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New York City's Health By Michael Roberts |
In the wake of the terrorist attack against the World Trade Center in New York on September 11, 2001, a number of serious health and environmental problems have arisen or existing ones greatly aggravated. Indeed, perhaps the second casualty of 9-11 was that 911, the state's emergency telephone number, did not work for almost 13 days after the attack. What this meant was that quite literally thousands of people suffering medical crises, or who believed they were about to suffer a major health emergency, were either unable to get to emergency rooms in a timely fashion, or not at all.
Consider a city of approximately 8 million people that is suddenly faced with the most traumatic and deadly attack in its history, and the accompanying loss of life that has been officially put at over 4,300, with thousands more injured, then one starts to comprehend the magnititude and scope of the problem.
For Community Health Centers in the immediate area of the World Trade Center, and in places like Brooklyn and the Bronx, the loss of telephone contact was just one of the serious irritants that the terror attacks spawned. But far more important was the crowding of these centers by people suffering from a number of health problems. Many of these patients some visiting health centers for the first time came with pre-existing medical conditions that were aggravated as a direct result of the WTC attack.
Among the medical cases that Community Health Centers in Manhattan, the Bronx, and Brooklyn saw in the first 15 days after the WTC attack were:
Increased levels of anxiety
Increased chest pains and the belief by patients that they were suffering heart attacks
Increased frequency and case loads in both senior and juvenile asthma
Chronic headaches
Acute sleep disorders
Eating disorders
Panic attacks
Increased levels of hypertension
Chronic depression
As the deep trauma and the scope of the attack sunk home Community Health Centers in the boroughs surrounding the WTC attack reported that the combined loss of revenue for the first two weeks after the attack reached about $9 million. For hospitals in the city that figure has been put at over $330 million, and officials have warned that if the federal government does not help quickly, then these hospitals will have to cut many programs and services. They will also have to lay off workers as downsizing will become the only option to keep their doors opened.
Moreover, the WTC attack has caused the loss of approximately 70,000 jobs in the city, and the relocation of hundreds of companies to neighboring New Jersey. Remember that the WTC employed over 50,000 people and many of these jobs have been permanently lost since some companies that cannot afford the cost of relocating, and the other logistical elements that are proving to be far too expensive to operate have simply gone out of business. This massive loss of jobs have affected the lives of literally millions of people in the state who now face a bleak future with the loss of one or more than one breadwinner in affected families. Competition for scarce jobs one recent job fair saw as much as 20,000 people competing for just about 6,000 jobs will become even keener as the unemployment situation puts further strains on the social security network.
The world has been made aware of the sacrifice of the members of New York 's police and fire departments, and the trauma that their families are still suffering, yet little or nothing has been said about the thousands of undocumented immigrants who worked for bosses in an "off the books, cash only" arrangement, and who lived in the social shadows for fear of deportation. These immigrants have been reluctant to come forward and tap into services that the city is offering because they believe that the information they give when filling out basic forms will be shared by with the Immigration and Naturalization Services (INS) that remains the bogeyman for the vast majority of immigrants.
For non-English speaking undocumented immigrants these challenges are even steeper. They are intimidated by officials and functionaries who are not culturally sensitive, and so they prefer to remain in the shadows, and swallow continued acts of exploitation including working longer hours for less than minimum wages because the avenues opened to them for semi-decent jobs suddenly came crashing down with the WTC. With the contractions in the construction industry where large numbers of the undocumented historically earned decent wages, thousands have lost their jobs. This has further aggravated the situation.
But the biggest problems facing the undocumented is not so much the loss of jobs and the exploitation by bad employers, but the fact that many of their loved ones died under the rubble of the World Trade Center, and whose bodies remain unclaimed and unnamed because these immigrants are afraid to come forward and identify their loved ones, for fear of deportation by the INS.
