Linda Murray, MD, MPH

Linda Murray, MD, MPHWhen Dr. Murray was in college, a friend’s mother, a black doctor, challenged her to consider becoming a physician.  Until that moment, her aim was to be a community organizer, a plan that was motivated by her past involvement in civil rights organizing during the sixties. After that conversation she decided to go to medical school.  She also learned that at the time the majority of African-American doctors were 50 years of age and older and steadily decreasing in numbers. She admits that in hindsight, she had no idea what it really meant to be a physician, but knew that she would need reliable skills in order to make a living and make a difference. If you know Dr. Murray, particularly her impressive career in public health leadership and activism, then you know that she strongly believes that everything is public health. It is with this spirit that she has managed to impact the way many public health institutions, leaders, practitioners and students think about the issues, the work, and their own careers.

Career in Profile:

  • 1973: Completed her Bachelor of Science in Mathematics
  • 1977: Completed Doctor of Medicine degree
  • 1980:  Completed her Masters of Public Health
  • 1977 – 1980: Was the Resident Physician of Internal Medicine and Occupational Medicine at Cook County Hospital in Chicago
  • 1981: Completed residency in Occupational Medicine
  • 1981 – 1982: Worked as an Emergency Room Physician in Chicago
  • 1983 – 1985: Led one of the first Occupational Medical clinics in Canada as Medical Director for the Manitoba Federation in Winnipeg Manitoba.
  • 1985 – Now: Consultant to the International Chemical Worker’s Union and its health and safety staff
  • 1985- 1987: Worked as Assistant Professor in the Department of Community and Occupational health, Director of Environmental and Occupational Medicine and Residency Director of Occupational Medicine at Meharry Medical College
  • 1987 – 1988:  Served as Medical Director of  Environment and Occupational Health and later as Acting Bureau Chief of the Bureau of Comprehensive Environment/Public Health
  • 1988-1992: Internist
  • 1990: Interim Clinical Director of Internal Medicine at a hospital in Chicago
  • 1992- 1997: Medical Director of and Internist at a two-site Federally Qualified Health Center in Chicago
  • 1997 – 1998:  Was Medical Director of two community health centers within the Ambulatory and Community Health Network of Cook County
  • 1998 – 2003: Served as Co-Chief Medical Director of the Ambulatory and Community Health Network of Cook County
  • 2003 – 2007:  Served as Chief Medical Officer of the Ambulatory and Community Health Network of Cook County
  • 2006 – Now: Serves as Chief Medical Officer of the Cook County Department of Public Health
  • 2009 – 2011: Elected and served as President of American Public Health Association
  • 2012: Elected as Fellow of the American College of Physicians

 

What’s a highlight in your career or work that you’ve done that you are particularly proud of?

I don’t think we’ve done anything to be particularly proud of! I think there are lots of activities that I’ve done that I think had impact on other people. At each stage of my career, starting in medical school, there were different things that I thought were more important. For example, when I was in medical school I spent a lot of time trying to make sure that minorities got into medical school, and as a medical student I spent a lot of time trying to collectively organize the minority medical students to make sure that we stayed in medical school.  And that meant study groups, a mock anatomy exam, or politically testifying about the lack of admission, all of those things. So I think at each point of my life, because of the nature of what I was doing in my life outside of my profession, certain things become a highlight. You raise a child, then you are really about the conditions in society that impact the health of children.  Not that you are not concerned about this at other times. When I was in residency and working at Cook County Hospital, a public hospital, I was concerned about the quality of care available at that hospital, and I’m still concerned about that.

