Kuleana means having a sense of place in society such that each person has a right to basic necessities needed to sustain oneself—security of housing, food, health care, transportation, safety, and justice—and in turn has a responsibility to contribute to the sustenance of society,” Boyd says. She likens this sentiment to “client rights and health care ethics” in the Pathway program.

A contrast to the vacation resort paradise with which the continental 48 are so familiar, Hawaii actually experiences a great deal of socioeconomic instability. Pathway out of Poverty helps the impoverished, particularly native Hawaiians, build self-reliance and guides them toward a career in nursing.

Teaching since 1998, Boyd is currently an assistant professor at University of Hawaii, Windward Community College in Kaneohe, in addition to serving as Director of the Pathway out of Poverty program. In her own words, the program is “a curriculum based in Hawaiian values and traditions of healthy living that leads underserved community college students through a nursing pathway from Nurse Aide (NA) to Licensed Practical Nurse (LPN) to Registered Nurse (RN), with inherent increases in wageearning potential.”

Boyd won the Robert Wood Johnson Foundation Community Health Leaders award in 2011 for her commitment to improving health care in her community while overcoming immense personal obstacles. She received $20,000 for personal growth and a $105,000 grant for the Pathway program. The grant’s mission? “To support and sustain the capacity of individuals who demonstrate creativity, innovation, and commitment to improving health outcomes at the community level.” This mission was well served in honoring Boyd’s life and work.

From the ground up

When her guardian grandmother died, Boyd found herself in a much darker world. “My grandmother instilled in me that I was a precious blessing on earth. After she died and I went to foster care I was told that I was fortunate to have food on a plate or a roof over my head,” she says. “I was given old tattered clothes while foster parents bought new clothes for their own daughters. I was made to scrub toilets while other kids played outside. It sounds Cinderella-ish, but it’s true.

Boyd accepting the Robert Wood Johnson Foundation Community Health Leaders award in 2011

“I was warned that if I didn’t surrender I would be put on the street,” Boyd says. “I found myself 13 and pregnant. After my early childhood with my grandmother I was never again told in my youth that I was a blessing. I knew inside that my blessing was to help others.” Through this experience, Boyd says she learned “society treats the havenots as want-nots,” casting them aside. But she convinced her social worker she could live as an independent, and went on to complete nurse training and education up to her Ph.D.

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“I was fortunate to have come across folks in my own path out of poverty that held knowledge about supports for have-nots: orphaned, teen mother, impoverished, minority,” Boys says. One of the folks was Kathryn L. Braun, Dr.P.H., Boyd’s Ph.D. mentor and a professor of public health at the University of Hawaii. They met through Braun’s work with `Imi Hale, The Native Hawaiian Cancer Research Training Network, and Braun also served on the University of Hawaii’s dissertation committee throughout Boyd’s doctoral studies.

“I have always been inspired by Jamie, who overcame many obstacles to get where she is today,” Braun says. “The road was difficult, but it has motivated her to help others ascend the path out of poverty through education and service.”

From the early days, when Braun was helping her mentee obtain research funding from the National Cancer Institute, to now, where they support each other’s professional pursuits and even room together at public health conferences, the two women forged a close, supportive relationship. “As a Native Hawaiian I could not have completed my Ph.D. training without her dedication to mentoring NH [native Hawaiians] and other Pacific Islanders,” Boyd says of her mentor. Braun also notes that Boyd is one of the state’s first Ph.D. nurses to come from an indigenous background.

“She declined a [University of Hawaii] research position in favor of [Windward Community College], so she could reach Hawaiian and other disadvantaged students,” Braun says. Originally charged with developing a health curricula that would help get students “done and out,” Boyd recognized the deficiencies and disparities plaguing her vocational students. “They are not eligible for federal financial aid or student health insurance, WCC provided no graduation ceremony for NA graduates, and there were no supports to transition graduates to living-wage jobs,” Braun says. “She worked to convince WCC to approve a ‘pathway’ approach, helping transition NAs to the Associate Degree in Nursing. She worked nights and weekends to secure financial and in-kind resources to reduce barriers facing students, which won WCC and community support.” Boyd also steered the WCC’s administration toward indigenous teaching models.

