Mālama & Kōkua

When she was 12 years old and living in foster care, Adonica Ihilani Kauwe Tuitama took her paper route money and bought a life insurance policy. It was a concept she had overheard grownups talking about, and she figured that if something happened to her, at least her younger siblings would be OK.

She wasn’t so much a worrier as a problem-solver, a little girl whose impulse was to help the people she cared about.

Caregiving, indeed, has been the drive that has propelled her in the decades since then, culminating this year in two doctoral degrees from the University of Utah’s College of Nursing—a PhD in nursing and a doctor of nursing practice (DNP). With those dual credentials, her goal is to help Native Hawaiian and Pacific Islander communities live healthier lives.

Two Hawaiian words explain how she moves through the world. Mālama means to care for something—to protect it, to tend it, to keep it whole. Kōkua means to help, to put your hands under someone else’s burden. Neither is a favor you grant when it’s convenient. “They go together,” Kauwe Tuitama says. “Kōkua is what you do. Mālama is why you keep doing it.”

As a teenager, Kauwe Tuitama dreamed of going to medical school, but her high school guidance counselor made it clear this was an unreasonable aspiration, even though she was a B+ student. Feeling like an outsider, Kauwe Tuitama chose to graduate from high school at 15 so she could work full time. By 18, she was married and working three jobs. By 27, she had left an abusive relationship and was a single mother with two small children and one on the way, still working three jobs. Hoping to change her life trajectory, she enrolled in college.

Michelle Taylor MSW’95 MPA’02 PhD’02, former Utah Valley University vice president for Student Affairs, first met Kauwe Tuitama when she hired her as a math tutor for her son; she was so impressed, she later hired her as a vice-presidential intern. “If you give her a project,” says Taylor, “she magnifies it,” not just solving the problem at hand but creating a process so that other problems can be solved in the future. There are typically two types of people, Taylor philosophizes: “Those who see the broad picture, and those who see all the details you need to get there. But Adonica sees both.”

On the other hand, there was a level of naivete. Taylor remembers one late night when the two of them were working on a project, Kauwe Tuitama’s three children asleep under a desk in Taylor’s office. 

Suddenly, Kauwe Tuitama broke down in tears. “I haven’t even started my homework yet, and I’m so tired,” she confessed. “I don’t understand how people do this. As hard as I try, I can’t seem to be full time in school.” By “full time,” Taylor discovered, Kauwe Tuitama thought everyone else was taking 40 credit hours a semester. “Because she was so gifted and bright, people assumed she knew how college worked,” Taylor remembers. “But she didn’t know. She didn’t have anyone to pick it up from.”

In 2013, also unaware that most students were content to have just one major, Kauwe Tuitama graduated from UVU with two: accounting and nursing. By then, she had come to realize that if she wanted to make a broader impact on health care, nursing, and policy, pursuing a PhD would be an essential next step.  As a Native Hawaiian woman, she says, she was concerned that she would otherwise “be put in my place.”

She set her sights on the U’s College of Nursing but discovered that, to be considered, she would first need a master’s degree. So she got an MBA. Then, in 2016, she became the first person accepted in the college’s brand-new dual doctorate program.

She earned both the clinical doctorate (DNP) and the research doctorate (PhD) so she could bring evidence, clinical experience, and the voice of nursing to the tables where health policy is decided in Utah and across the country.

When it came time to pick a dissertation topic, Kauwe Tuitama knew what she wanted to tackle: the astronomically high rate of diabetes in Native Hawaiian and Pacific Islander populations—among the highest rates in the world.

As she surveyed the literature, she discovered the cultural barriers that make treating and even studying diabetes difficult in Pacific Islander populations. “The research has not always been kind, historically,” she says. There are assumptions, even among doctors and researchers, that Native Hawaiians and Pacific Islanders have more diabetes “because people are fat, lazy, and don’t eat right,” she says—assumptions that don’t take into account Pacific Ocean nuclear testing that contaminated food sources, or the flooding of Stateside food into Indigenous diets, or the fact that the standard BMI measurement does not take into account the bigger bone mass of Polynesian bodies.

