Commentary, Special to The Hawai‘i Herald
Writer’s note: For the purposes of this article, the term “women” will refer to those who have female reproductive organs. I want to be mindful of our transgender and non-binary persons. Women have the responsibility of not only needing a primary care provider, but a gynecologist or obstetrician. Obstetricians deal with pregnancy, childbirth and postpartum care. Gynecologists take care of reproductive health from puberty through menopause, including infertility and contraception needs, breast cancer and any other diseases, infections or issues pertaining to the female reproductive system. However, many people do not realize that there are other medical professionals who can provide much of the care needed in the realm of women’s health.
TRIGGER WARNING: MENTIONS OF SEXUAL ASSAULT, MISCARRIAGES AND ABORTIONS ARE INCLUDED IN THIS STORY.
It’s no secret that O‘ahu residents have the privilege of having more of certain services such as malls, restaurants, hotels, schools, the list goes on. However, one thing that is on that extensive list that shouldn’t be is more access to medical services and facilities. In particular, the issue of concern is the accessibility of women’s healthcare on neighbor islands. There are already less medical facilities and practices on the neighbor islands and, while it is true that the number may reflect the smaller population sizes, the COVID-19 pandemic brought to light just how limited all of Hawai‘i’s medical resources can be.
Sharon Offley and Colleen Bass are both advanced practice registered nurses and certified midwife nurses who opened a practice on Kaua‘i called Hua Moon Women’s Health. As APRNs, they are able to diagnose, treat, prescribe, order labs and provide expert care in relatively uncomplicated pregnancies. Both have been in practice on Kaua‘i for over 10 years. Offley actually graduated from Kaua‘i Community College’s nursing program before she earned her master’s degree and opened Hua Moon. Bass is from O‘ahu and worked at Tripler Hospital before moving to Kaua‘i. She also has her master’s degree and is a certified doula. Located in Kapa‘a, Offley and Bass take pride in running a holistic and family-centric practice and make a strong effort to build a relationship with their patients. In fact, when meeting with a new patient, they actually block off an entire hour so that they may really get to know them.
Providing personal, quality care to their patients is something that Hua Moon does not take lightly. “We support women, wherever they’re at and whatever their choices are,” Offley shared. Due to the recent overturn of Roe v. Wade, women across the country are worried about how this decision could affect them. As it is, access to an abortion can already be difficult, depending on the procedure necessary for certain circumstances. Hua Moon, along with most women health care providers, is able to provide medical abortions in the forms of pills. However, more complicated abortions or terminations of pregnancy require a flight to O‘ahu and could take weeks to schedule.
On Kaua‘i, the wait for an ultrasound can be weeks. Women also have the added barrier of first needing an appointment with their PCP who is the only one who can make the referral for obstetrician care. It can therefore take weeks just to get an appointment with said PCP. Over-booked medical care is an issue not necessarily unique to Kaua‘i or any of the neighbor islands. It is an issue that faces any rural community. So why not cut out the extra hoop to jump through and abolish the rule that requires a referral for obstetrician care? One word: insurance.
But why terminate at all? Some women elect for an abortion because they are not ready and that can include a wide range of factors. However, Offley shared that she has more often treated women and pregnant people needing abortions due to sexual assault, partners who removed condoms or other forms of contraception without their knowledge or consent, and devastating prenatal diagnoses. She also explained the three main medical reasons a pregnant person would need an abortion:
- Ectopic or tubal pregnancies. This is when the pregnancy occurs outside of the uterus and the pregnancy can never result in a baby being born. Moreover, the embryo or fetus can cause damage to surrounding organs. For instance, if the embryo is in the fallopian tube and gets too big, the tube could burst, causing dangerous bleeding and could be fatal for the mother.
- Molar pregnancies. There is not actually a fetus but instead it is a tumor. Molar pregnancies are extremely rare but they can also cause a type of cancer called choriocarcinoma. Without access to a proper abortion and surgery to remove this tumor, the result can also be fatal.
- Process of miscarrying. A miscarriage means an abortion is inevitable because the pregnancy cannot and will not result in a baby. Many probably do not realize that a miscarriage requires an abortion. Some miscarriages can be treated by terminating the pregnancy with oral medication. Others require a dilation and curettage procedure where the inside of the uterus is scraped or suctioned to remove any excess placenta or contents of the miscarriage. In some instances, without a D&C there is risk of infection or excessive bleeding.
