Kristine Qureshi, phd

PH: Today is October 5th, 2021. The time is 6:33 a.m., and we are doing an oral history interview with you. So just to start things off, can you please state your full name?

KQ: My name is Kristine Qureshi.

PH: Thank you. And where were you born?

KQ: I was born in New York City, New York.

PH: OK. Can you describe your family and the neighborhood that you grew up in in New York?

KQ: Sure. I grew up in Queens County, which is part of New York City. I was a family of five children and two parents. We lived in a two bedroom apartment building. It was pretty crowded, but at the time, it never occurred to me that it was crowded. I lived in a community that was very Catholic, sort of like an Orthodox Catholic community. I went to Catholic school for the first 12 years of my education, and from there, I went on to nursing school to a diploma program.

PH: OK, and can you tell me a little bit about exiting high school? You chose to pursue nursing, but what were your options at that time and why did you choose nursing?

KQ: It was very different. The role of women were pretty prescribed at that point in time and especially in that particular type of community. So I had four basic options. I could become a secretary and in fact, you could major in secretarial studies in high school and take typing and stenography. So I could be a secretary. It would be acceptable to be a teacher. But then you needed money to go to a college. I could become a nun, or I could become a nurse. Those were the four things that girls who graduated from high school most commonly did at that point in time. So I went to nursing school because that was one of the four choices I had.

PH: Sure. And then can you describe your nursing career for me? I understand that you had a lot of experience with disaster based preparedness so maybe talking about that as well.

KQ: Well, when I graduated from nursing school, I started as a staff nurse in the critical care unit. I then moved on to the emergency department and worked in the E.R. for many years. Along the way, I rose through the ranks, and I became first a charge nurse, then I was a clinical nurse specialist, then became a supervisor, assistant director of nursing and ultimately, a director of nursing for critical care and trauma services for a health system in New York City. From there, I went into academe, and when I went to get my Ph.D. in nursing along the way, I got a bachelors and then a masters and then a Ph.D. in nursing science from Columbia University. And while I was there, I was introduced to community public health nursing, and they needed assistance on a large grant that was based on community based disaster preparedness. And due to my emergency nursing background, I knew a lot about disaster preparedness having been a responder to many disasters. I became heavily engaged in community and public health preparedness.

PH: OK, thank you. And you now live in Hawaiʻi. Can you tell me a little bit about your journey here and what brought you to the islands?

KQ: Sure. I have three sons. My middle son went to the University of Hawaiʻi at Mānoa and graduated and stayed. His older brother came to visit him and called me on the phone and said he was staying. And then his younger brother came and visited him, and they all three stayed. So I had three sons living in Hawaiʻi, down in Honolulu, and my husband and I were in the big house on Long Island, sort of all alone. By this time, I was somewhat of a recognized disaster researcher, and I met a faculty member from UH at a conference where we co-presented on the same topic. And he said, "wow, you have children who live in Hawaiʻi, you should move there." So I ultimately applied for a position at the University of Hawaiʻi at Mānoa in the School of Nursing. They were looking for a faculty member with experience in disaster preparedness and response. So it was a really good fit. So I moved. My husband retired and we bought a home on the North Shore and we live here up in Pūpūkea, and my three sons now live down in sunset. So we're very close.

PH: That's wonderful. Can you tell me more about that position that you took on with the School of Nursing? And then also when you made your transition to being the associate dean for research and global health?

KQ: Yeah, I started at Mānoa as an associate professor because I had experience at Columbia University as an associate research scientist, so I took a faculty position as the associate professor. I then did quite a bit of research. I put together the master's program in Population Health Nursing. I served as the program director of that program for 10 years. Along the way, I served as the graduate chair in the department. I was then offered the position. I attained the rank of full professor with tenure. I was then offered the position as the associate dean for research and global health.

PH: And for someone with so much research and background in disaster preparedness, can you tell me about some disasters or emergencies that you encountered in your career prior to COVID 19?

