Sala Horowitz, Ph.D.

B ecause of its multicultural history,the Hawaiian Islands have longdrawn from Polynesian, Eastern,

and Western healing traditions. In addi-tion to Hawaii’s lush wealth of flora,which is useful for medicinal purposes,other alternative and complementarytherapeutic approaches have long held afoothold in this exotic island chain thathas been a U.S. state since 1959.1 Tradi-tional Hawaiian folk medicine, as prac-ticed for centuries by highly respected“kahuna” (experts, in this case, in heal-ing), is well-developed. “Lomi lomi” mas-sage and such botanicals as noni (Morindacitrifolia) are still in use and are beingincreasingly studied and integrated intocontemporary Western medicine.

The relaxed “aloha” lifestyle of Hawaii(also spelled Hawai’i in some sources)should also be of interest to modern sci-ence because of the demographic fact thatHawaii is the healthiest state in which tolive, based on the criterion that its resi-dents live longer than anywhere else inthe United States—a mean age of 78.21years.2 Apparently, the Hawaiians aredoing something right, despite healthhazards from the subtropical sun andsome forms of marine life (e.g., sharpcoral, sharks, and stinging jellyfish).

Traditional Disease Taxonomies and Healers

In her comprehensive text on traditionalHawaiian uses of plants, ethnobotanistIsabella Aiona Abbott, Ph.D., a professor ofbotany emerita at the University of Hawaiiat Manoa, in Honolulu, Oahu, explained

that, while much traditional knowledge hasbeen lost, there has been a resurgence ofHawaiian interest in indigenous traditions,such as herbal medicine, in recent years. Dr.Abbott noted that Hawaiians traditionallydistinguished between illnesses caused byexternal forces (mawaho), such as anotherperson or supernatural being, and thosecaused from within the body (maloko). Eachcategory requires a different approach tohealing, although prayers/chants and offer-ings were the first line of defense responseto any health problem.3 A treatment course,known as apu, was holistic in that it typical-ly combined rest and mental relaxationevoked by prayers with specific herbal,massage, or other modalities.4 Healingkahuna were turned to in cases of illnessesarising from within. As in modern Westernmedicine, these healers—highly trained inmedicine, botany, and pharmacology—were specialists: diagnosticians (kahuna haha), medical doctors (kahuna lapa’au), andherbalists (kahuna la ’au lapa’au). WhileWestern contact resulted in the decline ofmany indigenous healing practices, theirpresence was st ill prevalent enoughthrough the nineteenth century to promptthe Hawaiian legislature to pass lawsrequiring that traditional practitioners keeprecords of their treatments. While manypractices continue to the present, few butsome kapunas (respected elders) know theage-old prayers for relief to accompany thegath e r ing o f sa cr ed p l an t s u sed a smedicine. Dr. Abbott noted that one West-ern-trained physician declared that the atti-tudes inherent in such rituals “wouldcertainly have afforded more relief than the‘sugar pills’ on which modern medicinesometimes relies .”3 The fact that someplants introduced later by other ethnicgroups replaced similar native ones some-what confuses the usage picture.3

Nils P. Larson, M.D., a Western doctorwho discussed ancient Hawaiian medi-cal practice in the 1930s, noted ways inwhich this ancient civilization was quitesophisticated in their healing practices incomparison to Western medicine of thepremodern period. He commented that,after studying for at a period of approxi-mate ly 15 years that “ [ t ]he kahunalapa’au, was, in my opinion, just as sci-entific as the old pharmacologist with histhousands of prescriptions.” Even theold system of kapu (taboos) encouragedsome pr even ti ve hea l th measure s .Because Hawaiians no longer undergothis extensive training, Dr. Larson warnsthat it is just as unwise to take a tradi-tional remedy on a casual recommenda-t i o n a s i t i s t o ex p e r im en t w i t h aprescription drug.4

Popular Traditional Botanicals

At the core of traditional treatments forcommon aliments by these traditionalhealers or for self-help are the manynative plants long used in the HawaiianIslands (either indigenous, or “canoeplants” introduced centuries ago by Poly-nesian settlers, who arrived by canoe). InNative Plants Used as Medicine in Hawaii,University of Hawaii ethnobotanist Beat-rice H. Krauss provides an excellent con-cise summary of the applications andpreparations of 27 botanicals that havebeen used for centuries.5 (See box enti-tled Frequently Used Traditional Hawai-ian Healing Plants for a ranked samplingof these plants, according to a 1985 litera-ture survey.)

