Paved paradise

“Don't it always seem to go
That you don't know what you've got
Till it's gone
They paved paradise
And put up a parking lot”

--Joni Mitchell, “Big Yellow Taxi” (1970) 

Joni Mitchell was inspired to write those lyrics during her first visit to Hawaii, a two-day trip in 1969.   

My parents have been aging in place, in Hawaii’s paved paradise, in one of the oldest neighborhoods undergoing transformation with higher density monster homes and crowded parking, replacing more traditional single-family dwellings with tropical fruit (mango, papaya, noni, breadfruit, etc.) and nut (kukui, macadamia) trees. 

Due to COVID-19 pandemic, I had not seen my parents in-person since my wikiwiki visit last year in January. When Hawaii Safe Travels Program was revised last month to allow vaccinated (yours truly) to skip COVID-19 test/10-day quarantine, and Hawaiian Airlines offered $250 SFO-HNL roundtrip airfare deal, I was ready to go!  

As my departure drew closer, reports from Hawaii Department of Health (DOH) about skyrocketing COVID-19 cases, hospitalizations and deaths had me considering whether to postpone my trip scheduled this month. Hawaii officials blamed community transmission and residents traveling back from Las Vegas (aka 9^th island, which had COVID-19 positivity rate of 14% last month). Hawaii DOH Director Libby Char warned, “This is a horrible time to travel. Stay home unless you have to travel. You don’t know that the person on the plane sitting next to you doesn’t have this.” 

Earlier this month as San Francisco experienced surge of COVID-19 cases and hospitalizations, SF Department of Public Health Director Grant Colfax projected peak numbers if behaviors remain constant (i.e., no changes to vaccine uptakes and interactions). 

Projected peak numbers did not materialize, thanks to SF public health policies leading to behavioral changes via reinstated indoor mask mandates, as well as vaccine mandates among all city employees, health care workers, plus patrons of bars, restaurants and other indoor establishments. 

“We certainly can try to teach critical thinking but you’re fighting a societal trend. It’s like giving educators too much credit… there’s an educational process in an informal way, it’s people talking to one another, and having institutions that encourage certain behaviors… teach you that you are part of something larger, and that’s a much more important way to change the process of thinking…”—University of Hawaii Professor Emeritus of Political Science Neal Milner, “Lying and Disinformation in America,” Think Tech Hawaii (July 1, 2021)    

Yes, we are part of something larger than ourselves! When I hear people objecting to mask and vaccine mandates (SF provides exemptions based on religious belief and qualifying medical reasons) as a violation of individual civil liberties, my (utilitarian) critical thinking leads me to validate legitimacy of mandates as harm reduction if they further collective civil liberties by protecting the greatest number and most vulnerable (older adults, people with disabilities, especially immunocompromised, essential workers exposed to public, children under age 12 who aren’t eligible for vaccine, etc.). Of course, belief in vaccine protection may be influenced by “inequality-driven mistrust” related to inability to access and evaluate (critical thinking!) trusted sources of information. Wisdom and fear contributed to 90% vaccination rate among older adults in USA!  

This COVID-19 pandemic is projected to continue another year or longer, and I’ve come to view it like the volatile stock market (given unpredictable human behavior) so it’s about risk tolerance. Living is full of risks, so my parents and I decided that investing in psychosocial benefits of a reunion after more than 18 months of physical separation (missed Mum’s home cooking!) outweighed COVID-19 risks, which we’ve mitigated by getting fully vaccinated (mahalo to Queen’s Geriatrics staff who personally delivered vaccines to my parents at home!) and practicing routines like wearing mask when around other people, seeking physical distancing and ventilation when possible, washing hands before touching face, etc.

At SFO Hawaiian Airlines gate, I presented my Safe Travels QR code for orange wristband that allowed me to quickly exit HNL. Boarded nearly full flight, grateful for aisle seat and kept mask on, except to take quick bites and sips (complimentary panini and drink served inflight). SFO is noted to have “some of the most well-behaved travelers” because its vendors do not sell alcohol to-go; Hawaiian Air suspended in-flight alcohol sales so spared unruly behavior by drunk (cognitively impaired) passengers.

Honolulu Star-Advertiser shouted headline (in capital letters): “IGE URGES TOURISTS TO STAY AWAY.” Gov. David Ige seemed to echo Dr. Char when he discouraged travel, at least through October (coinciding with shoulder season): “Now’s not a good time to visit Hawaii…I’m asking all residents and visitors alike to restrict travel, curtail travel, to Hawaii to essential activities only.” Wow, is Haunani-Kay Trask (died from Alzheimer’s last month) smiling from her grave?! 

According to Hawaii’s COVID-19 Data dashboard, majority of COVID-19 cases are “community-associated” (i.e., “most likely infected within the community”); and “travel-associated” (i.e., “most likely infected outside of Hawaii or by having close contact with a confirmed case who had recently traveled”) cases are mostly from residents rather than non-residents. (Perhaps more cases might be from non-residents who shed virus during short-term visits and only test for COVID-19 to be “confirmed case” after they return home?) 

Critical thinking practice: If community spread is the root of surge in coronavirus infections, why not target interventions to mitigate community transmission rather than travel? Restricting travel/limiting number of tourists would harm Hawaii’s economy, which already ranks worst in the nation, and worsen job opportunities for residents who have relied on COVID-19 safety net (expired federal eviction moratorium, expiring federal unemployment aid).

“Hawaiʻi may look like paradise, but it isn’t always for the people who live here.”—Michelle Broder Van Dyke, “Seven months of solitude,” Slate (Oct. 23, 2020) 

COVID-19 pandemic has exposed inequities, including divide between Hawaii residents and visitors/tourists. When Hawaii limited tourism for seven months (by imposing 14-day quarantine) last year due to COVID-19, all was not lost to residents who felt “like going back in time” (pre-jet era) to enjoy more of aina (the land) and healing of nature (perhaps undo climate change damage) without crowds of tourists.

