The Bronx Ink

One Monday in October, therapist Shlomit Levy was called to a classroom at I.S. 313, a middle school on Webster Avenue in the Bronx where she has worked for the last four years. A student was causing disruptions, storming out of class.

The clinician from a nearby mental health clinic, Astor at Highbridge, took the student aside for a two-hour therapy session. The student was able to return to class with the help of Levy, but not for long. Half an hour later, she had lost control again.

In her emergency session, Levy discovered the student’s family was not cooperating with her therapy. If Levy had been able to see the child earlier, the crisis might not have happened.

But last year, the state pulled its Clinic Plus funding that required I.S. 313 to have parents fill out mental health assessments for their children. Now that the program is gone, the clinician has no information about which children may need help.

The result is that Levy now in October has only one new student patient, at a time when she usually has at least 10. “I’m missing a lot of information,” she said.

Levy’s referral numbers from schools in no way reflects the area’s need. The only mental health outpatient clinic for children and teenagers in the Highbridge section of the Bronx, Astor at Highbridge  serves more than 400 clients ages 2 to 21. Patients are seen in its Shakespeare Avenue clinic and inside six local public schools. Its future is uncertain in a community where 52 percent of the population has already received mental health treatment or counseling. In 2006, mental illness hospitalization rates were significantly higher in Highbridge and Morissania than in the rest of the Bronx and New York City.

Levy said the children she sees are suffering from trauma and anxiety among other issues. Some of them have lost a family member to gang violence, or have been sexually abused. Others have parents who are either arrested, incarcerated, or deported. Levy has had patients who lost all contact with their deported parent. Undocumented, these students can’t leave the country to go visit them.

“All these children have such challenging life environments,” Levy said. The therapist is convinced five clinicians like her are needed in I.S. 313. “And we would all be very busy.

The end of Clinic Plus not only curtailed services for needy children, but also created a greater financial problem for the clinic. It came at a time when Astor at Highbridge is being squeezed by yet another cut in state funding. Since 2010, New York State has gradually reduced its direct support for Astor’s two outpatient clinics in the Bronx by 25 percent per year. The same day Levy was called to P.S. 313, the clinic received word that a third 25 percent reduction would go into effect next year, totaling 75 percent lost revenue in three years.  The cuts mean clinicians are under pressure to increase the number of clients who bring in Medicaid or private insurance money.

Astor at Highbridge opened the satellite clinics in schools in 2007. The clinic now has six clinicians who work in neighboring schools. Astor was keeping these services afloat after Clinic Plus money ended, yet times are difficult.

“A couple of my schools want more clinicians,” said Zory Wentt, program director at the Astor at Highbridge clinic. “Do we need it? Yes. Are we going to get it? No. We don’t have enough funding for that.”

Wentt has worked a Astor at Highbridge since it opened seven years ago. It remains the only mental health clinic in the area. It was difficult at first to convince residents to overcome their fears and seek therapy, she said. A strong stigma attached to mental health needs was a barrier.

“A lot of children need mental health services. Yet they have never received it,”  Wentt said.

At the clinic, therapists see children with conditions ranging from attention deficit-hyperactivity or oppositional defiant disorders to those with bipolar or suicidal symptoms. Violence in the area spills over into their clinic. Trauma and post-traumatic stress disorders are common illnesses.

“We had a little girl whose father was shot right in front of her,” Wentt said. “We have a lot of death cases, along with children being placed in foster care or suffering from sexual trauma.”

In a neighborhood where 35 percent of residents live below the poverty line, according to a study by Queens College, lack of resources can become a triggering factor when it comes to mental illness. The majority of the clinic’s patients are low-income, Hispanic and African-American residents. Eighty-five percent of them are on Medicaid and 5 percent have no insurance. Only 10 percent can afford a private health insurance. Revenue from these insurances is now Astor’s only chance to survive financially.

“Funding is a challenge, we’re constantly out there seeking private funding,” said Sonia Barnes-Moorhead, the executive vice president of the Children’s Foundation of Astor. Astor Services for Children and Families operates 12 sites in the Bronx, including two outpatient clinics. Clinicians have had to provide the same services in a way that could decrease costs.

Astor at Highbridge has been affected by what appears to be a national trend: increasing and larger cuts to mental health state funding.

According to the National Alliance on Mental Illness, more than $1.8 billion has been cut from mental health state budgets in the U.S. from 2009 to 2011. At the same time, one in 10 American children have serious mental health conditions like depression or stress disorder. New York is the second state where cuts are the largest, after California. It cut $204.9 billion in its mental health budget between 2009 and 2012.

Three years ago, the New York State announced it would reduce its Comprehensive Outpatient Program Services (COPS) funding by 25 percent each year, until no funding is left. The state increased Medicaid rates to keep outpatient clinics afloat, but centers like Astor at Highbridge face direct consequences. The COPS funding represented half of the clinic budget, about $1.5 million.

Services at the clinic have been reorganized, and the workload has become barely manageable for some therapists. In 2009, a clinician had about 20 cases in total. Now, their caseloads vary between 50 and 55 people.

“We’ve had to work harder, we’ve instituted a business-like model in mental health services,” Wentt said.

The mental health clinic started to launch open access sessions four days a week for three hours in order to build their client base.

Things can easily become hectic during open access time. Children cry when their parents meet with the therapist, leaving them in the waiting area. Crises can erupt when children fight. A parent advocate and front desk receptionists are available to care for them, but they can often feel overwhelmed.

“With open access, no one is allowed to have a free moment when people come in,” Wentt said.

