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Lunalilo Home Make a Difference Day

In honor of The Queen’s Medical Center’s 150th anniversary, 150 Queen’s ‘ohana (family) recently volunteered time on Make a Difference Day to help another community organization: Lunalilo Home. Queen’s staff, family members and others painted large portions of the interior and exterior of the adult residential care home and landscaped its porte cochere area with native plants. Lunalilo Home was established by the will of high chief William Charles Lunalilo, who reigned for just over a year as king of the Hawaiian Kingdom when he died in 1874. Although Queen’s participates in many health-related causes, the organization has recently sought broader ways to give to the community at-large, especially to those with roots in Hawai‘i.

Leaders of both Queen’s and Lunalilo Home felt a stronger alignment of the organizations should be developed, and that kokua (help) should be renewed since both were founded by ali‘i (royalty). Queen’s and Lunalilo Home also have another link in the past. King Lunalilo bequeathed a portion of his Waikiki lands to Queen Emma, who in turn wrote her will to benefit The Queen’s Hospital. These lands now help support the mission of The Queen’s Medical Center to perpetuate the health of the people of Hawai’i and to recognize the special health needs of Hawaiians.

King Lunalilo was the first of the ali‘i with large landholdings to create a charitable trust for his people. The purpose of the trust was to build and perpetuate a home for poor, destitute and infirm people of Hawaiian blood, with preference given to kupuna (elders). Lunalilo Home was originally established in 1883 near where Roosevelt High School is today. It serves 42 residents in its current location in Hawai‘i Kai. The last renovation of its building was completed in 2001. Since then, Lunalilo Home has expanded its elderly care services to include adult day care, respite and home meal deliveries. Although its focus is on serving Hawaiians, the Lunalilo Home has opened its doors and services to non-Hawaiians.

When Queen’s staff arrived to perform their work at Lunalilo Home, 50 gallons of paint, 15 yards of compost and 30 yards of mulch awaited them. The materials were donated by generous local businesses, and employees donated medical supplies and gifts for residents. Queen’s facilities staff contributed prep work during the previous week—including power washing and rustproofing—to prepare surfaces for painting. Facilities also coordinated the landscaping. Volunteers repainted the Koa Room, which is the entry to the residence where residents can greet friends and family, and the dining room. Others worked outside, repainting the porte cochere and the entire mauka (mountain side) façade of the building. Meanwhile, another team of volunteers spread the compost and mulch, then planted hapu‘u (tree ferns), kupukupu ferns and laua‘e ferns.

“The kupuna…are so pleased, excited and happy with the results of your magic, which has transformed Lunalilo Home,” wrote Stanley Hong, Chair of the Board of Trustees of the King William Charles Lunalilo Trust Estate, in thanking Queen’s staff. J. Kuhio Asam, MD, Executive Director of Lunalilo Home, also acknowledged the relationship with Queen’s: “I look forward to ongoing collaborations between our two institutions as we progress with our joint missions to serve. Na kakou apau ke kuleana pono e malama i ko kakou kupuna—the true responsibility to serve our elders is with all of us.”

HALO ablation catheter attached to an endoscopeAn increasingly common precancerous condition called Barrett’s esophagus can lead to a deadly cancer called esophageal adenocarcinoma, which has a very low survival rate. Barrett's esophagus is caused by chronic GERD (gastroesophageal reflux disease). In Barrett's esophagus, cells have undergone genetic changes that leave them vulnerable to further changes that can lead to cancer. A new treatment available at The Queen's Medical Center may turn the tide on Barrett's esophagus, and hence esophageal adenocarcinoma rates in Hawai’i.

Currently, about 44 percent of U.S. adults experience the symptoms of GERD almost monthly, while 18 percent have them weekly. Prolonged GERD has led to Barrett's esophagus in approximately 3.3 million Americans. The frequency of esophageal adenocarcinoma is on the rise, increasing six-fold from 1975 to 2001 in the U.S., making it the fastest growing form of cancer in America.

Until now, the standard treatment for Barrett's esophagus has been "watchful waiting," with upper endoscopies and biopsies every three months to three years to evaluate the progression of the disease. These procedures require a visit to a hospital, anesthesia, several days of recovery and eating restrictions. Certain types of advanced Barrett's and adenocarcinoma require removal of the esophagus, which has significant risks and a long recovery period. After removal of the esophagus, about 20 percent of patients may have a poor quality of life with swallowing problems, decreased food intake, hoarseness, reflux and diarrhea. The five-year survival rate for adenocarcinoma is just 17 percent.

A Sizing BaloonThe new treatment for Barrett's esophagus uses uniform and controlled ablation (the use of energy to remove cells), eliminating Barrett's tissue and allowing the regrowth of normal cells. The FDA-approved equipment, called the HALO System, is available at Queen's. "It's an alternative to major surgery," says Chris Aoki, MD, "and a way to [substantially reduce the risk] of getting cancer in the first place." Dr. Aoki explained that patients are placed under conscious sedation for the procedure, which uses a rapid burst of radio frequency ablation to remove a thin layer of abnormal tissue without injury to healthy underlying tissue. Healthy tissue replaces ablated tissue in three to four weeks in most patients. Several clinical trials have demonstrated that 98 percent of participants were Barrett's-free after one or two HALO treatments after two and a half years. A recent randomized controlled trial with 127 patients published in the May 2009 New England Journal of Medicine reported that the HALO System eliminated a high rate of Barrett's esophagus in all stages, and that the patients had a significantly lower rate of progressing to cancer.


Photo Captions:

1. Chris Aoki, MD, shows a HALO ablation catheter attached to an endoscope. Behind him is a monitor  which projects an image from the endoscope.

