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This episode was produced by Annie Nguyen and Ashley Tam, hosted by Amber Chan, and graphic by Callista Wu and Claire Sun.

Time Stamps: 

0:00 Introduction to White Coats & Rice: An APAMSA Podcast 

0:58 Introduction to Dr. Marcus Iwane 

1:48 Professional Background and Native Hawaiian Health

4:17 The Role of Cultural Identity in Career Choice 

10:50 Health Disparities in the Native Hawaiian & Pacific Islander Community 

18:01 Addressing Generational Trauma and Healthcare Mistrust 

23:21 Building Trust & Cultural Humility in Medicine 

29:58 Community-Based Healthcare Initiatives in Hawaii 

32:29 Climate Change

35:20 Healthcare Sustainability 

35:20 Work-Life Balance & Personal Life 

46:53 Closing Remarks 

48:00 AMA Outro 

 

Full Transcript:

0:00 Introduction to White Coats & Rice: An APAMSA Podcast 

Annie: Welcome everyone to the 8th episode of the Asian Pacific American Medical Student Association Podcast. From roundtable discussions of current health topics, to recaps of our panels with distinguished leaders in the healthcare field, to even meeting current student leaders within the organization – this is White Coats and Rice. My name is Annie Nguyen, a postbac at Stanford University, and a member of the Leadership Committee at APAMSA. I’ll be your host for today! 

This is our Ask Me Anything Series! Each month, we spotlight an extraordinary physician who shares their insights on medicine, life, and everything in between. This is your chance to ask questions, hear their stories, and learn from their incredible experiences. Whether you’re curious about their journey, their day-to-day, or their views on the future of medicine, nothing is off the table. Let’s dive in! 

Today’s episode was moderated by Amber Chan, a medical student at the Hackensack Meridian School of Medicine and member of the 2024 Leadership Committee. 

0:58 Introduction to Dr. Marcus Iwane 

Amber: All right. Um, so just to give a brief intro before I hand it over. Um, this is Doctor Marcus Iwane. Um, he’s born and raised on Oahu, and he’s a board certified internal medicine physician. He earned his medical degree and completed residency at the University of Hawaii. And he’s currently the

chief of Kaiser Permanente West Oahu Medical Office, where he promotes Native Hawaiian health and healing. Um, so he also currently serves as clinical faculty and has been listed on 40 under 40’s Exceptional Leaders as well as best Doctors in America. Recently in 2023, he also completed the Climate and Health Equity Fellowship. So definitely be excited to hear about that. So, I’ll hand it over. Doctor Iwane, if you want to introduce yourself and tell us just a little bit to start off. 

1:48 Professional Background and Native Hawaiian Health

Dr. Marcus Iwane: Yeah. Hi. Good evening everybody. Uh, thank you for inviting me. You know, so I’d like to keep this very casual. So if anybody has any questions, you know, please feel free to ask me anything. So I’ll tell you first a little bit about myself. Born and raised in Hawaii on the island of Oahu, I did all my training here in Hawaii. Uh, that includes medical school, my residency training. I’m a internist by trade. And, yeah, after residency, I’ve been practicing with Hawaii Permanente Medical Group. Um, initially started off with a clinic in Nanakuli, which is a small little community on the west side of Oahu. We can maybe talk a little bit about that if you folks have questions about community health and what that means. And now we’re practicing in Kapolei, which is a little bigger clinic that I can share you a little bit about as well. But my passion is obviously Native Hawaiian health. So I don’t know if any of you on the call have roots here in Hawaii, or are part Native Hawaiian yourself, or have family who are Hawaiian or come from any indigenous background. But that is something that drives me to continue to do what I do, um, to serve our community and help to uplift our, our people so we can talk about Native Hawaiian health or indigenous health as well. That is another topic that if anybody has questions regarding, I can definitely share some viewpoints on. I currently serve as president for ‘Ahahui o nā Kauka, which is an association of Native Hawaiian physicians. I’ll drop in the chat our website. Um, you guys can go to kauka.org and we are a nonprofit, if you also want to learn a little bit more about ‘Ahahui o nā Kauka and what we do. Uh, go ahead and check it out. There’s a little video on the– on the website homepage as well. That kind of highlights a little bit about, you know, how we were formed, why we were formed. We established in 1998. And yeah, it’s a really it’s a really cool and very important organization to be a part of, to really focus on improving the health status of Native Hawaiians. And so yeah, we can definitely talk more about that as well. Um, but that’s a little bit intro to myself. 