With Astor’s limited staff, new clients are often left waiting. On Oct. 1, Nilza Martinez, a 26-year-old resident of Highbridge took advantage of open access hours. She and her 6-year-old child waited for  more than an hour, only to be given an appointment two weeks away. No Spanish-speaking clinician was available that Monday.

Her son’s pediatrician at the Bronx-Lebanon Hospital Center had referred her to the Astor clinic. Her son, she said, was showing extreme anxiety about sleeping, and being left alone.

Clinicians said their heavy caseloads prevent them from being entirely available during open access services. Every week, they need to have an average of 25 billable hours of direct contact with their clients to keep the clinic alive. Some of them say they have to schedule appointments almost every hour to maintain this requirement.

“There is a lot of pressure since we have a lot of paperwork and accountability on top of the work you do in sessions with the children and families you’re working with,” said Audrey Williamson, a 26-year-old social work intern working as a full clinician at the clinic since September. She works 21 hours a week at Astor at Highbridge, besides her classes at Columbia University School of Social Work. She is required to see her clients for at least 10 billable hours.

“Yet I think the pressure of helping and assisting children and their families is much bigger,” Williamson said. “You have lives in your hands for the most part.”

On most days, Dagger John’s restaurant at Fordham University earns its reputation as the most popular on-campus eating place. Students gather in the spacious dining area with music playing in the background.

But on Sept. 27, the music disappeared and half of the tables were taken over by baskets of vegetables and food scales. Half a dozen people gathered around each table, checking out and selecting vegetables and there was a line of customers extending out the door.

The interloper is officially called the St. Rose’s Garden Community Supported Agriculture Market. It is a cooperative vegetable buying club that invests in Norwich Meadows Farm in upstate Norwich, N.Y. The founder is Jason Aloisio, 27, an ecology Ph.D. student at Fordham, who is also the founder of an on-campus farm, St. Rose’s Garden.

“I love eating good food,” said Aloisio, “and I want people to connect to the nature through food. I want them to put their hands in soil, to see what food look like originally.”

Aloisio sees St. Rose’s Garden and the co-op farmer’s market as ways to help make diets healthier in the Fordham community and even the Bronx at large.

People can buy cheap organic vegetables, including tomato, parsley, radish, soybean, turnip, pepper, carrot and garlic grown in St. Rose’s Garden, or they can join the co-op and receive different fresh vegetables every Thursday from Norwich Meadows.

St. Rose’s Garden is believed to be the only on-campus garden in the Bronx; the only other on-campus farmers’ market is at Albert Einstein College of Medicine.

Growing up in Shoreham on Long Island, Aloisio learned to eat healthy food. As a child, his father, a dentist, kept no candy or desert at home. Fast or processed food was also rare in his home.

“We always had cooked food,” Aloisio said, “so I grew up with real good food.”

Throughout his four years at Fordham, Aloisio has brought that sensibility to the Bronx.  When he’s not fulfilling his teaching responsibilities as a Ph.D. candidate, he spends his time on the rooftop of the university parking garage, which he considers his private lab. His dissertation is about “green roofs” in urban areas.

St. Rose’s Garden was originally a piece of unused land that university officials gave  to Aloisio to grow edible plants like tomatoes and pumpkins in order to demonstrate new uses for wasted spaces. But he decided instead to use the 1,500-square-foot area to build an on-campus community farm for the whole school.

Aloisio first had this idea of creating a garden on the grounds last year, but wasn’t able to recruit enough volunteers.

This year, Aloisio prepared a formal proposal to change the abandoned land in the unused corner of the school near faculty parking garage into a community garden. He also went to different academic departments, trying to get at least $1,750 to buy essential materials for the garden.

The proposal earned Aloisio a little more than the minimum from three deans at Fordham University who also volunteered in the garden’s construction.

In April, Aloisio and Elizabeth Anderson, an undergraduate student studying environmental policy, started advertising for more volunteers through blogs and by sending emails to students.

On April 23, more than 50 volunteers, including students and faculty members, showed up to assist Aloisio and Anderson building the garden. They removed weeds, built eight raised beds covering 244 square feet and bought 20 cubic yards of soil to fill them. They also laid a water system and planted seeds that blossomed into rows of eggplants, green beans, green and red peppers, cucumbers, lettuce, tomatoes, pumpkins and basil.

St. Rose’s Garden offered up its first harvest in September. Green leafy vegetables poked out of their beds. Eggplants turned purple and hid under big leaves. Pumpkins were still in the yellow flower phase, quietly waiting their turn to ripen into fruit.

The garden has also helped grow other efforts at Fordham.

John van Buren, the director of Environmental Policy Program who serves as the faculty advisor for St. Rose’s Garden, is including eight hours of volunteer work at the garden as part of his class.

“Aside from providing fresh, organic vegetables, and an opportunity for playing in the dirt,” said Aloisio, “the underlying mission of St. Rose’s Garden is to be an educational catalyst, both in the classroom and in social settings, for discussion about the broken food system and coupled human-ecosystem interactions.”

He seems to be reaching that goal. “He (Aloisio) is very outgoing, a good person to get things going,” said Joe Hartnett, a junior biology student in the environmental policy class who was one of the volunteers. “He always makes things clear. He is a really good teacher.”

Aloisio was Hartnett’s assistant teacher when he was a freshman. Hartnett said Aloisio brought a lot of different ideas to their environmental classes, making their studies fun and easy to understand. “He is very vocal and energetic,” said Hartnett. “In his email to me, he would say something like ‘Yes, Joe. You CAN do this!’ ”

“He is so passionate,” said Samir Hafez, an economics and environmental policy graduate student. “I admire him for his energies. He never gets discouraged.”