Often, too, the terminology in scientific papers was perplexing. If, let’s say, you’re trying to find out some of the struggles and challenges that face people who are caring for their family members, most of the scientific literature files it under the heading “caregiver burden.” No wonder she needed help decoding this; no one in her culture, she says, would ever use the word “burden” about caring for others.

Kauwe Tuitama gives credit to the academics and others who have helped her at every turn—women she calls her “angels,” including Michelle Taylor, mentor Nicci Young, the U’s Carrie Radmall BS’02 and Paula Meek in the College of Nursing, and Heidi Brett and Lorelei Rutledge MBA’19 at the U’s J. Willard Marriott Library. It was Rutledge who taught Kauwe Tuitama to use EndNote as she organized six six-inch binders of printouts and created hundreds of citations.

“I think she’s a brilliant medical practitioner,” Rutledge says about Kauwe Tuitama. “She’s truly dedicated to helping her patients. She wants to not only do research but to be their nurse practitioner.”

Kauwe Tuitama explains her desire to get the dual doctorates this way: “I’m a firm believer that clinical work feeds research, and research feeds clinical work.” But, she says, the “translational” link between the two is sometimes missing. “I’m hoping I can help bridge that gap.”

In 2016, as she began working on her doctorates, she was living in Samoa, where she was also working full time as principal investigator with a company researching strep and impetigo in children. She herself was suffering from a blood disorder that sometimes meant being hooked up to an IV bag as she drove from patient to patient. She was also volunteering as a nurse for LDS missionaries on the island. And in the midst of all this, the island flooded, leaving her without electricity and running water for two weeks. “Lots of other people would have crawled under a rock and given up,” says Radmall, doctoral program manager. “But she has persevered.”

When Kauwe Tuitama moved back to Utah in 2019, she took on other full-time jobs, ran her own floral business, volunteered at Habitat for Humanity, served as an Emerging Scholar with the American Diabetes Association, took care of her aging parents, got married, went through in vitro fertilization, and gave birth to a little girl. 

No surprise, then, that for years before she defended her dissertation last spring, she averaged three or four hours of sleep a night.

Kauwe Tuitama hopes to address “the guilt, shame, and blame” surrounding diabetes in the Native Hawaiian and Pacific Islander communities, expanding on the work done by researchers such as Pearl McElfish and Joseph Kaholokula.

Kaholokula, professor and chair of Native Hawaiian health at the University of Hawaii’s medical school and a member of Kauwe Tuitama’s PhD committee, stresses that there are better health outcomes when a community’s strengths are recognized and honored. Instead of simply urging islanders to “exercise more,” for example, why not encourage them to do hula dancing? “It’s not only a good form of exercise,” notes Kauwe Tuitama, “it also connects us to our families and ancestors, and there’s a spiritual side as well.”   

In the U.S., says Kauwe Tuitama, the medical community tends to look at health “compartmentally” and to think of medicine as “person-centered,” rather than considering a patient’s and a community’s mental and spiritual health. “But where I come from, it’s very holistic.” Family and church, she says, are not seen as separate from physical health but are “integrated to the core of who people are.”

“We as health care workers would do better learning from our community, instead of thinking we know all,” she adds.

She is quick to point out that none of it was earned alone. Alongside the mentors were the donors behind more than a dozen scholarships and fellowships, beginning with the Frederick Q. Lawson Graduate Fellows Scholarship the year she entered the dual doctorate program. “Others lifted me, and I have done my best to honor their generosity,” she says. “Without their belief in me, without their financial support, I would not have been able to achieve this.” It’s kōkua made literal—hands under someone else’s burden—and she hopes her story does for the next student what those gifts did for her.

Kauwe Tuitama currently works as a nurse administrator, volunteers at the secondhand store UGLY’s Closet (Utah Girls Love You), and twice a month hands out food at 5 a.m. at the Utah Food Bank. “I was taught from a very young age,” she says, “that service is our rent for our space on earth.” Asked what her favorite job is, she starts to answer, stops, then explains: “I don’t want to say I love helping people, because that changes the power dynamic. But I love manifesting the greatness of God that’s in everyone, no matter what I’m doing. I can be changing a bandage, talking to someone who is suicidal, actually saving someone’s life,” she says. “It’s all meaningful to me.”

Elaine Jarvik is a Salt Lake City-based freelance writer and playwright.