4:17 The Role of Cultural Identity in Career Choice 

Amber: Definitely. From what you’ve introduced, you’ve spent most basically all of your medical training based in Hawaii still. Is there anything, I guess, growing up that kind of motivated you or inspired you to really be connected to your roots and really wanting to focus on giving back to the community instead of, you know, coming to like, the continental states or going elsewhere. 

Dr. Iwane: Yeah, that’s a great question. So I’ll share a little bit about my upbringing. Uh. First as a child. So I grew up in Oahu. I’m not sure if any of you have been here before, but, uh, Nanakuli is a– is a little town on the west side of Oahu, and my grandparents used to live there. So growing up as a child, I’m spending a lot of my weekends there. Their home was right across the beach, so that was also another good reason to go every single weekend. But my grandfather was a farmer and he has a child. He would always get me involved with getting my hands dirty in the garden with him, taking care of the– taking care of the grounds and the garden areas. And what really intrigued me growing up was hearing him speak Hawaiian language to his plants. And I was always kind of– always kind of thinking, what is he doing? You know, what is it? Why is my grandpa talking in Hawaiian language to plants? And so, you know, it was something that I really didn’t appreciate until I obviously got a little bit older. I started to learn a little bit more about my culture, including Hawaiian language and everything that comes with that. Yeah. And so, you know, I realized that at an early age, my grandfather was really teaching me the importance of connecting to land. Yeah, connecting to– connecting to the things that sustain us. Yeah. So our people, you know, being, you know, folks who have inhabited Hawaii for centuries. Yeah. You know, coming from a place that– an island that really didn’t have a lot of endless amount of resources, right? So everything was about resource management, protecting our precious water sources. You know, our– our land that sustains us, the fish that, you know, feed us from the ocean. And it was all about sustainability and really focusing on the understanding that, you know, once our precious resources are gone, there is no next state to drive through, right? There’s no next– next area to get more resources. Right. You know, so it was, it’s a very fine balance, right? That our people had a connection to land is so important. And you know that concept we refer to as something called “aloha ʻāina”. So aloha ʻāina. ‘Āina is a word that we refer to as land. And aloha obviously is love, you know, caring for. And so having this concept of aloha ʻāina ingrained in me from an early on, childhood, you know, really kind of helped me to understand the importance of making sure that you stay rooted. Yeah, you stay connected to your community. You stay connected to the land that sustains you. And that in addition to. Connecting to the importance of language. “Ōlelo Hawaiʻi” is what we refer to as Hawaiian language. And, you know, as I started to go through grade school and then eventually in college, I, you know, I took my language courses and, you know, that’s– that’s very important because in language, you that’s where you connect to cultural identity and, you know, through, through all of these things. Right? You know, you really focusing on what we refer to as cultural health. And so that, you know, really helped to lay a foundation for me as a, as a kanaka, as a, as a Hawaiian, as a Hawaiian person, as a Hawaiian, as a Hawaiian male, and, you know, carrying that through, you know, my training, um, really inspired me to figure out how to bring this into my medical practice. And so, you know, I decided to stay home for training throughout my, my college career, throughout medical school, even residency, specifically because of, you know, this connection that I have to to my in my land and being able to understand and care for our people, you know, we, we, we see this as more of what we call kuleana or responsibility that, that we have as, as, as native Hawaiians to really to really be able to take care of our own home. Yeah. And so, so that’s kind of what inspired me, um, to stay home and, you know, get even more deeply connected with community, which I feel has only helped me along once I started to establish my medical career, um, and really helped to build those connections with, uh, with folks. So, yeah, a little bit about why I chose to stay home. I’ve shared there– there’s obviously more, you know, maybe we can talk a little bit about what I do in my free time later. But yeah, I– I could not personally live away from the ocean. So that’s another reason. 

Amber: But honestly such an inspirational story. Just going from like your childhood, being with your grandfather and realizing later in life what you didn’t realize, like growing up that he was instilling in you all these traits that as a child you don’t really appreciate. But I definitely appreciate how you know you consciously are bringing that into how you practice medicine today, because I feel like it really brings a factor of humanism that I think many patients who, you know, may deal with America’s health care system today feel that we don’t really have that provider patient connection as much anymore, like the way things are driven, especially like larger hospitals or like metropolitan areas. It almost feels like patients see the doctor for two minutes and then they feel that, you know, yeah, you’re doing all this stuff for me in the background. You’re treating my physical health, but I don’t really know what emotionally is happening. So I think it’s definitely sounds great that, you know, you’ve been so conscious about that in your practice today. 

