This is part two of RH Reality Check‘s examination of health care in New York City in the year since Superstorm Sandy. Read part one here.
The YANA (You Are Never Alone) Medical Clinic in Rockaway Park, Queens, sprang up in response to the overwhelming need for health care in the aftermath of Superstorm Sandy, which devastated the region in October of 2012. Nastaran Mohit, a labor organizer who helped create the volunteer-run clinic, remembers one young woman who came in about a week after the storm in excruciating pain. One of the volunteer doctors saw her and tried to help her, but shortly after her visit to the clinic, she had a miscarriage.
“She lives in that area, they had substantial flooding in their apartment. Who knows the stress she went through,” Mohit told RH Reality Check. “She didn’t have health care, they were an undocumented family, and who knows how many of those cases there are?”
In the United States, cisgender women’s and transgender people’s bodies are often the sites of political battles, but their everyday struggle for access to health-care services and procedures, as well as the necessities of living, is easily forgotten. In the aftermath of Sandy, as people in flooded areas lived without power for days, as hospitals and clinics closed and transportation was impossible, the specific needs of marginalized people easily slipped by the wayside.
After Hurricane Katrina devastated New Orleans, researchers from Tulane University’s Newcomb College Center for Research on Women noted that women’s specific physical and reproductive health needs were largely ignored by U.S. disaster managers. When women’s health care was mentioned at all, it was often “within the context of children’s needs, not independently.”
Even in the immediate days after the storm, women and queer and transgender people had specific needs that weren’t always being met, and as the recovery and rebuilding process goes on—and slips from the minds of those whose lives have returned to normal—there are still more problems that require an analysis through the lens of gender.
Who Gets Hit Hardest?
It’s too early for there to be much research on Sandy’s impact on long-term health outcomes, but studies after other disasters have highlighted the ways in which women are disproportionately affected. While Sandy was not Katrina, and New York is not New Orleans, the research done on prior disasters can give us an idea of what to watch out for.
A post-Katrina study of 1,043 adults found 2.7 times more occurrences of post-traumatic stress disorder (PTSD) among women than men, and 1.3 to 2 times more occurrences of other anxiety or mood disorders. Another study, of male and female primary caregivers, found that 46.5 percent of women (compared to 37.5 percent of men) “reported clinically significant psychological distress.” Yet, the report said, only a small proportion of those reporting PTSD and other psychological problems sought treatment.
Mohit spent much of her time in the weeks after the storm coordinating volunteer canvassers in the Rockaways, and saw firsthand the impact the region’s conditions had on residents, particularly women. “How stressful it must be to be living in this environment, scared that someone’s going to knock on your door and rob you, scared that someone’s going to knock on your door and sexually assault you, skeptical of the relief workers that are coming, living for weeks on end without heat, without hot water,” she said. “There were thousands of residents that did not have running water or hot water or were not able to flush their toilets, living in terrible conditions for weeks on end with no options to go elsewhere on the peninsula and shower somewhere else or find heat somewhere else. We had all these promises of these Tide trucks [mobile laundromats] showing up, or these mobile showers showing up; they never showed up. So people just made do, whatever that entails. That might mean not washing your clothes for several weeks. It might mean not showering for several weeks. Our canvassers found several families who were basically living in feces because they were unable to flush their toilets, or elderly folks who weren’t able to clean themselves. That just compounds a number of health issues.”
“I think that the mental health component of that is so enormous, but we don’t have a structure to address those issues,” she added. (For more on mental health and Sandy, click here.)
Rapes were rumored in some of the housing complexes, along with robberies. While Mohit found no hard evidence, she said that even the rumors added stress to people already living in intolerable conditions. “Some of these women weren’t even coming out of their apartment buildings because they were so scared,” she said.
Yet the same communities that were hardest hit by Sandy are also the ones that have longstanding reasons to fear turning to the police in times of crisis. According to WNYC’s stop-and-frisk map, young people of color in Coney Island and Far Rockaway saw some of the most punitive policing under the New York Police Department’s stop-and-frisk policy. As Kristen Gwynne wrote at AlterNet, “For the NYPD’s stats to add up, they’d have to have stopped every young, black man living in the city once—and then some.” Reporting for Truthout in the Rockaways, I spoke with residents Marie Satchwell and Kenyatta Hutchinson, who both told me that the police were more likely to stop and harass residents than offer aid.
For undocumented families, the heavy police and military presence added fear of deportation to the reasons that people were hesitant to reach out for help, leaving young women like the one Mohit met at the YANA clinic dependent on volunteer care. Parents with children born in the United States were eligible for Federal Emergency Management Agency (FEMA) aid, while many others were not.
In addition to race and immigration status, discrimination around gender identity and sexuality will affect recovery. Charlotte D’Ooge, writing about Katrina’s impact, pointed out:
While disasters … strike without regard for race, class, gender, or sexual orientation, how those affected are able to recover in the aftermath of such devastation is profoundly influenced by whether or not the survivors fit into the traditional, heterosexual category of “woman.”