This tranquility was lost as Hawaii reopened for tourism. Perhaps social skills worsened after months of isolation because Hawaii has been run to the ground by disrespectful travelers behaving badly, like disturbing endangered Hawaiian monk seals, and by elitist Bobos in Paradise, like 60-year-old former resident/retired U.S. President who is paving paradise for extravagant beach mansion and controversial renovation of century-old seawall on Waimanalo Bay. 

When “overtourism” created water shortage in Maui, residents were expected to make sacrifices (subject to fines for “non-essential” water use) while water was diverted for tourists staying in resorts that were allowed to fill their pools; why are there pools when beaches are nearby?

“Locals and kanaka maoli are being told to stop gathering, our keiki sports are canceled, while luaus for hundreds of unmasked visitors are taking place every night.  Nothing is sacred with the tourist industry and Hawaii has become a playground for visitors.” –Healani Sonoda-Pale, “Several Native Hawaiian organizations ask leaders to stop prioritizing tourism,” KHON2 News (Aug. 8, 2021) 

Residents, mostly Native Hawaiians (Kanaka Maoli), pushed back, demanding that leaders give consideration to aloha spirit: stop prioritizing tourists over residents, educate tourists to respect aina.

Last December, Hawaii’s Movers and Shakas program launched to seek “brain gain” (reversal of brain drain) by offering remote workers free roundtrip airfare + discounted Waikiki hotel rates + “connect with aloha” (cultural orientation + volunteer 15 hours) for at least one month on Oahu. This visitor control program motivated 90,000 people to apply (no fee, low-barrier) for 50 slots!  

No worries about demand for tourism in Hawaii, which can afford to do better to protect its natural and cultural resources (similar to travel standards set in Bhutan and Galapagos Islands) to promote livable communities. This latest pause on tourism could be an opportunity to reimagine Hawaii’s future beyond economic growth by using Social Progress Index to provide people “with the things they really care about. Are people healthy and safe? Do they have clean water and a roof over their heads? Can they freely access information? Are their rights protected?” 

Lucky you (seniors) live Hawaii, continued … 

Hawaii is ruled by gerontocracy (and Democratic elite who maintain their status quo): David Ige, aka nation’s “least popular” Governor, is age 64 and will be termed out next year; his predecessor Neil Abercrombie, now age 83. At age 65, Vicky Tiu Liu Cayetano (famous for being child star in Elvis Presley film, laundry business operator, former Republican and former First Lady who championed CarePlus long-term care proposal when her hubby Ben was Gov.) decided to run for Governor out of “desire to do more for the community.”  Honolulu Mayor Rick Blangiardi is age 74; his predecessor Kirk Caldwell, now age 69, intends to run for Governor.

Yet, kupuna politicians do not appear any wiser when trying to diversify Hawaii’s economy or accommodate more “sustainable tourism,” facing similar challenges by many Small Island Developing States (SIDS), due to small population size, low capacity, remoteness, narrow resource and export base, high dependence on imported sources of energy, vulnerability to climate change, exposure to natural disasters, historical trauma from colonization, etc.

Runaway tourism has ruined the quality of life for many residents, prompting kupuna to “run away and go live in Las Vegas” after retiring from Hawaii government job. Kupuna give up Hawaii’s humid weather (natural skin moisturizer!) and Pacific Ocean for retirement lifestyle in Las Vegas’ arid desert that offers more affordable housing, lower cost of living, Trader Joe’s, legalized gambling, no state income tax, no tax on retirement income, low property taxes, etc.

Honolulu Star-Advertiser’s Live Well section provided good coverage of healthy aging, though many articles were at least a month old (e.g., Living apart together published last month, and Seniors may need rehab originally published in May).  

Advertiser also had article about shortage of physicians participating in Hawaii’s medical aid-in dying (MAID), and later today I wondered whether this had any bearing on “elderly couple” who died of gunshot wounds at The Plaza Assisted Living in Waikiki, which police are investigating as murder-suicide or two suicides, because lethal prescription under MAID is less violent option but harder to access than firearms.

Guess how old?

In the eyes of the beholder, “young” and “old” are “really” relative terms: in SF Chinatown, 24-year-old Good Samaritan described his “bear-hugging” bystander intervention when "there was this really young guy beating up this really old man.” Turns out “really young guy” was age 44 and “really old man” was age 56!!! 

“Hawai’i seniors look young, so be sure to ask for these discounts before ordering or being served.”—Generations 808 Senior Savings 

Last month, Gov. Ige signed law lowering age from 62 to 60 to apply enhanced penalties for crimes against “our most vulnerable” kupuna, by perpetrators who “reasonably should know” that their victims are age 60+.  

Disturbing video went viral of a 37-year-old man knocking over a woman (race not identified) who falls on her head in Honolulu; woman’s age estimated “80 years old” in Honolulu Star-Advertiser and “appeared to be in her mid-70s to 80s,” in Hawaii News Now. 

“Introverts will inherit the earth”

“10. The introverts will inherit the earth. The virus that has killed 626,000 people in the U.S. and 563 people in Hawaii (as of Saturday) relies on person-to-person transmission. Some people simply cannot stand to be alone. They must venture out to gatherings no matter the cost. They are drawn to coughing, Covid-covered crowds like a moth to the flame, can’t be trusted to work from home, must be part of a herd to feel safe. Those who are happy with solitude greatly reduce their potential for exposure.”—Lee Cataluna, “10 Lessons We Should Have Learned From The Pandemic,” CivilBeat (Aug. 22, 2021) 

Something new every day with record-breaking COVID-19 cases (reported in Local Business section of Star-Advertiser): By mid-August, Hawaii’s COVID-19 cases reached four-digits for the first time (1,167 on Aug. 13, which included backlogged cases; 1,035 on Aug. 27, not including backlog). Hawaii reported over 10,800 COVID-19 cases in last two weeks!