10:50 Health Disparities in the Native Hawaiian & Pacific Islander Community
Dr. Iwane: Yeah, I see something. So, Victoria, I see you put a question in the chat. Uh, Victoria,

where are you from? 

Victoria Shi: I am from new Jersey, but I’m currently doing my medical school in Kansas City. 

Dr. Iwane: Oh, fantastic. Awesome. 

Victoria Shi: Thank you so much for being here tonight. 

Dr. Iwane: Yeah. No. My pleasure, my pleasure. Uh, so I see your question. Yeah. What are some unique health challenges or needs of the Native Hawaiian Pacific Islander community that you feel are important for all clinicians to be aware of? So that’s an excellent question. You know, and so I kind of– I’ll kind of give a roundabout answer to that one, uh, by sharing another story. Um, because I like to share stories. So, you know, one of the very first patients that I began to care for right out of residency training was a young Native Hawaiian man who was diagnosed with really bad and uncontrolled diabetes. And, you know, I kept really trying to push medications. Yeah, trying to get his– his diabetes under better control, trying to stress the importance of that because, you know, his grandfather and his father, you know, both ended up having end stage renal disease on dialysis. And, you know, a lot of these bad complications and diabetes. And, you know, I felt like at his stage in his life, he, he, you know, he was at a point where he could make a difference. Yeah. And prevent, you know, his kidney function from declining and prevent his eyesight from getting affected and other things, you know, including decreasing his risk of strokes or heart attack. And so, you know, really, really pushing the medications, including lifestyle changes for him. And, you know, he really kind of seemed almost resistant to, you know, wanting to take medications. I didn’t know how engaged he was. And yeah, I couldn’t really understand why he wouldn’t want to get his diabetes under better control. And, you know, so it wasn’t until until while, you know, he he talked to me and he, you know, he said, “hey, you know, it’s not it’s not that I don’t want to take my diabetes, you know, or get my diabetes under better control by taking medications. You know, at the end of the day, I really gotta figure out, you know, how am I going to pay for these medications? Or how am I going to put food on the table to feed my family?” And so, you know, that kind of took me aback at– understanding that there’s so much, factors outside of just the medical care we deliver that influences health and wellness. And so, you know, Native Hawaiians, Pacific Islanders, especially here in Hawaii, you know, have the highest rates of chronic disease, diabetes, heart disease, obesity, hypertension. Um, we have the highest cancer incidence. Native Hawaiian females have the highest infant and maternal mortality across all ethnicities in our entire nation. And so how can this be, right? Why are people so sick? You know, I think there’s a lot of things that influence health and wellness outside of, you know, genetics, right? Outside of predisposition to getting certain certain conditions. You know, we’re talking about social cultural determinants of health. And so that’s something that’s very important for all of you to kind of understand is that, you know. Actually what we do within our four walls of the medical clinics, our hospital systems is just about 11% of a patient’s overall health pie. Yeah. The larger part of that is, you know, access to food, right? Uh, access to places where you can exercise safely, you know, so the list goes on and on. Education. And so there’s– there’s many things outside of just what we do in medicine that influences health and wellness. Yeah. So recognizing that I think is is important specifically for Native Hawaiians. Yeah. And this story is very similar for various indigenous peoples across our nation and including the world is, you know, we gotta factor in our historical determinants. 

