11.1.26 ─ Health Pioneers in Hawaiʻi: Alice Augusta Ball, Queen Emma, and Queen Kapiʻolani

In the US, November is Native American Heritage Month. You may be aware that federal statistics place Native Hawaiians in a separate category from American Indians and Alaska Natives: "Native Hawaiian or Pacific Islander," and as such, Native Hawaiians are included in Asian American, Native Hawaiian, and Pacific Islander Heritage Month (May.) Other "PI" categories include Samoans, Chamorros, Marshallese, Tongans, and Fijians, folks separated by thousands of miles of ocean and very different histories with the Uncle Sam.

These classifications are more than annoyances or administrative red tape. With all the challenges we have faced around census counts, redistricting, gerrymandering, and the benefits and aid communities receive, these are important issues that deeply impact lives. In fact, a federal lawsuit filed in March of this year challenges the Native Hawaiian eligibility requirement of the scholarship program that trains doctors, nurses, and other health professionals, arguing that it constitutes racial discrimination. (I hope you've voted—or have your voting plan, friends!)

Following the words of Haunani Kay Trask, whom we celebrated in a recent issue, we think Native Hawaiian people should not have the indigeneity whitewashed away simply because Uncle Sam said so. And therefore, in this edition of #SistoryLessons, we are going to focus on three women in and from Hawaiʻi . All of them made important contributions to the health field. (I just discovered a whole calendar of health awareness months over the year: November is for diabetes and COPD. The things you learn in doing research on Foremothers!)

We have written about Queen Liliʻuokalani many times, but in this issue, I will share the stories of two Hawaiian queens who came before her, as well as a young chemist from Seattle who developed an injectable treatment for Hansen's disease at a time when that diagnoses meant exile to a remote island. But, her achievements were credited to her white male professor for decades.

Alice Augusta Ball was twenty-three when she developed an injectable treatment for Hansen's disease and twenty-four when she died. A white man then published her work under his own name and called it the Dean Method. Queen Emma went door to door with her husband to raise money for Queen's Hospital after a devastating smallpox epidemic killed thousands in Hawaiʻi. Queen Kapiʻolani raised eight thousand dollars through bazaars and lūʻaus to establish a maternity home for Hawaiian women while the Native Hawaiian population was declining.

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Alice Augusta Ball (July 24, 1892 – December 31, 1916) ─ The Chemist Who Changed the World, But We Didn't Know for Decades

Alice Augusta Ball was born in Seattle into a middle-class, shutterbug family. Her grandfather, James Presley Ball Sr., was a prominent Black photographer who worked with daguerreotypes, a process that required considerable knowledge of chemicals and their reactions. Chemistry would be important to Alice too.

At the University of Washington, she earned a qualification in pharmaceutical chemistry in 1912 and a bachelor's degree in pharmacy in 1914. She also co-authored a research paper, "Benzoylations in Ether Solution," with her instructor William M. Dehn. After that, she moved to Hawaiʻi, where she earned her master's degree in chemistry from the College of Hawaiʻi in 1915. She was the first woman and first Black person to earn that degree at the college, and she became its first woman and first Black chemistry instructor.

Treating Hansen's disease in Hawaiʻi

Ball's work in Hawaiʻi brought her into contact with physicians trying to improve treatment for Hansen's disease, commonly known as leprosy. Norwegian physician Gerhard Armauer Hansen identified the bacterium responsible for the dreaded disease in 1873, but effective antibacterial treatments would not become available until the 1940s. In Hawaiʻi, people diagnosed with leprosy would be removed from their families and confined in a colony on the remote Kalaupapa peninsula on Molokaʻi. More than eight thousand people, most of them Native Hawaiian, were sent there between 1866 and 1969. They would not ever return to their loved ones.

(Hansen's disease is one of the oldest recorded diseases, with probable descriptions in ancient Indian medical texts such as the Sushruta Samhita. The Bible also refers to "leprosy," though that term covered a range of skin conditions rather than necessarily the disease we know today.)

One of the principal treatments available to treat (not cure) the disease was chaulmoogra oil. Derived from tree seeds and used for centuries in Indian and Chinese medicine, it was the best they had, but it was very difficult to administer. Swallowing the oil could cause nausea and vomiting, making it hard for patients to tolerate enough for sustained treatment. Injections themselves were arduous: the thick oil was poorly absorbed and could cause abscesses beneath the skin.