Aloisio says the food co-op is another important component of his campaign to encourage healthy eating.

Consumers pay $16 per week to get a share of six to eight pounds of vegetables and fruit. They agree to buy produce from the farmers for 10 weeks. The vegetables are delivered to Dagger John’s every Thursday for less money than in the supermarket because there is no middleman.

Consumers don’t know what they will get for the week; it depends on what’s available. All the vegetables are picked less than two days before the market.

Katie Buckle, a sophomore at the Gabelli School of Business, did some math with her two roommates. They realized that it would only cost about $5 per person to receive more than enough healthy fruit and vegetables so the three of them decided to pool their money and buy a share together.

“The local farmers send whatever produce they have freshly harvested that week, so our weekly bounty will change and we will likely receive new fruit and vegetables we’ve never tried before,” said Buckle. “To me, this element of surprise is the best part.”

There are currently 137 shares of the co-op, more than Aloisio expected. “We were aiming for 50, and we got 137!” said Aloisio. “I was a little overwhelmed.”

Three resident assistants bought some shares to set up a little farmers’ market in their dorms.

“It helps me to keep a healthier diet,” said Jordan Higgins, a senior biology student. Higgins said she had to Google how to cook much of the produce, but it made her eat more vegetables.

Norwich Meadows Farm also provides vegetables to students at Fordham’s  Lincoln Center campus.

Both the co-op and St. Rose’s Garden share space at Dagger John’s. The student-run farmers market allows people who didn’t buy a share in the co-op the opportunity to enjoy fresh vegetables.

John Craven, a Fordham business professor, was one recent satisfied customer. “This is the best baby carrot I have ever had,” he said as he sampled a small fresh carrot grown in St. Rose’s Garden. He did not even scrub off the mud before he ate a second one.

Money earned by selling produce from St. Rose’s Garden goes to the daily maintenance of the garden.

“This is really not for profit,” said Aloisio. “We just want to get the food to people.”

The first day of the two markets was especially long for Aloisio. More than 200  people stopped by. Even though there were three volunteers helping him, Aloisio still had to answer all the questions about the food and the garden, organize containers and refill vegetables, and find bags for those who forgot to bring one.

Four full containers of vegetables were left after the first day. Aloisio and his volunteers donated all the vegetables to a local non-profit group called Part of the Solution. These vegetables are repacked in Part of the Solution’s food pantry.

Aloisio would like to have more efforts in the Bronx beyond Fordham. Statistics from the Department of Health show that  only 6.3 percent of Bronx residents eat the recommended five daily servings of fruit or vegetables.“I hope to get more people involved,” he said, “Maybe refugees in the Bronx can come and work in the garden. Or maybe make it a refugee garden or a asylum garden.”

At the moment, however, it’s hard for people outside of the Fordham community to benefit from the garden. Visitors have to show a valid ID and pass a security guard to get on campus.

In the meantime, Aloisio is focused on keeping St. Rose’s Garden working smoothly.

All volunteers work on a weekly basis now. But as the mid-term approaches, a lot of students are too busy to help. Aloisio dedicates most of his time to the garden.

“I have free time, somewhere, not really,” said Aloisio, as he dropped off four containers of vegetables at Part of the Solution — alone.

At 8:15 am Thursday, nearly 30 4th graders sent mini tremors through P.S. 73.

“Who can last longer than Mr. Rios?” said Juan Ramon Rios, director of Healthy Highbridge. He was trying to get children half his height through a warmup routine of jumping jacks.

Despite all the activity, 37 percent of the students in this class are overweight or obese, according to body mass index measurements that Rios and his team at Highbridge Community Life calculated this week. Two classes even measured in at 59 percent.

The overall rate of overweight students at the Anderson Avenue elementary school is consistent with that of the entire South Bronx, where 40 percent of students are overweight or obese. That percentage is higher than the alarming national level, which the American Heart Association estimates at 33 percent.

Healthy Highbridge meets with fourth and fifth graders at P.S. 73 once a week to combat the repercussions of obesity in an area that has a lot of obstacles to staying healthy. In the South Bronx, 38 percent of the residents live below the poverty line, according to the 2010 American Community Survey. Highbridge also has too few supermarkets to meet the needs of its 34,000 residents, a 2008 city study says. Rios said these factors lead to poor food choices and, by extension, poor health for area children.

“We’re losing a generation,” Rios said three days earlier from his cramped basement offices at Highbridge Community Life Center. “All of this is going to create a health cost”—that is, unless everyone gets moving.

After the exercise, Rios instructed students on how to take their pulses.

“Why did we do that?” Rios asked as 60 index and middle fingers pressed against 30 wrists.

“To lose some weight,” said Fatumata, 9.

“Because it could be fun to exercise,” said Shantel, also 9.

“Because we need to get exercise,” said 10-year-old Jonah.

These children are all participants in Healthy Highbridge’s year-long health education program, funded by a $30,000 grant from the Communities Impact Diabetes Center, which in turn receives its budget from the federal Centers for Disease Control and Prevention.

Before they start their education curriculum, Healthy Highbridge staff must measure the students’ body mass indexes, test their prior health knowledge and survey them on exercise and eating habits as well as their attitudes and beliefs regarding working out and eating. These initial studies will be used as a baseline to track students’ progress, as Rios and team return each week to tackle a different health subject: Michelle Obama’s “My Plate” and “Let’s Move” campaigns, diabetes, nutrition, and exercise, among others.

The goal is to help youngsters understand what it takes to be healthy, said Michelle Ramos, the diabetes center’s community project manager.