Among the plethora of other plantscommonly used for healing are: � Arrowroot (Maranta arundinacea)—for

diarrhea

68

Traditional Hawaiian HealingArts Enrich Conventional

Medical Practices

�Ripe banana peels—as a poultice forwounds (rich in vitamins A, B, and C;calcium; iron; and phosphorus)

�Breadfruit—sap for cuts and as a skinmoisturizer

�Coconut—as a moisturizing oil�Hibiscus (Hibiscus sabdariffa)—as a laxa-

tive�Kava kava (Piper methysticum)—in fer-

mented form, for asthma, urinary-tractinfections, rheumatism, headaches, andinsomnia

�Seaweed (Sargassum echinocarpum)—as atonic for children

�Sweet potatoes—as a tonic during preg-nancy; juiced as a gargle for phlegm

�Tamarind—as a laxative�Yams—for coughs, constipation, vomit-

ing, and appendicitis.An interesting case of the medicinal

use of a later-introduced plant is chaul-moogra (Hydnocarpus laurifolia), whichwas p lanted in Hawa i i by the U. S .Department of Agriculture. Used inAyurvedic and Tradit iona l ChineseMedicine (TCM) to treat skin diseases,chaulmoogra was the main treatmentfor Hansens’ disease in the 19th centuryuntil the plant was replaced by conven-tional drugs.6

Besides noni, plants being scientifical-ly investigated include mamane (Sopho-ra chrysophylla) for its potential use incases of asthma7 and a number of oth-ers, including kava kava and kopiko(Psychotria hawaiiensis), for their antimi-crobial activity.8

A uniquely Hawaiian plant–based ther-apy utilizing the power of suggestionconsists of a patient wearing a lei of alimu-kala (a type of seaweed) and walkinginto the ocean against the waves until thelei and his/her lingering sickness arewashed away.

Noni: A Major TraditionalHawaiian Botanical

Noni, a member of the Rubiaceae fami-ly, which includes coffee, is the plant inthe traditional Hawaiian pharmacopoeiathat has sparked perhaps the most scien-tific interest. In her text on Hawaiian cul-ture, Dr. Abbott lists noni as the secondmost frequently used plant in the Hawai-ian and other Polynesian traditions.3

Dr. Abbott, in an article in the early1990s, reported fielding approximatelyten calls a day about noni and comment-ed that “[p]eople are crazy about thisplant. They use it for diabetes, high bloodpressure, cancer, and many other illness-es.”9 Also commonly known as the Indianmulberry, noni grows as a small ever-green tree in diverse ecosystems in theHawaiian Islands. Commercial noni prod-ucts, made from the ripe yellow fruit, var-i ou s l y d e s c r i b ed a s r e s emb l in g apineapple with large leaves or a handgrenade, are marketed via the Internetand elsewhere. Hawaiians still make a teafrom noni fruit and apply noni leaves tothe skin for various dermatologic ail-ments.10 Among other sites, the authorfound noni trees growing at the NationalTropical Botanical Garden in Kalaheo,Kaui, Hawaii, where a gift shop carriescommercially prepared noni juice.

The pharmacologically active con-stituents of noni have been identified aspolysaccharides and damnacanthal, ananthraquinone compound.11 Its polysac-charide component, at least in several ani-mal and in vitro experiments, has beenfound to have an immune-enhancingeffect on white blood cells in destroyingtumor cells.12,13 Damnacanthal extractedfrom the noni root was able to inducenormal morphology in rat cancer cells14

and had a stimulatory effect on ultravio-let-induced apoptosis of human cell com-ponents that are re levant to cancerdevelopment.15 A case report of noni useby a patient who self-medicated forchronic renal insufficiency noted that thispatient may have alleviated his conditionby ingesting a needed source of potassi-um.16 Other research on mice suggeststhat noni has analgesic propert ies.17

Ralph M. Heinicke, Ph.D., a researcherformerly at the University of Hawaii, hasdeveloped a commercial noni product.His claim that an alkaline designated“xeronine” is a key fruit constituent hasnot been confirmed.18

The dosage of noni that is generally rec-ommended is four ounces of noni juice,500–1000 mg daily, or two tablespoons of aliquid concentrate, on an empty stomach.There are no known adverse interactionsbetween noni and other herbs or drugs,but noni is often taken in combinationwith other juices or in extracted form incapsules or tablets because of its notorious-ly foul odor and bitter taste (to which theauthor can personally attest).11 Other noniproducts, such as soaps and lotions madein combination with other natural ingredi-ents, are also available but no research onnoni in these forms could be located.

