E 'ao lu'au a kualima: Writing and Rewriting the Body and the N

Currently the Kanaka Maoli, or Maoli are struggling to restore Ka Lahui, or the Maoli nation. At the same time, they face the highest rates of chronic disease and cancer, and have become in the discourse of Western medicine the "unhealthy Hawaiian." This article seeks to trace the geneaology of the "unhealthy Hawaiian" as it articulates with the attempted destruction of the nation. But health is a contested terrain, and for the past two hundred years, the Maoli have resisted colonization and now neo or postcolonialism. This resistance encompasses health as well, in maintaining tradition against the inscription of the Maoli into the American and international political economies, as well as the restoration of the Maoli ola and the health of Ka Lahui. © 2005 Californian Journal of Health Promotion. All rights reserved.


Introduction: Ola na iwi
A nation is more than a flag, a constitution, or a capitol; it is the people or peoples who construct that nation.The United States and a small group of non-native conspirators overthrew the government of Ka Lahui Kanaka Maoli, the Hawaiian nation in 1893; but Ka Lahui existed prior to the conquest of the islands of Ka Pae 'Aina O Hawai'i, the Hawaiian archipelago, and continued to exist after the overthrow.Although the reconstruction and perpetuation of Ka Lahui has been ongoing since time immemorial, the "Hawaiian renaissance," beginning in the 1970s, marked a resurgence in efforts to actively rewrite Ka Lahui as an institutional entity, from 'olelo makuahine to and finally actually reclaiming governance of Ka Pae 'Aina (Kanahele, 1979).As part of the process, Maoli, particularly Maoli healthcare practitioners began to examine the health status of Maoli, particularly the relationship between the health of the non-human nation, constituted as 'aina, kai, and the spiritual world, and the health of the human Ka Lahui.This article exams the construction of the health of the nation, and the connections between the health of the non-human nation and the dismal health statistics of the human Lahui.It argues that the health of the human nation is intimately connected to the health of the non-human nation, and that the identity of the Maoli and restoration of pono is dependent on foregrounding and protecting those connections.In particular, the healthy Maoli requires the reunification of mind, body and spirit on the 'aina and in the kai.Within this context, the role of Western medicine in constructing the "unhealthy Hawaiian" is critically examined, as well as Maoli efforts to resist this construction, and reclaim the body of Ka Lahui: . . .[Maoli] were not 'the simple-hearted victims of colonialism [but] participants in a moral and cognitive venture against oppression' (Silva, 2004, p. 6).The article ends by positing that decolonization is not enough: what is needed is rekalonization.Rekalonization is the active reassimilation of the body of the Maoli into the body of the Lahui, through participation in protocols such as the consumption of kinolau, or body forms, and working the 'aina and kai.
Health is a social construction, either on a gradient from healthy to unhealthy or death, or as a dualism: one is either healthy or unhealthy (McMullin, 2005).This article, as that of McMullin (2005), will problematize the Western construction of health, which focusses on the individual and a predominantly internal causation of states of unhealth.Instead, health is historically and culturally contextual; "I think to be a healthy Hawaiian means that you understand your culture.You know it's . . .this is the way we were raised when we were young, it wasn't a good thing to be Hawaiian.My grandparents spoke Hawaiian and we weren't allowed to speak Hawaiian.So we lost the language.My grandmother practiced the ancient religion but she didn't pass it on.So we didn't learn the religion.So much was lost.I think there's a difference . . .-So a healthy Hawaiian would be someone who's practicing those things?-Uhmhmm.And understands what it means to be Hawaiian and how that's different from being a white, you know or an Anglo or whatever."(McMullin, 2005) In the discourse of Western medicine, Kanaka Maoli emerge as the people with the worst morbidity and mortality in Ka Pae 'Aina (Blaisdell, 1993(Blaisdell, , 1995)).While Kanaka Maoli writers point to the stark contrast between the pre-contact and post-contact health of Kanaka Maoli, and ascribe agency to political-economic factors, particularly "Kanaka Maoli depopulation and minority status from continuing foreign transmigration, colonial exploitation with Kanaka Maoli landlessness and economic dependency, coercive assimilation, cultural conflict and despair, adoption of harmful foreign ways and institutional racism" (Blaisdell, 1995);Haas, 1992;Mokuau, 1990).
Earlier Western historians characterize Hawaiian health similar to this commentator: They are firm believers in sorcery.With reference to their sick, there is no possibility that these primitive beings could possess any knowledge of botany and the medicinal uses of plants and other substances... (Bushnell, 1993).

Most modern analyses of Kanaka Maoli health reflect the following depictions of agency:
As the minority population of United States grows, so do the reports of diabetes and chronic kidney disease.New immigrants also adopt a more Western diet when they settle into the United States, which seems to increase their chances for obesity and Type 2 diabetes.Diabetes is a disease that affects the body's ability to produce or use insulin.Type 2 diabetes is also known as adult-onset diabetes or noninsulin dependent diabetes.
The Western diet is high in processed and fast foods.Many processed foods have little nutritional value and often contain high amounts of fat and sodium.A study of obesity in China has linked the increased weight in children to the increased availability of fast food as well as a diet emphasizing more Western foods than traditional Eastern foods.
Obesity is a cause of insulin resistance, which can lead to Type 2 diabetes.Obesity is also linked to some ethnic groups.A University of North Carolina at Chapel Hill study concluded that for unknown reasons, African American women become obese twice as fast as white women.The rate for Hispanic women is about midway between the two.Hispanic men become obese 2.5 times faster than white men, and after the age of 28, African American men became obese 2.2 times more rapidly than white men.
If minorities are more prone to being overweight, this makes them more at risk for Type 2 diabetes.Because diabetes is the leading cause of chronic kidney disease, minorities also have a greater risk of developing kidney disease.davita.comAn educator with Hui Malama Ola Na Oiwi constructs the health of Kanaka Maoli thus: "it's a cultural thing.Caucasians access medical care quicker, whereas Native Hawaiians don't see a doctor until it's a crisis," [she] said."Their diet also changed dramatically when other people began moving here.Before, everything was steamed and baked.there was very little meat, but lots of fish and vegetables.today, we live in a fast-food society, a very fatty diet" (Eaton, 2005).
These constructions mystify agency, placing the health of Kanaka Maoli in the inevitable dialetic of modernity/ postmodernity, helpless against the hegemony of hegemonic capitalism, immigration and the fast food industry.Similarly, Western medicine posits the "risk factors" for diabetes as possibly genetic, obesity, diet and physical inactivity, while ignoring race, class, gender, sexual orientation and history.As King (1989) and McMullin (2005), the identity of the "unhealthy Hawaiian" as become as problematic as the illnesses confronting the and ensure her health so that the health of the younger sibling is maintained (Kame'eleihiwa, 1992).Thus, if the land was healthy, the people were healthy as well; unhealthy people meant an unhealthy land.Malama ensured the flow of mana throughout the animate and inanimate world (Kanahele, 1986).The ali'i served to mediate these relationships, and a pono ali'i meant a prosperous society (Kame'eleihiwa, 1992).
In this context, the 'ohana cared for its close members, and relied on the perpetuation of these relationships for the continuity of the family (Kamakau, 1992;Pukui et al., 1972, p. 134).To care for a sick family member was to kokua, or serve (Inglis, 2005).If the family was not able to heal an ill family member, they sought out traditional practitioners, ranging from specialists in herbal medicine, to massage, childbirth, surgery, bone setting, or the engagement of spiritual forces or counterforces (Blaisdell, 1997;Kamakau, 1964;Kekaha, 1986;Malo, 1951).

