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Maureen:
My name is Maureen Zeufack, and you're listening to the I AM GPH podcast. In this episode, I speak with Johanna Miele. Joanna is a GPH alumna who now serves on the inaugural alumni board. She currently works as a manager in the Emergency Management and Enterprise Resilience Team at NYU Langone Health, working closely with infectious disease response and multi-casualty incident readiness, among other things. Prior to her role at NYU Langone Health, she worked in emergency management coordinating with the city of New York. She and I got a chance to speak about her public health journey and trajectory to where she is now, her insight into the very necessary domain of emergency management, as well as sharing her experience working on the front lines of the COVID-19 pandemic outbreak in New York City. Stay tuned for more.
Maureen:
I'm here joined today by Johanna Miele. Thank you for coming on to the I AM GPH podcast.
Johanna:
Thanks so much for having me.
Maureen:
To get started, can you tell us a bit about your intellectual trajectory and what drew you to study public health?
Johanna:
I started thinking about a career in healthcare when I was about 13 years old when I did my first summer internship at an MRI clinic that happened to be at the hospital that my dad worked in, and it was a really great experience for a 12 year old, certainly. And then I got more solidified when my dad was diagnosed with a chronic cancer. I really felt like my future involved healthcare. I had a friend who asked me, "Well, I understand you're so upset, but what do you feel like you could do about it?" And she said, "If you're interested in going into healthcare, convert all the energy you have and sadness into moving in that direction." And that's exactly what I did. After all of those experiences, I started looking for a high school that would cater to those needs and I found this school called Cathedral High School, where they had a Gateways to Health program. And as soon as you walk in the door, they're talking about pre-professional health options. I ended up interning at pretty much every hospital in the city, either as a patient escort supporting patients that came out of the OR and just finding new ways to volunteer. That was the interesting trajectory when it came to how it came personally, and I think ironically ... I don't know if it's helpful, but my second year in undergrad, I had my first semester of biology and I kept heading to the school's health center with a fever, swollen tonsils and coughing, and it was super unique because that happened to also be the fall of 2009 at the peak of H1N1 cases in New York City after it was declared a pandemic. I was sent back to my dorm room several times based on influenza-like illness. And it happened in October, then again in November and I didn't find out until pretty much December that I ended up not having H1N1 and I ended up choosing to pivot from pre-med at that time to public health, because somehow magically I did much better in my public health course than I did in my biology course. I had a professor there that opened the opportunity for me to pursue public health more professionally. He recommended a health research training program at the department of Health in New York City, and I'd say the rest is history. I really spent from about 2010 onwards interning at the Department of Health in various aspects from inter-governmental to emergency preparedness, kind of where I live now, and it's been such a fruitful journey. I'm very thankful for some of the unique circumstances that brought me to where I am today. And I always find the irony of a pandemic that took me away from pursuing pre-med is kind of bringing me right back into the right place in the job I have now, being in a pandemic at the right time at the right place.
Maureen:
That's so fascinating to see how that personal connection drew you to this field. And thinking back to your time at NYU, were there any courses or professors that had a strong impact on your experience and your aspirations for post-grad?
Johanna:
Absolutely. I think one of my favorite courses was a community health course and it was taught by professor Louise Cohen. It was probably the first time my coursework really tied back to what I was interested in at the time. The Disaster Public Health Group hadn't really been formed yet, so I was a bit of an odd ball in the public health program with my interests. And she took the time to get to understand what I'm interested in and was able to tie back the project I was working on, which was a memo, to a deputy commissioner back to the emergency management work I was doing as an intern at the Department of Health. That was one solid way I felt really heard and felt really, truly mentored. She also took the time to reach out to the leadership there at the time, who was the assistant commissioner, Beth Maldon, who happened to be her intern in the same exact program I was in. She set up the time for her and I to discuss what my trajectory would be, what opportunities exist, what my life could be post-grad. And I was thinking about those conversations now, and obviously at the beginning of my career. She sat me down and asked where I saw myself in five years and listed a few partners that we worked with, a few stakeholders and it really helps to solidify where I feel like I'm going, where I've been. And I kind of reflect back on that conversation to remind myself what I thought I'd be doing five years ago and how I've measured up to that when I was at my peak excitedness about going into the work field. It's been a very helpful conversation outside of the classroom, almost really, but I can't ignore how critical her relationship as a deputy commissioner there was to getting access for little old me, an intern, to some of the leaders at the health department at the time.
