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The Center Holds: COVID-19, Public Health & Drama

 

Leah McCall Devlin is a Professor of the Practice in the Department of Health Policy and Management at the UNC-Chapel Hill Gillings School of Global Public Health. She is also chair of the board of the CDC Foundation, an independent nonprofit created by Congress to mobilize philanthropic and private-sector resources to support the CDC’s critical health protection work. She has hserved more than 30 years in public health practice in North Carolina. including 10 years as the Wake County Health Director and 10 years as the State Health Director. Devlin also serves on the boards of the Robert Wood Johnson Foundation, the UNC Board of Visitors, the Gillings School of Global Public Health Advisory Council, Trustee of Campbell University, NC Medical Society Foundation, NC Foundation for Advanced Health Programs.

Lauren Gunderson is a playwright, screenwriter and short story author from Atlanta, GA. She received her BA in English/Creative Writing at Emory University, and her  MFA in Dramatic Writing at NYU Tisch, where she was also a Reynolds Fellow in Social Entrepreneurship. She was named the most produced playwright in America by American Theatre Magazine in 2017 and 2019, was awarded the 2016 Lanford Wilson Award from the Dramatist Guild, the 2016 Otis Gurnsey Award for Emerging Writer, and was awarded the prestigious 2014 and 2018 Steinberg/ATCA New Play Award for her play, I and You (also a Susan Smith Blackburn Blackburn and John Gassner Award finalist) and The Book of Will. That play was an NNPN Rolling World Premiere that started at Marin Theatre Company and has seen over 40 productions nationwide. She is also a recipient of the Mellon Foundation’s 3-Year Residency with Marin Theatre Company. Visit Gunderson’s website HERE.

Interview by Gary Gunderson

Gary Gunderson: Sort of a word of introduction between the two of you, the both of you have an enormous amount in common in the sense that you’re both really smart Southern women and have carved a career in fields that tend to be dominated by men and tend to be performed in public, but often with an audience that doesn’t really expect your voice, doesn’t really expect you to be the ones speaking. Lauren does that in theater.

And Leah, I’ve known you for at least 20 years, maybe 25 years when I was working at the Carter Center from afar. You were directing public health in the state of North Carolina. I was invited by you then to come up and I remember Ken Robinson of Memphis and I came and spoke to an audience that you created about the role of faith in public health. I’ve seen you since coming to North Carolina myself just seven years ago. I’ve come to realize the role that Leah plays in supporting the whole field of public health in a very active role, in leadership roles in the national organizations of public health, as faculty member in the School of Public Health at UNC, which is the only thing I would cheer for at UNC. But I’ve come to appreciate your role in creating a culture of professional support in this remarkable field. You, of course, are on many boards of influence. But I’ve noticed in your work, it’s never about you. You are always promoting others with a long view of who they might be in the work of public health.

Lauren’s done something not entirely unlike that. She’s a good friend that looks out for people in the broader field of theater. She is the most produced playwright in the recent several years but has primarily flourished in regional theater and really isn’t so concerned about the big audience as she is about the voice. I’ve watched her always look for the people and raise them into roles of prominence and cheering for others in the field. So I suspect you have a lot in common.

I think I mentioned Lauren from early, early on has been tuned to science and the drama of science and particularly the drama of women in roles of science. I think that’s in particular where I expect our conversation to go in this place.

So, let me tee this up with a question, Leah, to you. We have worked together recently with Gene Matthews, who is a common friend and trying to help those in positions of leadership in public health to find our voice in a time when public health is actively under attack. Suddenly we’re experiencing almost the flip of that, but it’s still difficult for people in public health actually to find our voice in this moment. I’m curious about how you have experienced these recent weeks as a leader in public health. Probably not the one at the microphone now, but you know every single person who is at the microphone and watching how they are doing as a communicator. I n effect, you are watching the drama a little bit like Lauren watches the drama. She may not be on the stage, but she is listening very carefully to how the words are working and whether the narrative is working. So tell me a little bit about how you’re experiencing this time.