“With the future so unknown…

I’ve just got to stay at home…

Suck it up, stuck at home…

Tour the paths around my home

I’ll just watch travel shows –

Eat exotic takeaways

Wear all my ‘ethnic’ clothes…

Watch a subtitled film

Close my eyes, pretend I’m there…

I’ve got travelling syndrome

But for now, cannot roam

Covid-19, be gone!”

--Shirley Serban, “Stay Away” parody song of COVID travel restrictions, tune of “Orinoco Flow (Sail Away)” (Jul 17, 2020) 

With Delta variant surge and restrictions on gatherings, in-person events were canceled/postponed (e.g., Aging in Place Workshop/National Senior Citizens Day, Made in Hawaii Festival/Statehood Day). My to-do list would have included joining DeTours for more enlightened visit, but decided to “stay home” with my parents. Later I could indulge in armchair travel, Detours: A Decolonial Guide to Hawai'i (2019). 

As homebody choosing “local,” I was careful about maintaining physical distance from my parents (though challenging to hold conversation with Pop who is hard of hearing), doing “essential work” (family business operations with Mum), hanging out in our patio, venturing alone in “best walkable neighborhood” by foot… 

In time for this month’s 12^th Annual Pedestrian Safety Month, U.S. Senator Brian Schatz introduced The Vulnerable Road Users Safety Act. Much welcomed as Hawaii is notorious for being nation’s deadliest for senior pedestrians, and the popularity of large vehicles in Hawaii poses safety risk to “vulnerable road users.” 

Age-friendly small town

“Since statehood, Senate District 10 residents have been among the oldest in the islands, and thus, my top district priority is long-term care for senior citizens.”—Hawaii District 10 (includes Kaimuki) State Senator Les Ihara, age 71 

Red dirt in Kaimuki construction site. NIMBY residents have protested and called cops to halt construction of monster homes built to maximum density. 

Newer monster homes dominate this block. (No street parking here due to TheBus line; last month, TheBus discontinued paper passes/transfers in favor of convenient smart transit card, Holo—functions like SF Bay Area’s ClipperCard.) Developers of monster homes argue they are filling need for affordable and multigenerational living, and perhaps rental units. 

While I favor multigenerational living (especially if this enables more kupuna to age in place), why construct eyesore monster homes that look like motels with window air conditioners (worse than three-family Richmond Specials in SF)?  

Kaimuki is desirable 8-80 model: people-centered with emphasis on sustainable mobility, parks and public spaces that try to work for all ages (“whether age 8 or 80”). My grandparents (who didn’t drive) and I (before getting my driver’s license at age 16) could walk or hop on The Bus to easily access whatever we needed.  Kaimuki was rich with after-school activities for latch-key kids, ranging from team sports (which I avoided, though I competed in Math League during high school) to the public library (which Tiger Mum encouraged and I loved to read magazines).

The real estate adage, “location, location, location” has coupled Kaimuki's stable community of residents who desire to age in place + monster home development. In 2015, Kaimuki was subject of age-friendly study by University of Hawaii at Manoa’s College of Tropical Agriculture & Human Resources Cooperative Extension Service in the Department of Family & Consumer Sciences (chaired by gerontologist Bobbie Yee, who lives near Kaimuki...and classmate of my Aunt Char who married Bobbie's cousin). 

Always eager to support local food, strolled over to Kapiolani Community College (KCC) Farmers’ Market on Saturday morning: at entrance, table with optional sign-in for contact tracing and hand sanitizer dispenser. This popular outdoor market sells all-local produce and prepared foods, attracting lots of tourists. After my visit, KCC decided to temporarily close its Farmers Market over next four Saturdays due to COVID-19 surge.

Similar to Samoan palusami and Hawaiian laulau, these luau bombs made of taro leaves stuffed with generous fillings (choice of beef, pork, mahi mahi, or vegan taro + sweet potato) were ono-licious!

At right, Hawaii 5-0 cop eyeing Luau Bombs booth.

Wanted: Tree huggers, grassroots advocacy

After KCC Farmers Market, planned to volunteer with Trees for Kaimuki at nearby Diamond Head trail (Leahi Peace Garden and Fort Ruger Path) but 9 am event canceled due to COVID-19 spike. 

In my small kid time, I understood the value of trees in facilitating connections between neighbors – literally, tree branches bearing fruits and nuts crossed over to one another’s property, so raking leaves and exchanging of fruits led to sharing recipes and small talk. Permaculture principle of edge effect to increase diversity! My ohana (extended family) would enjoy macadamia nuts (from makai side neighbor) and starfruit (from mauka side neighbor). Mauka neighbor enjoyed mangoes from our tree, so no complaints about raking leaves! Gung-Gung also cultivated trees growing papayas, tangerines, bananas, chili peppers, etc. in abundance to gift to neighbors.

At Kaimuki Neighborhood Board Zoom meeting, Trees for Kaimuki supporter Becky Gardner introduced “RESOLUTION URGING THE CITY & COUNTY OF HONOLULU TO ADOPT AND IMPLEMENT A TREE ORDINANCE TO PROTECT AND PRESERVE TREES THAT MAKE OUR COMMUNITY MORE LIVABLE; MITIGATE THE PROLIFERATION OF MONSTER HOMES; AND ENHANCE OUR ENVIRONMENT - IN THE FACE OF CLIMATE CHANGE.” 