So when you say what are you proud of, well, what I can tell you is that when I was an undergraduate student at Circle, there were more black students in the undergrad program, by percent, than there are today. Do we have something to be proud of? When I was in medical school there were more men and more black men in medical school than black women…today we are the only group where African-American men are there in much smaller percentages than our women and it keeps going down.   I think all other things being equal, men and women should be physicians and nurses at equal rates, so why is it that the percent of our men in medical school continues to go down?  Is that progress? The same hospital that I spent time with and risked my career and had repercussions, where I was blacklisted in the city (because of my efforts) to try and keep it open, that hospital is in still danger of closing, but for different reasons and at a different time period. So here we are on the eve of a major reform in medical care, the Affordable Care Act, and this public hospital which shaped my career as a physician, is closer to closing now than it has been in the past 20 years. So I don’t think it makes sense to think about tasks that you’ve accomplished.  I guess if I had to say, if there’s one thing I was the proudest of, it’s my role as a parent in the broader sense. My nickname in medical school was M&M…Mama Murray. To the extent that I’ve accomplished anything is to the extent that younger people have been influenced or guided by my work.

What’s a challenge that you’ve faced in your career so far?

I think the problem that professionals face, and that I’ve faced, has been the same problem over and over. If you stand up you are in danger of being personally hurt, or hurt career-wise or financially. That never changes. That has certainly happened to me. When people are young, your parents lie to you.  They say, “Be good and graduate from high school and college.” But the problem is being a good Negro never stops, because they can always pick away something from you. So understand that if you stand up against a public hospital closing, you might be blacklisted and not be able to get a job. So I spent a couple of years in Canada because I couldn’t get a job in Chicago. That problem and that reputation are always there.  I remember I was looking for a job outside of the city and I had two offers. One was in San Francisco at the General Hospital running their Occupational Medical program. The other was working for a Union in Manitoba. So I was discussing the differences between the two options with my mother and I said, “Well this one in California is a prestigious job in my field it would put me on a good academic trajectory, it’s a solid program. The job in Canada is a more political job.”  Her position was that it doesn’t really matter what you do. As long as you do something that you know is right, they are not going to respect you anyway so take the job you want. She said, “You are a black woman, there’s nothing you can do to make yourself more acceptable. There’s no way you could twist yourself to be acceptable to white folks, no matter how many degrees you have or brilliant research you do. Nothing you do will make you acceptable so you should do the right thing and do want you want to do.”

Going to the other job wasn’t wrong.  That’s the clear message here – you have to do what you think is right because if you do anything else then you are wasting your time. And nothing you do is going to make you acceptable. So that makes it a little easier. There are some people that can be more acceptable, I’m just not one of them. If you are black in America, you are not one of them. There’s nothing you can do to be acceptable. I have great respect for white Americans, upper-class, privileged people that actually are acceptable or can modify their behavior to be acceptable. When they make a decision not to be acceptable that’s a true sacrifice, that’s something to be truly admired. Those of us that are women or colored, there’s nothing we can do anyway.  People fool themselves, but there’s nothing that we can really do…so when we do stuff like that it’s really not that heroic or courageous it’s just the way it is.

When it comes to public health in general, what matters to you and why?

Well I think the basic issue in public health hasn’t changed.  That is, why some people are healthy and others not. Why are some countries rich and others not?  Why are some populations in good shape and others are in bad shape and what can we do to change it? Those questions never change. The only thing that changes is the policy issues of today that can make things better or worse.  Today we are still saddled with racism in this country. We have not addressed that, and until we do we have no hope of functioning as a country. The inequalities on all levels, the injustices on all levels, are still there and they ebb and flow, they are not always the same, but right now we are at a period where they are widening since the 1980s. So things are going to get worse for our people, and everyone in the country. Those are the issues of today. Climate change is the issue of today. The north/south divide. If we don’t address them in a rational way, things will get worse. So something like climate change may be out of control, we may get to a point where there’s nothing we can do about it. I don’t think we even understand whether we are close to that point at all. The critical thing is to link it to all of these issues. There’s a connection between the climate change disaster, and the fact that we haven’t addressed racism, and that fact that we have the north/south divide. The notion that today we have the technology to feed and clothe and amuse everyone in any way we could possibly want, the notion that malnutrition is still the leading cause of death in the world, this is a criminal notion. We should be ashamed. So when we talk about public health issues of today…starvation and malnutrition are still the leading cause of death across the globe. When I ask this in my classes at the school of public health, no one ever gets it. No one ever knows that’s the answer. They talk about HIV or Malaria. It’s starvation and malnutrition, as it has been throughout most of human history.