Leah McCall Devlin: Well, thank you, Gary, and it’s great to be with all of you and I’m really looking forward to our conversation. It’s nice to meet you, Lauren. Right now I am deployed to DHHS, working remotely. My responsibility there is to connect really smart academic scientists with the scientists that are at DHHS. I’m connecting communicators, modelers, we’re looking at vulnerable populations. I am working to help the School of Public Health at UNC coordinate its efforts, but also be responsive to Secretary Cohen who’s leading the charge in North Carolina. So a lot of knitting of really smart, passionate, committed experts together is I guess what you would say most of my role is right now.

North Carolina has had a tremendous response. They have great leaders. Many of them were there when I was working in state government as well. It’s been an incredible learning experience for all of them and for all of us. The thing that’s been most impressive to me is the great tsunami of awareness that we have, that we are all in this together. We’ve always carried that message in public health, that community is only as healthy as we all are healthy, that the most vulnerable are able to achieve their optimal levels of health as well. I think that message is really coming home to each person in this country now is that we’re all connected and we each have our part to play.

Gary Gunderson: So Lauren, I introduced you, but I don’t know if you recognized yourself.

Lauren Gunderson: I did, sort of. Leah, what a privilege to talk with you. It seems like you are doing the work that is often unseen by most of us on day-to-day normal non-pandemic times and it’s incredibly powerful to know that is happening during those crises and during this time now. I wonder, something that you just said about public health, what you just said reminds me of my mother-in-law who often says a mother is only as happy as her unhappiest child. It does seem that public health-wise, we should be only as happy as our unhappiest community member, as healthy as our unhealthiest community member and to keep those… Exactly what you’re talking about, that sense of collectivism now more than ever. It’s just so obvious that we are in this together and those who are denying it are the ones that are getting us in trouble or keeping us in trouble. Quite profound to think of it like that.

Leah McCall Devlin: I think that’s a really good analogy. Two things that come to mind on what you were saying is our everyday work is one comment that you made and it is something that we talk about a lot in public health, that we call public health the quiet miracle because when we do our work well, nothing happens. You can dine out in restaurants, you can send your children to school, you can drink your drinking water. Most of us have a healthy pregnancy and a good birth outcome, although we have more to do there. So when we do our work well and I mean that collectively, it’s not just the governmental public health. There’s many people working on public health and in this COVID outbreak, each person that stays home is doing their public health part. When things work well, it’s quiet and nobody knows we’re there. If we can come out on the other side of this with a new appreciation for the public health workforce it’s the same as the fire department. Same as the police department. You have to shore it up at all times so when a crisis happens we were ready to go.

Gary Gunderson: So Lauren, when I was thinking about Leah and not surprisingly Leah said, “No, I’m not the one you want to talk to,” I thought of the play you’re working on right now called “Beatrice,” which is focused on the quiet drama, the profound drama that usually doesn’t find itself on stage. Talk a little bit about that because I think that has a lot of resonance with how you make visible the mundane drama of public health.

Lauren Gunderson: I am thinking so much as you’re talking how heroic what you do and you, in particular, but the people that you surround yourself with and the people you work with are. It is a kind of heroism and the real greatness of great literary heroes, which is more my field than actual heroism, is that it is an ordinary person in an extraordinary circumstance. The hero is made of, do they claim that extraordinary moment to bring out their best self or do they reject it? And those who claim it turn into the heroes that we celebrate. And it isn’t because of ingrained or profound super heroic power and all of that. It’s doesn’t actually need a Marvel movie. We need people who say, I can do something about this. I may not trust that I’m the right person. I may not be the perfect the human being, but I know that I can do this and I’ll sure as heck try.

At a certain point, that’s all you need, is the trying and that it seems so much of what people who are in public health do is, you don’t have all the science all the time. Certainly now… This thing hit and we’re still trying to figure out what the science, and we have a lot of science but it’s not complete and we don’t have vaccines. We’re working on those. I mean it’s happening now. But if we all waited until we had every bit of evidence and every confidence that we were exactly the right person to jump in and save the day, the day would be long over.

