Leadership Stories

Understanding the Political Context:
An interview with Sarah Lee Neal

Rainelle, West Virginia

"Don't be discouraged if they disagree with you. That's half the battle. When you know what they think, you know where you can work."

For a former state legislator, Sarah Lee Neal speaks in a remarkably down-to-earth way about the complexities of the political process. She tells stories, recalls meetings, and describes the legislative environment as an interplay between people and their needs and issues. And she does it in a soft voice, speaking in warm tones about a traditionally edgy kind of work.

"People in government think of their own district as the most important area," Neal says easily. "If there's money available, they would say, 'put it in my county.'

"It's a competitive world," she admits.

Functioning in such a competitive environment does not preclude collaboration and cooperation, according to Neal. But you need to know how to get others involved.

"Some people get things done by shouting. But others do it by being pleasant and selling a good product," Neal says tactfully. "I think there is a possibility for everything. But you need to talk about it as if it can happen."

Building Support, Bridging Cultures
As a state legislator for 16 years (1972 - 88) and a community leader, board member, chairperson, and appointee serving on numerous regional, state, and national committees and boards since, Sarah Lee Neal knows how to make things happen. But when she became chairperson of the first joint governing board of the West Virginia Community Partnerships project in 1991, she took on the challenge of joining leaders from different cultures into a working entity.

"The board included medical school deans and, according to our bylaws, 51 percent community people. In the beginning the deans and the community members did not speak the same language," she recalls.

The project's long-term goal was to increase the number of primary care physicians educated in out-of-hospital settings. By joining community people, local practitioners, health professions faculty, and students in a common endeavor, the Community Partnerships project focused on changing the way academic institutions and communities interacted.

"At first, there were skeptics. But we held community meetings in town halls and elementary schools and talked about the Kellogg Community Partnerships project — what it would mean to our communities, what it would bring. And we were involved and enthusiastic," Neal adds.

Eventually, even the skeptics were won over.

Today the University of West Virginia System's health professions education programs continue to educate primary health care practitioners in rural centers throughout the state. The Community Partnerships model served as a prototype for connecting faculty and students with community health issues in rural areas through the Rural Health Initiative. Legislation joining the Community Partnerships and Rural Health Initiative was approved in West Virginia in 1995. Although many might wonder how so many changes occurred in so short a time, Neal tends to focus on why to explain the project's success. As a board member for the Rainelle Medical Clinic, Neal was drawn into the Community Partnerships project early in the process.

"The first community meeting I attended was in a little town 50 miles from here. We met in the Masonic Hall and people from all over came. People talked about how badly we needed health services, how there was no access to physicians. People were thinking about getting little clinics to meet their health care needs."

Articulating the unmet health care needs of people in rural West Virginia was a role Neal assumed naturally based on her familiarity with the community and local health issues.

"At a meeting in Washington D.C. — at the National Press Club — I was asked to speak about our conditions. It was an unexpected request and I can't say I was prepared to speak," she remembers. "But I explained how desperate we were for help. I remember talking about pregnant teenagers and underweight babies, older people dying without medicine, using only the old remedies. And I found out that the issues we faced in West Virginia were the same for people from Community Partnerships projects in Boston, East Tennessee, Texas, and Hawaii. It was like a wave running through the crowd. You could feel the reaction."

Staying focused on the "why" behind increasing the number of primary care providers explains Sarah Lee Neal's approach to pursuing an objective.

"If it is a sincere and right thing, then it can work," she says. But groups hoping to promote change must be strategic and focused to move from good intentions to practical solutions.

Explains Neal: "In order to accomplish a goal, you must form a plan and be totally sold on what you are doing -- not easily sidelined. Think what might be an influential method to accomplish your goal and pursue it.

"Don't be discouraged if they disagree with you," she continues. "That's half the battle. When you know what they think, you know where you can work. Get that door open and you can sell your project."

Finding Ways to Connect People
In Neal's view, understanding a political context depends on understanding the people involved in the process. "Each legislator knows what he or she wants to do," she says. "When they come together, they can see areas to work on together." Finding common interests, engaging people one-on-one, and looking for ways to connect people are all crucial to "selling" an idea, according to Neal.
One method employed by the Community Partnerships was a "legislative mini-clinic" at the West Virginia state house -- not one focused on pitching the work of the project, but on the legislators' health.

"We took doctors and staff from the clinic and students, too," Neal recalls. "In the hallway, we did blood pressures, weights, and checked basic health measures for the legislators and staff. We would stay all day. And in the course of taking blood pressures and so on, we'd tell them what we were doing at the rural centers."

Looking for ways to connect people is a theme in Neal's work on behalf of communities and the projects meeting their needs — and an approach she has used since her days in the legislature.

"When I was representing the region where the School of Osteopathic Medicine was sited, I went to the school and talked to the students. I told them to check with their parents, find out who their representatives were, and write a letter or go see them. 'Tell them you are in the program and what it means to you,'" Neal remembers. "The students liked that."

In her own way, Neal was showing those D.O.s-in-training how to navigate the legislative process. When asked, she offers this advice to others seeking to connect with legislative decision makers:

"You have got to get others involved in the process. Every person who touches what you are working on is another pair of hands, another opportunity for support. If you give people the impression that your idea is the only one, you've created yourself a failure. You need to be willing to work with people, to welcome participation and input."

Seeing the political process through Neal's eyes, working politically is a very collaborative endeavor.

"When we were able to convince legislators to support the Kellogg project, it was a major accomplishment," she agrees. "But it was the effort of so many people — people who became involved and plowed into the project. They saw an opportunity that had not been tried and the tremendous enthusiasm they brought made the project successful.

"That's what is exciting," Sarah Lee Neal emphasizes. "Doing something good for lots of people."