The University of Hawaiʻi Cancer Center in Kakaʻako: how it came about

March 8, 2023

By Michele Carbone

In celebration of the 10 years that the Cancer Center has been in its new home in Kakaʻako, Michele Carbone, MD, PhD, UH Cancer Center researcher and former Director, reflects on how the UH Cancer Center was built and about his dear friend, UH Cancer Center Architect Jeff Nakamura.

Preface: The University of Hawaiʻi Cancer Center building is widely considered to be the most beautiful cancer center in the country. It was designed and built by a local team of dedicated individuals with state funds 10 years ago. I was asked to tell the story of how it came about. It is a nice story, and it is time to tell it. The success was the result of teamwork. I asked the key members of our team to check my writing for accuracy, those who agreed to be named are listed below as co-authors.

The Beginning

In September of 2008, I was on my way to the villages in Cappadocia, Turkey where I was studying an epidemic of mesothelioma. Two years earlier, I had moved from Chicago to the University of Hawaiʻi Cancer Center. I had been told a new cancer center was about to be built, but, 2 years later, there was no evidence of any movement in that direction. Instead, there was widespread disagreement to just about everything related to the UH Cancer Center. Moreover, the UH Cancer Center had just received a negative evaluation by the National Cancer Institute (NCI), and our “NCI Cancer Center Designation” was in jeopardy.

I wrote to UH Mānoa Chancellor, Dr. Virginia Hinshaw, that, when I came back from Turkey, I would pack and return to the University of Chicago where I had a job offer. The Chancellor answered, “When you return, come straight to my office”. I did, expecting to say good-bye to each other. Instead, she told me that she had decided that a change of leadership was required at the UH Cancer Center, and she offered me the job of Interim Director. She said, “Your task is to find a way to renew the NCI-Designation and to get the construction of the new building on track because this is critically important to Hawaiʻi.”

I noted that there was already a deputy director and that I did not want to step over him. She said, “We asked him, but he is not interested.” So, I accepted the job. I was curious to understand why there was so much controversy and nothing was moving forward.

Next, I flew to Washington to meet the director of the NCI Cancer Center program who was Dr. Linda Weiss. She said, “Dr. Carbone, the UH Cancer Center will fail–it does not have enough grant funded faculty nor a building to accommodate new faculty with grants you need to recruit, plus there is no hospital.” Dr. Weiss gave me three months to figure this out. I told her, “If I can't do it, I will call you, resign, and move to the University of Chicago.” She looked at me, as you would at someone who is very naïve, and said, “Look Dr. Carbone, for the past 20 years we have been hearing of this building. What makes you think you can do it?” My response, “Dr. Weiss, I do not know. I will call you in three months.”

Forming the Hawaiʻi Cancer Consortium

I realized that there were several problems, listed in the order we solved them: 1) without a clinical component, we could no longer be an NCI-Designated Cancer Center. To make things worse, the UH Cancer Center did not agree with The Queen’s Medical Center (QMC) and with Hawaiʻi Pacific Health (HPH) on how to fix the problem—instead, we were competing; 2) there was disagreement about where to build the cancer center; 3) there was disagreement about who should build the center; 4) the Hawaiʻi State Legislature, being understandably tired of all this, was about to redirect a cigarette tax that had been proposed by State Senator Rosalyn Baker, to build the UH Cancer Center for other purposes.

I invited the CEO of QMC, Art Ushijima, and the CEO of HPH, Chuck Sted, for dinner at my home. There was a storm so we had to eat inside. As the dinner was ending, the CEOs seemed more relaxed. It was time. I said, “Look I can't do this without you. There will be no NCI-Designated Cancer Center in Hawaiʻi if we do not have a clinical component. We should do a Cancer Consortium, work together, share, and synergize our resources. Your medical centers will become our clinical component which will save money for the state and improve cancer care by providing new clinical trials to Hawaiʻi cancer patients. And, by the way, I also need 1 million dollars a year from each of your hospitals. We need this money to recruit top-notch physicians and scientists. We can't recruit them within the pay-scale of UH. We need to offer salaries that are competitive with the mainland by integrating their UH salary with a clinical salary, as is done in most cancer centers in the country. And this additional salary has to come from your hospitals, not from taxpayer money. And, just to be sure there is no misunderstanding here, I will never take one dollar of this money to increase my own salary, only to recruit others.” I added, “Why would we do this? Look, I know that this will give us a lot of headaches and work. The reason to do it is because it is a good thing for Hawaiʻi—there is no other reason. This is your island, your state, you decide. Please let me know within a month because, if you say no, I will not waste my time trying something that can't be done.”

