US Healthcare

HSJ US correspondent Howard Berliner applauds the spirit of generosity in his fellow New Yorkers in the wake of the terrorist attack. But as they struggle back to normality, anthrax takes its toll As I write, the television shows bucket brigades removing debris from what was the World Trade Center site, as well as satellite photographs of the devastation of a large section of lower Manhattan.

I was far away from the disaster area on 11 September.My family and friends are all safe and, for the most part, the direct impact of events escaped me. The secondary impacts are another matter.

I teach in a university about a mile from what was the World Trade Center site and I live just across the East River in Brooklyn Heights. The Twin Towers were the centrepiece of the view from my living room window. Now there is only a lingering smoke.

My university was affected in a number of ways.

We had just opened a 450-student dormitory in the Wall Street area which was evacuated and lost electricity for four days, necessitating impromptu housing arrangements for staff and students.

Classes were cancelled from Tuesday to Thursday, and many students now want to leave New York for a safer environment (wherever that may be). Internet and e-mail access was lost because our service provider was located in one of the destroyed buildings. It was not restored for almost a week, and many people feared the worst as they could not get through on the phone and e-mail messages were bounced back unreceived.

Because the New School is only a block from Saint Vincent's medical centre, the closest trauma centre to the site, university rooms served as a place where friends and relatives of hospitalised victims could congregate and get information.

New Yorkers are usually considered to be selfcentred and rude, but I was amazed at the degree of courtesy and politeness shown in the aftermath.

Newspapers had been full of stories about current and impending blood shortages in the New York region because of the expected imposition of rules banning blood from Europe (which accounts for around 25 per cent of the New York City supply), due to the fear of BSE.Yet my wife and I were turned away from a Red Cross centre on Tuesday evening because it was swamped with donors.

Everyone wanted to do something to help. Perhaps most telling, crime rates were down 30 per cent and there have been no reports of gang violence.

The health system performed remarkably well under the circumstances. The hospitals that bore the brunt of the attack - NYU Downtown (formerly known as Beekman), St Vincent's, and Bellevue, the large public hospital - sprang into action. Calls went out for volunteer doctors, nurses, and other health workers to come - and they did.One of the saddest sights was the large number of gurneys (wheeled stretchers) that had been left on the street to get people out of ambulances. Because so few people were rescued, they stood empty until they were eventually moved back inside the hospitals.

By Friday, with the mayor asking for a resumption of normal life, people began to emerge from their houses and go to movies and restaurants.Makeshift memorials sprang up across the city and there were special memorials at fire and police stations to honour the missing and dead public servants.

With the exception of changes in the subway service and the difficulty of getting around by car, life is relatively normal. But as the realisation hits home that there are no more survivors, I suspect another wave of depression will hit.

Twenty per cent of office space is gone, 150,000 people have lost jobs or have no office to work in, tourism is not likely to recover for a while, and financial markets are not reacting well - these things do not bode well for the future.

Though people have shown a resilience and an ability to work through the crisis, will companies want to remain in New York? Will companies ever want to come back?

If the World Trade Center is rebuilt, will anyone want to work in it?

As people struggle to come to terms with the Twin Towers disaster, New York - and the nation - has been swept by anthrax-mania.Only five cases have so far been confirmed, but people now see anthrax in every powder and mispelled envelope.

Two weeks ago gas masks were all the rage in New York; today it is scoring presciptions for Cipro, the antibiotic of choice for treating those who have been infected.Yet, in general, people remain far more afraid of flying than of testing positive for anthrax.

New York has always been the most international city in the US, and many people who want more security are also afraid of restrictions on immigration and civil liberties. At the New School, we are holding teach-ins, and more people who favour discussion and analysis than military action.

There is a concern that Muslims will face unfair discrimination, but also a concern that life will not be as carefree and fun as it was before.