Utah’s Pacific Islanders take culturally focused approach in reducing high number of COVID-19 infections

(Rick Egan | The Salt Lake Tribune) Haviar Tuitama Hafoka, 32, got COVID-19 in mid-April and was hospitalized for a week and a half. He is pictured in his dance and music studio on Wednesday, June 24, 2020.

Haviar Tuitama Hafoka didn’t want people to know he was hospitalized with COVID-19. He was physically and emotionally drained. He thought he might die. And he worried about what his community would think and say because of the stigma surrounding the coronavirus.

Tuitama Hafoka, 33, is now back at his Salt Lake City home, still recovering from the virus and using oxygen. But he’s not afraid anymore to share his experience. He wants fellow Pacific Islanders, and all Utahns, to take the virus seriously and to show respect to each other by practicing social distancing.

“It can affect anybody. It affected me,” Tuitama Hafoka said.

COVID-19 has disproportionately impacted Pacific Islanders and Native Hawaiians in Utah and across the country. In the Beehive State, Pacific Islanders and Native Hawaiians make up just 1.6% of the state’s population but 3.8% of cases. They are experiencing the highest hospitalization rate in the state, with 124.7 per 1,000 cases, and have the second highest rate of cases, behind Hispanic residents, at 1,537 per 100,000 people, according to state data as of Friday. In Salt Lake County, they have the highest rate of cases, local health department data shows.

Some of the reasons why the Pacific Islander and Native Hawaiian communities have been so hard hit are not unique to them, said Jacob Fitisemanu Jr., co-founder of the Utah Pacific Islander Health Coalition. But there needs to be a culturally focused approach to address these high numbers, he added.

COVID-19 has the potential to be a “perfect storm” that can “rip through the community,” he said, “if we don’t take mitigated measures.”

Reasons for increased risk

Fitisemanu, who’s also a West Valley City councilman and oversees the Health Clinics of Utah program, thinks a combination of factors help explain why Pacific Islanders and Native Hawaiians in Utah have seen such high numbers.

“We’re proud, working-class people,” he said. There are many people in essential jobs during the pandemic who aren’t able to work from home or practice social distancing, he said. That’s intertwined with the “prevalence of large multigenerational families” living together in the same home. If one person becomes infected, it can easily spread to throughout the house, he said.

Then, there are “the underlying chronic medical issues that are rife in the Native Hawaiian/Pacific Islander population,” said Dr. Kalani Raphael, who joined Fitisemanu on a panel in late May to discuss the impact of COVID-19 on these communities. High rates of asthma, diabetes and kidney failure put them “at risk of really needing to be hospitalized” and “needing to be on a ventilator,” according to Raphael, a nephrologist with University of Utah Health. That’s in addition to the barriers community members face in accessing health care.

(The Salt Lake Tribune) A screenshot image of Jacob Fitisemanu Jr. from a video conference call May 28 hosted by the University of Utah School of Medicine Office of Health, Equity, Diversity and Inclusion about the impact of COVID-19 in the Native Hawaiian and Pacific Islander communities.

When Tuitama Hafoka started feeling ill in mid-April, he didn’t initially think it was COVID-19 since he’d had other health issues in the past. But it was a “sick I’ve never felt before,” like the “flu times 10,” he said. He had trouble breathing and moving, and he couldn’t taste anything. The only solid food he ate for about two weeks were smoothies.

Tuitama Hafoka resisted going to a hospital. He felt shame that he might have the virus, and he worried about being ostracized by others because he could potentially spread it among his community. He also thought about the people who have denied the severity of the virus and pushed for the state to reopen, which felt like a “slap in the face” to those who have experienced it, he said.

Eventually, though, Tuitama Hafoka went to Salt Lake Regional Medical Center, where he was diagnosed and hospitalized for about a week and a half. He laughs now about how his family looked like they were characters in “Back to the Future,” wearing Marty McFly’s hazmat suit, when they wore protective equipment to visit with him through a window.

But at the time, the virus took a serious physical and mental toll on him. He describes himself as a “really big dude,” but said he felt “very vulnerable.”

When a Polynesian man in a neighboring hospital room died, Tuitama Hafoka wondered, “What would happen to my family if I die?”

Expecting ‘a hug and a kiss’

Tuitama Hafoka isn’t sure where he caught the virus. He had only left home to get food or go to a gas station, and he wore a mask and gloves when he did go out. He knows, though, that people can have the virus but show no symptoms and spread it to others.

There are social and cultural norms in the Pacific Islander community that are “completely contradictory to the tenets of social distancing,” Fitisemanu said.

“Seeing someone that you know, or have a blood relation tie or a tribal connection to, and just waving from afar, there couldn’t be anything more rude to our people, especially with a blood relative or a close relative,” he said. “Even a handshake for us is pretty distant.” Instead, there should be “a hug and a kiss and an embrace.”

Raphael said that during the pandemic, people are wondering, “Is that ever going to come back? How are we going to behave?” And how should they deal with family gatherings?

When Oreta Tupola attended a couple of funerals in late May, she struggled with the balance she knew she needed to strike. It’d be “disrespectful” not to hug and be close with people as they mourned. But with her experience in community health, including as director of the Utah County Pacific Islander Health Coalition and a representative on the governor’s multicultural subcommittee to the state’s coronavirus task force, she also knew how important it was to wear a mask and keep 6 feet apart from others.

“It was so hard,” Tupola said.

She might receive some resistance or backlash, but Tupola said she tries to help her community members understand why these safety measures are necessary. “We’re just trying to save lives,” she said.

‘Islander strong’

Over the past few months, Nisi La’a has reminded herself, “It takes a village to help our community.” And if she “can help one person, we can create a ripple effect of helping others.”

La’a and Cencira Te’o work as case managers with Pacific Island Knowledge 2 Action Resources, or PIK2AR. They’ve helped distribute money that the Salt Lake City nonprofit received from a United Way of Salt Lake grant to help communities, like theirs, disproportionately affected by the pandemic with whatever they need, such as paying rent and bills or buying food.

While doing this, Te’o said, she’s witnessed a mental strain on people as they try “to understand what’s happening” and “why it’s happening.” They want their community to know, “You’re not alone in this. There are a lot of resources we can help you with,” La’a said.

For more information and resources, visit Utah Pacific Islander Health Coalition at www.upihc.org and Pacific Island Knowledge 2 Action Resources at www.pik2ar.org.

Organizers with the Utah Pacific Islander Health Coalition created a COVID-19 resource site, which includes a 17-page, comprehensive guide of agencies and contact information to help with issues ranging from health care to utilities to unemployment. At the top, they purposefully included names, emails and cellphone numbers for more than a dozen people.

“We’re not just sending people to a phone tree. We’re not just sending people to a 1-800 number or an organization they have no familiarity with,” Fitisemanu said. Instead, they are connected with an actual person in their community “who can help navigate those resources,” he said.

The organizations have also helped people learn how they can get tested, where they can find food donations, and how to become more educated about the virus, with resources in multiple languages. Utah Pacific Islander Health Coalition also created a public service announcement video with West Valley City encouraging people to follow health guidelines and to remain “Islander strong.”

“In these times, we need to band together and help each other through this and not put each other down,” La’a said.

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