I think the great stories and the great heroes certainly of this moment are those who might consider themselves ordinary. I think of workers at Safeway and Whole Foods and people delivering our mail and the folks that oftentimes get forgotten and certainly taken advantage of in our society. And now those doing those “regular” jobs are the ones that are keeping us afloat. And then of course people who specialize in public health, virology, epidemiology medicine are doing great work. So it’s a combination, but it’s exciting to think who the heroes are, which is the job of the playwright, the storyteller, is to go, “Who’s the story about? Who’s the main character? What do they want and do they get it?” In this case it takes a lot of people going, “I want my community to get better. I want a vaccine. I want to make sure that the vulnerable populations don’t succumb. I want that.” Do they get it? Well that’s the question of the play that we’re all in right now.

Leah McCall Devlin: So a couple of things. I listened to your earlier podcasts and where you said every good story has three elements and it was justice and truth and love. And just thinking about how that translates into the everyday practice of public health and the type of people that go into public health. And by the way, your point is well taken that there are people in every sector of our society that are responding with justice, love, and truth as well. You mentioned the mailman. They’re all doing their jobs in a tough time.

People that go into public health really do have a passion for what they’re doing. And I think that gets to the comment you made about love. And they also by and large have a real passion for the underserved and the disadvantaged and the vulnerable. That’s just in the DNA of most people that I know that went into public health.

The issue related closely to that is equity and justice and making sure that everybody has a chance to be as healthy as possible, a fair chance. The truth for us in public health, of course, is the science. What does that tell us? The great literary figure of Chicken Little, right? Chicken Little didn’t wait for all the data to come in. We have to act on what we have. We don’t want to be hysterical. But we do have to take the data that we have and begin to prevent disease and save lives. I always say that, and someone else told me this, that if you don’t stick with the science, it’s a greasy slide downwards. That’s been one of my informal mantras for my life.

Lauren Gunderson: Stick with the science. Yeah. That’s incredible. I also wonder, what does it feel like to be a person who understands deeply the course and journey of public health when something like this was starting? Did you have a kind of Spidey sense of like, “Ooh, this might get big, this might get bad”? When did you feel the alarm bells going off in your head and what were your first thoughts? What were your first actions?

Leah McCall Devlin: Having been in the field a long time — I was at the local level in the ’80s when HIV surfaced and became an epidemic. And then we dealt with SARS, West Nile virus, monkey pox, pandemic flu planning. We had always planned for worst case scenario around flu, pandemic flu, and we’re in the worst case scenario and it happens to be SARS in a novel virus, which is worse than pandemic flu. So we’ve always known this was a possibility and we planned for it. So when you see a novel virus coming and what it was doing in other countries, yes, hair stood on end across the public health system. We were slow to the gate in some ways, but this is something that was a big flag for the public health workforce, federal, state, local.

Lauren Gunderson: Who were the first people that you talked to when it occurred to you oh, this could be our worst case scenario?

Leah McCall Devlin: Currently, my day job is at the UNC Gillings School of Global Public Health and we have amazing researchers in epidemiology, biostatistics, infectious disease and health communications. It was an incredible buzz around the school, for one. But I’m also very connected with our colleagues at the North Carolina Department of Health and Human Services. So everybody was on alert. Everybody’s talking about what does this mean for your work, for your life, for where you think we need to go within your scope of authority. Public health’s a team sport, right? We’re always every day working together across multi-disciplines and across different levels of government and with our external partners. Tickling those networks, seeing what antennas are up is something that we just do naturally. And so it was quite the bust from the early days in Wuhan.

Lauren Gunderson: And just because I’m a curious creator of character, I wonder, great characters have several things going on at once. There is the kind of outward goal of what they want in the world beyond themselves and the kind of inward thinking, introspection, what’s it like being inside your own mind and your own emotions? And I wonder what that is like for you? Obviously, knowing that so much of your work is dedicated to the outward scope of stopping this thing, understanding it, etc., is there something… What does it feel like just as a person? Can you separate public health Leah and personal Leah, the one who worries about yourself and your family and your own house and, you know what I mean?

Leah McCall Devlin: In some ways you’re talking about how do you go the distance, how you take care of yourself and your personal life and find a little bit of balance so you can get to the other side of this and can provide the leadership and the teamwork that’s needed. In a situation like COVID that is really tough. So I think people that are on the frontline in their response, they’re working 16-18 hour days. They are having to trade off, to tag team a bit. I think that they are getting and have gotten into a rhythm. There’s a rhythm to the work as you ramp up your response, that, okay, we’re going to have press availability at 8:00 and at 4:00. We’re going to have a coordinated work group for our academic partners and our epi experts at the state every Wednesday at 1:00. We’re going to have a communications team that gathers at 1:00 on Friday.