Maureen:
You currently work at NYU Langone Health in emergency management and enterprise resilience. Can you tell me a bit more about what that entails and what that role does?
Johanna:
Sure. A lot of what the emergency management team here does at NYU Langone is prepare for emergencies, respond to incidents and prepare honestly for whatever we don't know is coming. I think that's the leading edge of what makes our job so interesting is that we're constantly building in a way that is scalable, flexible, and can really be leveraged for all types of incidents across the spectrum of issues that we come across. And that comes from fliers to multi-casualty incidents, like an explosion nearby or something that involves a chemical or biological radiological threat, as well as mass fatality incidents, as we've experienced with COVID-19. We're trying to build things now that certainly can progress into other types of incidents and build that familiarity. I'm very lucky to be with NYU Langone Health because they have such a commitment to emergency response. Post-Sandy, if you remember some of the photos during that, a lot of those photos of neonates being brought down in the dark and just the level of commitment of the folks here from every level, every division, every department is just unfounded. Folks are really committed to supporting the mission of the hospital in any circumstance, which I think is absolutely admirable, especially when you first walk into the door and you're having an orientation and the CEO is telling you how critical our emergency response roles are. It really sets the tone in the organization. We have a great experience because I think NYU Langone is committed to responding to these types of incidents and providing the type of care that people expect every day.
Maureen:
And so right now, as we're in the COVID-19 pandemic and you're working there, are there any big lessons you can share from the beginning of the COVID-19 outbreak and lockdown in April?
Johanna:
I'd say that the biggest lesson is that there's always going to be a disease X, the unknown, the one we don't have tests, treatments or vaccines for anywhere in the world. We need to better learn to be ready for these types of diseases. They always start small for the most part and as a global community, the investment in areas without the public health infrastructure is critical. There's nothing that really teaches you more about how dependent you are on others like a pandemic, whether that's the interpersonal relationships we're dependent on, the interjurisdictional relationships between let's say states or countries, and really importantly, the value of intercontinental relationships. We've seen a lot of those change during this pandemic and we should probably leverage that for our preparedness in the future. The reality is is infectious diseases don't know geopolitical borders, and they don't really care for political affiliation. We do the best together to respond to these types of incidents. And I think that folks like myself who are interested in these types of things will have hopefully some validation and not seem so doomsday when we talk about the next disease X, because I believe it won't look the same and it'll be different and it'll arrive to us in a different way as well. I'd say another super key lesson that's probably relevant specifically to right where we are in the pandemic right now is to resist complacency. We've all been trying to restore a sense of normalcy in our lives. However, we're still living in a pandemic. Things might not return exactly to normal. We may just have to accept that we're going to live in a new normal. I know I'm going to be missing my family this year for the holidays and spending time with them, but I'd much, much rather miss a holiday than risk the health of our loved ones. It really is a small sacrifice in the grand scheme of being able to see them next year. I hope that we can all live in a way that's reasonable during this pandemic, but resist the complacency that we're dealing with right now, the fatigue, the COVID response fatigue, that we're all feeling that we just want it to be over. We unfortunately don't get to dictate that timeline. And I think we're hopefully at a pivotal point now to respond accordingly.
Maureen:
Knowing what we know now about the pandemic, how should companies and individual people think about emergency management in the future and what are some of the best ways that our industries and our households can be better prepared for whatever comes next?