So what are historical determinants, right? These are things that we refer to as non modifiable determinants to health. So um the impact of colonization marginalization of– of our people, you know, taking us away from ancestral and sacred lands. Yeah. And so through this you know transformation. Yeah. Through– through generations. Yeah. This generational trauma is what we refer to. It impacts health and wellness even hundreds of years down the road. And so, it’s so, you know, I think a lot of that is also a big factor, right. That we have to– we have to learn about, especially for our specific unique populations that we care for. Um, here in Hawaii, it’s obviously, you know, our Native Hawaiians and Pacific Islanders that we need to really kind of focus on so that we are approaching healthcare from an understanding and a place that, you know, we’re really a small part of the solution. So– so I think there’s a lot of things that– that, you know, we can learn. I can tell you, folks that Hawaii’s population of of Native Hawaiians is actually decreasing. More and more Native Hawaiians are now moving to various states around the continent because the cost of living is, you know, it’s hard to make it here in Hawaii. So we actually now have more Hawaiians living outside of Hawaii than we do actually here. So this is I’m I’m so happy that, you know, we’re having a conversation this evening with you folks because you folks are all going to be seeing Native Hawaiians one day. Yeah. In your– in your respective areas. And so, you know, the West Coast, uh, you know, Washington, Oregon, California, Las Vegas, right. Even Arizona, there’s– the population of Native Hawaiians and Pacific Islanders continues to grow. And so in order for us to really make a difference, and in order for us to be able to establish relationships with, with the people that we serve. Yeah, including Native Hawaiians and other indigenous populations, we gotta understand them. Yeah. We gotta understand where they came from. Uh, understand these historical contexts, all these factors outside of just their physical health. Yeah, that influences their well-being. So. So that’s just a brief, uh. Answer, I think to your question, Victoria, but yeah, it is– it is important to, to understand those things. 

18:01 Addressing Generational Trauma and Healthcare Mistrust 

Amber: I think you definitely highlighted some pretty important points there. You know like historical significance and how that impacts health down the road too and the generational trauma. So I guess that kind of made me wonder as well. Like as a native who’s practicing and working with this population, do you feel that you know, the native population and indigenous peoples have, like these communities have a mistrust of health care professionals and like the medical system because of how, you know, they’ve been treated over the years and just the effect of colonization and being marginalized in the past, having a trickle down effect now?

Dr. Iwane: Yeah, that– that is definitely alive and something that is a real challenge, you know. So what’s– what’s very important to note is that. You know, and we’re. We’re trained. Right. In a very Western way. You know, we’re trained to practice medicine, you know, by evidence, right? Um, by the book. And, you know, and so, you know, it’s very it’s very much, oh, you have this and, you know, you do this, this, and this, but a lot of a lot of indigenous cultures around the world, right? Not just Native Hawaiians have their own traditional healing methods. Yeah. That have been, that have been, have and continued to practice for centuries. Right. And so I think it’s important to note that or be aware that, you know, there are folks who– who do practice traditional healing methods. Yeah. And, you know, be open to hearing those. Uh, you know, one of the things that I love to do and where I go traveling and whatnot is always go check out some bookstores or different, different, different local areas that may sell, you know, books on on local plants that maybe are used traditionally for healing, you know, just to kind of read up because a lot of things are very similar across different cultures that you folks are starting to realize. 

Dr. Iwane: And so, so having an open mind and approaching– approaching your patients and community from– from a standpoint that– a standpoint of humility and curiosity, I think is something our great skills to have as a– as a clinician. I can tell you that that will only make you a better clinician because you’re able to build stronger relationships. Yeah. So, you know, the relationship between health care provider and the patient, I feel– and the patient’s family I feel is the strongest therapeutic force, even stronger than a medication we can provide for anybody. Right. Without that trust, without that foundational relationship its going to be very hard for you to, to, um, make change, right, to inform folks, to engage with them. And so and, you know, having a good relationship with, with your patients and their families, you know, is therapeutic not only for them it’s therapeutic for you, too, right? That’s what keeps us going, right? That’s what keeps us coming back every day for more. Right. Um, because medicine is really challenging. No matter what field you decide to go into, whether it’s surgical field, specialty, primary care, um, they’re all very challenging in its own ways. And so, you know, making sure that you have that foundation right to rely on it. That foundation is really, how do we build that trusting relationship. Yeah. So like you mentioned Amber, the generational trauma, the cultural trauma that our people have experienced, you know, even if it happened 100 years ago, for many it seems like it’s still happening. Yeah, there’s inherent racism and perceived discrimination is a real thing. Yeah. It impacts it’s a chronic stressor that increases– has been shown to increase risks for mental health disease. It increases risk for higher risk behaviors. Yeah. That impacts health and wellness. It also has been shown to affect cardiovascular reactivity and recovery increases the risk for diabetes. And so the list goes on and on. And so you know I think– I think it’s important right to talk about these things you know in forums. Yeah. Such as this. You know a lot of folks kind of like don’t feel comfortable talking about it. But it’s very important to talk about, you know, it’s not about pointing a finger or, you know, blaming this person or that person. Right? It’s about– it’s about the cultural humility. Yeah. And so wherever you folks go, wherever folks practice, you are going to have, you know, you’re going to be on indigenous rounds and in indigenous communities. And so learning in partnership with your folks and your population that you care for, I think is is extremely important. 