So you start to organize the body of work in a way that makes it predictable, tolerable and in some ways, I don’t want to use the word sane, it’s just so chaotic. There’s just so much to do, but you put structure around things that help guide you and move you forward, but also provides some clarity, which is comforting, right?

Lauren Gunderson: Oh yeah. God, that’s a great point. That’s a great point. Glad that I’m asking all the questions, but-

Leah McCall Devlin: I know, Gary, where are you?

Gary Gunderson: I’m fine. I’m just watching the two strong women at work here. I’m smart enough to know when to get out of the way. Both of you function locally and in national networks. I’m curious, Leah, about how you are living in the national community of public health in this moment.

Leah McCall Devlin: Nationally, the CDC Foundation is a big part of the response that I’m participating in. Judy Monroe is a former state health official. She’s a physician. She was a deputy director at CDC and she’s now leading the work at the CDC Foundation. And the goal there is to help philanthropy and business and other sectors do the work that they want to do and contribute to the COVID response in the easiest, best way. So the Foundation is established by Congress. It’s a 501(c)(3) and it’s there to be the nimble partner for CDC, highly responsive, and we’re working a lot with the states to meet their needs, as well. They have really ramped up their work and have become really the national leader in the foundation world for preparedness and response and particularly, not just for governmental public health, they’re doing humanitarian work as well.

But I can’t say enough about the role of these other partners and how the Foundation is working there. The Robert Wood Johnson Foundation, I have the opportunity to participate in their work as a board member and our leader is Rich Besser. He was former interim CDC director and a commentator on a national news network and has been at our foundation as the president for the last several years. And even prior to his being there, we had developed this culture of health philosophy and movement, it’s actually a movement, to have all sectors of our society participate in their lanes and in their roles to assure that health is a shared value, that everybody plays, and that we’re all going to benefit for the greater good. And I think that this pandemic event brings that home anew and actually makes that a little easier for everyone to understand.

When you have a job personally, as an individual, to stay home, to stay six feet apart if you have to go out, to listen to the guidance on testing and whether or not to wear a mask in certain situations so we don’t undermine the healthcare workers, I think people are understanding that even better.

I also think people now are experiencing for the first time what it’s like to not have access to the healthcare system. The hospitals are only taking essential services as they deal with the surge in COVID cases that are coming to them. So someone that typically would have access because they’re covered, they have insurance, for other reasons now doesn’t have access. How does that feel? That’s makes you very vulnerable. That makes you feel a little scared and I think there’s some shared experiences I hope that come from this, that when we get to our other side we’re able to go back and have more political will, community will, to correct some of the things that we have not done to support everyone in our country.

Gary Gunderson: I wanted the two of you to talk a little bit about not the COVID environment right now, but about the normal life of being a woman in science, a woman of science and how are you experiencing that? Lauren, this is something you’ve written a lot about. Leah could easily be a play.

Lauren Gunderson: Yeah. I mean to me it feels like, what would I actually want to ask is, how you got started in all this. What is the origin story and does it feel similar to other people in your career, if you know that? But I am so fascinated by where people’s passion comes from, especially the kind of dedicated passion that you have to have to do this work. I mean, you just mentioned offhand some of the more harrowing events humanity’s been through in the last couple of decades with HIV and, and all of these outbreaks and epidemics. Where do you get the strength and the passion and the excitement to do this work?

Leah McCall Devlin: It is exciting work in public health. And one of the things, the scope of public health and the opportunity to engage are so broad, whether it’s immunizations or infant mortality reduction, chronic disease prevention, or the reporting and investigating the 65 communicable diseases and conditions that in North Carolina, the local and state health departments are charged with doing that. The issues that we’re dealing with every day are the ones that people care about in communities. Really, if you boil it down, they don’t know what’s happening because as I talked about, it’s the quiet miracle when we take care of many of these issues.