Contrast with Western Knowledge Systems
Whereas traditional ontology revolves around mating and birth, spinning out interconnectedness from that piko to all of existence, Western knowledge evolves from the individual, through the conquest of knowing and subsequent ownership in the knowable and malleable universe (Foucault, 1970;Loomba, 1998).Western knowledge is privileged as beyond ideology, a metaknowledge; and thus in contrast to traditional knowledge which is inherently ideological, grounded in mythology and illogic (Lyotard, 1993).The Western biomedical model produces disease as the interaction of chemistry and physics, and disconnected from the mind (Charon, 2001;Engel, 1977;Morris, 1999;Stewart et al., 1995).Progress towards health in the Western model is progress towards assimilation to the mechanisms of the postmodern political economy: along with the demographic transition from "poor health" to the diseases of modernity, a people becomes industrialized, "democratized", and leaves the ranks of the "developing" countries to enter into the "First World" (Kleinman, 1997).Health becomes the management of costs to maximize resources (Kleinman, 1997).
In contrast, a postmodern analysis of illness extends beyond the biophysical model, to include history, gender, race and class (Morris, 1998).As Morris (1998) analyses, in the postmodern milleau, the distinction between the "objection" disease produced by the biophysical discourse of Western medicine and the "subjective" illness experienced by the individual is blurred.This analysis recognizes that even a diagnosis is constructed, and that neither the "objective" diagnostician nor the person experiencing the illness is unchanged by the making of the diagnosis, or its implications, as the diagnosis itself, or its lack, makes the body a subject of medicine (Charon, 2001;Morris, 1998).Moreover, illness is irretreviably embedded in culture: that of the practitioner, the person experiencing her illness, and her family (Morris, 1998).
Western physicians and medicine began to displace and eventually exert hegemony over traditional Maoli medicine as the land was being lost and sovereignty gradually eaten away through dominance of non-Maoli members of government.Illness became a biophysical phenomenon, the interaction of immune vulnerabilities and introduced pathogens, instead of an exchange between the Maoli and the akua; simultaneously, and 'aina became land and property, without history or mo'oku'ahau.It was not simply coincidental that the first missionaries included a physician; while Christianity provided the spiritual theology for delinking body and soul.Western medicine provided another ideology to construct the body of the Maoli as a source of weakness.
Thus, the knowing of the body of the Kanaka Maoli and Ka Lahui was intimately linked to the appropriation of the land and attempted destruction of the nation.In a different context, Brecht describes the speech of a worker to a doctor: We know what makes us ill When we are ill we are told That it's you that will heal us.
For ten years, we are told You learned healing in fine schools Built at the people's expense

Invasion and Ma'i: The Devastation of the Body: pu'ali ke kalo i ka wai'ole
As kalo does not thrive when there is no water, so the Maoli did not thrive with the introduction of previously unknown infectious diseases, beginning in 1778 with the arrival of Capitan Cook's crews.As Pukui (2003) relates, "lawe li'ili'i ka make a ka Hawai'i, lawe nui ka make a ka haole, or that the previously known illnesses only took few lives, whereas foreign illnesses wrought devastation (Pukui, 2003, p. 211).Samuel Kamakau (1996) 'O ka loli lapa'au 'ana. 11. 'O na kanawai o ke aupuni." Silva (2004) translates this passage as follows (Kamakau, 1996, p. 57;Silva, 2004, pp. 22-23): "The fruits and the seeds that his [Cook's] actions planted sprouted and grew, and became trees that spread to devastate the people of these islands.
1. Gonorrhea together with syphilis.2. Prostitution.3. The false idea that he was a god and worshiped.4. Fleas and mosquitos.5.The spread of epidemic diseases.6. Change in the air that we breathe.7. Weakening of our bodies.8. Changes in plant life.9. Change in the religions, put toether with pagan religions.10.Change in medical practice.11.Laws in the government." This construction of illness, marking both the introduction of disease and "change in medical practice" as well as "laws in the government" as being part of the gifts which destroyed Ka Lahui contrasts sharply with the earlier archaeology of Davida Malo, who traced agency for the devastation of Ka Lahui to the misdeeds of the ali'i, who failed to fulfill their obligations in maintaining pono between the Akua and maka'ainana.It was not the ali'i alone, however, who bore responsibility, for the Maoli practiced wasteful warfare, human sacrifices, and abortions because of "women's vanity" (Malo, 1839;Silva 2004, p. 25).Significantly, traditional practioners and the makaainana also bore spiritual as well as secular responsibility, particularly in a failure of "morality," which "arose from the ignorance of the people at that time, their manner of living, the want of care and nursing when sick; and their ignorance of the proper use of medicine."Silva and Arista both contextualize Malo's discourse within that of a Maoli who has appropriated the cosmology of American Christianity, and who bricolages both a traditional understanding of the role of the ali'i in maintaining pono with a Christian ethic of condemnation of traditional culture and political economy (Arista, 1998;Silva, 2004, p. 25).
The loss of the physical nation, specifically depopulation, was accompanied by the loss of the spiritual foundations when Ka'ahumanu and Keopuolani, the kuhina nui and most sacred wife of Kamehameha Nui, respectively, ate openly with Liholiho, and so abrogated the 'aikapu, or sanction against men and women eating together.This began the dismantling of the kapu system, and was followed quickly by the physical dismantling and destruction of many heiau and sacred objects by agents of Ka'ahumanu, as Osorio articulates the two processes: "Perhaps these two things were not perceived as mere coincidence by the Hawaiian people.There is evidence that Natives saw the growing presence of foreigners in the Islands as contributing to the miserable fortunes of the Hawaiian people.Many of them, even as Christians, wished the haole would simply go home.At the same time, the haole and their new religion promised to rescue the people and their chiefs from the social breakdown that accompanied the 'Ainoa by introducing a new commitment and discipline -namely Christian prohibitions, which were understood to replace the old kapu" (Osorio, 2002, p. 11).
Although there was resistance to the new religion, it gradually became the dominant belief system.This change, however, was a dialog, so that mana became appropriated to the new Akua, and beliefs about causality and consequence changed from the centrality of the role of the ali'i in maintaining pono between the Akua, Maoli and 'aina to new ascriptions of original sin and the Western discourse of pathophysiology.As these beliefs changed, so did practices related to health and healing (Inglis, 2005, p. 228;MacPherson, 1995).

Christianity: Alienating the Body, Alienating ka lahui
The Christianity inscribed on the Lahui by the American Congregational missionaries was one which demonized and stigmatized the body, attempting to segregate the body as the seat of evil.This discourse is in marked contrast to Maoli constructions of the body, which celebrated being in the body, and which manifested itself in the health status of Maoli.
During the Kingdom period, the Mo'i, despite the overlays of 'ainoa and Christianity, knew the centrality of their role in maintaining the health of the nation on multiple levels (political, physical, and spiritual).They provided leadership in resisting colonization, while at the same time facilitating colonization through institutions of property and franchise (Silva, 2004, p. 122).Kalakaua reenacted the traditional role of the ali'i through participation in cultural roles, including the revitalization of the hula, Specialists such as the kahuna ho'ohanau prescribed exercises to ease delivery, as well as version and the psychic transfer of labor pains to the spouse or other family members (Wong, 1994).Maoli psychiatry involved both mediation with the akua as well as counseling and possibly psychotropic medications (Wong, 1994).A significant part of dealing with family problems was ho'oponopono, which involved both prayer and self-inquiry in a process which Cody (1974) characterizes as "one of the soundest methods to maintain and/or restore healthy family relationships that any society has ever devised."After the arrival of Western disease and medicine, some kahuna would refer Western disease to Western physicians (Hope and Hope, 2003).Kamehameha Nui may have been involved in the first offshore medical inspection as a member of the boarding party of Kalaniopu'u sent to investigate the arrival of Cook's ships off of Wailua, Maui in 1778 (Mills, 1981).The first Western physician, Thomas Holman, however, arrived with the first American missionary party in 1820.Another missionary physician was to arrive in 1823 with the second party.Kauikeaouli ordered the appointment of the first Boards of Health for each island in 1839, and then the Department of Health in 1850.Vaccinations were established treatment by 1839 (Schmitt, 1995).Although earlier the King and Legislature passed legislation licensing Western physicians, kahuna were noted licensed until 1856 (Mills, 1981).With ongoing concerns about the high infant mortality rate, as well as sterility rates among Maoli men and women, Liholiho and Queen Emma raised funds, subsequently matched by the Legislature, for the Queen's Hospital, whose cornerstone was laid in 1860.
As the human bodies comprising the nation were rapidly dying off, so was the physical body of the Lahui, the 'aina disappearing into foreign ownership in the process begun under the Mahele.

