Bronx-Lebanon, site of shooting, more than hospital to neighbors

PHOTOGRAPHER: The New York Times

A customer at the Grand Cafe, a popular spot among locals, at Bronx-Lebanon Hospital Center in New York on July 3, 2017.

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(ART ADV: With photos XNYT98-103.); Sheri Fink and Khorri Atkinson contributed reporting.

NEW YORK — Practically everyone in the South Bronx knows about the place at Grand Concourse and East 173rd Street. You can pick up scratch-off lottery tickets there. You can grab a bacon, egg and cheese on a roll on your way to work. You can go to Sunday Mass.

You can also go there for medical care, whether it is an emergency, a kidney treatment or a checkup for your 1-year-old daughter.

These are just some of the ways that residents of one of the most poverty-stricken communities in the nation interact with the roughly 4,000 doctors, nurses, cafe countermen and others who work at Bronx-Lebanon Hospital Center, one of the biggest employers in the Bronx and the scene of a horrific rampage last week when a disgruntled doctor who had worked previously at the hospital killed another doctor and wounded six other people with an assault rifle before shooting himself.

Towering over the Grand Concourse, the 972-room hospital is enmeshed in the daily lives of those who live around it in ways that hospitals in more affluent areas tend not to be, from the cafe and the gift shop to the chapel and the emergency room. If the neighborhood is a varied mix of nationalities and backgrounds (1 in 3 was born elsewhere), the staff is even more diverse. The physicians alone represent about 40 countries.

And so the pain of the shooting is shared by all whose lives are touched by Bronx-Lebanon daily, in ways large and small, surprising and expected.

“We live in the Bronx. We know our patients, we meet them at the grocery stores, we go to the same places they do,” said Dr. Hafsa Abbas, one of the chief residents. “That’s why when we found that there was a shooting, we were all rushing inside, not outside.”

Nilsa Maria, 45, had all three of her children at Bronx-Lebanon. Now she goes there to be treated for skin cancer and diabetes. “I used to love going there because it was close by, it was in the neighborhood and doctors are good,” she said. “Now, I’m a little scared of going there. Anybody can go in there and hurt anybody.”

But that shudder of fear did not, after a few seconds of thought, deter her from the business at hand. “That doesn’t mean I’m not going — I have appointments.”

Bronx-Lebanon has never reached the prestigious status of larger, better-funded hospitals, yet it holds a unique position in the area as a place that has welcomed people who have nowhere else to turn, even if the welcome is sometimes accompanied by the brusque words of a harried doctor or nurse or long lines and longer waits. It is not a public hospital, meaning it is not required to take anyone who walks through its doors, but it often does.

Fifty-four percent of nearby households have an annual income of less than $25,000. About 70 percent of the patients are on Medicaid. Some have no insurance at all. Between 26 and 36 percent of patients have no regular physician.

The hospital has not been without controversy and has been criticized for the high salaries of some physicians and administrators, including Miguel Fuentes Jr., the chief executive, who clears seven figures annually.

But those who live nearby go there instinctively.

“The hospital is their entire support system often,” said Dr. Sridhar Chilimuri, the hospital’s physician-in-chief. “Even things that are wrong in their own families, they look to the hospital to solve them.”

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The emergency room sees about 150,000 patients annually and can act as a homeless shelter for a family unsure of how to get social services or as a day-care center for a mother who cannot find a baby sitter, Chilimuri said.

Bronx-Lebanon was formed in 1962 through the merger of two hospitals, one of which could date its founding back to 1890, providing care mostly to Jewish immigrants.

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Demographics in the Bronx have changed, but the community surrounding the hospital remains diverse. New immigrants are mostly from South and Central America, the Caribbean and West Africa. This has produced challenges that hospital staff members have met with creativity.

A special clinic of female doctors treats Muslim West African women because their religion prohibits their being seen by male doctors, said Robert Sancho, vice president for development and external affairs, who has worked at the hospital for 35 years.

The hospital partnered with Dominican taxi drivers to make them aware of the importance of health care.

“I’ve gone to the Dominican Republic to recruit doctors,” Sancho said. “We bring in about four Dominican doctors every year.”

