“From Public Housing to Distinguished Professor: The Story of how Nena Became Dr. Amaro”

HORTENSIA AMARO, PH.D.

Zuniga

I’ll start with a question: Why me?

Somebody must have thought that just because you are older you have more stories to tell just because you’ve been around longer.

Be that as it may. I’m not grateful for the invitation. Talking about myself in the context of work doesn’t come easy to me.

I guess most scientists are not trained to use the word often. We always go for the ".....data shows" long sentence followed by some numbers.

Also I have to watch out for other pitfalls. An old friend recently told me that although I’m such a fun person in person, when I talk about my work I sometimes sound like Mother Teresa or Don Quijote.

Maybe that’s true. I’ve always been moved to help people in need and tilt at windmills. After all, I came of age in the Sixties and Seventies when bucking the Establishment was all the rage and young men burned their draft cards and young women burned their bras. These things leave a mark on you.

But despite my ambivalence, I’m aware that rarely in our professional roles, do we have the opportunity to share the connections between the personal and the professional. It’s a challenge and, as you will see, I never run away from those.

But beware. I can’t share with you inspirational stories about how my parents inspired me to reach for the heights.

My parents were immigrants and although they were loving and caring, they were too busy to dispense pearls of wisdom while working to raise four kids, of which I’m the oldest girl, and starting a new life in a new country.

I must tell you that being the oldest girl of immigrant parents, is not a party. You are the first who learns English, you have to baby sit your brothers and sisters, protect them from bullies at school, do all the chores that your mami cant do because she is wiped out from working two jobs, act as your parents’ translator and so on and so forth. It is exhausting, and worst yet, you lose part of your childhood in the process.

So my parents just said, "Nena, whatever you do, do it well. If you can’t, then haz otra cosa, m’ija," and fell asleep on the couch.

Neither can I tell you anecdotes like the ones you read in some autobiographies about how, as a precocious child, I used to play with microscopes and drew charts and graphs with my Crayolas, already showing signs of my future career.

But there was a moment when I can proudly say that I successfully presented my first scientific argument when I was still in kindergarten.

My father was chastising me about something or other I’d done and ended with that well-known, guilt-inducing pronouncement: "You used to be such a nice little girl!".

I puzzled about it for a couple of seconds (let’s call it mental research) then came back with a challenge to his conclusion, followed by irrefutable evidence: "Pero, papi, when was that? I am only five years old!"

 I don’t know whether that counts as the beginning of the road that led me to today, to my work in applied research in substance abuse treatment and HIV prevention, to my role as a researcher, Associate Dean of the Bouve¢ College of Health Sciences at Northeastern University and Director of the Institute on Urban Health Research.

But as a woman and as a Latina, I have the suspicion that that moment does count as the beginning of challenging assumptions and prescribed roles.

I was born in Camaguey, Cuba, and grew up in a moderate middle-income family. My mother was a public school kindergarten teacher and my father worked in the communication tower at the local airport.

One of the most vivid memories of growing up in Cuba was being told that I could not do X, Y or Z because I was a girl.

One of the things was not to ride my bicycle beyond the block where we lived. One day, I decided to go where no girl in Camaguey had gone before --I’d join my older brother Rafa, in his regular outing with other boys to explore the nearby countryside. My heart raced as I sped away before my mother could notice and stop me. I worried the whole trip about what kind of punishment I’d face when I returned home. I was fearful and anxious because I was breaking a rule. I was entering unknown, forbidden territory. My fears were unfounded. Nothing bad happened. Just trees and some cows in the distance. When I got home, I got a lecture for sure, but I figured it was well worth it.

This proved to be a good lesson that I recognized later on and that would reoccur many times in my life, within the family, with teachers and as a professional-especially once here in the United States.

On October 20, 1960 when my parents decided to come to the United as political refugees after la Revolución I was about nine years old.

In middle school I was put into classes for low achieving students based on the results of an IQ test given to me back when I was in fourth grade and did not speak English. I complained to my parents relentlessly until they went to speak to the school counselor and I was given a new IQ test. I passed with flying colors and was put into the top-level college prep courses. Which in my middle school and high school meant that I would not have a Latino or Black student EVER in my classes. Tracking Mexican and Black kids out of college prep courses was standard practice at that time.

As a high school student, even though my counselor advised me to study to be a secretary, I pursued a college degree. In graduate school, I questioned why the social psychology course did not include institutionalized violence, such as racism, in the study of aggression.

