How the first Native Hawaiian psychiatrist set a course for diversifying medicine

Benjamin Young didn’t set out to be the first Native Hawaiian psychiatrist. Nor did he go looking to be the first physician on board what would become a landmark epic voyage from Tahiti to Hawaii back in 1976, using only the stars, sun, moon, and cloud and wave patterns as guides.

And Young had no clue that, toward the beginning of his career, he would be called on to start up a first-of-its-kind program at the University of Hawaii to diversify the number of Pacific Islanders and other underrepresented groups in medicine.

Young, who turns 85 this week, knew only that as hard as it was for anyone to get into medical school, it was even more so for people like him — the son of a domestic worker and a janitor at Hawaii’s Hickam Air Force Base. He wanted to encourage others like him, young people with seeds of both ambition and self-doubt that grew and towered over them like stalks of sugarcane.

When Young completed his residency at the John A. Burns School of Medicine University of Hawaii in 1972, the dean surprised him with news that Young was one of fewer than 10 Native Hawaiian-trained physicians. The Imi Ho‘ola program the dean tasked him with launching is now a half-century old, and helped raise that number to hundreds in Hawaii and hundreds more throughout the country.

These days, Young is retired from the university. When he’s not making music boxes that play Hawaiian tunes for former students, he’s working part-time to evaluate psychiatric claims for the Social Security Administration and writing a forthcoming book about the language of anatomy and Hawaiian culture.

“The intestines — they’re the seat of emotion — are really significant in Hawaiian culture,” he told STAT. “So is the anterior fontanelle, which is the connection to your ancestors.”

STAT spoke with Young over Zoom about his wide-ranging career, including his contributions to diversifying medicine and his work educating medical students about Hansen’s disease with visits to Hawaii’s former leprosy colony.

The interview has been edited for length and clarity.

You mentioned a documentary is in the works about the diversity pipeline program, Imi Ho‘ola (“those who seek to heal”), which you started in 1972. What did it take, both personally and on the job, for you to build it up?

The most important part was to find the students. I was heading to middle schools, high schools, and colleges and meeting with the counselors, finding out who their brightest students are who were interested in medicine — but thought they could never do it because their MCAT scores were low. All they needed was a review of pre-med chemistry, biochemistry, anatomy, zoology, and they could possibly get into medical school.

There were students like Neal Palafox, who became the chairman of family medicine and community health at the medical school. And Clayton Chong, who became the first Native Hawaiian oncologist.

What were the ways you encouraged hesitant students who maybe lacked a belief in themselves to join this program and pursue a medical profession?

That’s the story of Hawaii. Every group of people came there as immigrants. For the Hawaiians, Polynesians, Chinese, Japanese, Korean, Portuguese, Filipinos, Vietnamese, some of them were able to make it up that ladder of success. So many of them were not. You have the children of the plantation, descendants of immigrants, people who were in poverty, those who thought they could never do it.

The first student that entered the program — I met her through her father. We needed a vacuum cleaner, and her father came to our house to sell it. We were chatting and he asked me, “Now, what are you doing?” I said, “Well, I went to university. I’m trying to start this program and trying to get more Hawaiians and others into medicine.” He said, “You know, I think my daughter might be interested.” She was a senior at Brandeis University. She was pretty smart to get into Brandeis but never thought she could get into medical school.

So I was able to contact her. And I called her my “vacuum cleaner student.” She graduated, got her M.D. degree. And eventually she — Chiyome Fukino — became the Director of Health for the state of Hawaii.

Her brother, who studied art, also changed his program to medicine and entered our program. He graduated from medical school and became an ER physician on the island of Kauai. He passed away just a few months ago. I knew he was dying, so I flew over there with my ukulele. We were singing Hawaiian songs. He died a few days after that.

But one of the major [hesitations] was, “how much is it going to cost me?” The tuition was going to be pretty nominal for Hawaiian residents and for Pacific Islanders, as the program was federally funded and came with stipends, but they had living expenses, too.

So I ventured forth to several of the companies in Hawaii and they made donations. I wrote one drug company a letter and told them what I was trying to do, that there were so few from the underrepresented people of Hawaii, that I was starting this program, but the students had no funds. This was 50 years ago. Eli Lilly sent out a representative, a physician, all the way to Hawaii to talk to me. So he interviewed me and he said he makes no promises, but we’ll hear from him. And Eli Lilly sent me a check for $25,000.