“As attitudes around healthy behavior improve, hopefully the behavior itself will improve,” she said from her Harlem office. Ramos said that while she doesn’t encourage children to lose weight, she believes that as they grow, they’ll maintain their weights and their body mass indexes will drop.

“Hopefully they’ll pick up healthy habits and go and share them with their families,” Ramos said.

P.S. 73’s principal, Jean Mirvil, said sharing health information with the parents is critical to solving the obesity problem. Many of the families, he said, come from different countries and have a hard time making the proper, healthful adjustments in their new homes (34 percent of people in the South Bronx are foreign-born).

“The kind of food they’re used to does not present itself in the same way as they are making the adjustment with this country,” Mirvil said.

He expects that the children will bring information about what and what not to eat home to their parents.

“At school, they are given a full picture of what a regular, healthy meal should look like,” Mervil said.

To combat the obesity problem, this September the school instituted a salad bar at lunch, so students can add a rotating variety of produce—spinach, corn, radish—to their meals. The main courses vary according to the Board of Education menu. Recently, Mervil said, students had chicken and a choice of pasta or rice. Students can choose milk—not chocolate milk—or water for a beverage.

On the day of the Healthy Highbridge visit, breakfast consisted of a sausage and biscuit sandwich, and orange juice.

During this class, students were asked to pick which food choices they would make: chicken with the skin on or off, whole wheat or sweet bread, regular peanut butter or freshly ground.

Shannon, 9, said she preferred popcorn without butter, low-fat milk to skim, and would eat an apple before a piece of candy most days.
“Salt? Ew,” she said, her neat cornrows jostled back as she shook her head.

Winston, the largest boy in the class and the first to cease his jumping jacks, said he was less into self denial. He puts butter on his popcorn because, otherwise, “it doesn’t taste like anything.” The nine-year-old did acknowledge that salt isn’t always necessary.
“Sometimes, if you don’t add salt, food can still taste good,” he said.

Jaheim, 10, said he couldn’t replace french fries with potatoes, nor could he exchange a burger for a salad. “French fries?” he asked rhetorically as his hands shot from his striped hoodie to the sky. “I love them.”

As for burgers? “They’re very good,” he said. “You could even put bacon on them.”

When asked if all his poor eating choices left him a healthy individual, Jaheim was confident.

“Yeah, I do weights.”

 

Bronx Senator Gustavo Rivera marked National Food Day on Monday by sharing with students in Fordham that eating better helped him lose weight, NY1 reported.

Rivera, who weighed 299 pounds in June, has since lost 16 pounds.

He weighed himself during an event at the Academy of Mount St. Ursula.

Rivera began his dieting when the borough started its CAN Health Initiative, teaching residents everyday tricks to stay fit.

“I’m already eating smaller portions, I’m already making sure I drink more water than anything else, and the bottom line is, these are things that I can maintain,” said Rivera.

 

 

The Iris House South Bronx Outreach Center, an HIV/AIDS clinic and information center, opened its first location in the Bronx, reports the Bronx Times.

The clinic, which opened Monday, will be serving the Crotona community and will help to prevent the spread of HIV as well as those that are already positive.

Iris House already operates two locations in Harlem.

By: Mehroz Baig

Ron, a 79-year-old Bronx man, remembers the day a CAT scan revealed something was seriously wrong with his health.

“While the tech was doing the scan, she had this look on her face,” he said. “She said, ‘excuse me,’ and went and got the doctor.” The scan  eventually showed he had developed pancreatic cancer.

Ron asked for his last name to be withheld because he hasn’t told much of his family or his friends that he was diagnosed with pancreatic cancer in August 2010 and he doesn’t want them to worry.

Ron is a small figure who walks fast wearing a white, short-brimmed hat covering a head of light gray hair and a black sports jacket. His health has put many restraints on his life: as he puts it, his plumbing isn’t what it used to be. But he maintains a sense of humor. He talks about the nurses who take care of him and says that he likes to joke with them.

“They feel bad for everyone that has to be treated,” he says. “When I kid around, you get a rapport with them, you become friends.”

Pancreatic cancer can occur in two forms: one attacks the part of the pancreas that creates enzymes which make regulatory hormones, like insulin to control glucose levels in blood, explains Dr. Steven Libutti, director of the Montefiore-Einstein Center for Cancer Care. This cancer is called pancreatic neuroendocrine cancer.  This is is the kind of cancer that Ron has. The second form of pancreatic cancer is called pancreatic adenocarcinoma, which attacks the part of the pancreas responsible for helping the body digest foods. Adenocarcinoma occurs more frequently and is more deadly.

“Life expectancy for pancreatic adenocarcinomas is often measured in months whereas life expectancy for pancreatic neuroendocrine carcinoma can be measured in years,” Libutti said.

Libutti , who is also associate director for clinical services at the Albert Einstein Cancer Center, says that although pancreatic neuroendocrine cancer is less prevalent, it is increasing.

“Part of it may be we have better means of diagnosing or detecting them and part of it may be that they actually are increasing in incidence,” Libutti said.

The National Cancer Institute estimates that in 2010, there were approximately 43,000 new cases of pancreatic cancer in the United States. That same year, there were 36,800 deaths by pancreatic cancer in the U.S. The data was not split between the two types of pancreatic cancers. According to the New York State Department of Health, there were 2,768 cases of pancreatic cancer diagnosed in 2007. That same year in New York, there were 2,280 deaths from pancreatic cancer.

Libutti is heading the most recent venture in cancer treatment and detection at Montefiore and Albert Einstein Cancer Center. Through a partnership with four other institutions in Texas, Libutti and his team applied for a grant from the National Cancer Institute to research the use of nanotechnology to diagnose and treat pancreatic neuroendocrine cancer and ovarian cancer. In September, the team was granted a $16 million, five-year grant to pursue this technology.