When my Latino advisor called me to a meeting to question me about the wisdom of my presenting at a Latino mental health national conference a paper on stigma and the coming out process among Latino gays and lesbians his concerns about possible repercussions scared me. But I thought it was the right thing to do, to talk about an issue that hardly anybody was talking about. I went on with the presentation, which was a big success among the standing room-only crowd of mental health professionals.

When I negotiated the terms of my first professional research position, I felt that the salary was too low and negotiated hard to have the position be 80% time for the pay offered. My physician boss told me that I "did not seem like the typical compliant Latina".

As a young faculty member, when the chair of my department discouraged me from focusing on research on substance abuse among Latinos because Latinos were too specialized and small of a population, I asserted my wishes and pursued my interests.

These push-back experiences were not without negative consequences. At times I questioned my own decisions and would often recall the damming words of my high school teacher who chastised me for running for class president AND trying out for cheerleader, something no Latina or Latino in my school had dared to do: “Who do you think you are that you could do anything?" She was one of the judges so I guess you know how my cheerleading career turned out.

Throughout my career, a factor that kept me going in the face of discouraging individuals was that I sought out and found mentors and peers who understood and shared my values and who were committed to giving voice to the experience of groups that were not generally heard or visible in mainstream psychology.

I learned to inform my professional training with the work of scholars who focused on issues I cared about, like Franz Fannon and his work on the psychology of oppression, Paulo Freire’s work on the pedagogy of the oppressed, Jean Baker Miller’s ground-breaking work on the psychology of women and the early research pioneers of Chicano and Black psychology.

During my college education at UCLA I came to understand the underlying dynamics of social change. The Civil Rights Movement, the Chicano Movement and the Women’s Movement were thriving during this time and protests against the Vietnam War were daily news items. Television news broadcasts were filled with chilling images of police beating, handcuffing and sometimes killing people marching peacefully for equal rights and the chance to benefit from America’s promise and of students protesting the war in Kent State and other university campuses.

I felt in my gut that I needed to be part of change and, like many of my generation, sometimes wondered if change would more likely come about through knowledge or through violence. During the many late nights studying in my cubicle at UCLA, I decided that knowledge was the best weapon to bring about change, that an informed voice armed with data can make a contribution to do away with injustice, stigma, discrimination, and suffering.

As a young researcher, I was influenced by two important events that had an impact on my career. The first was the death of Rosario Jimenez. Rosie, a 27-year-old Chicana from McAllen Texas, was the first woman to die from an illegal abortion after the passage of the Hyde Amendment in 1977.

I learned about her death in a book by Ellen Frankfort, author of Rosie: the investigation of a wrongful death. Frankfort revealed the CDC investigation of this case and their inaccurate attribution to the role of culture in Rosie’s death. They had concluded that she went to a partera because of her Mexican cultural traditions, but Frankfort’s investigation revealed that Rosie had had two previous legal abortions. Her death became the national emblem of the impact of the Hyde Amendment, which took away coverage of abortion under Medicaid and with it, the right of poor women to safe and legal abortion and control of their bodies.

At the time, little was known about the reproductive attitudes and experiences of Mexican American women.

I chose this topic for my dissertation study and in 1988 published findings on the role of religion and culture in Mexican American women’s reproductive attitudes and behaviors in the Journal of Community Psychology.

While conducting my doctoral studies, I also had the opportunity to work as the data analyst and later as the project director on a study led by Dr. Linda Beckman at the UCLA Neuropsychiatric Institute. Dr. Beckman was investigating barriers to alcoholism treatment among women in California.

I originally took the job with Dr. Beckman because I had taken all the advanced data analysis courses available and wanted data analysis experience - something that at that time was typically assigned to male students. I had no interest in substance abuse and knew nothing about it. In fact initially, the topic seemed somewhat distasteful. Yet, the combined research experience on reproductive health and substance abuse opened the door for my first job after the doctorate.

I was hired as a research scientist to coordinate the fieldwork of a large NIDA funded study on women’s drug use in pregnancy and its impact on birth outcomes. An important topic at the time, since the "crack epidemic" was beginning its upswing and newspapers were carrying stories of "crack babies."  My work with this new research study at Boston University Medical School and School of Public Health afforded me the opportunity to add variables to the study instruments including measures of mental health symptoms, childhood abuse and intimate partner violence, social support and immigrant status. From this data set, I was able to publish multiple articles on these topics as first author as well as co-author. This study also led to my first grant as a WT Grant Foundation Faculty Scholar for which I worked on the, then new and ground-breaking Hispanic National Health and Nutrition Examination Survey dataset and published a paper on drug use among Latinos and the role of acculturation in risk of drug use.

Having that entry into the foundation, I was also successful in obtaining a second grant to study drug use among pregnant adolescent girls.

