In Bronx, a Fight for Health and Dignity

July 26, 2005
In Bronx, a Fight for Health and Dignity
By DAVID GONZALEZ

Gloria Altieri believes in the Bronx, especially in those neighborhoods that many of her contemporaries revisit only in memory, never in person. It is a mere detail that Ms. Altieri, born in Mott Haven 52 years ago and raised in Soundview, sleeps just over the border in Mount Vernon, since she has dedicated her most productive waking hours to the borough as an educator.

She could work elsewhere. But she won't. Instead, she runs a child development center inside a public school turned community resource center on the Rev. James A. Polite Avenue. Her commitment dates to the years when this Morrisania street was called Stebbins Avenue. At the time, she decided that the South Bronx was made better when those who got ahead came back to share their talents.

"I'm always going around saying we need to stay in the Bronx," she said. "People want to stay here."

This is not an easy time to have those sentiments. Last month, when Yvonne Pagan, one of her teaching assistants, was hit in the head by a stray bullet outside an apartment building. Their disappointment with the ensuing treatment at Lincoln Medical Center left Ms. Altieri with no alternative but to set up Ms. Pagan with a doctor and trauma counselor in Manhattan. The month before, Ms. Altieri took another employee to a Manhattan hospital when a local doctor was slow to diagnose a breast tumor.

"The frustrating part of this is, I chose to stay in the Bronx," she said. "I could be working somewhere else. It frustrates me to see the services provided to the people around here."
The bullet that hit Ms. Pagan is still in her. She can speak and walk, and she is doing both and then some. The night of June 8, she was relaxing with a girlfriend on the stoop of her apartment on 163rd Street and Prospect Avenue when she heard a quick "pop." She knew what it was and started to get up and run, when she heard another "pop" from a gunshot.

"I hit the street like I was hit with a bat going upside my head," she said. "One of them aluminum bats. I ran into my building and told my girlfriend, 'I'm shot!' She was like, 'No, you're not.' Yes, I was. I got a bullet on the side of my head."

Am ambulance took her to Lincoln, where Ms. Altieri met her the next day. Ms. Pagan's hair was unwashed, matted and bloody.

"The doctor came in and I said, 'Shouldn't somebody clean her wound?' " Ms. Altieri said. "And the doctor said, 'I guess so.' When I asked the nurse could somebody clean her up, she said it was not her job."

The next day was hardly better, the women said. Doctors decided against operating on what turned out to be a bullet fragment that was lodged in Ms. Pagan's skull. One doctor told her it would grow out and discharged her, Ms. Pagan said. During a follow-up visit, Ms. Pagan said another doctor told her that they would just leave it alone, advising her to come back if she had any headaches.

Dr. Ramanathan Raju, the medical director at Coney Island Hospital in Brooklyn, said there are times that, in the absence of complications, it is advisable to leave a fragment alone. "In certain areas of the skull they can remain there forever without producing any problems," said Dr. Raju, who previously directed a trauma center.

Yvette Martinez, Ms. Pagan's sister, is still worried about how she is dealing with the emotional effects of the shooting. She had to help her after the July 4 holiday, when the nonstop fireworks led Ms. Pagan to hit the floor in panic. Ms. Martinez had asked the hospital to refer her sister for trauma counseling, but said there was no follow-through.

"It's almost like she should have been used to being shot," Ms. Martinez said. "Their attitude was so cavalier. Not the main doctor, because she was good and explained stuff. But her staff was lacking."

The city's Health and Hospitals Corporation issued a statement yesterday that said confidentiality rules prevented a detailed comment about a patient without Ms. Pagan's permission. But the statement noted: "Her record indicates that her treating physician provided the patient an explanation of her diagnosis and prognosis. At the time of her discharge, Ms. Pagan received referrals and information regarding the social services that she requested, as well as on crime victims services. Counseling is provided on site or patients may be referred to other agencies through their health plans."

Ms. Altieri said she complained to the patient relations office but got no response. When she tried calling the hospital director's office, she said an assistant told her the director was busy and that she should put her complaint in writing.

"I believe they should treat anyone who walks through their doors with dignity," Ms. Altieri said. "I cannot question their medical expertise. But I know about dignity."

Indeed, she arranged for Ms. Pagan to see a neurologist as well as a trauma counselor at a Manhattan hospital, all covered by their employer, Easter Seals.

Last week, both women were at the Bronx center, where new parents were visiting to learn how to help their children develop language skills. Ms. Pagan, whose co-workers affectionately dubbed her "Bullet-head," was taking a group of youngsters to a park to play. Ms. Altieri was showing parents how to improvise low-cost arts and crafts games to develop young minds and bodies.

"Take away the television," she said in a calm mix of Spanish and English. "Give them a spray bottle or these clothespins. These are the muscles they are going to use one day for writing."
The center is roomy, clean and bright. Ms. Altieri made sure a tray of sandwiches and pastries had been laid out for the parents. This is not, some said, an unusual touch here. Yet they contrast the attention lavished on them here with the indifference they encounter outside.
"Other than here, it's difficult communicating with people or getting them to listen," said Lisa Rivera, whose twin daughters just graduated from the center. "Either that, or they do not have the time or - excuse me for saying this - they're just ignorant."

Ms. Rivera had an unpleasant experience recently at the Lincoln hospital, as have many of the parents at the Bronx center. But that was nothing compared with what happened at a social services office when she sought help in sorting out aid payments for her handicapped son.
"The caseworker there said, 'It's not my fault you had a retarded kid,' " Ms. Rivera recalled. "I went over the desk and hit her. You're supposed to be professional. How can you talk to somebody like that?"

Ms. Rivera was at the center to help Ms. Altieri orient the new parents. She urged them to speak up for themselves, to not settle for quick explanations from counselors or therapists when their children move to public schools. And yes, she said later that it was always important to stay cool. Hitting is not an option.

Ms. Altieri said women like Ms. Rivera have supported her in ways they may never imagine. Each of them, in their little battles, has affirmed her decision to stay put in the Bronx. She recalled vividly the look on Ms. Rivera's face when Delenn, one of her 4-year-olds, participated in last year's Christmas pageant.

"Delenn stood on stage, not saying anything, but not crying," Ms. Altieri said in a voice that mixed quiet wonder with admiration. "Lisa was so proud of her. The tears just rolled down Lisa's face, just because she stood there. I was not even looking at Delenn. I was looking at her."
Sometimes, staying put is a very good thing.

Copyright 2005 The New York Times Company