Beach Boys on break

Deadly bacteria may be a health hazard to Waikiki beach boys

Date
Place Waikiki
Text Jolyn Okimoto Rosa

Ka‘u Manaku remembers every detail of the staph infection that started as a small scratch, comparing it to how one feels after food poisoning.

“You get weak, can’t walk. High fevers,” says Manaku, who works as one of Waikīkī’s famed Beach Boys. Even though he had been cleaning the wound, “It got out of control really fast.”

Manaku’s experience with staph is not unique. Manaku, who grew up in the water and has been surfing for more than 10 years, has known quite a few Beach Boys who have suffered staph infections or the drug-resistant variety, methicillin-resistant Staphylococcus aureus (MRSA). He calls himself one of the lucky ones in that, at the time of his infection, he had health insurance. He was put on worker’s compensation while he recovered.

Watermen like Manaku and health experts want more people to know how to stay safe in Hawai‘i’s waters. Staph and MRSA can be found in ocean water. The Waikīkī Beach Boys are at particular risk since they work long days on the front lines of Hawai‘i’s visitor industry by teaching people to surf or canoe, and work long days—often without health insurance. The beach, of course, is playground to kama‘āina and visitors alike.

“I started working when I was 13 and I’ve been there ever since,” says Brandon “Kahiki” Tapati. “You’re out there 12 hours, and you’re thinking, ‘I better not get hurt today.’”

Some Beach Boys work two, even three jobs, to make ends meet. This mix of factors doesn’t sit well with Maile Tauali‘i, an assistant professor at the University of Hawai‘i Office of Public Health Studies. “I want to do something about it,” she says, noting that many Beach Boys have worked and surfed on Waikīkī Beach for generations.

“They are the legendary Beach Boys.”


Neutrophil ingesting methicillin-resistant Staphylococcus aureus bacteria

An electron micrograph of Staphylococcus aureus bacteria escaping destruction by human white blood cells

The Research

“The closest I come to a regular religious experience is the surfing I do on Sunday mornings at ‘Rock Piles,’ a body of water near Waikīkī Beach that is famous for consistent waves but a risk of shallow coral when the tide is out.”

That’s how Dr. Alan Tice, an infectious diseases expert in Hawai‘i, began his 2007 article, “Swimming with Staphylococci at Waikīkī” in Infectious Disease News. Tice described his interest in canoe paddling, and the stories he heard from teammates about staph infections in the Ala Wai. He wanted to learn more, so he began to delve into the research of retired University of Hawai‘i oceanography researcher Roger S. Fujioka, who found that staph bacteria wasn’t actually present in the Ala Wai, and also declined in the evenings.

“It soon became apparent that the Staphylococci were associated with bathers since no one swims in the Ala Wai and there were no S. aureus at beaches where there were no bathers,” Dr. Tice wrote. “It seemed apparent that people were shedding their bacteria into the sea and that the environment was not conducive to their growth or persistence.”

Dr. Tice repeated Fujioka’s studies, and confirmed that the quantities of staph correlated with the number of bathers in the water at Waikīkī.

As for the risk for exposure to staph in seawater, Dr. Tice wrote: “[We] have tried to connect the actual exposure to seawater and S. aureus infections but have not been able to do so.”

Staph and MRSA

Staphylococcus aureus is a bacteria which occurs naturally in the bodies of healthy people. Methicillin-resistant Staphylococcus aureus is an antibiotic-resistant type of staph that often begins with skin boils and is spread by skin-to-skin contact in such groups as high school athletes.

The Centers for Disease Control and Prevention does have a MRSA bacteria surveillance program. However, as of 2011, Hawai‘i was not among the nine states in the Active Bacterial Core Surveillance program. The programs are in California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New York, Oregon and Tennessee.

Unlike E. coli, staph is not among those bacteria tested for by the U.S. Environmental Protection Agency.


A Beach Boy teaches a couple from the mainland to surf.

