Country doc chronicles island-style health care
Plantation medicine in Hawaii paved the way for a state health care system that provides a model for a national universal health care system, says Dr. Frank Tabrah.
The veteran isle doctor has written a book chronicling development of health care "Hawaii style" before and during his more than 50 years here.
He spent 17 of those years at Kohala Hospital on the Big Island, and tells fascinating and humorous stories about his "near idyllic lifestyle" and experiences as a plantation doctor.
In an interview discussing his colorful career and book, "Healthcare Hawaii Style: Model for the Nation," he said he dreamed about working where it was warm as a young doctor in the snow and cold of Buffalo, N.Y., then Bellingham, Wash.
Skiing on Mount Baker one day, he met a doctor who had left Honolulu and told him he might like it here, he said. The doctor gave him the name of Dr. Nils Larsen, "a medical giant in the islands."
"I didn't have the faintest notion of coming here," he said, but he contacted Larsen, who told him he would have to live here a year to get a license.
A year later, just as he received word he had passed the California boards, Larsen called and told him there was a plantation opening. He visited Kohala and "was hooked," he said.
About six weeks later, he and his wife arrived at the remote 13,000-acre sugar plantation. That was in 1956, and he says, "I have not had one minute of regret."
A bleeding pig-hunting dog that fought with a wild boar introduced him to life as a country doctor.
He had just met the hospital supervisor and did not know how she would feel about using the clinic to operate on a dog, he wrote. So he took the dog and owner through back passages of the old frame clinic, "fired up the OR with its 1900s shiny multimirrored lamp with bull's-eye lenses, found instruments (unsterilized), sutures and went full ahead ... to fix our patient. ...
"With a large dose of penicillin and wrapped up like a mummy in gauze, my patient went home."
The plantation health system "was a real challenge at times," but it worked because everyone -- unions, plantation companies, doctors and public health workers -- "came to the table and left their guns behind," Tabrah said.
"Plantation communities thrived by a paternalism that led to decades of some of the most generous and effective public health advances anywhere in the world," he wrote. "Excellent medical care was provided, without billings, fees or dunning for payments."
"Looking back," he recalls, "We were practicing Mayo Clinic (medicine) alongside what was there 20 years before."
Hawaii's health care system evolved with multiple funding sources and coverage for most residents, he said, crediting "employers, the two largest insurers, the state hospital system and doctors who continue to work in this shrinking financial milieu."
The state hospitals, operated by the Hawaii Health Systems Corp., "are real winners," he said, providing high-level health care and long-term care in rural areas.
"Hawaii is a model for similar national coverage of the aged and chronically ill," he wrote.
Hospitals across the country are closing or are in trouble because of "unacceptable costs," inadequate payments and excessive paperwork and legal issues, Tabrah points out.
His book is available online at Amazon.com and Bor-ders.com for $14.95. Straub and the Kohala Book Store have ordered them, and Brookline Books will distribute them to bookstores.