Exactly as I finished this sentence, in that precise moment, my friend Makana, a Hawaiian slack guitarist and singer, banged on the window of the dining room and said, “Hey, bro, open the door! It is storming” He had climbed up the fence as he often did. He was dressed in black with a black hat and was totally drenched. He said, “Hey, I am starving! What is up for dinner?” Well, we had just eaten everything! So, I started cooking some spaghetti. Makana started playing and singing while outside the storm seemed to take on new energy. You know how, when it rains so much that it looks like you have a fire hydrant aimed at your home? That way. It was an unreal situation—I had the two CEOs of the main Hawaiʻi hospitals in the middle of a business discussion that was vital to the UH Cancer Center while Makana was singing and the CEOs listened in awe. All I could do was cook so Makana would stop singing and we could resume the conversation. Makana ate the pasta, then said: “I have a gig, I have to go.” He jumped the fence and was gone into the storm.

I said, “Well, sorry for the unexpected interruption. Anyway, it was nice to have you both here for dinner, please think about it and let me know.” Art and Chuck looked at each other and extended their hands and said, “No need to think, it is a deal.” We shook hands. From January 2009 we worked together and never had a problem because their word was better than any signed contract. Each year, the UH Cancer Center receives $2M from HPH and QMC, which makes $24M to this day. I am convinced Makana did the magic!

And soon after Gary Kajiwara, the CEO of the Kuakini Health System, joined the “Cancer Consortium of Hawaiʻi” and contributed about $2M over the years.

Building the UH Cancer Center

That agreement gave me the credibility I needed to help fix problems 2 and 3. I attended the first Board of Regents (BOR) meeting as Interim Director and listened to the Vice Chancellor for Research who recommended that the Cancer Center had to be built on Lot “C” which is today the parking lot toward the commercial port. He further proposed that the Cancer Center had to be built by a mainland company experienced in building cancer centers because of its complexity. I had realized by then that there was strong resistance to building the Cancer Center on Lot C, and I totally disagreed with the idea of a mainland company.

There was a lunch break, and I was thinking what I could do about it when the UH President asked me to have lunch—just the two of us. We sat in the cafeteria, and he asked what I thought. I said, “I think that the Vice Chancellor is right, Lot C is ideal because it is large and in the future, we could build more university buildings there. The problem is that the city is not convinced that that is the best use for Lot C, so, if we actually want to build the Center now, not ten years from now, we need to build it in—what was at the time—the parking lot of the John A. Burns School of Medicine (JABSOM). I have already spoken to the Dean of JABSOM, Dr. Jerris Hedges, and he agrees. It will be facing the medical school and will make a nice biomedical campus. As for who should build the Center, this is the Cancer Center of Hawaiʻi and must be built by a local company. They will put their hearts into it; they will not build it for money; they will build it for their loved ones and for all the cancer patients in Hawaiʻi.” The President said, “You know there are some people on the BOR who may be interested in hearing what you just said so will you please come with me into the closed session and repeat that?” “Sure!” I replied. I told the same thing to Chancellor Hinshaw. The BOR and Chancellor agreed. Now things started moving fast.