Insurance Gap

Most of the Beach Boys are working as independent contractors and are paid cash. While those situations have advantages like allowing them to set their own hours, health insurance isn’t one of them.

Based on his experience, Manaku estimates it can take 6 weeks or more to recover from staph or MRSA. For someone who does not have health insurance, seeing a doctor and paying for medication out of pocket might cost $300, and six weeks of lost income might add up to $3,000 or $4,000.

That's a lot for someone who might be making $21,000 a year, says Manaku.

The worry that the staph infection might be the drug-resistant variety adds another level of foreboding. Manaku recalls, “They say, ‘If this antibiotic doesn’t work, we don’t know what we can do.’”

Tapati feels lucky to have so far avoided infection, even when a surfboard fin from a person he was teaching to surf sliced his leg. His leg bears a big scar. But it doesn’t have to be a big injury to cause worry—MRSA can take advantage of even minor abrasions.

“All you get are abrasions when you’re surfing,” Tapati says.

Tapati’s work as a Beach Boy is one of three jobs he does. He takes pride in his work, but is concerned about the older Beach Boys still having to hustle for their money all day long in the sun.

“I want my kupuna to just be chilling,” he says. “To be called a Beach Boy: It’s not enough. [Visitors] come right off the plane to go to their hotel and the first person they see is a Beach Boy. What about them?”

SM

Duke Kahanamoku was one of Waikīkī's earliest Beach Boys

Making a Living

Today, Waikīkī is inextricably linked with Hawai‘i’s visitor industry. But well before that, it was a beach of choice for Hawaiians like Duke Kahanamoku (1890–1968), who is credited with popularizing surfing.

The modern Beach Boys work for about $8 to $10 an hour, plus tips. A full, busy day might bring in $300, but of that one would pay $60 to the “house”—the company for which he is working, two Beach Boys explain.

About a dozen surf stands line the shore, and three are rented from the city through a competitive bidding process. Winners of the bids pay monthly fees to the city. Bids were last accepted in 2010 for stands #1 and #2, which are being rented out for $23,000 and $29,501 per month, respectively. Data for stand #3 was not available at the time of this article.

Solutions

When asked what should be done about the situation, Manaku says, “The major thing is awareness. Let’s just make sure everyone is aware and have some kind of system in place for people to get the right kind of treatment.”

UH’s Tauali‘i of Public Health Studies points out that staph and MRSA are killed by ultraviolet light. Also, transmission can be reduced by alcohol, vinegar or hydrogen peroxide, she says.

The Beach Boys also believe sand moving projects have adversely affected water quality.

Manaku says he and many others feel a certain responsibility or kuleana to the water.

“[W]hen you see the water just get filled with dirt and all kinds of waste —people are getting staph in places that you used to go as a child—it really saddens you,” he says.

To Surf Another Day

In spite of all he knew about infectious diseases, Dr. Tice was not one to avoid the water. In fact, he loved the surf.

“What risk there is for incubating antibiotic resistance in the melting pot of microorganisms at Waikīkī is of considerable interest, but minimal funding seems available,” he wrote in his 2007 article. He continued, “Perhaps the oceans are a breeding ground for new antimicrobials as well as resistance to them.”

Dr. Tice added: “So what am I going to do next Sunday? Go swimming and surfing at Waikīkī and thank God and Neptune for the opportunity to do so. It is probably safer than the hospitals where I make my rounds—and a lot more fun as well. My only concern is whether I am shedding my normal flora into the sea, where it may affect the creatures that naturally reside there.

“I am happy to take all the risks and am hopeful that the exploration of the sea in regard to human health will be systematically explored in the future.”

Dr. Tice passed away in 2013 after a battle with cancer, taking with him a respectful connection to the ocean.

Manaku has a similar attitude. “It’s a struggle to come down here every day, to come down to the water. Parking, traffic, tourists,” he explains.

But he adds: “I honestly do believe that Hawaiians [and] people who are born and raised here—they have a strong connection to the water as I do. And a lot of people have a draw to a certain spot, someplace they were brought up, going to as a kid.
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