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Featured topic and speakers
Hawai'i Governor Josh Green, MD, joins to provide an update on the wildfire recovery efforts on Maui and discuss the role that physicians play in responding to and preparing for climate change and natural disasters. AMA Chief Experience Officer Todd Unger hosts.
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Speaker
- Josh Green, MD, governor, Hawai'i
Transcript
Unger: Hello and welcome to the AMA Update video and podcast. It's been two months since the deadliest wildfire in Hawaii's history swept across Maui. Today, we have the honor of talking with the governor of Hawaii, Dr. Josh Green in Honolulu to get the latest on the recovery efforts and what lies ahead.
I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Green, thanks so much for joining us during what I'm sure is a very, very busy time for you.
Dr. Green: Well, thank you for having me, Todd. Yes, extraordinary time. I just want to first say mahalo—that's the word we use which means "thanks"—to all my physician colleagues across the country and all of America. People have been so generous as we try to recover.
We lost 98 loved ones. We still have a few open questions, not many. And of course we have to recover for the whole region. But people have really stepped up, both in Hawaii and across the globe. So thank you for that.
Unger: Dr. Green, we're going to talk a lot more in detail about the recovery efforts and what you're doing next. I thought it might be nice to start with a little bit of background on you, given that you are both a physician and a governor. And I'd like to just talk how did you get from going from physician to governor of Hawaii?
Dr. Green: Well, my background story is I grew up in the East. I was a Pittsburgh kid. And when I was young, I didn't speak in the first couple of years. It turned out I was deaf, and my parents got me to a great primary care provider and they figured it out. And subsequent surgeries and whatnot made me, very gratefully, better. I was able to get my hearing restored and then ultimately grow into becoming a physician.
So I was grateful to medical personnel from the early days because they really rescued me. Went to medical school back in Pennsylvania. Went to Penn State Med School and then residency at University of Pittsburgh in family practice. Did my boards. And I was very fortunate to get a National Health Service Corps scholarship and the National Health Service sent me to the big island of Hawaii to be the doctor in Kahu.
So I inherited 8,000 patients. Half were Filipino and half were Hawaiian. And I just became the doctor for the region. And four years later, after seeing people struggle with addiction and not having access to behavioral health care, I ran for office for the state house to make a point, and I was very grateful to be elected. And at that point, I switched over from family medicine to mostly ER. So I've always been also covering the ER as a physician.
So went into the House and then ultimately the Senate, and then became lieutenant governor in 2018, which of course was during the COVID era. So I had a little bit more perhaps relevancy as a physician lieutenant governor. Hawaii did very well. We had the lowest mortality rate and the lowest transmission rate of COVID in the country.
And that's pretty much why I became governor. People have been very generous with me. But I've been a physician legislator or a physician governor my whole career until this year. And in Hawaii, they have a rule where you're not allowed to do anything outside, just outside, so I just volunteer now. But that was my—that was my arc, and I'm just grateful to still get to care for people occasionally, but I do it pro bono.
Unger: It's a very unique combination, and I totally understand as lieutenant governor about how that would prepare you for an era as unexpected as COVID. But I don't think that you can prepare for the kind of tragedy that you face with the wildfire. Do you think the fact that you are a physician gives you kind of a unique perspective on how to deal with something like this?
Dr. Green: It does, for sure. Jamie, my wife, who is actually an attorney, she says that all the time, that yes, I am very familiar with trauma. We practice trauma-informed care in our state. That's a focus of ours. I'm aware of the process of recovery, the mourning process, all these things. And all those years with people, taking care of tens of thousands of people over the years, of course makes me—I guess it qualifies me to be empathetic, and I have learned how people feel and what they're going through.
So I think that that is, just by as happenstance would occur, it's a good combination for us when we have a crisis. I would give anything to not have had this crisis and be happy to serve as a physician or run a hospital instead of being the governor during this tragedy, but I will step up for our people. I know what they need to recover. I'm building a lot of our recovery around what we often call the social determinants of health, which you're very, very familiar with, which is housing, which is access to health care and social support, which is access to other resources. So all the social determinants and ethnicity questions are very familiar to me. And I take that from my days as a family physician.