Nanoparticles are tiny particles, smaller than the diameter of a human hair. “The idea is that nanomedicines can be engineered to have unique properties that might allow them to help in the development of therapeutics that can be targeted to tumors as opposed to having a general effect on the entire body,” Libutti said.

Imagine a cancer tumor having a zip code, Libutti says. His goal with this research is to design an agent that can read that zip code. Once the agent is injected into the body, it would go directly to the zip code where the tumor lives. Once that is accomplished, the agent can be sent with medicine to kill the tumor or some other substance that would allow doctors to see the tumor more clearly.

Currently, there are various treatment options for people who are diagnosed with pancreatic neuroendocrine cancer: surgery is usually the first option. If a person is not able to have surgery, either due to medical conditions or because the patient chooses not to, other options include octreotide injections or sunitinib pills, both medicines that slow the growth of neuroendocrine tumors. “Traditional chemotherapy doesn’t work for endocrine cancers,” Libutti said.

Libutti points out that the concept for this research is not new. Doctors use iodine, for example, to diagnose and treat thyroid cancer. There isn’t a naturally occurring substance that responds to pancreatic cancer tumors the way iodine does to thyroid cancer. Libutti’s research aims to fill that void by creating something that will serve the same purpose that iodine does for thyroid cancer.

Libutti says that if the research is successful, his team could have a working form of nanomedicine ready to use in seven to ten years. Although the Einstein-Montefiore investigators are focusing on the pancreatic neuroendocrine cancer, the research could produce a substance that would also be useful for pancreatic adenocarcinoma as well as ovarian cancer.  These cancers are not linked but they were chosen because of the expertise and interests of the investigating teams.

“My question would be, is this something that they’d be able to detect early?” asked Kristen Angell, affiliate coordinator at the Pancreatic Cancer Action Network’s chapter in Connecticut. Angell’s father was diagnosed with the deadly pancreatic adenocarcinoma in April of last year and was given a year to live. Angell was her father’s caretaker during the last year of his life and says that early detection of adenocarcinoma is crucial to fighting this disease.

Angell points to the progress that’s been made in breast cancer and says she hopes the same efforts can be directed towards pancreatic cancer.

In the meantime, Ron continues his treatment with Dr. Libutti. Although he hadn’t felt too much pain in the beginning, he says he recently started getting an ache on the right side of his body, which he hopes to address with the nurse the next time he is at the hospital. Ron’s pancreatic tumors have spread to his liver, and while the treatment is meant to slow their growth, it is too early to tell what, if any progress has been made.

Since October 2010, Ron has been going to Montefiore for blood work every two weeks, a shot every month, and periodic CAT scans. Having survived a heart attack, prostate cancer seventeen years ago, and now living with a pacemaker, Ron simply did not think that he could survive a major cancer surgery and opted for the second treatment option of monthly injections that slow the growth of the cancerous tumors.

“I’m like an old car,” he jokes.

Ron has found ways to cope with his health: he maintains a strict diet, donates to children’s organizations and prays.

“I got to church a lot,” Ron says, “more so in the last couple of years when my health started deteriorating. I’ve lived my life. I want to live more but it’s in God’s hands.”

(Click on the interactive below to see pancreatic cancer cases and deaths for all five New York boroughs from 1976 to 2007.)

It was 9 a.m., on a cold November Monday, and the Morris Heights birthing center—one of only two free-standing clinics left in New York City—was buzzing.

Inside, three women were in the throes of labor, each in a private suite with a queen-size bed and home-like touches, including quilts, fluffy pillows, and cabinets.

As their births proceeded, two certified midwives shuttled back and forth, slipping behind spearmint-colored doors. They checked heart rates every half an hour, suggested position changes to alleviate pain, and helped the women in and out of their Jacuzzi tubs.

When the day was done, three healthy babies were born.

The scene seems timeless, and perhaps unremarkable. But in New York City, where the rate of births by Ceasarean section rose by 42 percent between 1998 and 2007, giving birth without medical intervention is increasingly rare. The Morris Heights Women’s Health and Birthing Pavilion is now an endangered species.

“Women’s labors can slow down when they get to the hospital, because they don’t feel particularly safe,” said Jennifer Jagger, a midwife who has worked part-time at the Bronx center for the past two years. “When they get to the hospital—boom!—it’s about what the hospital needs.”

There are currently just under 200 freestanding birth centers in the United States, centers not attached to a hospital that offer a homelike environment.  These are staffed by midwives who help low-risk women deliver naturally, free from medical interventions like inducement, Caesarian sections, or epidurals. Supporters of the natural-birth movement believe it is a better experience both physically and emotionally for mother and child.

Of the 175 some birthing centers in this country, a significant percentage are located in the suburbs. Jagger said she often tells her Bronx patients they’re getting a service that’s normally available only in wealthier, non-urban areas.

“There’s some truth to that,” admitted Ronnie Lichtman, chair of the Midwifery Education Program at the Downstate Medical Center in New York City. “In general, middle class, educated women are more aware of the options available to them and more assertive in seeking them out.”

But the irony is that in wealthier pockets of New York City, birthing centers have closed up shop over the years due, Lichtman said, to a variety of factors—budget shortfalls, management problems, and a medical approach that has made birthing a sickness, rather than a natural process.

Last year, a nonprofit group attempted to raise funds for an independent health and birthing center in Midtown Manhattan, near Macy’s.