KQ: Well, when I was an E.R. nurse, we were receivers. We were first receivers for many large scale disasters that would occur in New York City. Now, not to the level of COVID or 9/11, but we were the receiving E.R. for JFK. So if there was any type of an emergency at the airport, we were the receiving facility. So jet fuel spills and people coming off of a plane or people being injured during a plane landing, major vehicle accidents like school bus crashes, major fires in high rise buildings where they would get many burn victims. So I was very well versed in acute disaster preparedness and response. Then when I moved over to Columbia University and I got into community and public health nursing, I really took what I knew about that and applied it to a community public health setting. And at that time, then 911 occurred. So I got involved in research. I was a co-investigator on the World Trade Center evacuation study where we actually assessed what were the facilitators, as well as barriers for people exiting who actually survived the World Trade Center event by actually getting out of the building and surviving. And we interviewed those people as well as conducted a large scale survey. Shortly after that anthrax events occurred, and I became very involved in that response as a researcher because along the way in my nursing career I worked as an infection control nurse, so I was very well versed in infectious diseases. And anthrax is an infectious disease, so I did a study called The Ability and Willingness to Respond to a Disaster where we gave people scenarios of different types of disasters: mass casualty event, a bio event, and we gave them smallpox, a chemical events, etc. And we asked them, would they be able or willing to respond? And what we found was ability is really predicated on one's personal obligations: children, pets. In New York City, if you live in an apartment and you have a dog, you can't stay at work for 24 hours because who's going to walk the dog if you live alone. So it's things like that, whereas people in the suburbs, their dogs are in the backyard when they're not home, and that's not what happens in a place like New York City. But personal obligations such as children or elder care. Also, if your child is going to be let out of school at three o'clock and you need to pick them up, you can't stay. But then willingness is predicated on assessment of risk. So nearly everybody is willing to respond to a mass casualty event. We said if a small plane flew into the Yankee Stadium during a baseball game and there was a large mass casualty, would you respond? Almost everybody said yes. But as we went up the ladder of risk, willingness went down. So people least willing to respond would be to a smallpox event because we would perceive that they would likely either get sick or bring the illness to their family at home. That study has been replicated across the world. The tool has been shared with multiple countries, and they've actually adapted the scenarios to their local country situation. It's a very well-known study, and I put that together after the infamous anthrax events. So I used my clinical background to actually shape my disaster nursing research.

PH: That's fascinating. Thank you for sharing about that study. Could you tell me coming to the present day, when did you become aware of COVID-19, and was there a point when you considered it a threat I guess globally and especially here to Hawaiʻi?

KQ: Well, everybody heard about it on the news. During the fall of 2019, we heard about Wuhan, China, a couple of cases, so they said. And then we saw it spread across China and saw it come to other countries. So it was around November when I believe it sort of appeared in the United States, maybe some time a month or two plus or minus. And by December, we were heavily geared up. We started to heavily gear up for it here in Hawaiʻi. So in December, I put together for the School of Nursing an information sheet about COVID-19, what it was, and I spent a day looking up everything I could from a reliable source from the Centers for Disease Control, from WHO, from the NIH because there was a lot of misinformation being circulated. So I put together an information sheet. I made it very simple, but everything was referenced. So everything was factual and backed up with the science and the science behind, sent that out to the Department of Nursing. It was very well received, so we sent it to dental hygiene as well. I then put together maybe a week or two later an actual training program not only about what COVID-19 was as a disease, but what was the public health science behind controlling such a disease and gave that to the School of Nursing, School of Dental Hygiene. The faculty liked it so much that it was recorded, and all of the nursing students were required to see it. Then I gave the faculty in the school updates. Sometime towards the end of the winter and early spring, I was recruited to serve on the Hawai'i Emergency Management Agency, and I was appointed to serve as the unit leader for the Community Care Outreach Unit. In the interim, I developed some training programs for the Hawai'i Department of Health Medical Reserve Corps that they were planning to use for the MRC volunteers who were also serving in the response for the COVID 19.

