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One of the more unusual campaigns in the annals of American health care began in 1995 when the 60 women religious of the Servants of the Holy Heart of Mary met to talk about the future. Like those of other congregations, their membership was shrinking. ServantCor, their small northern-Illinois health care system, was increasingly under the direction of lay leaders. Gathering at their mother house in Kankakee, II., an hour's drive south of Chicago, the sisters asked themselves: What kind of legacy do we want to leave?

Joseph Feth, ServantCor's CEO, had suggested that the congregation and system do something to improve health in their service area. "Healthy communities" was then a hot topic, Feth recalled recently. "As we saw it, good health had to include jobs, education, and safe neighborhoods as well as hospitals," he said. "We realized that government and private insurers weren't prepared to pay for those things yet. But we were ready to make an investment. Eventually, we thought, that investment would have positive economic consequences, for the community and for our system too."

Defining health care broadly, the sisters decided to sponsor a pilot project somewhere in the area. But where? Craig Culver, a ServantCor staffer, remembered that a biological metaphor recurred often in those conversations. "We talked about the area as if it were a human body," he said. "If a body part isn't working correctly, it can shut down the entire body." So which was Kankakee County's most ailing "body part? For years the sisters had maintained a mission in Hopkins Park, a village in the eastern section of the county. There, they agreed, they would anchor their experiment in community outreach.

PEMBROKE TOWNSHIP-HOPKINS PARK
Hopkins Park, the most densely settled part of Pembroke Township, sits on the prairie 17 miles east of Kankakee, not tar from the Indiana line. Most of the township's 3,300 residents are African Americans, the descendants of Southerners who came north after World War II and settled in Pembroke because land there was cheap. The land was cheap, as it turned out, because it was too rocky and sandy for productive tanning and because the business people who developed it for home sites neglected to install the usual infrastructure.

When the Servants of the Holy Heart of Mary targeted the township for their project, a half-century after its founding, Pembroke still had no paved roads. (Area residents tend to say "Pembroke" in speaking both of the township and 800-resident Hopkins Park.) It had no bank, restaurant, or grocery store. Unemployment was high and many residents depended on government aid. A high percentage of the homes were shanties or trailers. The average annual income per family was only SI 1,000.' Pembroke was, said Sr. Carol Kamitsky, SSCM, ServantCor's vice president for mission, "a scarred community in need of healing."

Sr. Kamitsky, Culver's boss at ServantCor, put him in charge of the outreach effort. In January 1996 she drove him out to Pembroke and introduced him to the mayor, the township supervisor, and Sr. Patricia Kieffer, SSCM, and Sr. Yvonne Brais, SSCM, who had for years conducted the congregation's mission at Sacred Heart
Church in Hopkins Park. "We had no real plan then," Sr. Kamitsky said. "We were playing everything by ear. About all I could say to Craig was, 'Good luck, partner.'"

As it happened, the Kankakee Economic Development Council had also become interested in Pembroke. The council's president, Dick Durken, a former official of the U.S. Small Business Administration,
was looking for a way to bring economic development to the impoverished township. He and Culver found they worked well together. Durken, who had served in the Reagan administration, was a skilled publicist and politician. Culver, a former high school teacher who had recently formed a park district for nearby Bourbonnais, IL, was talented at bringing disparate people together in networks. "They were a powerful one-two punch," Sr. Kamitsky said.

They would need to be. The obstacles they faced were racial as well as economic. Culver and Durken are white — as are Srs. Kamitsky, Kieffer, and Brais and most of the various religious and health care people who would get involved in the project. Culver noted that the project involved a certain apparent presumptuousness. "What if I
came to your house and announced that I was going to landscape your yard for your You might be tempted to tell me, 'Get out of here! I like my yard just the way it is.' There was no getting away
from the fact that we were saying something like that to township people," Culver said. Because of these factors, Pembroke residents — who had in the past seen others, black as well as white, come into the township with schemes that sooner or later always foundered — were naturally wary of Culver and Durken and their approach.

