Nation’s southernmost DO practices rural primary care in Hawaii

In 2010, a visit to Hawaii forever altered the life path of Doede Donaugh-Rae, DO. The tropical weather, ukulele songs and laid-back atmosphere made a strong impression; within a year, Dr. Donaugh-Rae had left Wyoming for the Aloha State, where she found work at a community health center on the island of Hawaii, aka the “big island.”

Last year, with the help of another physician, Dr. Donaugh-Rae opened a new branch of a primary care clinic on Hawaii island in Ocean View, a medically underserved area a few miles west of the nation’s southernmost point. Below is an edited interview.

What was it like opening a new practice in a medically underserved area?

The need for health care here is huge. The nearest emergency room is 30 miles away at a critical access hospital, which also houses the nearest pharmacy, lab and X-ray. A lot of people don’t have vehicles or transportation. Between myself and two nurse practitioners, we do our best to provide primary care, same-day care and coordination of care to this population. So in some ways we’re practicing classic rural medicine.

Osteopathic manipulative treatment has become a sought-after commodity here. I have patients who travel about 50 miles to get OMT. I do OMT nearly every day, and I use it a lot for pain management.

What has surprised you about working in Hawaii?

When I first got here, every patient I saw asked me how long I was staying. I had assumed that everybody would love Hawaii. But the big island is different from Waikiki or Honolulu. Because it’s so rural, a lot of people get turned off by it. They either get island fever or they get bored.

My patients really wanted to know how long I was going to stay in this area because they were frustrated with having to change physicians all the time. I said I had no intention of leaving.

What is your patient population like?

About a quarter of my patients are native Hawaiians, and roughly 20% are islanders from the Philippines and the Marshall Islands. Most of the remainder are people who moved here from the mainland, and that includes retirees and veterans from Vietnam and other wars.

What illnesses do you see in Hawaii that are less common on the mainland?

The island is covered with solidified lava, which forms jagged rocks. I see a lot of lava gashes. Fishing is a big industry here, so I also get a lot of fishing hook injuries and sea urchin stings.

We’ve had a considerable number of cases of dengue fever. Hawaii has historically seen many cases of Hansen’s disease, otherwise known as leprosy. In this area, we are treating about 6 cases of it today.

What advice would you give to DOs and students who are interested in practicing in Hawaii?

Visit first to make sure you know what you’re getting into. Talk to other clinicians who have been here for a while. We have had some people interview and become interested in moving here, and then they come and do the site visit and change their minds.

Usually, people either love it or hate it. I’m one of the people who loves it. It really is paradise.