Mana Mama / Anax Angil

The problem we are working to solve is maternal child health inequity.  We know there is unequal access to care and support - birthing parents without access to prenatal care starting in the first trimester, babies being born prematurely, postpartum mood and anxiety disorders being under diagnosed, and lactation specialists hard to find or afford.  This problem is significantly worse for indigenous populations, where there may also be a health care desert, lack of information and resources, and providers that are not congruent with the community and culture.

However, almost everyone has a smart phone or access to one, and with that we can bring maternal child health information and care to their fingertips, with Mana Mama / Anax Angil.

Mana Mama / Anax Angil aims to give every parent and baby access to high quality health information, education, advocacy, lactation support and related resources via tele-health, a 24/7 Live chat platform, and our mobile clinic van, where applicable.  Our health access line is staffed around the clock with licensed health care professionals, allowing questions to seamlessly go into HIPAA protected video visits if the need arises.  By making this easily useable on a smart phone, people can go online whenever they have a question or need support, and have live response from an experienced provider day or night.  

On Oahu, Hawaii, we also use our mobile clinic van to reach people that would otherwise have a hard time accessing care.  This van had inception during early 2020, came to fruition in 2021, and has been in operation just over a year now.  The van is eco, utilizing solar for our vaccine fridge and rechargeable batteries for the cabin, making it ideal for the tropical climate.

Whether in person or virtual, 100% of our clients are screened for mental health, so that no one is left behind.  This allows for professional referrals to all that desire it, with tele-health option available for mental health therapy.

The target population we serve is Native Hawaiian, Micronesian, American Indian / Alaska Native, and people that would otherwise have no access to care or services.  This includes houseless communities, residential youth in shelter, victims of domestic violence or gender based violence, people with substance abuse and mental health disorders, and soon, incarcerated women.  Many of our Hawaii clientele is military or military dependent, including some of our HMHB staff as well.  

To understand the needs of our community and the people we serve, we attend state collaborative calls, participate in community stakeholder events, organize virtual meetings and panels to engage people and see what they need.  We also actively walk around and meet our community, sometimes with a lead, sometimes simply trying a new area and going around with a first aid kit, produce and a smile.  In addition to "boots on the ground" efforts, there is a plethora of behind the scenes work - getting credentialed with insurance plans, individual and group training, creating new programs and events, volunteering with partner organizations and foundations, building relationships and networking.

Healthy Mothers Healthy Babies Coalition of Hawaii (HMHB) is a non profit organization that the clinical arm, Mana Mama falls under.  The team consists of a diverse staff with many languages and cultural backgrounds.  We are all dedicated and passionate about this work, the organization, and our community.  Additionally, we regularly take on students, developing a unique workforce and inspiring future change makers.

Mana Mama / Anax Angil is an extension of the work we are able to do in person, by providing virtual health access options for communities that may not yet have maternal child health champions.  In the native communities, for example, this means monthly calls with elders and birth workers around the four directions, to discover what is working, what is needed, and how change, sharing and improvement can be done.  Design and implementation comes from the community, via all of our lived experiences and the information we gather from voices around us.

This solution means maternal child health access to tribal members and native nations, no matter where they are or where they live.  Support is essential for lactation, human milk is our first food and medicine.  We support all families who are literally feeding the future, and keeping indigenous peoples alive.

We have been intrigued by Solve since we first found out about it in 2020.  The fact there is an native innovator option for indigenous communities is reason enough.  Being selected as a solver team may open doors to us for funding, networking, support and connections.  Financial barriers may be an issue as we continue to grow, and for example when we are ready to secure our own building, for clinic and accredited birth center.  There may also be better software to meet our virtual needs that we haven't found yet.  Legal services may be another aspect to consider as we grow, especially when exploring new ways to conduct care, and work across geographical boundaries.  

The virtual solution is new and significantly improved by having all licensed professionals on the health access line 24/7.  This means expert input, with the ability to convert questions into immediate tele health visits any time of day or night.

Broad positive impacts could come with breastfeeding, for example.  If someone gets support where they may have not been another lactation consultant, for example in rural Alaska, she will then be more likely to have a positive experience, breastfeed longer, and encourage her peers to do it.  She may even go on to work in the field.  Normalizing human milk feeding is always positive!

