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Antonia Novello: a dream come true.

As a little girl in Puerto Rico, Antonia Novello dreamed of becoming "a pediatrician--a doctor for the little kids in my hometown." Last year, this smart, funny, 46-year-old pediatrician became a doctor for all Americans when she was sworn in at the White House as the nation's first Hispanic and also first female surgeon general.

"Dreams sometimes come true in a strange way," she told an enthusiastic audience that included President George Bush and Supreme Court Justice Sandra Day O'Connor. "The American dream is well and alive. . . today the West Side Story comes to the West Wing."

Now, one year after taking on one of the toughest jobs in Washington--following C. Everett Koop in the country's most visible health job--Novello is proving uniquely qualified to serve all Americans as their top health advocate.

"Being a pediatrician, a woman, and a minority has helped prepare me to do this job," explained Novello from her cozy, teddy bear accented office in Washington's Health and Human Services building. "The pediatrician takes care of the whole family and finds out what is wrong, even though the patient may not know how to put the problem into words."

In government, "the ability to speak up for the people who are not able to speak for themselves is key," said Novello, whose initial programs have targeted the health concerns of the nation's least vocal constituency--children and youth.

"Being a woman, I learned diplomacy," Novello continued. "We women have always learned how to listen and how to wait . . . until there comes your moment to speak. Then you take into consideration everybody's feelings and make sense of things that sound so complicated." As a minority she is exquisitely sensitive to the concerns of the under-represented. "The beauty is," she said, "that I can come up with something that is understood by all."

In addition to her unique perspective as the first female, Hispanic, Puerto Rican, pediatrician surgeon general, Novello's difficult childhood experience with a disease that forced her to be hospitalized every year has resulted in an extraordinary sensitivity for the patient.

"I was a sick kid, although my mother never made me feel sick," recalled Novello, who was born with congenital megacolon (an abnormally large, distorted, malfunctioning colon) that was not repaired until she was 18. "I was hospitalized every summer for at least two weeks. My pediatrician and my gastroenterologist were so nurturing and good to me that doctors became my buddies."

Although Novello was told she would have surgery to repair her colon at age 8, "somebody forgot," she said with a wry smile of remembered pain. "The university hospital was in the north, I was 32 miles away, my mother (who was a school principal) could only take me on Saturday, so the surgery was never done.

"I do believe that some people fall through the cracks. I was one of those." This is one reason why Novello vowed to be a doctor. "I thought, when I grow up, no other person is going to wait 18 years for surgery."

During Novello's annual hospitalizations "they would clean me up," she said. "When you have congenital megacolon your belly grows up very big . . . Everyone knew I had megacolon so no one talked behind my back. I think that would have been devastating. But by the time I was 18, it was not good to have those big bellies one month that are, in the next month, flat." That's when she told her mother that she was determined to have surgery.

A cardiovascular surgeon performed the operation because, she said, "he was the only one willing to give it a try." But after complications from the surgery she left Puerto Rico and checked into the Mayo Clinic for two months. "God bless my doctor at the Mayo," said Novello, who still seems upset that the experience cost her a semester of school.

Living with chronic illness until adulthood left Novello "very conscious of how people feel when they are in the bed as a patient," she said. "I'm very cognizant of the comments people make on rounds when they are trying to show that they're great doctors--when people say 'Look at the way she looks' right in front of you, when you already feel like you're going to die. I'm also cognizant of the ones who take the time to play with a child or bring him little magazines. I know it's the good doctors who come into your room and talk to you like a human being . . .

"Another thing that 20 years of disease did to me is that I have very little tolerance of people who complain of being sick and truly are not, or who use sickness as their piggy-back for not doing what they are supposed to do. And I have very little tolerance for people who say they can't do something or they can't get to the top, because believe me, if I did it--going through medical school, or making sure the microscope and the heating pad were both adjusted properly--it can be done."

Novello's triumph over illness resulted in a profound compassion mixed with confidence. "I hope this is not arrogance, but experience," she said. "If I can come back from my second surgery and go to college wearing Pampers for six months, I know that nothing is going to pull me down. When I was in college with Pampers on I used to laugh by myself thinking, 'If only they knew.' I survived many times in my life by learning to laugh at myself--that's the best medicine. But I also became very self-assured and capable of saying that if I could do that, I can do anything."

Novello was not always so confident. As a teenager, she did not tell her mother that she applied to medical school until after she was admitted "because of the typical attitude of women at that time--fear of failure," she confessed. "There were only 65 people per class" at the University of Puerto Rico Medical School from which she graduated in 1970.

Her father died when she was eight, and her mother and stepfather were far from rich. "But Mommy never panicked," she said. "When I told her I was accepted to medical school she said that as long as there is a bank out there we will find your tuition."

Novello went on to be chosen "Intern of the Year" in 1970 at the University of Michigan in Ann Arbor, where she also did her residency. She completed subspecialty training in pediatric nephrology at Georgetown University in Washington and earned a master's in public health from Johns Hopkins University in Baltimore in 1982. After several years in the private practice of pediatrics and nephrology, she entered the U.S. Public Health Service in 1978. She spent most of the PHS career at the National Institutes of Health in Bethesda, Maryland, rising to deputy director of the National Institute of Child Health and Human Development.

Today, she says, her special talent is "bureaucracy made easy," with the motto, "good science and good sense." Her approach: Remove fear, open doors, listen, educate, assist. "When people told me that the United States is in need of a nurturing candidate for surgeon general I felt very good," she said. "Because I know that if I make good sense and I,m understood, people might be willing to make some good changes.

"Some people believe that when you get policy out that is understood it means that you are simple. But I find it means that you are clever, because in the long run, people will remember your message. That is my quest," she said.

