You have been prominent in Rhode Island for many years and with many endeavors. For those who may not be familiar with you, tell us about the many hats you have worn – and wear still.
Let’s see. Author, editor and speaker now. I’ve got a new book out, publish one story a month and am the guest coeditor of a special issue of the American Journal of Public Health. Chief Health Strategist for the City of Central Falls. Sometime stand-in physician at Jenks Street Pediatrics in Central Falls, to give my friend and public health hero Beata Nelken, M.D., a break. Before that, Senior Populations Health and Chief Medical Office of Blackstone Valley Community Health Care, Inc. Director of the Rhode Island Department of Health 2011 to 2015. Medical Director of the Adult Correctional Institutions 2010 to 2011. Founder and Physician Operating Officer of Hillside Family and Community Medicine, which is now a part of Coastal. Founding Chair of the Department of Family and Community Medicine at the Miriam and Rhode Island Hospitals.
Founder of Health Access RI, the nation’s first direct primary care network. Co-founder and VP of the Scituate Health Alliance, which has made Scituate the only municipality in the nation to guarantee access to primary medical and dental primary care to everyone who lives in town. Community organizer in the South Bronx, for People’s Development Company, 1977 to 1979. Cab driver, poet, farmworker and factory worker in the way back.
Physician, author, activist, former Health Department director, health strategist and more – can you give us a bit of your background, the journey that led you from childhood to today?
I grew up in suburban New Jersey in the fifties and sixties, so in the shadow of World War Two and the Holocaust, during the Vietnam War and the Civil Rights and Anti-war movements, so it was hard not to be shaped by those events. I was an uncoordinated Jewish kid growing up in a WASP town where sports were important, and I wasn’t good at (or interested in) sports, during a period where there was still lots of cultural antisemitism. So I felt like an outsider, and identified with other outsiders, particularly those involved in the Civil Rights movement, and thought of myself as an intellectual and a bit of a hippie. I was also heavily influenced by Jewish social philosophy (exemplified by Jeremiah and Isiah), in part through what I learned as part of a Jewish youth organization called United Synagogue Youth, in part because my mother started social work school at Yeshiva University while I was in junior high school and brought these ideas home.
At the same time, I was reading fiction and poetry compulsively, fiction and poetry of all sorts – J.D. Salinger, Walt Whitman, Allen Ginsberg (who grew up a few miles from where I grew up and whose father my parents knew), William Carlos Williams (who lived and practiced pediatrics also just a few miles from where I grew up, and was the pediatrician for my high school Latin teacher’s kids), John Steinbach, Victor Hugo, Leo Tolstoy, A.J. Cronin, “The Autobiography of Malcolm X,” George Washington Carver, Booker T. Washington, Charles Dickens, Eldridge Cleaver, Amiri Bakara, Steven Crane, Edgar Lee Masters, Albert Camus, Sartre, Jack London — you name it.
So I demonstrated against the war, hung out with the Black Panthers, and stopped saluting the flag, took courses at the New School for Social Research on weekends with one of Hannah Arendt’s graduate students (who would become her biographer) — all while in high school. I edited my high school literary magazine, wrote poetry and thought I’d be a writer.
I went to Oberlin College for a year, worked summers on farms or in factories to pay for school, then moved to New York to drive a cab and be an apprentice to the poet Hugh Seidman while living on the Lower East Side, right across the street from CBGBs — and hung out with poets and artists, architects and musicians. Then I transferred to Haverford College to study philosophy with the great American philosopher Richard Bernstein, wrote poetry, edited the literary magazine there and started a poetry reading series which brought in some of the great New York School poets. When I graduated from Haverford, I moved to the UK, and lived in a little cottage built in the 1400s for a year, read poetry in pubs and on the BBC, and wrote fiction. And realized that I wanted to be more useful than sitting in a room by myself all day long.
While I was in the UK, I read an article in the Guardian about a new program Teddy Kennedy got started called the National Health Service Corps, which let you go to medical school for free if you’d then work in an underserved area, and I thought, hmmm, I was pretty good at science; it will take me ten years to make a living as a writer, and that would let me serve others instead of just myself, in the language of the time, that would let me serve the people as I’m learning enough about the world to write about it and say something. So I came home. And took premedical courses at Columbia while first working as a ghost writer for a corrupt cardiologist, which gave me early exposure to how corrupt medicine can be, and then I entered Vista, got trained and worked as a community organizer for an equity housing group of street kids in the South Bronx.
So I brought all these complicated influences to the table when I went to medical school: writing and a love for literature and how it uses the imagination to help us be one people; a start to life as an outsider, feeling the cold breath of the Holocaust at my personal back, a way to remember what happens when politics fails; but a start that had enough privilege and access to connect me to great minds and powerful ideals; a sense of personal responsibility for what happens; and an understanding of the lives of most people and many communities, the oppressed but also the lives of regular folks who only want to make a decent life for themselves and everyone else, who go to work every day and renew the world by that work and that decency.
One of your most-read books is “Health Care Revolt: How to Organize, Build a Health Care System, and Resuscitate Democracy―All at the Same Time.” In a nutshell, what was the message of the books?