Miscarriages are quite common and according to the American Pregnancy Association, 10-25% of pregnancies result in a miscarriage. Most people know at least one person, if not multiple women, who have suffered a miscarriage. It is a loss that often grieved privately, as most miscarriages occur before a woman has even had a chance to share her pregnancy with family and friends. Offley shared with me the following scenario to shed light on the lack of accessibility to such a common procedure for her own patients:
A woman from Kaua‘i who has found out she cannot carry her pregnancy to full term due to a devastating prenatal diagnosis. Now she must wait for weeks for an appointment and make the arrangements to fly to O‘ahu for a two-day process of terminating the pregnancy. She not only has to take off work longer for the added travel time, she needs to stay overnight away from her family and support system, possibly find childcare for any existing children, and unless she’s willing to pay out of pocket for her partner or a companion to accompany her, she is alone through all of this. This scenario Sharon shared is not a hypothetical one. She has firsthand been part of this heartbreaking and grueling process with her patients. The process to have an already difficult procedure taken care of is exasperated for our neighbor island women.
Sharon shared that the lack of access to such a basic procedure, much less any highly-specialized procedures, disproportionately affects women of low socioeconomic status, women of color and young women (which tends to correlate with not having financial means). There are negative stereotypes that those who get abortions are careless teenagers when in fact, young girls — especially minority women from low-income backgrounds — have even less access to abortions than her older, richer, white counterparts.
Keep in mind that despite the Supreme Court’s recent ruling, Hawai‘i state laws continue to protect women’s rights to choose to have an abortion, unlike the many states that have since stripped this right away since the overturn. Though Hawai‘i continues to have protection in keeping abortions legal, for the residents of neighbor islands, “legal does not necessarily mean accessible,” states Offley.
Some say abortions should only be allowed for women who were sexually assaulted. But as Sharon stated, “[that’s] saying, before a woman has autonomy over her [own] body, it has to be violated first.” Taking away women’s reproductive rights, starting with abortions, can be a slippery slope. Sharon believes that other things like contraception, sex education and infertility treatments can all be impacted by this overturn. Where will the line be drawn? And is it merely a line drawn in the sand?
If abortions were seen for what they are, a common medical procedure rather than being politicized and controversial, there would be no questions asked, no permission needed, no risking of further damage or even the mother’s life by waiting to prove the necessity of the procedure. It would be about the individual’s health and safety, rather than the opinions of lawmakers. In other areas the medical provider must get approval from the hospital board or wait for the patient to become unstable enough, for her life to be in “enough” danger for the abortion, to be clearly justifiable so that the medical provider does not get in trouble for completing the procedure “unnecessarily.” Luckily, in Hawai‘i, such consultations are not necessary. There is a lot less red tape but whatever barriers there are “should not and do not need to be there,” according to Offley. “Abortions are medically uncomplicated and legal. The resources, equipment and staffing shouldn’t be an issue.”
Offley and Bass feel so strongly about helping to eliminate some of the barriers around women’s health accessibility that they have started their own scholarship award. The Healthcare Equity Award is a $1,000 scholarship available to students in the nursing program at Kaua‘i Community College, the same program that Offley graduated from. Preference is given to those of Native Hawaiian descent who intend to work in Kaua‘i’s healthcare system. The idea is to give back to Kaua‘i locals, to invest in Kaua‘i’s own community and for more Native Hawaiians to see themselves represented in the medical field.
Hua Moon fundraised for the scholarship money and sought out local artist Maile Miyake to design a floral representation of the female reproductive system, which they named the “cuterus.” They then printed the design on shirts and sold them with the proceeds going toward their scholarship fund. Sharon and Colleen plan to continue to fundraise and award the Healthcare Equity scholarship to more Hawaiian Kaua‘i natives who are pursuing their nursing degrees. An article on the Hua Moon website also shared that in 2020, Offley and Bass worked with a local artist to fundraise for a new ultrasound machine for their practice. It is evident that they are passionate about removing as many barriers to women’s health care as possible, at least for their beloved Kapa‘a community.
Not all neighbor island medical professionals should be expected to be responsible for making appropriate and quality medical care more accessible. So who is responsible? Health insurance companies? Big Pharma? Lawmakers and shareholders? What are the real reasons women must fly to O‘ahu to take care of certain procedures? Why can only PCPs make referrals? Why does the government have a say in what women do with their bodies and whether they should carry a pregnancy to term, even if it is life-threatening? Seems like the common thread to all of these questions is control. The sad thing is that it is everyone but the patients who have a say in all of this.
The views and opinions expressed are those of the individuals in this article. They do not reflect the official policy or position of The Hawai‘i Herald. Any content provided by the interviewees of this article are of their opinion and are not intended to malign any group, club, organization, company or individual.
Alysa Tomasa has been an educator in the Windward District for the past 10 years, as both a teacher and TRIO Upward Bound program director, and spent a year in Japan teaching English after graduate school. Tomasa recently became a freelance writer for The Hawai‘i Herald as she has always enjoyed writing in her free time. When not working, she is usually busy chasing after her kids and planning events for her family and friends.