Hawaiian Massage: Ancient and Contemporary

As Dr. Abbott described in her text, phys-ical treatments are an integral part of theHawaiian healing tradition along withherbal applications. These include steam-ing, induced sweats, immersion in salt orfresh water, and sunning.3 However, lomilomi massage, perhaps the best-knownextant practice, is not mentioned by Dr.Abbott because she focused on natural sub-

ALTERNATIVE & COMPLEMENTARY THERAPIES—APRIL 2001 69

Noni is the plant in the traditional Hawaiian pharmacopoeia that

has sparked perhaps the most scientific interest.

70 ALTERNATIVE & COMPLEMENTARY THERAPIES—APRIL 2001

Frequently Used Traditional Hawaiian Healing Plants

Hawaiian name Latin binomial Common name Uses and part(s) of plant used Comments

Kukui Aleurites moluccana Candlenut Laxative—Raw nut kernel or oil Kukui is the official state tree of Salve for external sores—Mashed ripe Hawaii; in inappropriate doses, all or baked nuts, often mixed with parts may be poisonous.other plantsChildren’s mouth sores—flowersRheumatic joints, sore muscles, and deep bruises—wrap with leavesAsthma—barkSore throat—charcoal from shellGeneral tonic—nuts, bark, or flowersmixed with other plants

Noni Morinda citrifolia Indian mulberry Skin conditions—mashed green fruit See text for information on research Diabetes, high blood pressure, digestive on pharmacology and uses as andisorders,a menstrual cramps, and immune-system stimulant and poten-general tonic—juice drink from tial anticancer agentimmature fruit

’Ohi’a’ai Syzgium malaccense Mountain apple Sore throat—juice from crushed bark NoneBronchitis—crushed leavesCuts—juice from bark mixed with salt

Popolo Solanum americanum Glossy nightshade Sore areas—juice from leaves applied Botanists once confused this plantduring sunbathing with Solanum nigram, found inRespiratory-tract disorders—juice of temperate climatesberries and leaves, mixed with other plantsSkin eruptions—juice of berries and leaves, mixed with saltDigestive tract—young leaves steepedin small amount of salt

Koali’awa Ipomoea indica Bitter morning glory Purgative—juice from all parts of plants Was also used on horses and cattleBroken bones—poultice of mashed bark mixed with salt placed over kileaf to protect skin

Ko Saccharum officinarum Sugar cane Cuts—juice from young baked shoots Used as sweetener for herbal Help to reattach severed limbs and preparationsprevent scarring—young shoots mashedtogether with koali’awa vines and salt

’Awa or kava kava Piper methysticum Kava kava Menstrual, urinary, and respiratory- Well-known Polynesian ceremonial tract problems—root extract relaxant and soporific; now widely Abortifactant—leaves, inserted into used in the Westvagina

Ki Cordyline terminalis Ti Nasal problems—inhaler of fern leaves Called ti in rest of Polynesiainfused with ki flowers and ginger rootAsthma—liquid from flowers and youngleaves mixed with other plantsFever—leaves dipped in water used likea washclothHot pack—hot ki leaf–wrapped stones

Kalo Colocasia esculenta Taro Laxative—(in juice or suppository The raw calcium oxalate crystals areform); made from from the raw, inedibleinedible calcium oxalate crystals orsuppository from the “roots” (actually underground stems)

’Awapuhi-Kuahiwi Zingiber zerumbet Wild ginger Stomachaches—ground-up, strained The “roots” of commercial ginger “roots” (actually underground stems) are widely used elsewhere

Based on refs. 3 and 5, except as noted; aHorowitz, S. Alternative management of inflammatory bowel disease. ALTERNATIVE & COMPLEMENTARY THERAPIES 4(1):19–23, 1998.

stance–based aspects of the civilization.Lomi lomi or lomi is the name of traditionalHawaiian massage with a spiritual compo-nent, traditionally practiced by experts inmassage known as kahuna lomi lomi. (Inci-dently, lomi lomi is also the name given to apopular local dish of seasoned raw salmon.)