PH: And with HiEMA, I know you conducted a few surveys. Can you talk about the purpose of those surveys and what they were trying to collect?

KQ: Yes. So the the mission of the Community Care Outreach Unit was to monitor the impact of COVID-19 on the health and social welfare of the citizens of Hawai'i, and we wanted to gather information and give that information back to HiEMA so that they could use it for planning. And they really wanted us to also focus on individuals in the vulnerable groups in the community. So what we said was, "well, if you have vulnerable groups, in order to support them, there are social service and health care agencies." So the quickest thing to do first was to assess the organizations that serve these people because they know what's going on. Because if more people are in distress, they'll be seeking more services. So we put together a survey of health and social welfare agencies and asked them "has your volume gone up? Has it gone down? Are you seeing new problems, new requests and new types of people requesting services?" And we got that survey very quick out the door and 121 social service or health care agencies from across the state actually responded. It was a very good response rate, and they said yes, indeed, their volume had spiked. Some of the more frequent things that were asked for was food and that correlated with what we were looking at on the news where they're giving out food in Aloha Stadium the requests became so urgent. But they also said that they would like to be able to ramp up their telehealth services, but they lacked the equipment, and they lacked the personnel who knew how to deliver telehealth services, so that information was given to HiEMA, and HiEMA was hearing similar things from similar groups. It wasn't just our group. But that actually was the impetus for rapid increase in funding for telehealth services across the state. And as a result, the telehealth system has been markedly strengthened in the state of Hawaiʻi based upon the COVID needs and the COVID response.

KQ: So that information was put together in a report sent to HiEMA, but back to all of the agencies who responded and any other group that we could think of, and we said, "use this report as your statement of need baseline. So when you're requesting CARES funds or other resources, you have backup to document that, yes, this is a true need." We then tackled the more difficult charge of assessing individuals, so we assessed it at the organizational level now, at the individual level. And along the way, we expanded the Community Care Outreach Unit from five members who were basically faculty members at UH to 30 members, and those members were community representatives from vulnerable groups, as well as organizations across the state that serve the vulnerable population. So we had representation from the Native Hawaiian. Pacific Island, Filipino community and then the organizations that serve the homeless, the shelters, the food banks, the Center on Aging, all sorts of agencies and offices from the state of Hawaiʻi that serve the vulnerable groups. We had a GIS team from UH. So when we put together the survey, they were able to help us collect the correct information so we could map the data by zip code so that we could see where the respondents were by zip code across the state, but where the urgent needs were. So that was really very helpful and we put that survey together and then gave that to HiEMA, as well as to all of the agencies and the entities that actually responded that we knew so that they could use that information to inform their decision making. We found the group that by far was disproportionately most affected were the Pacific Islanders, and we actually had very specific granular detail what their particular needs were. That report was also posted on the HiEMA website. And just last week, we broke that large report down into several journal articles that each focus on the state as a whole, each island as well as each vulnerable group. And it's just been published in the Hawaiʻi Journal of Health and Social Welfare as a supplement. And I can email that supplement to you. You may want to appended it to your historical records because that gives the details of the impact on the people in the populations.

PH: I would love that. Thank you. That's really what we're looking for, and it seems like you had a really critical role in understanding how various groups were impacted and also getting them the resources they needed.

KQ: Yeah. See one thing I think it's important to note, when you have a large scale disaster like this, the State of Hawaiʻi using state funds as well as federal funds had additional resources to help people. But they just can't willy nilly give out hundreds of thousands and millions of dollars. There needs to be an established need. So putting together surveys like this and reports like this gives people the information they need in a formalized way that they can then use to establish need. After we completed that survey and we had the results, we asked each of the three stakeholder groups of the vulnerable groups to put together a list of their prioritized needs based upon that report findings. And Lieutenant Governor Josh Green actually came attended via Zoom, a community care outreach unit with the vulnerable groups. He read the report, and he gave them strategies that they could use to actually use that information to advance their issues. So it was very well received, and we were very honored that even the lieutenant governor when he came on the Zoom call actually had read the report and said, "I read your report. I understand these problems. This validates what a lot of people already knew and now is your time to move this forward. And this is how I suggest you do it." So it was really very powerful.