"Trees make Kaimuki home": Kaimuki faces threat of becoming a heat island, as more monster homes are built with heat-trapping concrete replacing trees and green spaces. According to Trees for Kaimuki, the tree canopy in Honolulu is 22%, Kaimuki is 17%, and goal is to increase/double Kaimuki’s tree canopy to 35% by 2035 under plan by City and County of Honolulu! Yay, more shade to cool the neighborhood and protect older adults who are more prone to heat stress (more than 80% of heat-related deaths are people age 60+).  

They took all the trees
Put 'em in a tree museum
And they charged the people
A dollar and a half just to see 'em

--Joni Mitchell, “Big Yellow Taxi” (1970)

Eclectic “vintage charm”

Wore mask for COVID/sunburn protection and limited exposure to indoor air-conditioning during quick trips for shopping and take-out food, revisiting pastime of eating along Waialae Avenue in Kaimuki Town!

Mural of aloha print designs and “Keep it Kaimuki” movement to maintain its “vintage charm” of mom + pop, locally owned independent businesses (including Civil Beat, non-profit and independent news outlet dedicated to watchdog journalism). Kaimuki has few fast food chains, and supermarket and drug store chains anchor Kaimuki Shopping Center (open-air, unlike air-conditioned Kahala Mall, which “postponed” its senior walks during pandemic).

Favorite vegan restaurant Juicy Brew with food prepared by Hee sisters. Connected to Chef Jennifer Hee’s nourishing food and her essay (“Paternal instinct: How can two people so closely related have such different outlooks on life?”) about negotiating expectations of her Asian Parent. 

Juicy Brew’s ready-to-eat bento so colorful and artful! Though not marketed as such, noted that age-friendly menu offers edibles for people who might have chewing difficulties due to missing teeth or dentures. Also, vegan diets benefit older adults, though need to be careful to consume enough calcium, protein, and vitamin B12. 

Mum could not understand spending $6 for purple rice yogurt (calcium-rich; purple forbidden rice chewy like boba but less sugary), like why can’t you DIY: boil rice at home and then drop cooked rice into yogurt blended with red jujube (Chinese date)?

Notably newer to Kaimuki were colorfully painted public parklets and utility boxes. Jennifer Noel’s ARTBOX Kaimuki and streetARThawaii won 2018 Awesome Foundation grants to paint utility boxes on Harding and Waialae Avenues in Kaimuki.

Historic renovation plan for 85+ year-old Queen Theater, vacant blight for at least the past 20 years. Nearby old businesses include hole-in-the-wall, made-to-order bento takeout (cash only, no website) and well-preserved (pun intended!) 70+ year-old crack seed store.

Historic house in Kaimuki: lava rock base, single-story with attic, porch awning, windows that open (no need air-conditioning), lush mango tree, “driveway” parking (no garage). 

Love this fence made from surfboards!

Virtual learning in Hawaii time

Connect+Cities was worth getting up early to attend 7 am program, especially to hear from Jasmine Little of Culdesac Tempe, which is building the 1^st car-free neighborhood from scratch to prioritize people over cars (actually plan includes shared bikes/scooters/cars to get around). 

Former Hawaii resident and Columbia Social Work Policy Professor Jeanette Takamura was subject of American Society on Aging (ASA) Legacy interview. She shared how Hawaii upbringing shaped her: diversity baked in aloha spirit, and preference for being called “auntie” instead of senior citizen. Her proudest accomplishments as caregiving champion: establishing National Family Caregiver Support Program (NFCSP) as Assistant Secretary of Aging (1997-2001), and putting together long-term care financing package (but could not get financing in 1989) as Director of the Executive Office on Aging in Hawaii.

Dorothy Colby, Certified Positive Approach to Care Trainer and Hale Kūʻike Director of Community Engagement, presented virtual workshop, It's All in Your Approach: Making Positive Connections with People Living with Dementia. As dementia progresses, person’s field of active vision gets smaller, and Positive Physical Approach helps facilitate communication. You (without dementia) can follow these steps to connect more effectively with person who has dementia:

1)   bring flat, open palm up near face = visual cue to look at you

2)   say “hi!” and use preferred name = verbal cue to look at you

3)   look friendly: smile, make eye contact

4)   move slowly toward person from front within visual range

5)   move into supportive stance: shift toward side position (instead of standing in front, which can be perceived as confrontational body language)

6)   put your hand-under-their hand (guide and help with movement, offer sense of control)

7)   get to same level eye contact (sit, kneel or squat) and respect intimate space

8)   make connection, then wait for response/acknowledgement before you start your care

Care partnering emphasizes doing “with”: compliment, then ask for help; ask person to try, use visual cues to offer concrete choices, break task down to single steps at a time.

Understanding changes to vision and language inform how we communicate with person who has dementia, in this order: 

1)   Visual – show (gesture/point)

2)   Verbal – tell (limit words, give simple and short pieces of information)

3)   Tactile – touch only if person is aware

Dorothy’s Positive Approach to Dementia Workshop series available at Catholic Charities Hawaii Caregiving for Persons Living with Dementia Trainings online. 

“Raising” parents

AARP Movies for Grownups hosted screening of It’s Not a Burden: The Humor and Heartache of Raising Elderly Parents (2021). 

Filmmaker Michelle Boyaner’s personal journey of caring for her divorced aging parents—mother Elaine with dementia, and father Morris with hoarding disorder—taught her to “appreciate what you have at the moment you have it.”

In addition to documenting the “raising” her own parents, Michelle reached out to feature other families to share their diverse experiences doing the best they can.  Notably, women are primary (unpaid) caregivers/advocates.

Elaine said she “had to give up an awful lot of dignity” for someone to bathe her when she moved into a board and care home. Michelle shared that she had to give up years of anger and “civilized estrangement” towards her mother who divorced Morris and moved away to start a new life. Based on awareness that her mother is different now, particularly with dementia, Michelle practiced forgiveness and bonded through caregiving experience.

