Some people considered it an expression of love—the ultimate sacrifice. Going willingly to Kalawao, into isolation, to help a husband, wife, or child diagnosed with leprosy. Starting in 1866, many relatives and friends voluntarily left their home to accompany their loved ones and provide social, emotional, and physical aid.

Known as na kokua, or helpers, these people provided loving care that could not have been provided another way. Their presence served to eliminate loneliness and pain. Often, Board of Health and religious workers could not keep up with the workload of providing medical care, let alone complete other chores. Na kokua provided able-bodied labor for many tasks, including carrying water, handling freight, gathering wood, and raising livestock.

One of the most prominent kokua was Jonathan H. Napela, a Hawaiian who accompanied his sick wife Kitty to Kalawao in 1873. An elder in the Church of Jesus Christ of Latter Day Saints, Napela and other Mormons organized a church at Kalawao. He was a contemporary of Father Damien, and like the famous priest, Joseph Napela eventually contracted Hansen’s disease and died within isolation.

In addition to friends and relatives of patients, many religious workers arrived at Kalawao and Kalaupapa to provide care. Board of Health administrative and medical staff lived in the settlements as well. Through the years strict regulations were enforced to minimize contact between patients and non-patients. Physical barriers, such as fences, kept people apart. Life was divided this way until the isolation laws were lifted in 1969.

Today, kokua refers to a person living at Kalaupapa who is not a former Hansen’s disease patient. Clergy, religious workers, state Department of Health employees, and federal National Park Service employees living in the settlement provide medical care, religious services, water supply, food services, upkeep of infrastructure and other aspects of daily life. Volunteer church groups and others assist with yard work, sewing, and other tasks. A work position at Kalaupapa is still considered a hardship logistically, but for a kokua, service in support of these special people is its own reward.