For trans people, this might mean a lack of access to hormones and doctors who treat them well, or who will treat them at all. Even during normal times, according to a 2011 report from the National Gay and Lesbian Task Force and the National Center for Transgender Equality, 19 percent of respondents reported being refused care due to being transgender or gender non-conforming, 28 percent were victims of harassment in medical settings, and 50 percent reported having to teach their medical providers about the care they needed. After a disaster, when one’s choices for help narrow to those within immediate reach, things just get more difficult. In shelters, the chance of being outed multiplies, as does the chance of being refused services or facing violence.
In the days after the storm, the Callen-Lorde Community Health Center in Manhattan, which provides health care to gay, lesbian, bisexual, and transgender people regardless of their ability to pay, was closed through November 5 due to power outages. The 1,800 patients who regularly visit the center in an average week were left without its services. However, the center did set up an emergency prescription line within 24 hours, and saw over 300 calls, and their mobile medical unit, normally dedicated to serving homeless or street-oriented youth, mobilized to provide care in the city. Many other LGBTQ-friendly health providers were similarly closed, leaving people to take their chances with new providers, or, all too often, do without.
Jeremy Saunders, lead organizer at VOCAL-NY, an organization that works with residents affected by HIV and AIDS, the drug war, and mass incarceration, noted that as VOCAL organizers did outreach after the storm, they found that three HIV/AIDS Services Administration centers were closed, they weren’t doing outreach, and no one was addressing the immediate needs of that community. The areas affected by Sandy were also home to many of the city’s nursing and adult care homes and to halfway and three-quarter houses, and it was difficult to find information on what happened to the people in those facilities. VOCAL was on the streets doing condom distribution and syringe exchanges, but few others were addressing those specific needs.
Pat Kane, an operating room nurse at Staten Island University Hospital and treasurer at the New York State Nurses Association (NYSNA), did relief work in Staten Island and told RH Reality Check that she’d seen at least two families with newborn babies, and that she and her colleagues had encountered women who had just given birth or were about to do so. Volunteers, she noted, were able to check back in with them, but she saw many families with small children struggling.
Getting to Care
As Mohit noted, “When you think about how women care for themselves, when you think about reproductive health, so much of it is about access”—access to a doctor, access to birth control, access to an abortion, being able to take time off from work to make it to appointments. In the days after the storm, with power out in huge swaths of the city, pharmacies, bodegas, and grocery stores remained closed, cutting off access not just to prescriptions, but also to tampons, sanitary pads, and over-the-counter medications.
At YANA, Mohit’s canvassers got requests for birth control, tampons, pads, and the morning-after pill. Occupy Sandy and other community groups that were collecting donations put out calls for baby formula and diapers, women’s clothes, and hygiene supplies, and canvassers tried to collect information to fill people’s prescriptions for them. Michael Duncan, medical director at VOCAL-NY, was one of the volunteer doctors writing prescriptions based on what information canvassers could bring back; he told RH Reality Check that it seemed unlikely that many of those prescriptions were filled, as the pharmacies that were open were hesitant to fill them, and many times canvassers didn’t have the correct information.
With the health problems that communities are already facing in the wake of Sandy, from respiratory problems to the flu epidemic, Mohit said, “I can’t imagine in this kind of environment that women are taking care of their reproductive health in any way, because the basic health needs that a population has are not being tended to. I can imagine it’s almost viewed as a luxury. We have women that aren’t being seen by a doctor when they have pneumonia, let alone regular checkups, who haven’t been able to care for their children properly, and we know they’re not caring for themselves.”
Judy Sheridan-Gonzalez, an emergency room nurse at Montefiore Medical Center in the Bronx and vice-president of NYSNA, told RH Reality Check, “I’m sure that things that weren’t medical emergencies just sort of fell by the wayside. There’s probably a lot of unplanned pregnancies that occurred in the last two months. There’s a triage of what people felt comfortable requesting assistance in. I’m sure people felt guilty even asking for stuff like that.”
Some hospitals are reporting an increase in birthrates this July and August, nine months after the storm and ensuing blackout. The Chief of Obstetrics and Gynecology at New York-Presbytarian hospital said that there was a 20 to 30 percent likely increase in deliveries at the end of July and beginning of August.
The storm did have an effect on people who did not want to keep their pregnancies as well. According to Phillip Kim, one of the volunteers who runs the New York Abortion Access Fund (NYAAF) which helps individuals pay for abortion procedures, several clinics that provide abortions were closed after the storm or were shortstaffed as transportation was impossible. Medicaid offices, he said, were having computer troubles and couldn’t process people’s requests, and as clinics reopened they were overloaded and backlogged. That lasted over a month.
One person who lived in the Rockaways was unable to get to a clinic for weeks, increasing significantly the price of an abortion procedure; another had to travel to Maryland because too much time had elapsed (the cut-off for abortions in New York is 24 weeks), raising the cost from $3,000 to $6,000. NYAAF had to go to other funds to get enough money to pay for the procedures.
