Rocky Mountain PBS: Well, just to get started, for our viewers who are less familiar with the office, what role does the surgeon general serve in the nation’s health? 

Dr. Antonia Novello:  Well, the surgeon general is really the eyes and ears for the presidency with regards to what’s happening in the country’s health and needs. And, so, it’s a four-year term and it’s recommended by the president but it is approved by the U.S. Senate. As of now, there’s only been one surgeon general that has served two terms–that was Dr. [C. Everett] Koop. And in 100 years, we have had only 21 surgeons general. Seven of us are still alive. 

RMPBS: Are you in contact with any of them?

Novello: All of them. We do public policy roundtables. When there is a subject that is important, then we all get together and we go public and discuss it. 

[Editor’s note: Novello’s fellow living surgeons general include M. Joycelyn Elders, David Satcher, Richard H. Carmona (who is also of Puerto Rican descent), Regina M. Benjamin, Jerome Adams, and Vivek H. Murthy — the current U.S. Surgeon General.]

RMPBS: That’s really good to know. One of my favorite anecdotes of the book is when you talk about how, instead of using sofa cushions outside of your office of surgeon general, you used Cabbage Patch dolls that all had different disabilities, as a way to test people. Were there any reactions that touched you or surprised you?

Novello: Well, I think it was very important for me to know who was visiting me. There’s always a different purpose for everyone that comes, so I thought, ‘Let me use this as a surveyor of personalities.’

And it was really interesting because I got every Cabbage Patch, every kind of disability you can think of–deaf, blind, with crutches. And I put them in there instead of cushions, and I would look at the people from the corner of my desk. And some of them would drop it, some of them will sit on them. And some of them would put them in their lap until they got to see me.

And it was really interesting that the ones who dropped them were the first ones who were crying, ‘I need, I want, I deserve.’ And I kept thinking, ‘The way you treated that Cabbage Patch, you’re getting zero!’

RMPBS: Who did you write the book for and what do you hope they take away from that?

Novello: I think that as the years passed by and I realized some of my friends are dying suddenly, I figure [that] what I remember to this moment, I have to put it in writing. Because I see the youth is changing and the world is changing. And, so, when I look into the way by which I can influence someone is, basically — don’t do the mistakes I did. 

And second, realize that there are gains and losses. You follow the book, you will be able to join me in doing the ones we’re doing, the good ones. 

I felt that almost every surgeon general has written a book and I said, ‘I’m not going to be out there without one being the first woman following Dr. Koop and then being the health commissioner of the State of New York during September 11.’

There are many things that set me apart and for that reason I thought, ‘let me just put it in writing.’ And then I met Jill [Tietjen], and Jill put my emotions into writing. And for that reason, the book is really a terrific cohesiveness of feelings put into words.

RMPBS: What was the process like for you? Were there moments where you felt a little bit hesitant or moments where you thought, I need to just say my piece?

Novello: It was really interesting, I never dreamed I would write a book. But then I started writing and writing and, all of a sudden, it was just what was coming to my head. The beauty of doing it with Jill is that she concisely, and precisely [wrote it] but it did not take away from the message. And, so, there were times it was, ‘My God, I said so much!’

And then I would say, ‘My God, but it’s true!’ And one of the things I think is important to bring into here is my husband was very sick and he died in March. And so I read him the whole chapters where he was being told of his misbehavior and he said, ‘Don’t lie about it, it happened. You have my permission.’

RMPBS:  There were a lot of people who championed your career throughout the years, but there were also moments where you said that you would have hoped for, or could have used, guidance from a mentor. For young women who find themselves in positions like what you were in when you were beginning your career, how would you encourage them or what do you have to say about them finding mentors?

Novello: Well, the problem that I find, when they are coming to me for mentoring is that they do not want to start at the base. They all want to be me within one year. So that reality is artificial and they immediately start thinking, ‘But I’m going through it all and I can’t wait that long.’ Sweetheart, then don’t come to me for mentoring. 

