GUEST EDITORS' NOTE:
Harlem Hospital Center historically has played an important role in the training of African-American physicians. As racial barriers eroded during the 1960s and access of African-Americans to other training programs increased, Harlem Hospital Center increasingly became a site of training for foreign medical graduates. Established in 1940 and affiliated with Columbia University, the program accepts six interns per year. In 2001, there were 18 residents and a chief resident who came from the United States, Nigeria, Yemen, Iraq, Iran, India, Jamaica, Ghana, China, Pakistan, and Ethiopia. The pediatric residency program at Babies and Children's Hospital of New York, established in 1888 and affiliated with Columbia University, has a long history as one of the premier training programs in the nation, preparing pediatricians for careers in primary and subspecialty care, research, and academic leadership.
The communities of Washington Heights and Harlem in northern Manhattan in New York City are among the most impoverished areas of the country. Washington Heights, with 300,000 inhabitants, has the highest density of Hispanics in New York City (67% of the community, predominantly from the Dominican Republic). One quarter of the residents are younger than 15 years of age and nearly one third of the households do not speak English. Harlem has 206 000 residents who are predominantly (69%) African-American, although the area is rapidly changing with an influx of Dominican and West African immigrants. One fifth of the inhabitants are younger than 15 years of age. Only an estimated 8% of the households do not speak English. Poverty, with its many manifestations, characterizes both communities. Despite these grim benchmarks for health outcomes and economic viability, these communities have tremendous resilience and assets that have inspired exciting and innovative partnerships.
We asked one resident to reflect on caring for children and families in New York City on September 11, 2001.
When I was asked to write about Sept. 11, 2001, as a Harlem Hospital resident, that request brought to me many emotions. I kept thinking and thinking, "What I am supposed to say and what can I say?"
That day, at 8:30 we were rounding with the attending on the 17th floor of Harlem Hospital Center. Suddenly on the television, a plane hit one of the towers, and now it is burning. I remember - I couldn't help it - the rounds were not interesting anymore, and I couldn't focus on any medical discussions. My heart and mind were with those who were killed or trapped in these towers. I was leaving rounds and going back and forth to the adolescent dayroom on the same floor where you can see a wide beautiful view of Manhattan's high buildings. We could see the towers burning and then melting as candles. I can say my dreams were melting too!
I came to the United States with my husband and my daughter eight years earlier, leaving the Middle East, with its craziness, looking for peace, and a safe future for our daughter. Looking at these buildings, I could feel the pain, smell the smoke, and think about those who were trapped there. I have been there and I know how it feels when you are trapped in a war without a choice. At this horrible moment, I had to return to reality and think as the chief resident again to keep everybody in order.
Most of the staff members were panicking and checking on family members. I was trying to keep myself calm and strong. With the help of the chief of the department and the associate director, the residents and I multi-tasked, trying to organize emergency services, to help the patients, and to calm each other. We were not thinking about our safety; we were thinking what we could do for Harlem's community if our building was hit or biological weapons were used. We felt helpless, and wished that there were no wars. Why can't we live in a peaceful world where you can enjoy your life without being a target?
We were waiting and waiting, listening to the news, expecting that we would get some of the victims. These hours were so painful and long, not knowing what happened and why it happened.
Late in the afternoon, everybody was talking about Islamic extremists. The associate director came to me and said, "You know, you have to be careful." I said, "Why?" He replied, "People are angry now and I don't want you to get hurt. If you need any help we will be there to help you." He was reassuring, and I will never forget his kindness.
The following days were harder. The psychological impact on our patients and their families was obvious. We tried to do our best as doctors and human beings. We worked as a team supporting each other and at the same time helping and supporting our patients. An 8-year-old girl, living on the 13th floor, could not sleep at night because she was afraid that planes might hit her building. Another 7-year-old Muslim boy, who started to have enuresis, asked his parents, "Are we bad people? I love my friends and my teacher, and I want to be a firefighter." Another young student told his parents, "Yeah, I know, I am lucky to be alive. I just don't want to hear about it anymore." Many of the adolescent patients believed that September 11th was the most significant event of their lifetime.
At Harlem Hospital, the patient population is diverse. As are the medical staff and the faculty members. And I guess that's what makes Harlem unique and special - everybody who works there feels that he or she belongs to hospital and to the Harlem community. I can say, as residents we had great teachers and excellent mentors who walked us through this stressful time.
Being a woman, a mother, and a Muslim, this was the most painful experience that I had ever encountered. I needed to survive, like everyone else, and everybody survived it in his or her own way. For me, I had a couple of incidents where I was cursed. Nothing was taken personally. I can say that people started to ask more questions, and I was happy to answer them; they want to know more about my culture and me.
I don't regret starting a life here with my family. I still believe there will be a bright and a peaceful future for us all. I learned. I grew stronger. And I may be wiser.