Dr. Harry T. Hollmann, a physician at Kalihi Hospital on Oʻahu, asked Alice to investigate the oil after learning about her graduate research on the chemistry of kava. She developed a method for separating the oil's fatty acids and converting them into ethyl esters, producing a preparation that was now suitable for injection. At twenty-three, she had substantially improved an existing treatment, and while it was not a reliable cure, it offered patients a better prospect of recovery and, for some, even release from confinement.

Effective antibacterial treatment came in 1941, when Dr. Guy Faget and his team at the National Leprosarium in Carville, Louisiana, began treating patients with a sulfone drug called Promin. Today, Hansen's disease is curable with multidrug therapy, a combination of antibiotics that treats the infection and reduces the risk of drug resistance. Though it no longer means exile, leprosy has not disappeared. It's recurring in more than 120 countries, with the highest incidence reported in India, Brazil, and other tropical regions; around 200,000 new cases are reported each year.

Global public health matters!

What Alice's discovery enabled

Ball's formulation was a big deal. A 1920 report documented 78 patients discharged from Kalihi Hospital after treatment with the modified oil, and Hollmann himself reported in a 1922 paper that he had treated 84 patients who subsequently tested negative for the bacteria and were free of visible lesions. These were significant results for people whose diagnosis generally otherwise meant years of confinement and separation.

While the treatment suppressed bacterial growth rather than killing the bacteria, its greatest effectiveness was in patients treated early. Nevertheless, preparations based on Ball's work remained an important therapy until sulfone drugs, which provided more effective antibacterial treatment, became available in the 1940s.

Give That Woman Credit!

Alice Ball died on December 31, 1916, at the tragically young age of twenty-four, and before she could formally publish her findings. Though the cause of her death remains uncertain, some accounts suggest exposure to lab chemicals.

Chemist Arthur L. Dean, who was by then the president of the College of Hawaiʻi, continued Alice's research and published papers without acknowledging her contribution. Appallingly, the preparation became known as the Dean Method. Her work remained largely overlooked for decades.

Thankfully, latter day researchers would conduct substantive reviews, helping restore Ball's place in the history of chemistry and medicine. In 2000, a plaque honoring her was dedicated beside a chaulmoogra tree on the University of Hawaiʻi at Mānoa campus, and the university awarded her its Medal of Distinction in 2007, and retired faculty librarian Paul Wermager established an endowed scholarship in her name in 2017. Hawaiʻi has also honored her with proclamations declaring February 28 Alice Augusta Ball Day.

Reflection: When has someone else received credit for your work? Who was in a position to correct the record, and what did they do?

Queen Emma Na'ea Kaleleonalani Rooke (January 2, 1836 – April 25, 1885) ─ The People's Queen

Emma Naʻea was born in 1836 to High Chief George Naʻea and High Chiefess Fanny Kekelaokalani Young. Through hānai, the Hawaiian practice of raising a child within another family household, she was sent to be raised by her maternal aunt, Grace Kamaʻikuʻi Young, and Grace's husband, English physician Dr. Thomas Rooke. She grew up in a medical household and would dedicate her adult life to expanding medical care access.

Emma grew up in an era where diseases introduced from the West had caused decades of devastating losses among Native Hawaiians. The smallpox epidemic of 1853–54 killed thousands and reinforced the urgent need for a hospital that could serve the Hawaiian population. When she married Alexander Liholiho, King Kamehameha IV, in June 1856, the couple would make public health a central concern of their work together.

A hospital and schools for Hawaiian people

The Hawaiian legislature was unable to fully fund a public hospital, so Emma and Kamehameha IV personally solicited donations throughout Honolulu, visiting businesses, homes, docks, and other gathering places. In just over a month, they raised $13,530, to which the legislature added $6,000. This combined sum of $19,530 was roughly $790,000 in today's dollars. Queen's Hospital was established in 1859 (it continues today as The Queen's Medical Center). Queen Emma wanted to ensure Hawaiian people could receive care at the new facility. She organized the District Visiting Society, a group of women who supported the hospital's work, and visited patients regularly.

Education was another of her priorities. She and Kamehameha IV supported the establishment of an Anglican mission, whose first bishop and missionaries arrived in 1862. The royal couple's support for education helped establish the institutions that became ʻIolani School and St. Andrew's Priory. In 1867, Emma founded the Priory with Mother Priscilla Lydia Sellon to provide girls with educational opportunities comparable to those available to boys. The school continues to enroll students today.

