Ka Wai Ola - Office of Hawaiian Affairs, Volume 37, Number 5, 1 May 2020 — He Ma'i Makamaka 'Ole The Social Consequences of COVID-19 [ARTICLE+ILLUSTRATION]

He Ma'i Makamaka 'Ole The Social Consequences of COVID-19

By Dr. Keawe Kaholokula, Dr. Robin Miyamoto, Dr. Andrea Hermosura and Dr. Nieole Aurellano e ma 'i makamaka 'ole means "the disease that Ē Ē deprives one of relatives and friends," as translated by Tūtū Pukui. This 'ōlelo no'eau from the Ē Ē mid-1800s, in response to the leprosy outbreak Ē Ē in Hawai'i, sums up what many are experiencing today with the COVID-19 coronavirus crisis. The socialdistancing we are practicing today to stop the spread of COVID-19 is nothing compared to the experience of our kūpuna and their 'ohana who were afflicted with leprosy. Nevertheless, COVID-19 is a highly infectious disease that is depriving us, in the short-term, of ourrelatives and friends, impacting our physical and mental heahh.

Joseph Keawe'aimoku Kaholokula, Ph.D. - Photos: Courtesy

The United Nations expects the C0VID-19 pandemic to pose a serious health threat to Indigenous peoples throughout the world. Public heahh agencies in the United States also expect the burden of C0VID-19 to be greater for Indigenous communities. Data from Hawai'i, California, Oregon and Washington show that Native Hawaiians and Paeihe Islanders have the highest rates of confirmed COVID-19 cases, as high as 189.5 cases per 100,000, compared to other ethnic groups in those states. All Indigenous peoples share similar concerns that put them at an increased risk for COVID-19 and other related

problems. These include limited access to healthcare services, more chronic and infectious diseases, and poorer eeonomie and living conditions. These are all long-standing heahh concerns for Indigenous people that predate the arrival of COVID-19, but they are even more concerning now. Aside from the publicized physical threats caused by COVID-19, the public heahh measures of "shelter in plaee" and "social distancing," although necessary to stop the spread of COVID-19, ean pose serious physical and mental heahh problems for many. Kūpuna are the people most negatively impacted by COVID-19 should they get this virus (since they often have muhiple preexisting age-related medical conditions). People living with chronic medical conditions, such as diabetes and heart disease, are also at greater risk, but sheltering in plaee makes eating healthy and getting regular exercise more difficult. Another group at risk are people who smoke and vape; behaviors particularly high among our 'ōpio and mākua. Because COVID-19 is a respiratory illness that attacks the lungs, people with a preexisting respiratory illness, such as asthma, and people who put too mueh stress on their lungs by smoking or vaping, are at risk of having severe symptoms should they get COVID-19. Sheltering in plaee and social distancing ean also have an impact on a person's mental heahh. It ean cause depression or sadness, anxiety orfears, and increase stress levels, whieh, in turn, ean result in substance abuse and domestic violence. Many people are out of work due to the closing of businesses. Parents are homeschooling their keiki while managing their household and finances. Kūpuna are unable to leave the home and are in need of extra care. And, everyone is disconnected, physically at least, from their extended families, friends and coworkers - the people we most often turn to for help during difficult times. Being at home under these conditions ean plaee a physical and emohonal toll on anyone. Our personal emotional wellbeing is critical, and being self-aware of your feelings and behavior is key. Here are signs to be maka'ala (alert) to and for whieh you might want to seek help: excessive fear and worry about your heahh and the heahh of your 'ohana; changes in sleep or eating patterns; difficulty sleeping or concentrating; worsening of chronic heahh problems; increased use of aleohol, tobacco products, e-cigarettes or other drugs or; increased anger and arguments with others in the home. A person's emoīional wellbeing also affects their ability to take good care of their physical heahh, including proper care of any chronic medical conditions such as diabetes or heart disease. People often smoke, vape or drink aleohol more than usual to deal with their stress or negative emotions, whieh are not good coping strategies under any circumstance, but even more so now. Too mueh aleohol coupled with frustration ean lead to hurting others and ean threaten the safety and wellbeing of the 'ohana - behaviors not consistent whh our cultural values.