The group had secured much of its funding and had put together a high-profile board of directors that included Ricki Lake, the talk show host turned-natural birthing advocate who, thanks to her 2008 pro-natural birth documentary “The Business of Being Born,” has become the poster mom for midwife-assisted labor.

But with the recession, Lichtman said the new center’s efforts were “stymied.” Investors dropped out and the center never opened. And several established centers have faltered as well.

In 2003, the Elizabeth Seaton Birthing Center—which was associated with St. Vincent’s hospital and was this country’s first birthing center—closed along with the hospital. Last September, Bellevue Hospital shuttered its birthing center as well.

The closing of these centers prompted New York City Council’s Committees on Health and Women’s Issues to host a joint oversight hearing on the status of birthing options in New York City earlier this fall.

Advocates who testified in the hearing argued that birth centers are key in helping to lower the cesarean section rate. Patients in natural centers are not hooked up to fetal monitoring machines, which frees them up to move around. Proponents of this approach say it gives women a better chance at laboring naturally, as it uses gravity to help the baby navigate the pelvis.

Low-risk mothers whose babies were delivered by certified professional midwives had significantly lower rates of Caesarean surgery—4 percent—than those delivered in hospitals—19 percent,  said Farrah Diaz-Tello, a lawyer with the National Advocates for Pregnant Women, citing a recent study.

Currently, only three birthing centers remain in New York City—the in-hospital center at St. Luke’s Roosevelt, the Brooklyn Birthing Center, and Morris Heights. The former is the sole facility that caters directly to low-income women, which it does by accepting Medicaid and helping those who don’t have insurance to get it.

“The only time we won’t accept a patient is if someone starts their prenatal care really late—our cut off is after seven months,” said Susan Billinghurst, a clinical manager at the center. “Otherwise, we accept anyone here.”

Indeed, the difficulty isn’t turning patients away, but it’s in attracting the attention of pregnant moms in the first place. 

“One of the biggest challenges is trying to find the time and help them learn and understand what a birth center is and how it works,” said Kristin Paul, midwife. “Many of them come here without necessarily being aware of what the potential benefits to an out-of-hospital setting are.”

To achieve that goal, the center conducts classes for new patients about the benefits of a non-hospital birth—more support, more time to labor naturally, and a judicial use of technology.

Jagger, the part-time midwife, added that there are certain immigrant populations in the neighborhood that seek out the center because laboring naturally is customary for them culturally.

“I’m thinking in particular of Mexican immigrant women,” she said. “There are a lot of them in this neighborhood and they tend to labor naturally out of habit—out of custom. They do it extremely well.”

But for all of that effort, deliveries still represent only a small percent of what the pavilion’s business. It also offers full-spectrum gynecological and women’s health care.

Indeed, of the 2,000 or so prenatal clients that visit the facility every year, Billinghurst estimates that 70 percent are not candidates for the birthing center. Only low-risk women are approved for a center delivery, which eliminates anyone with medical conditions like high blood pressure, obesity, and diabetes—conditions that are rampant in the South Bronx.

Of the remaining 30 percent of clients who come in for prenatal care, only about 60 to 100 actually end up delivering in the birthing center every year.  Some are unable to because of restrictions the center imposes. For example, a woman who plans to birth at the center, but fails to go into active labor within 12 hours of her water breaking is transferred to a hospital, as is a woman who goes two weeks past her due date.

But other women simply opt not to have a birthing center birth, choosing instead to deliver at Bronx Lebanon Hospital, Central Bronx, or one of the other nearby hospitals.

“It’s not easy to get women to be confident that they don’t need an epidural,” Paul explained, “or to be OK with their choice when everyone around them is going into the hospital to give birth.”

Because of the relatively low number of babies delivered, the center relies heavily on revenue generated from other services, like general obstetrics and gynelocgical care to stay afloat. Billinghurst said that some salaries at the center are covered by federal and state grants, but that the bulk of the money comes from billing patients or insurance. There is no set fee for services; the staff works with patients and insurance companies to charge rates according to what they can afford.

And the center also benefits from the fact that non-invasive births are relatively low cost.

In testimony from the September City Council hearing, Diaz-Tello, the National Advocates for Pregnant Women lawyer, cited a 2005 study that found that the national average hospital charge for childbirth ranged from $7,000 to $16,000, whereas a birth center delivery was about $1,600.

But that is true of all birthing centers, and yet Morris Heights is one of the few that thrives.

Billinghurst said that the real reason why the center has continued to succeed where so many others have failed is that it has been in the neighborhood “forever” and has built up a real trust. Women whose mothers, sisters, cousins or friends delivered in the center know they can go there and have the experience that they want, in a private comfortable room instead of in a shared room in a hospital.

“I recently had the privilege of delivering the baby of a 20-year-old first-time mom who was born at the center herself,” said Jagger. “There’s a community here that has been here for a long time.”

The small rural town of Tecamtalan is covered with natural colors. They are the colors of acres of harvested land, where food like tomatoes, watermelons, peanuts, beans and corn dot the central Mexican state of Puebla. These are the lands where only three years ago Sindy Cecilio, then 10 years old, climbed up and down wooden ladders picking plums from their trees. Agriculture was a family business. The Cecilio family sold fresh produce in a market 15 minutes north of their home.

The fresh air and open spaces are a contrast to the life she now leads as a seventh grader at M.S. 328 in the Kingsbridge section of the Bronx. Gone are the afternoons playing and running in open fields or the Saturday mornings helping her father in the harvest. Now instead of selling food in the market, she accompanies her mother Araceli Merino to buy fruits and vegetables twice a week from the small Green Cart that parks on West 231^st Street and Kingsbridge Avenue.