Then there was another company that was a publisher of medical textbooks, Lange. I happened to write to the guy who owned the company, and it turns out he was a physician, and he flew in and talked to me. He said he would provide the textbooks for the students. I was astounded.

What were some challenges to your diversity efforts?

There were many complications. First of all, in the 1970s, there was a white applicant to the University of California, Davis, [Allan] Bakke. He sued the University of California, Davis, because he felt qualified to enter medical school and that there were others who were less qualified than he was, but who were able to get in because of their race. The board in 1978 ruled that you cannot use race as a primary factor.

So at that time in the 1970s, we had to be careful that we use the word “underrepresented” rather than “getting more Hawaiians, Filipinos, Koreans into medicine.” But we also included so many of those who came from less advantaged socioeconomic backgrounds. And in 1976, the dean asked me to expand the program to recruit more women, who were underrepresented in medicine at that time. So we accepted clinical nurses and lab techs and other women to help increase the numbers of women in the medical school.

What were some of the barriers to increasing the number of women in medical school and who were doctors at that time?

The history of medicine and medical school is very male-dominated. I came across a nurse, [Sharlene] Teefey, who had always thought about medical school. I met with her — she was a nurse in the ICU at one of the hospitals in Hawaii, and she came into the Imi Ho‘ola class in 1977. She was so smart — she became a full professor of radiology at the Washington University School of Medicine in St. Louis. But her MCAT score was not that good. A review of pre-med classes was perfect for her. Then she was able to get into medical school, as she just bloomed so beautifully.

Some of the women came from this poor section of the country out of the way — one came from this place called Nanakuli. She was a Hawaiian woman. Her name was Laverne Kia. And she really wanted to be a doctor since high school. She was advised that since she was smart, she should attend a different school rather than the public school. She was accepted but she couldn’t afford the tuition. But the night school told her that if she could clean the bathrooms and the classrooms, that they would use that to pay for her tuition.

And she was able to graduate from that high school, and then went to the University of Hawaii and the Imi Ho‘ola program. There were several that I remember who got pregnant while in medical school and were nursing a child while attending classes.

You were the first Native Hawaiian to receive a medical degree from Howard University College of Medicine, a historically Black institution. What made you choose to go there? 

My undergraduate degree was in English literature, and so I had nothing in the sciences. I graduated from a small college in Tennessee called Milligan and went out to California and worked on my master’s in church history. Then I realized that church history was so boring. I wanted to go into medicine.

I got into three medical schools, but Howard was willing to give me the best scholarship and I didn’t have that much money. I was already married, had a child. So then I figured, well, Howard would be an interesting experience because it’s an African-American school mainly. So we packed up all our belongings in a U-haul trailer and drove across the country to start four years of medical school at Howard.

What was that like, those years at Howard’s medical school?

Those were interesting times. Martin Luther King, Jr. was at the forefront of the new Civil Rights movement. The Civil Rights Act was passed by Lyndon B. Johnson the year I started; there were so many issues that were floating around the country.

I had never been around so many African-Americans, so that alone was an interesting experience for me. And that had such an impact on my life. I had professors who were really very wonderful role models. Like LaSalle Leffall, the first African-American president of the American Cancer Society, my dean in medical school. He knew every one of us medical students very well — he was part of the inspiration for me to learn about every student’s life in Imi Ho‘ola, to know that everyone has a story to tell.

And Paul Cornely, chairman of the Department of Public Health at Howard and the first African-American to be president of the American Public Health Association. He helped me get a fellowship to work with migrant health workers in New Jersey — I learned where they lived, tried to pick vegetables with them, how they moved with the sun. New Jersey’s commonly called the garden state — by the brow and back of the migrant workers. And they had no access to health [care], when access is one of the key ingredients in the social determinants of health.

Could you speak about another adventure — your trek to the island of Moloka‘i, which later became an annual trip with Native Hawaiian Imi Ho‘ola students?

In 1973, when I was with the medical school, this artist by the name of Herb Kāne contacted me and said that he had this dream of building a canoe and sailing it to Tahiti and back to Hawaii, without instruments, and he wanted to do this as Hawaii’s contribution to the bicentennial celebration of the nation. He asked if I would be willing to be part of this crew as the physician on board. I said yes.

The voyage began in 1976. I was part of the crew that came back from Tahiti to Hawaii. Our first landfall was at Kalaupapa on the island of Moloka‘i. That is historically a very significant place because that’s where patients were sent first in 1866 to isolate when they were diagnosed with leprosy. [Editors’ note: Hawaii’s quarantine was lifted in 1969, though some remained at the colony voluntarily.]