An impact goal for the next year is to get Mana Mama / Anax Angil to collaborate with at least one tribal group, such as where I am enrolled or another south central Alaska area, under Cook Inlet Region Incorporated (CIRI).  

An impact goal for the next five years is to open the first accredited birth Center in Hawaii, so that we have a physical space that houses clinical care, education, training facility, and more all under the same roof.  We would still continue to do virtual and mobile care, but this would expand local capacity and provide another safe birthing option.  We would like to see more native midwives and lactation consultants, and with a training site we can make that dream a reality.

Measurable indicators of success that are already being done are to track number of clients with each service or program that HMHB offers.  This is done with online software, and is updated daily.  This allows for real time accuracy about what program is working and how many are accessing services.  

With Cribs 4 Kids, for example, participants are given pre and post tests about safe sleep to see what they know before and after watching the material.  Then a few months after receiving a crib, they are given follow up calls to see how baby is sleeping, ask about feeding patterns / habits, and give input about the program.  This is highly effective feedback!

We expect our solution to have a positive impact on the problem.  When people have more information, they have better outcomes, and birth is no different.  We hope to see more parents access regular prenatal care starting in the first trimester, babies getting to full term, people satisfied with their birth experience, being successful with human milk feeding, and reporting overall positive experience with postpartum.  

Our community based doula program is around 1.5 years old, and the data supporting it is positive as well.  Participants complete information before, during and after their time with a doula, and the findings are used to improve the program, see what is working and what needs to change.  It has been quite successful.  

We rely on apps, platforms, the internet, smart phones and the good old motor transportation to make our work possible.  This helps with internal communication, communicating with clients, provider and the public, and helps keep everything organized and HIPAA compliant.

As I mentioned before, our mobile clinic van has a solar freezer, which send precise measurements to our smart phones at 10 minute increments.  So I like to say we are eco savvy as well as technical now!

This is an integral part of our work and hopefully evident throughout the stages of this solution.  I believe diversity, equity and inclusion is part of being a leader, and what makes a strong leadership team.  HMHB is made up of a diverse staff, with many experiences and backgrounds that make for a unique and inclusive environment.  We include all people, and do not prevent participation by marginalized groups or exclude opportunities from those that might be disadvantaged.

A great example of this is with maternity leave and mothering during the pandemic.  Obviously babies are part of our lives, and they have come with us, we have worked from home, we are flexible, and we fit it all in.  Sometimes this means over the weekend, into the night - as we often write, and being there for the kids when we can.  Everyone is welcome and that makes it much easier to go to work feeling supported and included and loved.

HMHB is a Non profit that has a long history of social programs and referrals and resources, as well as a new clinical arm making patient care possible.  Mana Mama / Anax Angil falls under this, and allows the use of a 24/7 health access line and tele health available to anyone with a smart phone and wifi.  We provide most services free to qualifying participants, going off the 2022 WIC guidelines for income restrictions.  If people can pay, they do, and we also rely on donations and grants, while starting to bill for some services and clinical care.  Lactation consulting is provided in office, at home, Telehealth or in a group virtual or in person setting.  Midwifery care (prenatal and postpartum visits) happens in the mobile clinic van, the office or peoples homes, with the occasional tele health, and launching at the end of this month we will also start group prenatal classes.  It is always good to have options!

We are working toward financial sustainability by having grants that are project based versus simply charity, and starting to bill for services, when we can, as well.  HMHB relies on foundation grants and donations to cover our services, and we are excited to see the organization expand and grow and flex, as it did during the pandemic.

One of our recent successes was being in the first grant pool recipients for Direct Relief's Health Equity funding, in 2021.  This generated our first year budget of Mana Mama, and allowed us to do community outreach (Covid vaccinations and PPE distribution) with the mobile clinic van. Direct Relief also generously supports us with in kind donations of masks, gloves, medications, and other items (as available) needed for clinic operations.  

Additionally we receive grants from local foundations in Hawaii, such as Office of Hawaiian Affairs, The Longs Foundation, and City and County of Honolulu.

We have also been recipients of private foundation grants, such as the Trotula Foundation, for our work in maternal child health, along with donations from individuals and other organizations.  

Healthy Mothers Healthy Babies has been around since 1992.  We continually write grants, conduct fundraising events and look for funding opportunities to keep the organization successful.