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Health Care: Kidney Disease

Cheryl Neal took the legacy of her husband's work and created a program that offers a healthy understanding
of kidney disease and life choices for disenfranchised youth


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A portion of the MIKE Mural outside a dialysis clinic in
Northeast Portland
. © Foreign Interest, 2009.

For more information:
MIKE Program
Centers for Disease Controls and Prevention

A Legacy for Health

By Sherry Harbert, Foreign Interest


It is difficult to continue the dream and work of one who has died. All the familiar guides shift into unknowns that carry with them great expectations. When Cheryl Neal’s husband, Dr. Michael Hartnett, died in 2000, he left her with a substantial impact on the medical community in Oregon, a vision for the future and an weighty emptiness. She could have filled it with many things, but she chose to build upon her husband’s work to reach as many people as possible. Hartnett, a Portland nephrologist (a kidney specialist), was instrumental in establishing a broad range of medical services and education about kidney disease in the state. It is a quiet killer that devastates millions of lives. Kidney disease is the ninth greatest cause of death in the U.S., yet it rarely is mentioned. Neal hopes to end that with the Multicultural Integrated Kidney Education (MIKE) Program.


“It seemed like the only reasonable thing to do,” said Neal. “The program’s mission seeks social justice, parity and education for those disenfranchised in our communities. It works on community building. Outreach is very difficult with vulnerable populations. Issues of social justice emerge because these are the marginalized in our communities.”


Neal, recently retired from her own substantial practice as an internist and medical doctor, could not ignore the impact of her husband’s contributions. “The density of his experience and influence is greater than anyone’s, so his living memorial had to do him justice,” she said. The weight of Hartnett’s legacy compels Neal to reach beyond both her husband’s and her own conceptions. From that foundation, Neal has taken MIKE to a multitude of new levels. But she is always reminded that needs are far ahead of the responses.

“We’re starting way too late,” she said. “We, as a society, are approaching health care in isolation. Our community health is not a community. There needs to be an over-arching awareness.” Neal added that the individual’s health is reflective of the society’s health.


Creating a Model for the Now and the Future


Neal sees health care beyond medical terms. “It is a socio-ecological model,” she said. Neal sees health care as issues overlapping onto other issues which lead to greater inclusion and encompassing programs. She sees MIKE as one element in empowering people for a stronger society. “It builds on interpersonal and community strengths,” Neal said. “You can’t ignore any element. Our society is like a chain bracelet. We are as strong as our weakest link.”


Neal advocates for education and awareness at the earliest levels to build a foundation for individuals and the community. “Early childhood education is so important,” she said. “It helps both the children and the parents.” Neal said adequate childcare is important because people need to work. She envisions greater training in parenting skills to create a stronger family. “Whatever investment you make in the individual, it will be seen in the community,” said Neal.


Neal pointed to the critical point that determines a positive future for a strong individual. “It begins in middle school,” she said. “After that point, there is a real deficit in training and support.” Neal sees these years as a struggle that sets in motion the next generation of issues. “We need to continue through those years, because they will be the next generation of parents, workers, healthcare consumers and providers,” she said. “We need to stuff the pipeline at all levels and not just cherry-pick in the end for the best people.”


Neal has pushed MIKE to reach out in many directions, both forward and back. She sees it as a way to support workforce development, greater diversity in the healthcare industry and broader the scope of knowledge of healthcare providers. “We need more than what I received when I went to medical school.”


The Need for Substantial Policy Awareness


Of the many issues surfacing in the current health care debate, community health and youth training is largely ignored. Neal feels any healthcare policy without considering such factors will fail to address the encompassing needs of American society. “There is often a dis-understanding on policy levels,” she said. “I don’t know if policy makers have any idea of the realities of the disenfranchised. They seem to be irrelevant in their thoughts.”


Neal was struck by the impact of health care and corporate control after watching a segment of the Bill Moyers Journal on PBS. The July segment featured Wendell Potter, a former CIGNA executive who discovered another world of healthcare outside his own in 2007. Moyers asked him why it took him so long and Potter responded that “I was insulated. I didn’t really see what was going on. I saw the data. I knew 47 million people were uninsured, but I didn’t put faces with that number.”


The news segment reinforces Neal’s work with MIKE. “The challenges are beyond belief,” said Neal. “You need to invest thoughtful practices and put the best convictions forward.” Neal found that the social justice issues were larger than healthcare itself.