"LEVERAGING" RESOURCES
Even so, by the summer of 1996 the two were making visible progress. They began by holding meetings in which they asked Pembroke residents what they wanted. "What they wanted first was natural gas for their homes," Sr. Kamitsky said. "Most homes were heated with propane; they wanted gas pipelines, like other communities have." The residents' second wish was paved roads. Culver and Durken understood the connection
between paved roads, for instance, and health care. "I've learned that poor people tend to see health care as something you look for afterward" he said. "If my roof leaks or I don't have a decent job, I'm less likely to seek help for, let's say, an unexplained pain in my side. I need to fix the roof and get a job first."

To work for better roads, natural gas, and similar goals, Culver and Durken helped area residents organize the Hopkins Park-Pembroke Township Partnership, which is essentially two things:

• A monthly meeting, held in the Hopkins Park village hall, at which township residents and interested outsiders discuss
  residents' goals and progress toward them
• A network of agencies, companies, and individuals
  seeking to help township residents achieve their
  goals*

The Pembroke Partnership is an informal group that, in the beginning, depended heavily on Culver's and Durken's contacts in the outside world. Because they had no capital
themselves, the two had to use those contacts to "leverage" resources, to use a favorite Culver phrase.² Leveraging, in this sense, means persuading a person or group
to do something that serves his or her interest as well as your own. For example. Culver and Durken discovered that a division of the U.S. Department of Agriculture (USDA), looking for ways to aid African-American farmers, was hampered by the fact it had little experience in dealing with such farmers. The two promptly brought together agency representatives and Pembroke's two dozen truck gardeners. Soon, with USDA help, the gardeners had formed a vegetable-growers'' cooperative arid were taking classes in organic farming and raising free-range poultry. The USDA thus became a Pembroke Partner.

PEMBROKE PARTNERS
Since its inception four years ago, the Pembroke Partners have grown to comprise some 250 organizations and individuals, including the following.
Catholic Charities Pembroke is part of the Joliet, IL,
diocese of the Catholic Church. The diocese's Catholic Charities agency, working with Sacred Heart's Srs. Kieffer and Brais, runs a program in which the more able-bodied of the township's older people do chores for the infirm. The Construction Corps, a volunteer group sponsored by the agency, makes repairs on residents' homes.
Lutheran Brotherhood After Culver discussed Pembroke
with a friend who happened to work for the Lutheran Brotherhood, that lay organization helped township residents rehabilitate a derelict building as a shelter for members of troubled families.
Illinois State University The Normal, IL, institution has a program that sends former Peace Corps members (or people planning to serve in the corps) to work in area communities. These Peace Corps "fellows" are typically funded by private companies. In 1999, a fellow spent 11 months in Pembroke, primarily advising the farmers' co-op. A second fellow, whose stay is partly funded by a local bank, is currently working on the gas pipeline project.
Kankakee County The county government has promised seed money for a trash collection service for the township, something the community has long lacked. A trash collection company has
given Pembroke a garbage truck.
U.S. Army Reserve A unit of reserve engineers, arriving in Hopkins Park with its heavy equipment, paved both the village's main road and a parking lot adjoining the village hall.
State of Illinois Gov. George Ryan announced last spring that Pembroke Township will be the site of an $80 million 1,800-bed women's prison that, when construction is completed two years from now, will bring 700 to 900 new jobs to the area. In theory, at least, the prison could end poverty in the township.

*A formal organization, the Unified Community Development
Corporation, was established to handle grant
money earmarked for road improvements and a natural
gas pipeline. The corporation has a board composed
of township residents and representatives of
various area agencies.

Illinois, which will build and operate the prison, is not strictly speaking a Pembroke Partner. In fact, some residents oppose the prison and, as a result, the Pembroke Partnership has been officially neutral on the issue. "We shared with the prison selection site team economic, topographic, and demographic information we had gathered about the township," said Sr. Karnitsky. "But we did not champion the idea."

On the other hand. Culver and Durken have for several years successfully urged newspaper reporters to write about the township's profound poverty. Those stories frequently noted Pembroke's proximity to Kankakee, the hometown of the governor. Some observers believe this publicity inclined Ryan to choose
Pembroke for the prison, rather than one of several other possible sites. In a sense, then, the prison decision is probably the result of
partnership efforts after all.