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“I always had the capacity to give and would have to work very hard to earn resources to experience the privilege of helping others,” Boyd says. “I learned that every individual who presents as a ‘have-not’ may hold within the potential to make lasting positive change.”

On the Pathway out of Poverty

Native Hawaiians seem to have the deck stacked against them: they are more likely to hold low-paying jobs, lack health insurance, suffer from chronic disease, and drop out of school. According to Boyd’s 2007 article “Supports for and Barriers to Healthy Living for Native Hawaiian Young Adults Enrolled in Community Colleges,” “in 2000, 72.5% of Native Hawaiians were overweight, 54.4% met national recommendations for physical activity, and about 10% enrolled in college.” They are underrepresented in areas that count, like amongst college students and health care practitioners. Because of these disparities and others, Boyd is taking action.

At the crux of Boyd’s efforts to improve the health and socioeconomic livelihood of indigenous Hawaiians is the Pathway out of Poverty program: “A Values-Based College- Community Partnership to Improve Long-Term Outcomes of Underrepresented Students.”

Boyd points to a snowball effect in native Hawaiians’ achievement levels: students do poorly in the K–12 levels and cannot gain entrance to public universities. After years of insufficient grade school support, and consequently poor achievement, they’re also unprepared to enter fields like nursing. “But we naturally give so much to community and have a natural aloha to care for the sick,” she says. “We need for Hawaii universities to stop social exclusion behaviors of our early colonizers and allow Native Hawaiians to selfdetermine entrance criteria to nurse training in Hawaii.” The alternative? “Allow me to create the first Indigenous School of Nursing that is inclusive of Native Hawaiian values and cultural practices.”

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Boyd reports 135 students, or 90%, of those who have participated in the first three and a half years of the program graduated and became certified nurses assistants; 77 of those individuals went on to higher education, including 33 entering nursing programs.

“Her vision is to reduce poverty and increase representation of Hawaiians in nursing,” says Braun. “Toward that end, she secured critical partners and more than $1 million to build . . . Pathway out of Poverty.”

What nurses can do

“There are big gaps between resources that slow people’s potential to heal themselves,” Boyd says from experience. “My motivation is to eliminate gaps and create a steady, continual path out of poverty.”

It’s not about handouts, Boyd says. It’s about education. “Don’t give childcare; provide centers for child care co-ops,” she says. “Don’t give food; protect land to grow food or designate certified kitchens where [the] disadvantaged can feed each other.”

To that end, Boyd recently secured funds and began developing a “Seed to Plate” curriculum, says Braun. “Pathway students use the garden as a healthy foods ‘lab.’ Recognizing Jamie’s success in nursing and Hawaiian educational approaches, she was asked to join with faculty in botany and nutrition to build cross-disciplinary learning communities that aim to impart Western knowledge while honoring Hawaiian traditions for healthy living.”

Boyd’s Ph.D. dissertation defense. Committee members (left to right): John Casken, R.N., M.P.H., Ph.D.; Kathryn Braun, Dr.P.H.; Boyd; (chair) Chen Yen Wang, A.P.R.N., Ph.D., Lois Magnussen, A.P.R.N., Ed.D.; Bee Kooker, A.P.R.N., Dr.P.H.Boyd’s Ph.D. dissertation defense. Committee members (left to right): John Casken, R.N., M.P.H., Ph.D.; Kathryn Braun, Dr.P.H.; Boyd; (chair) Chen Yen Wang, A.P.R.N., Ph.D., Lois Magnussen, A.P.R.N., Ed.D.; Bee Kooker, A.P.R.N., Dr.P.H.

Boyd says those who are working diligently should be awarded with “change credits,” like those given to her by the Robert Wood Johnson Foundation. Boyd’s life’s work, her ultimate goal, is to reduce poverty and health disparities amongst indigenous and minority populations. She intends to do so through education, advocacy, and tapping into native teachings. Her solutions draw upon economic and cultural research. In the end, these people will have brought themselves out of poverty. “Through my volunteerism, peer mentorship, publication, and dissemination I help other underserved, and together we pull ourselves up and in turn again pull up even more.”