Loss, leadership, and the 1874 election

Emma and Kamehameha IV's son, Prince Albert Edward, was born in 1858 and died in August 1862, at only four years old. Fifteen months later, in November 1863, Kamehameha IV died at twenty-nine. Emma was twenty-seven. Following her child's death, she had been given the name Kaleleokalani, "the flight of the heavenly one"; after her husband died, the name became Kaleleonālani, "the flight of the heavenly ones."

Queen Emma continued her work in healthcare, education, and the church. In 1865, she traveled to Britain, continental Europe, and the United States, raising funds for the Anglican mission and meeting Queen Victoria and other heads of state.

After Kamehameha IV's death, his brother became King Kamehameha V. He died in 1872, not having named a successor, and the legislature elected their cousin, William Charles Lunalilo, to the throne. But then Lunalilo himself died in February 1874, also without naming a successor! Emma, beloved among Native Hawaiians, was a strong candidate for the throne, but the decision belonged to the legislative assembly, not a public vote. On February 12, the legislators elected David Kalākaua by thirty-nine votes to six.

Emma's supporters rioted at the Honolulu Courthouse, attacking legislators who had voted for Kalākaua. It took the intervention of British and American forces to restore order.

Emma continued her work with the hospital, schools, and church. When she died on April 25, 1885, at forty-nine, she left much of her estate to support Queen's Hospital, St. Andrew's Priory, and St. Andrew's Cathedral. The Episcopal Church commemorates her and Kamehameha IV together on November 28, recognizing their contributions to healthcare, education, and religious life in Hawaiʻi.

Reflection: When an institution cannot or will not provide what your community needs, how do you decide what to build—and whom to ask for support?

Queen Kapiʻolani (December 31, 1834 – June 24, 1899) ─ She'd Speak Only Hawaiian

Let's meet another Foremother who was not in my book and deserves much more recognition for her contributions. Kapiʻolani Napelakapuokakaʻe was born in Hilo on December 31, 1834, to High Chief Kūhiō Kalanianaʻole and High Chiefess Kinoiki Kekaulike. Through her mother, she was a granddaughter of Kaumualiʻi, the last independent king of Kauaʻi, whose kingdom came under Kamehameha I through negotiation rather than conquest. She was baptized Julia.

Kapiʻolani served as a lady-in-waiting to Queen Emma and helped care for Emma and Kamehameha IV's son, Prince Albert.

After her first husband, High Chief Bennett Nāmākēhā, died in 1860, Kapiʻolani married David Kalākaua in December 1863. She became queen consort in February 1874, when the legislative assembly elected him to succeed King Lunalilo. As you read above, this appointment led to rioting by the Hawaiian people, who greatly preferred Queen Emma.) Kapiʻolani and Kalākaua had no children themselves, but helped raise her sister's sons, and in 1883, Kalākaua granted princely titles to all three nephews: David Kawānanakoa, Edward Keliʻiahonui, and Jonah Kūhiō Kalanianaʻole. (After King Kalākaua's death in 1891, it was Liliuokalani became the queen of Hawai'i, and the land's last monarch as the islands were annexed by the United States.)

Aid for Hawaiian families

While Queen, Kapiʻolani was deeply concerned about the declining Native Hawaiian population, and in 1874, she became a leader of the Hoʻoulu and Hoʻola Lāhui Society, a group that supported Hawaiian families, mothers, and children, addressing the consequences of introduced diseases as well as the high risks associated with childbirth and infant mortality. This work would inspire her next act.

In 1884, she visited Kalaupapa, where people diagnosed with Hansen's disease were confined under the kingdom's isolation policies (as we read above with Alice Augusta Ball). There, she met Father Damien, a Belgian Catholic priest who had lived and worked among the patients since 1873. She joined him, physician Eduard Arning, and Mother Marianne Cope in establishing a home for girls. The Kapiʻolani Home for Girls opened on November 9, 1885, on the grounds of the sisters' convent at the Kakaʻako Branch Hospital on Oʻahu. It provided housing, schooling, and personal care for daughters of people with Hansen's disease, including girls being observed for possible infection. Mother Marianne and the sisters administered the home.

Representing Hawaiʻi abroad

Queen Kapiʻolani traveled to Britain in 1887 to attend Queen Victoria's Golden Jubilee (her sister-in-law, Princess—and future Queen—Liliʻuokalani was with her), stopping first in the United States where they met President Grover Cleveland. Kapiʻolani represented the sovereign Hawaiian kingdom and conducted her public appearances in Hawaiian, with Liliʻuokalani serving as interpreter.