Bronx-Lebanon employs interpreters, but many employees use the hospital’s free online language-learning resources to better communicate with patients. Abbas, who is from Pakistan, and Dr. Ahmed Baiomi, another chief resident from Egypt, have picked up Spanish.

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Sancho said Bronx-Lebanon did not have a large number of U.S.-trained doctors, who “tend to pick out the hospitals that are not in the low-income neighborhoods and are in the major education centers.”

Instead, the halls of Bronx-Lebanon are filled with a rainbow of faces in white coats. Some of the doctors and residents trained at the hospital are political exiles whose experiences can make them more compassionate, said Chilimuri, who is from India. “They’re extraordinary physicians, because they know what it is to suffer,” he said.

Many applicants to the hospital residency program hear about Bronx-Lebanon from other students in their home countries, creating a pipeline of sorts.

“Many of them have already finished their course of study in a foreign country, but they are not recognized in the United States and have to start all over again,” Sancho said.

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In 2016, Bronx-Lebanon submitted 213 applications for temporary, nonimmigrant visas that allowed foreign doctors to work there temporarily. Only one other hospital in the country submitted more applications.

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Doctors at the hospital incorporate their experiences with medicine abroad into treating their patients.

Dr. Yvonne Cruz was born and raised in the South Bronx but completed medical school in Mexico.

“We have patients who come in, and they have these illnesses they’ve seen in their everyday life that I thought I would never see, that it was only textbook,” Cruz said. “And we’ve been able to approach it, because our patient population is so diverse, and our residents are so diverse.”

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Dr. Henry Bello, the gunman who fired on his co-workers on Friday before killing himself, had attended medical school in the Caribbean. He was hired at Bronx-Lebanon as a “house physician” who had to be supervised because he had a limited permit from New York state that allowed him to practice medicine as an international medical graduate. He resigned from the hospital in 2015 after an accusation of workplace sexual harassment.

Bello’s fatal victim was Dr. Tracy Sin-Yee Tam, 32, a hospital anomaly — she was trained in the United States. Studious and dedicated, she got her degree from the new Touro College of Osteopathic Medicine, a medical school that occupies an old department store building in Harlem.

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The deadly Friday afternoon also brought out the camaraderie that fast overcomes cultural differences.

“When we were in the middle of the crisis, one of our doctors from Pakistan brought us Pakistani food,” Baiomi said. “I really liked it; I never ate it before.”

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Ruben Diaz Jr., the Bronx borough president, called the hospital “a microcosm of everything good that is coming out of the Bronx. That immigrant community.”

But he said the Bronx also had to recognize its shortcomings, and the poor health of its residents is one of them. The Bronx is at the bottom among the state’s 62 counties, Diaz said.

The ranking is so dire that Diaz began a health awareness campaign with a social media component, #Not62. Bronx-Lebanon has been an active participant, hosting workshops that teach residents to make traditional, cultural foods healthier, Diaz said.

Diabetes and asthma are some of the most frequent chronic illnesses that keep Bronx-Lebanon’s emergency room full.

Longtime residents and even tourists have found less urgent reasons to go to Bronx-Lebanon.

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At least once a week, Adel Fernandez, 77, eats at Grand Cafe, the restaurant run by a vendor through a lease with the hospital. Partial to the strawberry cheesecake, he can see his apartment from the mustard-colored booths.

The restaurant used to be run by two men named Jose and Juan and was called J&J, said Fernandez, who immigrated to the Bronx 42 years ago and lived in Spain for three years. “One was from Cuba, like me, and one was from Spain,” he said.

Fernandez said he began attending Mass in the hospital’s chapel about two years ago. “Anybody in the neighborhood can go,” he said, explaining that there are about a dozen regular parishioners.

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The chapel popped up on Google maps when Luz Marte, 52, and her husband, Adriano Taveras Capellan, 65, tourists from the Dominican Republic, were looking for a church to attend on Sunday. “And then afterward, we needed coffee, too,” she said as she and Taveras inspected the cafe’s menu.

The gift shop, where many customers bypass stuffed animals and flower arrangements and make a beeline for lottery tickets, was also up and running as usual on Sunday.

People streamed in from the street to the lobby to use the public ATM.

This article originally appeared in The New York Times.