In parking lot, Michelle considered "meet people where they're at" advice to try and join her mother’s world.

“Kindneys”

Love “kindneys” (sic) from UCSF geriatrician Dr. Anna Chodos’ presentation on Mobility: Falls and Gait. Her point was aging increases risk of kidney and bladder problems associated with urinary incontinence that can limit mobility. Yet, I wished she addressed the role of "kindneys" (kindness) and connection (“The Rabbit Effect”) in promoting overall health and well-being.

Kindness is like aloha spirit, characterized by benevolence, truth, caring, and tough love. 

“There are three ways to ultimate success: The first way is to be kind, the second way is to be kind and the third way is to be kind.”—Mister Fred Rogers 

Ways to be kind: Look out for one another + sacrifice for the common good!!! Stop paving paradise + cultivate trees!!! Get COVID-19 vaccine + wear mask to protect self and others!!!

“The modern meritocracy is a resentment-generating machine…The ability to perform academic tasks during adolescence is nice to have, but organizing your society around it is absurd. That ability is not as important as the ability to work in teams; to sacrifice for the common good; to be honest, kind, and trustworthy; to be creative and self-motivated. A sensible society would reward such traits by conferring status on them. A sensible society would not celebrate the skills of a corporate consultant while slighting the skills of a home nurse.

Some 60 years after its birth, the meritocracy seems more and more morally vacuous. Does the ability to take tests when you’re young make you a better person than others? Does a society built on that ability become more just and caring?”—David Brooks, “HOW THE BOBOS BROKE AMERICA: The creative class was supposed to foster progressive values and economic growth. Instead we got resentment, alienation, and endless political dysfunction,” The Atlantic (Aug. 2, 2021) 

Kindness could go a long way to see us through the end of this pandemic. With Delta variant surge, KZYX Local Coronavirus Update with Dr. Drew Colfax returned this month (after “grand finale” show on June 28). As emergency room physician directly serving COVID-19 patients and former public defender, he is more passionately outspoken than his older brother (SF DPH Director Dr. Grant Colfax) and love how he closes each week’s program with his timeless prescription, “Be safe, be patient, be kind.” 

Time in a bottle

When flying from San Francisco to Honolulu, sit on right side of plane for this aerial view passing Diamond Head.  Flygskam! Couldn’t I have set sail on a solar yacht instead, like Greta Thunberg and her father?  This month, 50-year-old Spanish endurance athlete Antonio de la Rosa paddled 2,900 miles from San Francisco to Honolulu.  His self-described journey of “absolute loneliness and self-sufficiency” to raise awareness about protecting the ocean from man-made pollution took over 76 days.

    

In contrast, I didn’t even last 76 days rowing for my college crew team, so I took a full passenger flight for 5 hours, contributing about .59 metric tons of carbon dioxide.  Climate change is real as much of Hawaii (sparing Honolulu) was declared a disaster (eligible for federal funding) after Category 5 Hurricane Lane last year.

This time-consciousness relating to travel reminded me of two favorite songs from the 1970s about time, coincidentally by singers who died in transportation crashes:

“If I could save time in a bottle
The first thing that I'd like to do
Is to save every day till eternity passes away
Just to spend them with you…
But there never seems to be enough time
To do the things you want to do, once you find them”

--Time in a Bottle (1973) by Jim Croce (died in 1973 airplane crash)

Cat’s in the Cradle (1974) sung by Harry Chapin (died in 1981 car crash) and written by his wife Sandy from the point of view of a busy father—when son asks to play, father brushes him off, time passes; father and son grow older, now father asks son to spend time with him; by now, grown-up son very busy so brushes off father who sings wistfully:

“I've long since retired, my son's moved away

I called him up just the other day

I said, "I'd like to see you if you don't mind"

He said, "I'd love to, Dad, if I can find the time

You see my new job's a hassle and the kid's got the flu

But it's sure nice talking to you, Dad

It's been sure nice talking to you"

And as I hung up the phone it occurred to me

He'd grown up just like me

My boy was just like me”

             

Once I landed in Honolulu, I lowered my carbon footprint by taking TheBus, carpooling and walking.  But mostly I was a homebody because I am more conscious of time ticking away…

Growing up in a free-range household, we were not homebodies but often out and about.  Both parents were busy working, my siblings and I (under influence of Tiger Mum) were busy in school and extra-curricular activities (including child labor in family business, fired/rehired many times!), and my grandparents (with dementia) enjoyed wandering.  With my grandparents dead and one storefront business sold, my parents have relatively more “free” time (though still managing other family business) so I make time to be with them during my wikiwiki visits.

Slow healing

While listening to slack key guitarist Makana’s “Deep in an Ancient Hawaiian Forest” (from The Descendants film soundtrack), I looked at forest bathing materials – struck by sign stating “Neuroscience shows that 50-year-olds can have the brains of 25-year-olds if they sit quietly and do nothing for 15 minutes a day.”  Yikes, better avoid that because I don’t want to revert to immature 25-year-old brain! (Researchers have found that short-term memory peaks at age 25, emotional intelligence in our late 40s, and crystallized intelligence in the late 60s or early 70s.)  

Uloha hosted “Under the Banyan Tree” talk on Forest Bathing Hawaii by Phyllis Look, Hawaii’s first and only forest therapy guide (trained in Costa Rica) certified by Association of Nature & Forest Therapy (ANFT).  Her role as guide is to open door by awakening senses for groups to connect to the forest = therapist.  Her point is to slow down.  She presented a power point presentation using anatomy of a tree to explain forest bathing:

·       Roots in Japanese tradition of shinrin-yoku (“forest bathing”), term coined in 1982 by Japan’s Forestry Minister to encourage its mostly urban population susceptible to karoshi (“death by overwork” legacy of competition and economic dominance from post-World War II reconstruction) to de-stress in nature while taking advantage of forests that make up nearly 70% of Japan, in a public health promotion program 

·       Trunk in science with 30 years of evidence-based research showing forest bathing therapy results in physiological (lower cortisol levels, higher natural killer activity, cardiovascular and immune health) and psychological (improved well-being and social harmony) health benefits from breathing phytoncides (wood essential oils) 

·       Crown relationship of reciprocity, so nature connection and culture repair arise together, like caring between Kalo (taro) as the older brother to kanaka (Hawaiians).