Mahele
Initially, the term mahele referred to the redistribution of resources with the changing of ali'i.With each succession of ali'i, lands were redistributed, ensuring that land was not monopolized, and reflecting the concept of humans as stewards of the land, rather than owners (Kaiser and Roumassett, 2004).A significant change occured with the ascendency of Liholiho after the death of Kamehameha Nui: there was no mahele, and the holdings of the ali'i became inheritable, rather than redistributed.Following the cession and subsequent return of the sovereignty of the Kingdom, Kamehameha III sought to secure the rights of the maka'ainana to the land through fee simple title.However, with the Mahele of 1848 there was a reification of new relations between Maoli and the land.Initially the process divided the land between the King, Kauikeaouli, and the Ali'i.The land was then further divided, ostensibly to ensure that the maka'aianana retained their lands.The three divisions of land became known as those of the Crown (approximately three million acres), Government, and Konohiki lands (about one million acres total).All lands were subject to the rights of native tenants, despite this reservation, however, the Mo'i and the Legislature were presented with the need to attempt to preserve access and gathering rights traditionally exercised by the maka'ainana; thus, they enacted what was to become the predecessor to Hawai'i Revised Statutes section 7-1 (Kanawai, 1850).
Claims to individual kuleana, or parcels of land, were made through the Land Commission (Application of Robinson, 49 Haw. 429, 437-38, 421 P.2d 570, 576, 1966; The Fundamental Law of Hawaii, 3).After hearing testimony, the Land Commission would award Royal Patents to certain parcels.The awarding of a Royal Patent vested legal title in the claimant by quitclaiming the government's interest in a parcel (Robinson,421 P.2d at 576;The Fundamental Law of Hawaii,.Any other claims to the parcel must be proven by a showing that a predecessor in interest acquired a Land Commission Award, a Royal Patent, a Kamehameha Deed, a Grant, a Royal Patent Grant, or other government grant for the land in question" (State by Kobayashi v. Zimring, 58 Haw. 106, 114, 566 P.2d 725, 731, 1977).Thus, in the discourse of the Hawai'i State and US courts, the majority of present Maoli, whose ancestors did not make legal claims to land, are voiceless.
In this contrast, research by David Keanu Sai and others indicates that underlying the system of fee simple title in the Kingdom was the terrain of vested rights, where the King, ali'i in their capacity as konohiki, or stewards, and maka'ainana retained undivided 1/3 interests in the land; this was the dominion of the Kingdom (Perkins, 2005, p. 199).These vested interests contrast with the proprietary interests, in the form of alienable interests which are bought and sold, and commonly believed to be fee-simple title.Even if a Royal Patent quitclaimed the government's interest in a particular parcel, the other undivided interests, those of the konohiki, and maka'ainana remain.Thus, there is only one layer of ownership which is alienable, and the underlying vested rights remain, as there has not been a quitclaiming of these interests by either the konohiki or the maka'ainana.
Even in circumstances where maka'ainana received a majority of the most valuable lands, as in Kahana on the island of O'ahu, these holdings were lost after a generation through non-judicial foreclosures (Stauffer, 2003).Further lands continued to be lost through the doctrine of adverse possession, and subsequent quiet title actions, often by ranches and other large landowners.
However, as the 'Ainoa destroyed the spiritual foundation for Kanaka Maoli culture, so the Mahele of 1848 commodified the relations between Kanaka Maoli and the 'aina, destroying that relationship through the law (Kame 'eleihiwa, 1992;Cook et al., 2003).Geneaological relations were replaced with ownership, and for the majority of Maoli, this ownership was either never obtained or quickly lost.
Western law thus became a new inscription on a landscape already crowded with meaning: reading again opens up all the inbetweens and the shimmering, burning traces across the always was shattering slowly choking resin of sleep the gears turn and grind bodies inbetween to drip into the communion cup black boots and black jackets on the sand ink leaks from a black book across the 'aina to rewrite boundaries and obliterate birthings the ink flows into walls which write silence, obedience and the missionary position mu'mu'u and till death do us part the ink seeps and makes green carpets that grow nothing gates and walls that do their best to terminate geneaology but sometimes ink can run into water be washed away in the cold flows and the hot spasms and the ink turned sideways disappears

Destruction of Nation Through Destruction of Diet: I ola no ke kino i ka ma'ona o ka 'opu
When the stomach is well filled, the body is healthy (Pukui, 2001, p. 135).Food, as much as 'aina and 'olelo, was and is a contested terrain in the political economy of national identity and health.From the means of production, to the foods actually produced, and the manner in which they are consumed, food articulates with health: testimony from the hearings on the original Hawaiian Homes Commission Act illustrates this axiom, as Maoli officials testifying in favor of the Act pointed out the centrality of kalo to the Maoli, and how without land, this was impossible.
Medical ideology is the foundation of links between food habits and health/disease, which in turn articulates with racial and cultural identity politics (Nayar, 2002).Thus, as Western medical ideology permeated healthcare in Ka Pae 'Aina, so did Western constructions of healthy diets.The medical ideology of health did not emerge from an uncontested terrain; instead, medical ideology served to reinforce the dominant forces of production.In Ka Pae 'Aina,, the inscription of a Western model of health accompanied the inscription and appropriation of land.Kalo and other traditional foods were described as unhealthy, as Maoli and other peoples of the islands were encouraged to abandon these foods and adopt foods such as white rice and processed meats.The adoption of these foods accompanied further appropriation of lands and water, from the adverse possession/quiet titling of former agricultural lands, to the diversion of watercourses to irrigate sugar lands, and later golf courses and housing developments.The loss of lands and water for agriculture, as well as access to traditional gathering sites, meant the loss of the means for sustaining traditional diets and lifestyles.Changes in diet not only moved Maoli from a high complex carbohydrate, low fat, low sodium diet to a simple carbohydrate, high fat and sodium diet, but also major impacts on spirituality and economic resources.Loss of land meant that Maoli could no longer practice "subsistence" agriculture and aquaculture, which destroyed not only relationships to the land through occupation and labor, but also destroying the means of production and thus self-sufficiency.Applying the label of "subsistence" to traditional Maoli agriculture and aquaculture is extremely problematic, because traditional systems of production were not solely for subsistence, but produced surpluses sufficient to provide for classes which largely did not participate in production, such as the ali'i and some kahuna.Surpluses also underlay the ahupua'a system, which enabled the people of uka, or the uplands, to concentrate on production of wood, kapa, olona, la'i, ie, and wild birds, while from the kai, or ocean came i'a, or fish and other marine products.
As more and more Maoli lost access to land, they were forced to the cities, becoming lowwage labor for the new industries of tourism and the US military.Moreover, loss of land meant also loss, to some degree, of the spiritual means of production.Maoli faced barriers, particularly economic, to the reproduction ancestral connections by the consumption of kinolau and the performance of rituals inherent in the production of traditional foods.
The appropriation of land is the drawing of new landscapes upon the earth, so it is not surprising that those who sought and eventually gained control over Ka Pae 'Aina displaced subsistence agriculture with export agriculture; kalo, 'ulu and 'uala were quickly replaced by nonsubsistence foods, chiefly sugar and pineapple, but including coffee and macademia nuts.The colonial relationship to the land was, and still is established by altering the land for colonial enterprises (Smith, 2003, p. 82).As the Maoli diet, as those of other residents of Ka Pae 'Aina, became increasingly dependent on imports, so the Maoli themselves, in the eyes of the colonizers, became more domesticated, more integrated into the cash economies which had not been a necessity with a land base on which to practice traditional lifestyles (Smith, 2003, p. 83).

