Introduction
This was “The best PRIDoC ever,” exclaimed one of the attendees at the ninth biannual Pacific Region Indigenous Doctors Congress (PRIDoC) held in Hilo, Hawai‘i on July 12–17, 2018. PRIDoC is a biannual conference that brings together indigenous physicians and medical students from around the Pacific and from those lands and territories connected to the Pacific in some way. What made this PRIDoC so special? PRIDoC offers a culturally safe space where indigenous doctors and medical students can come together to build relationships and share resources and expertise. The week-long event included extraordinary cultural grounding on the island of Hawai‘i. Hawai‘i island is the largest in the Hawaiian Island chain and is home to Kilauea, an active volcano that had erupted continuously since 1983 (flows stopped in the fall of 2019), and the home of Pele, Native Hawaiian goddess of volcanoes.
The PRIDoC medical conference strives to improve the health of indigenous populations while offering CME (continuing medical education) activities, but what truly sets it apart is its use of a cultural lens to focus providers on how to better their care for patients. Sharing stories, histories and struggles as well as achievements and best practices empowers participants to influence public policies for the health of our ecosystems, our lands and waters as well as the well-being of our communities. As indigenous physicians, we know that “the health of our lands” cannot be separated from the “health of our people.” PRIDoC creates a space to share research advances, issues, strategies, and best practices for health and well-being. In addition, mentorship of medical students, is emphasized as they are “our future.”
Background of PRIDoC
PRIDoC has its origins in 1999 when both the ‘Ahahui o nā Kauka (Association of Native Hawaiian Physicians) and Australian Indigenous Doctors Association (AIDA) reached out to Te ORA (Te Ohu Rata o Aotearoa-Maori Medical Practitioners Association) for assistance in organizing indigenous doctors in their respective territories. An invitation to speak at Te ORA's annual meeting and a subsequent visit to the AIDA annual meeting led to discussions about similarities in the impacts of colonialism and the health disparities seen within indigenous populations. The three organizations decided that a conference focusing on indigenous health care disparities, including highlighting indigenous-specific best practices, could be very valuable. The leadership of the three groups decided early on that the conference would be different; it would provide an indigenous safe space and culture would be an integral part.
The conference was named the Pacific Region Indigenous Doctors Congress to reflect the Pacific connections of the three original members. The acronym “PRIDoC” was felt to represent our commonality as proud (“PRID(e)”) indigenous doctors (“Doc”). PRIDoC has since expanded from the original three organizations of indigenous physicians to include Indigenous Physician Association of Canada (IPAC), Medical Association of Indigenous People of Taiwan (MAIPT), and the Association of American Indian Physicians (AAIP). The Pacific Basin Medical Association (PBMA) is a long-standing associate member.
In 2002, the first PRIDoC was held in Honolulu, Hawai‘i at Waikiki Beach and was supported by funding from Te Ora, the Native Hawaiian Center of Excellence (NHCOE) at the John A. Burns School of Medicine (JABSOM), and a grant from Eli Lily New Zealand. Local conference organizers work hard to obtain support for subsequent PRIDoCs through many governmental and nonprofit agencies. The organization chosen to host the next PRIDoC conference also leads the PRIDoC council for two years. Other member organizations form the PRIDoC council and provide guidance and support to the hosting organization. Conferences are held every other year and rotate amongst the various partner organizations. Conference locations are included in Table 1. Plans are already underway for PRIDoC 2020 which will be hosted by IPAC in Vancouver, Canada on September 15–18, 2020.
Table 1.
PRIDoC Locations Since Beginning in 2002
| 2002: Honolulu, Hawai‘i, USA |
| 2004: Cairns, Australia |
| 2006: Rotorua, Aotearoa (New Zealand) |
| 2008: Waimea, Kauai, Hawai‘i, USA |
| 2010: Whistler, Canada |
| 2012: Alice Springs, Australia |
| 2014: Hualien, Taiwan |
| 2016: Auckland, Aotearoa |
| 2018: Hilo, Hawai‘i, USA |
| 2020: Vancouver, Canada |
Cultural Grounding at PRIDoC 2018
Since PRIDoC's founding in 2002, culture has played a central role. As host organizations change every 2 years, the host culture dictates the protocol and cultural activities offered at PRIDoC. ‘Ahahui o nā Kauka (Association of Native Hawaiian Physicians) hosted PRIDoC 2018 and worked closely with the Edith Kanaka‘ole Foundation (EKF), a widely respected Hawaiian cultural based organization whose mission is to elevate Hawaiian intelligence through cultural education founded on the teachings and traditional practices of Edith and Luka Kanaka‘ole. Pualani Kanahele and her daughter, Kekuhi Keali‘ikanaka‘oleo Haililani, are cultural consultants from EKF who were profoundly involved in the planning and execution of the cultural components of the conference. Members of ‘Ahahui o nā Kauka were asked to undergo training in Hawaiian cultural protocol as part of the responsibility of hosting PRIDoC. The consultants helped guide the cultural aspects of the conference from opening and welcoming protocols, to daily reminders of connections to culture, to closing ceremonies. The consultants also gifted us with the theme of the conference, “‘Oi Ola Wai Honua,” meaning “life is better while the earth has water,” which reminded participants of the importance of “caring for our resources, including those of us who function as resources to our people.” The hope was that the theme would inspire the exchange of ideas and collective knowledge that would enable “our people, our communities, our lands and especially us as indigenous healthcare providers, to thrive physically, emotionally, spiritually, socially and culturally.”
