While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
Position: Co-President and CEO, Center for Health and Wellness
The Center for Health and Wellness is more than just a building. It is a center with an attitude, an attitude that is shaped around Arneatha Martin. She is truly concerned about the health and well-being of others and works hard to decrease high-risk behaviors and encourage individuals of the African-American community to focus on prevention and wellness education.—Donald L. Beggs, President, Wichita State University
Arneatha has realized a dream that helps the community overall. The center is a place where we can come to get excellent medical care in a respectful environment. The center is a source of pride for our community.—Client/Patient, Center for Health and Wellness
When the clinic opened, Arneatha insisted that patients would be seen by the physician and other clinic staff first. Proof of insurance, Medicaid, Medicare and Healthwave cards would be requested after services were delivered....By breaking a customary practice, Arneatha took a huge risk to ensure the self-worth of her patients, and it's paid off by gaining the confidence of the community.—Teaching Associate, University of Kansas Medical School
She was a high school graduate, married and pregnant with her first child at age 17. When Arneatha Martin needed a hospital in the fall of 1961, she and her husband were poor, African American, young and without medical insurance. The traumatic indignities she suffered at that time sparked a determination in the young Martin that would lead her to create a medical system that values patients as people, not as paychecks.
Growing up in the very poorest section of northeast Wichita, Kan., Martin was the youngest in a family of five children that included four girls and one boy. She remembers that she "always felt old. I never felt like I was young." Her parents divorced when she was 10 years old, and her mother immediately took two jobs, working as a housekeeper during the day and in the evenings.
"She always worked hard. She never put us on welfare," Martin recalls. "She was a huge influence on me, because she took care of herself, she took care of us, and when she said, 'You be here and you do this at this time,' you did it. And Mother would always say, 'If I catch you skipping school....' That was the most important thing for her, for us to get a high school education."
Martin graduated from high school at age 16 and married Dwain, a young truck driver. "He has always been the person, who said, 'Well, okay, whatever you want to do,'" she says. But even her supportive husband could not protect her from the discrimination they felt when she became pregnant.
At first, she was denied prenatal care because she and her husband didn't have insurance; they finally begged a local doctor to monitor the pregnancy. Martin, who had never been in a hospital before, remembers how she was treated when she arrived at the hospital to deliver her baby. "The nurses came into the room and looked at me like, 'What are you doing here? What are you having this baby for?'"
After her baby daughter was born, the nurses began using medical jargon that the new mother did not understand. "They should have been able to look at me and know that I was not familiar with the medical lingo they were talking," she recalls vividly. "So when they asked me if I needed to urinate, I wasn't familiar with that word and they had to catheterize me. That's when I knew what it meant. And I got an infection and had to stay a day or so longer."
The experience was clearly a turning point for Martin. "I was young, I was poor, but I think it was being poor and black" that caused the nurses to treat her with such disrespect, she recalls. "Back in 1961, all the nurses were white. It just seemed like to me, in my mind, they could have told me. It could have been easier. And I thought, 'Life should be different from this.' I've always wanted people to be treated with dignity and respect, for things to be explained to them so that it won't be a hardship."
From that moment on, Martin vowed to be a nurse. In less than a year, she was studying to be a licensed practical nurse (LPN) under President John F. Kennedy's Manpower Development Program, which paid her $50 a week plus book fees.
In 1964, she graduated form Wichita Vocational School of Practical Nursing with an LPN degree and went to work at a local hospital. A second daughter was born in 1965, but Martin never stopped working or thinking about getting more education. "My older sister was always supportive," she says. "We would hire babysitters and work and go to school. That's the way it was supposed to be."
Gradually, Martin realized that something was missing. "I was a good LPN, but I couldn't make decisions for my patients. As an LPN, you had to do what the head nurse wants you to do." From 1971 to 1975, Martin worked part-time while attending Wichita State University, studying for her Bachelor of Science degree in nursing. "I was the first person to go to college in my family," she said.
After graduating in 1975, Martin worked as a psychiatric nurse and nurse counselor in the drug treatment center at the Sedgwick County Department of Mental Health, dispensing methadone to an average of 80 patients a day while serving as an advocate and group session leader for the clinic participants. The work reminded her of why she wanted to be a nurse in the first place.
"At the methadone center, you could help people change. I never felt like, 'These people are all crazy.' To me, but for the grace of God, I could be on that other side, and if I was, I would hope that someone would treat me right. I still see people, who were in that clinic, and they have grandchildren and they still say, 'Thank you.'"
In 1978, Martin left the clinic to teach psychiatric mental health nursing at the St. Francis School of Nursing. That same year, she joined the U.S. Army Reserve, which promised travel opportunities and, after 24 years, retirement benefits. Juggling the responsibilities of part-time military work, a career and a family didn't faze Martin. "I've always worked several jobs," she says.
Martin was now deeply involved with yet another cause—the Wichita Black Nurses Association, an organization that works to close the health care gap for the African-American community by sponsoring free health fairs and educational seminars at local churches to promote prevention and healthy behaviors. Beginning in 1973, Martin volunteered with other nurses two or three times a month to "get out our stethoscopes and go into the community to try to get people to understand that hypertension was something they could control."