Legal
Inscribing Western Ontology and Epistemology Onto 'Aina From a traditional epistemology, "he ali'i ka 'aina, he kauwa ke kanaka:" the 'aina is the chief, and the person but the servant (Pukui, 2001).Kumu John Ka'imikaua analyses of the relationship of the health of the 'aina and the actions: "man causes the land to be ma`i.land, left to itself, assumes a perfect and natural state.but land can only take so much.man must malama `aina or the land will, at some point, cleanse itself and man will pay the price for this.this is more than just physical filth, but is also emotional filth and intent to do harm.using the land for greedy purposes, to defile the land, causes physical, mental, spiritual and emotional illness.for man to be well, man must exercise his kuleana to care for the land so that both can be well and thrive together."Similarily, Dr. Kekuni Blaisdell posits: "Since we Kanaka come from the 'aina (environment/cosmos), our parents are skyfather Wakea and earth-mother Papa (sacred environment/cosmos), we are part of this sacred 'aina, we depend on the sacred 'aina for our nourishment, including the ha of Wakea that we breathe with each breath, we return to the `aina after we leave our mortal flesh at leina (the place where the soul leaps to join the ancestral spirits).No laila (therefore), we Kanaka are only as healthy as our 'aina.As long as the 'aina is/are ma'i (ill), we Kanaka are ma'i.No laila, as long as any land is polluted/contaminated and unhealthy, we Kanaka are similarly." No Maoli was free of the obligation to malama 'aina (Silva, 2004, p. 40).In apposition, Western law is based on relations of property, and functions to facilitate the transfer of this property as Merry (2000, p. 19) indicates: ". . .[m]odern law is itself a creature of colonialism, developed during an ear of mercantilitism and imperialism and shaped by those conditions . . . the creation of modern law is grounded in relations of imperialism, distinctions of race, and the opposition of savage and civilized . . . the system of international law originated in efforts to construct a legal framework for the relations between the Spanish and the Indians that would justify Spanish intervention and war." In this context of Euro-American law, however, the Mo'i and ali'i sought to preserve and strengthen the independence of Ka Pae 'Aina in an era of global imperialism (Merry, 2000, p. 36).Adopting the grammar of Euro-American jurisprudence allowed participation in the discourse of international law and legitimacy: it was, and still remains to some extents, a measure of resistance and affirmation.Legalization was part of the process of Western civilization, so that the attainment of a commodified system of exchange became a mark of the "superior" achievement of Maoli over other Polynesians and other peoples, both in Ka Pae 'Aina and in the Pacific (Merry, 2000, p. 38).

Land Cases
'Aina is more than land; it describes the traditional geneaological relationship between the Maoli and the Akua, between the younger and the older sibling.David Keaun Sai and Don Lewis, through the Perfect Title Company, foregrounded the struggle over the grammar of property rights in Ka Pae 'Aina through their work in the Perfect Title Company.They contend that the indivisible vested rights of the maka'ainana and konohiki, in all circumstances, as well as the vested rights of the Crown, continue in all lands of Ka Pae 'Aina.

Crown and Government Lands
Hawaiian Home Lands As the Maoli continued to endure high levels of depopulation, Maoli and American political leaders recognized the need for a return of the Maoli to the land, as in a statement from then U. S. Secretary of State Franklin Lane: "the native[s] of the Islands, who are our wards, … and for whom in a sense we are the trustees, are living in poverty and dying off rapidly" (Vause, 1962).Since the beginning of the Territory, however, the former crown and government lands, many of the most valuable of which had been leased to large ranchers and sugar plantations, had been open to homesteading by members of the general public without regard to ethnicity.During the period of [1917][1918][1919][1920][1921], leases on up to 200,000 acres of these lands were due to expire.With the enactment of the Hawaiian Homes Commission Act, the general homesteading program was terminated, and the most valuable sugar lands were protected, ostensibly to provide income to the new Hawaiian Homelands program through leases (Dinstell, 2000).
Important in the efforts of the sugar planters to impose a 50 percent blood quantum requirement was the higher morbidity associated with Maoli of 50% or more Maoli ethnicity.Although the discussion of the social construction of race is largely beyond the scope of this paper, it should be noted that beyond obvious origins in the American fixation on blood quantum originating with African Americans (the Queen was described as the "illegitimate [child] of a mulatto shoemaker"], and divisions in to quadroons and other "parts," it is likely that the sugar planters and their allies based their insistence on the system of American Indian reservations, where the indigenous nations were required to document blood quantum (Silva, 2004).This documentation was and is required for registration as an enrolled member of a tribe; without reservation, an individual is not recognized as an "official" Indian, and is denied benefits otherwise available to the tribe.The system of segregation and deprivation that resulted from the U.S. "trusteeship" over the indigenous nations of the continent functioned to inspire the Boers of South Africa to model their apartheid system after the American program.
In this problematic context, the original concept of a program to benefit Maoli of 1/32 or more quantum was changed, by the time of passage, to a requirement of 50% or more quantum.With this requirement, those pushing for a higher quantum believed that any lands initially placed within the jurisdiction of the program would eventually accede back to the then-Territory of Hawai'i with the passing of those Maoli of 50 or more percent blood quantum.In addition to this concept, the program was an unfunded mandate: the funding of the program was to come solely from receipts from the lands not in homesteading, limited to thirty percent of sugar land and water leases (Dinstell, 2000).Additionally, the Territory and later State of Hawai'i consistently abused their fiduciary responsibilities, as lands were transferred to other federal and non-governmental entities and persons.Moreover, the lands set aside in the original act were marginal, and homesteaders did not receive title to the lands, thus requiring them to remain dependent on the program for financing (Dinstell, 2000).
Significantly, however, the Supreme Court of the State of Hawai'i has affirmed that the purpose of the Hawaiian Homes Commission Act was to establish a program for the rehabilitation of Maoli, under which the US government, and later the State upon Statehood, assumed fiduciary responsibilities (Ahuna v Department of Hawaiian Homelands, 64 Haw. 327, 338, 640 P.2d 1161Haw. 327, 338, 640 P.2d , 1168Haw. 327, 338, 640 P.2d , 1169Haw. 327, 338, 640 P.2d , 1982)).This court has also held that individual beneficiaries under the act have a private right to action against the Hawaiian Homes Commission (HHC) and Department of Hawaiian Home Lands (DHHL) for alleged breaches of trust (Aged Hawaiians vs Hawaiian Homes Commission, 78 Hawai'i 192, 891 P.2d 279, 1995).Even given these rulings, however, Maoli face many obstacles in attempting to actuate the stated intent of the Hawaiian Homes Commission Act, which was to rehabilitate Maoli.Since the chairpersonship of Hoaliku Drake, the Commission has interpreted this mandate to imply that qualified beneficiaries should be equivalent to other, non-Maoli residents in Ka Pae 'Aina, residing in masterplanned communities (Dinstell, 2000).Although the HHC/DHHL have begun to work on a small number of more affordable housing developments, for the vast majority of qualified Maoli, as well as those of less than fifty percent quantum, the developed communities remain unaffordable.

Adverse Possession and Loss of Lands: Hana'i'o ka ha'ole
The foreigner, or particularly European and Euro-Americans, "does it in earnest" (Pukui, 2001, p. 55).The Maoli did not look on land as a commodity to be owned, and generally did not order people off as trespassers.With foreign ownership of the land, however, came enclosure and the enforcement of trespass law.While some landowners sought to purchase land from Maoli, the purchasers often sought to expand their holdings, and others to establish holdings, through the doctrine of adverse possession.This doctrine, originating in English common law with the enclosure of the commons and beginning of the Industrial Revolution through expansion of sheep herds for wool production, enables a claimant to pursue a quiet title action after a prescribed amount of time using another's land without the opposition of the landowner (Hawaii Revised Statues, sec 669).Specifically, an adverse possession claim requires five elements: It must be [(1)] hostile or adverse; (2) actual; (3) visible, notorious and exclusive; (4) continuous; and (5) under claim of ownership.The party who claims adverse possession has the burden of proving that the foregoing elements have existed for the statutory period of not less than 20 years.In addition, [that party] must prove, by clear and positive evidence the location of the boundaries [that party] claims.Such boundaries must be established at the inception, during the continuance, and at the completion of the period of adverse possession (Campbell v. Hipawai Corp., 3 Haw. App. 11, 13-14, 639 P.2d 1119, 1120-21, 1982).
Particularly given the fundamental dichotomy in understandings between maka'ainana and foreigners in relationship to ownership of land, large areas of formerly Maoli land were lost, often due not only to misunderstandings, and sometimes subterfuge, not only during the actual period of adverse possession, but in the process of the quiet title action.Although the laws establishing causes for adverse possession in Ka Pae 'Aina required, and still require notice to potential claimants to the lands in subject, potential defendants need sometimes extensive genealogical knowledge to simply know that they may have a claim.If they believe that they may have a claim, they then must have the means to answer a legal complaint, and to contest the plaintiff's claims in court.This process, requiring legal representation, thousands of dollars and years, is often beyond the means of many Maoli.Moreover, the Hawai'i Supreme Court has ruled that ubstantial interest in the property and that [its] title is superior" to any of the other parties in an action (Maui Land & Pineapple v. Infiesto, 76 Hawai`i 402, 408, 879 P.2d 507, 513, 1994).Thus, lands continue to be lost to small, medium, and large landowners.With the loss of lands to foreigners came the loss of genealogy, of connections to the kupuna and the means of continuing traditional and customary practices.Thus, the loss of lands was not simply a loss of living and agricultural/aquacultural space: it was a loss of culture and identity.

