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Living Aloha and Pono

On September 27, 2013, I was blessed with the opportunity to be the keynote conference for the Western Occupational Health Conference. I felt honored to serve in this role; it was also challenging. The following are my remarks.

“`I am sharing you my perspectives of “Living Aloha and Pono” not as a Hawaiian (which obviously I am not) rather simply as someone who has lived here for a decade and have become engaged in this culture.

I am known as Kamaʻāina which is the word for a long-term resident of the Hawaiian Islands; however I no longer consider a decade as being a long period of time. I could also be known by the less flattering term – Haole. Haole refers to a foreigner – typically to a white person from the mainland. Yes, it appears as if many of you are also Haoles. Caucasians make up only 19% of the Honolulu population, Japanese are 23% and native Hawaiians are only 7%. The original meaning of Haole is “no breath”. Some Polynesians greet by touching nose-to-nose and inhaling or essentially sharing each other’s breaths – foreigners were “breathless”. Haoles did not share breath; although you are welcome to try – perhaps this evening at the reception – not now. The implication is not only that foreigners are aloof and ignorant of local ways, but also literally have no spirit or life within. Actually, no one has referred to me a Haole (at least that I am aware of), other than my other Haole friends. Rather what I have experienced is being embraced by the many cultures reflected on our islands. It is a matter of choosing to be receptive and non-judgmental.

I initially had some reluctance in addressing this topic, not so much because I am not native Hawaiian, rather by the fact that not all of my life has reflected living aloha (love) and pono (in proper order and balance). Yet, I suspect many of us, if not all of us, feel this way to some degree, at least some of the time. What I have learned is that many of the Hawaiian values, when practiced, result in a joyful, rewarding life – being happy and achieving purpose. I have tremendous gratitude for being exposed to these values, and being in partnership with others who also share them. Preparing to be here with you today, has also resulted in personal reflection, and for that I feel blessed.

Today I would like to share with you some of these Hawaiian values, serving as your translator. I have spent much time working with others to learn Hawaiian concepts and values; it is sometimes a challenge to translate concepts from one society to another. This is a learning process for me and I am still inept with Hawaiian language. I am still learning how to live aloha and pono.

You will find that many of these values are consistent with the foundations of many spiritual beliefs, concepts such as love one another, maintain balance and order in life, responsibility and humility.

You will also find that the theme of this discussion will resonate with the message that Les Kertay has to share with us on “Factoring Happiness into the Productivity Equation” – including how to achieve happiness and the need for balance.

My goal in these few moments is that I can impart some key Hawaiian concepts that will touch your lives, your family (ohana), your friends, the people you work with, and most importantly your patients – in a positive, life-changing way.

During this conference we will learn from each other– giving and receiving knowledge – what is known as a`o. The concept is “I learn from you, you learn from me, and together we evolve”.


Aloha is the Hawaiian term that is most recognized by visitors. It is used to say “hello” and “goodbye”. You have already seen that it appears everywhere you turn in Waikiki. Many visitors depart believing they understand the term and they have felt the Aloha experience – because someone greeted them with “Alooooooha” – it is much more.

Aloha is a value, one of unconditional love. It is the outpouring and receiving of the spirit. One’s inner spiritual power is assumed in the Hawaiian culture and it is celebrated. Individual religions are different expressions people have for their own spirituality within them – religion is a personal choice. To understand Hawaiian culture and to expand our lives we are strongly encouraged to acknowledge our own spirituality and get comfortable with it. Many of the core Hawaiian beliefs pertain to tapping into the spirit that is inside you, and embracing your intuitions.

Aloha can be defined as the breath of the life within. Many of us believe that the spirit within us is innately good. Aloha is the outpouring of my spirit, freely given to you with nothing but good intent.

Aloha is a very deep and powerful concept that supports us in our ability to see everyone we serve through the eyes of compassion and sincerity. The word itself is Alo = face and ha = breath. When we expel all of our breath, we release pre-conceived ideas, perceptions and we remain open to new information. When we breathe in, we absorb all the new information and are receptive to new information. Isn’t this why we are here at this learning event? Isn’t it all about aloha?

For me, saying aloha is a consistent reminder of expressing unconditional love. It reflects the critical importance of positive relationships – the foundation of happiness. Not surprisingly, people love aloha. It has so much more significance than “hi” and “bye”.

The arms of Aloha embrace our lives – both personal and work – they seek to serve. Aloha is an attitude, one that is positive, inclusive and healthy. It is the feeling of good service, given with genuine sincerity. Reflecting aloha in your practice means treating our patients, coworkers and everyone we interact with (including employers, other health care providers, insurers, and even attorneys) with openness, honesty, trust, dignity and respect. If our practice embraces Aloha, our patients will return and recommend us – we all want to experience unconditional love.