And while she continued to be a part of the volunteer effort, something about the health fairs bothered Martin. "It was medical care that wasn't organized," she remembers. "You had to find someone to ask, 'Can we use your church?' Then you have to set up tables and take your equipment, and it worked OK, but we couldn't follow up on them if they had high blood pressure. That was very frustrating for me, that all of these people were roaming around with this high blood pressure and I thought, 'It is stupid, right here in America.'"
Martin talked about health care issues so often that people started to say to her, "You need a master's degree in nursing," so that she could begin to implement her ideas. And so the teacher became a student again at Wichita State, graduating with a Master of Science in Nursing in 1980.
For the next seven years, she was an instructor of psychiatric mental health nursing at Wichita State, and in 1986 she was also appointed medical center nursing supervisor back at St. Joseph Medical Center, one of her earliest employers. In 1987, she accepted a position as director of the Department of Education and Research at St. Joseph Regional Medical Center.
From 1987 to 1996, Martin was responsible for developing and directing the medical center's education programs. Working to implement health care outreach programs helped her truly focus on the problems inherent in the health care delivery system, and she began to consider how it might work better.
In 1990, she was deployed by the Army for six months during the Gulf War, which she still calls "an experience of a lifetime." The time away gave her more time to think, and gradually, her thoughts and experiences began to come together—taken from the pages of her own life's story:
In her underserved northeast Wichita community, where 45 percent of the residents have no health insurance, Martin began to visualize her dream. "Not to build a place that is a dark, dingy store front... I wanted to promote a brand new, state-of-the-art family health center so that anyone who came there would get the best possible care. And that's what our mission said: Primary health care with a focus on prevention, an unrelenting focus on prevention and education. I know that's how you make people healthy, if you focus on prevention."
From the beginning, Martin called her idea the Center for Health and Wellness. To make her vision a reality, Martin turned to the community for support, drawing on one of her core beliefs: that once a community identifies its own problems, it can use its power to develop strategies and ensure ownership of the intervention. A core group of concerned volunteers responded from nearly every facet of the community—city and county governments, businesses and community groups, along with the St. Joseph's and Via Christi health systems.
In 1994, the newly formed Community Clinic Committee completed a detailed business plan for the health center, and Martin began with the help of a businessman, Walter "Bud" Gates, to raise the $2.4 million needed—knocking on doors not only to ask for money but to conduct surveys about the health care needs of the community. The fundraising efforts immediately struck a chord with everyone. The bulk of the money ultimately came from local businesses, foundations, universities and health care providers, but individual citizens from northeast Wichita contributed more than $100,000 in donations that ranged from $5 to $500 to support a health center in their neighborhood.
By 1996, Via Christi had agreed not only to support the project financially but to help underwrite Martin's job as the new director of development for the future Center for Health and Wellness. In August 1997, Martin and a host of state and city dignitaries participated in groundbreaking ceremonies, and in July 1998, the Center for Health and Wellness opened its doors, offering a chronically underserved medical community a fully staffed state-of-the-art medical center with six examination rooms, a procedure room, laboratory and X-ray services, an education center and a children's courtyard.
When the center opened, Martin fulfilled her dream of providing improved access to health care to her community, regardless of ability to pay. She required that all patients be seen by a physician and a nurse first—before any questions were asked about insurance. Ultimately, everyone pays for the service they receive at the center, either through small monthly contributions or volunteerism, helping to ensure the patients' self-worth. Says one client: "If I had to pay for all the services provided for me, I couldn't afford it. They allow me to volunteer at the clinic to help pay for my care and that makes me feel good, to know that I am giving back to the clinic and the community."
In 2001, Martin was nominated for and received a $100,000 Robert Wood Johnson Community Health Leadership Award, of which $5,000 is a personal award. The $95,000 stipend allowed her to obtain nearly $300,000 in additional grants to expand the center's services, primarily in the area of outreach and education about hypertension, one of the leading diseases confronting African Americans.
Today, the Center for Health and Wellness continues to offer first-class family health care and provides prevention and wellness programs. It accounts for about 13,000 to 14,000 patient visits a year, from "birth to death," as Martin likes to say.
In addition to its educational programs for hypertension, diabetes and breast and cervical cancer, its Stork's Nest Program offers incentives to expectant mothers to make and keep prenatal appointments. The moms obtain points for certain activities, such as attending doctors' visits and taking infant care classes or getting their high school diploma. They can then use the points to shop in the "nest," a closet full of new baby supplies at the center.
Now 61 years old, Martin retired from the center in May 2005, eager to spend time with her husband, their two daughters and three grandchildren, and to help take care of her mother, who passed away in June of that year.
She is still active on the center's board of directors and continues to volunteer; her new passion is helping elderly patients understand how to pay for their medications. "It's too much for the average person to figure out," she says. "It's awful to me, so what about people who can't maneuver the system?"
The recipient of numerous awards and distinguished honors over the years, she was recently appointed to the board of the Kansas Health Policy Authority, which she sees as a very positive step in recognizing preventive health care and education as an important part of any health care policy.
When asked what she is most proud of, she responds: "I'm most proud of the fact that when we started in 1998, the whole state was stuck in these 'sick care' issues. And in these eight years [to 2006], the state of Kansas has moved toward understanding that prevention goes along with providing health care through an increased focus on wellness. That's all I ever wanted."
For more information on the Center for Health and Wellness, visit the website.
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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