Traditional and Customary Rights
The alienation of the proprietary rights of land as a result of the Mahele and Land Commissionn process produced a realization in the Mo'i that instead of protecting the rights of the maka'ainana, ofttimes alienation of land produced hardship to those people who lived from the land.Cut off from resources essential to survival, such as 'aho cord and ti, maka'ainana were further marginalized.As a result, Kauikeaouli signed what was to become, in the period of statehood (Hawai'i Revised Statutes 7-1): "Where the landlords have obtained, or may hereafter obtain, allodial titles to their lands, the people on each of their lands shall not be deprived of the right to take firewood, house-timber, aho cord, thatch, or ki leaf, from the land on which they live, for their own private use, but they shall not have a right to take such articles to sell for profit.The people shall also have a right to drinking water, and running water, and right of way.The springs of water, running water and roads shall be free to all, on all lands granted in fee simple; provided that this shall not be applicable to wells and watercourses, which individuals have made for their own use." This portion of the Kuleana act was crafted to protect the traditional mauka-makai practices of the ahupua'a: "the proposition of the King . . .a rule for the claims of the common people to go to the mountains, and the seas attached to their own particular land exclusively, is agreed to."Privy Council 1850: 713.This act has been read in conjunction with what has become Hawaii Revised Statutes 1-1, which modifies English common law, interpreted by English and American caselaw by "Hawaiian judicial precedent" and "Hawaiian usage."These sections, which were initially interpreted narrowly by the courts of the late Kingdom and Territory, later became the basis for reshaping the judicial landscape concerning property rights in Ka Pae 'Aina.

Tradition, Writing and Health
Traditional Kanaka Maoli spirituality evolves around relationships, particularly the relationships of descent.
As Silva (2004) indicates, traditional practices are the iwikuamo'o, or spine of Ka Lahui, "without their own traditions they could not stand up to the colonial onslaught" (Silva, 2004, p. 88).The Mo'i saw the need to preserve those traditions that the missionaries had sought to ban, by specific church edict for both hula and la'au lapa'au, and indirectly for traditions such as mele, 'oli, mo'olelo, and mo'oku'auhau.Traditions connected the Mo'i with the nation through genealogy, as the other traditions reconstructed the narratives of origin, nationhood, and resistance to the missionaries (Silva, 2004, p. 89).

Mele
As hula went underground, Maoli turned to other media for expressing their nationalism and opposition to the further advancement of nonnative control.Thus, Kalakaua composed Hawai'i Pono'i, which referred back to the era of Kamehameha Nui for imagery.After the overthrow of the Monarchy, mele, often composed in the new idiom of guitar or 'ukulele based songs, continued to express solidarity within the Lahui and resistance to occupation: one famous example is Kaulana Na Pua, from which one verse follows (Chock 2004b;Prendergast, 1895): Kaulana na pua a`o Hawai`i Kupa`a mahope o ka `aina Hiki mai ka `elele o ka loko `ino Palapala `anunu me ka pakaha Famous are the children of Hawai`i Ever loyal to the land When the evil-hearted messenger comes With his greedy document of extortion Songs such as Hawai'i 78 reflect a pro-Maoli, pro-Monarchy and anti-development perspective (Chock, 2004b;Ioane, 1978): If just for a day our king and queen would visit all these islands and saw everything How would they 'bout the changing of our land Could you just imagine if they were around and saw highways on their sacred grounds How would they feel if they 'bout this modern city life?
Other songs, such as Ku'u Home O Kahalu'u, lamented the loss of place, specifically Maoli places with the contagion of development (Chock, 2004;Santos, 1976 Thus, as Silva ( 2004) situates them, mele were and are another expression of resistance for Maoli against resistance.But even more, mele, particularly the resurrection of writing in ka 'olelo makuhine since the "Renaissance" of the 1970s, are an affirmation of survival and an assertation of self-determination in a Western and English-dominated cultural landscape.Chock 2004a; Chock 2004b.

Ke ala aloha, 'a'ole ala koa: Domesticization
The Construction of Hawaiian Women and Men As the nation became a landscape of struggle, so did the Maoli identity.As the land was colonized and domesticated into the grammar of fee simple and property, so the Maoli became Hawaiians, better fitting into the imperial grammar of Western geopolitics (Cook et al., 2004).No longer were Maoli kane and wahine, maka'ainana, ali'i, kahuna, mahi'ai and lawai'a; instead, Maoli became Hawaiian entertainers, hula girls and urban proletatariat, policemen, firemen, and laborers.Moreover, civilization required the domestication of the body, the containment of sexuality to prescribed American, Christian norms (Merry, 2000, p. 39).
As law sought to domesticize the body, engaging in "illegal" activities such as extramartial sex became means of resistance, a differentiation of the self from dominant groups (Merry, 2000, p. 219).As Merry indicates, the vast majority of defendants in cases involving "adultery" and "fornication" were Maoli: civilization required conduct in line with the prescribed Christian morality (Merry, 2000, p. 221).For the missionaries and their descendants, sexuality was engaged solely for duty and procreation, whereas for the Maoli, sexuality was enmeshed within the kapu system of the sacred and the profane.Sexuality was a means of political advancement, both for those of rank and sometimes maka'ainana as well; conversely, sexuality was at the same time, except for the most kapu ali'i, a relatively free landscape, navigated without shame or guilt, and with fluid relationships (Handy and Pukui, 1972;Linnekin, 1990;Malo, 1951;Merry, 2000, p. 228;Ralston 1989).Marriage was noho pu, or "just settling in," a mutual agreement of kupuna about the union of a man and woman (Handy and Pukui, 1972: pp. 44, 107;Merry, 2002, pp. 231-32).Such unions could be ended easily, although they were usually permanent (Handy and Pukui, 1972, p. 110).Significantly, the unit of production was not the nuclear, husband/wife union, but instead the 'ohana, the extended family under the leader of the haku, or elder male (Handy and Pukui, 1972, p. 6;Merry, 2000, p. 232).
Maoli ideology concerning sexuality contrasted with that of American Puritan Christianity, which foregrounded original sin, and held that sexuality existed only for procreation.Moreover, the sublimation of the body within the legal framework through laws prohibiting adultery, prostitution, and imposing marriage was also to further incorporate the body into the mechanisms of property.This rewriting of the body, particularly the body of the wahine, was on multiple levels.A woman became the property of her husband, with a prescribed role of service: a woman was not a self-determined subject, a position only open to men (Merry, 2002, pp. 255-56).A woman also became subject to the disciplines of the body, from religious prescriptions against the "seductions of evil" to civil laws governing sexuality (Merry, 2002, p. 72).As Merry indicates, "marriage and the control of sexuality was at the core of the mission project."The missionaries constructed the new, self-discipline subject through civil law, so that by 1827 laws against both adultery and fornication, and establishing indissoluble marriage were enacted (Merry, 2002, p. 73).
At the same time, the missionary and missionary descendant efforts to domesticate Maoli women also worked to de-center women, and simultaneously to further the destruction of the duality which had been central to the Maoli knowledge system.