23:21 Building Trust & Cultural Humility in Medicine
Amber: Yeah, definitely. Oh, yes, I see Reanna, you’re unmuted. Do you want to ask a question?

Reanna: Yes. Hi, Doctor Iwane. Thank you so much for being here today. My family is from Waianae, so I have roots there. And I’ll actually be out at the University of Hawaii soon for my OB-GYN rotation with maternal fetal medicine. So I think yeah, I’m– I’m so excited to, like, come and I go to school in the Bronx. So I have some experience with like underserved communities. But I was wondering if you have any advice for just medical students in general when they are even just on a clinical rotation, we don’t have very much time with our patients. So how– how do we incorporate cultural humility and build that relationship in a– in a short period of time? 

Dr. Iwane: Yeah, that’s a great question. You know, and I think, you know, part of that is. It comes with time. You know, I think the more, uh, the more folks you’re you take care of, the more people you talk to. You develop your own style of how you build that rapport. So, you know, I can tell you that mentorship is extremely important. Yeah. So I wouldn’t be in a position I am today without having awesome mentors. Yeah. And so, you know, you learn from your mentors, right? You can see how your mentors interact with patients and how they are able to build relationships. So, you know, one of my mentors, I don’t know if you folks have ever heard of him, Dr. Noa Emmett Aluli, um, so he is a family physician on the island of Molokaʻi. And, uh, you know, one of the things that really kind of stuck with me as I started to spend time with him in his clinic before, even before I went to medical school, uh, was his ability to– to make that instant connection. Yeah. With his patients. And, you know, for– for Uncle Emmett. Right? It wasn’t so much about them, about the medicine. Right? It was about that connection. And so, you know, when, when I would see him talking to his patients. Yeah. He will be talking about what’s your last name or who who your mom, who your dad or, wait, where are you from? You know, and so, you know, he’s trying to figure out he was always about that connection on a, on a humanistic level. Yeah. And so finding that commonality with, with your patients, I think is, is probably the first step, you know, that we all should be trying to aspire to reach. You know, I think the challenge that you mentioned is we have such a short time right, in primary care. You know, we’re on 20 minute visits, but after the patient gets worked out, right after the vitals and everything gets done, uh, I maybe have ten minutes in the room with the patient right before I gotta hop onto my next one. And so, uh, in the busyness of the day, you really you. It’s very easy to get caught up in addressing your needs as a physician rather than the patient’s needs. Right? And so it’s okay to take a pause. Right. It’s okay to slow down and just kind of like talk story. You know, most of the time I can tell you if it’s a brand new patient for me or even if it’s like a patient I’ve been taking care of for ten years, sometimes I hardly– we hardly even talked about medicine in the exam room. You know, we’re talking about fishing. We’re talking about where did they last go on their on their most recent vacation. Right. You’re talking about their grandkids. We’re talking about oh their son got married and you know so it’s it’s that type of connection that I feel like matter most to our patients. So yes we do have to address their medical needs. But unless you can figure out how to– how to build that relationship, right. And get to know people on a personal level, you know, it’s it’s going to be it’s going to be hard, right, to continue to engage with them. And so that’s kind of like something that that I would actually focus on. You know, when I go in to see, see my patients and I encourage, you know, you folks all to kind of also take cues from, from various mentors and see how– see how you know, your, your preceptors, you know, interact with their patients. Everybody has a different style, right? And so yeah, here, here in Hawaii, we’re all about the connection. Yeah. And so connection is not only personally but you know, connection is from a family. A family centered approach. Yeah. So so to me that to me that’s what matters. Right. And yeah you it’s fun because you find some really interesting things about people. You know, they, they do all kinds of really cool stuff in their life. And, you know, it’s just that’s what– that’s what excites me, you know, to, to learn more about them. You know, every time I see, see a patient. Yeah, I’m learning something new about them, which is super awesome. Yeah. And it’s these things that you remember. Yeah. But it helps you to also ground yourself as a physician, too. Yeah. So so awesome. No, I’m glad that you’re going to be coming out here. You know, you feel free to message me if you want to come out and check out, check out our clinic over here in Kapolei. 

Reanna: I would love to. I’m staying with my uncle. He lives in Makakilo. So it’s perfect. 

Dr. Iwane: Perfect. Yeah. Perfect. Yeah. Awesome. 