Marguerite Pennington, LMT, in Hanelei,Haua’i, Hawaii, who has been practicinglomi lomi massage for more than 20 yearsin the state, is a licensed massage therapistwho learned the venerable technique froma Hawaiian massage master. Ms. Penning-ton describes lomi lomi as: “A deeply relax-ing massage that is rhythmical, much like abeautiful dance. Therapists use their bodyweight coming from [the] center so it is easyto give deep pressure without as mucheffort.” The forearms and hands engage incircular patterns moving toward the heart,which is considered to be especially benefi-cial for patients with circulation problems.In her massage, nutritional, and spiritualcounseling practice, mainly for tourists whostay at the resort area of Princeville, Kauai,Hawaii. Ms. Pennington uses lomi lomi as agentle prelude to deeper structural realign-ment therapy. Depending on individualneeds and limits, which are assessed in aninitial interview, Ms. Pennington may alsointerweave with bodywork the traditionalHawaiian Hooponopono problem-solvingapproach involving loving communicationand forgiveness of self and others; Hawai-ian rock-salt hot packs, and salt scrubs,and/or walks in a streamside tropical val-ley setting that is considered to be sacred bysome people for gathering and learningindigenous herbal remedies. Prayers forguidance in how to minister to clients are akey component of sessions, which typicallylast 1–2 hours. Client feedback indicatesthat stress or chronic pain is often alleviat-ed. Ms. Pennington also offers training

workshops for massage-therapy students.Lomi sticks, generally made of local guava-tree wood, for self-massage are available.

Penny Prior, LMT, a lomi lomi practi-tioner based in Anahola, Kaua’i, Hawaii,similarly noted the sacred and gentle t’aichi–like nature of this unique Hawaiiantype of massage. From her study with akahuna, Ms. Prior has crystallized heradaptation of this ancient bodywork,which is practiced both formally in tem-ples and informally within families, intowhat she terms Lomi Mai Ka Na’au, i.e.,lomi from the center; this center refers toone’s emotional, intuitive aspect. “Lomiliterally means to massage; to separate,smooth, and put back together,” she says.Wishing to go beyond “just rubbing bod-ies,” she has, for more than a decade, inte-grated her extensive experience with

body and trauma work with what shecalls a “transformational continuum ofmotion path back to wholeness.”

With diverse clients referred from otherbodywork practitioners, chiropractors, andothers, Ms. Prior emphasizes that herclients’ needs for letting go and manifestingat often critical points in their lives guidetheir sessions, rather than any preset agen-das or time limits. Other crucial sessioncomponents are an environment that is con-ducive to relaxation and empowerment; theestablishment of trust and communicationvia “loving presence,” and guidance viaprayer invoked from all sources, includingnature and what the Hawai ians ca llaumakua (personal guardian spirits). Ms.Prior also serves as a trainer for workshop

ALTERNATIVE & COMPLEMENTARY THERAPIES—APRIL 2001 71

Lomi lomi or lomi is the name of traditional Hawaiian massage with a spiritual component, traditionally

practiced by experts in massage known as kahuna lomi lomi.

Noni plants growing in Hawaii. Photos bySala Horowitz, Ph.D.

retreats on personal transformation andancient Hawaiian bodywork in Hawaii andelsewhere, in partnership with an indige-nous Hawaiian, Ku’uipo Latonio. TheirWeb site shares a Hawaiian proverb reflect-ing the spirit behind lomi lomi: “When wemeet with love, we shall be whole.”

Perhaps because of its sacred origins inan oral tradition, little has been writtenabout lomi lomi massage, and not all of thisliterature is accurate. Given the lengthy his-tory of misinterpretation and exploitationof Hawaiian culture, Ms. Prior understand-ably expressed concern about how suchtraditional practices are represented.

Eastern Bodywork and Herbal Medicine

With a sizable population of Chineseand other Oriental-ancestry residents, suchEastern disciplines and healing modalitiesas acupuncture, t’ai chi, and TCM are alsoreadily available. The Kauai Association ofthe Healing Arts is a good source for suchservices on that island. (See box entitledResources.) In addition, despite the WorldWar II–era popularization of Spam® andthe more recent influx of fast food restau-rants from the mainland, many islandersstill eat a basically healthy diet. Farmers’markets offering a cornucopia of tropical

72 ALTERNATIVE & COMPLEMENTARY THERAPIES—APRIL 2001

“When we meet with love, we shall be whole.”

Organization

National Tropical Botanical Garden (NTBG)3530 Papalina RoadKalaheo, HI 96741(808) 332-7324Web site: www.ntbg.org

The NTBG is dedicated to the conservation of tropical-plant diversity, particularly rare and endangered species, and scientific research on the medicinal and other potential uses of such plants. NTBG’s headquarters contain a research library, anherbarium, and propagation facilities. Guided public tours are available.