Phyllis wrote Chinese pictographs for tree + human = rest.  After working in SF Bay Area theater scene, she returned to Hawaii 20 years ago for “family reasons” and now enjoys an encore career that takes her outdoors as forest therapy guide. 

Phyllis offered us mamaki (Hawaiian nettle) herbal tea, invited us to join her 3-hour, 1-mile forest bathing walk through University of Hawaii at Manoa’s Lyon Arboretum.  Her forest therapy was featured in August/September 2019 issue of Hana Hou, in-flight magazine of Hawaiian Airlines.  She offered me kama’aina (Hawaii resident) discount for forest walk.

Instead, I spent slow time with my parents, including being present for house call visit by Jessica Ackerman, NP with Queen’s Medical Center (QMC) Geriatrics, who spent a whole hour with us! Pop is patient, Mum is primary caregiver, and I am pro bono gerontologist freely offering my assessments 😊.  My parents say different QMC geriatric specialists visit quarterly, but consistently good! Plus, they know to call me (“daughter in California”) if follow-up needed. So grateful for their thoughtful, unrushed care provided to Pop, who had been immobilized due to pain after falling twice in monster home.  With one-time epidural shot for pain, ongoing physical therapy to regain strength, and deprescribing meds, Pop has gotten much better! We are so relieved because he had polio in his youth, and worried he might have post-polio syndrome (experienced by some of my clients).  Now Mum wants her own geriatrician, as her internist as primary care physician gives her only 15 minutes.

Quick building a village

At Ala Moana Hotel, enjoyed breakfast at 15^th Annual Hawaii Floodplain Management Conference hosted by Hawaii State Department of Land and Natural Resources. 

With limited time, I only showed up for Hawaii Homeless Initiative presentation, which fit conference theme Ho’o Laulima (“Many Hands Working Together”)—as well as my return to community work with older adults who are homeless or at-risk of losing their housing.  Hawaii State Homelessness Coordinator Scott Morishige, MSW, described how government and private sector worked together to quickly build Kahauiki Village, which provides long-term, affordable rental housing ($725 for 1 bedroom, $900 for 2 bedroom) for homeless families with children (no mention about kupuna).  The Village’s plantation-style community was brainchild of local businessman Duane Kurisu, who had organized fundraising for survivors of 2011 earthquake and tsunami in Japan; this “Aloha for Japan” returned to Hawaii in the form of pre-manufactured units, previously used to house them.

Government’s contribution came in the form of State land transferred to the City via executive order and leased to Duane’s aio Foundation for 10-year term at $1 per year, and Governor’s emergency homeless proclamation (Hawaii has highest per capita rate of homelessness) to suspend regulations facilitating quickly build of infrastructure (utilities, sewer, electricity, water).

  

Relatively isolated with water on 3 sides and highway, near industrial Sand Island Access Road, this almost self-sufficient Village (on-site preschool, daycare, laundry, and market) apparently did not have to contend with protesting NIMBY neighbors. Scott emphasized that Village tenants are screened and selected by Institute of Human Services (social services agency) – targeting people who are “clean, no substance use, motivated to get out of homelessness” and able to take advantage of nearby employment opportunities like laundry business operated by Hawaii’s former First Lady.  Replication of plantation village for modern-day laundry service workers…no wonder kupuna excluded?! 

Project Manager Lance Takehara presented Case Study: Kahauiki Village, which was built up on a floodplain, avoiding low-lying areas.  Transplanting modular units involved adjustments like short doorway and installing whole fans.  Project began in Fall 2015, and tenancy began in 2018.

Hope there's a good evacuation plan in event of flooding disaster!

This quick build project reminded me of The Union’s 5-storey, 110-unit apartment development in West Oakland, after 10 days fitting together pre-assembled modular units for relatively affordable housing (but not designed for homeless families and their plantation labor). 

History

Hawaiian history has been about its many struggles over land use, and tourism/military/commercial development usually won over affordable housing and traditional uses like agriculture, threatening Hawaii’s food sovereignty.  While riding The Bus, bittersweet to see this patch of watercress farm (since 1928) near Pearlridge Mall and along Kam Highway with passing vehicles spewing exhaust pollution.  Also viewed nearby construction of Honolulu (snail) Rail Transit, very slow work in progress.  

At Honolulu Design Center, attended screening of Reel Wahine of Hawaii, an intergenerational project of young graduates of Hawaii Women in Filmmaking (Executive Director Vera Zambonelli, in photo above) making documentaries of veteran women filmmakers, including

·       Victoria Keith, schoolteacher-turned-filmmaker of Hawaiian culture documentaries focused on local land struggles, from the 1976-1997 

·       Heather Haunani Giugni, co-founded first woman-owned video production company and filmmaker of stories about native Hawaiians 

·       Ciara Leina`ala Lacy, “directher” of Out of State (2018) documentary about the rehabilitative role of cultural practices among Native Hawaiians in Arizona prison 

·       Anne Misawa, director of State of Aloha (2009) documentary about Hawaii's history, motivating paths toward statehood and its legacy 

McCully-Moiliili Library commemorated its 50^th anniversary with a screening of Under the Blood Red Sun and talk with 75-year-old Graham Salisbury, haole author of 1994 novel that inspired film, and Tim Savage, director of 2014 film.  The novel focused on racial tensions following the 1941 Japanese attack on Pearl Harbor, as seen through the eyes of a Japanese boy living on Oahu with his immigrant grandfather and parents; the film was local production with mostly local cast.  Graham is a descendant of Thurston Twigg-Smith, Honolulu Advertiser publisher who wrote Hawaiian Sovereignty: Do The Facts Matter? (1998) and Lorrin A. Thurston, leader of Annexation Club instrumental in overthrow of Hawaiian Kingdom that replaced Queen Liliuokalani with Republic of Hawaii. (Pictured above is librarian in long-sleeved turtleneck, appropriate given air-conditioning blasting inside library, while it was sweltering hot outside, typical summer weather in Honolulu.)

