When Amenina Opet heard that one of her friends might lose her job at McDonald’s because her immigration documents had expired, Opet immediately called Dina Shek at the Medical-Legal Partnership for Children in Hawaii.
In its six years of operation, the small legal office located in the Kokua Kalihi Valley community health center has become a go-to resource for Kalihi’s diverse immigrant community.
Years ago, Shek had helped Opet secure guardianship documents for her adopted child. Opet hoped that Shek could help her friend before it was too late.
All it took was one call from Shek to the human resources department at McDonald’s explaining that Opet’s friend was still allowed to work legally in Hawaii, and she was able to keep her job.
It was one of hundreds of times that attorneys from the Medical-Legal Partnership for Children in Hawaii have helped low-income residents get the help they need to avoid homelessness, stay employed or keep their families together.
It’s a law office, but not the typical kind. The partnership is a collaboration between the University of Hawaii Richardson School of Law and Kokua Kalihi Valley, a community health center.
“We think of ourselves as lawyers who help improve health. If you are homeless or are being discriminated against, it will affect your health.” — Dina Shek, Medical-Legal Partnership for Children
Despite its small size, the organization takes on more than 100 clients a year and helps hundreds more through community education and advocacy for public policy change.
Shek, who founded the partnership fresh out of law school, calls what she does “preventative law” — addressing issues before they snowball into legal problems.
The concept is simple: Doctors refer patients to Shek and her two colleagues to help with issues such as housing discrimination. The attorneys provide free legal services within the health clinic to low-income people who may not have known how or where to get help otherwise.
The first medical-legal partnership was formed in Boston in 1993. There are now more than 230 nationwide, but Shek’s organization is the only one in Hawaii.
It’s based on the idea that in order to have healthy families, you need to address the root causes of health problems such as homelessness, discrimination and unemployment.
“We think of ourselves as lawyers who help improve health,” Shek said. “If you are homeless or are being discriminated against, it will affect your health.”
Health providers and community members say the program has become an invaluable resource in Kalihi, helping hundreds of Hawaii’s most vulnerable residents.
Last year, it was one of only two organizations honored with a designation of Outstanding Medical-Legal Partnership by a national organization for medical-legal partnerships.
David Derauf, a physician and executive director of Kokua Kalihi Valley, said the partnership addresses the social and economic problems that can lead to chronic diseases like diabetes. He sees it as a model for other health clinics throughout the state.
“We need to understand people more in the broad context of their lives,” he said. “It’s going to require a diverse team of people to do that well.”
The law office within the Kokua Kalihi Valley community health center is so tiny you can nearly touch opposite walls with both hands at once.
A single desk serves Shek and her colleagues, U’ilani Goods and Randy Compton, who sit side by side. On the wall is what looks like a hand-drawn organizational map: “Shedding the trappings of our profession,” reads one section.
The attorneys meet with clients in the pediatric exam rooms across the hall, or in a storage room overflowing with boxes and supplies. Frequently they’re assisted by University of Hawaii law school and medical school volunteers.
Shek started the organization after learning about the concept in law school, and partnering with Chris Derauf, then a pediatrician at Kokua Kalihi Valley.
At first, she would hover outside the exam rooms to remind the doctors she was around. “She’s a lawyer,” Derauf would explain to patients. “No, not that kind of lawyer.”
Years later, Shek and her staff of two are so well-known at the clinic that they have the opposite problem — patients knocking at their door so frequently that it’s hard to get the paperwork done.
But it exemplifies how the program has become integrated into the health center.
“I can’t imagine practicing without it,” said Alicia Turlington, a pediatrician at KKV. “I’d be scared to.”
Turlington has gotten used to asking her patients questions that help identify whether they have any needs that Shek and her team can help with.
Sometimes the solution is as simple as calling the Department of Human Services to remind the state agency that it is legally required to provide an interpreter to a non-English-speaking resident seeking financial assistance.
In another instance, Shek’s letter to the state public housing agency helped speed up a renovation in Mayor Wright public housing that got rid of asthma-inducing mold and improved the health of a young child.
Sometimes families return for help repeatedly. One Chuukese family was first referred to the medical-legal partnership when they had trouble finding housing that accommodated their disabled son. When the language barrier made it tough for his parents to speak with school officials, attorneys helped the child obtain an Individualized Education Program in school.
Later, when the family became homeless, the attorneys helped ensure the school bus picked the child up from a shelter so the father wouldn’t have to push his son’s wheelchair to school. Another time, the lawyers filed an employment discrimination complaint on behalf of the father.