While the women were abroad, the Hawaiian League—a political organization dominated by American and European residents and businessmen—and its armed supporters, the Honolulu Rifles, forced King Kalākaua to accept a new constitution that transferred much of his authority to the cabinet and legislature. These were locally organized opponents of the monarchy; the more direct involvement of U.S. diplomatic and military officials came six years later, after David Kalākaua's death, when Liliʻuokalani was overthrown.

A maternity home for Hawaiian women

But back during her travels, Kapiʻolani visited hospitals and returned determined to improve care for mothers and babies in Hawaiʻi. Through bazaars, lūʻaus, and other fundraising activities, she raised eight thousand dollars to establish the Kapiʻolani Maternity Home. It opened on June 10, 1890, providing a dedicated place for women to receive essential health care during childbirth. In 1978, Kapiʻolani Hospital merged with Kauikeōlani Children's Hospital to become Kapiʻolani Medical Center for Women and Children. Today, it is Hawaiʻi's only full-service maternity, newborn, and pediatric specialty hospital.

Kapiʻolani died at her Waikīkī home on June 24, 1899, at sixty-four, less than a year after the United States annexed Hawaiʻi. Her name remains attached to the medical center and community college, as well as Kapiʻolani Park and other places across Honolulu. The healthcare institution is a particularly meaningful part of that legacy: her work continues in the care provided to women, children, and families.

Her motto was Kūlia i ka nuʻu—"Strive for the highest." Kapiʻolani Community College, named in her honor, continues to use it today.

Reflection: Who is doing the work to keep mothers and children healthy in your community, and what support have they been left to find on their own?

Reflection and Action: Journal Prompts for Everyone

As you think about Alice Augusta Ball: was there a time you accomplished or built something that somebody else got the credit for? Give yourself the credit now by writing about it, dating it, signing it, and printing it out to remind you that you matter, even if someone else got the credit.

Celebrating Queen Emma: has there been a cause you've raised funds for? What motivated you?

Remembering Queen Kapiʻolani: who in your community is working to improve the lives of mothers and children? What could you contribute to their work—not just money, but time, skills, or connections?

HerStory / OurStory: Journal Prompts for Women of Color

In tribute to Alice Augusta Ball: what contribution are you proud of that has not received the recognition it deserves? How would you describe that work?

Honoring Queen Emma: when have you brought people together to meet a need that others were overlooking? What did you learn about your ability to organize, ask for help, and get something done?

Thinking of Queen Kapiʻolani: which women helped care for you as a child, beyond your immediate family? Write about what they provided and how that care has influenced what you do for others.

Activated Allies: Prompts and Actions for White Friends

In honor of Alice Augusta Ball: read the American Chemical Society's account of her research and the effort to restore her credit. Then consider whose work goes unacknowledged in your workplace or community. If you have repeated an inaccurate attribution or left someone's contribution out, correct the record where you helped create it.

To honor Queen Emma: visit the Native Hawaiian Legal Corporation and read about its work protecting Native Hawaiian land, cultural practices, and family relationships. Choose an issue you know little about and spend time with the organization's explanation before turning to outside commentary. What assumptions about Hawaiʻi does that reading ask you to reconsider?

For Queen Kapiʻolani: learn about Healthy Mothers Healthy Babies' services for Native Hawaiian families, including culturally grounded prenatal and postpartum care. Then visit the organization's website to find a way to support its work, or use what you learn to seek out a comparable effort where you live.

What These Women Knew, and What We Must Remember

All three of these Foremothers, Queen Emma, Queen Kapiʻolani, and Alice Augusta Ball used their knowledge, relationships, and resources to address unmet needs of the people of Hawai'i. Their legacy reminds us to pay close attention to the health inequities and funding challenges facing institutions serving underserved populations today. Further, just learning the history of the sovereign Hawaiian nation, its overthrow, the loss of land, and the obligations and institutions that arose in response helps us recognize what is at stake when lawsuits and cutbacks threaten programs serving Indigenous communities.

Pay attention to the people carrying on the work of Hawaiian health and education, as well as those doing this work in Indigenous communities throughout the United States. The challenges they are being asked to defend against should matter to all of us who support justice and solidarity.