PH: Yeah, that is. Wow. Can you also tell me about your work to develop and execute a contact tracing team?

KQ: So moving down the timeline. So that was done in the spring, this work. Now COVID 19 is in the state of Hawaiʻi, and they know that they want to do contact tracing. So the Department of Health came to the university and they said, "we need a contact tracing training program put together, and we need it done very quickly." And they came to us in May, and they wanted 400 people trained by July (laughs). So they came to me and said, "you clearly know something about this. Can you do this?" I said, "actually, yes, because when I was an infection control nurse, I actually did contact tracing. So I've done it. And I know what it is." So I put together a team. It wasn't just myself. These types of responses were always done in a team. And I think people really need to understand that. But I was the team leader, and we put together a curriculum that was really, I have to tell you, I'm very proud of it. It wasn't just your looking at a PowerPoint slide set and going through the thing. It's sort of like flat learning. We put together a synchronous meaning a live, but via Zoom training program it was eight hours of didactic. But in that didactic, every 30 minutes there was a breakout session and people would go into rooms of four people and discuss and come back and report back. So it was very interactive learning. And then they would come back the second day for a four hour live simulation via Zoom. And we got actors from the School of Theater Science, and they were trained on how to pretend they were, as an actor, they were a person who gets the phone call that your COVID-19 test has been positive and you need to go into isolation or quarantine or you've been exposed, and you need to go into isolation or quarantine. And we had four different scripts. The person who was accommodating, a person who was like angry, another person highly anxious, etc. And they were just wonderful. And the student learner, they were in groups of four, so each one took a turn making the call and getting the response. And then they had to think on their feet. And the actor improvised. So it was really very, very highly regarded. We evaluated it on a scale of 1-5 for every question it was 4.5 or higher with 5 being the highest. People really, really approved it. And we looked at knowledge as well as their skills. And then we had faculty in each of those rooms. So it was a highly intensive but very effective program, and we met our goal. We trained 396 people by July 15th. So we developed a workforce for the state and because it was all online via Zoom, we had individuals from the neighbor islands as well as Oʻahu. And the requirement for the UH Mānoa program was you had to be a clinician, so a physician, a nurse, a pharmacist or a social worker were the key categories. And then we added paramedic, but we had very few paramedics. That was at the request of the Department of Health. They wanted the initial contact tracing to be done by people who were licensed health care providers because those people had the ability to make an assessment over the phone when they were talking to a person as towhere they short of breath, did they need to call 9-1-1 for them, etc. We learned over time that you really don't need a licensed health care provider to do that, but at the beginning of COVID, nobody knew and the DOH was being very judicious and using caution and feeling our way as we went along. So I respected that decision that they made. So it was a very succesful program.

PH: Yeah. And you also mentioned, I mean, for those students, how were they able to use those skillsets even if they didn't become contact tracers? Could you talk about that?

KQ: We just did an assessment of people who went through the program, and we just got the data a couple of weeks ago. What people said was, first of all, quite a few of the people who got contact tracing training, they didn't work for the DOH, but they worked for Queens, they worked for a Community Health Center. But they also reported that they felt like they were much better informed about COVID 19 and the whole hot button contact tracing issue, which we know is on the news. People had lots of opinions about it, and they served as sort of community educators to the general public. When people were talking and asking questions, they actually knew what was involved and why certain decisions will be made. And they said it gave them what they describe sort of as a sense of control in the sense that they actually knew what was going on and took away some of the uncertainty that many people had during that time period of the COVID pandemic. And we didn't teach them only about contact tracing in the contact tracing training program. That program included content: What was COVID 19? What was the virus? How was it spread? With the public health principles to prevent the spread of the disease because a contact tracer needs to tell people why you're going into quarantine? So it gave the entire background, and it also talked about how to keep yourself mentally protected and to reduce the stress so that you yourself did not get responder stress. So it was a very comprehensive program, not just how to do contact tracing, and they felt that that information was very, very useful for them and were very glad that they took the program.

