Michael Fine, a past director of the Rhode Island Department of Health, is a physician, writer and community organizer. He is the chief health strategist for the city of Central Falls and the author of four books, both non-fiction and fiction.
We recently conducted a Q-and-A with Dr. Fine. His remarks, which follow, have been edited for clarity and length.
What was the path that took you from medicine to authorship?
It was actually the other way around. I thought I was going to be a writer, and I was looking for something to do before I got well-enough known to make my living at it. I had a little bit of a science brain, so I thought I’d put it to use. [Medicine] turned out to be a fairly major distraction.
You’re a family physician. Why that specialty?
[Before] medical school, I hadn’t done any real science, so I had to do a post-bac [baccalaureate] pre-med. I worked in the South Bronx [in New York City] and trained as a community organizer; I thought that medicine in general, and primary care in particular, was a particularly good organizing focus.
Tell me more about your community organizing work.
It was in the middle of the South Bronx. It was a place where my family had lived; my father went to Yeshiva around the corner. This was in the post-Robert Moses era; many landlords abandoned their buildings and there was this sort of devastation, like Dresden after the war. My friends and I ended up organizing a health-care system inside each building, to support the people who were there.
When I went to do medicine, I thought, “How do you use medicine to strengthen and build resilient communities so that kind of thing doesn’t happen to a place?”
How did you wind up in Rhode Island?
I came for residency. I trained at Memorial Hospital, a long time ago, and [came back] after going to east Tennessee for three years with the National Health Service.
Why did you return?
It’s a nice place, you know? It’s calm and cultured enough, and the community makes it feel like you can make a home here. It’s got this intimacy, that one degree of separation, like we all know each other.
I’ve been here long enough that I’ve probably taken care of 1 or 2% of the population. I’m always running into people I used to take care of.
Your first three books were non-fiction, but your latest, “Abundance,” is a work of fiction about the Liberian civil war. Why the change?
The others came as a result of practicing [medicine], but I wanted to write fiction. I started “Abundance” in 2009; it just took time to get organized and finished. I took a couple of years out to run the Rhode Island Department of Health, so that was a bit of a distraction!
[I wrote] my last book of non-fiction, “Healthcare Revolt,” because I understood that it would be easier to publish non-fiction. I got a publisher for that book, who then published the novel.
How did you become Rhode Island’s director of public health?
I stopped my practice in late 2008 [in order] to write. A friend had been working for years in the prison [the Adult Correctional Institutions], and at the time the ACI had no medical director, so my friend said, “you’ve got to come and work at the ACI.” I said, “No, no, c’mon, I’m writing.”
He convinced me to take a look, and they made me a deal that I could write in the morning and come to work in the afternoon. So, I was at the ACI as its medical director, and in January of 2011, I suddenly got a bunch of LinkedIn requests. I don’t do social media, so I said, “What’s going on?”
Well, there was a new governor, and the director of the Department of Health had resigned. I was in state service, with public health interest and experience, so I guess a bunch of people said, “Why don’t you get him to do it?”
I became the interim director. They asked whether I wanted to do it full time, and I said “no” a couple of times, and finally … well, I’ve had this idea that the way to fix health care in the United States is to provide primary care to everyone. In Central Falls [we have] a “neighborhood health station”; it has resources to provide medical, dental, mental and behavioral health care, urgent care, labs, X-rays, physical therapy, all in one place and for a city of almost 20,000 people. Nobody gets turned away regardless of ability to pay, insurance status or documentation. We’re there to take care of everybody.
If you have primary care in people’s communities, they use it and don’t go to the emergency room – the logic of this is not complicated. This is what I’ve been working on for all these years since the South Bronx … so I said, “Put me in charge of the delivery system and I’ll take the job.” They said “OK,” and I took it.
What do you see as the greatest threat to public health in Rhode Island?
I think it’s the existential threat of diseases of despair. We’re fifth in the nation for [substance-use disorders and alcoholism], and we have a very high suicide rate. You have to ask, “What have we done as a society to create meaning for people’s lives, so that people are connected, feel connected, stay connected, feel purpose and hope?” Somehow we’ve failed to do that, and that’s probably the greatest threat to the public’s health.
Do you have thoughts on how to turn that around?
We’re doing way better than we used to, but there are still opportunities to integrate people into communities. I think we have to go way beyond that and think about every kid growing up in every neighborhood, and how to make a life for them.
Some of that, I think, is building these neighborhood health stations, which, as far as I’m concerned, ought to have [services] that build the sense of a commons. It’s a difficult problem, because it’s not like a doctor’s diagnosis and treatment; these are societal approaches to societal problems.
But those issues are so closely tied together.
Right. The question for clinicians is, what is their role and responsibility beyond “see the patient, write the note, write the prescription,” when they see patterns of disease, of despair? What tools have we given them to advocate for the community? This is not just a problem of policy, but one of imagination. The challenge of our politics is to see ourselves as one people.
And there’s a current divisiveness.
It’s overwhelming. “Abundance” is really about that; [I wrote] intentionally to give a look at what a real civil war looks like, and to give some close-up and personal sense of what happens if we don’t fix these divisions.
We have this precept that I grew up with, “If I am not for myself, who will be? If I am for myself alone, what good am I? If not now, then when?” That’s [Rabbi] Hillel, and that is fundamental and incredibly important. You have to start with yourself, but if you’re only for yourself, the world comes to warfare and everything falls apart. If you put off changing it to tomorrow, it never changes – you’ve got to start today.
The self doesn’t exist in a vacuum. We’re all in this together, whether we want to be or not.
Tell me a bit about your practice of Judaism and your upbringing.
I grew up in a community anxious to forget its Judaism, in a Conservative synagogue that drifted Reform, where they didn’t have regular Shabbos morning services, only Friday night. My parents kept Kosher, I keep Kosher. I tend to go to shul on Shabbos. There’s a little morning minyan at Temple Emanu-El [in Providence]; it’s a wonderful group of people.
Do you have a favorite Jewish holiday?
I’m not sure. I think a lot about Yom Kippur. I think that just being there, being with my family, that’s what matters more than anything else.
What about a favorite Jewish food?
It’s funny you should ask. I am a true lover of water bagels, with a hard, shiny outside and a beautifully soft inside, which you can’t find anymore except at Rainbow Bakery [in Cranston]. I think we forget that Rainbow exists, but it’s the last Jewish bakery in Rhode Island.
Favorite Jewish or Yiddish word or phrase?
There are two. The first is the quote from Hillel; the other is from the story about Abraham and Isaac, “And they walked together, both of them.” To me, that is the founding story of Judaism; the moment at which we understood that life is holy. There’s a poignancy and a beauty to that expression, which is used over and over again, even though this terrible thing was being contemplated.
Is there a piece of advice that you’ve received that you’d like to share?
I have a mentor, Dr. Bernard Lown. He’s 98 years old and won the Nobel Peace Prize in 1985. When he won, he took his mother with him [to Oslo]. She said, “Peace Prize? You couldn’t win the Nobel Prize for Medicine?”
But Bernie says, “If you can see the invisible, you can do the impossible,” and to me, that’s the best advice there is.
During the week of Sept. 16, an interview with Dr. Fine was featured on PBS’ “Stories in the Public Square,” produced by the Pell Center at Salve Regina University.
MICHAEL SCHEMAILLE (firstname.lastname@example.org) writes for Jewish Rhode Island and the Jewish Alliance of Greater Rhode Island.