Admission or Statehood Day is a holiday (3^rd Friday in August) in Hawaii that is not celebrated with fanfare.  Hawaii State Library hosted The Promise of Statehood: Looking Back, Moving Forward, with exhibit commemorating the 60^th anniversary of Hawaii’s statehood and a “Try Think” community discussion on “What do we dream for the future generation of Hawaii” with panelists: Anne Misawa (one of Reel Wahine of Hawaii); John Rosa, UH History Professor; John Waihee, former Hawaii governor and leader in 1978 Constitution Convention and formation of Office of Hawaiian Affairs; and Dean Itsuji Saranillio, author of Unsustainable Empire: Alternative Histories of Hawaii Statehood (2018) and critic of ongoing U.S. occupation (including Thirty Meter Telescope on Mauna Kea) and Asian settler colonialism in Hawaii. 

Waihee, age 13 when Hawaii became a state (only kupuna on panel), said he viewed statehood as civil rights victory against racism during territorial era, and supported ability to elect its own Governor.  Native Hawaiian Waihee represented his self-interest as he was elected 4^th Governor of Hawaii (1986-1994) during a period marked by tourist industry boom and increased foreign investment, mostly from Japan. To this day, many Native Hawaiians (Kanaka Maoli), whose ancestors were dispossessed of their lands, regard Hawaii statehood as continuing illegal occupation and motivated by capitalist greed of haole and Asian settlers. 

Statehood enabled Hawaii residents to vote for current Governor David Ige, best known for his delay in communicating correction about false ballistic missile alert because he forgot password to his Twitter account! 

At Made in Hawaii Festival in Blaisdell Center, surprised to see stand-up comic Frank de Lima doing “sit-down” comedy until he explained he had hip replacement surgery.  Now age 70, he remains the one comedian who can do gentle ethnic humor due to his own inter-ethnic background, descended from indigenous (Hawaiian), colonial settlers (Irish, English, Spanish, Scottish), and plantation immigrants (Portuguese, Chinese). 

To folks outside Hawaii, ethnic humor might seem politically incorrect—and some are downright sarcastic and demeaning.  But Frank might be an exception and his impersonations—especially of his multi-ethnic neighbors—might suggest empathy, as he views his contribution to peace:

“Hawaii's ethnic humor developed in the plantation days when people had humility, which they needed because if they weren't humble, the pride everybody has could have turned into arrogance and hatred and violence. Instead it turned into humor. And there was a lesson that went out through the years. Most people can handle Hawaii's humor, not everybody. But during the plantation days, most people could find humor in the different ethnic behaviors, and that's why there was peace.”—Frank de Lima, Acid Logic 

Frank’s “sit-down” comedy extended beyond ethnic humor. To tune of Jackson 5’s Rockin’ Robin, Frank sang these clever lyrics:

“Donald Trump

I sit in the White House all day long

watching TV and getting the news all wrong

with the news reporters

I grab my phone and I tweet tweet tweet

Tweeting Donald, tweeting Donald”

Derek Kurisu (older brother of Duane who inspired Kahauiki Village) introduced Chef Sam Choy, who used to say “never trust a skinny cook.”  Surprised to see his weight loss, but trust that 76-year-old Sam still knows how to cook… he made Hawaiian Poi Beef Stew using local ingredients like breadfruit (ulu), Hilo sweet potato, poi.

“Aging in Place”

Back at Ala Moana Hotel, 13^th Annual Aging in Place event was a mix of workshops (few informative, mostly marketing) and providers exhibiting their products and services (lots of assisted living facilities, though they really should not count for “Aging in Place”).  Visited Kupuna Pono, program of non-profit The Mediation Center of the Pacific, designed to help “families talk and support their kupuna” including advance care directive family conferences.  It was formerly named Neighborhood Justice Center, where I did an undergraduate internship!

Eileen Phillips, RN, discussed Understanding Your Home Care Choices.  (Reassuring familiar face as I took her Fall Prevention class years ago!)  She didn’t talk about me and family members (unpaid caregivers), but how to choose among 150 home care agencies in Hawaii that charge at hourly rates starting at companion level of $24 (minimum 3 hours per day).  

Afterwards, I walked couple of blocks over for tour of The Plaza Assisted Living at Waikiki.  It had the vibe of a cruise ship, but windows did not open for access to nature like breeze from trade winds, air from outdoors—just stuck with air-conditioning indoors, 24/7 year-round—like TheBus, hospital, and other controlled environments; no balconies, though there was patio on 3^rd floor facing Kalakaua Avenue traffic. 

I don’t like how air-conditioning has taken over; rather welcome humidity which is like natural skin moisturizer. Very sad to see wooden jalousie windows closed shut in older buildings and window mounted air-conditioners blocking out access to fresh air and natural sunlight.

Though made in Hawaii, I never felt like I belonged – I used to say I felt like an outsider.  Now I think it’s more accurate to say I didn’t feel at home in Hawaii because its land and culture has been hijacked by U.S. military, tourism, horrendous traffic, and air-conditioning!