Kalihi residents like Opet say they are grateful for Shek and her staff.
“People need help always and they don’t know where to go,” Opet said. Having a clinic within the health center makes it easier to get help, especially when a trusted doctor can walk you to the door.
Nia Aitatao, a community researcher who leads a group for patients with diabetes, said the Medical-Legal Partnership attorneys helped ensure two of her patients avoided eviction.
To her, that’s crucial because they may not have been able to continue the diabetes treatment otherwise.
“It has nothing to do with diabetes, but it has everything to do with diabetes,” she said of the medical-legal partnership. “To think, how do we survive without it, it’s like email!” she laughed.
While the work is rewarding, it’s tough to sustain.
Shek struggles every year to scrounge up enough funds to keep the program going on a budget of about $200,000. Her salary is paid by the University of Hawaii law school, but grants and private donations are needed to cover other staff salaries, office supplies and initiatives such as strategic planning.
There is also the emotional toll of working with vulnerable populations.
It’s hard for Turlington when she finds out her patients are in difficult situations but they don’t want to go to Shek for help. Many fear retaliation from landlords or are afraid to file discrimination complaints.
“At the end of the day it can be really depressing, really demoralizing,” Shek said.
Once, when Shek and Turlington parked across the street from the University of Hawaii medical school in Kakaako to give a presentation on the partnership, they saw some of their patients living in a tent.
The kids were happy to see them, but it was tough to see how the family was living.
Shek said the days that she focuses on individual legal problems are the most exhausting. But that’s where community education and public policy advocacy comes in.
For the past six years, she has been working behind the scenes with other community groups to advance policy changes such as helping recent immigrants obtain needed health care.
In 2012, she helped found COFA CAN, an advocacy group for migrants from the freely associated states in the Pacific, including the Federated States of Micronesia, Republic of Palau and Republic of the Marshall Islands.
While the systemic advocacy work is a lot more time consuming than making a call to a state agency, it pays bigger dividends. Just last week, Hawaii’s congressional delegation introduced legislation to reinstate Medicaid coverage for migrants from those Micronesian island nations.
Shek was quoted in the press release saying that the legislation would “undoubtedly save lives.”
“I think a lot of our ability to maintain our sanity is to take a lot of those individual stories that are very challenging and painful and say, let’s do something at a bigger level and with people who are also doing that work,” she told Civil Beat.
A Samoan woman sang a prayer in a room filled with Polynesian and Micronesian kupuna.
Minutes later, upbeat music blared and the group began to dance. The women swayed in colorful dresses and even those who remained seated waved their arms to the beat.
Shek, Goods and Compton danced along. It was a Kokua Kalihi Valley program aimed at helping seniors exercise and socialize, and even though it’s separate from the medical-legal partnership, sometimes the attorneys stop in to greet their clients and meet more Kalihi residents.
The next day, the attorneys taught a “Know Your Rights” workshop to women in a KKV sewing class, handing out binders to help people keep track of important documents.
Building community relationships is a core part of their work.
David Derauf jokes that one measure of the organization’s success is how often Goods, Compton and Shek have been invited to weddings, funerals and other family functions for Kalihi residents.
As a physician, Derauf believes a feeling of interconnectedness within the community is integral to health, and it’s something that the partnership both benefits from and helps sustain.
“It manifests itself in the confidence in which patients express themselves,” Derauf said. Not only do patients know where to go for help, but they’re better able to advocate for themselves.
It’s something that Shek, Goods and Compton hope will one day be expanded beyond their small office in Kalihi.
From Kapiolani Medical Center to a community health center in Waimanalo, Shek dreams of growing the program.
Goods hopes to one day duplicate the model in her home on Maui. Compton, who has ties to Hilo, has talked of starting a branch there.
“What Dina and her team have done is incubate innovation at KKV,” said Ellen Lawton, executive director at the National Center for Medical-Legal Partnership. “Now the challenge is to scale it.”
That would require more funding and support from more doctors and lawyers. But given how much they’ve accomplished so far, it’s not out of reach.
“The dream is there,” Shek said.
Disclosure: The Medical-Legal Partnership for Children in Hawaii received a two-year, one-time grant from the Omidyar Ohana Fund through Hawaii Community Foundation in 2011-2012. The Omidyar Ohana Fund is funded by Civil Beat publisher Pierre Omidyar.