry courses through my body, I choose to walk the way of a ha`ole," that person will find a measure of peace. The person who says, "I am Hawaiian. The blood of my Hawaiian ancestry courses through my body and I choose to retain my identity as a Hawaiian," that person too will find a measure of peace. But the person who asks, "What am I? Ha`ole or Hawaiian?" That person will never find any measure of peace. Confusion is his fate. It is not a simple matter to resolve this question. The choice to retain an indigenous identity is most difficult when we look about our social, cultural, economic and physical environments and find so little support to incline us toward being indigenous. All the signals around us are instead tugging us toward identifying as one of the very foreigners in our homelands. Yet, even those who have consciously chosen to identify themselves as ha`ole cannot deny the fact that there is a continuing call to their inner spirit to be Hawaiian - cannot deny the fact that they are the tangible proof of an ancestry which refuses to be forgotten. I submit that the division of spirit is the fundamental problem, to a large extent going unrecognized, which leads to a whole array of other ills. That schizophrenia has lead to members of the Hawaiian race ranking in the lowest of college graduates as compared with all immigrant groups, an unemployment rate almost twice that of the state of Hawai'i, over 25% of our people below the poverty line, members of the Hawaiian race in the forefront of crimes committed, our people lead in acute and chronic health conditions and in substance abuse. The vast majority of indigenous peoples today who have been confronted with the same intensive European colonization efforts as we have been here in Hawai'i by the Americans are caught in similar situations. The dilemma of having to choose placing one's spirit in a foreigner's or an indigenous world must be one of more than passing interest to us. That dilemma is often the root of genocide of a people. Programs to address conditions of poverty of a people is essentially the work of bringing about good health - Health as defined in the broader World Health Organization's definition as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." How can we address the health conditions of Hawai'i's indigenous race? First, perhaps, we need a clear definition of the Hawaiian race. If we strip aside the philosophical, spiritual, intellectual and emotional aspects of the Hawaiian race, then it is the oldest to the youngest individual alive today who has flowing in his or her body the blood of ancestors who populated these islands before our discovery of James Cook lost at sea. I will call this the biological definition. But if we do not strip away those philosophical, spiritual, intellectual and emotional aspects and consider the race intact, than the Hawaiian race: 1)is a continuum stretching as far back into time as creation itself and as far forward into time as the last of the Mo`omo`o will be birthed. 2) The Hawaiian race is part and parcel, not of mere land, but of its traditional territories of the earth, meaning the mountains, the plains and the valleys, the ocean, rivers and streams, the minerals, the steam however deep they may be found, the rain, the air space to where the highest birds fly, and all the plants and animals, fishes and birds where ever they may be found. 3) The Hawaiian race consists of both individuals and a collective. They are inseparable. 4) A primary characteristic of the Hawaiian race has always been free will. These basic characteristics are enmeshed into one another and must be understood as a whole. This I call, the comprehensive definition. What definition of a people should one work with in attempting to attain the highest possible level of health? If the definition of health itself is more then a mere biological one but a comprehensive one, is there any doubt that the definition we should work with should be the comprehensive one? How, then, do we address the health of a people, using a comprehensive definition? The first characteristic was the continuum of a people. What are the elements of a society which connects the generations? They are elements of history and tradition, art forms, literature, etc. These elements must be intact in order for a people to maintain their health. Therefore, providing health services to the Hawaiian race must address these connective social forms as an important part of the health program. Health services should support the continuity of the consciousness of a people. The second characteristic was the indivisibility of the Hawaiian people and their traditional territories. In the Hawaiian language, we commonly use the term 'aina which can mean not only the land but the source of all sustenance of the human person. To separate a people from that sustenance is tantamount to genocide. Recently, the International Labour Organization's recent Meeting of Experts discussing revisions to Convention 107 which is the only international convention specifically addressing the plight of the indigenous peoples recognized "the continued possession of the lands they occupy is essential to the cultural and even physical survival of indigenous and tribal peoples." That ILO report discussed the concepts of land and ownership of land. "[Indigenous peoples' representatives] described the special relationship ofindigenous and tribal peoples with the lands they occupy. He stated that reference should be made to traditional territories rather than simply to land. This included all the things pertaining to the lands themselves, including waters, the subsoil, air space, all the occupants and plant and animal life and all the resources relevant to the land. . . . Territory was thus not simply a factor of production as for other peoples, but a source of spirituality as well. In addition, many indigenous peoples did not perceive the concept of ownership as an ability to transmit all rights over the territories to other persons. They felt instead that they were the trustees of the territories they occupied, and that there was a continuity running from their ancestors, through themselves to future generations, all of whom possessed rights to the territories. They therefore regarded these territories as inalienable, in the sense that they could not transfer permanently the rights of those who were to follow after them. In addition, these lands were held collectively in almost all indigenous and tribal societies." In the words of one of the leading international indigenous organizations, the World Council of Indigenous Peoples: "The Earth is the foundation of indigenous peoples. It is the seat of spirituality, the fountain from which our cultures and languages flourish. The Earth is our historian, the keeper of events and the bones of our forefathers. Earth provides us food, medicine, shelter and clothing. It is the source of our independence; it is our Mother. We do not dominate Her: we must harmonize with Her." The health of the Hawaiian people cannot be addressed without addressing their continual need for `aina. The third characteristic of the Hawaiian people is the individual and collective character. Oftentimes, people believe that by addressing the individual, the collective is well taken care of. That is the philosophy of protection behind the United Nations' Universal Declaration of Human Rights. The reality, however, is that attempting to address only the individual is not sufficient to address the overall conditions of a race. To address the health needs of a race, their collective needs must be given just as much attention as their individual needs. Their customs and traditions must be preserved; their religious practices must be honored; their system of social organization must be respected. The fourth characteristic of Hawaiian race is their free will. Oftentimes, people working with Hawaiians do not appreciate this characteristic which is held very preciously by Hawaiians. This lack of appreciation often leads to much frustration by health service and other providers, believing that the patients are uncooperative. Rather, the truth is often the providers of service are attempting to impose their will upon the patients they are to serve. So, when you see a Hawaiian who accepts the medication, listens to all the instructions on how to take it, then goes home and never uses it, you will find that the taking of the medicine was never his decision. His politeness prevented him from confronting the physician with questions or objections but that politeness certainly did not mean agreement. Only when he accepts suggestions as his own and believes it is the way to good health, and only when his spirit is ready to accept good health, will such a patient conform to treatment. I offer these observations about our indigenous people of Hawaii in the possibility that portions of these comments may help in your work in your communities. Aloha a hui hou.