2. A sizing balloon is first used to size the patient’s esophagus. Then a correctly sized ablation catheter is inflated at the treatment area. An energy generator is activated to deliver a rapid burst of ablative energy.

While in Hawai’i for the August recess, U.S. Senator Daniel K. Inouye and his wife, Irene Hirano Inouye, came to The Queen's Medical Center to visit the Emergency Department, Queen's Cancer Center and Women's Health Center. Both Senator and Mrs. Inouye also supported Queen's 150th anniversary fundraising event, "An Everlasting Legacy of Giving," by serving as Honorary Co-Chairs. (See related story below.)

A standing invitation had been extended to Senator and Mrs. Inouye earlier, so when they returned to Hawai’i, they took time out of their two-week stay to visit Queen's. The Senator—who has had a longstanding interest in health care long before the current debate on reform—saw his visit as an opportunity to see firsthand some of the recent changes at Queen's and hear directly from staff about the issues facing health care providers.

The first stop for Senator and Mrs. Inouye was the Queen's Emergency Room (see photo). Staff had the opportunity to discuss with them the current issues in emergency medicine in Hawai’i. The fact that the ER saw nearly 50,000 patients last fiscal year was noted, as well as Queen's reputation of accepting all patients regardless of their ability to pay and of providing the best care. Staff members stated that as unemployment rises during the recession, increased demands on services will continue due to the loss of health insurance benefits.

Doctors at the Queen's Cancer Center discussed cancer statistics and how many cancers disproportionately affect Native Hawaiians. Physicians informed the Senator that 50 percent of cancer patients in Hawai’i receive at least some part of their care at Queen's, ranging from diagnosis to treatment. The Senator was surprised to learn that the Queen's Cancer Center offers complementary and alternative medicine (CAM), such as acupuncture and massage therapy. Both he and Mrs. Inouye were impressed with the resort-like feel and décor of the Women's Health Center (see photo) and the range of services offered.

At the fundraising event, which was held the following evening, Senator Inouye said, "Yesterday was an inspiration—I really mean that." The Senator went on to say that he has served as honorary chair for many organizations, but it was the first time that he had been led around by people who were so exceptionally proud of their institution. "I am proud to be Chair," he concluded, noting that Hawai’i has an institution that ranks with many of the best health care centers in the U.S. Mrs. Inouye had equally kind words to share, saying that what came through strongly was the "warm spirit" of the staff and their sincere care for the patient.

Advanced Technology 3T MRIThe Queen's Medical Center is the first in the State of Hawai’i to install a short bore, 3 Tesla diagnostic MRI scanner used to create images of the soft tissues of the body. Queen's also has two 1.5T short bore units. The new short bore 3T MRI has an extra large opening of 70 centimeters (about 27.5 inches) for patients, and the length of the bore, or tube, is short, so patients are much less likely to feel they are in a tunnel as in older models. "We want to [bring in] patients we haven't been able to examine because of claustrophobia or size," said radiologist Darren Lum, MD, who noted that most MRIs have an opening of only 60 centimeters. The extra large opening can accommodate a patient of up to 550 pounds. The new equipment is also fast, with scans taking as little as 15 minutes.

The high magnetic field strength of 3T means that images are sharper, producing 1 millimeter pixels. Certain types of exams, such as most neurology, vascular and orthopedic work, are better on the 3T because of the sharpness of the scans and the flexibility of the software. New software purchased with the equipment has significant features which improve MRI scanning, such as motion correction, useful particularly if a patient has an involuntary twitch. The advanced software can also be used to examine the cartilage between joints to detect damage at a much earlier stage.

For vascular work, the software allows doctors to measure blood flow to the brain in stroke patients. This can be done without injecting contrast, which some patients are not able to tolerate. Non-contrast imaging can also be used for other blood vessels of the body to detect blockages. Magnetic Resonance Angiography (MRA) can also be performed to study conditions such as congenital heart disease, peripheral vascular disease and arterial-venous malformations (AVMs). MRA is a technique which allows doctors to see blood vessels in motion.

Queen's new 3T MRI is not only good for patient accommodation and comfort, but also provides many hardware and software advancement unavailable anywhere else in the state. The Queen's MRI Department is open Mondays through Fridays from 7:00am to 10:00pm, and Saturdays and Sundays from 7:30am to 4:00pm.

An Everlasting Legacy of GivingA 150th anniversary celebration fundraising event, "An Everlasting Legacy of Giving" was held at The Kahala Hotel & Resort on August 14. U.S. Senator Daniel K. Inouye and Mrs. Irene Hirano Inouye served as Honorary Co-Chairs of the event, which raised over $230,000 with 370 guests in attendance.

In addition to the distinguished co-chairs, the event featured Eric K. Keawe, who reflected on the exceptional care his mother, Aunty Genoa Keawe, received at Queen's in the last stages of her life until her death in February 2008. Accompanying herself on the ukulele, Pomaika'i Keawe Lyman, daughter of Eric and granddaughter of Aunty Genoa, moved the audience with her rendition of "For a Peaceful World," written by Irmgard Aluli.

Queen's Chief Operating Officer and Executive Vice President Mark Yamakawa donated 37 glass and ceramic pieces which he created. A silent auction was held for the works of art, which were a part of the centerpiece on each table. Naleen Andrade, M.D., Chair of the QHS Board of Trustees, closed the successful event by thanking the patrons and comparing them to the first subscribers of The Queen's Hospital. "Giving to Queen’s began in the mid-1800s," she said, "it's not much different today." She also recalled how the Queen devoted herself to her hospital in spite of the "crushing grief" she felt over the loss of her child and husband. Concluding, Dr. Andrade called on our Founders, King Kamehameha IV and Queen Emma, to be our guides into the future. Proceeds from the event will be used to support programs and services at The Queen's Medical Center. 

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