I did it [rose through the ranks] exactly how I would have expected, except that I went from a captain in the public service to a vice admiral within the moment I became surgeon general. That was not a movement in fashion, as it was a leap in history. But I think if I would have had a mentor, I wonder if I would have done much better. 

Because I remember when I entered to take my test for the medical school, I never knew that there was a problem. I never knew that you could study for the test. I knew nothing. 

And so, I also learned that when you’re in doubt, you get a second opinion. Because when my name did not appear in the list of people who were to enter that [medical school] class, I questioned it, and I was not on the list. But I was on the list with my male counterpart name, “Antonio,” instead of “Antonia.” 

If I would not have been assertive, I would have not gone into the class and they would have eliminated that post or given it to an alternate. So, never be afraid to ask when you think that you are in the right asking for that. There’s ways and means, you don’t have to be crass, just assertive.

RMPBS: In your time as surgeon general, you met with AIDS activists and you felt that you found a lot of common ground there. It’s one of the most moving stories in your book. Can you tell us a little bit more about that?

Novello: Well, between [the tenure] of Dr. Cooper and myself, AIDS was rampant. And during Dr. Koop, we were identifying [the virus] in them; during my term, it was finding treatment, and that was ACT UP and the AIDS Memorial Quilt. 

The benefits of the medication did not take away the anger of people having to say, ‘I died of pneumonia,’ rather than, ‘I died of HIV/AIDS.’ And so the quilt became the expression of every emotion you ever dream of being a human being that was sick with the disease. And I have never, ever had any difficulty with the gay community because I understand exactly that. In every job I have, I have HIV/AIDS as part of my mantra. 

And I remember I took a piece of the quilt to my office and I put it at the entrance — I had my cabbage patches and my quilt of activism. And so I hear the ACT UP people outside the door as they had gone to the NIH, to the FDA, everywhere, to clamor for respect and recognition. 

And I remember that my office was the next one that was picked. When they came into my office, all of a sudden, the person that was doing this stopped. And so, the quilt, by sheer coincidence or God blessed, it had been his partner’s. So he started crying because he realized that I had no negativism and I had selected, unknowingly, his partner. 

So he started crying, and of course I started crying, too. Because I felt he understood what I had put in there and I understood what it meant for him. 

RMPBS: I think your assertiveness and your willingness to, if people are upset, you’re going to meet with them. You’re going to speak to them. This also came up when they abortion rights activists were protesting you.

Novello: The young girls. 

RMPBS: Yes, from Barnard. Protesting the closing of the abortion clinic in New York State. And so I wanted to hear a little bit more about that. And, also, since your time in New York, and even as surgeon general, now in a post-Roe world, you know, where do you see the landscape of reproductive justice?

Novello: Well, I don’t think that just turning it off, the Supreme Court has turned it off in the States, so I am hopeful that women’s rights will prevail. It may take some time and it might be different from one state to the other. But, on the same token, it has not been erased, it has just been kind of — in some areas— kind of gotten almost too strict.

Maybe we opened the Pandora’s box. 

And so I am confident that this will take time, but it will not stay like that forever just because the women of today are not the women of when Roe v. Wade was passed. 

When I went into New York, one of the things that happened is, I closed an abortion clinic in the first months that I was there. My goodness gracious! It’s almost like if I had closed the whole world, the protests were intense. Ans so I asked that the group that was protesting come and meet me and I’ll tell you why I closed it. So they did and came in face-to-face. 

They came to see me and I said, ‘Let me tell you, I closed that abortion clinic. I closed it because there was an abortion every single hour or every single half hour in their clinic where they did not remove that piece of white paper after each abortion and this place is full of HIV/AIDS that put them at risk.’ 

‘Second, they only have one [tool] to take the blood pressure of women post-abortion. It’s one for 20 women, you’re not going to do that because what do you think of hypertension? Are you going to wait until one recovers to put it in another one? No.’

‘Number three, you are doing a suction machine abortion that is 1950s material, and that is pain. So, that’s unnecessary.’