In any case, Ryan's decision brought a bonus. It now seems likely that the pipelines earning natural gas to the prison will carry it also to Hopkins Park and other homes in the township. Thus what Pembroke residents saw in 1996 as their number one problem will at last be solved.

PROVENA PARTNERS
In 1997 the Servants of the Holy Heart of Mary decided to join two other congregations — the Franciscan Sisters of the Sacred Heart, Frankfort, IL, and the Sisters of Mercy of the Americas,
Regional Community of Chicago — in cosponsoring
a new health care system, Provena Health. Feth first became Provena's chief operating officer and then its CEO. Sr. Karnitsky became the new system's vice president for mission effectiveness. Culver was named director of a Provena program called Healthy Communities.*

* Durken, Culver's Pembroke colleague, retired from the
Kankakee Economic Development Council earlier this
year.

He and Sr. Karnitsky have spent much time in recent years launching a new campaign, the Provena Health Partnership for Healthy Communities. Provena Partners began as an annual meeting at which representatives of the member hospitals would discuss ways to improve their communities' health. One idea was hospital wellness programs. "We thought, hey, in each of these places our hospital
is the biggest employer," Culver remembered. "So why not start wellness programs in the hospitals and let them radiate out from there? They could not help but have a good, community
wide impact."

However, some Provena hospitals have been more direct in their community outreach efforts.
Provena St. Joseph Hospital, Elgin, IL In collaboration
with Sherman Hospital, a secular institution, St. Joseph sponsors a free dental clinic for uninsured and low-income area residents. located at the local community college, the clinic is staffed by 14 volunteer dentists from the county dental association.
Provena Mercy Center, Aurora, IL
Provena Mercy sponsors Companeros en Snlud (Partners in Health), a coalition of 56 organizations serving the large local Spanish-speaking population. Meeting monthly, the group's representatives discuss ways to improve Hispanic people's access to health care. The coalition is currently training bilingual interpreters to aid Hispanic patients in area clinics and hospitals.

Provena United Samaritan Medical Center, Danville, IL
This facility sponsors the HALO Project, an attempt to involve area residents in improving community health.* In 1999 HALO persuaded 434 peopleto
attend small group discussions of area health. This year similar meetings are addressing racism and its effects on health.

*HALO is not an acronym.

Culver sees Provena Partners as an "incubator" tor ideas in community outreach. The partnership has talked about hiring someone to write applications for grants for various projects in its communities. More recently, the partners have considered
making the grant specialist a person who would also travel among those communities teaching residents how to leverage resources.

A continuing problem. Culver said, is finding ways to measure Provena's outreach efforts. "We need to get a better handle on how much we're doing for our communities and how much more we
need to do." In approaching Pembroke, he said, he and Durken had had no blueprint for what they hoped to accomplish. "We brought tons of Opportunities and resources to the community," Culver
said. "We never said no to a proposal. We saw a lot of things fail, but we stayed open to new ideas."

Eventually, Culver said, Pembroke residents began making their own decisions. "The main thing we did was help the community learn about different processes and how to create new systems — all of which is very difficult to measure. But we just know it's the right thing to do. It's our mission. Even though we don't yet have a lot in the way of quantifiable results, we know we're making progress. We've learned that we can go into communities and help people help themselves."

Sr. Karnitsky said hope — which she sees as the result of purposeful activity — is the main thing Provena is trying to bring to all its communities. She cited the prison controversy in Pembroke as an example. The debate is more important than the jobs the prison will bring, she argued. "What you see out there is that people are stirred up, either on one side or the other," she said. "The prison issue is causing some wild and woolly encounters out there, creating both heroes and villains. But people are engaged. Workingthrough this will be good for everyone involved." — Gordon Burnside

For more information contact Craig Culver, 815-
928-6904, or Sr. Carol Karnitsky, SSCM, 815-928-6903.

N O T E S

1. Provena Health, Village of Hopkins Park and Pembroke
   Township Partnership: General Background
   Information, Kankakee, IL. June 2000. is the source
   of most of the demographic information contained in
   this article.
2. ServantCor (and later Provena Health) spent about
   $100,000 a year on the Pembroke project, most of it
   for Culver's salary, office space, and expenses, Feth
   said.
   Hopkins Park, IL.