PH: Outstanding. Well, switching gears a little bit and talking about some of your other roles, can you tell me when you assumed a full time position with the Pacific Island Health Officers Association?

KQ: Yeah, so I took you through July of 2020, and then I did a lot of pod work (Point of Distribution Operation) with vaccine distribution, developed a pod training program that was used by the state for the Medical Reserve Corps. All volunteers had to go through the pod training program that I developed for the MRC. I'm also a Medical Reserve Corps member for the Hawai'i Department of Health. And then helped the university stand up a pod, and then we came into 2021. All those pods were put together. At that point then everything was sort of set up with COVID response, and I had done work for many years for the Pacific Island Health Officers' Association as a consultant. And they asked me several times to come onboard, and they had a position open as the regional coordinator for Human Resources for Health for across the US affiliated Pacific Islands. And I had enough years at UH it was I said, "my time to retire and to move on to something else." So I retired from the University of Hawaiʻi and on September 1st I started working at PIHOA (Pacific Island Health Officers' Association), and that's what I'm doing now.

PH: OK. Sorry, I didn't mean to skip over in the timeline.

KQ: That's OK.

PH: Could you talk a little bit about those vaccine pods and especially the one that you helped establish at UH Mānoa?

KQ: Well, again, it's very important for the record to understand no one person does anything like this. It's always a team effort. As I mentioned, the training program I developed for how to be a pod worker and then also one for bloodborne pathogen exposure training, because that's an OSHA requirement. Any time any worker is going to be exposed to blood or body fluids, they have to have OSHA approved blood borne pathogen exposure training, so I updated that program for the Hawaiʻi Department of Health. I had developed it several years ago and I updated it for them, and every worker who worked in a pod had to have that blood borne pathogen exposure training, as well as the how to be a pod worker training. Those two training programs were posted on the UH Mānoa website because we could get it up very quickly. DOH was very busy responding to COVID 19. It has been since taken down and now given back to the DOH, and they're going to post it on their website as enduring material. So that training, we originally had student nurses helping out. We trained our student nurses, and they helped with the public pods that the DOH put on over at Leeward Community College, as well as the community colleges across the state and UH Hilo. Then back here at Mānoa, there was a team that worked through the UH systems, you know, executive office and we put together a pod for the first people eligible to get the vaccine in the state were, of course, nursing home residents, healthcare workers. And they deemed the UH system health science students and faculty to be healthcare workers because they also went into hospitals, and they did not want to be bringing COVID into hospitals or nursing homes or health facilities. But those students and those faculty were also deemed to be high risk for getting COVID in a hospital. So what they did was they put together a pod for UH Mānoa at UH Mānoa, and it was all of the health science students in Honolulu County were eligible and their faculty were eligible to come to the UH Mānoa pod. And on the neighbor islands those health science students got vaccinated through their district health offices. They had similar programs. There were some people who had gotten vaccinated at other places, like at the hospital pods for healthcare workers. But we had it open, and we put together a pod, and it was just shy of 700 individuals that came and got vaccinated. They were given appointments, and we put it on. We hosted the site and provided the vaccinators and the pod. Most of the pod staff and the Department of Health sent a public health nurse and the National Guard came. They actually managed the vaccine and maintained the cold chain. And then we did it again for the second dose 21 days later. We then had experience with this, and later on when it was open to the general public, we made the arrangements to have pods on the Mānoa campus, but Safeway came and they were actually the entity that administered and managed the vaccine. But again, then we provided some of the support personnel, the line flow controllers, registration clerks, etc. So these pods have always been a multipronged effort. And then throughout this entire time, the UH Mānoa Nursing, the medical school, the JABSOM as well as UH Hilo College of Pharmacy regularly provided students and faculty to work at the Leeward Community College pod, which was operating, I think it was four days a week and they were vaccinating between about 700-800 people per day, and the health science students based in Honolulu actually served as vaccinators. We provided a good portion of their vaccine workforce. There were others. The DOH also had vaccinators there that worked for them that were were hired by the DOH. So I think about half of the vaccinators at any given time came from one of the UH schools. And I led the initial efforts to coordinate that. And then the UH system, there's an office from U Healthy Hawaiʻi, and they then got a scheduler and they took that over.

