Ailing community: Medical offensive fails to cure Harlem residents

Subject: Medical offensive fails to cure Harlem residents
Date: 4/3/2005 11:58:59 P.M. Eastern Standard Time
From: tenant@tenant.net
Sent from the Internet (Details)

Ailing community
Medical offensive fails to cure Harlem residents
Crains
By Samantha Marshall
Published on April 04, 2005

Born and bred in Harlem, 72-year-old Barbara Skinner is on the verge of
leaving her neighborhood. With four children under her care--including a
10-year-old severely asthmatic boy and a 15-year-old girl who suffers from
schizophrenia, borderline diabetes and obesity--the retired corrections
officer figures there has to be a healthier environment for the four
children in her care, even if it means moving upstate.

"There's got to be a better place to raise kids than this," says Ms.
Skinner, a mother of nine, grandmother of 28 and great-grandmother of 12.

Harlem stands on the bottom end of a yawning health gap that's persisting
despite the economic recovery, several good nearby hospitals, pockets of
neighborhood gentrification,

and dozens of targeted health programs and campaigns. Life expectancy there
can be as much as eight years shorter for people who live just a few blocks
away from their Manhattan neighbors on the Upper East Side.

While some public health indicators, including infant mortality and
tuberculosis rates, have improved over the past few years, the incidence of
diabetes, obesity and asthma in Harlem, along with the South Bronx and
parts of Brooklyn, remains alarmingly high. Residents in these
neighborhoods suffer from depression in greater numbers than average New
Yorkers, and are more likely to seek solace from the stress of poverty
through cigarettes, alcohol and drugs.

Most people don't have regular doctors and rarely seek preventive care,
such as colon cancer screenings and mammograms. Even those with insurance
often put off care until a crisis sends them to the emergency room.

"It's frustrating," says Adam Aponte, director of the diagnostic and
treatment center of North General Hospital in East Harlem. "It takes a lot
of commitment to work here."

Millions for research

Harlem has become an emblem of health problems in urban America, attracting
millions in research dollars from agencies such as the Centers for Disease
Control and Prevention. So many door-to-door surveys have been conducted in
the area that when community health workers try to offer free treatment and
screening, they're met with weary resistance. But despite all the
attention, health experts can't pin Harlem's vast health disparities on any
one factor.

"It's still mind-boggling," says Alwyn Cohall, director of the Harlem
Health Promotion Center at Columbia University's Mailman School of Public
Health.

A steady influx of immigrants from some of the world's sickest countries, a
lack of health insurance coverage, poverty, language barriers and poor
health education may partly explain why Harlem's health is hurting. But
longtime residents and frontline doctors and nurses say it's the area's
physical environment that really drags people down.

Vacant lots and boarded-up buildings harbor rats and mice, while residents
of overcrowded housing projects contend with dust, mold and cockroaches.
Affordable fitness clubs are almost nonexistent. Fruit stands are scarce,
but fast-food joints are common.

"You've got more liquor stores here than churches," says Dr. Aponte, who
was born and raised in the neighborhood.

Six out of the city's seven bus depots belch out diesel fumes throughout
northern Manhattan, which is also host to several major traffic routes.
Particulate matter settles in lungs and triggers respiratory problems that
strain hearts and shorten life spans.

"It's in the air," says Ms. Skinner, whose adopted son Michael struggles to
breathe so much that he needs to be rushed to the hospital as often as a
few times a month.

Her high-rise home, which is owned by the Department of Housing and Urban
Development, shares the block with several newly constructed co-op
buildings. Urban renewal has done nothing for her family but raise prices
in the area, says Ms. Skinner. If anything, the new construction has kicked
up more dust and created a concrete valley that traps pollution from idling
buses.

Host of ills

About half of Ms. Skinner's extended family suffers from varying degrees of
asthma. Her late husband died of cancer, and one of her grown sons has
cerebral palsy. She spends much of her time in hospitals negotiating care
for her chronically ill children and grappling with paperwork from
Medicaid, which only sporadically pays for Michael's five costly asthma
medications.

To make sure he gets a break from the summer pollution, she sends him to
stay with friends in Albany. To keep him breathing when he's home, she uses
an air purifier in his room and makes sure all surfaces in the crowded
four-bedroom apartment are dust-free. But she's constantly battling with
her HUD landlord to rid the apartment of mildew caused by leaking pipes.

"Might as well knock these buildings down and start over again, they used
such cheap construction materials," grumbles Ms. Skinner, pointing out
walls of buckled paint in her toy-cluttered hallway.

There are plenty of hospitals in the area, but primary care doctors and
pediatricians who could help families maintain their health are rare. The
city Department of Health and Mental Hygiene opened an office in Harlem two
years ago to do more outreach after a health survey revealed just how wide
the health gap is. Instead of waiting for patients to come to their
emergency rooms, providers such as North General and Harlem Hospital Center
recently began sending their clinicians into the streets, bodegas and
churches to sign up ailing residents for free health programs.

Yet it's up to women like Ms. Skinner to battle other health threats. She
watches the diet of the teenage daughter, scouring four supermarkets over
20 blocks to get the freshest fruits and vegetables for her family. But the
presence of McDonald's, Popeye's and White Castle within blocks defeats her
efforts.

"She sneaks out for the bad stuff," says Ms. Skinner.

As for her own health, Ms. Skinner is in the pink. The only time she was
admitted to the hospital was to give birth.

"The good lord must be keeping me here so that I can look after all these
children," she says.