PRIDoC 2018 Conference Overview (Table 2)
Table 2.
PRIDoC 2018 Conference Overview
| Date/Location | • July 12–17, 2018 in Hilo, Hawai‘i |
| Attendees | • 315 conference delegates, from Australia, Canada, New Zealand, Taiwan, Hawai‘i and the US Continent • 64 medical students |
| Academic program | • 18 Plenary, 59 oral abstract presentations, 10 workshops, 27 poster presentations • 28.5 AMA Category 1 CME (Continuing Medical Education Credits) credits |
| Preconference Workshop | • NNaCOE /NHCOE Indigenous Faculty Forum |
| Conference Venue Sites | • Hilo: ‘awa (kava) ceremony at Wainaku, academic program at UH Hilo—Hale‘Ōlelo and Performing Arts Center, opening reception at ‘Imiloa Astronomy Center, lu‘au (feast) at Aunty Sally's Lū‘au Hale, banquet in the Crown Room at the Grand Naniloa Hotel • Kamuela: Kahilu theater, Kanu o ka ‘Aina, • Mauna Kea: Pu‘u Huluhulu • Kawaihae: Na Kalai Wa‘a (home of Makali‘i) |
| Kekuni Paratene Advocacy Award 2018 Recipient | • Mr. Romlie Mokak (Australia) given for his Advocacy work for the indigenous people of Australia (Aboriginals and Torres Strait Islanders) |
Pre-Conference Workshop (July 12): Indigenous Faculty Forum
PRIDoC has featured pre-conference workshops in the past, usually focusing on medical education and/or research. The University of Hawai‘i John A. Burns School of Medicine (JABSOM) Native Hawaiian Center of Excellence (NHCOE), has been an essential partner of PRIDoC when held in Hawai‘i. While preparing for PRIDoC 2018, the Northwest Native American Center of Excellence (NNACoE), based at Oregon Health Sciences University, reached out to the NHCOE to collaborate on a pre-conference Indigenous Faculty Forum (IFF). NHCOE and NNACoE are the only 2 indigenous focused COE's which are funded by the Health Resources and Services Administration's Bureau of Health Professions, US Department of Health and Human Services. The 2018 pre-conference workshop would be the second IFF for the NNACoE and an extension of the NHCOE's previous involvement with medical education workshops at PRIDoC 2008.
Speakers delivered valuable, riveting discussions relevant to indigenous faculty development in medical education and health care. Tips and pointers specifically for indigenous faculty were shared including guidance on effective leadership and mentorship as well as lessons learned in balancing clinical practice and academia. An international panel addressed the topics of microaggression, racism and bias in medicine and academia. The IFF closed with an inspiring speech on how to walk in two worlds, western medicine and culture as an indigenous doctor.
Welcoming Ceremony
As is customary, delegations are welcomed to the lands of the host organization. At PRIDoC 2018, the welcoming took place off site at Wainaku. Overlooking Hilo Bay with the glow of Kilauea's eruption in the distance, over 300 conference participants and guests were welcomed to the island of Hawai‘i with an ‘awa (kava root) ceremony offered by kauka hui (host physicians) and Native Hawaiian medical students.