The Kaiser Family Foundation issued a report in July which found that the current economic crisis has greatly impacted the most vulnerable in American society. Their findings point to a greater loss of healthcare for non-whites. The foundation concluded that even ARRA infusions for COBRA coverage have failed to sustain many individuals and families. The foundation also noted that states have decreased many public services to create even greater hardship. The Kaiser Family Foundation also issued a report in July to detail rewarding healthy behaviors, which found few businesses offer any substantial reward for healthy lifestyles. The report emphasized that “more than one in five workers comes from a low-income family─a group less likely to have the means to readily change health habits. Such findings are what MIKE works to counter on the local level. It is a difficult process.


The MIKE Program works to teach youth to advocate for themselves. “I work with extremely marginalized youth,” said Neal. “Our work in schools adds support to make their programs meaningful.” Neal pointed to the need for multiple organizations to work together to achieve a greater good. “We don’t have the infrastructure to do it all,” she said. “It’s about many organizations working together. That’s why we reach out, we’re like-minded adults.”


Neal sees beyond the current problems to a future that incorporates community and knowledge for a local and global approach. “This model can be adapted globally,” she said. “It’s culturally specific, yet addresses the core needs of any social environment.” Neal explained that the same message can approach health issues in an equal arena. “It’s just a matter of translation and training.” Her insight and experience is built upon working with youth and families from multicultural backgrounds.


One of the ways MIKE has increased awareness is through a mural project that encompassed local youth, medical workers and artists to create a visual concept of healthy lifestyles for the community. Student interns worked with professional artists to create a 100-foot mural along the side of a DSI dialysis clinic in Northeast Portland this summer. MIKE facilitated the logistics and funding to bring in people from all levels of society to work on the project. The result is an artistic expression of community and caring which Neal finds most inspiring. “You look at the youth doing this mural and realize they don’t have access to healthy foods and activities,” said Neal. The mural focuses on the many foods and activities that build upon a healthy lifestyle.


The MIKE Mural Project sought to approach kidney disease and health from many levels. The location was a regular target for graffiti and gang tagging. It displayed a negative image for those entering the building to sustain their life through dialysis. For the community, it became a constant nuisance. The mural changed all that with a vibrant look at healthy lifestyles through images of that the community can instantly encourage.

Neal proudly followed each step of the process. “It’s a reflection on youth and good health,” she said. “I look at this mural and all its potential.” The MIKE program tracked each stage of the process to provide a positive foundation for those who worked on the project. “It’s the little things that help them,” said Neal. “We created a photo album of their progress and show images of success down the road. The albums show a sequence of events to begin to help them see themselves as successful.” The albums take their owners on a “before-during-after” visual diary to show them where they can be in the future.


Incorporating the Knowledge of Kidney Disease for the Community


Success in the individual means greater success in staving off kidney disease. MIKE focuses on all aspects of society to build awareness and positive lifestyles to counter the disease. MIKE’s efforts were rewarded with a Multnomah County Health Department Heroes Award in 2008 for its work. Neal said there are many contributing conditions to kidney failure. Much is due to other factors, such as diabetes and hypertension. “Even if you simply strive to decrease diabetes, you can lessen the chance for kidney disease.”


The reality of chronic kidney disease is cause for alarm. The Centers for Disease Controls (CDC) issued a warning that kidney disease is a threat to American healthcare. It is placed as the ninth cause of death in the nation.


Such dire warnings are largely ignored in many communities. MIKE works to break that barrier and offer education to counter its deadly affects. “The greater good is building a context of health,” said Neal. “This one disease takes such a toll on our financial and social worlds. It strips budgets. Cardiovascular disease is the greatest killer, but even that is a multiplier, so teaching healthy lifestyles is important.”


Neal says that the public needs to be aware of how important kidneys are for health. “Kidneys are such an integral part of our system,” she said. “They supply clean blood to our heart.” Kidneys cleanse the blood to allow more oxygen to the heart by decreasing toxins every half hour. The output is urine and blood. The process affects many other organs. “Kidneys affect our health and mental functions,” said Neal. “You may get along without a few organs, but you need functioning kidneys or you die.”


MIKE takes the complexity and fear out of the equation so youth and others understand the importance of healthy eating and lifestyles. Neal is passionate about making kidney health a priority for the most vulnerable in the Portland area and around the world. “People around the world need to know it’s a chronic disease,” said Neal. “It’s going to be the poster child of where we’re headed. Prevention has got to be on the table.”


October 12, 2009

© 2009, Foreign Interest


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