Cancer services need restoring

Kapiolani Medical Center for Women and Children has restarted bone marrow collection in Hawaii, which brings an enormous sense of relief. Almost a year after the closure of the Hawaii Medical Centers, another milepost has been reached on the road back to restoration of a broad range of health-care services in the state.

It’s a milepost, but the journey isn’t over yet. Marrow transplants are being done at Kapiolani in pediatric cases, but not for adults.

The closure of HMC, which operated East and West branch hospitals, dealt a serious blow to the health system. The loss of HMC-West left a vacuum, especially in emergency care, on the Leeward side of Oahu, but The Queen’s Medical Center is inking a deal to acquire and reopen it.

There’s no such immediate plan for HMC-East in Liliha, which is being pegged for redevelopment as a long-term care facility. While Honolulu is well served by other acute care hospitals, the primary void created here was the shutdown of organ and bone-marrow transplant programs.

Queen’s has stepped up and, with state funding assistance, is now delivering organ-transplant services.

And Kapiolani recently announced completion of the first local bone-marrow collections since HMC-East closed. This is a boon to all the willing donors who prove to be a match for a patient needing a transplant, because it makes the process of donation so much less stressful and expensive.

Since HMC-East closed in January, donors traveled to the mainland at a cost of about $25,000. That sum is billed to the transplant patient, but donors don’t recoup lost wages expenses for child care and other donor needs.

Becoming a donor means making a time commitment. For example: Renee Tulonghari of Kaimuki flew to San Diego twice in February to donate bone marrow to a woman with aplastic anemia, a blood disorder. For some potential donors, the flights would represent an insurmountable burden.

However, the burden is even greater on the transplant patients themselves. The goal must remain restoration of bone-marrow transplants for adults as well.

Chantal Napalapalai is one adult whose story has a happy ending but who knows the stress this lack of services will cause. The Kapolei mother of two was diagnosed with childhood leukemia at 15 and was treated locally. Last year, about a decade later, she had a relapse. Because she had been a pediatric patient, Kapiolani made an exception and performed her transplant.

Napalapalai said she doesn’t know how she could have managed a flight to the mainland or, lacking a caregiver, the prospect of living in isolation for six months to a year.

While it’s true that bone-marrow patients in rural areas across the mainland face a similar challenge, the distances and the likelihood of even longer separations from loved ones are more daunting for Hawaii residents.

Hawaii’s medical system is a lifeline for its own residents, but also many from Pacific nations as well.

About 20 adults from Hawaii receive bone-marrow transplants each year, and while that may not sound like a large number, the impact of the lack of patient services compounds over time, especially when the regional repercussions are considered as well.

These transplants, unlike the organ procedures, are not regulated by the State Health Planning and Development Agency, and there’s no expectation of budget surpluses fat enough to underwrite such services. So it’s unclear what role the state could play in smoothing the pathway for the private sector to provide adult bone-marrow transplants.

Still, contemplating that role is an important discussion for lawmakers to have this session. They share the public interest in seeing that Hawaii is as self-sufficient as possible in the medical care of its citizens.