Tourism and Prostitution
With the arrival of Westerners came the institution of prostitution (Kamakau, 1961, pp. 95, 100;Ralston, 1989).Although initially prostitution was a reciprocal relation, these exchanges were converted to buying and selling as Maoli became more thoroughly integrated into the new political economy (Merry, 2002, p. 228).Initially, the missionary advisors to the King encouraged measures to outlaw prostitution, such as an 1835 law making illegal "illicit connections," and an 1841 act "Law Respecting Lewdness" (Greer, 2000).Subsequently, with the efforts of Lota Kamehameha and Queen Emma to invigorate Ka Lahui, the devastation wrought by syphilis and gonorrhea, chiefly in infertility was identified as an infectious, rather than moral process, and the Act to Mitigate the Evils and diseases arising from Prostitution" was passed in 1860.The Act required the registration and periodic physical examination of women engaged in prostitution.Although another act outlawed the keeping of brothels, by the turn of the 20th century, prostitution was contained in circumscribed areas of Honolulu.
As the US military was the one of the driving forces for the attempted annexation of Ka Pae 'Aina, and came to be one of the dominant forces in the Territory and later State, it also used the sex industry, both formal and informal in Ka Pae 'Aina for its soldiers.During World War II, the military assumed control of the sex industry in Honolulu, passing regulations and commandeering many of the hotels in Waikiki for its use.At the same time, it did not prosecute the sex crimes of its soldiers and sailors, so that hostility grew towards the US military among local men, particularly with the poor treament, including rape, of Maoli women by US sailors.Waikiki: A Thousand Stories.

Disease
The medicalization of the body is not a neutral process; instead, Western medicine, foregrounds and centers the knowing subject/ physician/ researcher as the repository of knowledge and producer of cure.
In this section, which considers the impact of different pathologies on Maoli morbidity and mortality, the diseases themselves are necessary, but not sufficient explanations of the unhealthy Hawaiian.Pathophysiology has been strongly associated with ethnicity, but as Blakely et al. indicate in Aotearoa, the external political economy, particularly unemployment and underemployment, as well as income disparities play a large part in a partial explanation of health disparities (Blakely et al., 2005).In the analysis put forth in this article, even adding behavioral factors and differential access to health services is not a sufficient explanation; instead, mana and mo'oku'auhau must be considered as factors to the restoration of Maoli ola.Moreover, Western medicine tends to focus on the health of the individual in terms of treatment, or assigns certain ethnicities as "risk factors;" in the US, however, there is not group responsibility, either for group health or group unhealth.In the US, health, specifically the attainment of a disease-free state, is a marker of successful integration into American society (McMullin, 2005).Those peoples who have not achieved health, or who have lost health, are by definition not successful, outside the boundaries of the norm (Crawford, 1994;McMullin, 2005).
In the US, health is not a fundamental right.This is in marked opposition to international law: "health, which is a state of complete physical, mental and social wellbeing, and not merely the absence of disease or infirmity, is a fundamental human right and that the attainment of the highest possible level of health is a most important worldwide social goal whose realization requires the action of many other social and economic sectors in addition to the health sector" (WHO, 2004).This language, paralleling that of the Universal Declaration of Human Rights, goes on to point to the unacceptability of the inequalities interand intra-nationally, and to the responsibility of governments to implement measures to ensure that people reach socially and economically productive lives.The implementation of this goal is through primary healthcare (WHO, 2004).The right to health is well established in international law, through such instruments as the Universal Declaration of Human Rights, Article 25; International Covenant on Economic, Social and Cultural Rights, Articles 7, 11, 12; Convention on Elimination of All Forms of Discrimination Against Women, Article 10, 12, 14; Convention on Elimination of All Forms of Racial Discrimination, Article 5; and Convention on Rights of the Child, Article 24 (UNOHCHR, 2005).Although not a focus of this article, it should be noted that under Article VI of the United States Constitution, international law is the supreme law of the land.Thus, although the US government often chooses to ignore norms of international law, and enforcement is difficult, the obligation persists.

Infectious Disease
As in Australia, infectious disease was racialized in Ka Pae 'Aina: those with Hansen's disease (leprosy), particularly Maoli, were spatially isolated by the mechanisms of the Kingdom and later Territory, while those with similar, and more infectious disease, such as tuberculosis, were self-isolated (Bashford, 2004;Englis, 2005).As Bashford (2004) indicates, diseases such as Hansen's disease were those dominated by "non-whiteness," subject to the quarantine of Western medicine because of the potential threat it posed to the imperium, represented initially by missionaries and Western physicians, and later the colonial apparatus of the Provisional Government, Republic, and Territory.The "healthy" were those who survived, and disease was often located in the non-Western other (Bewell, 1999).

Cancer
Maoli have some of the highest incidences of cancer in Ka Pae 'Aina (Hawai'i Cancer Facts and Figures, 2004;Tsark, 1998).Many of these cancers are linked to personal "choices," including smoking and diet (Frezza et al., 2005;Glanz et al. 2003).In the current US, up to 35% of all cancer mortality may be related to diet, including a lack of high fiber, low animal fat, high fruits and vegetables, and a lifestyle which is active.Obesity itself, particularly in association higher levels of insulin and IGF-1 is associated with a number of cancers, including colon, breast, prostate, pancreatic, non-Hodgkin's lymphomas, hepatocellular and uterine cancers (Bugianesi, 2005;Cerhan et al., 2005;Freedland, 2005;Rapp et al., 2005).With breast cancer, a disease with high associations with obesity, particularly through hormonal effects on adipocytes, despite higher incidence of estrogen and progesterone-positive tumors, Maoli women have higher incidences of both breast cancer and mortality (Hayes, 2005).

Cultural Trauma
The theory of cultural trauma posits that as in the individual with post traumatic stress disorder, certain historical events experienced by a group continue to be experienced by that group, even decades or perhaps centuries after the initial event; the events or processes are a "traumatic loss of identity or meaning, a tear in the social fabric" (Eyerman, 2002).Other authors characterize cultural trauma as "national trauma," tropes that interpret history through differential lenses (Neal, 1998).These experiences transform communities, oftentimes in negative aspects.There are both biological and psychological bases for the transmittal of the traumas.Biologically, neurons store memories contingently: prior experiences shape the storage of new information based on changes in neurotransmitters, neurohormones and neurotropic growth factors which produce changes in the synaptic micro-architecture, as well as the levels of chemicals involved in cellular communications and gene expression (Perry 1997(Perry , 1999)).Particularly during childhood, development is use dependent, and subsequent modification of the regulatory system is much more difficult after the first three years of life (Perry, 1999).As an individual experiences new events or processes, the brain processes new inputs and compares them against previous similar patterns of activation to generate a response.If inputs are incorrectly interpreted, state memories may be activated, so that there is a generalization of a specific event, which may become maladaptive.Such is the case with an ex-soldier, who may have state memories of gunshots, and whose state memories of war result in a generalized activation of the sympathomimetic system in response to any startling input.Thus, the autonomic nervous system itself becomes involved in the storage of memory as emotional memory, as a hierarchy of responses evolves: the most advanced response is first, and the most primitive last (Ogden and Minton, 2001;Porges, 1994;Scaer, 2001;Schore, 2001).Importantly, in childhood it is the caregiver who regulates positive and negative states, and she in turn can transmit trauma which she has experienced to her child (Andermann, 2002;Eyerman, 2002;Perry, 1999;Schore, 2001).
Psychologically, cultural trauma is not experienced immediately: it is a struggle of meaning and interpretation (Eyerman, 2002).In Maoli history, the beginnings of cultural trauma are in what Stamm and Stamm (2001) characterize as the era of cultural challenge, when there were epidemics of new diseases, expanded traded opportunities, warfare, competing belief systems, and intellectual innovations.Coterminously, or perhaps slightly after, Maoli entered a period of cultural loss, dominated by a discontinuity of experience.There, cultural memories were lost, as well as language, the use of traditional resources, and economic opportunities.Maoli also experienced and continue to experience poor health care options and the disruption of family patterns, particularly in the extended family.Although still somewhat in the teleology of "progress," Stamm and Stamm (2001) locate the fourth era of cultural trauma as being that of reorganization and revitalization, where "bicultural adaptation uses the best of both worlds," and there is restoration of sovereignty on individual, family, community and national levels.Particularly important in the context of the present paper is that there is a "renewed sense of health" in the fourth era.The eras of cultural trauma overlap, however, and there may be an uneven progression for members of certain groups from one era to another; for the most acculturated, the transition to reorganization and revitalization may be much quicker, although the cost may be the surrender of most of traditional culture, which can be constructed as an "impediment" to progress in the dominant culture.Additionally, transitions are uneven, so that during the "Hawaiian renaissance," there was a resurgence in language and traditional culture, yet there has yet to be the emergence of a substantial machinery of self-determination (Kanahele, 1979).
The effect of the traumas, although experienced as a group, may be somatized on an individual basis.In the Maoli case, the trauma of alienation from the body and lahui may be somatized as behaviors characterized as non-compliance, or self-destructive health behaviors.Maoli may not consciously experience the national traumas of the overthrow or the loss of land; yet at the same time, they may encounter reminders of these events in the high cost of housing or the relative lack of Maoli representation in government or privileged professions.With the national memories and daily reminders, as context, they may in response subconsciously choose to resist dominant models of compliance or "health" by making lifestyle or treatment choices which may not be congruent with the dominant model.Thus, being outside "normality," or health as defined by the American biomedical system, is resistance to the technologies of health, and by extension the continued occupation of Ka Pae 'Aina (Crawford, 1994;Das, 1990;Foucault, 1973Foucault, , 1977;;McMullin, 2005).In this context, non-adherence to prescribed medications, use of controlled substances, or multiple births out of wedlock are ways of marking one's self as not "normal," not totally subject to the technologies of colonization.
Any program which seeks to modify behaviors then must be contextualized within history, and negotiate and validate the experience of the national traumas while providing a process to go beyond them.This is not a discourse of victimization; instead, it contextualizes behaviors such as substance abuse, over consumption of unhealthy foods, or multiple births outside of marriage within historical and ongoing structural violence.
Along with cultural trauma, perhaps as a result of cultural trauma, there are a number of more traditionally biopsychosocial impediments that some Maoli men identify as barriers to health seeking.Barriers include finances and geographic distance, negative attitudes towards Western medical practitioners, "conflicting priorities," use of traditional and non-Western healing modalities, lack of Maoli health practitioners, and lack of information on services available at Western health institutions (Hughes, 2005).Hughes (2005) suggests that strategies to overcome these barriers include closer communication between community members and practitioners, including reminders, improved access, as well as removing logistical and cost barriers to accessing care.A central place is the foregrounding of self-malama as taking care of the family: the health of the individual is linked to the health of the family as relational harmony articulates to spiritual and physical health (Hughes, 2005;Ka'opua Mitschke and Lono, 2005).