Unger: Since the devastating wildfires, you and many others of course have been working around the clock to recover. How are you feeling about the progress thus far?
Dr. Green: The progress has been extraordinary. In Hawaii, we have a word called "ohana," which means kind of loosely a family. It's a value also. So we care for our ohana.
And we've done things that most places have never dreamed of. We had immediately—for our audience, for their edification, we had—the community of Lahaina was totally destroyed. It displaced 12,000 individuals. Normally, recoveries only house like 5% to 10%. We housed just under 80% of the people immediately. Within two weeks, we had everyone in a hotel room that asked. Everyone.
And it didn't matter whether they were a traditional citizen or whether they were from one of the compact free associated states, like in Micronesia, or if they were homeless. Because I view that as a health consideration too. We just made sure we had everyone housed. And now we're heading as we speak into the next phase, to get people into long-term housing for 18 months to two years.
So they'll gradually leave the hotels, but they'll have housing based on humanitarian relief and state relief so that I can do the next thing for them, which is of course stabilize their job, stabilize the education for their children. We have to build a new school. The Kaiser Clinic was totally destroyed. The local hospital, of course, was overrun by victims of the burn, of the fire injuries.
So all these things happened, but we're recovering. I'm grateful to both the president and the now-former Speaker of the House. They both came, and they were very generous with me. And they set aside politics and they just saw me as a physician, which I am, as opposed to as a governor of one party or another. I won't even say it, just because your people don't care. They care that we care for people. That's what we are as physicians. And that was good. That was a very good thing.
So the recovery is going on. We expect it to be a long one. We won't be able to rebuild housing for years because it's going to take three months to do the environmental health part, which is the EPA taking out toxic waste. Then it's going to take 6 to 9 months to restore the land and remove debris, and only then can people even consider building.
But we'll build again. And there are cultural considerations. Very heavily Filipino and Hawaiian community. We want to be mindful of that.
But all these things are happening, and it's bumpy. Don't get me wrong. People are worried. They are worried about when we open.
I'm opening. In fact, the day that you guys view this, I'll be opened two months to the day, gently, with special consideration. I want people to travel to West Maui, because if they reach out to me and ask when it's the right time, I say now. Be kind, be very considerate, but come and have that trip to West Maui. Because I have 7,000—I'm sorry, forgive me—8,773 people that are unemployed right now, and I have 7,000 people in hotel rooms. I need people to recover economically so that they can recover physically, so they can recover spiritually. So all that's happening in real time, and we're just going to keep supporting people until they're all OK.
Unger: So a long road ahead, but a lot of accomplishment already in this short amount of time. And that, as you pointed out, has involved a lot of collaboration at the community and state and federal levels. What role have Maui's medical practices and physicians across Hawaii been playing also in the recovery efforts?
Dr. Green: They've been just amazing. We had a lot of need for behavioral health. A lot of individuals are suffering deep depression. We mobilized our psychiatry community. They came right on in. In fact, the secretary of health and human services came also and asked what we needed. We needed grants and they did that.
Again, we have a ton of social workers supporting our physicians, so I want to mahalo them. And of course our first responders, the fire and police folks. But the docs have been great. Maui Medical Group, special. Hawaii IPA, special.
Some of my friends have been volunteer physicians. I went and took care of individuals that were houseless who had been burned, actually, in the aftermath of the tragedy. So it's incredible what physicians can do. And in our community, we just had people volunteering. Some of their practices were burned down, so they had to ultimately kind of relocate to the hospital and set up different sites. That is a concern, but man, people stepped up.
And it's always great, because physicians have that capacity to kind of go and just be out and about and give their service. We did a lot of medical mission work together, the physician community and I, over the past year, and this is kind of an extension of that.
Unger: Well, clearly physicians like you bring a unique perspective to the table. And while this disaster was historic, it seems like we're just seeing more and more climate-related emergencies that are becoming so much more common. And you and other governors have been speaking about the need to prepare for that. What steps can health systems and medical practices take now to be even more prepared in the future?