PH: And with these pods, and I guess especially the first one at UH Mānoa, can you just describe why that was so rewarding for you? I know you talked a little bit about it in the pre-interview.

KQ: Yeah. During any kind of a disaster, well, it's a human trait. People don't like uncertainty and people want to do something. They don't want to just sit and just have have the event around them occur. For me as a person, it was an intrinsic personal reward to know that I could contribute in some way to the response. I loved working at the University of Hawaiʻi at Mānoa. I felt that I was part of the ʻohana. And this was my way of giving back and contributing. And there's a personal satisfaction that one gets from being able to do that. So it was both rewarding to me as well as, I'm assuming helpful to them.

PH: Yeah, absolutely. I can imagine it was very helpful. I want to get into some personal questions, but before I do, just talking about all of your experience with disaster preparedness and your work in New York and then coming now to Hawaiʻi, I guess obviously you experienced the COVID 19 pandemic here. But are there any similarities or differences between your work in community or disaster preparedness between these two states? I guess culturally or even ecologically that stood out in terms of how you would respond to a disaster?

KQ: There are some similarities and there are some differences. So in similarities, the state uses the Incident Command System, which is a system that's used across the United States and actually about half of the world uses the Incident Command System. It's a very structured, organized way to manage a disaster. And it's hierarchical, and there are people in charge. There's a chain of command and people have very specific roles, and they're supposed to stay in their lane. But what's different in Hawaiʻi is Hawaiʻi is a small community. Everybody knows everybody. And so it's easy to get stuff done. It's easier to get stuff done here because, first of all, people are very connected to the community. There's a lot of people who are related where they know each other and people are very embedded in their communities and care about the community very, very much. There also is I find this aloha spirit. So people rise to the challenge, they're good natured, they follow the rules. I didn't see people trying to jump the line when the vaccine was being rationed at that point. They waited their turn, and they they cared about the kupuna and the keiki. So culturally, I think it's gentler, it's much more cohesive. And people really, even the participants at every pod I was at and I was at many, many pods out at Leeward, there were no events. You didn't have to worry about outbursts of people getting violent or testy or tired that they were waiting. When we did the Mānoa pod, at one point, we didn't have enough vaccine defrosted, so there was a 45 minute delay. And people were standing in line in the hot Hawaiian sun, and we didn't hear one complaint. We went up and down the line and we said, "we apologize. The vaccine has to defrost and we're sorry." And we move the line into the shade. But people just said, "thank you for telling us." And in other states, if that happened, there would have been complaints, and it just didn't happen. So I think culturally, people are quite connected here, and they are very community minded, and I found it was a pleasure. One thing I noticed was there were individuals when I was working in HiEMA, a few, not a lot, a few who came from the mainland. They were deployed here. And at the beginning, they sort of had an attitude like they were coming to help us because maybe we weren't smart enough or something. So there was an event where we were on a call and they said, "well, we came here to help you do some community based outreach." And after the call, I called up a colleague at the med school and I said, "I was a little offended. Do they think we're like stupid that we can't do that?" She said, "you're like the third person who has called me about this." It was really very inappropriate, but it was very interesting because when that person went back to the mainland, to California, they had to do something. They then put in a call and said, "no need to come back." So it's funny. I'm in Hawaiʻi now. I'm living here for 15 years full time. But I had actually bought a house on the North Shore, and my three sons had lived here, and we bought a bungalow, and I can see now the attitude that sometimes people come in, and they think they're going to help the islanders because they're like too stupid to figure things out. And it's subtle. But boy, when you're here for a while, I can pick it up, and especially because I'm from the mainland, I can read what they're saying between the lines, and it's really very interesting. But it was dealt with in a very diplomatic way. But nobody would come into New York City and behave like that, otherwise, they'd have been thrown out the door. Well, they wouldn't come with an attitude that they come in to help New York City because they're too, you know, they don't know enough to help themselves. People from big cities on the mainland don't have to deal with that. So it was interesting that I picked up on it immediately.