So the opportunity to make a difference is huge. And every day people in governmental public health, they go to work and they’re excited about what they’re doing. How can we make a difference? What can we work on today? Even in normal times.

And certainly the workforce has been reduced over the past decades, even as the needs of the population have increased for our services and opportunities to engage in new technologies, new strategies, new evidence-based interventions. It makes it more exciting and the opportunities are even greater. At the same time, the administrative burdens are incredible within governmental public health. We always had a saying that you should never say that things just can’t get worse when you’re trying to get something done because that’s immediately when something else locks down. And we had another little saying to help us keep going in that regard, which is, “We have to live to fight another day.”

It goes back to your earlier question about pacing yourself and taking care of yourself. But I think people go into public health because of the opportunity for health improvement, but also because it’s focusing on the upstream and the prevention aspects of these problems as opposed to treating, which is important. Everybody needs care. But if you really look at your health and the health of the community, access to medical care is on the lower end of what really impacts your health. We all need it, we all want it. I don’t want to minimize that. But really your behaviors, your genetics, your environment, those factors are really more upstream and what we try to address collectively in public health. So it’s that preventive challenge that’s exciting as well.

Lauren Gunderson: Were you a little scientist when you were young? Were you an adventurer? Were you a question asker? Who were you when you were 10?

Leah McCall Devlin: Well, I guess it’s a cliché that we’re all products of our environment to some extent, but my mother was a biology professor at a small college, Campbell University, and my father was the basketball coach. So I had a good dose of health and science growing up. I found my way into dental school, and when I was in dental school, and this makes sense because dentists are the first preventionists, if you think about what your messaging as a child was, “Brush your teeth, don’t eat sugary foods, floss, see your dentist, of course, twice a year.” That whole preventive message of dentistry… I found myself saying, “I’m learning to do surgery on hard and soft tissue for diseases that never need to happen. We can totally prevent oral health diseases, tooth decay and gum disease,” lay words to say that.

So I found out about the School of Public Health, which was across the street and how actually you can have a bigger impact if you deal with populations and that you deal with prevention in a population. That was real attractive to me.

The other part was my father is a coach. So as I mentioned, public health is a team sport and you need everybody engaged, Everybody playing. Every day you go in there and you’re practicing for the big one. You’re getting ready for COVID-19. And everybody plays and everybody has a perspective. The other sports analogy, and this comes from Coach Kay, even if he’s at Duke I like to use it, because even if you’re going for the big tournament and you want to be the best, most successful team and you individually want to be the best basketball player, what he tells his kids at camp is, to do that you’ve got to keep your socks clean and dry. You have to take care of the fundamentals. You have to start at the very bottom. And so we do that every day in public health, across the board, preparing to be that hero that you talk about, that champion for a cause, in this case, protecting lives from COVID-19.

Lauren Gunderson: Oh, that’s so good. See, that’s a great story. That’s amazing. Basketball and biology created the superhero.

Leah McCall Devlin: I really like people. This is a people thing, too. I think that’s another part of the work. Not that everybody that’s on the team in public health has to be a people person. We need our scientists at their desks working on data and data analytics. That’s totally foundational, but a lot of our work does involve engagement with our partners and others, the public.

Lauren Gunderson: Yeah. And I would say that part of what grips me about it is your original point where you don’t know how much work has gone into making it look like no work has happened. If there is no outbreak, that’s saving the day, even though everyone just goes about going to the movies and going out to dinner, etc. So to me, that would be the movie or the play is the almost. And how close the people who know, know we got, but everyone else doesn’t have to know. And it’s the glass of wine shared at the bar knowing this bar could have been closed because there could have been an outbreak, but we stopped it. If I were writing the Steven Spielberg movie, that would be the last scene.

Gary Gunderson: So, Lauren, you’re actually close to what I was a mulling on asking and that is the experience of anger in public health. The anger of seeing the opportunity missed, of seeing something happened where it was actually a poisoned fruit of a conscious act of greed that creates something. Some of the public health talks about preventing things that a virus could do or a germ could do. Virus and germs actually, they’re just being themselves. They’re not doing it on purpose. But some things in public health happen decade after decade and really are poisoned fruit of political choices and social patterns that are very ugly. So, Leah, talk to me a little bit about anger.

