木瓜直播

Kekoa Taparra, MD, PhD, is still early in his career -- doing his fellowship at Stanford Medicine -- but he's already making waves in the medical field.

He's published extensive research on both cancer and Native Hawaiian/Pacific Islander (NHPI) health disparities. In addition to his other degrees, he's working (virtually) on his Master's in Public Health (MPH) at Hawai'i Pacific University, slated to graduate this summer.

And Taparra, who is Native Hawaiian, found out in 2020 from 'Ahahui o nā Kauka, the Association of Native Hawaiian Physicians, that he was among the first Native Hawaiian physician-scientists to have both an MD and a PhD.

While Native Hawaiians don't have a wealth of physician-scientists in the traditional sense, Taparra said, they "definitely have a deep, rich culture of people who have learned and passed down knowledge in other ways" and that he comes from a long cultural lineage of healers.

Taparra is working on changing the relationship between medicine and the NHPI community, by building a community of NHPI medical students and scholars, and by publishing research on NHPI disparities and cultural understandings of medicine.

Getting His Start

Taparra grew up in Mililani, "a former pineapple field town up in the middle of O'ahu up in the mountains," he said. None of his family worked in medicine; his mom was a public school teacher and his dad worked at the local power plant.

Long before Taparra became a cancer researcher and radiation oncologist, cancer shaped his home life. He's had 10 family members develop cancer, nine of whom are now dead. To Taparra, cancer was one of the many health disparities his Native Hawaiian 'ohana faced.

He earned his PhD in cellular and molecular medicine at Johns Hopkins University in Baltimore, which he described as a translational medicine program. While at Hopkins, he worked in a cancer biology lab. That's where Taparra met one of his mentors, Phuoc Tran, MD, PhD, professor and vice chair for research at the University of Maryland School of Medicine in Baltimore.

Tran was Taparra's PhD advisor and also the first physician researcher Taparra had ever met. After hearing Taparra speak about his family's history with cancer, Tran encouraged him to become a doctor too.

Taparra met another key mentor, Curtiland Deville, Jr., MD, an associate professor of radiation oncology and molecular radiation sciences and medical director of the Johns Hopkins Proton Therapy Center, during residency interviews. Taparra didn't end up at Hopkins for residency, but Deville still encouraged him to contextualize who "Pacific Islanders are as a people because we're very often forgotten and ignored in the medical literature," Taparra said.

After finishing his PhD, Taparra was off to Rochester, Minnesota to attend the Mayo Clinic Alix School of Medicine. While in Minnesota, Taparra cared for a Native Hawaiian patient. Taparra said a big misconception about Native Hawaiians is that they only live on the islands rather than having an extensive diaspora. The that more Native Hawaiians live on the continental U.S. rather than their indigenous homelands in Hawaii, which Taparra said is tied to factors like the high cost of living on the islands.

"A lot of my newer work is now looking at how there's a lot more health disparities for Pacific Islanders on the continent actually than back home," Taparra said.

Contextualizing NHPI Disparities

Taparra has covered a lot in his nearly 60 publications. In 2021, Taparra, alongside Deville, in the Journal of Oncology Practice detailing the cultural and historical context of cancer disparities for NHPI populations.

The piece, which was Taparra's first foray into population health disparities research, was selected as the issue's cover story and has become one of his most cited works. It explains how NH health disparities began with colonization when Europeans brought new diseases to the islands. Additionally, the piece explains how Western countries tested bombs on Pacific Islands, whose residents later had spikes of certain cancers. Plus, in Hawaii, NH people are most likely to be uninsured and impoverished, which makes it especially hard to seek preventive care.

Taparra also noted how most of Hawaii's food is imported, and foods with abundant preservatives are cheapest to import. Plus, Native Hawaiians have far less control over their land than before colonization. Not to mention with few NHPI physicians, the community doesn't have a representative healthcare workforce.

In 2021, Taparra published a piece in about how NHPI are underrepresented in medicine, making up less than 1% of medical students. Even in Hawaii, where NHPI are a quarter of the population, they are less than 5% of the physician workforce. To work toward NHPI health equity, he urged disaggregating NHPI data and funding pipeline opportunities for NHPI to enter the medical field.

Taparra said that lumping Asian Americans and Pacific Islanders into one category does a disservice to both groups. It wasn't until 1997 that separated Asian and NHPI into two groups. But in 2022, Taparra and a coauthor in response to a study that used the outdated race category of API (Asian or Pacific Islander) rather than looking at the two groups separately. In it, he explained how life expectancy of NHPI people varies greatly from Asians, and looking at the two groups together hid the truth of NHPI health disparities.

