The free service can’t solve rural health care access issues. But organizers say it can help more people than it does currently.

Tekauri Tanaka was 6 when he was diagnosed with cancer. Doctors gave him five years to live.  

Maui County

None of the treatment he needed is available on Maui, where the Tanaka family lives. So Tekauri, with a guardian, has had to board a plane to access care at children’s hospitals in Honolulu and Seattle too many times to count.

In over two years of managing her son’s cancer, Kala Tanaka has navigated a difficult trajectory from diagnosis to the surgical removal of her son’s brain tumor to radiation, chemotherapy and, now that Tekauri is cancer-free, routine post-treatment checkups. 

Paying the cost of commercial airline tickets, however, has been one less worry. A network of volunteer pilots called Angel Flight West has shuttled Tekauri to and from off-island medical appointments for free.

Tekauri Tanaka and his parents pose for a photo with volunteer pilot Yosuke Tanaka (no relation). (Courtesy: Angel Flight West/2023)

The Tanakas are just one of dozens of local families who depend on the group’s Hawaii chapter, the fastest-growing branch of the Santa Monica, California-based Angel Flight West.

The nonprofit was established in 1983 to deliver sick people in the 12 westernmost states to out-of-reach medical care. The Hawaii outfit launched in 2003 with an inaugural flight to bring a Hilo woman with breast cancer to radiation treatment.

Last year volunteer pilots in Hawaii flew 122 missions — up from 15 in 2018. With the average one-way trip valued at $606, the organization’s efforts in 2022 equate to an in-kind donation of $74,000, totaling 285 hours of flight time and 9,902 traversed miles.

These numbers do not include seats donated through Angel Flight’s partnerships with commercial airlines. Hawaiian Airlines donated 20 interisland flights last year. Mokulele Airlines donated one.

Angel Flight is not a panacea. It’s more of a stopgap measure. Organizers don’t intend the organization as the missing link to solve Hawaii’s rural health care access issues.

“We play a critical role in bridging that gap in home to health,” said Angel Flight West Director Josh Olson. “But realistically do I think Angel Flight can serve the entire need out there for transportation to health care? No. I think that need is massive, especially in the outer islands that have less resources and where you’re seeing adverse outcomes because a lot of people are just not getting to treatment. But I think we can help a lot more people than we’re helping right now.”

Tekauri Tanaka, 8, of Maui benefits from skipping the public airport when he flies with Angel Flight West to his cancer treatment. Crowds can pose an elevated health risk to cancer patients with weakened immune systems. (Courtesy: Angel Flight West/2023)

The challenge, Olson said, is not enough people who could benefit from Angel Flight know about it. Networking with medical workers is a crucial way that organizers promote Angel Flight as an option for patients who struggle with the financial or logistical hurdles to accessing care.

Chad Holcomb, a volunteer pilot who also flies for Hawaiian Airlines, said this year the organization has seen an uptick in requests for medical flights to Honolulu from Molokai, where residents rely on air travel for even some routine care. The pandemic has worsened rural health access, slashing flights to Molokai and reducing the number of public airlines servicing the island from three to one.

“What really hit home for me when I first started flying for Angel Flight is some people I was flying had been suffering for years,” Holcomb said. “They just accepted that for the rest of their life they were going to suffer because they had no idea they could get assistance like Angel Flight to get them to Oahu for medical assistance because their insurance had run out and they have no other way, no other resources.”  

A survey published last July warned that health care access issues in rural areas like Molokai and Lanai were “particularly troubling” due to their remote geography. The report surveyed 3,287 Hawaii residents and 324 medical providers online.

“About 70% of the care residents of Lanai and Molokai receive requires a trip off island, which is arduous and expensive,” the report said.

For patients and their families, the cost savings extends beyond the price of a commercial airline ticket. Angel Flight has afforded the Tanaka family more time together, eliminating the need to arrive at the airport early to check in luggage and get through ticketing and security. With Angel Flight, the family can skip all of that and board the plane within minutes of departure.

Flying privately also reduces the health risk of schlepping through a crowded airport — a real concern for someone with a weakened immune system.

“One day I sat down and figured out how many hours they saved us, because you literally drive right up to the plane, and it was something crazy, it was into the hundreds of hours,” Kala Tanaka said. “Having this as a support has made it so much easier on us and let us focus on being a family and being together. I think that’s what every cancer family wants is to be together.”

Bronwyn Cooke, 76, of Molokai relied on volunteer pilots to transport her to and from daily radiation treatments in Honolulu. (Courtesy: Angel Flight West/2023)

There’s no cap on the number of flights a patient can take. Passengers must prove a financial need, submit a doctor’s note attesting that they’re medically stable and be physically able to get in and out of the plane without assistance.

The group does not offer emergency travel. But it does provide flights for some non-medical reasons, including summer camp for burn victims and events for wounded veterans.

Bruce “Ace” Ellinwood, the head of the Hawaii chapter, said this year the organization is on track to fly more missions than ever. To keep that pace, the organization needs more volunteer pilots. 

It also needs cheaper access to aircraft. While some pilots have private planes, others rent planes to fly missions, a limiting factor.

Twice in the last month the organization did not have enough pilots or aircraft available to fulfill a medical flight request from a Molokai patient who needed to get to a doctor appointment in Honolulu, Ellinwood said. In both instances the patient had to cancel the doctor visit because there were no more seats available to buy on Mokulele Airlines — the only commercial airline servicing Molokai.

For Bronwyn Cooke, 76, of Molokai, flying with Angel Flight eased the financial burden of traveling to Honolulu to undergo daily radiation to treat sarcoma, a rare type of cancer.

The treatment only lasts about 15 minutes, Cooke said. But factoring in commercial air travel from Molokai to Honolulu and back again, shuffling to and from these appointments without Angel Flight would have taken up most of each day. 

The other option — staying in a hotel for seven weeks of daily treatment — would have been cost prohibitive.

“It isn’t even about the money,” Cooke said. “It’s that you know that somebody who cares about you is going to pick you up and take you to your treatment. You can sort of relax. That’s a big deal because it’s not a relaxing situation when you have cancer.”

Civil Beat’s coverage of Maui County is supported in part by grants from the Nuestro Futuro Foundation and the Fred Baldwin Memorial Foundation.

Civil Beat’s health coverage is supported by the Atherton Family Foundation, Swayne Family Fund of Hawaii Community Foundation and the Cooke Foundation.

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