They were so pleased that I had closed that clinic and so immediately, everything started being done correctly.

But, it was really interesting that it was the mayor of the city, the one who did not open it until he wanted it done with his name. But, for my part, I closed it.

RMPBS: And then, so much of your work ...[you're] not afraid to jump into the fray and do what needs to get done. Your motto of 'good science and good sense.' You know, you worked on iodizing salt. 

Novello: That’s quite a history.

RMPBS: Yes, that’s quite a history, promoting childhood vaccines and a lot of that. Recently, we were just talking before the interview, a lot of that has received backlash recently. I mean, you’re a medical doctor and you were surgeon general of the United States, but an influencer on Instagram can say iodized salt is bad for you. It feels as though a lot of public health policies that were accepted have now been…
 

Novello: We didn’t have anti-vaxxers before.

RMPBS: Yes. 

Novello: The United States had a 67% vaccination rate when I was surgeon general and we just moved [the rate] to the 90s and for that we got an award. But the interesting part is that the generation had seen what the disease that was being prevented by a vaccine had done in the past without the presence of the vaccine. So, I had them on my side because they didn’t want to go back into the influenza of 1919 or 1918. So they understood perfectly. 

After I left the post of surgeon general, you have to put me in a position where I have rank and respect because I am a career officer of the public health. I am a true career officer. So, to complete my 30 years of career, they sent me to UNICEF. 

When they sent me to UNICEF, the goal was the plan for childhood for the 1990s, and one of them was iodizing salt. I remember when Mr. [Jim] Grant, who was the head at the time, told me, ‘Toni, we’re going in the world to iodize salt.’ I said, ‘Mr. Grant, have you heard about Morton’s?’ Because I thought that’s what this is.'

The arrogance was so intense that I said, ‘Mr. Grant, if you give me a good excuse, I might help you.’ 

He says, ‘Ok. When you look at a person that has a goiter, don’t look at that. Look at the biggest damage of a lack of iodine is mental retardation.’  Okay, I understand, what’s the second one? He says, ‘Tyrants in countries do not iodize so that they can control the multitude like if they were just passive.’ I said, ‘I’m going to do this immediately!”

The first place I got iodized was India and China. In India, we iodized the salt of the cows before the humans. And, in China, they iodized more than anybody, immediately. 

RMPBS: What do you see as the biggest public health challenge of today, or what are the public health challenges of today?

Novello: I truly believe that one thing that is worrying me right now is this feeling of equity. Equity today, it seems to be the mantra of the world. And I think that they do not understand what equity is all about. They think equity is equality. No, equality is the same for you and me. Equity is according to my circumstances. Equity is equality with justice.

And for that reason, then I went ahead and read all the speeches of Dr. Martin Luther King, Jr., just to see, because the most affected happens to be the African-American community. And so I was asked to speak at an equity meeting, ‘Who has equity today?’ And I told him, please, you cannot use equity today because you have to cover seven subjects before you can get equity to be equal in the African-American community.

And the more I read, it’s the same for the Hispanics, and it's the same for the Native Americans, not so much for the Asian Pacific Islanders or the whites. The other side is, you have to have wealth. There's a difference in wealth. You have to have education. There's a difference in education. You have to have housing. There's a difference in housing. 

You have to have food. Hunger among African-Americans is twice [that of other communities]. And on top of that, you have food deserts and food swamps, no good food to eat and buy. 

So one thing that really I feel equity is important is that there is research that showSo one thing that really I feel equity is important is that there is research that shows that there's so many moments of microaggression to the African-American community that is really now impinging on the children's development.

Dr. Geronimo is at the University of Michigan and he discovered that microaggressions do accumulate, and they destroy your immune system. 

And this is why Martin Luther King says there are two Americas, the rich and the poor. 

So having read that speech, I really recommend it to Americans from Martin Luther King, it gives you a sense of ‘get out of your inaction!’ Because God didn't mean for some of us to have so much and some others have so little.