Reanna: Everything has changed there in West Oahu. So much the past. Well, the past 20 years, I feel like. 

Dr. Iwane: Yeah, yeah, yeah. So. Yeah. If yes, please send me a message. I’m not sure. Amber, does everybody have my email? 

Amber: I can send it out in the. 

Dr. Iwane: Actually, I’ll just type it in the chat right now. Yeah. So? So please feel free to email me anytime if you folks have questions. 

29:58 Community-Based Healthcare Initiatives in Hawaii
Dr. Iwane: You know, I guess I take a little bit to kind of talk about, you know, what we’re doing specifically over here in Hawaii within Kaiser Permanente. So maybe, maybe we’ll see you soon and you can come check it out over here. But, you know, we’re talking we you know, I talked a little bit about sociocultural determinants, right. And how that influences health and wellness. And if we– if we drill down health and wellness even to life expectancy per zip code. So if we’re looking at different zip codes or zip code where Reanna has roots, you know, if you come from this zip code, your life expectancy is actually 10 to 12 years less than if you if you reside just five, ten miles down the road. And there’s different pockets like that across all islands in Hawaii. Yeah. And typically these pockets are rural areas. These pockets are areas that have a very high concentration of Native Hawaiians. These are where what we call our homesteads are located. And so, you know, it’s it’s it’s really frustrating. Yeah. To to see this. Yeah. How can your life expectancy be determined by where you live? So that really kind of alludes to the fact that, you know, there are a lot of other things that are in the wellness. And so what we’ve done specifically in our– the clinic that we– I practice that here in Kapolei is really focusing on on that cultural health aspect. Right. And building programs and building community partnerships specifically to address these needs right, within our our vulnerable populations, our native Hawaiians or Pacific Islanders. Actually, our Filipinos have a very, uh, high rates of chronic disease as well. Um, so what we’ve done over here is we’ve we built this almost like center of, of excellence for Native Hawaiians. And so, you know, within our, our clinic grounds, we have a walking pathway that has garden beds and we have a traditional healing mala or garden, and we have taro patches, two that we actively farm on our clinic grounds. And so it’s a different way of approaching health and wellness. And so, uh, you know, you’re not just you’re not just a physician, right? That comes in practices within our four walls. But, you know, your reach goes far beyond that, right? Community partnerships. 

32:29 Climate Change 

Dr. Iwane: You know, I talked about the importance of mentorship. So we have high school students that come out, or medical students come out and work the land with us. Right. Going back to. The importance of aloha ‘aina. Yeah, that I talked about early on setting that foundation. Right. That understanding that, you know, our health is directly connected to the health of our land. And so being able to work the land, being able to harvest kalo, right, or taro and incorporate that into our diet is important culturally. Yeah. And so there’s a lot of other things that, that, that we do, um, to focus on that, uh, within our, within this specific clinic that, that we have built here in Kapolei. So, you know, the other thing that’s important, right? Aloha ‘aina is also it’s also a concept of being good stewards. Right? Environmental stewardship is a– is a big thing. And so, you know, putting in energy efficient features over here. Right. To reduce our carbon footprint and reduce our greenhouse gas emissions is also very important. So that’s another big passion of mine too is you kind of mentioned earlier about the climate. Yeah. Climate change and how climate change impacts on health and wellness of our communities. And so, you know, we constantly talking about these things, right. And trying to figure out how to be on the leading edge of, you know, being good stewards of what we do in in medicine. Right. You know, health care sector, you know, contributes 8.5% of greenhouse gas emissions in this country. That’s huge. That’s huge. 8.5%. This is you know, that comes from the health care sector. Yeah. A sector that should be taking care of people and taking care of our land. Right. How come we are destroying it by emitting 8.5% of greenhouse gas emissions? Well, you think about it, right? Everything we use. Yeah, all of our– our single use devices, you know, processing of labs, processing of, you know, all of these types of things. It takes energy. Yeah. It you know, this waste has to be disposed of. And so, you know, we’re having conversations about how can we be better stewards of all of this. Yeah. So so yeah, it’s very interesting. But yeah got lots to talk about. 

Amber: I think that’s really cool having, you know, having high school students even come in and work the land physically and really being able to connect. And it’s like being able to pass that on generationally and how, you know, like harvesting things brings it back into your diet. And it’s like this self rewarding cycle. I think that’s really cool. I wish I had something like this here that my school could do. 

