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.

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