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Lisa Zick-Mariteragi, A.P.R.N.-R.X., M.S.N., M.P.H., an advanced practice nurse practitioner in internal medicine, worked with Boyd at Waianae Coast Comprehensive Health Center in 1998– 1999. “Jamie was a NP student at the time and knew that I took students who had a vested interest in improving health outcomes for indigenous populations,” Zick- Mariteragi says, who agreed to mentor the eager student. “She had a very clear picture in her mind of where she wanted to go professionally and what she needed to do to get there.” Zick-Mariteragi says Boyd, even then, was focused on the bigger things beyond the horizon of her graduate studies.

“Based on, among other things, the Native Hawaiian principles of ‘Ohana, Aloha (appreciation), Laulima (work), Lokahi (unity), and Malama (service), Jamie has been able to create a venue and provide access for disadvantaged individuals to improve their own lives by addressing their social, cultural, educational, familial, and fiscal needs through her programs,” Zick-Mariteragi says. “She demands commitment from them to pay back— not to forget where they came from—and forward-extend a hand to those in greater need than themselves.”

Sharmayne Kamaka, C.N.A., experienced that demand firsthand. She was one of the first Native Hawaiians to join Boyd’s Pathway program. The two met at Windward Community College, where Boyd served as Kamaka’s CNA instructor. “My first impression was that I thought I couldn’t meet her expectations. She was very strict, yet loving at the same time,” Kamaka says of Boyd. “I felt a magnetic pull toward her ‘mana.'” But over the four years they have known each other, that intimidation gave way to deep admiration and a strong mentoring relationship.

“Without Jamie, I wouldn’t be where I am today,” Kamaka says. A divorced mother of five when she met Boyd, Kamaka couldn’t afford to begin her CNA training, but Boyd helped her do the legwork needed to secure funding. “Four years later, I am on the dean’s list, a Phi Theta Kappa member, and a KCC Practical Nursing Student [graduate],” Kamaka says. “Without all the countless selfless hours of Jamie writing grants and securing contracts and community partnerships, I would have given up. It was always a dream of mine to become a nurse. Jamie is making it possible for my dream to come true.” But Boyd says Kamaka is “fulfilling her own dream….She hasn’t gotten anything she didn’t work very hard for.”

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Visions of the future

Zick-Mariteragi says she imagines Boyd will continue to grow the Pathway program; to surprise her colleagues with her unstoppable energy; and to make her kupuna (ancestors), her keiki (children), and her mo’opuna (grandchildren) proud. “All that she is, all that she’s done, she’s truly fought hard for. Determined, focused, passionate, humorous, pressed to improve the outcomes for native peoples by creating models of personal and community development—quite literally from the ground up,” Zick-Mariteragi says. “Though I was her mentor before, she could be mine now.”

Braun says she also imagines Boyd simply continuing her current trajectory: reaching out to the community to engage students and administrators, health care providers and funders alike.

Kamaka imagines Boyd establishing Hawaii’s first indigenous nursing school, with buildings named after her. “She is definitely a community leader and should be recognized as such,” Kamaka says.

And what does Jamie Boyd imagine for herself? Her ultimate goal is, indeed, to create a school of nursing for indigenous peoples, she says, combining traditional healing with cutting-edge medical technology—and social justice training to boot. She hopes the disparities affecting native Hawaiians and other underserved populations become a non-issue.

Yet, as long as they persist, and perhaps simply because they persist, disparities and deficiencies make so many people feel helpless—particularly the people living them. Then, someone fights back. Though disparities often prove stubborn, when confronted with individuals determined to eradicate them, they can topple. Jamie Boyd is one such fighter, armed with her cultural roots, her resolve, and her Pathway out of Poverty program.

“For every gain I experienced, I promised to turn back and pull up 10 just like me,” Boyd says. “I’ve already pulled up 10, and I’m still going strong.”

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