After 9/11, Ailing Residents Find a Place to Turn

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.

Dr. Stephanie Lau examined Manuel S. Bruno, 82, at the W.T.C. Environmental Health Center at Bellevue Hospital.

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 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.