public health

Shigella Outbreak Highlights Lack of Public Restrooms

Hepatitis A outbreak sickened nearly 600 San Diegans in 2016-17 and was blamed for 20 deaths

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Nearly 50 people have now gotten sick from a Shigella outbreak in San Diego County, calling attention to the city's lack of public restrooms and showers.

The bacterial infection causes fever and digestive issues, and, if left untreated, can be deadly. So far each known patient in San Diego is homeless.

A troubling Shigella outbreak has been reported in the county. NBC 7's Kelvin Henry has more on what this means.

“We are failing, miserably,” said Amie Zamudio, homeless outreach director for Housing for the Homeless.

Zamudio helps get San Diegans who need medical treatment off the streets.

“There are thousands of people out here who are medically fragile and immuno-compromised, and are desperately in need of restrooms and hygiene,” Zamudio said.

The lack of sanitation resources impacts more than just personal hygiene, according to experts.

“We’re all susceptible to infectious diseases,” said Jennifer Felner, who is an assistant professor of public health at San Diego State.

Felner spent years studying San Diego's hepatitis A outbreak that started in 2016. Her team was able to make a direct link between a lack of public restrooms and the outbreak, which infected nearly 600 San Diegans. The outbreak was blamed for 20 deaths.

“We all are affected by this lack of access to bathrooms, showers and other critical resources in San Diego," Felner said.

In response to the current shigella outbreak, the county has rolled out 16 new handwashing stations, and eight new portable toilets

But, Felner said, until we provide more permanent solutions, we will continue getting sick.

“We keep having this conversation when emergencies happen,” Felner said. “And these emergencies are going to keep happening if we don’t come up with concrete solutions.”

One possible solution is based out of Portland. The Hygiene Hub is run by a nonprofit on city-donated land. Four days a week, it offers one shower, two toilets, a clean bedding exchange, foot- and leg-injury treatment and storage services.

“There’s a failure of public infrastructure,” said Sandra Comstock, the executive director of Hygiene 4 All, the nonprofit heading the hub. “That’s the real problem. We don’t have the housing for people, but we also don’t have the bathrooms, the trash services or the other things that people in houses take for granted.”

Back in San Diego, the city has what's called the Day Center in East Village, a site where people can use the restroom, shower and do laundry. The center has 10 toilets/urinals and 5 sinks. And Father Joe’s Village’s main campus dedicates 9 toilets/urinals, 10 sinks and 12 showers to Day Center clients. An average of 326 people use the center’s services in a given month.

But here's what makes the Hygiene Hub in Portland different: The restrooms and showers are sanitized and stocked by attendants, not security guards.

“It’s a giant difference,” Comstock said.

The attendants, all of whom were homeless themselves, receive training on de-escalating violence, and intervening in mental health or substance abuse situations.

Over the past year, Comstock said, most of their 20 attendants have found stable housing.

“The sense of happiness when people come into this space,” Comstock said, “particularly when they come out of the shower, there aren’t words to describe how beautiful that is.”

The hub serves about 80-100 people a week.

“I think there are a lot of things that are really interesting and exciting about that kind of a model,” Felner said.

Zamudio said she, too, would welcome a program like the Hygiene Hub in San Diego. At the very least, she said, it's paramount that elected officials include hygiene options in their plan to tackle the homeless crisis.

“It’s just really sad that we’re not able to see how sick people already are and the need for restrooms and ongoing hygiene and ongoing care,” Zamudio said. “It’s not an unrealistic demand.”

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