Day 1 (July 13)
The main conference venue for PRIDoC 2018 was the University of Hawai‘i Hilo. Plenary sessions were held in the theater, and breakouts and workshops took place at Hale‘ōlelo, the home of Ka Haka ‘Ula o Ke‘elikōlani College of Hawaiian Language. Day one began the formal opening of the conference with a march of the conference attendees into the UH Hilo theatre where they were greeted by the beating of pahu (traditional drums) and blowing of pū (conch shells). The leaders of the various delegations from PRIDoC then bestowed ho‘okupu (traditional gifts or offerings) for the lele (structure upon which to place the offerings) which was built on the stage and remained a focal part of the conference throughout its duration. The opening ceremony set the tone and foundation for the conference which was further solidified by the opening speaker, Dr. Pualani Kanahele, who described Native Hawaiian “Nomenclature Profundity.” Thereafter, plenaries discussed “Our Healthy Future,” “Mana and Maoli Ola (Power and Native Health),” and “Racism and Mental Health.” Afternoon breakout sessions fell into one of several streams such as “Mental Health,” “Medical Education,” “Workforce Development,” “Chronic Disease,” and “Changing Systems of Care.” Various other topics of clinical importance, as well as numerous workshops, were featured throughout the conference.
Day 2 (July 14)
The following day, the conference venue moved to Kamuela, on the northern part of the island, where activities centered around the theme of “Ke Ala Ola” (Pathway to Health). The opening featured a discussion on traditional wayfinding (navigation used by Pacific Islanders) led by a panel of a navigator, captain, and crew from the Hōkūle‘a Hawaiian voyaging canoe, which had recently completed her Mālama Honua (Care for Island Earth) voyage circumnavigating the earth. This set the stage for a day of “caring for ourselves, our communities, our canoe.” Other topics of discussion included traditional Native Hawaiian health practices and caring for our ‘āina (land), especially Hawai‘i's sacred mountain, Mauna Kea.
In the afternoon, conference attendees were able to choose from a number of workshops which promoted personal cultural growth. These workshops were presented by cultural consultants or traditional healers who were conference attendees or from the local community.
The medical student attendees had a separate “track” that involved a visit to a local voyaging canoe, the Makali‘i, to learn from her crew about traditional wayfinding and the importance of caring for our resources. Conference guests were offered an afternoon of shopping, visiting a nearby beach and/or learning about local loko i‘a (fish ponds) — resources used by ancient Native Hawaiians to help feed their communities.
At sunset, all three groups (delegates, medical students and guests) gathered at the base of Mauna Kea to pay honor to the ‘āina (land) with protocol at Pu‘u Huluhulu.
Days 3, 4, and 5 (July 15–17)
The following days featured more plenaries, breakouts and workshops on specific topics affecting indigenous people and their health. Some examples of topics included climate change, workforce diversity, chronic diseases, women's health, men's health, indigenous child rearing, traditional healing, genomics and social justice. A separate gathering for the kūpuna (elders) from the various delegations was held as a new and unique addition to this PRIDoC. All of the presentations were powerful, uplifting spirits and buoying resiliency.
The conference closed with the following set of resolutions that were generated and approved by the conference delegates to:
Address “waves of colonialism: destruction of our natural and cultural resources,”
Advocate and support access to healthcare for Marshallese and other Micronesians in Hawai‘i and throughout the USA.
An oli (chant), gifted and taught to the conference participants, and a moving hula (dance) performance by Hālau o Kekuhi formally closed the conference.
Student Tract
Special mention should be made about the medical student track. JABSOM students, under the tutelage of ‘Ahahui o nā Kauka board members who were medical students at previous PRIDoCs, introduced a curriculum for visiting international indigenous students involving Native Hawaiian protocol and ‘āina (land)-based activities. Students attended the conference but had separate or parallel tracts during the pre-conference workshop as well as during parts of day 2. The students all stayed in the same dorm to promote camaraderie, and each was housed with someone from a different medical school. As mentioned above, students were fortunate to visit the Makali‘i, Hawai‘i island's voyaging canoe, and to participate in workshops that emphasized the importance of protecting our island resources while advancing indigenous health care. Many students presented either a poster or oral presentation, helping them to prepare for future leadership, and giving insight to cutting edge advances in research and education that support indigenous health and the reduction of health disparities throughout the world.
Sponsorship
PRIDoC 2018 benefited from very generous sponsors; Hawai‘i Permanente Medical Group sponsored the Student Track; the Queen's Health Systems, including Queen's Medical Center, Moloka‘i General Hospital, and North Hawai‘i Community Hospital sponsored the Ke Ala Ola Day in Kamuela; and Hawai‘i Medical Service Association and Hui Mālama o Ke Kai sponsored the cultural program throughout the conference. Other sponsors included the Center for Native and Pacific Health Disparities Research, the Native Hawaiian Center of Excellence, the Department of Native Hawaiian Health at JABSOM, Moloka‘i General Hospital OLA Training Grant, Papa Ola Lōkahi & the Native Hawaiian Health Scholarship Program, the Australasian College for Emergency Medicine, Aloha Care, Hawai‘i Pacific Health, University of Hawai‘i Hilo & Kīpuka Student Center, in Memory of Dr. Kekuni Blaisdell, Northwest Native American Center of Excellence, Southcentral Foundation, MDX, Dawson ‘ohana, Big Island Candies, Edmund Olsen, Henry Lee-Loy, Richard Lee-Ching, and an anonymous donor. In addition, many ‘Ahahui o nā Kauka Board members and JABSOM students, along with family and friends volunteered numerous hours to contribute to the success of PRIDoC 2018 and related planning and reporting events.