What’s a persistent public health problem that still concerns you today?

Other than starvation or malnutrition? I think the notion that we have the low hanging fruits is a profound conceptual mistake.  When I get up in the morning I have to work on something, I can’t work on everything.  There’s no question about that. But to think that you can solve one problem and call that a victory is absurd! These problems are all linked together. I can use a jargon word if you would like. We need to fight for social justice! What does that mean? That means you have to fight on all fronts. The minute you ignore a front in a deliberate way, you’ve sown the seed for failure. You can always make the decision that “here are the three most important things that I’m going to work on for the next ten years.” That’s fine, that’s a little different than saying here’s something like racism, or gender issues that I’m going to ignore, and I’m going to worry about small pox. So how we frame problems, these are symptoms. “I’m going to work on youth violence or motor vehicle crashes, immunization, death from malaria”. That is a tool through which you are trying to solve the real underlying forces in society. What are the forces that stratify us? Power and resources, and therefore happiness and outcomes. That’s really what we are talking about. And those things will change according to time and place.

If you could do something about this problem, what would be the ideal solution?

It’s easy to have an ideal solution. The ideal solution would be a society that is socially just. Where you have resources and power equitably distributed. For each according to his means, for each according to his need. You can think of a number of slogans from a number of different fields – political science, history, religion – that express that same notion. I think that those expressions are the heart and soul of public health. Public health concerns itself with health of the whole and that’s the first thing you want. You want the whole and every component of the whole to be as healthy as possible.  So those philosophical notions define public health. I don’t think you can define it by saying, “Here is Healthy People 2020; if you solve these objectives you’ll be fine.” I’m not saying we shouldn’t have objectives and try to solve them, or interventions, but I think it’s a mistake to think that we have separate problems siloed in separate areas that you can do actually something about. This is population level stuff, so it doesn’t mean that I have to work on everything. That’s literally impossible. If I never slept I couldn’t do that. But what it does mean is that collectively, as a society, we have to address all of these issues. That’s the problem, it’s hard for people to think not only individual level.  That’s why we do stupid stuff, like “I can’t worry about that, it’s too complicated…I can’t worry about the impact of racism on black mortality, so let me just try to make sure teenagers don’t get pregnant.” I’m not for teens getting pregnant, but nobody said that one person has to worry about everything. Collectively, we have to work to address all of these issues at all different levels that they interact.

Susan Avila, RN, MPH

susanSusan originally planned to be a nun.  Instead, she took advantage of a government-sponsored financial assistance program that would support her through nursing school, a decision that took her to the infamous Henry Horner housing projects in Chicago, where she and a team of community health aides were responsible for the well-being of community residents. Several years later, as a result of a shift in the political climate and subsequent funding cuts, the program was eliminated.  Susan emerged politicized and became involved in union work.  This began a career dedicated to advocating for the health and livelihood of disadvantaged communities in Chicago.  The Affordable Care Act has returned the spotlight to the necessary role that community health workers play in our healthcare system.  Listening to Susan speak about her beginnings as a field nurse reminds us of how vital these workers are to the well-being of all, but especially to those in our communities that are marginalized, under-represented and often unheard.

Career in Profile

  • 1970 – 1973: Completed her bachelor of science in nursing
  • 1973-1987: Worked as a staff nurse at several hospitals and community health centers in Chicago
  • 1987: Created and coordinated Chicago’s Food Protection Program as Director
  • 1988:  Worked as a nurse and certified diabetes educator at the historic Cook County hospital
  • 1991:  Completed her Masters in Public Health in Epidemiology
  • 1995 – Now: Became Nurse Epidemiologist at John H. Stroger Hospital’s Department of Trauma. Established the Injury Surveillance Unit and leads the injury violence prevention programming.
  • 2003 – Now: Serves as Trauma Nurse Coordinator assisting with nurse leadership in violence prevention and overall management of the trauma service with special emphasis on the clinical quality data process

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What’s something in your career that you are particularly proud of?

