After 9/11, Ailing Residents Find a Place to Turn
http://www.nytimes.com/2007/02/21/nyregion/21clinic.html?ref=health
By ANTHONY DePALMA
Published: February 21, 2007
They say they suffer the same rasping cough, shortness of breath and gastrointestinal pains as thousands of rescue and recovery workers who fell ill from the dust and smoke at ground zero. They worry, as the others do, that the future may bring more health problems.
Yet residents, workers and students who returned to Lower Manhattan after the Sept. 11 attack say that their medical problems have largely been overlooked as officials focus increasing attention on the responders who were more exposed to the hazards.
“Not to take anything from them, but everything has been concentrated on the fire, police and E.M.T. guys,” said Agustin Chaves, who lives and works in an apartment building two blocks from the World Trade Center site. “Nobody has been helping regular working people.”
Mr. Chaves, 53, developed asthma and severe acid reflux about a year and a half after Sept. 11, 2001. As his condition worsened, he tried to find out whether it was connected to the dust he had breathed in after the twin towers collapsed. Then last fall he heard that the city was giving millions of dollars to Bellevue Hospital Center to treat people excluded from other programs, like the one that monitors and treats recovery workers at Mount Sinai Medical Center.
Since that announcement in September, the number of people being treated at the W.T.C. Environmental Health Center at Bellevue Hospital has doubled to more than 900. Several hundred more people are on a waiting list, including many low-income residents of Chinatown and the Lower East Side, and immigrant workers without health insurance. And after Mayor Michael R. Bloomberg last week encouraged residents who might have been exposed to the dust to be checked by the clinic’s specialists, the number of patients is expected to rise substantially.
Dr. Joan Reibman, a pulmonologist who directs the center, said that most of her patients had not been exposed to the dust as intensively as firefighters and workers who toiled on the debris pile, but that they might have been affected by the contaminated air nonetheless.
Doctors and scientists have not definitively linked the dust to serious illnesses like cancer. But certain symptoms of respiratory and gastrointestinal ailments have been strongly associated with exposure to the dust. Thousands of firefighters developed gastrointestinal problems and what has become known as World Trade Center cough; the seriousness of their symptoms was found to be related to how soon they arrived at ground zero after the towers collapsed. Medical studies have also shown that they suffered substantial losses in lung capacity after working at the site.
Testing done by the Fire Department is considered especially important because all firefighters undergo thorough physical examinations every year, making it possible to track with a degree of medical certainty illnesses that developed after 9/11.
Most other studies about exposure to trade center dust — for example, the World Trade Center Health Registry of 71,000 workers, residents and volunteers — have been based on people’s own reporting of when an ailment began, and thus were less reliable indicators of a link between the dust and disease.
However, in the past year, both the federal and city governments have expanded monitoring and treatment programs for recovery workers and others, based on the premise that there is some association between the dust and those respiratory ailments.
An overwhelming majority of residents in Lower Manhattan have not developed any illnesses because of the dust, Dr. Reibman said. But whether some patients who have come in complaining of symptoms actually were reacting to the dust may be determined by looking at the extent of the dust exposure and the person’s medical history.
While ground zero recovery operations ended in June 2002, dust could have remained in interior spaces and duct work in nearby office and apartment buildings far longer. In many buildings that were never thoroughly cleaned, that dust may still be present.
Dr. Reibman said it was possible that some clinic patients believed that their symptoms were associated with the dust even though there may not be a connection. As a doctor in a public hospital, she said that did not matter to her as long as those who were sick could be cared for.
But she said many of her patients do have “asthma-like symptoms that we’re treating. And a small number have more complex diseases. Where you fall in that spectrum depends on exposure and susceptibility.”
Most patients are treated with medication, though a few who develop more serious illnesses are hospitalized at Bellevue whether or not a specific link to trade center dust can be proved.
The half-dozen examining rooms at the clinic have been serving a constant stream of patients since Mr. Bloomberg pledged $16 million over five years for the clinic to treat anyone who needs it without charge. Dr. Reibman has so far adopted a policy that accepts nearly everyone.
Many people, like Mr. Chaves, arrive at the clinic with worry in their eyes and asthma inhalers in their pockets. He is the resident superintendent of a condominium complex on Greenwich Street. When his building was engulfed by dust on Sept. 11, he was standing guard in the lobby and was covered in a layer of fine particles.
