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While the country remembers the 3,000 people who died at the World Trade Center, there's also growing concern about the health issues associated with that disaster. Problems are showing up in thousands of police, fire fighters, construction workers and volunteers who took part in the rescue and cleanup efforts.

NPR's Joseph Shapiro reports.

JOSEPH SHAPIRO: Andrew Porazzo worked in the rubble of the World Trade Center towers. His health has never been the same.

Mr. ANDREW PORAZZO (Rescue Worker, World Trade Center): There's a $10 co-payment. Here's a $35 co-payment. And then I have my inhalers at $10 each for co-payment.

SHAPIRO: Porazzo sits at his small kitchen table and flips through some medical records. Quiet reminders of 9/11 are all around. Newspaper clippings. A tattoo on his chest with the initials of his buddy, a fireman who died that day. And the scarring on Porazzo's lungs. His medications alone cost about $200 a month. That's a lot now that he can't work anymore.

Mr. PORAZZO: I didn't want this problem. I didn't want to depend on medicine. Forty-five years old. Never needed medicine before, now I need it. And it's something that's maintaining my life right now. And it's just not making me happy.

SHAPIRO: Porazzo says he's luckier than many who did rescue work. He's got pretty good health insurance. He got his workers' compensation. Still, his income's been cut in half. He took a roommate to pay the rent on this sparse apartment in Staten Island, New York. His family helps out, too. Most of all, he misses being able to work. He just doesn't have the energy.

Mr. PORAZZO: I'm an electrician. An electrician in Local 3.

SHAPIRO: On 9/11, he got his teenage son and daughter out of school, then volunteered doing rescue work at Ground Zero. When barges and trucks dumped the rubble at the Staten Island Landfill, he helped build the temporary city there for the police and other workers who sifted through the debris looking for body parts and evidence. He says working at the landfill was like working inside a giant snow globe, with debris sparkling in the air.

Mr. PORAZZO: It was like a glass bubble, walking around and see all these crystals and all these things just floating around. And you're just looking. You had all kinds of molecules falling. Debris molecules. And we had no idea what they were. No idea.

SHAPIRO: It turned out the air was filled with pulverized concrete, tiny shards of glass and agents known to cause cancer. Porazzo and thousands of others worked without the protective masks called respirators that might have helped.

Mr. PORAZZO: They had certain people walking around with protective gear but guys that were working, they didn't give us nothing. We had nothing. I think they had everything else but respirators. They had clothes, they had boots, they had candy, they had soda. Everything but respirators.

SHAPIRO: Porazzo's eyes watered. His throat got sore. After a month, he had to stop. Later, he'd be diagnosed with the illnesses now so common among the rescue workers. Lung spasms, shortness of breath, acid reflux and post-traumatic stress disorder, too.

Porazzo signed up for a monitoring program at the Mt. Sinai Medical Center in Manhattan. First, doctors tested his lungs. Porazzo looks fit but when asked to breathe hard through a tube, he had the lung capacity of an old man.

Mr. PORAZZO: Yeah, I hate that test. I can't stand it. Every time I go to the doctor and breathe, you know, it's like listen, you've got my paperwork by now. What I gotta breathe for? Because that's another thing, when you take that test they're actually almost forcing an asthma attack because - breathe, breathe, breathe, breathe and you're like. And then you've got to inhale now, now and you're like, it's something that I don't really enjoy going to the doctor's for.

Unidentified Man #1: Deep breath, open mouth. Go. Good.

SHAPIRO: At Mount Sinai's clinic, a pulmonary lab technician gives the test to a patient.

Unidentified Man #1: Inhale fast. Hold it. One down, two more to go.

SHAPIRO: Here at Mount Sinai, doctors have checked the lungs of some 16,000 World Trade Center volunteers and rescue workers. Last week, Dr. Robin Herbert released results of tests given to 9,000 of the first patients.

Dr. ROBIN HERBERT (Mount Sinai Hospital): Our World Trade Center patients were highly exposed and they are now highly symptomatic with very high rates of breathing test abnormalities.

SHAPIRO: Almost 70 percent develop breathing problems. What really worries the doctors is that for the most part those breathing problems haven't gone away. Herbert says nearly 60 percent still had difficulty months or years later.

Dr. HERBERT: I think one of the most important lessons that we should be learning here is that there should no longer be any doubt about the health effects of the World Trade Center. Our patients are sick and will need ongoing health monitoring and treatment for the rest of their lives.

SHAPIRO: Concern about these workers grew with the death of police detective James Zadroga in January. He was just 34. A medical examiner linked his death to breathing the toxic dust at Ground Zero. At Mount Sinai hospital, Dr. Philip Landrigan said the problems are particularly striking when you consider who these patients are.

Dr. PHILIP LANDRIGAN (Mount Sinai Hospital): These are people who before 9/11 were very robust individuals. These were construction workers, police officers, fire fighters, people who tend to be hyper-fit. And now in the aftermath of 9/11, they're having serious problems, disability, trouble holding a job.

SHAPIRO: Landrigan says doctors also fear that years from now they'll find spikes in cancer rates.

Dr. LANDRIGAN: The principal basis for our concern about cancers in these men and women has to do with the terribly toxic, carcinogenic composition of the dust and the debris that they inhaled. We know there was asbestos there. We know that dioxin was formed when the towers burned. We know that there were polycyclic aromatic hydrocarbons there, the same carcinogen that's found in cigarette smoke, and moreover we know that people were exposed to all of these compounds simultaneously.

SHAPIRO: All of this raises questions about who will pay for treatment. There are several clinics, including one set up for people who lived and worked near Ground Zero. Congress has just made $52 million dollars available, the first federal money for treatment since 9/11. Dr. John Howard runs the federal government's efforts. He says the money may barely be enough to cover a few years of drugs.

Dr. JOHN HOWARD (New York): We're concerned about the treatment costs associated with pharmaceuticals to treat some of these asthmatic conditions and others. There are expensive medications that have to be used. We're hoping to be able to have enough money for three years. But that's going to be tough.

SHAPIRO: As the Mount Sinai doctors released their results at the press conference, Andrew Porazzo was around the corner at a doctor's office. He goes to one or two appointments a week. For this one, he has to drive more than two hours round trip. He seemed tired, and yet Porazzo says he has no regrets about working in the dangerous debris of the World Trade Center.

Mr. PORAZZO: One-hundred percent - I'd do it 100 percent all over again. I might have took some years off my life, but I'll never give up the patriotic feeling that I have inside me.

SHAPIRO: Researchers at Mount Sinai will release more studies of the 9/11 workers. The next will look at how many of them, like Andrew Porazzo, are also dealing with mental health problems. In the past year, 39 percent of the Mount Sinai patients have been diagnosed with chronic depression or post-traumatic stress disorder.

Joseph Shapiro, NPR News.

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