Moloka'i is the story of Rachel Kalama, a young native Hawaiian girl growing up in Honolulu at the end of the 19th century, who at age seven is diagnosed with Hansen's disease, taken from her family, and exiled to the leprosy settlement on a remote peninsula on the island of Moloka'i. It is the story of her life there, the friends who become her family, the man she falls in love with and marries, the child she is forced to give up, and her eventual, miraculous release from exile.

Though a work of fiction, Moloka'i is based very much on fact. The author weaves real, historical patients and caregivers--from Father Damien to Mother Marianne Cope to the governor of the Territory of Hawai'i, Lawrence Judd--into the fabric of the story. Most everything in the novel has its basis in history, but the book is far more than that; it is the moving story of a woman's life, a life that sadly had too many counterparts in the real world.