RMPBS: You started your career in Puerto Rico, where you and I are both from, and I found it very kind of touching and sort of a full circle moment that after you retired, after Hurricane Irma, Hurricane Maria and the earthquakes of 2020, you returned to Puerto Rico to bring in medical infrastructure, to bring in treatment. How did that feel for you? And are you feeling more, more committed to returning? I know that they tried to draft you to go into politics there.

Novello: Well, when I saw the hurricane coming and I saw all the devastation of the island, I wanted to go there immediately. But there were no airports in the island to receive me, or in Orlando to send me. So five doctors from the Adventist hospital had already arrived in one of those airplanes, the ones that put you in the ocean when you're transporting drugs.

I visited 45 towns in one month and went directly to the Department of Health or to the hospital, and you could see people waiting. The doctors were not there. There was no electricity, but they were sick. So with the five doctors, we did so much medical treatment.

And then we left the town and we went to the other one. It was extremely fulfilling to help. 

And so then I thought, okay, now we are okay. And we went and here comes the earthquake and thank God that I have already met the general in charge of this National Guard and he says, ‘We're going to construct cities because if people were sleeping outside, they were afraid of this aftershock.’

And then when I thought everything was okay, then comes the [COVID] vaccine. So now I go to Puerto Rico two weeks every month, depending on what is happening in the country.

RMPBS: But you're energized, you're ready to go.

Novello: Because in Puerto Rico, it doesn't matter where I go, people really are very appreciative because they realize that it’s my responsibility. They have a secretary of health and the Department of Health but when they see me, they realize that I'm going to watch it like a hawk that it gets done. And there are programs in television for which I can make public the appeals.

But when you're on this side [working for NGOs instead of the government], you can't be too mean to the people who are doing it on the other side, because there are so many things impinging on your ability to do things, among them politics. But since I don't have any contract with the island that pays me, I can speak my mind and they know that.

So my presence is seen by some as of some importance for getting this things done.

RMPBS: Because it's interesting that you're still working and you're still working in public service, but not in a political role.

Novello: No, I don't want it.

RMPBS:  I enjoyed your book. I don't think other surgeons general books have all of this in it. So we're very happy to have you here in Colorado. And this is a full circle moment for you because, as it turns out, your first public appearance as surgeon general was in Denver.

Novello: A John Denver concert. I remember.

RMPBS: Yes. So I'm going to put you on the spot. What's your favorite John Denver song? 

Novello: Take me Home, Country Roads. I couldn't believe that. I promised I would be in Denver for my first appearance. And I was sworn in and two hours later, I took a plane and I was here.

RMPS: What a celebration.

Novello: What a celebration. But it was worth it, you keep promises. 

RMPBS: Make good friends that way. So before I let you go, I just wanted to ask. You've accomplished a great deal in your life. You are still going 100 miles per hour. What is next for you and what do you most want people to understand about a life of service?

Novello: It may come unexpected. Some label it service, some opportunity. Depends where you are.That's why I am a public health officer and I have a doctorate in public health because I believe that in public health you do goodness without having identifiers.

They will never know I exist, but I know what I did. That's why I like public health and service. It makes me feel good that somebody benefits because I lived and they might not even know my name. So that for me is very important and I don't feel I have finished.

That's why the book, The Bucket [list], the book. I think if somebody benefits because I lived, somebody benefits from my books, then it was worth it to be transparent and real in that book. 

But the other thing that I need more than anything, I need an academic chair because I believe almost all the surgeons general have it. I don't.

RMPBS: Well, speak it. Where would you be open to an academic chair?

Novello: Well, since this was my first visit to Colorado. 

RMPBS: University of Colorado?

Novello: Academic chairs are powerful no matter where they happen. I just feel that wherever it comes from, it will attest to the fact that they honor what I have done in my life. And for that reason, whatever it is, I will honor them as well.

Gabriela Resto-Montero is the managing editor at Rocky Mountain PBS. Gabrielarestomontero@rmpbs.org