Training/Practice

Although the Journal does not normally list individualpractitioners, the following two are included as resources becausethey offer lomi lomi training as well as treatment.

Marguerite Pennington, LMTP.O. Box 1065Hanelei, Kaua’i, HI 96714(808) 826-1522e-mail: godheals@aloha.netWeb site: www.garden-isle.com

Ms. Pennington’s services include training in traditionalHawaiian lomi lomi massage therapy as well as treatment,Hawaiian herbal walks, structural integration therapy, andnutritional and spiritual counseling.

Penny Prior, LMTLomi Mai Ka Na’AuP.O. Box 655Anahola Kaua’i, HI 96703(808) 822-0919Web site: www.hawaiianmassage.comPenny Prior, LMT, and her partner offer training retreats in theiradaptation of Hawaiian lomi lomi massage as well as individualtreatment sessions.

Web sites

The Hawaii Medical Librarywww.hml.org/WWW/resources/medpla.html //hml.org/WWW/resources/medpla.html

The Hawaii Medical Library’s web site offers a bibliography of majortexts (some of which are out of print) on Hawaiian medicinal plants,some of clinical interest and others that are more of historical interest.

Ralph W. Moss, Ph.D.www.ralphmoss.com/cach379.html

Dr. Moss, an advisor on alternative cancer treatments to theNational Institutes of Health and elsewhere, provides a balancedpreliminary report on noni research and marketing on his Web site.

Kauai Association of the Healing Arts (KAHA)www.webpages.hsa-kauai.net

As part of its mission to encourage vacations with a holistic wellnessfocus, KAHA offers a directory of, and referrals to, practitioners ofvarious healing arts, including traditional Hawaiian lomi lomi massage, andinformation about other services related to bodywork and metaphysicaland transformational tools. Contact: Joan Levy, L.C.S.W., the director.

Resources

Recommended ReadingLa’au Hawai’i: Traditional Hawaiian Uses of

PlantsBy Isabella Aiona Abbott, Ph.D. Honolulu: Bishop Museum Press, 1992

Native Plants Used as Medicine in HawaiiBy Beatrice H. Krauss (2nd printing)Honolulu: Harold L. Lyon Arboretum,University of Hawaii at Manoa, 1981

Noni: Aspirin of the Ancients (2nd ed., rev.)By Diana FairchildAnahola, HI: Flyana Rhyme, 1998

fruits, fresh fish, seaweed, and other natu-ral foods have long been popular with resi-dents and tourists alike.

Integrative Health Services

A recent article in this journal discussedthe increasing recognition of the concept ofcultural safety as a way that biomedicinecan help to preserve and respect indigenousknowledge related to healing.19 Some pro-grams have provided indigenous Hawai-ians with innovative, culturally sensitiveprimary and preventative health care. Onegrant-funded project discussed in a 1997health journal article successfully combinedancient lomi lomi massage with allopathicmedicine in clinical services provided bynurse-practitioners, with the assistance oflocal community outreach workers.20

Another culturally-appropriate, com-munity-dr iven intervention projec tsought increasing breast- and cervical-cancer screening practices among indige-n o u s H a w a i i a n w o m e n v i a t h einvolvement of peer advisors. A baselinesurvey found that 28 percent of thesewomen had reported using traditionalremedies during the prior 2 years.21 Suchcomplementary health care has obviousimplications for treating indigenous andminority peoples elsewhere.

Summary

Hawaii, with its lovely environment,generally healthful diet, and traditionalHawaiian folk medicine practices centeredaround a venerable tradition of respectfullyutilizing plants for healing, in combinationwith the culture’s contributions from TCMand other traditional modalities, has muchto o f fe r c on t empo ra ry in t eg r a t iv emedicine. The islands certainly provide asetting that is conducive to reestablishingphysical, mental, and spiritual balance inone’s life. Medicine practiced in Hawaii ispart of a trend that seeks to be more cultur-

ally sensitive to traditional mind-body-spirit beliefs and uses of botanicals andmassage. It is hoped that Hawaiian’s envi-able longevity statistics will not be deflatedby the ubiquitous influx of unhealthful fastfood restaurants and mainland Westernmodes of handling stress. Among Hawaii’sbotanical treasures, noni, in particular, war-rants further scientific investigation to con-fi rm and uti lize further th is p lant ’spotential as an immune-system boosterand supplementary anticancer agent.