PH: Yeah, thank you for sharing that perspective, especially coming from the mainland and then now living here.

KQ: Yeah, I'm a good advocate now (laughs).

PH: Yeah, exactly. From this past year and a half, were there any major lessons or takeaways that you'd like to share?

KQ: I think it's really important to note and put on the record. In every disaster and this is a catastrophic disaster with 700,000 people dead. This is a catastrophic disaster. But it's sort of a slow evolving, you know, people are getting tired of this disaster already. There has been a lot of criticism about the Department of Health. And I feel very confident to say they have done a remarkable job, and I'm sometimes disheartened by the lack of recognition for how hard the Department of Health has worked and how good they really are. They were dealing with a lot of uncertainty. They didn't know until two days before how much vaccine was coming into the state. They would get notice 48 hours ahead of time. Well, sometimes 24 hours ahead of time. The plane is in the air, and it will be landing in Hawaiʻi, you know, x y z time. They have done and they continue to do the best that they can do with the uncertainty, the lack of resources and the evolving and unfolding situation. So I rarely hear people speaking in support of the DOH, and even in the beginning when there was so much uncertainty, there was uncertainty across the world. DOH has gone out of its way to reach out to communities, to reach out to people. I was given the task. We want to know what is the impact on the people in this state, but pay attention to the vulnerable groups. This was way back and just at the beginning they were concerned about the vulnerable populations. The public health nurses have been working tirelessly. They ran the pods across the state, and they rarely get that recognition for not only the hard work they've done, but the expertise. They're the ones who knew how to operate a pod in Hawaiʻi because they ran the Stop Flu at School program every year. It was run by the PH:Ns, so they used that model. And I think it's really important to go on record that while people are very apt to criticize, I need to tell you the work that the DOH has done, Dr. Char, the PH:Ns, the whole DOCD, the state epidemiologists, the division for vaccines, they're working seven days a week without complaint and quietly. They're not grandstanders. The Medical Reserve Corps comes out of the Department of Health. They staffed half the pods, too. So I think it's important to go on record and recognize, and I would love it if somebody at some point in time would say, "thank you" to the department as a whole and to the workers that work there, especially the ones... They translated materials, all sorts of stuff that people don't say, "how did this get done?" It was done by the DOH. So I want that to please be on the record.

PH: Yeah. Thank you for sharing the work of that department and especially some of the overlooked individuals from the department.

KQ: Yeah. And I don't work for the DOH. So I'm an unbiased person, but I have been there and I've worked with them and they've gone out of their way.

PH: Yeah. Can you tell me when you weren't working, how did you spend your time during the pandemic? That was probably a very limited portion of time.

KQ: Yeah. I will tell you, I work seven days a week, and in the beginning I was working 14-15 hours a day and then probably turned it down to like 10 hour days. There was never a day that was less than 10 hours and never a day on the weekend that I wasn't working as well. But I followed the the advice of the Department of Health, and I formed the family bubble. I work from home at some point, unless I was going out to a pod clinic. And then I wore my mask and good hand sanitizer, and I formed a family bubble. And the only time I went out was to go to Costco or Foodland. That was it. Once in a while, a run to Wal-Mart if I really need something that Costco or Foodland didn't have and almost everything else from Amazon. And I continue to do that today. I haven't gone to a movie. I did go for the first time in August, I went to a restaurant. I went to Turtle Bay because they have outdoor dining now. You eat on the golf course. So with my family bubble and we went to Turtle Bay, and it was my husband's 79th birthday. So they put tables out on the golf course for us and our grandkids ran around on the golf course. So that's it. That's all I've been doing.