About 18 months later, Mr. Chaves started having trouble breathing and began to think that his symptoms were connected to the trade center dust. His family doctor could not pinpoint what was wrong even as his condition worsened. He was once athletic and agile, he said, a basketball-court terror his sons could not catch.
“Now I can barely run around with the grandchildren,” he said.
All the apartments in his building were professionally cleaned several years ago. But he finds the dust — a toxic mixture of chemicals and concrete that scientists say can be as caustic as drain cleaner — when he has to work in spaces above ceiling tiles.
Most alarming, he said, is finding the fluffy, gray dust when he or his men are called to remove a balky air conditioner from its slot in the building wall.
“We pull it out of the wall,” Mr. Chaves said, “and all the dust is still in there.”
The Bellevue clinic, which he visits every few weeks, has its roots in an asthma clinic that Dr. Reibman started in 1991 to investigate why the city had some of the highest rates of the disease in the country.
In 2002, she collaborated with the State Department of Health on a survey of residents who lived within a mile of ground zero. The study, one of only a few to deal with the effect on residents, found that about 60 percent of the 2,812 residents who responded complained of coughing, wheezing or shortness of breath that began after the terror attack.
The study has limitations. Those who responded to the survey were not given physical examinations, nor were their medical records checked for pre-existing health problems. Their responses were based on their own estimations of when their symptoms began.
In the same 2002 study, in a control group of residents about five miles from ground zero, 20 percent reported similar symptoms, again based solely on their own recollections.
Dr. Reibman’s asthma clinic became part of the city’s overall public health response in the months after 9/11. But it played a relatively small role until Mr. Bloomberg sharply increased funding in response to community pressure and emerging medical issues among recovery workers and others.
This month Manuel S. Bruno, 82, had his first examination at the clinic after reading news articles that said firefighters and police officers were developing serious, and sometimes fatal, illnesses.
Mr. Bruno said that shortly after he and his wife cleaned ground zero dust from their apartment on the Lower East Side, he developed an eye infection and an unusual rash. He said his regular doctors dismissed any possible link to the dust, attributing the symptoms to his age. Now he said he is willing to undergo specialized tests that the clinic’s doctors ordered because, whether they find a link to ground zero dust or not, “at least maybe they can help me.”
Another recent patient, Miguel Lopez, 40, said he had felt awful since he worked several months for a company that cleaned the dust from office buildings in Lower Manhattan. Without health insurance, he struggled for years to find someone to treat his severe rash and muscle ache before he heard about the specialists at the Bellevue clinic in October.
Mr. Lopez said he wanted to return to Ecuador, his native country, but was afraid to do so until he knew more about his medical condition.
“If something happens in 5 to 10 years,” he said, “I don’t want to be in Ecuador.”
Dr. Reibman recently added psychiatrists, psychologists and social workers to the clinic staff because so many of her patients also have stress-related symptoms, stemming in part from their concerns about medical problems that could develop.
She said she was so overwhelmed with new patients that she had not had the time or staff to conduct a follow-up to her 2002 residential survey. And she is likely to get even busier. Mr. Bloomberg, in describing the city’s comprehensive plan for dealing with 9/11 health problems last week, said that the Bellevue clinic might need to care for as many as 12,000 patients.
Dr. Reibman said she did not know the extent of the health problems among Lower Manhattan residents, or how much money would be needed for treatment. But she shares data with the Mount Sinai program and the Fire Department and hopes to reach conclusions about 9/11-related symptoms and treatment.
Meanwhile, officials from the federal Environmental Protection Agency have said that trade center dust poses little continuing danger to residents. Still, in December, the agency offered to test and clean apartments in Lower Manhattan. (To register, residents and building owners can call 1-888-747-7725.)
In 2004, residents, workers and students in Lower Manhattan filed a federal class action lawsuit against the E.P.A., its former administrator, Christie Whitman, and other federal officials, seeking a more thorough cleanup and an aggressive screening and treatment program.
The suit, which does not ask for individual monetary awards, claims that Ms. Whitman deliberately distorted information and put families at risk by encouraging them to return to apartments, schools and places of business before comprehensive tests of the air quality were available.
Last year, Judge Deborah A. Batts of Federal District Court in Manhattan said that Ms. Whitman’s statements that the air downtown was safe to breathe were misleading and “conscience-shocking.” She allowed portions of the suit against Ms. Whitman and the agency to go forward.