Thus, it is also hoped that heightenedenvironmental consciousness will help topreserve native plants for their functionaland inherent value. In the words of a staffmember of the R.W. Bliss Army HealthCenter in Fort Huachuca , Ar izona :“Hawaii will probably continue its role inthe transition of plants from traditionaluse to conventional use.”6

References1. McBride, L.R. Practical Folk Medicine ofHawaii. Hilo, HI: Petroglyph Press, 1975.2. U.S. Census Bureau. Average lifetime in yearsby race, by state: 1989–91 [table]. StatisticalAbstract of the United States. (1999 ed.) Washing-ton, D.C., U.S. Department of Commerce, 1999.3. Abbott, I.A. Medicines and healing. La’auHawai’i: Traditional Hawai ian Uses of Plants .Honolulu: Bishop Museum Press, 1992.4. Handy, E.S. C., et al. Ancient Hawaiian Civi-lization. Honolulu: Mutual Publishing, 1999.[reprint of 1933 classic of the same title, whichcollected a series of lectures given at TheKamehameha Schools in Honolulu].5. Krauss, B.H. Native Plants Used as Medicine inHawaii. (2nd printing) Honolulu: Harold L.Lyon Arboretum, University of Hawaii atManoa, 19816. Norton, S.A. Herbal medicines in Hawaiifrom tradition to convention. Hawai i Med J57(1):382–386, 1998.7. Massey, D.G., et al. Mamane: Scientific thera-py for asthma? Hawaii Med. J. 53(12):350–351;363, 1994.8. Locher, C.P., et al. Anti-microbial activityand anti-complement activ ity of extracts

obtained from select ed Hawaiian plants. JEthnopharmacol 49(1):23–32, 1995.9. TenBruggencate, J. Native plants can healyour wounds. Honolulu Sunday Star-Bulletin &Ad v e r t i s e r . F e b ru a ry 9 , 1 9 9 2 ; s ou r c e :www.hawaiiannoni.com 10. Fairechild, D. Noni: Aspirin of the Ancients(2nd ed., rev.). Anahola, HI: Flyana Rhyme,1998. 11. Web site of Healthnotes: www.health-notes.com12. Hirazumi, A., et al. Immunomodulationcontributes to the anticancer activity of Morindacitrifolia (noni) fruit juice. Proc West PharmacolSoc 39:7–9, 1996.1 3 . H i r a z u m i , A . , F u r u s aw a , E . A nimmunomodulatory polysaccharide-rich sub-stance from the fruit of Morinda citrifolia (noni)wi th anti tumour act iv ity . Phytoth er Res13(5):380–387, 1999.14. Hiramastsu, T., et al. Induction of normalphenotypes in r as - t rans formed ce l ls bydamnacanthal from Morinda citrifolia. CancerLett 73(2–3):161–166, 1993.15. Hiwasa, T., et al. Stimulation of ultraviolet-induced apoptosis of human fibroblast Uvr-1cells by tyrosine kinase inhibitors. FEBS Lett444(203):173–176, 1999.16. Mueller, B.A., et al. Noni juice (Morinda cit-rifolia): Hidden potential for hyperkalemia? AmJ Kidney Dis 35(2):310–312, 2000.17. Younos, C., et al. Analgesic and behaviorale f fec ts of Mor inda ci t ri f o l i a . Plan ta Med56(5):430–444, 1990.18 . Web s i t e o f Ra lph W. Mos s , Ph .D . ,www.ralphmoss.com/cach379.html19. Hagey, R. Cultural safety: Honoring tradi-tional ways of life. ALTERNATIVE & COM-PLEMENTARY THERAPIES 6(4):233–236, 2000.20. Allison, D.M. Ko’olauloa: Hawai’i’s NorthShore nurse practitioner based clinics . NursePract Forum 8(1):14-20, 1997.21. Banner, R.O., et al. A breast and cervicalcancer project in a native Hawaiian communi-ty: Wai’anae cancer research project. Prev Med24(5):447–453, 1995.

To order reprints of this article, write to or call:Karen Ballen, ALTERNATIVE & COMPLE-MENTARY THERAPIES, Mary Ann Liebert,Inc., 2 Madison Avenue, Larchmont, NY 10538-1961, (914) 834-3100.

ALTERNATIVE & COMPLEMENTARY THERAPIES—APRIL 2001 73

Some programs have provided indigenous Hawaiians with innovative, culturally sensitive primary and preventative health care.