Johanna:
For the future, I feel like the value of building out a proper business continuity if you're in the private sector or emergency management program far exceeds the upfront cost of hiring staff. The value really comes from the investment upfront to building those mechanisms, working with folks, building those relationships, understanding what expectations would occur during all types of emergencies and making sure that folks know what to do in their workplace is critical. And I think it seems to me based on this incident that there might be a little bit more of an appetite for this type of work in nontraditional settings than previously thought. For governmental agencies that don't really have an emergency role, they might see now that there's value in having at least one assigned employee that might be working on these types of incidents so that a lot of this type of work is not happening during the incident. We always say in emergency management that the work really happens on the lead-up. The preparedness, the planning, all of that is where you get the response structure you need in order to have a successful operation. When it comes to individuals, that's a key focus with these types of programs. I can't think of a program in emergency management that doesn't emphasize personal preparedness. When it comes to responding to any type of emergency, you need to make sure that people can show up. And a lot of times what ends up happening is that there's an expectation that the person that you leave behind at home is not the person who's showing up at work and the reality I've seen over the years working in city government is that we're all impacted typically. When Sandy was going on, there was several employees whose houses were completely filled with water. They lost their objects and family artifacts. They were impacted by the incident just as much as everybody else, but expected to respond to the incident as if nothing was happening. And I think their preparedness plans build that resilience to be able to accept the reality of what's happening and move forward. I think you could almost not have a really thorough emergency plan without really thinking about the individual, thinking about everybody's pets, making sure that their family is safe so that they can report to duty for work.
Maureen:
That's such an important point that you made there about the duality of being both a healthcare worker and also an everyday person who has things and affairs to take care of back home, because I think that a lot of us who don't work in that sector might not understand that or realize the sacrifice that people working on the front lines make.
Johanna:
Absolutely. Especially in this pandemic, there were arrangements made for staff to live in alternate locations so that they wouldn't risk exposure to their family. Particularly in this incident, you really do feel the personal preparedness component because the incident starts with you in a way. It's definitely an interesting application of the concept for the pandemic, for sure.
Maureen:
For someone in your position, how do you manage anxiety and worry during this time of uncertainty?
Johanna:
I have to say this is something I definitely struggled with and struggle with, but I had to confront it head on during the peak of the COVID response. Part of managing my anxiety and worry during the response really came down to managing the team I was working with and their mental health. We worked with our chaplains at the hospital to build a virtual check-in on Sundays to allow the space to talk through uneasy feelings and troubleshoot any issues. We talked through relaxation techniques, we talked through other mechanisms to help calm down when our shifts were over and be fresh for the next day. Part of that process included downloading the Calm app and looking at their sleep stories and meditations to just decompress. There was one that also was helpful called Stop, Breathe, and Think. And that one has you name how you're feeling with a bunch of emojis, which is exactly how we express ourselves these days, and what it does is based on your assessment of how you feel in your body and how you feel in your mind allows you to move into a meditation that's meeting those exact needs, whether it's a breathing technique or just some quietness. And for me personally, I think the best medicine I've had for this incident was spending quality time with my husband, my family, and my closest friends, and even if it was just jumping on the phone to talk about how they were doing, understanding their concerns about staying at home and realizing that we were both experiencing two different types of stress. I was stressed by being in the hospital every day and they were stressed by being stuck in their house every day. Having a Zoom call and Zoom parties was really restorative. At the peak when I had time to be able to join those things, they were really grounding to talk to my family and friends and really connect with people because we were in a very Twilight zone focus. Wake up, go to work, come home, wake up, come home. To stop and listen to my friends and family was really one of the best things I was able to do to manage the anxiety and the stress during this time.
Maureen:
Those are some really great, helpful tips that you've provided us with. What advice would you give to young professionals who want to pursue public health and emergency management as a career?