Among this population the Community Health Care Association of New York State has identified the following health problems directly linked to the WTC attacks:
1. Deep feelings of guilt
2. Chronic depression
3. Increased domestic abuse
4. Increased child abuse
5. Respiratory aliments
6. Nervous breakdowns
7. Anxiety
8. Chronic fear
9. Suicidal tendencies
These health problems are finding their way to Community Health Centers because most of the undocumented live in the outer boroughs of the Bronx, Brooklyn and Queens. And despite reassurances by the Environmental Protection Agency (EPA) and the City Administration in New York State, there are major concerns about the quality of air in the city. Again, Community Health Centers in the Bronx are seeing a dramatic upsurge in the frequency of asthma visits since the WTC attack. They attribute these visits directly to the contaminated and polluted air quality that hangs over the South Bronx. Remember also that the Bronx has one of the highest if not the highest rates of asthma in the state. CHCANYS member centers in the Bronx also report an upsurge in the number of visits to the center for all of the above medical problems.
In response to these problems CHCANYS' CEO, Dr. Lorna Scott McBarnette, has taken the lead to not only highlight the problems that Community Health Centers face, but to create public awareness around a number of issues relative to medical professionalism, community health, and now initiatives aimed at complimenting the work of Community Health Centers.
To this end, CHCANYS believes that the retraining of our physicians and health workers is critical at this moment, especially since the Anthrax scare, and the underlying assumption that the State and City's response were not well thought out because this was a novel attack. Dr. McBarnette has been at the forefront of advocating that the State, City and federal governments allocate dollars for the retraining of medical personnel to recognize and treat victims of biological and chemical attacks.
CHCANYS has also held workshops dealing with how to handle what we call "WTC Syndrome," how to ask the right questions, and how to diagnose health problems related to the WTC attack as distinguished from pre-existing medical conditions. This goes to the heart of cultural sensitivity and competence for health workers and the ability to understand exactly what and how different ethnic groups react to medical questions.
CHCANYS has also partnered with a community organization and a cluster of religious groups in north Harlem in developing a faith-based community health program that may turn out to be a state, or national model. This pioneering project seeks not only to enroll poor, underinsured and low-income residents into health programs and get them into Community Health Centers, but is putting in place a software regime that allows for the collection of vital community data, allows for checking and tracking patients relative to follow-up visits, taking of medication etc., and which will help to better analyze these communities and their health needs.
CHCANYS testified before the City Council's Sub-Committee on Mental Health on November 9, 2001. Dr. Lorna Scott McBarnette, CEO of CHCANYS led a three-member delegation to the hearing that included Dr. Mel Aldman, Director, Behavioral Services Department, at Morris Heights Community Health Center in the Bronx. Dr. McBarnette told the hearing that over the next 9 12 months CHCANYS projected that mental problems will quadruple in the state, and that already our communities were seeing a number of behavioral problems directly associated with the WTC attack.
Among these behavioral problems CHCANYS has identified are:
1. Increased violence
2. Increased juvenile gang activities
3. Reckless sexual behavior, especially by people suffering from HIV/AIDS
4. Increased abuse of alcohol, especially by young, school age people
5. Hyperactive behavior among young children
6. Mental problems in children, including nightmares, sleep disorders, trauma, anger and depression
Community Health Centers in New York state now face challenges that their sister members across the nation cannot yet fully comprehend. Aside from the constant struggle to find funding, the World Trade Center attacks have added an increased burden. In communities like Bedford Stuvyesant in Brooklyn that has seen an 83% increase in the uninsured over the past two years, and in Far Rockaway in Queens where one Community Health Center treats the "poorest of the poor and sickest of the sick," and where the highest number of amputees the result of unchecked diabetes live, the situation could be very overwhelming.
But CHCANYS continues to grow and to aggressively advocate on behalf of its members because the organization knows that its mission is a noble one, and that its centers are the only place that New York State's growing population of poor people can go to for quality, affordable health care now more than ever.