Staying mentally and physically healthy means finding positive ways to eope and to deal with sheltering at home and social distancing. Here are some ideas: Be creative. Haku (compose) a mele, pule, oli or poem, or journal your experiences to memorialize this time as our ancestors did in the past; start a new hobby or home project; try new recipes or; learn a new language (like Hawaiian!) at home online. Stay socially connected using technology. Host or join a live concert over social media - many of our talented musicians have already done so; host "happy hour" or gettogethers over social media or videoconferencing and; eall or text friends and family often - reconnect with old friends and distant relatives. Reconnect with 'ohana. Create family challenges with board or video games; film a TikTok; spend time whh your keiki and teach them how to do something new (make a lei or a family recipe), or let them teach you how to do something or; get to know your mākua and kūpuna better - revisit your mo'okū'auhau (genealogy) and share family mo'olelo. Help others. Check-in with kūpuna to make sure they are safe and fed or reach out to keiki or at-risk members of our community who may not be safe at home. Practice self-care by creating a schedule that includes playtime and exercise. Eat healthy and balanced meals with more fruits and vegetables; go outside and spend time in the sun walking (while maintaining a safe distance!) or gardening, or swim, surf or hi'uwai in the oeean; exercise - there are so many online and free programs - use cans of food or water bottles as weights or some Hawaiian music to hula your way to health; pule, practice breathing exercises, or meditate (there are free apps for meditation including, Headspace, Calm, and Buddhify) or; manage your breathing through blowing bubbles, practicing oli, or by blowing a pū. We ean and should draw on our Hawaiian values to deal with the COVID-19 crisis. Aloha , Mālama, and 'Ohana , and the affection we hold for our keiki and kūpuna, are needed more than ever to overcome our current situation. Social distancing changed one way we express our Aloha: honi. Although we need to temporarily refrain from sharing a honi, there are many other ways to express our Aloha for one another. We ean reach out to eaeh other over social media or phone to show we care by checking-in with our family and friends. We ean express our value of Mālama by helping our kūpuna and keeping our families and communities safe - all while wearing a mask, washing our hands, and maintaining some distance. We ean express our values tied to 'Ohana by treating everyone like they are family members, friends and neighbors. Most of all, this means that we do not harm the ones we love. We also need to extend our Aloha and Mālama to the most vulnerable in our communities - the homeless and incarcerated. The homeless are already stigmatized and experience social avoidance and rejection by others while living under

threats of physical violence. They laek access to healthcare, education, housing and employment. Incarcerated individuals are vulnerable to C0VID-19 because of the overcrowded and unsanitary conditions of the prisons. There is a loeal and national eall to release prisoners sentenced for non-violent offenses and who are close to completing their sentences. These people are part of our 'Ohana and need our Aloha. As we deal with the COVID-19 outbreak, remember that our kūpuna overcame many disease outbreaks in a similar fashion. In 1881, a smallpox epidemic broke out in Hawai'i while King Kalākaua was on his world tour. The future Queen, Lili'uokalani, served as Regent in her brother's absence, leaving her to respond to the outbreak. To contain the spread of smallpox, she ordered the closing of ports to prevent ships filled with passengers, possibly carrying the disease, from entering. She ordered a quarantine of the infected and asked all citizens to shelter in plaee. Our Hawaiian community is resilient and looking to our history and culture ean help us overcome even the most difficult of circumstances to protect and grow our lāhui. Kihe, Mauli Ola! ■ Joseph Keawe' aimoku Kaholokula, PhD, is a Clinical Heallh Psychologist and a Professor and Chair ofNative Hawaiian Health at the John A. Burns School ofMedicine, University ofHawai'i at Mānoa. Robin E. S. Miyamoto, PsyD, is an Assistant Professor with the Department of Native Hawaiian Health at the John A. Burns ScliooI of Medicine, University of Hawai'i at Mānoa. She is a!so a practicing CIinicaI Health Psychologist with University Healtli Partners, Departments ofNative Hawaiian Health and Family Medicine and Community Heahh, Andrea H. Hermosura, PhD, is an Assistant Professor with the Department ofNative Hawaiian Health at the John A. Burns SchooI of Medicine , University ofHawai 'i at Mānoa. She is a!so a practicing CIinicaI Psychologist with the Queen 's Medical Center and University Heahh Partners, Department of Family Medicine and Community Heahh. Nieole AureIIano, PsyD, isanAdjunctAssistantProfessorwith the Department of Native Hawaiian Health at the Jolm A. Burns ScliooI of Medicine, University ofHawai 'i at Mānoa. She is also a practicing Clinical Psychologist with University Heahh Partners, Department ofNative Hawaiian Health.

Robin E. S. Miyamoto, Psy.D.

JB ^ Andrea H. Hermosura, Ph.D.

Nicole Aurellano, Psy.D.