Keeping her three children healthy is important to Merino, a stay-at-home mother, because she knows it is easier for them to gain weight now that their new lifestyle requires less physical work than what children are used to doing in Mexico. That’s true for her as well. In Mexico, she had to wash clothes by hand, one piece at a time. Today she just goes to the laundromat down the street.

For evidence of how their new lifestyle has influenced her children’s health, Merino has only to look at her. Last September, Mileidy’s doctor told Merino that the little girl needed to lose 12 pounds.

“In Mexico children eat but at least they go out and walk, run and play outside,” said Merino in the hallway of the family’s two-bedroom apartment.

Unlike her sister, Mileidy did not experience the active lifestyle helping in the field.  Merino said that other than weekends when the weather is warm and they go to Van Cortlandt Park, the children spend their free time at home. And because P.S. 207 is only a few buildings south from their Godwin Terrace ground-floor apartment, Mileidy’s physical activity is limited to a school dance class once a week.

Forty-six percent of Hispanic children across the New York City public school system are overweight or obese, according to a recent study released by the Department of Health and Mental Hygiene.

Mileidy has become part of this statistic after living in the Bronx for three years. This weight gain may be influenced by her family’s adjustment to a new lifestyle because in Puebla, physical activity and healthy eating were rooted in their livelihood.

The U.S. Census estimates there are 282,965 Mexicans living in New York City, with nearly half originating from Puebla, a state known for its agricultural richness.

While the weight gain for recent immigrants may seem relatively small, public health experts worry that it’s an indicator of bigger problems to come.

As children become accustomed to the American culture, their body mass index levels increase. The National Council of La Raza released in November their latest installment of a 12-part series titled Profiles of Latino Health: A Closer Look at Latino Childhood Nutrition, which indicates that “first-generation immigrant children were significantly less likely (24.6%) than second-generation children (U.S.-born children of immigrant parents) (32.1%) and third-generation children (U.S.-born children of U.S.-born parents) (31.7%) to be overweight or obese.” In the Cecilio family, those statistics translate into the fact that one of the four children is experiencing weight issues.

Merino attributes her daughter’s weight gain to her diet both at home and at school, which serves pizza for lunch every Friday. Since September, she has tried to make the meals at home healthier. She stopped making spaghetti, which they ate at least once or twice a week. She returned to caldo de pollo (chicken soup), cemitas (a sandwich specialty from Puebla) and the traditional mole poblano.

“They used to eat a lot before,” said adding that she has now restricted Mileidy from eating her favorite evening snack: Mexican white cheese with sour cream.  After 6 p.m., the family is now only eating healthy snacks like oranges and Mileidy’s favorite fruit, the mango. Before that, they were having a full meal right after school and again at around 8 p.m.

The second grader has since lost three pounds and her mother keeps working for more.  Merino said she will continue buying fresh fruit from the Green Cart and going to a live poultry shop called a vivero on 231^st Street and Broadway. She said she does not buy prepackaged poultry or meat from the supermarket because she is used to growing chicken in her home in Puebla.

“I think it’s because they spend more time in the supermarket, and in the viveros you can buy them the way you like them,” said of her interest in keeping her Mexican customs and not buying frozen food.

According to Andrew Rundle, a professor of epidemiology at Columbia’s Mailman School of Public Health, her desire to buy fresh fruit from farmer’s markets and poultry from viveros is consistent with what his team found in recent studies of health-conscious New York immigrants.

In his interviews with 350 Hispanic immigrant women about what makes food healthy, the majority suggested they want to know where the food comes from and they like to be able to choose the meat or poultry they want. These women did not use terms like gluten-free or organic, which in local supermarkets can mean a higher cost in food, to describe their nutritional choices.

The idea of healthy food originated in the lifestyle of their native Latin American countries, but also echo the slow food movement that started in Italy, Rundle said.

The slow food movement was established in 1986 as an alternative to fast food, suggesting a need for fresh and organic food that is not altered for faster growth.

“This is an idea that is seen as very elitist, yet these women who are immigrants and live in poor areas have these ideas and attitudes that are very familiar to slow foods,” said Rundle, adding that the women in the study perceived the dirt on the vegetables they buy at farmers’ markets as an indicator of freshness.

This principle of freshness is valued among other Poblano immigrants in the Bronx who are used to eating organic produce their family harvested. At the age of 22, Ines Juarez moved to the Bronx from a small town in the mountains of the Mexican state of Puebla, where her family planted corn, oranges, and bananas in the fields adjacent to their home.

“[In Mexico] things are more natural,” Juarez said speaking of the fruits and vegetables she now tries to buy for her family. “Here they regularly have to have chemicals to help them grow faster for production.”

Her two boys, who are also students at P.S. 207, did not get to experience that rustic lifestyle in her native Mexico, where she woke up to the sound of roosters and chickens. In contrast, Jonathan, 9, and six-year-old Bryant’s childhood experiences are limited to the busy city streets surrounding their Bailey Street apartment, where the #1 train rushes through in the background and honking cars crowd the nearby Major Deegan Expressway.

Juarez tries to continue the customs she learned in Puebla, where the women in the family would spend time making food from scratch, including rolling and pounding on dough to make corn and flour tortillas. Food was not purchased in cans or packaged to last for weeks. If they wanted something sweet to drink, they would pick oranges from the ground near the fruit trees around their home and have freshly squeezed orange juice.

They rarely watched television because they were busy harvesting the field and tending to the chickens and turkeys the family grew.

When the children were not going to school or helping the family, they had lots of room to run and play, Juarez added. Because other family members lived nearby, it was easier for children to go out with relatives without worrying about where they were.