Novello purposefully spent much of her first year as surgeon general listening and studying in preparation, she said, "to sprint. No one ever sprints in the first year . . . Now I am definitely in my crawling stage, occasionally propping myself up on the furniture."

This year she has launched several major campaigns that address the special problems of America's youth which she calls "a generation at risk." In press conferences and speeches she frequently focuses on the hazards of smoking, alcohol abuse, and violence.

"Alcohol remains the No. 1 drug problem among our youth," Novello said. "It is the only drug whose use has not been declining significantly. Alcohol-impaired driving remains one of the leading causes of death among our youth. Yet kids still think that drinking is cool, and that is what frightens me so much."

Most young drinkers do not understand that beer and wine coolers are alcoholic beverages. "They think it's water with a little bit of taste," she said. "When I go to college campuses and tell them beer is alcoholic, they think I am being funny."

Novello's "Spring Break '91" campaign focused on college drinking, which is linked to such problems as date rape, vandalism, injury, death, and dropping out of school. Among the alarming facts, Novello noted that:

* "Forty-one percent of our nation's college students engaged in a bout of heavy drinking (five or more drinks in a row) in the last two weeks, while only 34 percent of their noncollege counterparts did.

* "Twenty-six percent of eighth grade students and 38 percent of 10th grade students reported having had five or more drinks on at least one occasion within the previous two weeks.

* "The typical college student spends more money for alcohol than for books."

Cigarette smoking, particularly among young people, is another of Novello's frequent targets. She often speaks out against what she calls "the self-serving, death-dealing tobacco industry and their soldiers of fortune, advertising agencies" and has vowed to maintain Dr. Koop's momentum towards a smoke-free society.

"We have made some progress," she said. "But as a woman I am deeply troubled that the decline in smoking has been substantially slower among women than among men, and HHS projections show that women will be smoking at a higher rate than men by the first half of this decade. It is tragic--and a frightening result--that lung cancer has surpassed breast cancer as the No. 1 cause of cancer death in women. Call it a case of the Virginia Slims woman catching up with the Marlboro Man."

Youth smoking is also a grave concern, she said, "because we are creating a new generation of smokers than 3,000 teenagers begin to smoke each day. If the current rate of smoking among adults were to continue at the present rate, then at least five million children now living in the United States will die of smoking-related diseases."

An example of the kinds of programs Novello advocates to declare war on cigarette smoking by children is the "We don't sell to kids" campaign in Woodridge, Illinois. After hearing complaints that a 13-year-old girl was seen buying cigarettes, the Woodridge police sent a letter to tobacco selling merchants reminding them that the sale of tobacco to minors is a criminal offense. About the policeman who initiated the program, Officer Bruce Talbott, Novello says, "I love this guy for what he's doing."

But she is less than enthusiastic that her own brother-in-law, Don Novello, smokes cigarettes as part of the character he portrays, Father Guido Sarducci of "Saturday Night Live" fame. The cigarettes are just part of the act, however. In real life, Don Novello does not smoke.

Amid a hectic schedule--she gets 650 invitations per month--Novello has also taken time to draw attention to three of her particular concerns: immunizations, pediatric AIDS, and injury prevention.

Although children must be immunized to attend school, she warned that pre-schoolers frequently aren't vaccinated. "Children ages 2 to 4 have the greatest number of cases of measles," she said, "and it's not because of a lack of vaccine." Injuries remain a leading cause of death in childhood, said Novello, who noted that some so-called accidents may be the result of child abuse. "And AIDS is the only epidemic in the world where children will survive their parents," she said. "By the year 2000, we might have as many as 10 million children who are orphans of this epidemic. We've got to do the best we can for all children."

The challenge is "tremendous," said Novello, who credits the support of her husband, Washington psychiatrist Joseph Novello, with helping her accomplish her many goals.

"It helps a lot to be married for 21 years," she said. "Not having children probably has helped because I don't feel so torn between kids who are at home and taking care of all the kids out there."

As for her own health habits, she said, "The surgeon general is a normal person. I don't want people to put me on a pedestal like Mother Theresa. My intentions to exercise are good, but my time is zero. So I walk three to six blocks around my neighborhood, and I always take the stairs . . . I eat a well balanced diet, making sure everything is in moderation. And every Friday I drink one glass of champagne at Martin's Tavern in Georgetown. So when I talk to the kids about drinking I talk from experience. It's a question of how you use it . . . Each person is different, and you must know when to stop."

For now, Novello knows that she is succeeding "because people no longer ask me 'How do I feel in Dr. Koop's shoes,'" she said. During her early days in office, that question was so frequent that she quipped, "I'm going to have to learn a new specialty in podiatry."

When the time comes to step down as surgeon general, Novello said, "I hope by then women will have learned that smoking is not so much fun, that Americans will understand that they have to take a responsibility for their bodies, that young people will no longer think that drinking is cool, and that AIDS will be just one more disease without the discrimination. I also hope clinics will accommodate to family needs, not the other way around, and that we will change the climate of violence in this country so our kids will survive."

And she would like, she said, for people to get her name right. "Antonio Novella," she said, rolling her eyes at this frequent misspelling of her name. "They still think the surgeon general must be a man."

But within four years it seems clear, Americans will all know and respect the name of this fast talking, fast-thinking surgeon general.

"I want to be able to look back someday and say, 'I did make a difference,'" she said. "Whether it was to open the minds of people to think that a woman can do a good job, or whether it's the fact that so many kids out there think that they could be me, then all the headaches and the chicken dinners will have been worth it."
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Title Annotation:article continues on page 92; United States surgeon general
Author:Krucoff, Carol
Publication:Saturday Evening Post
Article Type:Cover Story
Date:May 1, 1991
Words:2471
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