"Unless racial group data are disaggregated and contextualised properly, structural inequalities, biases, and racism in society will persist through these encoded data," he wrote.

After fires raged through Lāhainā in Maui last year, killing a hundred people and displacing thousands more, Taparra and fellow Native Hawaiian researchers that tied the devastating fires to the history of oppression and health inequities. Climate change is often cited as a major driver of the fires that burned the capital of the former Kingdom of Hawaii, and Taparra and co-authors wrote that more than a hundred years of land and water mismanagement tied to colonialism amplified the severity of damage.

Taparra's research features his expertise in cancer, too. He published a in 2022 that found compared to white patients, NHPI people had inferior survival outcomes for common cancers while Asians had better outcomes. He noted how these results further emphasize the need for data disaggregation.

"For decades now, it's been other communities trying to make sense of the data within our populations without ever consulting members of the community, and then you end up having some misconceptions that only lead to greater distrust or mistrust within the community," he said.

Hence, Taparra said it's vital "to actually go into communities and engage with community members and incorporate them into the research practices so that we can deliver this optimized care in a culturally competent way that really leverages collaboration within the community."

Taparra emphasized that these ideas -- data disaggregation and understanding health disparities through various NHPI cultural lenses -- aren't his own. Rather, he's building upon the work of others, and the community of NHPI physician-scientists is growing.

Just last year, another Native Hawaiian, Brittany Sato, MD, PhD, . Sato had already earned her PhD in cell and molecular biology from the University of Hawaii at Mānoa before finishing medical school at the University of Hawaii John A. Burns School of Medicine on O'ahu in 2023.

Tran told 木瓜直播 that he isn't surprised by the level of success Taparra has achieved and that "some people don't need much guidance to do good things, and he's definitely one of them."

"He's been talking about how he could use his training to try to help his fellow Native Hawaiians and Pacific Islanders almost literally since we've been talking about his career path, which is now approaching a decade ago," Tran said.

Deville also thinks highly of his collaborator.

"He's primed and poised to continue to lead not just radiation oncology – our field – but to continue to lead thinking around disparities, inequity, and actually how we achieve health equity for Native Hawaiian populations, given his own lived experience and cultural background, but also his amazing, bright mind and his research and educational background," Deville told 木瓜直播.

From Mentee to Mentor

As he published more work on NHPI health disparities, Taparra said there was a point where he had a new student reaching out to him each week interested in this kind of work.

To create a space for research and community, he created Taparra Labs, a team of mostly Native Hawaiian and Pacific Islander undergraduate, graduate, and medical students. The team works on interdisciplinary projects "to further our understandings of the unique health disparities of Pacific Islanders in order to improve health outcomes for our future patients," .

"Even though I'm serving as a mentor for research, they're teaching me as much as I teach them in terms of how do we tell our stories and how do we interpret the data using the context of our histories," Taparra said.

Megan Gimmen and Ryan Benavente are both second-year medical students at Harvard 木瓜直播 School in Boston who wanted to work on education projects related to the Pacific. Both are Pacific Islanders; Gimmen is Yapese (native to the island Yap) but grew up in Guam while Benavente is Chamorro (native to Guam) and grew up on O'ahu.

When Gimmen and Benavente met at medical school, they looked into the literature on health disparities for Pacific Islanders and kept seeing a particular author: Kekoa Taparra. In the past year, he's become a mentor to them both and they've both become members of Taparra Labs.

They haven't met him in person yet, but Benavente told 木瓜直播 that Taparra has managed to "shorten the distance and make the world feel smaller" by keeping in touch virtually and connecting even more Native Hawaiian and Pacific Islander students to each other with his lab.

"It was very, very comforting to know that there are people like me, who have very similar interests and goals," Benavente said. "You feel like you're less alone, from a cultural perspective, and from a mission perspective – that there are other people out there trying to fight the same fight."

Gimmen added that Taparra became "a really awesome mentor in a way that I have not been able to find since moving away from the islands."

Taparra said he "was raised to find strength within the community." He explained that connecting over NHPI identity involves a shared history of structural racism and colonialism. Thus, mentorship within the community meant being someone "who saw us and understood who we were. And so I think that's what has brought a lot of students within our group together," Taparra said.

Ultimately, Taparra hopes that his work will eventually lead him back home to Hawaii. But for now, he's growing a community of NHPI researchers so that more people see themselves represented and understood in medicine.

Correction: This story has been updated to reflect that Taparra is one of the first Native Hawaiians to earn an MD, PhD.

Comment