Leah McCall Devlin: In my experiences, I think what you’re talking about are the issues of justice and injustice and the difference in the have and have-nots in health. Of course, we know that’s grounded in many of the fundamental social determinants of health, like lack of education, poverty and housing, many other aspects. But the role of anger, I found actually, Gary, that there’s not a place for anger in governmental public health, that in our work the role is very important to stay centered and you talk about the center has to hold. The center for us in governmental public health is the data and the science. The best practice is the intervention, the communication tools, finding out what works and doesn’t, recycling into your plan. I think part of that is awareness of vulnerable populations and advocating for change. I always felt that the advocates are incredibly important in our work and the anger part is something… that we rely on the advocates that have more time and space and freedom for that.

In governmental public health I’m reminded of what Frederick Buechner once said that the skeleton at the feast is you. And so I think that we have to stay a little off of that emotional response. Can we tap into it? Absolutely. It’s there. We’re asked to do really a lot of work and may be asked to do things that we think could be done better. But I think anger is not something that we can afford, but we can support it in others. I guess that’s what I’m trying to say.

Lauren Gunderson: That was exactly my question to add. It seems to have the knowledge that you have, the experience that you have, and see incompetence being the cause of the thing that is the worst case scenario to most of us would just be rage-inducing, would be frustrating to a point of combustion. To have your calm head, I think you must be totally right that that is the right call. Calm heads prevail. Take the high road, keep the eye on the prize and all the other platitudes of keeping calm and carrying on. But, man, it must be frustrating. I hope at some point you get to take a good whack at something, to vent what must be frustrating.

Leah McCall Devlin: I don’t mean to say we’re not mad when we get thwarted and we’re in these impossible situations where we know we can do more. That’s just not our official position, obviously, but we do hang up the phone or walk away from the camera and ventilate to each other. It is a real issue. We just have to control where we go with it.

Lauren Gunderson: Which also makes for a great character, the character that has to keep it in spite of their instincts to go, “Aah!” is a really interesting one.

See, we’re writing some great theater here. This is great.

Leah McCall Devlin:  Now I will say one of my heroes, a shero in this case, about a year and a half ago, I was questioned about her statements and her position on a scientific issue here in North Carolina and she resigned. So it does happen. There are people that say, “I’m not going to deal in this system with this kind of approach to a problem.” So sometimes you do walk away from it. That’s always on the table.

Gary Gunderson: But as part of the professional art and craft, what you’re describing is knowing what to do with your own emotions and recognize that your own emotions are not the ultimate good. But there is a craft that is measured in the good for the public, so there’s a selflessness to this field that isn’t just emotional. It’s part of the craft. It’s part of the work.

Leah McCall Devlin: I think you have to decide what swords you want to fall on. Some issues may be incredibly frustrating, but as I said, you’re going to live to fight another day so you sign up to fall on that one. There’s a bigger, longer goal you’re striving for. This is not a COVID issue, but we’ve worked for decades, over 30 years just in my experience, on tobacco prevention and control. And we have a chipping away policy where we just, every year we say, “Okay, how can we move the policy and regulatory environment for the tax environment forward?” And we just do little step by little step because we are in it for the long haul.

I think that’s something that’s important to remember, too, when you get into these incredibly stressful situations like COVID is that we are going to get to the other side of this. We do want to have our relationships intact. We do want to learn from this and build from what worked. You mentioned the glass of wine. I always think of the symbol of public health as a cup of coffee because I have drunk more coffee with more people in establishing relationships that you’re going to need every day, but that you’re really going to need in a crisis like this.

Gary Gunderson: Yeah. Beautiful. I think that’s actually not a bad ending unless Lauren, you have a last comment?

Lauren Gunderson: No, I’m always happy to end with a cup of coffee.

Gary Gunderson: Yeah, that’s not a bad place to go. I do want to thank you. I know about both of your lives just enough to know that it’s no small feat to pry loose the time for a conversation that may not seem like the most urgent thing to do today, but I know you’ve lent your common voice to inform the work of many, many people who, like you, love the public and whether they’re an audience or a public that pays for public health, they’re the thing you love. And I appreciate that, too. Thank you very much for the two of you.