We pulled into Kalaupapa and anchored there. The patients [with leprosy, or Hansen’s disease] were so excited. And we started thinking, this is such a historical place — what a wonderful place to bring medical students. So that’s how it all started. I began to bring medical students for the weekend to learn about medical history, [including] Father Damien, Brother Joseph Dutton, Mother Marianne, all those other people who were significant in Hawaii’s history of leprosy. In the early 1860s, there was no one to take care of patients who were sent there to die. It was people like Father Damien, who was a Roman Catholic priest from Belgium, who went and took care of them and sacrificed his life, because he eventually contracted leprosy.

What was that experience like with and for the medical students?

I had to charter small planes — there’s usually about 20 to 30 of us, including faculty, and we would fly in on Friday until Sunday and stay by the lighthouse. I would invite people from various hospitals to go with me, and so over the years I’ve taken hundreds and hundreds of people there. The Imi Ho‘ola program is still doing it — they stopped because of the pandemic but started it up again this year.

One of the things that I always required  — nobody was excused from it — was to go to mass on Sunday at six o’clock in the morning. In the olden days the communion was in Latin. And just before Holy Communion, there was a very, very special hymn. [Young started to sing the hymn “O Lord, I am not worthy.”] It was such a special moment because you’re ingesting the body and blood of Christ, and the patients [with Hansen’s disease] would go up to the altar to receive Holy Communion.

You had these patients who had stumps where they had feet and their arms had withered away, and they’re hobbling on from their aisle all the way up to the front to receive Holy Communion. That was so touching, that I wanted to make sure everybody who went to Kalaupapa would recognize that, for these patients, no matter what happened, religion was a source of survival for them.

Do you see any lessons that we can draw from the stigma around the disease?

I look at it with a retrospective telescope. We don’t, even today, know what causes the spread of the disease, possibly by droplet infection. We know it’s by close contact. But if I look at it in terms of a physician who’s interested in public health, I would probably say that the best method of treatment in the olden days, in the 1800s, would have been indeed to isolate, but not isolate and ostracize them in a separate colony, because that was such a terrible experience. For so many of these patients who were maimed, diseased, dying, there were very few people to care for them if they were isolated from their family.

Now that we know so much about public health and mode of transmission, if they could have been isolated, and trained the families or loved ones how to care for them with isolation techniques at home, that would have been so much better.  Without the trauma of separating them from the traditional Hawaiian ’ohana, which was so cruel.

The stigma of mental illness is still very real. Some of the work you did as a psychiatrist was helping patients with schizophrenia learn how to best communicate. Could you speak to that experience? 

These are some of the most seriously ill patients who go to the emergency room. With the schizophrenic and with the very depressed patients, oftentimes, it was so difficult to get them to communicate because they’re so sick. So I would just take out a sheet of paper and give them a pencil and tell them to write, “I am in the hospital, because of …”

I’ve collected hundreds and hundreds of essays from people who are unable to really communicate because there was so much mental anguish and so much distress. But they were able to write out why they were in the hospital. And surprisingly, people would write a whole page or pages — they couldn’t express their thoughts in speaking to me, but they would do it in writing.

What do you think it was about the writing itself that allowed them to communicate what they couldn’t while speaking? 

Oh, because I’m a stranger to them. How could they express, how could you express your thoughts, your most intimate, deep thoughts to someone you just met? [In the ER] I didn’t have that much time, so I used this device and I would go over their work later.

There was one woman who was very depressed. She was suicidal and I didn’t have much of her history. I would have her write, and she had difficulty writing “I am so depressed because my son died.” She left it blank. So I said, “Well, are you having trouble writing?” She nodded her head. I said, “Why don’t you draw something?”

I was astounded. She drew a picture of a young boy and a woman holding his hand — they were walking along the road. She drew it with all kinds of flowers. I finally asked her to describe what she drew.

She said she was walking along one of the highways on the rural side of Hawaii and she let go of her son’s hands for just a second. And a truck came along and killed him. Oh my gosh, so tragic.

So we were able to talk about that and the guilt that she experienced. What she went through when she had to identify his body, his funeral, and how depressed she was. She felt that life was not worth it. And so when you go through the process of developing insight, you can develop a sense of seeing that life is worthwhile.

Correction: This article has been updated to reflect that Ben Young completed his medical residency in 1972 and that Jenny Nguyen is a medical student at the John A. Burns School of Medicine.