Johanna:
I think I'm going to lean heavier on the public health side, especially for students, just speaking from my experience at the time I went to GPH. If there was no course at the school that matches your interests, see what's available within the university. I took a very exciting urban planning course on emergency planning my last semester. And one of our class speakers ended up being the lead interviewer for my job search. Later that year I ended up taking the job that was in his unit and it was fantastically connected to a class that was not really part of my curriculum. And I think getting as much exposure as you can is probably the best advice I have for students and for those who are new to the field. I've interned at the City Department of Health and Mental Hygiene. I also interned at FEMA region two, so the Federal Emergency Management Agency region two, which covers Puerto Rico, New York, New Jersey, and the Virgin Islands. And I also interned at New York city Office of Emergency Management, which is where I got my first job. And it really proved beneficial, not only for my interviews, because the folks who are familiar with me had seen me in previous meetings, but during my career, I was able to leverage these relationships during emergencies so what could have been a concerning conversation between somebody from one agency to another was, "Oh, it's just Johanna, our intern, asking a question." And it was very easy conversations to have because we built up that relationship over many, many years. And I guess the last thing I'd say is we need more people that are interested in public health in emergency management and we need more folks that are interested in emergency management in public health. These two fields haven't really worked together in a synergistic way just yet. They kind of do end up in some silos and we could really benefit from each other because it's really hard to see where epi skills could be leveraged in EM and it's really hard to see where the EM structures could benefit public health, unless you're in the center of a disaster. It all becomes clear when you're in the middle of a response, but I really would love to see students who have these interests explore them, take a look at the other side, see what skills they could bring to it. If you really love statistical analysis, I would love you in emergency management because we just don't have that skillset in it yet and we want to build it more. I'm excited for all of these students who might be interested in this field. It is quite the time to get invested in this type of work. And I have been waiting for this moment to be able to communicate to the public health community that we want whatever you have. We could really use some of the intelligence and excitement and enthusiasm that new students and new folks that are interested in career switches could bring to the table. We can leverage it all.
Maureen:
And for you in particular, where does your motivation come to put in the hours and do this work that you do?
Johanna:
That's a great question. I think I was talking about this recently. I can't remember why I was talking about it, but ... Oh, actually we have a book club in my department and we were talking about the one thing and it's the one thing that motivates you. What's the one thing? And I think a lot of us were taking it quite literally, like, "The one thing I should do is write this document that's required for my job." And I think it finally clicked that the one thing that was valuable to me was really doing opportunities like this. For a long time, I worked in government. There was a lot of approvals in order to do outside engagements and reviews. And so I would often say no to opportunities that I didn't benefit from. I should have said yes to a lot of those things as I was getting into this field. Now that I'm saying yes more, I think the motivation I'm feeling now is to share the overall excitement about what we're doing, how processes can work, how success can be defined in this field, how to be prepared in a way that's tangible, because oftentimes it can be a bit of a buzzword. Let's prepare more. It doesn't really have much substance behind it. I think most of my motivation comes from sharing what I've learned along the way and what I've heard from the people before me and trying to implement what they've recommended based on my experiences as well. And sharing that with as many people that are willing to listen. So going to classrooms and being available as a mentor to folks, I think that's sort of the biggest motivator, but I'd say the sort of deepest motivator is really helping people. I think it goes back to when I was 12 years old and as my dad was diagnosed, what is it that I really wanted to do with myself? And I think over the years, I've transformed and evolved different ways of helping people. And every time I was helping people is when I felt no sense of concern in my motivation, helping people in whatever capacity, whether that was when I was an EMT helping on the ambulance or working with pre-med students to try to get them into health professions, specifically minorities, more representation there. All of those things were different ways I was helping people, so the motivation kept growing I think from there. Hope that is a decent answer.
Maureen:
I really want to thank you for coming on and sharing your story with us and express my gratitude for people like you who are working hard to ensure things as they are now are not the permanent reality. Thank you.
Johanna:
Thanks so much for having me. I'm so excited to be part of this experience and I've listened to several podcasts along the way, and I really love what this is providing for not only our community, but pretty much anybody that's willing to listen. I love it. I think it's such a great idea. I'm so glad to be part of it