I feel proud of the times that were most formative. For me this was when I worked at Miles Square Health Center and Rush as the field nurse, the one that went out and visited people. It really impressed on me the issues that everyday people face. As the home health nurse, I loved the ability to establish a relationship with someone outside of the hospitals in their own environment. Understanding how people talk about and love their community. We were in the Westside of Chicago and I still go by there. I remember walking down Madison Street on a spring evening, I was on my way back from a particularly sad home visit.  I had seen maggots and all kinds of horrible things, and yet we were within a five minute drive to the loop (down town Chicago). It was 3PM on a Friday, and people were starting to come out for Friday. People were putting their chairs out in front of the barber shop and liquor store.  There was a shop that did car repairs, and there was a tall guy who wore overalls and played Taj Mahal and danced. So you had this feeling: you’d just left that terrible home, but there was also this strength in the community.  As a community health nurse, you were taught that you were part of that community.  Even though the projects were horrible – clearly dangerous – you were there as the advocate for the community.  Even when you were in the people’s homes you were their advocate and you helped figure out what needed to be done. When you are in the hospital, you are only seeing a part of this person, because you can only try to imagine what their house is like.

Have you faced any challenges in your career, so far?

One of the biggest challenges I’ve faced is finding the ability to do what I really like to do. Finding the ability to create that space where you care for people clinically, but you are also actively involved in some of the real issues that affect them.  The health care system has also been a challenge.  We used to steal medicine for our patients at Rush! You would have a patient that was sent home from Rush and needed medication and had no money, and they were going to die. Or a TB patient they sent home to die. We found a way to fake prescriptions to get them for free, and they caught us. I almost lost my job.   Another challenge is to not feel ground down by the system.  I work at a diabetes clinic now, we have some really good nurses but the system is so messed up they get to the point where their attitude is, “Let me just do my job”.  They are burned out.

So when it comes to public health, what matters to you and why?

I guess everything matters to me and I go crazy! But what really matters to me is what I think I can focus on or what I can do. To make a difference is what matters, however you want to define it. Making the connections with people. To me, that’s the most important thing in public health, making those connections with people, so you can constantly keep on thinking of  or understanding the problem and different people’s point of view.

What is a persistent public health problem that still concerns you today?

For me, it’s inequity. In the 70s, I felt like I had more opportunity. The philosophy was there, you saw everyone, your responsibility was clear. For example, you were responsible for making sure the family had milk, that they got their baby in for follow up services. Today, I feel like it’s worse and there are less services. That experience seems like a golden age – and it really wasn’t – compared to what people have to face now. So the persistent problem has been the step backwards.  The step backwards has been so severe that people die because the infrastructure failed them, and there’s no recognition of that. Whereas when I was working in the projects, you knew that the patient was going to die, you knew it was going on, even if nobody else had that understanding. We used to stand on the landing on the 13th floor in the projects and look at the big buildings downtown, and we knew that nobody understood what was going on in that building. 90% of the girls there had been raped and there was no recognition of that, but at least you knew that and they knew that you knew. Now its just there, and nobody knows.

What’s an ideal solution to this problem?

I think people solve it by testimony. What the Chicago Teachers’ Union has done is really a public health initiative.  At school board hearings, people testify about how horrible things are. It has opened up the walls.  People are forced to recognize the horrible conditions and the strength of the people that are in those schools. Before, you would have the Mayor’s presentation and everything was fine.  It’s like when you hear the statistic that 1 out of 4 people go hungry, because it has no meaning to most people, they just say, “Oh, ok!” But when you present it in a public way, and talk about it, and it’s there, you force the policy makers to make a decision about it. So Chicago Teachers’ Union has opened up those doors and started the discussion. I think this should be part of most major public health initiatives.