Though Kim stressed that it’s impossible to extrapolate anything from the number of calls that NYAAF’s funding hotline received, the end of November and beginning of December did see an uptick in calls and pledges of funding. “Abortions are just necessary for so many individual reasons, hurricane or not,” he pointed out.
Moving Forward, Ongoing Issues
The neighborhoods still struggling to recover from Sandy are mostly ones that had fewer resources to begin with. Federal funds—for rebuilding, for homeowners and businesses—began to be released to businesses in late May and to homeowners in June. In late August, the Obama administration’s Hurricane Sandy Rebuilding Task Force released its rebuilding strategy, a jargon-filled document big on “resilience” and “green infrastructure” but with surprisingly little to say about health care. The question remains, as Michael Duncan of VOCAL said, how to push for rebuilding that addresses the problems that already existed—that rebuilds better than before.
Hospitals slowly got back on track; Coney Island Hospital reopened its Women, Infants and Children (WIC) nutrition program February 5, and Bellevue, one of the city’s largest providers of mental health services, resumed full services on February 7. Saunders said that some residents of halfway and three-quarter houses in the Rockaways and elsewhere were back in by the spring, while others, “we’re not entirely sure.” For displaced people in care facilities, it’s a struggle—they don’t get a say in where they go or when they come back. NPR reported on residents of Belle Harbor Manor, an adult home for people with mental illnesses and physical disabilities, coming home in February after three-and-a-half months in crowded shelters, dirty hotels, and a state psychiatric facility—to find their rooms had been looted, their possessions gone.
But now, another crisis has risen up in New York health care: hospitals at risk of closure, and specifically labor and delivery units being shut down. At North Central Bronx (NCB) Hospital, far from Sandy-ravaged areas but a safety-net institution for thousands of lower-income residents, the labor and delivery unit closed August 12 with just days’ notice. The unit’s nurses and patients were transferred to Jacobi Medical Center, nearly four miles away. Nastaran Mohit said that others may be at risk as well.
“We were having a rally at NCB Hospital [August 12], and I’m handing out fliers to community members that are passing by, and I saw at least three expectant moms going in there for their checkups. One of them started crying; she said, ‘What am I going to do? I’m supposed to give birth here in a couple of weeks.’”
Labor and delivery, Mohit explained, is on the chopping block in many places because it’s not profitable. Detox departments, too, are being slashed—in the Rockaways, which have one of the city’s highest drug-dependent populations, the detox department at St. John’s Episcopal Hospital is gone, and in Staten Island, which has one of the highest prescription-drug dependent populations, Bayley Seton Hospital has lost its detox department. And as explored in part one of this series, hospitals around the city, including St. John’s, are at risk of closing entirely.
Most of the cuts that are coming, as well as the slow recovery—signs at an August 14 rally in the Rockaways called to “speed hurricane $$, save our only hospital!”—hit communities that are already underserved and marginalized. Stacy De-Lin is a primary care physician who worked as a resident at St. Vincent’s Hospital in Greenwich Village before it closed, and then wound up at Beth Israel Medical Center, where she worked through Sandy. After the closing of St. Vincent’s, which served a large HIV-positive community, De-Lin said that many of those patients lost access to primary care or had trouble finding doctors who would take their insurance, and began to have complications related to HIV and turn up in much worse shape than they had been. Leaving aside the longer wait times that become the norm at other institutions when one hospital closes, the problem of access is much larger for people with specific health needs.
As studies begin to come out, it’s worth watching for Katrina-like disparities in mental health and other illnesses, for birth rates and problems, and for long-term illnesses that disproportionately affect women, people of color, and poor communities.
“In the social justice community, there’s often a call that people should get out of their silos and all work on big issues,” Saunders said. “We totally believe [in that]—we believe in people with AIDS engaging in the fight for a fair economy—but we often say, ‘Look, the reason silos exist, the reason we have these identity-based models for addressing community needs for building power, is because we found historically that without doing them, there’s a bunch of groups that are going to get left out.’”
In the Rockaways, Coney Island, and Staten Island, there were already people living in less-than-ideal conditions; the Rockaways particularly have more than their share of nursing homes, halfway and three-quarter houses, and public housing for low-income New Yorkers. Imagine that community, then, without a full-service hospital for miles. “When you’re part of the working poor, the thousands and thousands of working poor in the Rockaways who are just on the brink of financial disaster, and then a natural disaster hits, [it] compounds these existing problems. Unfortunately, health care is always placed on the wayside,” Mohit said.
Rebuilding those neighborhoods means looking at what was already missing, whether that be HIV/AIDS Services Administration centers, or clinics where pregnant people can get checkups or abortions. It means thinking critically, as the NYSNA nurses and their coalition partners have with the Alliance for a Just Rebuilding, about the problems with our current health-care system and the people who are not served by it.