Humanist Perspectives: issue 153: Wealth and Hellfare on the Lower East Side

letter from new york
Wealth & Hellfare on the Lower East Side
by Jonny Diamond

It is easy to forget that New York is an ocean city. Manhattan is an island girded by highways, looks inward rather than out, while in Brooklyn and Queens, the path of upward mobility moves inland, away from the heavily industrial, working-class waterfront. But every now and then, when you catch the shriek of a gull blown in on thick, salt air, or a rare working ship on the East River sounds its horn on the way out to sea, you remember you’re living in a once-great harbour town, a port that welcomed thousands of boatloads of immigrants in the 19th and 20th centuries. They came from Ireland, Germany, Italy, China, from all over Eastern Europe, and each group — before beginning the inexorable hundred-year journey to the suburbs — passed through one small neighbourhood, a staging point for the middle-class dream: Manhattan’s Lower East Side.

This is the New York of the last fifteen years: rapid, dizzying gentrification in dense urban neighborhoods; the creation of simultaneous communities existing within and around each other, separated by economy, culture and language. But it wasn’t always like this.

In Spanglish they now call it Loisaida, and it is a study in American extremes. On any given block you can find high-end boutiques selling $600 handbags sitting beside tiny bodegas (Spanish for ‘cellar’) offering handfuls of jalapeños for a quarter. Shiny new condominiums steal light from ancient rent-controlled tenements, as b-list rock stars rub shoulders with Latino teenagers in baggy clothes, on their way to minimum wage jobs at fast-food restaurants. This is the New York of the last fifteen years: rapid, dizzying gentrification in dense urban neighborhoods; the creation of simultaneous communities existing within and around each other, separated by economy, culture and language. But it wasn’t always like this.

The story begins in the 1890s, a decade that saw annual immigration numbers to New York approach 50,000, primarily Eastern European Jews looking for a better life — but that’s not what they found. Living conditions on the Lower East Side were wretched: struggling families, who spoke little or no English, slept ten to a room; typhoid, diphtheria and scarlet fever were rampant, contributing to infant mortality rates the highest in the western world. At the peak of overcrowding, one district — the notorious Eleventh Ward — was said to contain nearly 600 people per acre, higher at the time than the worst urban slums of India. Journalist and social reformer Jacob Riis vividly described the situation in his 1890 book, How the Other Half Lives, a publication intended to inspire readers to action with an unflinching look at conditions as they were. In one harrowing passage he describes the plight of women with sick children: “Sleepless mothers walk the street in the gray of the early dawn, trying to stir a cooling breeze to fan the brow of the sick baby. There is no sadder sight than this patient devotion against fearfully hopeless odds. Little coffins are stacked mountains-high on the decks of the Charity Commissioners’ boat when it makes its semi-weekly trip to the city cemetery.” Riis was remarkably successful in his endeavour, as his evocations of real human suffering, worse than any in Dickens, pushed people past sympathy and into action.

But there was something new behind this surge of charitable and philanthropic activity on the Lower East Side, something powerful: the idea that perhaps access to healthcare wasn’t so much a privilege as it was a right. An umbrella group known as United Hebrew Charities was central in orchestrating help in all areas, from health to education to placing new immigrants on the path to a viable trade. But as is often the case, it is an individual story of self-sacrifice and courage that abides as an example.

In 1891, Lillian Wald — daughter of German Jews who’d made it as far west as Ohio — was sent on a graduate assignment by the New York School for Nurses to develop strategies for home nursing to poor immigrant families. She was so appalled by the conditions she encountered, and so moved by the plight of the people she met, Wald devoted the rest of her life to bettering the lives of those around her. The office she set up went on to grow into the now legendary Henry Street Settlement, and her staff of over 100 was the foundation of the Visiting Nurse Service — both are now city institutions, helping thousands of New Yorkers every month.

in American emergency rooms … admitting nurses do everything but a credit check to determine whether or not a prospective client can receive the treatment they need

This all may seem mildly compelling as an historic look at reform and volunteerism at the beginning of the 20th century, a hopeful account of people helping one another improve their lot in life, but there is one problem — if anything, things have gotten worse. I was startled to come across the following passage in an 1896 Riis article, writing of New York’s Jews: “Their great hospital, the Mount Sinai, stands in the front rank in a city full of renowned asylums. Of the 3,000 patients it harboured last year, 89% were treated gratuitously.” To read that lofty percentage now, at a time in American emergency rooms when admitting nurses do everything but a credit check to determine whether or not a prospective client can receive the treatment they need, is heartbreaking. Consider, by way of contrast, the following statistic: According to a United Hospital Fund report, in 2003 over 1.8 million New York City residents (nearly one in four) had no health insurance; and nearly one in three adult New Yorkers were unable to get necessary health care when they needed it. These numbers make 1896 look a lot better than we thought.

Sadder still, more than a century after it was deemed the worst slum in the world, the Lower East Side continues to suffer from poverty, high crime and a lack of healthcare. But at least the spirit of individual social activism has also endured, as people still struggle to help those who cannot always help themselves. One such is Dr David Ores, or “Dr Dave,” as he’s known to patients. Dr Dave set up a walk-in clinic in the mid 1990s, just as the area was really beginning to gentrify. Up to that point, the neighbourhood had been among the most dangerous in the city, as drug dealers worked openly in the streets and a crackhouse stood on every block. The Columbia-educated Dr Dave describes himself as “a neighbourhood country doctor in an urban setting,” and appropriately he charges on a very slippery sliding scale, having been paid in everything from art (much of which adorns the walls), tattoos and free coffee. It is not a cushy life to say the least, but Dr Dave has channeled his rage at the cruelties of the American health insurance industry into a sustained passion for helping people. And helping people, says Dr Dave, “…is something all doctors do, you just don’t hear about it much.”

But while the social reform movements of the past, and the accompanying stories of individual moral courage, are rightly seen as romantic and hopeful, the ongoing struggle of people like Dr Dave seems rather more tragic. As an individual, his devotion is laudable and exemplary, but the fact he’s in such demand points directly to a system in America gone terribly wrong. Less than half an hour north of Dr Dave’s tiny, ramshackle office is the world-renowned Memorial Sloan-Kettering Cancer Center, an international destination point offering the finest care that money can buy, money that most Lower East Siders simply do not have. Ultimately, disparities like these are inevitable in a system that puts Profit ahead of Care, and there’s nothing the Lillian Walds or Dr Daves can do about it.

There are lessons to be learned from the story of the Lower East Side — of courage, conviction, hope — but we are in danger of losing them. It’s as if the very will and drive it took for families to escape their awful circumstances has made it impossible to look back, impossible to see that others are suffering, in need. There is so much fear in the United States of losing the privileges money can buy, no one is interested in talking about the rights of those who go without. As Jacob Riis showed us, stories have tremendous power — but on the Lower East Side it seems, almost all the stories have been told.

Jonny Diamond is a transplanted Torontonian who currently works as a writer and editor in New York City. His short fiction has appeared in Geist, Prism and Exquisite Corpse.