A second major historical event that shaped my work was the beginning of the AIDS epidemic in the United States in the mid to late 1980’s.

While conducting the study of women’s drug use during pregnancy, I interviewed Mary, one of the study participants in the postpartum ward at Boston City Hospital. Mary, an African American woman, who looked way too old for her 27 years, was an injection drug user and sex worker. She had just been told that she was HIV positive and was waiting to hear whether her baby was infected.

Hearing Mary’s story made me realize that there was little information on HIV risk for women like her. I had been making good progress in my academic career and doing all the recommended things like publishing and getting grants. But something about meeting Mary and hearing her story was disturbing. How could I focus on publishing findings that may not ever make the light of day in any practical way, papers that would do little to improve the reality of women like Mary?

Then, tragedy knocked at my door.

A few months later, my 27 year-old brother Armando, who I had practically raised since my family’s arrival in the US, was diagnosed with AIDS. This was devastating news for me and my family.

At that time, an AIDS diagnosis was a death sentence with a short time frame.

Soon after, I became involved in organizing the Latino community around the impact AIDS in our community and founded along with several other Latinos, the Latin American Health Institute and later the Multicultural AIDS Coalition - organizations that still exist in Boston today. Then, Dr. Ken Edlin, an African American gynecologist who was the head of OBGYN at Boston City Hospital, gave me an opportunity. He needed someone to take his place as PI of the Boston site of a NIDA-funded study on HIV prevention among women drug users, sex workers and partners of sex workers.

With the Mom’s Project, as the intervention program is known in the community, I accepted the challenge even though I had limited background on HIV prevention and had never developed an intervention of any kind much less with active drug users! But at the time, not many had such experience. With support from experts in the community and in the field, I moved forward. That study changed the direction of my work and I concentrated on working on HIV and substance abuse treatment interventions.

My brother died two years after his diagnosis, at the age of 29.

Since that time, incredible progress had been made not only in HIV prevention but also in the treatment of HIV and AIDS. My own work on HIV prevention and substance abuse treatment grew into multiple treatment programs for women and men that became the Division within the city’s health department - all evidence based but also adapted to fit the populations we work with. And even though all the scientific advances could not bring Armando back, the pain of his death has been eased every single day because of the help my work has provided to others who now live in his name.

And that’s what my job, your job, all our jobs are all about-- people, brothers and perfect strangers alike. Whether our research is in the lab, the bedside or the community, we need to stay connected to the purpose of addiction research, which is to improve the health of individuals, families and communities. Success as a researcher is not really about how many papers you publish or how many grants you get. I encourage you to challenge yourself … Judge your success by the impact of your work on the end goal of contributing knowledge that improves the public’s health.

To conclude, I’d like to recap some pointers to take along in your journey: First, you need to have muchas GANAS, the will, energy and commitment to do work that is important to you. GANAS is more than desire, it comes from the gut, it’s the source of passion.

Second, develop the ability to discern which opportunities to take advantage of while considering your passion and intended direction. We are all bombarded with "opportunities." Many people will tell you "this is a great opportunity" when they need you to do something for them (eg serve on this committee, review this paper, take on this advisee, work on this grant with me, take this job, etc). Sometimes opportunities come "difrazadas" as when someone tells you "if you don’t do X, there won’t be diversity in that important group." This can be a real trap, be cautious, if your participation is the only way some institution or group may achieve a level of diversity in its staff or committee, you probably don’t want to be part of it as the token Latino. Third, know when to ask for help and seek mentoring and collaboration, when to get others involved who have expertise that you don’t have and others who can do part of the work. Sometimes you cannot do it all by yourself. This also means appreciating and valuing the contribution of your collaborators and partners in the work and expressing that often.

Fourth, disseminate your work, share it with others, and let your department chair, colleagues and higher ups know about your work and its impact. Make sure to consistently get notice of papers to be published and grants received to the communications office in your institution so that your faculty colleagues and students as well as those outside of the university are aware of your work and expertise.

Do this with some level of humility and discretion. Tooting your own horn too often and too loudly, may get valuable work lost in the noise.

Finally, be open to suggestions and critiques but be smart about what advice to take. If I had listened to my high school counselor, I would not be here today. I would be word processing in a cubicle somewhere. If I had limited myself to the cultural expectations of what girls should do, I would never have ridden my bicycle through the hills, or found my own voice to speak up for what I believe is right in society or in the realm of science.

So, I encourage you to delve into your own history, if you have not done so - discover and give voice to what has shaped you, take your bike out and explore new territories, pursue your passion for research that makes a difference, and share the story of your journey with those you mentor and those who mentor you.