Dr. Green: Well, this is a very well educated group, our physician community, perhaps the most educated in the country, and if they can, do their research. But I said that to the UN. I went to the UN two or three weeks ago. We're no longer anticipating the impacts of climate change. We're experiencing them.
And I'm not trying to be provocative here. I'm just saying we only had six fire emergencies from 1953 to 2003 in Hawaii, and then we had six in August. I mean, it's happening. And because of that, people are going to be climate refugees. They're going to be subject to all kinds of additional concerns, especially across the Midwest, where it's very hot. We're going to have to be mindful that that is part of the health care condition. We're going to have to do prevention based on heat, prevention based on storms. And that's going to happen not just in America but all across the world.
So I'm hopeful that we will help lead this movement. I know that it's coming. I want people to imagine what happened after 9/11. 9/11 occurred. It took the lives of more than 3,000 of our incredible citizens, and then we had to change how we looked at policy and prevention and security. Now that these storms are occurring, whether it's in California or north of the border in Canada, and causing respiratory challenges across the East Coast or in Hawaii, people should realize there's going to be public health consequence.
There probably will need to be a full discipline of environmental health care among physicians. I hope that that really blossoms. I know some people have gone that direction, but that should be very real as far as what we do. And we should encourage institutions like our hospitals and our housing institutions to begin to kind of amp up what we provide as health care providers, because people are going to go into heart failure more and more.
We now believe—I read this morning I think from the AMA, one out of four of our individuals will experience heart failure over the course of a lifetime. It's going to be a lot worse when we have temperatures of 110 degrees persistently in June, July, August, September in Chicago, in Orlando, in LA. So we should be prepared for that.
And I've always felt physicians should be policy leaders where we can be. That's the walk I've tried to walk. And I would love to have more partners in governorships and in senate positions, in Congress positions amongst our field, because we have kind of this unique perspective, which is we put people first. Even if we are pretty different from a political ideology, we're still capable of putting our patients first. And if we had more of that, we'd be better off.
Unger: Now Dr. Green, you mentioned earlier in the conversation that you'd love to see people coming back to to Maui to support everyone there. Is there anything else that folks can do to help?
Dr. Green: There is. So in addition to traveling and helping us heal, and I humbly ask this, if people want to be supportive, go to the American Red Cross and donate, because those dollars will go to help us house people. Or go to the Hawaii Community Foundation and there it's Maui Strong.
What I'm trying to do is raise—and we will do this—$225 million so that anyone who lost a loved one can get resources so they can begin to rebuild their lives. We're doing that with the top people that dealt with the 9/11 tragedy that have dealt with these other kind of crises across California. But the physician community can be very generous. And Jamie and I would appreciate that kind of love for our people, because that will help them heal. It won't bring them back, but it'll help them heal.
Unger: Dr. Green, thank you so much for your insights and everything that you're doing for the people of Hawaii. Do you have any final thoughts you'd like to share before we end?
Dr. Green: Well, there's so much to do. I will tell you there's something special that we just did recently. A week or two ago, we announced that we're going to do essentially universal loan forgiveness in our state for the full spectrum of health care providers, from physicians through nurse practitioners and PAs also and social workers, everyone.
We intend—and I believe we should have an era of national service where if we serve two years or more, we forgive loans. We're offering $50,000 per provider if they commit to Hawaii. And that I think will tip the scale in favor of health care for everyone without having to have the divisive dialogue about single payer or insurance reform or anything. I just want to support providers.
And so that's what we're doing. And maybe check in with me in a year and we'll see how it's worked. It's working pretty well so far. We have a lot of applicants. And I'm hopeful that this is one of the ways we get more health care providers into public policy.
Unger: Dr. Green, it's truly an honor to have you join us today. That wraps up today's episode. And if you enjoyed this discussion, you can support more programming like this by becoming an AMA member at ama-assn.org/join.
We'll be back soon with another AMA Update, and in the meantime, you can find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us and please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