How does aloha fit with clinical care? When we approach our patients with unconditional love, we must take steps that will promote their health and if they are injured or ill facilitate their recovery. It means not doing things that are in our own person interest, rather it means being of true service to them. It means delivering care reflective of best current knowledge, evidence-based medicine, rather than what may be most profitable for us or reinforces our egos.

Although making a profit is often necessary for survival, profiteering is not – it is a betrayal of trust and the unconditional love that our patients and others in our lives deserve. Failing to take the time to understand a patient’s experience or depriving them from the ability to return to work does not reflect Aloha. If we practice Aloha our patients and other stakeholders will know it, it will drive the actions that we take, it will establish relationship and engage others, and result in positive emotions.

I would like you to pause for a moment and reflect on changes that would occur in your life and your practice if all your encounters and actions reflected living Aloha. I encourage you to use this conference as an opportunity to practice Aloha. When you meet someone greet them with Aloha; more important than the word reflect on what this truly means.

Aloha is a choice, it is a way of living, as is happiness. Will you make this choice?


Pono refers to being in proper order and balance. It is a state of being and a way of living. When we are Pono all is right for us and all that we juggle in our lives is in harmony and in balance. We are content, we are happy. Yet, we often struggle with balance – at home, at work, and with home and work. Certainly I struggle with this. Struggle is energy draining and often unnecessary.

Hawaiian culture names three different things that make up a person – the physical body and health, the mind and beliefs, and our soul and spirit. This body, mind and spirit trilogy is not unique. Pono means bringing all of these three components together in balance.

This concept is core to the care we provide for our patients. When someone presents with a problem, such as pain or fatigue, we will be of the greatest service if we do not restrict our focus to their physical body. For example, if a patient presents with chronic low back pain, if we focus solely on that anatomical region, we will miss other aspects which are crucial – psychosocial and spiritual.

Most of us are more comfortable in considering the mind and beliefs, than soul and spirit. For mind and beliefs, we need to have insights and manage psychosocial, personality and psychological issues. We practice in secular environments so typically we ignore the soul and spirit. Ancient Hawaiians believe ultimately the spirit is stronger than the other two components. We can, however, open up a conversation and recommend continuing this conversation with others.

How do we achieve balance for ourselves and our patients? We can improve our physical bodies through exercise and how we care for them – healthy diet, not smoking, avoiding excessive alcohol, no drugs, and other healthy life style choices. We can improve our mind and beliefs through techniques such as meditation and practicing healthful strategies – such as kindness. For our soul and spirit, we can recognize and honor this aspect of who we are.

From a Hawaiian worldview in a location with finite resources, it is especially important to be in harmony and balance with all things. The goal for each of us is to be in balance with ourselves. We should assist others in restoring balance and harmony.

For Native Hawaiians, there is an interdependent relationship among mankind, the land, and the spiritual realm which includes god and ancestral spirit. Pono exists at both the micro and macro level. This is not unique to Hawaiians but it is helpful to understand this context in considering the work that we do and the reflection of the interconnectedness among people, the spiritual realm and the environment. Does your life reflect pono?


There are three other concepts I would like to very briefly touch on. The first is Kuleana which is the value of responsibility. This drives self-reliance and self-motivation. This is both a personal value worthy of embracing and it is a value that our patients deserve to have instilled in them. This personal sense of responsibility means that “I accept my responsibilities and I will be held accountable.” We need to empower our patients to assume responsibilities for their lives. So often our patients hear advertisements saying “Ask your Doctor if Drug X is right for you?”. Perhaps we should promote public service announcements that state “Ask your doctor if Kuleana is right for you?

It is our privilege and honor to serve others and it is our responsibility to be held accountable for the well-being of our patients. We should serve as an invited guest vs. an unwelcomed intruder. How do we do this? We deeply listen and learn from our patients and validate their voices in their treatment. When we think of ourselves as guests in people’s lives vs. telling them what to do, we are willing to be humble listeners and connect with them.


A Hawaiian value that I have struggled with over the years is Ha`aha`a. I suspect that I am not alone. This reflects being humble, modest and open to our thoughts and perspectives of others. It reflects awareness that no individual can satisfy every need and all are to be respected and supported for their uniqueness. In our clinical practices, this is reflected in working as teams and engaging the resources our patients need.


All of us have values that influence the way we think, feel, and act. We are not separate from our values. By living in gratitude and appreciating and accepting one another we achieve happiness, for us and others. I encourage you to use Mahalo often, expressing our thankfulness and appreciation of others. When we are especially thankful, we say “mahalo nui loa” (thank you very much). We may also say a hui hou, which means until we meet again. This implies that there is a connection between us that is not separated by time and space.

Mahalo nui loa. A hui hou.”