PH: Has the experience deepened your connections with family or community or changed how you see those relationships at all?

KQ: Well, I had a very deep connection with my family already, but I think it got deeper. I think ilooking at all of the people who lost family members makes you understand how precious life is and how precious family is. We all became more tolerant of each other in the sense that there were times when I made a comment to my daughter-in-law and I said, "you know I love you all to death, but I'm getting a little tired of you" (laughs) because I live on an acre in Pupukea. So the gathering place is our home because we have a fenced in acre yard and the six grandchildren can run around outside in the yard safely. And I have a big enough house to feed everybody. I can have 14 people over my house and feed everybody upstairs. I have enough people to sit in my great room between the kitchen counter and the dining table, everybody gets a chair. So my sons live down in sunset in their very small homes. So the whole family wouldn't be able to... We'd be on top of each other. So the gathering place is my home, but we've gotten into a family rhythm, and I'm delighted to have it. I will tell you, once COVID is completely over, we'll probably disperse and not see each other as much. But that's OK. The children need to have other friends and learn how to interact with other people. And I know that they also yearn for friends in their age group. My adult children want to have social interactions with people in their age group. I'm sure they talk about different things. And I think we're pretty typical. Most people I've spoken to in my generation have actually done that and many of my friends who are in my age group, also, they have the bigger home and their children or their close people, they tend to come to them.

PH: With all of your knowledge about the pandemic, I mean, both on the operation side and also how it affected groups and individuals, do you have any concerns or hopes for our community moving forward? I mean, exiting, hopefully this pandemic and then post-pandemic.

KQ: I think at the end of the day, there's that old adage what doesn't break you leaves you stronger. And I know that at the end of this, Hawaiʻi will emerge, and our communities will be stronger. I hear all the time people saying, "you know what, the slowdown in tourism, this is what it used to be like in Hawaiʻi, and we don't want to go back to the masses." You know, it's like being in Times Square, in New York City sometimes down in Waikīkī. So I think a lot of people have learned that it's human connections and people connections that are important in life, not the things. And a lot of people have learned to do without because you just can't go shopping to the mall and you can do fine without half of those things anyway. So I think people will come out of this with a stronger appreciation for human connections because that's what really enriches one's life, not things. And I do hope, though, that we learn this lesson and understand this is probably the first of more pandemics that are going to come. And there's a whole host of reasons for that. One, there are so many people on the Earth now that you just have population pressure. You have a lot of people living in one place. You have vertical living where people moving into high rises, and when you have air conditioning systems that come off a main system in office buildings, you have shared air. And then just density in the urban settings is a fuel for spread of infectious disease. We know from the 1600 and 1700s where cities would develop and the plague would break out. All the rich people would move to their country estates. That's why country estates were built for the rich people to get out of the urban environment during the outbreaks. And then the viral load in the environment, etc. And people moving in closer proximity to wild animals. There are a whole host of pressures. And then there's a cycle of life. So I personally think there will be more pandemics to come, and I hope we use these lessons learned so that for the next pandemic that erupts, we'll recognize it early and get our ducks in a row, and we'll get things in order with a little less chaos. You can't do something like this that you've never done before without some chaos. And we had expected chaos in the beginning. But it's not because people or departments or agencies weren't functioning. That's just the normal order of these things. But I hope we learn from this. So when it occurs again, we won't have as much chaos standing it up, and if we do, we'll get through it.

PH: Well, thank you, Dr. Qureshi. I think those are all the questions that I have for you, but I just want to say I'm very honored that you took so much time, both for the pre-interview and for this interview to share your insights. I was looking over those questions before the interview and just thinking, oh my goodness, I don't know if we'll be able to cover everything in an hour. I really appreciate you hit each point one by one, and you did a great job explaining your work and the work of others. So thank you for contributing to the project.

KQ: Well, I want to tell you, I'm very honored to actually be asked to do this. So and I wish you only the best with your project and look forward to seeing some more work from you.