Eye on The Native Hawaiian Health Gap

Health, history, and who receives care

The health concerns that motivated Queen Emma and Queen Kapiʻolani persist to this day. A University of Hawaiʻi study published in October 2025 reported that, in 2020, life expectancy on the islands was 88.2 years for Chinese residents, 77.4 for Native Hawaiians, and 69.6 for other Pacific Islanders. In every decade studied since 1950, Native Hawaiian life expectancy has remained roughly ten years shorter than that of those of Chinese ancestry.

This inequity helps explain why programs like the Native Hawaiian Health Scholarship Program are so important. The initiative helps train Native Hawaiian health professionals who commit to serving communities in need. However, in keeping with the heartlessness of our current times, in March 2026, a Utah-based advocacy organization called Do No Harm sued to end its Native Hawaiian eligibility requirement, arguing that it constitutes racial discrimination. Papa Ola Lōkahi, a Native Hawaiian health nonprofit that jointly administers the program, intervened in its defense; the court granted its request in June. Its defense points to the federal government's longstanding trust responsibilities to Native Hawaiians. Before accepting the premise that a program intended to meet these documented needs is simply an unfair advantage, we need to take the history into account.

And what about the Pacific territories?

I'd also invite us to look beyond Hawaiʻi when discussing AAPI health, and not just six months from now, in May. This broad category includes people whose homelands have very different relationships with the United States, including those living in three Pacific territories. Here is a brief reminder of where they are and how they came under U.S. authority—with a Foremother from each whose contributions deserve our attention.

• Guam is in the western Pacific and is home to the Indigenous CHamoru people. A quick history: Spain ceded the island to the United States in 1898 after the Spanish-American War, and then Japan occupied Guam during World War II. U.S. forces retook it in 1944, and Congress granted U.S. citizenship to its people in 1950, but Guam remains a territory rather than a state. A Foremother to know is Agueda Iglesias Johnston (1892–1977), a CHamoru educator who became a school principal and later superintendent of education. During the Japanese occupation, she helped circulate information from hidden radios and supported people evading capture, at considerable risk to herself. Another Foremother, whom we celebrated in Our Brave Foremothers, is Bernadita Camacho-Dungca, a University of Guam professor and advocate for the CHamoru language. She wrote the Inifresi, a pledge to protect CHamoru beliefs, culture, language, air, water, and land. Adopted as Guam's official CHamoru pledge in 1998, it is recited in schools and at public gatherings. (The spelling "CHamoru" with a capital "H" reflects the distinct phonetics of the language, because "CH" represents a single sound in the CHamoru alphabet. This spellng also affirms the identity and culture of the CHamoru people.)

• The Northern Mariana Islands are located north of Guam, with Indigenous CHamorro and Carolinian communities. After successive Spanish, German, and Japanese rule, the islands came under U.S. administration following World War II. A covenant approved in the 1970s established their current status as a commonwealth in political union with the United States. A Foremother to know is Felicidad Taman Ogumoro (1949–2024), one of two women elected to the first Commonwealth legislature in 1978 and the first elected woman of Carolinian heritage. She chaired its committee on health, education, and welfare during her early legislative service.

• American Samoa is in the South Pacific, 3,596 miles from Guam, and 7,029 miles from Washington, D.C. Its islands came under U.S. authority through deeds of cession in 1900 and 1904, which Congress ratified in 1929. People born there generally become U.S. nationals, not U.S. citizens at birth—a distinction many Americans do not know exists, but one that denies American Samoans (not to be confused with Samoans, citizens of an entirely separate, independent nation) the right to vote in federal elections even after moving to a U.S. state. A Foremother to know is Mary Jewett Pritchard (1905–1992), an artist who helped sustain and revive siapo, the Samoan tradition of decorated bark cloth. Through her business and teaching, she supported other makers and passed the practice on to younger generations.

All three are U.S. territories whose delegates to the House of Representatives can participate and vote in committees but cannot vote on legislation before the full House. Unlike states, which receive federal Medicaid matching funds through an open-ended arrangement—one imperiled under this administration—these territories operate with capped federal Medicaid funding. Patients who need complex medical care may have to leave their islands to receive it, facing untenable costs and separation from their loved ones.

Let me also point out that, although often grouped in discussions with the territories mentioned above, the Marshall Islands, the Federated States of Micronesia, and Palau are independent nations in free association with the United States. “AAPI” is a broad designation encompassing many peoples whose histories and circumstances are too often treated as interchangeable. I think it’s important for us to know whose lives we are discussing, what histories and cultures they have, what resources their communities can access, and what responsibilities the United States has toward them.

See you in two weeks!

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