A race between two Roanoke women with differing experiences on their resumes will determine the Democratic nominee in the 40th state House District.

Donna Littlepage is recently retired as the senior vice president of accountable care strategies at Carilion Clinic. It’s her first run for elected office.

Kiesha Preston is an activist, actress, consultant and domestic abuse survivor who has used the difficulties she’s faced to seek change, she said. She ran as an independent for Roanoke City Council in 2020, finishing sixth in an eight-way race for three seats.

The winner of next Tuesday’s primary will face Del. Joe McNamara, R-Roanoke County, in the general election Nov. 4. McNamara had held the seat since 2018. It has historically trended Republican.

Littlepage said running for office was “not on my bucket list.” However, she said she was encouraged to do so, and she believes this is a perfect year for her to serve constituents. She said with the flurry of changes coming at the federal level — driven by the Trump administration — she can use her knowledge as an accountant to address issues such as Medicaid and Medicare changes. She helped administer Carilion’s federal health insurance plan when she worked in administrative roles there, she said.

She said she also believes her skillset can help the legislature with financial matters affected by the loss of jobs in Northern Virginia, a part of the ongoing federal overhaul.

Littlepage said she considers herself a moderate Democrat – socially-conscious and fiscally pragmatic.

She said she hopes voters will focus on “not what she says today,” but “to look at what I’ve done.”

“My goal is to help,” she said.

Of McNamara, Littlepage said she was disappointed that he voted against legislation during this year’s General Assembly session that would allow a protection of abortion rights to go to a statewide referendum. 

That is “unfair to voters in Virginia,” she said.

Meanwhile, Preston, too, supports reproductive freedoms. And she said Medicaid will be an issue.

This election may be the most important “in our lifetime,” she said. 

Preston said in addition to being a victim of domestic violence, she also has dealt with poverty.

The domestic violence she endured led her to help draft a bill that was signed into law in 2020. The law eliminates certain housing barriers for victims of domestic/sexual violence and human trafficking.

During the lobbying for the bill, she said she was struck by the number of legislators who had no idea the situation existed. That helped her understand the importance of being involved, she said.

Preston said her life experiences make her real, and that helps distinguish her as a candidate.

“We need more of it,” she said.

Littlepage has raised $27,322 and Preston $10,195, according to the latest reports compiled by the Virginia Public Access Project, an online campaign finance and political database.

The 40th District includes the city of Salem, a large part of Roanoke County and a small section of Roanoke. In Roanoke, the precincts include 15-Grandin Court, 16-Deyerle and 17-Lee-Hi.

Early voting ends Saturday. Polls will be open on Tuesday from 6 a.m. to 7 p.m. Democratic primary races for the state attorney general and lieutenant governor are also on the ballot.

Correction (6/11/25): Donna Littlepage retired recently from Carilion Clinic. An earlier version of this story listed an incorrect job from which she retired. We regret the error.