Recovering the Nation
Voyaging The voyages of Maoli canoes based on traditional designs not only served to disprove then-standing anthropological views on the "drift" settlement of Ka Pae 'Aina and Eastern Polynesia, but also were and are visible symbols of the resurgence of the Maoli and connections into te Moana nui a kiwa.The voyages, beginning with those of Hokule'a, were coterminous and a major part of the "Hawaiian renaissance" of the 1970s, which also saw the reemergence of ka 'olelo makuahine, as well as the reoccupation of Kaho'olawe and other land protests.The renewal of Polynesian voyaging contrasted to contemporary anthropological theories which spoke of the stories of purposeful navigation as "myth, and instead held out for "drifting" or other non-guided voyages (Cordy, 1974).

Maoli Healthcare
Part of the reclamation and restoration of the healthy Maoli is the development of a Maoli health infrastructure.This infrastructure is both human and institution, with foundations in Western and traditional practices.This process has already begun, through the establishment of Papa Ola Lokahi and the five Native Hawaiian health care systems.Additionally, the University of Hawai'I, John A Burns School of Medicine has recently implemented the Department of Native Hawaiian Health.Additionally, from a relatively few Maoli physicians, there are now more than 100.
Significantly, agencies and individual Western practitioners have provided leadership to bridge the gap between traditional and Western healthcare practitioners.Medicine itself is a contested space, and both colonials and Maoli struggle to gain control over knowledge and healing practices (Gordon, 2003, p. 42).Thus, Maoli provide leadership in returning to the Maoli ola through insights on history (Blaisdell, (2005) and traditional values (Kanahele, 2005).Also, Maoli and non-Maoli authors recenter the role of culture in providing healthcare (Braun, Fong, Kaanoi, Kamaka and Gotay, 2005;Lassetter and Baldwin, 2005;McMullin, 2005).
Looking to the future and the reconstruction of landscapes, as Kame'eleihiwa (1992) posits, with a pono ali'i, the land and people thrive.The legacies of the ali'i in the current political economy are the ali'i trusts, both acknowledged (Queen Lili'uokalani Children's Center, Kamehameha Schools, Lunalilo Home), and the unacknowledged (Queen's Medical Center and the Queen's Foundation, Kapi'olani Medical Center).The dismal morbidity and mortality of the Maoli are indicia that the universe is far from pono.The ali'i trusts were created to perpetuate the role of the ali'i to malama for the Lahui.To recreate this relationship, where the pono of the ali'i was measured by the health of the people and 'aina, the ali'i trusts can form the kuahiwi of the reconstituted Lahui.Queen's and Kapi'olani Medical Centers are natural choices for the infrastructure for universal healthcare for Maoli.Such a program might start with providing for those Maoli who have little or no care at this point: children, the houseless and indigent kupuna.Such expenditures would be relatively small.At the same time, services could be constructed to begin to provide, possibly through an expanded network of community health centers, care for all Maoli.This care would not have to be at the exclusion of care for the other peoples living in Ka Pae 'Aina, instead, the Maoli would have care provided for, but in a system of mutual obligation.Kuleana would entail that people enrolled in the plan would be responsible for taking care of themselves, as well as their 'aina.Self and family care would entail participation in regular checkups and screenings, at either Western or traditional providers.Family care would require making sure that kupuna and keiki were also taken care of.Malama 'aina could be accomplished through service projects, depending on the skills of the participant.Thus, those with skills in masonry might help to rebuild fishponds or heiau, or house foundations; carpenters could learn forestry skills, and attorneys could help to develop codifications of new kapu.Part of the reciprocity would also involve participation in production, whether in a family or community garden or lo'i, or a fishpond or forest or wetlands restoration.

You Are What You Eat: Contested Landscapes/ i ola no ke kino ma'ona o ka 'opu Connections Between Consumption and Healthcare
As George Kanahele indicates, vast areas of 'aina, formerly cultivated for kalo, became rice paddies, and later changed from agricultural lands to hotels and other development (Kanahele, 1995).Prior to this, however, the ali'i acutely recognized the connection the productivity of the land and the centrality of kalo and the health of the nation.While Kamehameha was also known as "black backed" from working in the sun on his lo'i, Kamehameha IV also sought to preserve the ancient role of the ali'i of exhibiting his role in making the land fecund.Thus, he established a 17-acre lo'i in Waikiki, where he worked, together with other chiefs and maka'ainana (Kanahele, 1995).By 1861, however, "rice fever," specifically the export opportunities in California, gripped the Kingdom, and lo'i were converted wholesale into rice paddies (Kanahele, 1995).Tourism, ultimately triumphed, however, as Dillingham's Ala Wai Canal, brought the end of both kalo and rice production in Waikiki (Kanahele, 1995).With the loss of 'aina for cultivation was the loss of the opportunities for the reproduction of connections associated with working the land and consumption of kinolau.

Poverty and Obesity
Although controversial, most studies indicate at least an association between poverty and obesity (Hofferth and Curtin, 2005;Goldstein et al., 2005;Drewnowski and Darmon, 2005;Chang and Lauderdale, 2005).Obesity rates among Maoli are higher than those in most other ethnic groups in Ka Pae 'Aina (Aluli, 1991;Chai et al., 2005;Mau et al., 2001).As Drewnowski and Specter indicate, energy-dense foods, processed foods with high amounts of simple sugars, fats and refined grains are those often are the lowestcost to consumers.These foods, particularly with their association with the genetically programmed palatability of fats and sugars, lead to higher total energy intake.Groups in poverty are not able to afford diets rich in fruits, vegetables and lean meats and fish.
In Ka Pae 'Aina, colonization has produced "local" culture.In this culture, featured foods are products such as spam, kalua pig, musubi, lumpia, chicken tonkatsu, kal bi beef, loco moco, and haupia (Wikipedia; Pollard nd).A primary feature is the "plate lunch," which consists of multiple scoops of white rich, macaroni salad, and several selections of meats.Although the plate lunch may contain some "Hawaiian" foods, these foods are removed from their cultural context, or most commonly, foods that have been appropriated into the local gastronomy as "Hawaiian."For example, although pork (along with dog) was a traditionally consumed meat, it was reserved for special occasions.Moreover, kalo or other traditional starches remained the centerpiece of the traditional Maoli meal; meats and seafoods were relishes.With the plate lunch, however, the meat is the centerpiece, and the starches (which are in largest quantity high glycemic index, non-Maoli starches), are side dishes.Presently, a traditional diet is prohibitively expensive for most Maoli, largely because of the loss of kalo-producing lands, but also because of a general shift from "subsistence" agriculture to export agriculture and non-agricultural land uses: Our Hawaiian diet has kind of lke gotten out of hand for us as Hawaiians 'cause it's so expensive.You know, try go to the market buy fish and it's all kike, at times it's six to seven dollars a pound, depending on the season . . .Trying to go otu and find poi, which is a basic staple for us is really thelahty, but try to go out to the shelf, and you won't find it anymore."(McMulllin, 2005) Some diets, such as the Wai'anae Diet and later modifications, including Dr. Shintani's Eat More, Weigh Less diet, feature the substitution of more readily available high glycemic index, low fat and low sodium foods in place of traditional foods (Shintani, 1993(Shintani, , 1999)).These substitutions, however, remove eating from its cultural context: there is no geneaology in brown rice or tofu.Restoring the Lahui requires a restoration of self-sufficiency in foods, particularly indigenous foods.Even for nontraditional Maoli, the oppportunity to participate in a traditional production and consumption economy may invoke relatively dormant traditional norms, and link to improved selfidentity as health improves.