“Health Care Revolt” argues that health care in the US is a mess — a market focused on profit, not a system designed to improve the health of Americans. It argues what we need is a health care system that is for people, not for profit, that starts by providing robust primary care to all Americans, in every American neighborhood and community. “Health Care Revolt” argues that it will take a social movement, like the Civil Rights Movement or the Antiwar Movement or the Movement for Marriage Equality to fix this mess, and lays out how we might build such a movement.
And you have a new non-fiction book out, “On Medicine as Colonialism.” Describe it for us.
“On Medicine As Colonialism” recounts stories from the pandemic, when I saw close up and personal how government was used by people out to make a profit to drain communities of their resources. It shows how government is used again and again by those people, in every sector of health care — hospitals, insurance companies, specialty physicians, primary care physicians, pharma, research, the health policy bar — how every bit of health care in the U.S. is government funded or regulated, and how every bit is being used to drain our communities of the resources that we should be devoting to public housing, public transportation, community centers, public schools and the environment, which are what really matter if we want people to be healthy.
Switching genres, can you give us a summary of your three fiction books: “Rhode Island Stories,” “The Bull and Other Stories,” and “Abundance,” a novel. A snapshot of each, please.
“Rhode Island Stories” are stories first published on RINewsToday On Line, all short stories about Rhode Islanders, about teachers and farmers, nurses and violin teachers, deer hunters and cops and firefighters, community organizers and web entrepreneurs, immigrants, and people whose families have been here for hundreds of years. About hopes and dreams.
“The Bull and Other Stores” are stories set in Rhode Island and around the country, people who struggle and survive through lost hopes, inappropriate loves, and irrational expectations. “The Bull and Other Stories” was the 2021 IPNE Literary Fiction Book of the Year.
“Abundance” is a novel, a romantic thriller, set half in Rhode Island and half in Liberia at the end of the Liberian Civil Wars. Two young Rhode Islanders go independently to Liberia to work for NGOs, meet, start a relationship, and are then separated by the War. One is captured by a warlord, The other is evacuated back to Lincoln, Rhode Island, and then puts together two comrades who return to Liberia to try to free the woman left behind.
Do you have a favorite genre, fiction or non-fiction?
Fiction. By far.
Last year, in the early days of Russia’s war against Ukraine, you traveled to the Polish border to participate in relief efforts. What motivated you to go and what did you do when you were there?
For me, Putin is the reincarnation of Hitler and Stalin. I couldn’t not go, and I wish there was a way I could go back and do more — I think all Americans should be doing everything we can to stop this madman. For me, this was what we all should have done to stop the Holocaust, and being there felt like I was paying back a debt. Democracy doesn’t happen by itself, and we need to stand together to defend it where-ever it is threatened.
I did primary care for a few of the thousands of people coming across the border at Medyka, the major border crossing into Poland, for two weeks in April and May 2022, and went often into Ukraine itself, bringing primary care to internally displaced people holed up in schools and villages.
You literally had a frontline seat to the COVID pandemic. What lessons do you draw from it?
That a house divided against itself cannot stand. We lost 900,000 more lives than we needed to, and had millions more infections, mostly because we let Vladimir Putin and his trolls divide us by exploiting our addiction to the internet. That the political process has become the tool of our division. That we have lost too much of our humility and our decency, as I watched politicians try to practice public health and do it badly, because they were protecting the stakeholders, their funders, and had inadequate regard for the lives of ordinary Americans.
What can Rhode Island – and the U.S. – do to prepare for the next pandemic, which is not a matter of “if” but “when.”
We’ve got to build a health care system that is for people, not for profit, to provide robust primary care to all Rhode Islanders, in every American neighborhood and community. We need a public primary care medical school that trains students from all out communities (Brown likely only trains six to 10 Rhode Islanders who went to high school here a year). We need to also double the training of community health nurses, advanced practice nurses and PAs to be part of the primary care process. We need to make sure that hospital and health center boards, administrative staff, and health professionals look like the communities they serve. All so people develop trust in a system meant to serve them.
I think we should make the Department of Health independent of the executive branch and fund it directly from a tax dollar assessment, to remove it from political control, and I think we should build a Primary Care Trust, which we invented here and is being proposed in Massachusetts now. And we need to address income inequality, inadequate safe and healthy housing, public transportation, racism and division, promote personal responsibility and free speech and start building resilient communities of people who live together, who take care of one another, not just park their cars on parallel driveways and never meet.
There will be another pandemic because there are so many people in the world, living in close proximity and traveling a lot, which is how you breed new viruses and bacteria. And the next one could well be worse, perhaps even far worse. This pandemic was like one of the plagues in the Old Testament: It was a warning for us about what we must do. How we need to develop kindness and humility and create a more just society if we are to survive.
The open question is what it will take to get that message, which echoes across history, a message we are too often deaf to.
What’s next for Michael Fine?
More listening and learning I hope. More books, perhaps. A couple of novels and a short story every month. And maybe, just maybe, the ability to lend a hand, firing up the movement it will take to build a that health care system that is for people, not for profit, and provides primary care to all Americans.