Although she still makes tortillas from scratch and stays away from canned food because her family doesn’t like the taste, Juarez believes Jonathan is about five to 10 pounds over his healthy weight.

But as a first-generation Mexican immigrant, the factors influencing Jonathan’s weight may be defined by his mother’s struggle to maintain hints of a Poblano lifestyle while not limiting her children’s American experience.

“Their friends bring snacks to school and they want some,” said Juarez. Often, Jonathan and Bryant are asking for cookies and chips. “I tell them ‘no’ because it’s not as healthy and they don’t need it…But it’s difficult to limit so many things.”

Juarez’ children are easily tempted by snacks from the bodegas surrounding their school. According to “Disparities in the Food Environments of New York City Public Schools,” another study completed by Dr. Rundle and his team, there are on average 10 bodegas within a 400-meter radius of New York City public schools.

Even though Juarez, who is a stay-at-home mother, tries to maintain a healthy diet, other Mexican immigrants may not be as aware of the low nutritional value of processed food.

In the 2009 study “Moving to the Land of Milk and Cookies: Obesity among the children of immigrants,” Dr. Jennifer Van Hook, a professor of sociology and demography at Penn State, and her team followed approximately 20,000 children from kindergarten through 8^th grade and found that 40 percent of first-generation Hispanic children are overweight or obese by the time they get to eighth grade. About two-thirds of Hispanic children in the study were of Mexican descent.

She said that immigrant parents may not understand the significance of childhood obesity because it may not have been a major problem in their native countries. Even in the U.S., it has only become an issue in the last 10 to 20 years.

Van Hook said that children in the study whose parents come from the poorest countries had the highest obesity rates.

“The idea of dieting, the idea of exercising… is probably foreign to a lot of these people coming from pretty rural areas of Mexico and agricultural backgrounds, especially if parents grew up in situations where they did not have enough,” Van Hook said.

Although Puebla has a prominent agricultural economy, it is still one of the poorest states in Mexico. CONEVAL, Mexico’s council for the evaluation of economic development reported in August 2010 that over 61 percent of youth in Puebla live in conditions of poverty. In all, over half of Puebla’s five million residents live in poverty.

Children in Mexico who live in rural areas are thinner than those who live in urban areas of Mexico, said Van Hook, which suggests that a higher income does not translate to a healthier lifestyle.

“There’s more opportunities to go out to dinner and to eat more, and to eat more sort of non-traditional preprocessed foods when you live in an urban area,” she said adding that immigrant families who have gained a level of financial stability in the United States are also still at risk of gaining weight.

Although family economics may be better than when they arrived to the Bronx almost 10 years ago, Juarez rarely eats out, and instead takes her children to Van Cortlandt Park on the weekends She said she tries to keep the children as physically active as possible even if it’s inside the house.

Sixty minutes of daily physical activity are recommended for children, but, according to the New York City Department of Education, only 40 percent of the city’s six- to 12-year-olds achieves it. The department’s 2009 Child Health Survey suggests that one in every 10 children did not get even one hour of physical activity outside of school the week before the survey was administered.

With the goal of providing fun alternatives to exercise, Manhattan-based USA Fitness Corps partnered with Thomas C. Giordano Middle School in the Bronx to offer Fun Fitness Day this past October.

Jaci Van Heest, a professor of kinesiology and child psychology at the University of Connecticut, designed the workout for the event using traditional activities and modifying them with fun new elements. For example, the simple act of kicking a soccer ball incorporates body movements to increase physical activity as children participate in a circle.

“If you use the word exercise, it conjures up images and feelings that are typically negative – work, sweat, sore, not fun,” Van Heest said. “If adults think that, why would children think or say anything different?”

Seventh grader and Puebla native Jeffrey Munoz enjoyed playing Van Heest’s modified soccer version as he gathered with other children in the southeast corner of the M.S. 45 Doc Serpone playground on East 189th Street and Lorillard Place.

The session was led by a group of retired veterans of the U.S. armed forces. Jeffrey watched the ball closely to kick it during his turn. When it went out of bounds, he took a breather, bending down and restings his left elbow on his knee.

The 11-year-old said that sometimes he does not get a chance to play soccer, his favorite sport, with his friends because they don’t want to go out a play.

“My dad told me that I needed to lose weight because I’m getting a little fat,” Jeffrey added.  “It makes me feel like he wants me to exercise.”

Jeffrey, who moved to the U.S. with his family five years ago, is now 10 pounds over his healthy weight, said his mother Arminda Muñoz.  “He likes to exercise but he also eats a lot,” Munoz said of her son, who also watches at least two hours of television each day. “I want him to get healthy because he’s at risk of having diabetes and other health problems.”

A doctor advised Jeffrey to lose weight earlier in the semester and Muñoz now wants her two younger children to learn the value of being healthy and staying active.  That’s why she brought her children to the fitness session at Jeffrey’s Mott Haven middle school.

Principal Annamaria Giordano said the school decided to become the first to offer Fitness Fun Day in the Bronx as a way to provide school families resources to fight childhood obesity.

“The small steps are perfect because they lead to the big steps,” she said of that Saturday’s two-hour activity series. “We are trying to ensure that our children are healthy and fit. Our small part can help a child or two or more.

Van Heest said Fun Fitness Days strives to change the perception of exercise for the over 100 schoolchildren who participated. The next time they have the opportunity to be active, she hopes they will bring back the memory of “the last time I had fun.”

Similarly, parents like Merino, Juarez, and Muñoz rely on memories of the Puebla they left behind to continue influencing their children’s diet and exercise habits. Their children may grow up as Americans but they each strive to preserve the best of what their families experienced in Mexico – if only for the sake of their children’s health.