Landscapes
A reconstruction project could involve reclaiming landscapes, including those areas long inscribed into the colonial matrix.One such area might be Waikiki, and could start with the resacralizing areas which have been desecrated.La Pietra, now an exclusive school for girls, is built on the site of Papa'ena'ena, formerly a surfing and luakini heiau (Kanahele, 1995;Hibbard and Franzen, 1986).While the current property regime makes such transformations difficult, implementing Sai's research into the invalidity of land transfers since the overthrow may open up many wahi pana and wahi kapu.Rededicating heiau destroys the reifications between ka wa mua, ka wa nei and ka wa hope; time becomes cyclical again.Such acts would transgress the existing production of meaning, to foreground a cosmology of re/production and geneaology.In such a context, surfing would become again, for some people, an act which acknowledges connections between the Maoli and the kai, not simply a sport or pastime.
Other transgressive acts could be the reclamation of land currently in cultivation for luxury housing or golf courses to traditional agriculture or other traditional practices.Restoration of forests would in turn help to restore rapidly-depleting aquifers.Beaches, instead of being dedicated to human tourist uses, could again be viewed as part of the flow of mana, in terms of the need for the sand to flow back and forth as the tide changes.In Waikiki, such a project would require the destruction of the breakwaters and groin.Here, destruction would be re/constitution, as the restoration of sand flow would restore the surf to patterns last seen by Duke Kahanamoku, who was famously able to ride a single wave for more than one mile.The re/constitution could help to restore a sacred landscape, as the surf would again link to Papa'ena'ena.

Case Studies
Loko i'a As Maoli have struggled over the identity of the "unhealthy Hawaiian", they have also struggled over the means of production, which on a concrete level are also the means of production of the healthy Maoli.A visible aspect of this struggle are the loko i'a, or fishponds.Nowhere else in the Pacific was aquaculture as developed as in Ka Pae 'Aina (Farber, 1997;Hlawati, 2002).The loko i'a was a protected hatchery for certain fish, and served as a storehouse for fish when they were otherwise unavailable (Summers, 1964).Fishponds ranged from small freshwater lokowai to extremely large "royal fishponds:" the loko kuapa, loko pu'uone, and lokowai (Greene, 1993).Each loko was under the management of the local konohiki, who managed the area for her or his ali'i.The fishponds largely provided resources for the ali'i of that area, rather than the maka'ainana (Apple and Kikuchi, 1975;Greene, 1993).Kelly (1979) argues, however, that by virtue of their labor on the ponds, maka'ainana gained usufructary rights in the loko which existed until the time of the Mahele.The US Supreme Court has held that under the Mahele, the Monarchy awarded loko as private property, however, the name of only one owner, Kekuanao'a, is recorded (Kaiser Aetna vs. United States, 444 US 164, 167, 1979;Kanahele, 1995).Moreover, the US Supreme Court gives no citations for its statement that the ponds "have always been considered to be private property by landowners and the Hawaiian government" (444 US at 167).Other authors state that fishponds are "indivisible assets," with rights retained to the Government (Kaiser and Roumassett, 2004).
With depopulation, however, Maoli lost much of the means to manage the loko, which were leased to Chinese.Under Chinese management, the ponds were used both for traditional uses, such as the raising of 'awa'awa and awa, but also the goldfish, or i'a pake, and introduced species of duck (Kanahele, 1995).The native inhabitants of the loko, the koloa, alae ke'oke'o, ae'o and 'auku'u, were lost as habitat and hunters intervened (Kanahele, 1995).
Recently, loko have been objects of litigation, with claims to private ownership of ponds, particularly arising out of the Mahele, being heard in courts (Hlawati, 2002).Some property owners insist on individual ownership of loko, and have attempted to rebuild them as commercial ventures (Environment Hawai'I, 1993).
Loko are very much a contested landscape, on a Western legal terrain as well as the terrain of nation-building.Reclamation of Maoli ola and Lahui require the re/production of the means of self-sufficiency, both materially and culturally; this would entail resolving the question of "ownership" of the loko.With the current legal system, they could be constructed as part of the public trust, as they extend over the shoreline, although this is contraindicated by at least one federal district court decision.Alternatively, under the undivided interest theory of Keanu Sai, the ponds have never been completely alienated, and thus are part of Maoli lands, similar to any other part of Ka Pae 'Aina.

Towards a Theory of Reclamation and
Restoration: e 'ao lu'au a kualima This analysis actively seeks to deconstruct the production of the "unhealthy Hawaiian," and put flesh and bones into that space, to recenter and re-recognize the agency of the Kanaka Maoli in producing their own health.As the opening 'olelo noe'au states, one must offer kalo leaves to the gods five times to seek to restore health (Pukui, 2001).Even without the specific belief structures of the old Maoli religion, foregrounding the embedding of healing within culture is essential to the restoration of Maoli ola.
Unlearning is demystifying and denaturalizing the discourse of the "unhealthy Hawaiian," to kaukau and recenter the Maoli ola as navigating into the future on the shoulders of her ancestors, observant of the inseparable mind, body and spirit.
One path is that indicated by Cook et al. (2004): "the way of the warrior, integrating through traditional paths of the warrior, without violence but with strength of spirit, understandings of the traumas which continue to shape the lives of Maoli.Understanding in this practice is not for the acquisition, and thus power over, knowledge, but instead the construction of meanings which bring wisdom to the learners.Wisdom brings an understanding of the pain felt on largely psychic levels, but manifested in the 'unhealthy Hawaiian.'The processes which brought the pain are construted in a discourse aimed at healing, and thus bringing individuals, 'ohana, communities and ultimately the nation to a new path, which is at the same time a very old path: "through engaging in many cycles of insight, forgiveness and wisdom, a person or community can develop options for living a healthy and powerful life . . .[o]ptions are freedom . . .][f]reedom allows for graciousness and peace to emerge."(Cook et al., 2004) Ultimately, the movement from unhealthy Hawaiian to Maoli ola parallels the process of reclamation and reconstruction of the nation: it is a process, which begins in ka wa mua, and sails backwards into ka wa hope.Maoli ola requires rekalonization, the reintegration of the body of the Maoli into the body of the nation through revolutionary acts, such as reclamation of diet and land, as well as ultimately health and community.Finally, rekalonization is a process, continued redefined and reclaimed by those who participate in it and who own it: the Maoli.Loa'a ke ola i Halau a ola (literally, life is found in the house of life, but figuratively, one is happy and well again) (Puku'I, 2001) (Kalahele, 2003, p. 77) A Timeline Time immemorial Papahanaumoku and Wakea mate, giving birth to the island of Ka Pae 'Aina, as well as a daughter, Ho'ohokuikalani.Ho'ohokuikalani mates with her father, Wakea and gives birth to Haloanaka, who is stillborn; after being buried, he becomes the first taro.His brother, also Haloa, is the first human.See Appendix A for the complete timeline.For Glossary, see Appendix B. For a PowerPoint presentation of this paper, see Appendix C. .