Ten years after the Sept. 11 terrorist attack that killed nearly 3,000 people, the New York City skyline remains an oddity. The large empty space in Lower Manhattan remains a constant reminder of the Twin Towers that used to stand so tall.
But at street level, life has returned. Well-dressed commuters hustle into surrounding buildings while hordes of tourists take in the construction site and new 9/11 Memorial, cameras in hand.
The scene is that of a typical New York tourist destination.
Life is still anything but typical, however, for those who survived the terrorist attacks. For those who were onsite as many tons of dirt, dust and debris spewed into the air as the towers imploded, the impact is still great, both physically and mentally.
First responders - police, firemen, emergency medical personnel - many of whom spent months at or around Ground Zero immediately following the attacks are reporting health conditions associated with exposure to the area. The World Trade Center (WTC) Medical Monitoring and Treatment Program (now known as the Medical Monitoring and Health Program) started in 2002 to provide critical monitoring and treatment for this population. There are currently five locations throughout the New York area.
"My first feelings when I saw the towers imploding on TV were fear and anger," said Mit Singh, then working as a police sergeant in the 6th Precinct of New York City. Singh, who was usually patrolling the streets of the West Village on any given day, happened to be on a family vacation in Las Vegas on Sept. 11, 2001.
Singh tried to get back to New York City as quickly as possible, but air travel was suspended into NYC-area airports and by the time he stepped onto Ground Zero it was nearly a week after the attacks. "I didn't even recognize the street I had worked on everyday for years. It looked like I was in Beirut or Lebanon."
"Once I got back to NYC, I spent all my time down at Ground Zero with my command. We ate, slept and drank down there. The potential health impact wasn't on my mind at all," Singh said. "We were just so angry about the loss of life of colleagues, friends and citizens."
Now, however, Singh is all too aware of the health effects associated with Ground Zero exposure. Conditions such as upper and lower respiratory illnesses, obstructive sleep apnea, GERD, PTSD, depression, anxiety, substance abuse and even cancer plague his former colleagues.
Knowing he could face such health effects, would Singh have done anything differently? The answer is a resounding "no."
Singh, who was born and grew up in Vietnam, was forced out of his home country in the early 1980s by the Communist regime, who declared he was not truly Vietnamese because his father was Sheik. Kicked out of the only country he had ever known, Singh made his way to India (with a pair of pajamas as his only belongings), and eventually, to the U.S. and New York City. Here, he became a police officer, met his wife and had three kids.
"I became a police officer to give back to this country that welcomed me in and allowed me to have freedom and the chance for a wonderful life. When I became a New York City cop, it was the proudest day of my life," said Singh, his voice thick with emotion.
Monitoring & Treatment
Singh contacted the Queens location of the WTC Health Program in 2007 when a former detective in his precinct passed away of lung cancer. "He never smoked and, because he was a narcotics detective, he only spent about half the time around Ground Zero I did," Singh said.
The gradual realization that breathing and sinus problems were affecting his quality of life, coupled with the news of his colleagues' passing, spurred Singh to take his health concerns seriously.
Singh joined more than 5,500 patients currently enrolled in the Queens WTC Health Program. The program, administered through the National Institute for Occupational Safety and Health and the CDC, provides free medical monitoring and treatment for WTC first responders and volunteers who assisted with search and rescue, clean up and recovery at Ground Zero. About 80 percent of patients enrolled in the Queens clinic are male.
Regular medical monitoring is offered every 12 months. "Patients undergo a series of tests including blood tests, urinalysis, chest X-rays (offered every 24 months), PFT, medical history interview and mental health interview," said Grace Dada, RN, case manager at the Queens World Trade Center Health Program Clinical Center of Excellence.
The physician completes a physical exam on the patients and based on his findings, patients are referred into the treatment program or will continue with the yearly regular medical monitoring program. Conditions include: upper respiratory conditions (interstitial lung disease, asthma, COPD), upper respiratory conditions (chronic rhinosinusitis, chronic nasopharyngitis, chronic laryngitis), gastroesophageal reflux disease (GERD) and obstructive sleep apnea in combination with upper respiratory condition or GERD.
Patients who have a condition associated with WTC exposure are referred to the treatment program, where he'll get access to specialists, such as pulmonologists, gastroenterologists, ENT, psychiatrists or psychologists. Common mental health conditions being treated include posttraumatic stress disorder (PTSD), major depressive episodes, generalized anxiety disorder, substance abuse and many more. Patients can participate in group and individual therapy. Patients can receive medications and medical devices (such as CPAP machines, nebulizers and ambulatory oxygen) at no cost.
Nurses play a large role in patient exams, as well as in patient education. Nurses conduct the medical history interview, which takes into consideration the respiratory, gastrointestinal, musculoskeletal, medications, as well as symptoms patients have had within a 12-month period and other diagnosed medical conditions.
The nurses coordinate the overall care of the patients.
"We explain various diagnostic procedures and ensure the patient complete their tests and follow up with our physicians," Dada explained. "Patients with abnormal reports are notified in a timely manner. Patients with missed appointments are contacted and provided with new appointments."
Dada has to make sure patients not only understand how to use the prescribed regimens, such as the correct use of the asthma pumps and nasal saline irrigation, but also why they are needed. Patients are generally compliant when they understand how the medication regimen or device will directly benefit their daily life, Dada said.
There is a benefit counselor on site who helps patients with worker's compensation, financial assistance, community resources in terms of obtaining a primary care physician and medical health insurance for other medical conditions. As of July 1, 2011, LIJ Medical Center partnered with Queens WTCHP at Queens College to increase access to medical and mental health programs for WTC responders in Queens to increase access to the outpatient network of physician groups, mental health services and family wellness programs.
"Many of my patients want to know whether they'll develop cancer," Dada said. It's a question for which there is no direct answer. "They say, 'My colleagues are dying. What will happen to me?'"
Dada, however, does her best to reassure patients they are getting excellent care. "I always start by telling my patients about my background; I worked for 3 years at the WTC Health Program as the clinical nurse coordinator at Mount Sinai [Medical Center] before coming to the Queens location, so I know the program very well."
"Patients are very proactive about their health within our program," she said. "They quickly let us know when they are running low on medications and when they need to be seen. They are grateful for this program. They know they deserve to be treated for their WTC related conditions."
Ultimate Job Satisfaction
For the nurses who work at the WTC Health Program, every day is an exciting day. "I love working with the responders," said Maria Letellier, LPN. "I had never heard of this program before I applied for a job here. Now, I'm so enthusiastic about it.
"Every single day you hear a truly amazing story from a patient. I'm so inspired working here. I want to go back to school to become an RN and so I can work here in that capacity," she added.
Patients seem to share Letellier's enthusiasm. "This program has helped me psychologically, emotionally and physically," Singh said. "And, it's all free. This kind of care would cost a lot anywhere else."
"I view each day at work as chance to give back," Letellier said. It's a similar sentiment to the one expressed by Singh regarding his days as a police officer. The work may be different, but each works toward the goal of recovery, whether of a city or of a person's health.
Diana Friedman is regional editor at ADVANCE.