Evaluation
Formal conference evaluations were completed as were “word clouds” generated via audience participation during closing talks. A powerful example of a word cloud (Figure 1) resulted from a request for “one word that reflects how you feel about the conference.” Common responses included the words: MANA (power), Connected, Pride, Inspired, Proud, Indigenous, Wonderful, and Resilience.
Figure 1.
Word Cloud Demonstrating “One Word that Reflects How You Feel About the Conference”
The following excerpts come from formal qualitative evaluations supporting the value of PRIDoC:
“This was an exceptional conference. I came away with spirit gladdened and my cup refilled.”
Regarding common themes:
“Importance of knowing and studying our roots or heritage. Knowing where we came from and what makes us who we are will help us understand who we are striving to become.”
“There is so much to be done and we can do this together. It was remarkable to see how some ideas have actually taken shape and grown in different parts of the world…. Sharing about and advancing indigenous ways of being, viewing the world, approach to science and education… can help to heal us all.”
When asked to describe what the theme meant to them and their work:
“Part of caring for patients and families, is caring for communities and the earth. It is important for me to consider all of the things that affect the health of our patients.”
“We have to take care of our planet — we are custodians not owners.”
We have to take care of ourselves in order to take care of our patients. That means caring for ourselves culturally, spiritually, physically, and emotionally.”
When asked on a personal and professional level, what you would do to advance “Oi Ola Wai Honua” in the next 12–18 months:
“Ensure this concept is promoted within my roles in education, health service provision and population/public health.”
“Be a more patient and understanding provider, coming from a place of humbleness and realization that not all of my partners have had the gift of wai (water) in their honua (world) — asking myself how I can help cultivate that for them through my patient interactions.”
“I am committed to discussing health in a more broader way with my patients and families.”
Participants were queried on whether they attended any PRIDoC in the past, and were asked to describe how PRIDoC informs your perspective and practice within your indigenous community;
“…it is a real call to action for me – to see researchers and scientists from around the world working on such issues… it is amazing for me to attend as it is the single most applicable conference for me, my professional development, and the nurturing of my personal beliefs and values.”
“By providing a cultural context to do all that we do professionally; great framework to do all of our work in community; uses a great indigenous lens through which we all need to see.”
“It just feels like home. My heart rejoices in our shared knowing. I feel like I have a place in the profession of medicine. We aren‘t alone in our struggles.”
“Keeps me centered; keeps me going; tells me the important things to remember and to do.”
“It always inspires and enlightens me. It reenergizes me to continue the often hard and challenging work of advancing indigenous health. Coming together every 2 years is like a big family reunion. We are always so happy to see each other. The networking and mutual support is amazing.”
“This was my first PRIDoC. It won't be my last.”
Inspiration was the most important thing that was taken away from the conference, along with aloha (love, compassion), knowledge, strength and friendship, peace and hope. Hopes are high for more cultural inspiration, indigenous networking support, and sharing of knowledge at the next PRIDoC, hosted by IPAC and scheduled to take place September 15–28, 2020 in Vancouver, Canada.
Abbreviations
- AIDA
Australian Indigenous Doctors Association
- CME
Continuing Medical Education
- IFF
Indigenous Faculty Forum
- JABSOM
John A. Burns School of Medicine
- NNaCoE
Northwest Native American Center of Excellence
- NHCOE
Native Hawaiian Center of Excellence
- PRIDoC
Pacific Region Indigenous Doctors Congress
Conflict of Interest
None of the authors identify a conflict of interest.
Disclosure
Both Dr. Dee-Ann Carpenter and Dr. Martina Kamaka work for the UHM John A. Burns School of Medicine, Department of Native Hawaiian Health Native Hawaiian Center of Excellence. Dr. Martina Kamaka is the Secretary and past-President of the ‘Ahahui o na Kauka and Dr. Dee-Ann Carpenter is an immediate past-Board member on ‘Ahahui o na Kauka. Neither has any conflicts of interest.
This project received support from the Native Hawaiian Center of Excellence award, D3HP16044, from the Health Resources and Services Administration's Bureau of Health Professions, US Department of Health and Human Services. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the BHPr, HRSA, DHHS or the US Government.