   

In politically correct SF, there’s often an acknowledgement of being on indigenous land; unless one is indigenous, everyone else is an outsider.

Wonder what “aging in place” means for Kanaka Maoli? Hawaiian nationalist Haunani-Kay Trask gave advice about going away for college, leaving Hawaii because it’s too small, to find your voice because one always has to be too careful about what to say/what not to say in Hawaii, like definitely “no make waves” though surrounded by water?! “Get out of the colony” or drown.  How does one feel at home without free expression?

The end

“You better know that in the end
It's better to say too much
Than to never to say what you need to say again…”

--John Mayer, “Say (What You Need to Say)” from The Bucket List (2007) 

Lori Protzman, RN, Advance Care Planning Coordinator at QMC, presented all-day Ain’t the Way to Die: Advance Care Planning Workshop.  She reminded us that 5% of patients “create” 50% of health care costs, including 1/3 during last month of life; nearly 20% of deaths occur in ICU or immediately after discharge (“treated to death”).  Objective: help patients and families “say what they need to say” and let them know they were heard. 

What’s a good death from perspectives of Family, Patient and Health Care. Goals of care: concentrate on improving quality of life; help live meaningfully in time you have; ensure you receive kind of treatment you want; comfort and dignity will be our top priority. 

Lori recommended watching film, The Farewell, based on Taiwanese director Lulu Wang’s own experience with her dying grandmother, and her family wanting to hide terminal diagnosis from her and planning fake wedding as excuse for family reunion. 

I like palli care doc + cartoonist Nathan Gray’s Dying Words Aren’t What I Imagined. 

Back in SF Bay Area

At this month’s SF Bay Area Network for End-of-Life Care meeting, Lonny Shavelson, MD, presented on Medical Aid in Dying: Ethically Challenging Cases (and a pharmacology update!).  Based in Berkeley, he is a former emergency room physician, author of A Chosen Death: The Dying Confront Assisted Suicide (1995), and founder of Bay Area End of Life Options for patients at the end of their lives who are considering various options, including medical aid-in-dying (MAID) under California’s End of Life Option Act (2016).  He said writing a lethal prescription for terminally ill patients is “last resort,” with purpose for “dignified death” (never use “death with dignity”) after considering hospice and palliative care options.  He also consults with physicians and plans train-the-trainer as he intends closing date for his practice.  Always at his patients’ bedside, he highlighted challenges:

·       Secobarbital (induces sleep into coma so brain stem no longer drives respiration) cost increased to $3,500, then “disappeared from market”; DDMP2 (valium + morphine suppress respiration for cardiac arrest) takes longer for effect.  Taking more than 4 hours to die after ingesting lethal meds is “problematic,” less than 2 hours possible after “playing with meds.”  Brain damage can result from incomplete AID.

·       30% of terminally ill patients eligible for MAID died during 15-day waiting period; most oncologists decline to participate, and refer to primary care physician, who has no training, so refer to hospice which provides consulting MD, but only attending MD can start 15-day waiting period.  In July 2019, Oregon amended its law to make it ok to administer drug during waiting period if death is imminent.

·       If terminally ill patient loses ability to swallow (oral self-ingest), self-administering meds or ingestion can take place using GI tract, feeding tube or rectal catheter, with patient pushing syringe.

Meeting Co-Chair Nate Hinerman introduced psychiatrist and bioethicist Stanley Terman, MD, PhD, of Caring Advocates.  Dr. Terman is proponent of VSED (Voluntarily Stopping Eating and Drinking) as alternative to MAID. 

Scribd hosted How to Live Life and Face Death with UCSF palliative care physician BJ Miller & Shoshana Berger, co-authors of A Beginner’s Guide to the End: Practical Advice for Living Life and Facing Death, discussing what really matters, how to prepare for the inevitability of death, and make the most of life before that time comes. 

Researchers are getting closer to developing a blood test that predicts when a person will die.  Last month, California Department of Health issued report finding that 88% of people who use California’s EOL Option are white. 

In Oakland, attended Racial Equity, Homelessness, and Homeless Systems of Care, hosted by Bay Area Regional Health Inequities Initiative (BARHII coalition of public health departments) and Homebase.  BARHII Executive Director Melissa Jones discussed roots of crises from structural racism: homelessness is result of failed housing policing and systems v. individual/behavioral issue for intervention.

According to Point-in-Time counts, SF Bay Area has the 3^rd largest population of people experiencing homelessness (28,200) in the U.S., behind NYC (76,500) and Los Angeles (55,200).  Bay Area also shelters a smaller proportion of its homeless (33%) than any metro area in U.S. besides Los Angeles (25%), making crisis highly visible. 

Bay Area’s homeless population is disproportionately comprised of single, male minorities age 25+.  Meeting focus on race so no breakdown for older adult age range provided.  African Americans, Native Americans and Latinx are overrepresented among homeless.  Bay Area Asians were reported to have 0.1x homeless rate relative to general population, so I asked whether this was due to Asians living in multi-generational households like 6 people crammed in single-room occupancy unit with bunk beds? Who knows?! Group activities involved using Government Alliance on Race & Equity toolkits. 

Lunch included soda + chips below “health happens here with prevention” poster!

At SF Village, Palo Alto University Professor Lisa Brown presented on Climate Change and Healthy Aging, discussing impacts of rising temperatures, flooding and changing wind patterns; how to stay safe and make a difference with Elders Climate Action and next month’s Global Climate Strike with 1000 Grandmothers.

Finally, another reminder about breathing from geropsychologist Janet Meiselman, PsyD, who presented talk on Brain Health, Mindfulness, Mood & Memory.  And remember what we learned from forest bathing presentation: “50-year-olds can have the brains of 25-year-olds if they sit quietly and do nothing for 15 minutes a day.”