35:20 Healthcare Sustainability 

Reanna: I had I have a question I’ve always sort of had the struggle of like with the health care sector. And like in my background, I studied like environmental engineering and sustainability in undergrad. And so it really like shook me when I, you know, started medical school and saw like all the single use items we have and like we– for sterility, we have to have a lot of these plastics and single use items. But I was wondering if there’s any suggestion you have or like if your medical practice has put into place some sort of effective like reduction of waste or recycling of items that you’ve found to be like really useful and like very satisfying to see that in practice. 

Dr. Iwane: Yeah. So I can tell you it’s really challenging to make such a big change happen. So across a large organization. Yeah. And so, you know, just bringing it back to understanding that, you know, change starts at home, right? It can start with you and, you know, making a conscious choice of, you know, how we how we support our environment, right, individually. So I can tell you agriculture, yeah, is a big contributor to greenhouse gas emissions. And so, you know a two pound, two pounds of beef, right to have two pounds of beef land on your plate. That’s actually equivalent to about 160 miles of greenhouse gas emissions driven by a car. So that’s just two pounds of beef, right? So, you know, figuring out how to– how to how to support local I think is also another big thing. So you know, for us over here in Hawaii, everything has to come to us by boat or plane. Right. And so that’s a huge amount of, of energy that needs to to make that happen. Yeah. You know, a lot of these things we have come to rely on in our everyday life. And so how can we be better stewards of supporting local, of supporting sustainable organizations? Yeah. Within your own communities and also being a little bit more mindful of, you know, the types of things that, you know, we’re eating. Uh, because I give you the example,  85% of food that we consume here in Hawaii is not from Hawaii, but yet traditionally, yeah, our lo’i kalo systems or our agriculture, traditional kalo system supported a population of upwards of a million people. And so I think about that. Right. We have come so far away from land stewardship, from resource management, right, to relying on something that is not even produced here in Hawaii. And so how do we get back to rebuilding that, that model of sustainability of land and resource management? Because food grown locally, wherever you are at right, the shorter distance of food has to travel from from the ground to your plate, the better it is for not only the environment, but it is for your health too. Less processing, right? The food is always fresher. It’s more beneficial to your health. So I always kind of encourage folks to think about how they eat, the types of foods that they eat, the type of things that they buy, you know, and so just making a little conscious effort starting at home. Yeah. And so that includes even, you know, lower carbon forms of transportation, right. Like electric vehicles, LED lights, all those types of things. So but yes, change is necessary. I think a lot of folks, you know, across the nation now, especially in the health care sector, is looking individually within their own organizations on how they can reduce their own greenhouse gas emissions and carbon footprint. So but but yeah, I think we have a long way to go, you know. But but we’re getting there. 

Dr. Iwane: Which is which is why, you know I think individuals like you folks. Right. If you are interested. Right. If, if, you know, environmental stewardship and environmental justice is a passion of yours, you guys should really harness that passion. Yeah. There’s so much environmental groups out there, right, that are doing fantastic work. So partner with them. Right. Get involved with these nonprofit organizations. One of the things that I completed in 2023 was what we call a Climate and Health Equity fellowship. So as a ten month fellowship based out of DC, to have physicians get trained in everything that we need to know about how climate impacts health. And so it’s a really cool fellowship because I got to meet so many folks across the nation. All physicians. Yeah, we’re passionate about this work. So the reason why there’s a big push to educate physicians about climate change is because there’s this critical intersection between how climate impacts health, but more importantly, it’s not universal across the board. Much like social and cultural determinants, the impact of climate on health is is more severe for specific vulnerable populations. And these are our indigenous communities, our brown and black communities, our redlined communities. Right. And these are the communities that folks that we’re going to take care of. And so the other important thing is to notice that there’s this thing called a trust veracity index. So it looks at all professions across the entire nation. And guess who are amongst the most trusted professionals amongst everybody? 

Reanna: Doctors. 

Dr. Iwane: Yes, it is physicians and nurses. And so we have to use this, right. We have this very unique position. Yeah, that you folks are going to be entering as a physician. Yeah. Your voice matters. Okay. Your voice matters in the exam room. Your voice matters outside of the exam room. And so we can all be leaders, right? In advocating for what’s right. Yeah. For our people and our communities. So, uh, so that is something, you know, that is, I think, going to be growing in popularity and importance over the next couple of years, especially as, you know, our our global warming continues.