At about that time, Dr. MRC Greenwood became the President of UH, and soon after I was appointed Permanent Director. Dr. Greenwood told us that the Cancer Center was one of her priorities. We would meet every Monday for two hours in her office, together with Chancellor Hinshaw, Dean Hedges, and other university leaders, and we would discuss the progress. Those meetings were key! They allowed us to overcome lots of problems that would have otherwise delayed the Cancer Center project. At about the same time, the Chancellor informed me that I would report directly to her—a decision that allowed me to get things done more effectively. Anytime I had a roadblock, I could ask for Chancellor Hinshaw’s help so that alone discouraged many who wanted to create problems from doing so.

How about the Hawaiʻi State Legislature? They were, according to everyone I spoke to, determined to re-allocate the portion of the cigarette tax that went to the Cancer Center to other purposes. Without that source of funding, we could not have built the Cancer Center, nor could we have recruited anyone. There were two key factors that made them change their minds. First, State Senator Rosalyn Baker, a nurse, and State Senator Josh Green, a physician and now Governor of Hawaiʻi, fully understood the importance of an NCI-Designated Cancer Center for Hawaiʻi. They strongly supported this project and helped us convince their colleagues to support the Cancer Center. The other factor was that, when we sat in front of the legislature, we were always a team: President Greenwood, Chancellor Hinshaw, Dean Hedges, HPH CEO Chuck Sted, QMC CEO Art Ushijima, and me. That show of consensus impressed upon the legislators that this was not “my project” or “whoever’s project” but that this was “Hawaiʻi’s” project and had to be done.

Jeff Nakamura’s Legacy

The Kobayashi firm was chosen by a committee to build the Cancer Center. I met with them and with their architect, Jeff Nakamura. I said, “Jeff, you have to give Hawaiʻi a beautiful Cancer Center, a place where people are not scared to come, an open space in communication with nature, a place that makes you think of Hawaiʻi. Look, you know what some people say that it will take ten years, not two, to do it, and that it will cost five times more than we budget, and that it will be crap. You must prove them wrong on all three fronts. Actually, you know what I will do if you accomplish that? I will put your photo next to the elevator and write next to the photo: I did it! So, if you do a good job, everyone will know you deserve credit and, if you screw it up, everyone will know who did it!” That became the joke of the construction team: every time I visited the construction site, workers would ask me, “And you will put his photo next to the elevator? Will you?” I replied, “Of course!”

One year into the project Jeff Nakamura developed a malignant sarcoma in the scapula, a very rare cancer. His radiation and chemotherapy were brutal, and sadly nothing worked. Yet, Jeff kept coming to work each day. In the end, he could not walk more than one flight of stairs. He said, “Do not worry Dr. Carbone, it will be done on time. I can't die till it is complete, so we have to get it done soon.”

Well, it was done four months ahead of schedule and 17 million dollars under budget! I think that is a record for any State building! Jeff handed me the keys—see photo—but he asked me not to put his picture next to the elevator. “I did it for Hawaiʻi,” he said. We opened the building in February 2013, and he was there to celebrate the most beautiful Cancer Center in the country, maybe in the world. Two months later I was told that Jeff was dying so I called him and said, “Look, I am putting your photo next to the elevator, okay?” Okay was his reply. He died the next day. His photo is and will always be next to the elevator. Come see it!

Mahalo Hawaiʻi

And yes, there is more to this story. The support of the local Hawaiʻi community was key to our success and I considered them an integral part of our team. On average, during my tenure as Director, we raised $5M dollars per year, with Hospital contributions over $7M per year. We used that money for recruitment and to buy equipment and furniture. We recruited many top scientists, physician scientists, and staff, and thanks to them, along with all of the other changes made, we renewed—against all odds—our NCI-Designation for a full five years. So, we did it. And I really mean “we.” It was a team effort. And we had an excellent, highly committed team!

Let me conclude with a Hawaiian proverb—-“Everybody paddle the canoes together; bail and paddle, paddle and bail, and the shore is reached.” The shore, in this case, was to provide a great building needed to advance cancer care and research for the people of Hawaiʻi for generations to come.

Ciao,

Michele Carbone

This story was fact checked by my former direct supervisor, Chancellor Hinshaw, and by the former CEOs of HPH and QMC, Chuck Sted and Art Ushijima.