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TB Notes 1, 2004

The Renovation of Hawaii’s Lanakila TB Clinic

In many areas, TB control has been neglected with diminished funding, support, and interest. The Hawaii (HI) State TB Control Program is uniquely fortunate to be supported by the State Legislature, Governor, health partners, community, and CDC to aggressively address the state’s continued high TB morbidity.

After 15 months, the Lanakila Tuberculosis Clinic returned from temporary quarters to a completely renovated 13,000-square-foot headquarters in Honolulu.  A dedication ceremony celebrated on August 7, 2003, began with a beautiful Hawaiian chant by Makia Malo, a local Hawaiian storyteller. Dr. Chiyome Fukino, Director of the Hawaii State Department of Health, hosted the ceremony with several distinguished guests, including Dr. Ken Castro of CDC, HI Representative Dennis Arakaki, HI Senator Suzanne Chun-Oakland, and HI Representative Felipe Abinsay. The Honorable U.S. Representative Neil Abercrombie gave poignant remarks on the achievements and dedication of the U.S. Public Health Service in public health and TB control in Hawaii and the United States. 

This grand opening celebration showcased over 2 years of detailed planning toward the development of a model TB Clinic with separate clinics for screening and treatment. Two capital improvement bills totaling over $3 million dollars were approved in 2000 by the Hawaii State Legislature and former Governor Ben Cayetano to completely demolish and renovate the old TB clinic and procure a digital X-ray imaging system.  The TB Program worked closely with Teresa Seitz and Ken Martinez of the National Institute for Occupational Safety and Health to optimize infection control features. Highlights of the renovation include the following:

  • Dual TB clinics: The Screening Clinic and Chest Clinic are separated, with independent ventilation and air conditioning systems to prevent potential mixing of air between low-risk and high-risk populations.

  • Negative air pressure clinic: The entire Chest Clinic (including all waiting rooms and examination rooms) is under negative air pressure and is serviced by a one-pass ventilation system that exhausts HEPA filtered air externally. These engineering controls are augmented by the use of stand-alone HEPA filters and wall-mounted ultraviolet germicidal irradiation lamps which offer optimal infection control for clients and staff.

  • Computed radiography: A complete digital X-ray and image database system was installed. This state-of-the-art system offers rapid processing of X-rays; decreases radiation exposure for clients and staff; and eliminates the need for film, chemical film processing, and storage of analog films for the approximately 16,000 X-rays taken annually, with the ease of computer access, manipulation, interpretation, and storage of electronic images.

  • The Bishop Museum installed a permanent exhibit chronicling the history of TB in Hawaii (done in partnership with Leahi Hospital and the American Lung Association of Hawaii). The exhibit presents a timeline beginning in January, 1778, when Captain Cook brought two shipmates with TB to Waimea, Kauai. In the early 20th century, TB sanatoriums and preventoriums for children were established on each island before widespread use of surgery and antibiotics.

  • The Hawaii State Art Museum’s Art in Public Places Programs loaned over 20 pieces of original art, including paintings, statues, photographs, and ceramics from local artists for display in public areas throughout the clinic. A noted Hawaiian artist with family ties to the TB Program also loaned several of his pieces for display.

Several hundred people enjoyed the grand opening festivities, which included an open house, tours, Hawaiian story telling, local food, and entertainment. The event was covered by all local television news stations and documented for video presentation by community access television.

A small team of visitors from the CDC’s Division of TB Elimination was led by Dr. Ken Castro. The team met with Dr. Boz Tucker of the Pacific Island Health Officers Association, representatives of Pacific Resources for Education and Learning, and the Hawaii State TB Laboratory Staff. Dr. Zachary Taylor provided an in-service training session to TB Program staff. Dr. Castro was the featured speaker in a presentation on international TB issues, teleconferenced live to Bangkok from Tripler Army Medical Center. In partnership with the American Lung Association of Hawaii and the Hawaii Thoracic Society, Dr. Castro also inaugurated the new TB conference room with a presentation on the new ATS/CDC/IDSA TB Treatment Guidelines to a large group of physicians and nurses.

The CDC Team also reviewed program data with local CDC personnel (Dr. Jessie Wing, CDC Medical Officer and Hawaii TB Program Chief, and Jason Nehal, CDC public health advisor) and TB Program staff in Honolulu, Maui, and the Big Island of Hawaii. The State of Hawaii has reported the highest annual state TB incidence rate for most of the past decade (11.9/100,000 in 2002) with over 80% of its cases in foreign-born persons each year.

The busy CDC team visit was capped off by a very enlightening visit to Kalaupapa Settlement for Hanson’s Disease on the island of Molokai, hosted by Mike Maruyama, Branch Chief of the Hanson’s Disease (HD) Program. In the World Health Organization model, TB and HD are placed under the same program. Closer collaboration with the HD program is helpful since HD and TB have similar at-risk populations in Hawaii and the Pacific region.

The Hawaii TB Control Program plans to build on the momentum afforded by this new beginning to maintain a high profile in the community and with the legislature. The program will continue to work collaboratively with its partners to promote engagement, collaboration, and funding to advance the goals of TB elimination. Ninety-three years after the Hawaii Bureau of TB was established, the Hawaii TB Control Program is proud to have a cutting-edge facility to develop more responsive and progressive initiatives for Hawaii and the Pacific region and go forward in the 21st century.

I mua a lanakila:  Go forward to victory.

—Submitted by Rachel Blair, Ricardo Silva, Dzung Thai, Jason Nehal, and Jessie S. Wing
Hawaii State TB Control Program


Released October 2008
Centers for Disease Control and Prevention
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