 

Amber: Yeah, it’s definitely I feel like I would echo everything you’ve been repeating how the importance of just having these conversations and just starting that thought process, like plant a seed in all of our minds and, you know, as we’re going day to day working with our patients and encountering all these single use, you know, medical supplies, it’s I would definitely admit it’s definitely not in the forefront of my mind, but having these conversations always plants that idea were, you know, looking back, I would say today I probably threw out like 13 gallons because I have so many patients in contact rooms and. Then people are, you know, using the disposable stethoscopes and the amount of gloves and everything we’ve gone through. And it’s so difficult to try to balance, you know, how we can advocate as physicians and I guess lead by example and demonstrate it when at the same time, I feel like we’re bound by the other medical side of things when it comes to these things. But I did notice we’re coming to our last five minutes. I know, Doctor Iwane, you were, you know, excited to share a little bit about what you do in your free time outside of medicine as well. Um, so if you want to wrap it up and end by sharing a little bit of what your life is like enjoying the beaches and the culture and life there, we definitely love to hear it. 

35:20 Work-Life Balance & Personal Life 

Dr. Iwane: Yes. So. So yeah. So I am married. I have two children. Uh, so our son is 11 and our daughter is 6. And so, you know, it’s a lot of time outside of, you know, taking care of patients and the daily grind of being a physician is obviously spent with family. So family is a big, a big thing, you know, that is what grounds me. And, you know, I think that work life balance. Oh, look at that. Yeah. Yes. So that work life balance as a physician is extremely important. Yeah. You know, family is is really everything. Yeah. Family is who you can fall back on in your tough times, you know, and even celebrate with you and your good times. Yeah. And so, you know what? One of my, one of my best friends is, is also one of my colleagues. You know, he he always she always tells me, yeah, we’re all going to pass away one day. Right. And so what do you want. You know, people to write on your, on your, you know, your, your gravesite or your tombstone or whatever it may be. Right. Do they want– do you want people to know you, as you know, Dr. Iwane, he was a great physician. Dr. Iwane, you know, he is a great, you know, you know, clinician or whatever, you know, or would you want people to remember you as, you know, uh, Dr. Iwane, you know, he was a he was a great father, right? A great mentor. Right. You know, so, you know, it’s I think it’s important to really focus on what matters most to you. Um, and remember that through your medical training and even as you, as you start practicing because. You know, like I said, medical, the field of medicine is– it is a challenging profession. Yeah. But it is also, in my opinion, one of, if not one of the most rewarding. Yeah. When you can make the difference, right, when you can see that smile on your patient’s face, right? You know that that’s what keeps keeps me coming back. Right. And so, you know, besides family, you know, I love the outdoors. Fishing is like one of my my biggest, most favorite pastimes. And I love hiking. And I do a bit of hunting too. So just kind of being outdoors. And that allows me to also connect to our environment, connect to the land and that’s grounds me. And you know, just having that– that time right to, to rejuvenate. Yeah. To kind of re-energize and you know that that’s important. Yeah. So whatever it may be. Right. If you guys don’t have hobbies you know that is okay. You know. But I encourage you folks to explore your passions. Yeah. Whatever it might be. Because in the tough times. Yeah. That’s just going to keep you going, right. Or to your happy place and, you know, take care of yourself. Yeah. That’s important. 

46:53 Closing Remarks 

Amber: Yeah. That’s definitely some great advice that I think as students we can all try to really take

away and actually explore. I know it’s so difficult for students. Once you start school, the hobbies, the priorities aren’t exactly up there to be pursuing them as much. But you’re definitely right. You know the things that will ground us at the end of the day, whether it is going outdoors or knitting, whatever the climbing the hobby is, is always going to be there for us at the end of the day and this exam will be over, you know, the next thing you know, but the things that really ground you are really still there. Great words to end on. Thank you, Doctor Iwane, for taking the time to speak with us today. 

Dr. Iwane: Yes, absolutely. And like I said, you folks have my contact information, my email. You can go ahead and share it. You know, even to the broader– who put in joining us today. If you folks have any other questions or want to reach out any time, okay? 

Amber: Thank you. Enjoy the rest of your night. 

48:00 AMA Outro
Annie: And that’s our latest installment in the Ask Me Anything series. If you have a specific physician or specialty that you’d love to hear from, let us know. You can reach us at professionaldev@apamsa.org. We hope you enjoyed today’s episode as much as we did, and don’t forget to tune in next time! Thanks everyone!